Brandon Dyson, PharmD, BCPS
Dr. Dyson co-founded and writes for www.tldrpharmacy.com - which helps pharmacy students and practitioners get to the next level by simplifying clinical topics. He is also a clinical pharmacist at an academic medical center in Austin, Texas. He graduated from Howard University College of Pharmacy in 2013 and completed a PGY1 practice residency at Georgetown University Hospital. He teaches pharmacology online through the Georgetown University School of Nursing. His professional interests include oncology, education, and infectious diseases.
This time of year is a stressful time for pharmacy students; especially those in their fourth professional year. Graduation is just around the corner, and APPE rotations are in full swing. Many students are in the middle of residency interviews while many others are polishing their CVs in preparation for life after pharmacy school. No matter where a student's careerpath leads after graduation, one thing is true: a pharmacy student must eventually transition to a pharmacist.
But this shift in mindset is difficult. Changing your self-view from "student" to "pharmacist" can be surprisingly tough; I personally think I didn't "get it" until I had completed most of my PGY1 residency. Most P4 students will grapple with this transition to at least some degree no matter their eventual practice environment.
To make the process easier for you, here are 3 things I learned during my own transition from student to pharmacist.
1. Take an active role in patient care.
One of the reasons I think it is so difficult for students to begin their practice careers is that the skill set required to succeed in pharmacy school doesn't always translate into clinical practice. During school, most clinical knowledge is evaluated in a multiple choice format, and on IPPE and APPE rotations the student will rarely be granted full autonomy. This hits the new practitioner like a bucket of icewater when they begin their practice career. Suddenly, there's a wide open patient profile of drug interactions and renal dose adjustments to evaluate; with no multiple choice question to narrow or guide clinical reasoning. In the inpatient setting, the new pharmacist is expected to contribute by politely (yet forcibly) speaking up when a drug therapy issue is noticed during medical rounds. This skill isn't easy to acquire and the student may not have had much experience with it during his/her APPE rotations. In the outpatient setting, the new pharmacist is in charge of balancing clarifications from prescribers, phone calls from patients, technician lunch breaks, and dispensing several hundred prescriptions per shift.
This is not to paint a grim picture of the reality of practice or to attack the current pharmacy school curriculum. It's just to point out that there are very real struggles faced by new practitioners. In order to overcome this challenge is the new pharmacist must commit to take an active role in patient care. There is no longer a preceptor who bears the ultimate burden of responsibility; it now falls on you, the new pharmacist.
My former PGY1 residency director (and mentor) wrote an article recently about how to be a successful pharmacy resident. In it, he makes a great point about finding success as a PGY1: "If you go in with the mentality that there is a checkbox of things that your preceptor has asked you to do (work up patients, look up 'xyz' drug information questions, attend rounds, do a case presentation, etc...) and you are just completing these tasks to 'complete the assignment', then you are not really understanding the point of residency training and will not be a successful resident."
While he was speaking specifically about PGY1 training, the same lesson applies to any practice environment. If patient care is approached as a checklist of "assignments" to be completed (which is a thought process that often leads to success during school), then the transition from student to practitioner will be very difficult. Overcome this hurdle by mentally accepting your new role as the pharmacist and by fully embracing the responsibilities that come with it. Visualize yourself as an active part of the patient care team and always act in the best interest of the patient.
2. Hone your communication skills.
As a pharmacist, you are a translator. You may not be bilingual, but you are a translator. You decode medical diagnoses to patients and their families. You make recommendations to physicians and other prescribers. You communicate handoff to pharmacist colleagues. You discuss patient care issues with nurses.
No matter what your practice environment, your ability to communicate effectively can make or break you. In your professional life, you will work with diverse socio-ethnic groups both as patients and as providers. Every individual has a unique background and personality. Your key to success lies in how well you can understand, empathize, and ultimately interact with people of varying temperaments. This "soft skill" is difficult to teach during the didactic phase of pharmacy school; so it's not uncommon for new pharmacists to start practicing without ever having thought about their interactions with other people.
Always remember to communicate on a level appropriate to the person you are speaking with. When speaking to patients, take care to actively listen and don't interrupt. When speaking with busy healthcare providers, be succinct and to the point. Above all, be friendly and respectful to everyone. As much as possible, seek out opportunities to hone your ability to communicate. Start early, and practice often. The more effectively you can interact with others, the easier your transition from student to pharmacist will be.
3. Understand what a pharmacist contributes to patient care.
You are the only person on the medical team with your level of medication expertise. Most providers only receive one semester of pharmacology, and many don't get any formal training in therapeutics. For other health care professionals, most of their medication knowledge is "on the job" training. In a similar vein, you likely don't have the ability to interpret a CT of the abdomen to the level that a physician does. We each have our own role on the health care team. We all contribute the expertise from our respective fields to make a complete picture of patient care.
To successfully transition from student to pharmacist, you will need to be able to contribute the skill set that only a pharmacist brings to the table. While it's impossible to make an exhaustive list of what that entails, here are some common areas of opportunity on which to focus your attention:
- Renal adjustments
- Drug-Drug interactions
- Therapeutic substitutions for patients with a drug allergy
- Antibiotic streamlining and stewardship
- IV to PO switches
- Discontinuing unnecessary use of acid-suppressing agents
- Drugs with a narrow therapeutic index
Transitioning from a student to a pharmacist is difficult, but not impossible. By committing to play an active role in patient care, honing your communication skills, and understanding the clinical role of a pharmacist, you can make your transition a lot less painful.