Precepting Skills 101

Reflecting on the two-week precepting skills rotation, I can see now how my previous DPC rotations had been preparing me for this. The process of providing direct instruction, modeling, coaching and facilitating as well as the art of recognizing the appropriate time for each have been demonstrated by my previous preceptors. Being on the other side, I could recall times were each of these methods was employed. I did my best to model this and gauge where my preceptee was at and to interpret her needs. Observing her progression was a rewarding process as she became more independent and curious when completing patient drug therapy assessments. As she became more independent, I was able to focus my attention on optimizing drug therapy for patients on the surgical ward and to practice balancing the two responsibilities. This is a valuable skill and the rotation increased my confidence as a clinical pharmacist as the two roles became easier to manage and in some ways complemented each other.

We were fortunate to be involved in the care of a patient with extreme shoulder pain, not yet diagnosed. While observing the ID physician’s assessment, infection appeared high on the differential however no organism had been isolated and there had been little response to broad-spectrum antibiotics. The purulent discharge was also new therefore infection was not necessarily the primary cause. When examining the CBC, one potentially significant finding was that the patient’s platelets where high at 600 x 10*9/L. The preceptee noticed this and was able to take concepts we had been discussing and recognize some possible causes for this including surgery and hyperproliferative disease. She hypothesized and began to investigate if this could increase her risk of VTE (a subclavian DVT was on the differential however a prior ultrasound, rated low quality, had been negative for this). Soon after this a repeat ultrasound was been ordered. The diagnosis of this patient remains unclear at present however it was extremely rewarding when my preceptee began to synthesize some concepts we had been discussing regarding laboratory values and apply these to a patient assessment.

With another successful rotation complete, on to my final project week. The main objective of this week: complete the data analysis and produce a poster to communicate my findings for the residency poster presentation.

Journal Club 1(1/2)

Today my and Scott’s preceptees presented their first journal club to the group at VGH. The two student critically appraised an RCT assessing the efficacy of vortioxetine in improving cognitive function in major depressive disorder (MDD) !independently of the antidepressant effects. We had coached them in anticipation of questions that may be asked and they appeared well prepared. I believe it may have been more anxiety provoking for myself than the student. Perhaps it was because it was no longer in my control or maybe because I recalled being nervous for my journal club. Nonetheless, they did well and I was afforded an opportunity to provide direct feedback. Providing feedback is a skill in itself and I was relieved that it was well received. The main constructive criticism was slightly ironic as it is a concept I continue to grapple with: trust yourself and be confident when you know the answer to a question. Below is the result of their (and our) hard work.

The CONNECT Trial Critical Appraisal by Thea Lo and Jaswinder Kaur

Additional information for all of the pharmanerds out there: just the week prior to their presentation, the FDA rejected the expanded claim of vortioxetine as a cognitive enhancer in MDD based on this and the FOCUS trial. Hot of the press!