Reflections on Residency & Learning

Clinical Orientation Reflection

Holy batman. That was the best week ever.  The term “hit the ground running” really felt prevalent in this week, in the best way possible. I felt like I could really start to see my self synthesizing a thought process and as the week progressed I noticed how much the head to toe approach really started to become intuitive in my process. Not at the unconscious competence stage by any means, but I can see myself getting there slowly but surely!

Some of this week’s tidbits that I will carry with me throughout this year:

  1. Up-to-date is a quick and dirty… but its not everything! Looking up guidelines is also just a starting point. If something doesn’t make sense, or I don’t understand why this is being used, look at the primary literature.
  2. When its a condition I haven’t heard of, don’t spend the majority of my time looking it up – instead think of how does it relates to drug therapy? Indication wise, and even more so how does this affect the way the drug’s PK/PD?
  3. Info gathering – don’t rewrite the chart. This has saved me loads of time this week. I’m getting to the point where I feel comfortable leaving the ward to work up my patient in the office (more so b/c of computer access/space), and not feel the panic of “but what if I need to see the chart!” because I’ve been more comprehensive, but efficient at info gathering.
  4. Alternatives, alternatives, alternatives: I have been shifting to spending (or at least trying to) most of my work up process time in this part of the therapeutic plan. As my preceptor told me: this is useful, because if someone asks you why not drug “x” you already have thought about it and can give a smart and thoughtful response.
  5. If you do a good goals of therapy, your efficacy portion of your monitoring is already there! In general my goals of tx are: 1) dec. mortality (how will they die?) 2) dec. morbidity (what are some sequalae/complications I’m concerned about) 3) dec. s/sx/surrogates 4) prevent ADRs 5) inc. quality of life (if applicable…e.g. acute antibiotic therapy isn’t really gonna change their quality of life)
  6. Be able to know the most common/prevalent ADRs (for monitoring/alternatives rationale) and the most severe, concerning ones (e.g. TEN/SJS). Monitoring and goals of therapy are only good if they actually mean something… how does this relate to my patient? Frequency of monitoring, who’s going to do it (esp. if its the RN –> what kind of instructions am I going to give them? The basics of antibiotic ADRs (for monitoring plans): allergic, site rxns (if IV administration), blood dyscrasias, renal/hepatic insufficiency, GI.
  7. How to choose antibiotics: bug/drug/host
  8. Fact I learned at a clinical case sharing presentation: G#P# –> g= # of times the patient was pregnant, P= # of deliveries (post 20 wks – viability age)
  9. And last, but definitely not least: efficiency and thoroughness are key to successful workups.



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