Ridiculous expectations from preceptors

[WorthlessOxygen]

it is pretty sad that there are even ID pharmacists specifically when
every pharmacist should be knowledgeable about ID and current guidelines for it. hospitals shouldn’t even have specialties for pharmacy

The community pharmacists I encountered knew the same things hospital Pharmacists knew and shared their knowledge more to their students. Maybe they forgot goal trough levels for vancomycin but everything else they remember

There are places for generalist knowledge and places for specialist knowledge. Have you had any direct experience with an ID pharmacist? The ones that I interacted with in my APPEs were easily able to justify their positions.

I'd say the same type of thing happened with community vs hospital pharmacists. Sure, any RPh should be able to work either but each environment develops slightly different skills and knowledge.

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[BC_89]

Whoa stalker much?

You posted your questions and goals on SDN. Don't be surprised if users try to see the whole picture of where you're coming from to help better answer your questions. The fact that you're considering on jumping ship to further put 4 more years to the DO route definitely warrants answering your concerns in a different format than most.

Anyways my preceptor directly told me he gets paid to precept students so that’s why he takes on students . Not sure how much or if the department or the school pays but that is what he said.

Well, if that explains the arrogance and off-putting attitude of the preceptor, report it in your evaluation to the school. I would also follow-up with the school to see if they do indeed pay the site or if the incentive is from the workplace of your preceptor. I've gathered my information by asking the sites how the incentive works (if any) for certain preceptors. Ask your school how they're involved in making arrangements for your sites.

it is pretty sad that there are even ID pharmacists specifically when
every pharmacist should be knowledgeable about ID and current guidelines for it. hospitals shouldn’t even have specialties for pharmacy

It's ok to vent, but I would say you're venturing to the part of grinding your axe on something you don't seem to fully understand yet. No one disagrees on the importance to be a hybrid of knowledge for things you may encounter. That said, guidelines and clinical experience eventually start to pull in different directions. In those cases (and it happens often), we need those with that specialty knowledge that you just don't get taught or have the opportunity to encounter on the daily basis in other locations.

The community pharmacists I encountered knew the same things hospital Pharmacists knew and shared their knowledge more to their students. Maybe they forgot goal trough levels for vancomycin but everything else they remember

All fields have overlap, all fields have portions that don't overlap. As a student, your exposure is simple - understand the fundamentals and apply it (that's what I did as an APPE student last year). If you get an ER pediatric oncology pharmacist, then great! Seeing them apply the basics should help you better understand those simple topics you'll need for the NAPLEX.

If they're a poor preceptor, document-document-document...complain...then document-document-document some more. The more we document, the better chance we get to help the next cycle of APPE students (pretty happy I assisted in a small way to push a preceptor out of their role after years of toxicity).

 

[deleted727644]

You posted your questions and goals on SDN. Don't be surprised if users try to see the whole picture of where you're coming from to help better answer your questions. The fact that you're considering on jumping ship to further put 4 more years to the DO route definitely warrants answering your concerns in a different format than most.

Well, if that explains the arrogance and off-putting attitude of the preceptor, report it in your evaluation to the school. I would also follow-up with the school to see if they do indeed pay the site or if the incentive is from the workplace of your preceptor. I've gathered my information by asking the sites how the incentive works (if any) for certain preceptors. Ask your school how they're involved in making arrangements for your sites.


It's ok to vent, but I would say you're venturing to the part of grinding your axe on something you don't seem to fully understand yet. No one disagrees on the importance to be a hybrid of knowledge for things you may encounter. That said, guidelines and clinical experience eventually start to pull in different directions. In those cases (and it happens often), we need those with that specialty knowledge that you just don't get taught or have the opportunity to encounter on the daily basis in other locations.



All fields have overlap, all fields have portions that don't overlap. As a student, your exposure is simple - understand the fundamentals and apply it (that's what I did as an APPE student last year). If you get an ER pediatric oncology pharmacist, then great! Seeing them apply the basics should help you better understand those simple topics you'll need for the NAPLEX.

If they're a poor preceptor, document-document-document...complain...then document-document-document some more. The more we document, the better chance we get to help the next cycle of APPE students (pretty happy I assisted in a small way to push a preceptor out of their role after years of toxicity).

Does the schools actually read the students evaluations? Do they actually send it to the departments?

What more knowledge does ID pharmacists have that hospital pharmacists don’t?

 

[deleted727644]

There are places for generalist knowledge and places for specialist knowledge. Have you had any direct experience with an ID pharmacist? The ones that I interacted with in my APPEs were easily able to justify their positions.

I'd say the same type of thing happened with community vs hospital pharmacists. Sure, any RPh should be able to work either but each environment develops slightly different skills and knowledge.

Yes I have. What more knowledge does ID pharmacists have that hospital pharmacists don’t? I didn’t see any difference other than them making protocols for antibiotics

With a whole year of APPE, shouldn’t students have the skills for both hospital and community? Maybe not as intensive training like residency but a year is a long time for APPEs. Preceptors be slacking and leaving all that training for “residency”

 

[WorthlessOxygen]

Yes I have. What more knowledge does ID pharmacists have that hospital pharmacists don’t? I didn’t see any difference other than them making protocols for antibiotics

Making antibiotic protocols requires being more familiar with guidelines and local resistances than the staff pharmacists generally have time for. Add in leading or co-leading the hospital's antimicrobial stewardship program and you're already looking at a full time pharmacist dedicated to ID concerns.

With a whole year of APPE, shouldn’t students have the skills for both hospital and community? Maybe not as intensive training like residency but a year is a long time for APPEs. Preceptors be slacking and leaving all that training for “residency”

I don't really understand your point. Residency trained pharmacists obviously have more experience than new grads with just APPEs as their hospital experience. I know people who were hired straight out of school for hospital positions but it certainly made their job search harder.

 

[Rockinacoustic]

What more knowledge does ID pharmacists have that hospital pharmacists don’t?

Do you feel the same way about ID physicians and hospitalists?

 

[BC_89]

Does the schools actually read the students evaluations? Do they actually send it to the departments?

Absolutely. Whether it be E-Value, Core-Elms, Pharm-Academic, or some other evaluation platform that is used to grade each of your APPE rotations, your program would be required (at a minimum) to open your personal evaluation(s). As the preceptor gives feedback, you in turn also provide feedback that should have two parts: one for the preceptor, as well as a portion that is only meant for the school.

On top of this, you should have access to specific school coordinators (ours was called OEE - office of experiential education) that should be on the ready to reply to your emails and calls. Point is, you have plenty of opportunities to report a preceptor if you honestly feel they are toxic to student development (hence why the preceptor should be doing initial, mid, and final evaluations to tell you about your progression). It's a two-way street.

In the end, you have plenty of paper-trails and resources to build a case on the same preceptor over time. When you don't report, you leave the next cycle of students exposed.

What more knowledge does ID pharmacists have that hospital pharmacists don’t?

General care vs specialty care is the big difference (You wont fully appreciate that difference until you're licensed on your own).

So, to the same token (since you now wish to be a physician), I'm curious about your thought process pertaining to the question put out by @Rockinacoustic

Since we're also talking about terrible preceptors, how do you think your preceptors are going to treat you as a medical student + resident? Do you believe they'll fit your narrative below?

A message to certain preceptors to keep in mind and not do to students:
verbal and non-verbal behaviors that counts as BULLYING: undervaluing; negative, sarcastic, or condescending remarks; unreasonable expectations; hostile or degrading treatment; being ignored or socially isolated; and being shouted at or threatened

Perhaps we're not answering your deeper question (honestly I'm not sure) - Are you more mad because of your preceptors or because you can no longer justify doing pharmacy?

 

[deleted727644]

Do you feel the same way about ID physicians and hospitalists?

Do you feel we go through the same training and curriculum as physicians? Do we do 3-7 years of residency on top of 4 years?

I looked at ID pharmacists BCPS study guide and it’s just the guidelines which regular hospital pharmacists should be aware of anyway

 

[deleted727644]

Absolutely. Whether it be E-Value, Core-Elms, Pharm-Academic, or some other evaluation platform that is used to grade each of your APPE rotations, your program would be required (at a minimum) to open your personal evaluation(s). As the preceptor gives feedback, you in turn also provide feedback that should have two parts: one for the preceptor, as well as a portion that is only meant for the school.

On top of this, you should have access to specific school coordinators (ours was called OEE - office of experiential education) that should be on the ready to reply to your emails and calls. Point is, you have plenty of opportunities to report a preceptor if you honestly feel they are toxic to student development (hence why the preceptor should be doing initial, mid, and final evaluations to tell you about your progression). It's a two-way street.

In the end, you have plenty of paper-trails and resources to build a case on the same preceptor over time. When you don't report, you leave the next cycle of students exposed.



General care vs specialty care is the big difference (You wont fully appreciate that difference until you're licensed on your own).

So, to the same token (since you now wish to be a physician), I'm curious about your thought process pertaining to the question put out by @Rockinacoustic

Since we're also talking about terrible preceptors, how do you think your preceptors are going to treat you as a medical student + resident? Do you believe they'll fit your narrative below?



Perhaps we're not answering your deeper question (honestly I'm not sure) - Are you more mad because of your preceptors or because you can no longer justify doing pharmacy?

Perhaps you should’ve been a therapist

 

[thumbz]

Whoa boy, this thread is a good one. I didn't read most of it, and I'm not a pharmacist. From what I can glean - manan you're gonna have a bad time as a medical student if you're having your current preceptor issues. Surgery and obgyn will be merciless.

What I really wanted to weigh in on is the ID pharmacist vs hospital pharmacist.

I round with a hospital pharmacist. When we have an ID question, she knows 80% of them (she's a rockstar). However the other 20% of the time she says "Let me ask XX (our ID pharmacist)". Why? Because ID is nuanced as hell and no hospital pharmacist is going to know the antibiogram as well as an ID pharmacist (just as no hospitalist will know it as well as an ID doc).

Did you know pathogenic Corynebacterium striatum is almost universally resistant and needs vanco? No? Neither did I. Neither did my pharmacist. But our ID pharmacist knew! Heck, I had never heard of it until it popped on a blood culture.

And no, it isn't on our antibiogram. The cases we have in a year can be counted on one hand.

Edit: not that any of this needed to be said to any practicing pharmacist. But it's a shining example of "you don't know what you don't know". I promise you 7 years of med school and residency is not going to be a greener patch of grass.

 

[Rockinacoustic]

A message to certain preceptors to keep in mind and not do to students:
verbal and non-verbal behaviors that counts as BULLYING: undervaluing; negative, sarcastic, or condescending remarks; unreasonable expectations; hostile or degrading treatment; being ignored or socially isolated; and being shouted at or threatened

Perhaps you should’ve been a therapist

What more knowledge does ID pharmacists have that hospital pharmacists don’t?

The irony...

 

[deleted727644]

Whoa boy, this thread is a good one. I didn't read most of it, and I'm not a pharmacist. From what I can glean - manan you're gonna have a bad time as a medical student if you're having your current preceptor issues. Surgery and obgyn will be merciless.

What I really wanted to weigh in on is the ID pharmacist vs hospital pharmacist.

I round with a hospital pharmacist. When we have an ID question, she knows 80% of them (she's a rockstar). However the other 20% of the time she says "Let me ask XX (our ID pharmacist)". Why? Because ID is nuanced as hell and no hospital pharmacist is going to know the antibiogram as well as an ID pharmacist (just as no hospitalist will know it as well as an ID doc).

Did you know pathogenic Corynebacterium striatum is almost universally resistant and needs vanco? No? Neither did I. Neither did my pharmacist. But our ID pharmacist knew! Heck, I had never heard of it until it popped on a blood culture.

And no, it isn't on our antibiogram. The cases we have in a year can be counted on one hand.

Edit: not that any of this needed to be said to any practicing pharmacist. But it's a shining example of "you don't know what you don't know". I promise you 7 years of med school and residency is not going to be a greener patch of grass.

The ID pharmacist most likely knows because another doctor asked her first or another pharmacist asked her first since they know that’s her “specialty” or she routinely gets new emails since she’s board certified. I get what you’re saying but That question could’ve easily be looked up using guidelines or literature evidence. Heck even google has that answer that vancomycin is the DOC for Corynebacterium striatum. All pharmacists are trained on drug information.

 

[deleted727644]

The irony...

I’m not a preceptor…
Nor am I on a rotation… so idc I’ll speak my mind

 

[owlegrad]

…That question could’ve easily be looked up using guidelines or literature evidence. Heck even google has that answer that vancomycin is the DOC for Corynebacterium striatum. All pharmacists are trained on drug information.

Very nearly all medical questions can be “easily looked up” and “google” has the collective knowledge of all mankind. What a pointless “critique“.

I do agree that all pharmacists are trained on drug information. Good point.

 

[projektreverb]

Very nearly all medical questions can be “easily looked up” and “google” has the collective knowledge of all mankind. What a pointless “critique“.

I do agree that all pharmacists are trained on drug information. Good point.

This.

I’m not a preceptor…
Nor am I on a rotation… so idc I’ll speak my mind

Which begs the question, where are you?