In this article two clinical pharmacists discuss strategies for success with pharmacy topic discussions.
Bryan P. White, Pharm.D., BCIDP & Athena Hobbs, Pharm.D., BCIDP
Article Posted 9 May 2022
Topic discussions are commonly used as a tool during pharmacy clinical rotations to help a learner focus on common disease states or important literature in the area. Unfortunately, learners sometimes view topic discussions as a necessary part of rotation (eating your vegetables, if you will) as opposed to an opportunity to do a deep dive into a particular area of infectious diseases. We have compiled a list of five steps to use to sweeten your topic discussions for learners.
Step 1: Plan
Decide on topics, ask learner about interest areas to try to help personalize, decide who will lead topics (student, resident, yourself, team, etc.), decide on articles you will provide or whether the learner will provide articles
In a four to six week rotation, it can be difficult to narrow down the number of topics that you want to cover. One to two topic discussions per week is a normal load. But which of the topics makes the cut? Like desserts, you can’t have them all! Having a core set of required topic discussions and flexibility to customize based on the learner’s interests is key. We try to ask our learners on day 1, or perhaps even before the rotation, about their goals for the rotation as well as their strengths and/or weaknesses in the clinical area. Then, we use this discussion to work with the learner and personalize some of the topic discussions.
Deciding who is going to lead the topic discussions is also an important part of planning. Are you in a layered learning model [1] (with students as well as first and/or second year pharmacy residents) where residents will lead the topics? Or do you have team-taught topics [2]?
Choosing the right number and set of articles depends on your learner. Some articles may be appropriate for a PGY-2 resident, but not a P4 student. Saving standard articles that you use for topic discussions in electronic folders that residents can access can improve efficiency. We also evaluate standard articles from time to time to see if they need to be updated. Additionally, if you have a more advanced learner or one whom has had a similar rotation in the past, consider asking them to identify and send a recently published article to the group ahead of time. This can give them more autonomy in choosing what they would like to discuss as well as potentially expose you to new literature in the area.
Step 2: Communicate expectations
Communicating expectations is an important part of precepting. Learners want to succeed, but unspoken or confusing expectations can lead to frustration on behalf of both the learner and preceptor.
Discussing with the learner about who will lead the topic discussions and how they need to prepare is key. Some preceptors prefer that learners have a prepared handout for topic discussions. We always aim to send articles to the learners at least a week before the topic discussion to give them time to review. Additionally, preceptors should provide guidance if there are certain sections of articles or guidelines that learners should focus on more. Similar to how many is too many chocolate chip cookies, the most important sections in a long guideline can be subjective and something that needs to be defined.
Step 3: Ask questions
During the topic discussion, use Socratic questioning [3] to get to the why, probe for implications, and solicit alternative viewpoints. Understanding how different temperatures affect the crystalline structure of chocolate is important to be able to properly temper chocolate. Likewise, when reviewing complex infectious diseases topics, we always strive to test our learners’ comprehension. Do they know that vancomycin plus ceftriaxone is the first line therapy for most adults with meningitis? Do they know that the reason we use vancomycin is for ceftriaxone-resistant Strep pneumoniae as opposed to MRSA [4]?
We often encounter complex patients who do not qualify or cannot receive the first line therapy for various reasons. Asking learners about alternatives and the rationale behind the recommendation prepares them for complicated scenarios, new information on rounds, or push back they may receive on recommendations. Just like being able to convert a failed cake into delicious cake pops, we want our learners to develop the clinical thought processes to think on their toes when challenged.
Step 4: Follow up learning
A topic discussion is just the start; preceptors may assign follow up questions based on gaps in a learner’s knowledge revealed by Socratic questioning. I mean, what is cake without ice cream? We often send follow up FYI articles to augment a learner’s own literature search and then reinforce the concepts learned during patient discussion and rounding.
We seek to use topic discussions as a tool to help develop a learner’s critical thinking skills, so they understand the why and evidence behind their recommendations instead of simply following hospital protocols. For instance, by the end of rotation, we want learners to be able to explain to their providers that we use carbapenems for ESBL bloodstream infections based on the MERINO trial and not just because, “that is what Bryan or Athena said” or “that’s just what we do here” [5].
Step 5: Ask for feedback
Precepting is something in which we can always grow. Our current topic discussions and readings were the result of trial and error and borrowing good ideas and articles from colleagues. Get feedback from learners on topic selection, article choices, amount of required reading, and the format of topic discussions.
As it turns out your can have your cake and eat it too!
REFERENCES
1. Delgado O, Kernan WP, Knoer SJ. Advancing the pharmacy practice model in a community teaching hospital by expanding student rotations. Am J Health Syst Pharm. 2014;71(21):1871-1876.
2. White BP, Hobbs ALV. Infectious diseases virtual topic discussions: co-preceptorship adaptations during a global pandemic. J Pharm Pract. Published online March 11, 2022:8971900221076427.
3. Gentry L. Teaching with questions. Proc (Bayl Univ Med Cent). 2015;28(1):118-119.
4. Tunkel AR, Hartman BJ, Kaplan SL, et al. Practice guidelines for the management of bacterial meningitis. Clin Infect Dis. 2004;39(9):1267-1284.
5. Harris PNA, Tambyah PA, Lye DC, et al. Effect of piperacillin-tazobactam vs meropenem on 30-day mortality for patients with e coli or klebsiella pneumoniae bloodstream infection and ceftriaxone resistance: a randomized clinical trial. JAMA. 2018;320(10):984-994.
ABOUT THE AUTHORS
Bryan P. White, Pharm.D., BCIDP
Dr. Bryan White graduated from the University of Georgia, completed his PGY1 pharmacy practice residency at Albany Medical Center, and completed his PGY2 residency in infectious diseases at the University of Mississippi Medical Center.
He has been an infectious diseases clinical pharmacy specialist at the University of Oklahoma Medical Center from 2016 to present. His areas of interest and publication are in antimicrobial stewardship, OPAT, and bacteremias.
Dr. Athena Hobbs graduated from the University of Texas at Austin, completed her PGY1 pharmacy practice residency at the University of Chicago Medicine, and completed her PGY2 residency in infectious diseases and antimicrobial stewardship at Seton Healthcare Family in conjunction with the University of Texas at Austin. She was the infectious diseases clinical pharmacy specialist and co-chair of the antimicrobial stewardship committee at Baptist Memorial Hospital-Memphis from 2015-2021.
Dr. Hobbs is currently the infectious diseases clinical pharmacy coordinator at Methodist University Hospital in Memphis. Her particular areas of interest and publication are in antimicrobial stewardship, antimicrobial resistance, and antibiotic pharmacokinetics.
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