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Main theme of this post: Today, I would like to discuss the main objectives of Clinical Clerkship and Internship; the duties and responsibilities of Doctor of Pharmacy (Pharm.D) students in ward round participation, the steps to deliver a better patient care and the expected outcomes of the clinical pharmacy services.
Pharmaceutical care:
Pharmacists are the important health care providers - drug experts; whose primary job is to interact with the health care team, interview and assess patients, make specific therapeutic recommendations, monitor patient response to drug therapy and provide an evidence based drug information for better pharmaceutical care. "Pharmaceutical care" is a broad-based, patient focused responsible provision of drug therapy to achieve definite and patient specific outcomes that improves the quality of life. The outcomes include:
- Cure of the disease
- Elimination or reduction of symptoms
- Slowing the disease process
- Prevention of disease
In order to achieve these patient specific outcomes a pharmacist needs an expert knowledge of therapeutics, strong communication skills, understanding abilities of the diseases, therapeutic planning skills, expertise in drug monitoring and basic knowledge in physical assessment.
What is Clerkship??
"Clerkship is an organized, directed, post graduate training program in a defined area of pharmacy practice", which is to be carried out under the supervision of a well trained preceptors who have expertise knowledge in drug therapy and clinical skills for better patient care (Unfortunately, this is lacking in India). Clerkship aims to provide students with a practical and stimulating learning experience where they are given an opportunity to participate in ward rounds along with the health care team and provide a wide variety of clinical services.
Responsibilities of a clerkship student:
1. Ward round participation:
The images below will give an outline on the duties of pharmacist in Ward round participation.
2. Optimization of drug therapy:
The optimization of drug therapy is achieved through proper Medication therapy management which improves the quality care of the patient through education and communication. This mainly focus on the medication related problems and their mismanagement; identification, assessment, monitoring and documentation of adverse events and to address the patient safety through proper analysis. Well established evidence based medicine and standard care guidelines helps in addressing these problems through therapeutic interventions. In case of patients suffering with chronic diseases like HIV, TB, hypertension, diabetes etc.; proper patient counseling through a well approached manner helps in improving their quality of life, which eventually requires medication adjustments, drug monitoring and proper follow-up.
3. Providing drug information :
This is a challenging task and requires proper knowledge on primary, secondary and tertiary resources that include standard drug references, textbooks, practice guidelines and scientific databases. A proper approach to the query, identification of the information lacking and fulfilling the gap with a proper evidence based guidelines is mandatory. The document and follow up of this service is to be carried out for providing better therapeutic care. The pharmacists need to provide information to all the health care professionals and sometimes even to the patient. This requires a better communication with the entire healthcare team. The follow up is carried out to access the satisfaction of the information seeker which is to be graded and documented.
4. Other activities:
The clerkship helps in developing and strengthening students’ pharmaceutical care skills through pharmacotherapy, hospital pharmacy and clinical pharmacy rotations which are to be assessed by the preceptors through assignments, case presentations, journal club presentations, group discussions through a proper grading approach. All the documentations are to be produced by the students during assessment where the preceptor will be evaluating each intervention through the evidence and correlating with the present diseased condition of the patient. This helps in establishing systematic evaluation procedures and standard documentation.
What is Internship??
Internship is a temporary period of supervised training that provides real world experience to gain the relevant knowledge and skills required to enter a particular career field. This period of internship will be usually funded by the respective education councils, where the pharmacists are expected to provide clinical services. The internship includes pre-ward rounds with nurses to gain proper knowledge on the disease state and history of the patient, followed by ward rounds with the physicians and health care team to discuss the present situation and recommend a standard therapeutic approach, followed by post ward rounds to monitor the patient and rule out medication errors.
Internship can be performed in any of the clinical settings like ambulatory care, critical care, emergency medicine, interventional medicine, pharmacy management etc.; depending on the skills the pharmacist is expertized. An intern can also focus on the research activities provided on the feasibility and access with the health care team, this helps in updating the knowledge on the therapeutic guidelines for getting proper conclusions. Every clinical services provided and therapeutic intervention made through the internship is to be documented well in a standard format which helps in easy access to the data and for further evaluation.
Interventions made and documentations done in the absence of a well trained preceptor are invalid.
Message
This is the procedure I follow in my daily practice, any further suggestions are highly appreciated. I wish good luck to all my juniors and hope a change begins...
Happy Blogging...!!!
Regards,
Deepak Kumar Bandari,
Pharm.D Intern,
Vaagdevi College of Pharmacy - India
Elsevier Student Ambassador - South Asia
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