Standford Medical Center

As you may know, one of our previous blog posts by Rajjit Sidhu was also about Stanford Medical Center. I had the pleasure of doing my elective rotation at Stanford as well but focused on Administration (which was referred to as Practice Management). I was also fortunate that my preceptor has given me an array of experiences while I was here – Emergency Department, Transitions of Care, Informatics, Ambulatory Care, and Perioperative Units.

Let’s start with my first week. One of my daily responsibilities from day 1 were Medication Education – the idea is pretty much like an anticoagulant clinic but inpatient and includes “high risk” medication counseling as well. A report is run every morning and the patients on that list must be seen that day. I was also assigned to 2 separate projects from week 1, and throughout the weeks, the projects kept coming. Projects ranged from troubleshooting certain things to collecting data for a variety of operations within the pharmacy. By the second week, I had the autonomy to facilitate morning “huddles” that would then be presented to pharmacy leaders in later meetings that occurred daily.

I am with two other students who are on different rotations, and we all concluded that we have almost the same responsibilities as residents. Which is technically true – when my resident (who I report to) was off in meetings or interviews for PGY2, I acted as her proxy and took on her responsibilities for when she’s out of office. The attitude I sense is EXCELLENCE and if you are here, you must be ambitious, and you must want to be excellent to provide excellence. Period.

Now let’s talk about Stanford itself. Stanford is a private, teaching facility currently at about 600 beds, and later in 2019 they will be expanding to another 500 beds. On top of that, there are about 400 clinics in the surrounding area - so this is a really big health system! Now, lets touch on the teaching/learning aspect. Every healthcare professional within this facility is very proactive about teaching. For example, the ED pharmacist I was with had me go with him to a patient and counsel the nurse on an IV medication and how to administer the medication, the rate to go by, what to expect if there is a problem, and how to troubleshoot that problem. This nurse was only pretending to be a "new" nurse for my benefit, all while there's emergent cases surrounding us. Teaching is such a prominent thing - residents meet all the time with pharmacists and physicians on their research projects/presentations, and part of committee's that include every health professional.

My advice to students interested in acute care is to start practicing thinking how and when medications are used and in what situations, as well as anticipating possible problems that can occur with medications ( ADR, , stability, dose adjustments, etc. ). The hardest transition I felt with myself is transitioning my "academic brain" vs. "real life brain" , its great to know everything about Drug A but if you don't know the real life implications of Drug A , that doesn't do you any good.