Steph’s Note: As preceptors, there are certain tidbits of advice we wish all learners could have before starting rotation. Of course, we completely recognize that there’s a learning curve - Rome wasn’t built in a day! And we fully expect to provide feedback and guidance throughout your rotations because if you already came in knowing everything, A) rock on, B) what’s the point of rotation, and C) we’re retiring now. BUT if we can level the playing field from the beginning on some of the big ticket core items, that will allow for deeper learning!

Basically this - if we’re able to spend time during our topic discussions talking about the nitty gritty (e.g., the dilemmas, the gray areas, the studies) rather than spending copious amounts of time reviewing how drug A works, imagine how much more knowledgeable you’ll be after that topic discussion.

And so, with this line of thought, Brandon and I had the brainwave to turn our previous How to Do a Damn Journal Club post into a mini-series. Stay tuned for additional damn topics in the future… We hope these posts will help you get the most out of your rotations!

^^When you’re running late for your first day and the hospital elevator doors open up to a maze of cinder block white hallways in the basement. Don’t forget your bread crumbs…or your mirrors to look around corners. (Image)

It’s your first day of clinical rotations, and your preceptor hands you a sketched calendar for the next 5 weeks. You get the brief synopsis of the experience, including that you’ll have multiple topic discussions each week. You’re not really sure what to expect beyond the fact that they’ll be happening, but it’s syllabus day…and let’s be honest, you’re basically counting day 1 as a success since you figured out the parking and bus situation and navigated your way to the dungeon, errr, central pharmacy.

So you take your penciled-in calendar, shove it under your decade-old, 20 pound hospital tablet (that you don’t yet know how to log into), and go into observation mode as your preceptor sails into pre-rounding. You’ll worry about the assignments later when they get closer.

Totally understandable. We’ve all had to operate in survival mode at some point or another.

Day 3 of rotation rolls around, which according to the calendar, is supposed to host your first topic discussion. You sit down with your preceptor at her station on the unit, and she says, “Alright, tell me what you know about…”

And you’re like…wtf. You thought this was going to be her doing the teaching and you listening and learning.

You squirm. This is bad. Awkwardness abounds. You feel your rotation high pass slipping away with each tick of the clock’s second arm, and she’ll never write you that letter of recommendation you need for residency applications.

Ok, perhaps it’s not that serious. But we’re type A in pharmacy, and we don’t like making bad impressions or not knowing things, right? So the shame feels very real.

Could this have been avoided??

Because you’re faithful tl;dr readers, absolutely. Here are the things we want you to know about how to do a damn (good) topic discussion!

Topic Discussions Have Multiple Phenotypes

First, there is no formula for what makes a great topic discussion, so don’t set your heart on filling out a form or always talking about the exact same highlights. Unlike journal clubs, during which you can pretty much expect to always touch on whether you agree with the authors’ conclusions or whether you would have designed the trial differently, each topic discussion varies depending on the topic, the preceptor, the day/schedule, and who’s participating.

Sometimes we all need to channel a little more Argyle in our lives. (Image)

So you just gotta like, go with the flow, man, and see where the topic, like, takes you.

Some topic discussions may be impromptu quick 5 minute sound bites based on your team’s patients, some may be planned but informal over a cup of coffee, and others may come complete with 6 or 7 article references to review.

Your preceptor may step up to a whiteboard to do some explaining, or he may expect you to get up to the whiteboard and explain. Maybe it’ll be a mix of the two. Maybe you’ll look up information together as you go. Maybe you’ll prepare out the wazoo for one, but then in the middle of your session, there’s a STAT order for a crashing patient that cuts your learning short that day.

How are you supposed to know?

A simple answer…ask! And I’m not saying you should ask your preceptor, “Do I have to lead the topic discussions?”

Please, for the love of Pete, don’t unveil such deep disinterest on day 1. I don’t care if you think you’ll never work in an ICU and you’re absolutely thrilled you got stuck with this rotation because of a last minute cancellation. (Guess what, you can ask my mom - I was never going to be a pharmacist, and I was never moving to Texas. Done and done. So remember that never is a funny word, and treat each experience with the respect it deserves! Personally, I now like to think I’m never going to win the lottery…)

Anyways, I’m saying you can clarify expectations with a, “How do you typically like topic discussions to go? Anything special I should know beforehand?” Your preceptor may respond with some very specific guidelines, or she may say there’s nothing in particular. In the latter case, you can just take each session as it comes and tweak each time until you have a good flow.

Long story short, don’t go into every rotation expecting that topic discussions will look the same every time. Heck, don’t even expect every topic discussion on a single rotation to be the same format. Feel free to try to clarify upfront what your preceptor likes, but be flexible since #lifehappens.

Since you can’t necessarily predict how every topic discussion is going to go, what can you control? Here goes.

It is a Truth Universally Acknowledged that a Damn Good Topic Discussion is…

Well-Prepared

If your preceptor gives you articles to read prior to your topic discussion session, please read them… I know, it sounds stupid basic. But when push comes to shove and rotation, work, and life start to get the best of you, it can be tempting to skim those articles or even just wing the whole shebang without reading anything at all.

For all the fellow Jane Austen fans out there who acknowledge universal truths ;) (Image)

I can assure you, we know when someone hasn’t read. Very rarely can a person wing their way through an entire topic discussion. So like Nike says, Just Do It. Plan accordingly and make it happen. (And if you’re feeling overwhelmed by rotation or life and getting through everything, that needs to be a separate discussion!)

Also, when I say read the articles, I don’t mean reading them just to say you read them. Rather, you should take the time to study the articles, take notes about treatment schemes, pick out what you feel is most important, and highlight those things you don’t quite understand so you can make sure they get ironed out during the discussion.

It’s also possible that your preceptor may not give you any articles ahead of time. WIN, right? A night off of assignments! Well actually…

I can pretty much guarantee that your preceptor is looking for initiative in this situation. Do you seek knowledge independently? Are you resourceful? Do you know how to find relevant and reliable information? As a pharmacist, you will need to find your own information resources, and sometimes preceptors prefer to stretch your info gathering and sieving skills by leaving the topic discussion reading assignment open-ended.

Live up to the challenge! This is the Information Age. Demonstrate that you are comfortable navigating through it.

In addition to (finding and) reading articles, preparation includes researching drug information related to the topic at hand. If your discussion is about urinary tract infection treatment and you read articles about ceftriaxone versus ciprofloxacin versus sulfamethoxazole/trimethoprim, please take the extra step to refresh yourself on how these medications work!

You should have a handle on drug classes, mechanisms, pharmacokinetics, common doses and adverse effects, and monitoring. Yes, it sounds like a lot (and it is!), but these are the basics that you can generally memorize and have in your hip pocket. Obviously, if you need clarification on a piece or two, that’s understandable! But try to nail down as much drug information as you can ahead of time.

Being prepared for a topic discussion also includes making an attempt to understand how therapies relate to each other. Again, as preceptors, we expect to discuss therapeutic dilemmas and how we use the data to make treatment decisions, but we can go way farther into this nitty gritty if you already know that the treatment options are X, Y, and Z (and how those drugs work). So even if you’re not exactly sure of the correct medication lineup on the playing field, it’s a good idea to at least know which ones are on the bench to choose from.

Finally, and this is like the cherry on top, the extra credit… Being prepared means knowing if there’s any current “buzz” about the topic. Has there been a big hullaballoo about a treatment option, and it was recently removed from the market by the FDA? Is there a newly approved treatment option that the 3 year old guidelines don’t incorporate?

We don’t need 500 miles, but maybe just an extra mile or 2… (Image)

This can be a bit of a shot in the dark because how can you Google search something when you don’t know if there’s anything to search…so don’t rabbit hole forever. But I’d say at least try! You just might teach your preceptor something new :)

Participatory

One sided topic discussions are not discussions… those are lectures. And as awkward as it is in school when the professor asks a question and no one attempts an answer, it’s worse when it’s just a handful of people there. So please don’t come to topic discussion thinking you’ll just hang out, take some sparse notes, and then be done.

As difficult as it may be, try to put aside your worries about your research project, your residency applications, etc, and focus. Your preceptor is taking precious time away from patient care to focus on your education, and you’re taking time away from ^^all of the above responsibilities. So please please give them your full effort and attention. This includes putting away your email, phone, and Apple Watch text messages (not even kidding…) because we can see the secretive eye glances down, and it hurts our souls.

Even though these discussions aren’t lectures, it’s totally ok to take some notes so you can review them later or add them to your peripheral brain material for NAPLEX studying. Just try not to make them head-down, nose-to-the-paper, transcribe-every-word notes that make us wonder if we’re talking to a human or a typewriter. We do want to actually discuss with you too!

On that note, being participatory means feeling free to ask questions of your preceptor! You’re with an expert in their field, so take advantage of the time to pick their brains. For concepts you don’t understand, now’s the time to ask them to slow down and/or clarify. For gray areas or therapeutic dilemmas, ask them how they interpret and handle the situation.

(Of course, they may want to first hear how YOU would interpret the data and handle it, but then hopefully you can hear their side too! This is how we gain perspective and exposure to the difficult scenarios pharmacists encounter every day, and it’s also how we begin to mold our clinical judgment.)

Nonjudgmental

Speaking of judgments… topic discussions should really be nonjudgmental. Now a lot of this is out of your hands as a learner unless you’re a resident leading a discussion for students, but hopefully your preceptor makes your learning environment a safe (yet challenging) space for thinking out loud and critically. Topic discussion sessions should also be safe spaces for being wrong.

Trust me, this is the time to be wrong - not when you’re a pharmacist taking care of patients. So get the information straight as much as you can when you have your preceptor safety net.

In short, be prepared to put yourself out there. If you’re not sure how to answer a question, make educated, thoughtful statements rather than guessing erratically. Consider what you know because even though it may not always feel like it, you know a lot!! You’re in pharmacy school or perhaps just graduated, and the guideline/trial data is fresh for you. You have so much knowledge to bring to the table if you can uncatalog the right file in your brain and connect the dots!!

The tl;dr of Topic Discussions

Basically, topic discussions are your opportunities to log away as much knowledge as possible that perhaps you can’t get from a book, journal article, or Dr. Google. Prepare the memorizable information as much as possible beforehand so you can spend that rare and precious non-patient care time doing higher level critical thinking, which will help you develop your clinical judgment.

That being said, if you need to fill in some knowledge gaps, don’t be afraid to ask for clarification!

Finally, be prepared to go with the flow because there’s no template for topic discussions. Each one is a unique snowflake, just like you :)

How to Do a Damn Topic Discussion