By Paul Swinger, PharmD
“Ami,” can you believe that you are already roughly halfway through your APPE rotations? The time passes quickly, making it challenging to get as much as possible out of every month. While you may feel disillusioned with some aspects of the process, you are doing an excellent job taking active steps to maximize your own experience and maintain a positive, open-minded attitude.
If you continue to approach the rest of the year in the same way, I am confident that you will find the “hAPPEness” you are looking for!
Internalize that positive attitude
When first ranking APPE rotations, many student pharmacists are unsure of what path they want to pursue in the profession. Even those who initially feel certain of their next step sometimes end up radically changing their minds because of either positive or negative experiences during their final year. For these reasons, it makes good sense to diversify the types of rotations you rank highest to give yourself the best chance of discovering where your passions and talents really lie.
As you mentioned, putting yourself in a position to succeed at each site starts with your ability to consistently show up with an open mind and an eagerness to learn. Outwardly displaying a positive attitude while on rotation is important, but internalizing that attitude is what gives you the power to fully enjoy rotations you otherwise might not be excited about.
Your time at the emergency department illustrates another great strategy: choosing to focus on aspects of the experience that you appreciate and enjoy instead of bitterly dwelling on the disappointment of unmet expectations. You came up with an impressive list of things that went well that month. Reflecting or journaling about your APPEs is a good way of reminding yourself to be grateful for those things and to celebrate the small victories.
Way to speak up
I would also commend you for communicating with your preceptors about what you want to get out of the rotation and what you would like to see done differently. Making your goals and interests known early in a rotation makes it easier to tailor activities and assignments to meet those needs.
With your ambulatory care rotation, you took that one step further: you pointed out specific ways that you could use your physical assessment skills to enhance your contribution to patient care. At a site that wasn’t using student pharmacists to their full potential, you effectively advocated not only for your own needs within the rotation, but also for the profession of pharmacy within a multidisciplinary team.
Have faith in the system
You are right that despite setting yourself up for success in these ways—scheduling a broad range of APPE rotations, arriving with a positive attitude, focusing on the bright side, and being proactive in communication—it is possible to still not feel much passion for anything you have encountered so far. Reality of life on rotations does sometimes fall short of your expectations, which is a danger with both APPEs and (potentially) your future career. That’s one of the reasons for the high rate of burnout among pharmacists.
To an extent, I would encourage you to have faith that the system works, even if the rotations selected for you by a computer algorithm seem non-ideal. One of my classmates fully intended to become an ambulatory care pharmacist when she started her APPE year, but a chance hospital transplant rotation (that she hadn’t ranked) caused her to completely change direction, and she is now completing a transplant specialty PGY2.
If your rotations aren’t giving you the specific experiences you hoped for, ask yourself if there’s a way you can get some of those experiences on your own. Can you reach out to shadow preceptors you didn’t match with? Can you volunteer in new settings or for different patient care projects? Is there a faculty member in a position you want to learn more about? These examples may be more in your control than the 9 months assigned to you by a computer.
Focus on the short term
It is natural to want to have it all figured out by the end of your rotations, but, realistically, you might still have trouble formulating a solid 5-year plan at that point. Instead, I would suggest focusing on the short term and asking yourself: what is the right step for me right now? As you continue to pursue the “next right thing,” you will find that your passion reveals itself over time.
I am excited to see where the journey takes you!