First off, CONGRATS! You made it through grueling years of pharmacy didactic years. So many exams and assignments, on top of other responsibilities like work, leadership, student organizations, research, and more. If your experience was anything like mine – there were a lot of tears, self-doubt, and sacrifices over the last 3 years. I hope you take the time to celebrate your accomplishments and be proud of the hard work that got you to where you are today.
Looking for tips on picking APPE rotations? Or wondering if you should pursue a longitudinal APPE program (LAPPE or APPE-RT)? I talk about how I picked my rotations and why I decided not to pursue a longitudinal APPE program, as well as my tips and advice for you on my Instagram.
Now onto my tips!
1. Remember that you are still a student and you are not expected to know the answer to everything! That is the whole point of APPE rotations, to learn, improve, and grow. It is normal to feel anxious / nervous / scared, but your preceptors are not expecting you to be performing at the level of a resident or clinical pharmacist from Day One. You should get used to saying “I don’t know but let me look that up and I will get back to you with the answer.”
Rotations often start with letting you shadow for the first few days until you feel comfortable trying something new for the first time.
I am a big supporter of the “See, Do, Teach” learning method. Meaning, first you see (shadow, observe) an action like counseling, patient assessment, attending rounds. Then you do it yourself, with supervision and assistance when needed. You continue to practice it until you feel comfortable enough to teach others, such as P1-P3s on their IPPE rotations.
2. Always be professional. You want to put your best foot forward on every rotation. Some great advice I received from a pharmacy resident is “every rotation is like a 6-week interview“. Your preceptor may write you a letter of recommendation, may know someone in your career field of interest, could connect you with a future job after graduation, etc.
Ways to ensure you are professional:
- always show up on time
- show enthusiasm for learning and taking on projects or other tasks
- be respectful to everyone including your preceptor, other pharmacists, pharmacy staff, other healthcare professionals, patients, family members, other students, and anyone else you encounter
- bring any needed materials like printed assignments, your laptop, notebook, etc
- dress appropriately according to the setting (business professional or scrubs, closed-toed shoes)
- always offer to be helpful to others like going to find a provider to ask a question for the team, calling an insurance company for a coverage clarification, etc
- be aware of your non-verbal body language (facial expressions, acting uninterested/bored, etc)
- generally, just try to have a positive attitude
3. Be ready to learn something from every rotation. You are likely required to rotate through community and hospital, as well as some others like ambulatory care and health system administration. Many people have some idea what they are interested in by the time APPE year starts (it’s totally ok if you don’t too). BUT – each rotation can teach you something valuable for your future career.
- For example, I am interested in practicing in ambulatory care. So when I started my six-week hospital rotation, I was just trying to get through it. Once I started, I realized how much I enjoyed the challenge of complex disease states, acute issues, working as a team with others, and seeing the day-to-day improvement of my patients. I realized I wanted to further my clinical skills in this area, and ultimately decided to pursue PGY-1 programs with a good balance of acute care and ambulatory care rotations
- I have gained valuable skills from all my rotations, without a doubt. My administration rotation helped me to develop project management tools and furthered my presentation skills. My community rotation increased my clinical knowledge of drug interactions, proper administration, and common dosing for so many medications. You get the idea. I even used what I learned in my first few rotations and applied it to different situations in my later rotations.
4. Make specific goals for each rotation tailored to your personal career goals and ask for those opportunities. Since I want to be an ambulatory care pharmacist, I thought about what I could gain from each rotation that would be valuable for my future career, and then wrote specific goals and action plans to accomplish them before the rotation is over. I also would highly recommend you talk to your preceptor about these goals and your career plans. I mentioned to my preceptors that I was applying for residency and interested in ambulatory care so they adapted the rotation to give me further opportunities.
Example of one of my SMART goals for my administration rotation:
During my hospital rotation, I was able to focus a lot on transitions of care when discussing patient interventions and during my ambulatory care rotation I was invited to attend clinical staff meetings to understand the administrative side of working in primary care. Other opportunities could include networking with pharmacists working in your area of interest, shadowing other healthcare professionals, additional projects. If you haven’t had the chance to have a particular experience that you want to have, ask your preceptor if it is possible to incorporate during that rotation. There are soooo many opportunities available beyond the basic requirements of rotation, you just have to ask!
5. Take charge of your own learning. There will be so many things you don’t know on rotation. It is so important to stay curious and try to learn as much as you can. But instead of asking your preceptor right away, “what is acute interstitial nephritis?“, take the time to look it up on UpToDate or Lexicomp. Then when you ask your preceptor, you can share what you think it is and apply it to your patient situation, and your preceptor can expand the discussion further from there.
I also highly recommend you write down the answer to whatever you looked up briefly in a notebook or word document. Eventually, that same thing will come up again, and writing it down also helps you remember it better. Taking the initiative to look things up shows your preceptor you are engaged in your own learning and prepares you for the day when you don’t have a preceptor to answer all your questions!
6. Ask for positive AND constructive feedback. This really depends on the preceptor and their precepting style. This is a conversation you should be having during that first week together. I like to ask the preceptor what their feedback style is, and then go from there. I personally like feedback at least once a week (like Feedback Fridays), and prefer feedback in the “moment” as much as possible.
In my experience, preceptors are very happy to give positive feedback but do not share constructive feedback as often. I like to improve upon my skills while I am still on that rotation, rather than find out during the final evaluation. If you ask for feedback from the start, preceptors are way more likely to communicate regularly with you about both what you are doing well and what you can improve upon. You may not always agree with the feedback given to you, but that is part of the process of growing and learning from each rotation and the styles and preferences of different pharmacists.
7. Be adaptable with your organization. I got through pharmacy school by using a DayDesign planner for keeping track of my daily and weekly tasks and assignment or exam dates. This changed a lot for me when I went into APPEs. I didn’t always have my backpack and planner next to me when I was on my rotation.
If your APPE rotations are similar to mine, you don’t have exams and assignments every week. Instead, I had most of my assignments due at the end of every rotation, with a few presentation dates during the rotation. This meant way less day to day assignments I had to keep track of. I ended up relying on my physical planner less and simply used my Moleskin notebook for daily tasks, which I carried with me always.
I used my Outlook calendar to keep track of due dates for presentations and assignments. I also enjoyed using my Notes app on my iPhone and Macbook to write a list of assignments and write “DONE” once I had finished them. I got back into using my Passion Planner once residency application started to stay organized but even then I didn’t use it consistently. Bottom line: be open and flexible to changing what ways you use to stay organized during your rotations.
8. Document interventions. Whether you are pursuing a residency, fellowship, or post-grad employment, you are likely going to interview multiple times for a position in the winter or spring. Common interview questions involve behavioral topics like “Tell me about a time when you ____”. APPE year will fly by, and if you don’t keep track you will easily forget about the specific interventions and experiences you have on rotations. My best advice is to keep a notebook (I carried around a moleskin notebook) and/or write in a Word document or in your notes app on your phone about your interventions and the outcome. Trust me, you will thank yourself later on when you are preparing for interviews and have so many stories to choose from.
Some topics I recommend you document:
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- Stressful day/situation or patient
- Best/proudest intervention
- Intervention not accepted
- Best interdisciplinary interaction
- Positive and constructive feedback (and how you implemented it)
- Topic/situation without adequate background knowledge
- Time management story
- Project(s) – impact, challenges, innovation, collaboration
- Communication challenges
- Making an error
- “Broke the rules” or “went above and beyond”
- (for more ideas, skim these common residency interview questions HERE and HERE)
9. Use your resources. You likely will have assignments, presentations, journal clubs, and projects you will complete. Remember to use your resources around you! I completed a monograph for P&T committee on a drug that had very limited literature and was struggling to access the evidence I did find. I reached out to our university librarian who was able to locate the articles for me. I also had my preceptors help review my presentations and literature review assignments that were part of my school assignments.
Resources to utilize:
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- your preceptor and other pharmacists
- your APPE course coordinators/professors
- office hours for assignments
- university librarian
- university writing center
- other pharmacy students (example: practice presenting to each other)
10. Build your network. You have 4-6 weeks (depending on your rotation length at your school) to get to know your preceptor(s). Use the opportunity to really get to know them, their career journey, and be open to any guidance or advice they can give you (and don’t be afraid to ask for advice either). You may be surprised how well you connect with some preceptors or other pharmacists you work with. I really enjoyed getting to build that relationship with my preceptors, to the point where we began to feel like colleagues. We talked about our dogs, our families, things happening in the world at the time. I also had preceptors write me letters of recommendation for residency as well as offer to write me letters of reference if I ever needed one in the future for a job. Pharmacy is a small world and those connections could open new opportunities for you in the future. And of course, don’t forget to thank them at the end of the rotation with a written thank you card!
11. Prevent burnout. I get asked a lot if you have more free time as an APPE student compared to a P1-P3. Yes and no. Yes because you don’t have exams to study for. Rotations tended to be busier for me towards the end when most assignments and projects were due. I was able to spend the earlier portion of most rotations relaxing and enjoying my evening. This was such a nice change from constant school work 7 days a week. Once residency application season started around October, I lost most of my free time towards researching programs, preparing my application, and then preparing for interviews.
So when you start the APPE year, try to create self-care habits to ensure you take care of yourself along the way. This is a lot easier said than done. One thing I struggled with was my “schedule” changing every 6 weeks.
One rotation I started at 7:00 am at the hospital, so going to the gym beforehand was out of the question for me. Then the next rotation I started at 9:00 am, which made morning gym sessions a lot easier, but I was also out of my routine I had built before. It is important to stay flexible and learn what types of activities are important to your mental wellbeing. “
Some self-care tips:
- take time away from rotation and any school responsibilities, at least one full day a rotation, and more if you can. I always took at least 1 day during the weekend after a rotation ends and before a new one starts to not be productive and do things I enjoy without any guilt
- enjoy your hobbies! you don’t have to give them up just because you are on rotations now
- exercise – going to the gym, yoga, walks, running, whatever it is you like to do. stay active at least a few times a week if you can
- eat well – avoid buying hospital food for lunch every day or boxed dinners at night. I personally don’t like meal prepping but I am a big fan of making larger portions of dinners and eating the leftovers for a few nights in a row, especially when I know I will be busy.
- mental health – journal, practice gratitude, affirmations, therapy, talk with friends. be sure to care for your mental well being and if you are struggling seek out a professional or at least a trusted friend to talk to
12. ENJOY! Each rotation flies by so fast, before you know it you will be giving APPE advice to someone too. Take the time to enjoy the experience along the way rather than always thinking about the next step.
