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6th Year Perspective: APPE Rotations at the Westchester Medical Center Bundle

Featuring: Justin Budz, PharmD Candidate c/o 2023
By: Isabelle Lim, PharmD Candidate c/o 2024

Justin Budz is a sixth-year pharmacy student at St. John’s University. While at St. John’s, Justin participated in multiple organizations, which ultimately led him to discover the career path he wanted to pursue. Most notably, Justin served as the Development and Outreach Coordinator of the Rho Chi Honor Society and currently serves as the Editor-in-Chief of the Rho Chi Post. Following his graduation from St. John’s, Justin will begin a two-year Post-Doctoral Fellowship in Pharmaceutical Marketing with RevHealth.

Why did you choose to go to pharmacy school?

I liked the idea of pharmacy practice because there was a good balance between providing treatments to patients and educating both patients and healthcare professionals. Also, there was the aspect of being able to read more into the background and pharmacology behind drugs, which really spoke to me since I was very interested in science growing up. Pharmacy school ended up being a very happy medium between healthcare and science.

What drove you to apply for a clinical bundle? Why did you choose the Westchester Medical Center bundle over others that were offered?

I was interested in a bundle after I spoke with older students about their experiences with bundles. On one hand, bundles may be more work at times, however, the upside is that you gain a very thorough and great learning experience. You’re at a site for a much longer period of time compared to a normal rotation, which is about one month. I was at Westchester for three to four months in total and I was able to stay with those preceptors for long periods of time. Not only did I get to know them better, but I also got a better learning experience being at one facility and seeing the different aspects of healthcare it was able to offer. I ended up choosing Westchester compared to other bundles because of location. I also heard great things about this site from previous students, so putting these two things together, Westchester seemed like a great fit for me.

What do you need to apply for a bundled rotation?

Different bundles will have different requirements, but in general, I would expect all bundles to require a CV. The Westchester bundle also required a letter of intent and two letters of recommendation. It’s a little bit more work but in the end, it’s worth it for having a more impactful learning experience at one location.

Summarize your time at Westchester Medical Center.

I had three rotations at Westchester. My first rotation was in the emergency room (ER). Here, you never knew what was going to come in through the doors each day. One unique case that I won’t forget was a skydiving accident. That was definitely something you don’t see every day. The coolest thing about the ER is that you have to think on your feet a lot. It was incredible to see how smart and professional my preceptor was in this fast-paced environment. There’s a unique set of medications in the emergency room. You have a variety of emergency, pain, and other medications that you will need for different codes. Learning about these medications was my biggest takeaway from this rotation.

My next rotation at Westchester was in oncology, which was very different compared to other clinical rotations I’ve had. Physicians were kind of the artists of all things – they weren’t always following guidelines to a T, instead, the physicians determined the right treatments from their past experiences. For instance, if a patient would come in with a particular type of cancer, based on the physician’s past experiences with treating that cancer, they’ll recommend a certain regimen based on what they have seen work. Of course, they would still be basing the therapy off some kind of guideline, but they would fine tune it to their liking. It was interesting to see because as different physicians would switch off, sometimes they wouldn’t agree with each other and would go back and forth about what regimens to proceed with. As a pharmacist, a lot of our focus, asides from the chemotherapy regimens, would be on checking other medications that the patient is on – making sure there are no drug interactions, paying attention to supportive care, etc. One of the coolest things I got to do on my oncology rotation was assisting in a bone marrow biopsy. I’m just proud of myself for not getting too dizzy during the procedure.

My last rotation was an administrative rotation, which can really differ depending on which hospital you’re at. At Westchester, I was paired with the pharmacy director who entrusted me with a lot of big projects. For one project, they were moving the pediatric satellite which was relatively outdated. The satellite didn’t use a lot of electronic means of storing medication information, so a lot of their medications were stored in bins rather than in an automated medication dispensing system. I was in charge of essentially taking note of all inventory to see what they had in the satellite and compare it to the most common fast movers on the pediatric floor. My project helped aid in moving everything down from the satellite to the main pharmacy and storing all records electronically. I had a large impact in this project to which my preceptor would even joke that upon creation of the new pediatric satellite, they would name it after me.

Of the three rotations you recounted, which was your favorite and why?

My favorite rotation was definitely the administrative APPE. I think it comes down to each student’s individual personality. I really liked the aspect of managing projects. A lot of those projects assigned to me didn’t have many set requirements. My preceptor would just tell me the objective and would ask what I wanted to do or thought we should to do to get that project accomplished. I really liked that aspect of collaboration as it helped me develop my project management skills.

What was the most valuable thing you learned through this bundle?

I think the most valuable thing that I learned is that the effort you put into the bundle, or any rotation in general, is what you get out of it. A lot of my preceptors challenged me with presentations, unique opportunities, and even research. These opportunities weren’t required, but taking them on helped supplement my experience at Westchester. After all, we are essentially paying for these experiences, so you might as well get the most out of each rotation. By taking on additional responsibilities, I got to learn more in depth about different disease states and medications while building communication and research skills.

What would you say was your biggest achievement?

I was very involved, so I got to know everyone very well, especially the pharmacy director and the clinical pharmacy team. With that being said, I am proud of myself for all the extra initiatives I took for the Westchester team. Also, this bundle was around the same time I was doing a lot of fellowship applications and interviews, so I am proud of myself for being able to balance all my APPE responsibilities with my personal and work life.

What would you do differently if you could do it again?

I wish I could have taken more time to learn more about some of the medications that I saw in the ER and oncology settings. I wasn’t too familiar with some of these medications, especially since they were medications that you don’t typically see in community settings or learn about in school. I wish I had more time to deep dive into these medications just so I could be more comfortable with them overall.

How did your experience at this bundle compare to other clinical rotations you’ve had?

For some of the other clinical rotations I’ve had, for example, my general inpatient and pediatric ICU rotations, the biggest downside is that you’re there for a short duration. I had a lot of great experiences at those sites just from my patient interactions and assigned projects, but as soon as you got comfortable it was time to switch experiences. What I really liked about the bundle is that you got to know your team very well. Because it was a large site with many rotation opportunities, I also got to meet a lot of students from different schools. The longer duration is unique not only for the learning experience but also for networking and getting jobs down the line.

What advice would you give underclassmen that may be unsure of whether they want to pursue a bundle for APPEs?

I think an uncertainty that I had before applying for bundles was the idea that you may be there for three or four months. Some students may worry that they won’t end up liking the site or their preceptors, which are potential risks, but one way to clear things up is by talking to upperclassmen who have had experiences you’re curious in learning more about. I think it is definitely worth trying to apply for a bundle since you will have multiple experiences all in one hospital. This way, you get to see how that hospital functions in different areas. I think bundled rotations are a bigger bang for your buck, especially if you put in the effort and seek additional opportunities to learn.

What tips would you give students to get the most out of a bundle experience?

Definitely be open to any unique opportunities. For example, I got to sit in many different codes that happened in the ER. Another example is from my oncology experience where I got to be part of a bone marrow biopsy, which is definitely outside the scope of your traditional pharmacist role. By being open to different experiences, you really don’t know what you’re going to learn and it’s great because you get to see how different healthcare professionals function both individually and inter-professionally. So my biggest tip, regardless of whether it’s a regular rotation or a bundled rotation, is to always be open to different opportunities that come your way.

Published by Rho Chi Post
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