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UTMB Health: A Day in the Life of a PGY1 Resident

December 19, 2018

Celine Zhong, Pharm.D. is currently a PGY1 Pharmacy Practice Resident at UTMB Health in Galveston, TX and graduated from Northeastern University in 2018. Her interests include pediatrics and academia.

UTMB Health: A Day in the Life of a PGY1 Resident
Neonatal Intensive Care Unit
By: Celine Zhong, Pharm.D.

 

Just a few months ago, I was a P4 pharmacy student with so many questions about life post-graduation. From all of the residency brochures, website surfing, Googling, even Reddit forms— I was hoping to encounter authentic experiences that would be relatable to my journey. So after settling into my PGY-1 residency, I wanted to offer a unique look into a day of my life. Hopefully, this helps!

If you are considering a residency, you should be aware that you may be signing up for 60 – 70 hour-weeks. However, I can tell you that it definitely does not feel like it if you enjoy what you do. As a resident, you are an officially paid learner! You will receive hands-on experience and the autonomy to develop your own practice as a clinician while still having a safety net. Your preceptor, residency director, and other staff members are there to help when you don’t know what to do. If you’re on the fence about completing a residency, I would recommend that you first identify your long-term professional goals. Residency is not for everyone, and may be a very tedious commitment especially if you are not passionate. To the pharmacy students reading this: I would advise you begin tracking your thoughts on what makes you excited about your profession. Once you have your end goal in mind, I can guarantee that your career plans will naturally start aligning around these factors!

To give you more insight about a typical day in my life, my morning starts with familiarizing myself with each patient and rounding with the team. My first rotation was at UTMB Health’s 60-bed level-IV NICU. I try to get up around 5:00AM – 5:30AM, and make my way to the hospital; below is a small sample of questions I ask myself during a patient work-up process:

  • Since we are in the NICU, nutrition is a vital component of my patient work-up. Adequate growth may be some of the best “medicine” that we can provide—especially in our kids born prematurely or that have gastrointestinal anomalies (e.g. gastroschisis, jejunal atresia, omphaloceles).
  • Enteral and parenteral nutrition:
    • Does the patient need to be started on IV fluids—TPN, D10W (we actually see more D10W than D5W in the NICU), or Admission solution?
    • Is the patient receiving mom’s breast milk? Donor breast milk? Formula—if so, what is the kcal/oz?
    • What’s the patient’s growth velocity? Is their head circumference adequately increasing with growth?
  • I also consider parts of pharmacy practice I’ve seen a lot more of in school, and put that knowledge into the context of the disease states seen in the NICU.
  • Optimizing medication regimens:
    • Are we concerned for necrotizing enterocolitis?
      • IS there feeding intolerance? Abdominal distension? Pneumatosis intestinalis on radiography?
      • What organisms should we cover with prophylactic antibiotics?
    • Maternal history – Pertinent serologies? Antenatal steroids? PROM ≥ 18 hours? IUGR?
    • Is there good evidence based medicine behind starting furosemide, hydroclorothiazide or spironolactone for bronchopulmonary dysplasia?
    • Should the patient receive epoetin alfa if their reticulocyte count is 35%?
    • Is caffeine going to help the apneic events in a 36-week corrected gestational age baby?
  • And, as always, follow-up and monitoring are essential under all circumstances to prevent complications, and ensure that therapy is working.
  • Other clinical issues:
    • Concern for an intraventricular hemorrhage?
    • Screening for metabolic bone disease of prematurity?
    • Apneic events – is it central or obstructive?
    • Scheduling a retinopathy of prematurity work-up?
    • 2-month vaccinations?

Rounds usually span from 9:00 AM – 11:30 AM. I would also like to add that throughout the entire process, we cannot dismiss practicality and administrative issues throughout the day. For example, my preceptor had initiated discussion revolving around changing the standard administration time on caffeine.  Since there is no pharmacologic reason to give caffeine at a certain time of day, the administration time was moved based on work flow preferences for both pharmacy and nursing. It is interesting how pharma cists can have such unique involvement in patient care, and all of these types of experiences add to the excitement of developing your own clinical practice.

Then, I fit a lunch in (usually around 12:30PM) and have time for other learning and teaching opportunities. In the afternoons, I transition to working on research projects, answering drug information questions, participating in and leading topic discussions, and making additional recommendations through our antimicrobial stewardship on-call program and clinical on-call program. Some days, we have pharmacy student presentations, grand rounds (basically a more specific and lengthy topic discussion), or journal clubs (my favorite!) which give us the opportunity to explore and share recent developments with colleagues. In a recent instance, I gave a topic discussion about patent ductus arteriosus, and drew out the compartmental diagram, explaining to my student why we see a wide-gap blood pressure in those patients. Despite the rigor of some lengthy days, there really is not enough time in the working day to complete the tasks you want and need.

My residency experience has been extremely rewarding at UTMB Health and I’m so grateful to have the opportunity to learn and grow under the mentorship of so many talented clinicians! If you have any questions, about my experiences at UTMB Health or residency in general, feel free to contact me at cezhong@utmb.edu.

 

UTMB Health Pharmacy Clinical Specialists Top Row, Left to Right: Scott Ferren, Pharm.D., BCIDP; Sonia Matthews, Pharm.D., BCPS; Michele Tieman, Pharm.D., BCPS, BCCCP; Eddie Lee Pharm.D., BCPS Bottom Row, Left to Right: Jordan Burdine, Pharm.D., MBA, BCPPS; Regina Ramirez, Pharm.D., BCPS; Bonnie Chen, Pharm.D.

 

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UTMB Health: A Day in the Life of a PGY1 Resident

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