We spent the last two weeks at different hospitals reinforcing our knowledge of pharmacokinetics and critical appraisal. Even though I took pharmacokinetics course with Dr. Ensom at UBC in Spring 2011, there were parts of which I had no recollection of. I guess, if you don’t use it, you lose it! During my SPEP rotation, I employed by pharmacokinetics skills for only couple of patients on phenytoin and vancomycin. However, the refresher crash course on pharmacokinetics was essential and useful. I have been told that I would get to apply this knowledge starting during my clinical orientation rotation with Dr. Dillon and of course during my time on the ward afterwards.
During the second week, we focused on critical appraisal. I am glad we started from the basics and built our way up. Having spent 4 weeks with Dr. Tejani on my Pharmacotherapy Evaluation and Optimization rotation, he had exposed me to some areas of critical appraisal already. I believe every pharmacy student should have exposure to concepts of critical appraisal and evidence based medicine during first year of pharmacy school. I remember receiving few of lectures on the topic every year, but we never really got a chance to employ the skills in real setting. But I believe that this would not be the case during my residency and future tenure as a hospital pharmacist.
Initially, I had a perception that the way Dr. McCormack and Dr. Tejani appraise articles, we always end up concluding that the intervention does not work. However, after a discussion with Dr. Tejani my opinion has changed. The goal of critical appraisal is not to render every trial or an intervention as useless, rather providing us with a tool to determine the appropriateness of the trial and inclusion of all the required information. The key is not to believe everything that is presented, but use our critical skills to find the truth and establish if the results are applicable to my patient. Even a bad trial has some valuable information to offer. Earlier, I was under the illusion that industry funded trials are more biased and cannot be trusted. However, it was a surprise to find out that industry funded trials are actually more organized and well thought-out versus independent trials which are not funded properly.
We discussed the issues surrounding conflict of interest and pharmaceutical industry. Aaron and I had discussed this topic during my PEO rotation as well, and it was interesting to know that the size of the gift doesn’t matter even though when receiving the gift we might not think so. There is a reason why companies invest in marketing and gaining the favor and trust of healthcare workers.
As more and more trials being conducted are randomized controlled trials and focus is shifting towards evidence based medicine practice, analyzing the impact of an intervention is becoming more accessible.
After one week of didactics on critical appraisal, I am familiar with an approach to evaluate systematic reviews, meta-analysis and clinical trials. This knowledge would be solidified more during my 2 weeks of evidence based medicine rotation. We also gained appreciation for different ways to keep up to date with ever evolving world of pharmacy literature and engage in life-long learning. One of my goals is to become more timely in reading and assessing primary literature, therefore, I have signed up for Feed Reader and I am finding pharmacy sites that syndicate content and adding their RSS feed to my list. It is a great medium for information dissemination and exchange.
The assignment at the end of the week summed up most of the lectures as we incorporated different skills and knowledge in answering our clinical question. The skills used include: formulating our clinical question, conducting search, analyze the information presented, interpret statistical parameters and applying the information to answer the clinical question. I am looking forward to incorporate the skills and principles learnt in decision making process.