CSHP Internship round 2

Today is the last day of my internship with CSHP, and as I look back it has been an amazing two months. As I’ve mentioned, working in an office is an adjustment from working in a pharmacy or attending school; there is no customer service, no homework, no standing for 8 hours, and I get extraordinarily helpful coworkers (which is not necessarily the case in a pharmacy). In an office, everyone has their own silos and projects, but just from walking around and chatting during our staff lunches and meetings, I learned about what everyone else is doing. Among our staff, we have quite distinctive personalities and people in different stages of their lives, but we work very well together for such a small group and there is no negative internal drama.

I don’t think I have publically written about my conference experience in Halifax, either. In early August, we went to Halifax for SES 2010 (Summer Educational Sessions). The first half of our trip was actually for executive and Council meetings (which we stick right before the conference for convenience). We stayed at the Delta Barrington, which is closer to the waterfront than the Lord Nelson (the hotel I stayed at last year with AFPC) and although there was no view, it was very comfortable living in a room with a king-size bed and free LAN internet. One of the best things about our trip was the food. Living in Ottawa by myself, I have been somewhat self-conscious with eating out, just because it feels awkward; but in Halifax, we ate out every night and the staff picked good restaurants! On my next trip to Halifax, I will have to try Jane’s (they were closed on the long weekend). The seafood in Halifax is very good, especially the haddock and scallops, and we also went just at the end of a very productive lobster season.

Our first meeting was an executive meeting with just the executive director, the director of finance, and the four presidential officers. The general idea was to go over the material to be discussed over the next few days, in order to ensure that we allocated enough time to each item, to brainstorm what Council might bring up, and to make sure that everyone was prepared and was on the same page. The day after, we had our strategic planning meeting with all of Council, as well as some branch presidents. The whole concept of strategic planning – developing a mission, vision, strategic directions, and objectives – was new to me, and it was exciting to see how we could pull together all the strings as we tried to map out where CSHP wanted to go and how it is going to get there. This process also gave me some thoughts about the merits of personal strategic planning – mapping out what I want to accomplish for the next year – and also in regards to my volunteerism back home, how as one of the more senior executives, I should also think outside the box, at a high-level, and not only get bogged down in the detail.

The next day was our Issues Day meeting with Council, and this occurred in a large room with a rectangular setup of tables in a conference panel format. Issues Day is a full agenda for the entire day without Robert’s Rules, and the delegates can just talk and debate the issues that face the Society. Unfortunately, the discussion needs to stay inside the room so I cannot write about the content here, but for me as a student, it was special to be treated as an equal with these leaders in hospital pharmacy, to be able to present some of my research that I did in July to inform the discussion, and to throw in my own two cents a few times. The day after was our formal Council meeting, which does abide by Robert’s Rules, and so I was not permitted to speak.

By this point in the conference, I had gotten to know some of the other delegates. It was really interesting to learn about life in other Canadian provinces, and I’ll just share a few anecdotes. I learned that in Manitoba and Saskatchewan, cars have electric plugs in them, so that you can plug in your car to make sure the antifreeze does not get too cold in the winter. They actually have poles outside with electricity for this purpose. In the “good old days,” Al from Manitoba used to drain out the oil from his car and bring it indoors to keep it warm, and then pour it back into the car in the morning. For PEI, Iain talked about the unmanned stands that advertise sacks of potatoes for $3. And for Newfoundland, Tiffany talked about how one of the things the older generation Newfoundlanders still eat is boiled hard bread (ugh). At the conference, we also had a “suite” each evening, where delegates could gather in a room with some wine and cheese and socialize. I only had a little bit of wine each night, but I am pretty sure it affected my sleep cycles, as I was abnormally tired the next few days.

It was a great way to learn about how hospital pharmacy is so different across the nation as well. People love to talk about their work when they are passionate about it (we know that from researchers at UBC). I learned about some intriguing hospital pharmacy management concerns; while I don’t consider myself interested in management (although I do enjoy collaborating and organizing people), I can see how such instability and burnout at the management level can negatively impact the quality of care that the front-line pharmacists are able to provide (eg. Due to the management responsibilities that some are obliged to take on).

When the conference got started, I was fortunate to be allowed to attend many of the educational sessions, despite the staff and executive with CSHP still going through other business meetings with stakeholders. Unfortunately, I have had trouble tracking down the slides. But there was some good review of pharmacy-related material, some interesting discussion of hot topics during our plenary sessions, and also, I was able to network with the residents that attended. Most of them are from Ontario, because CSHP’s other conference, PPC, is hosted in Toronto every year, and so the Ontarian residents can afford to attend this one as well; the others were from the Maritimes. Because the residency programs are more distinct from each other in Ontario (they have smaller residency programs in more hospital health authorities), it was interesting to learn how different the residency programs can be, and thus how important it is for me to select one that fits my learning style and what I want to derive out of my residency experience.

In contrast to my visit to Halifax the year before, I had more time to explore Halifax, although for some reason I did not feel as motivated to be such a gung-ho tourist. Plus, I was already getting the food part of tourism taken care of by the CSHP staff (I am so spoiled). Instead, I explored the waterfront, enjoyed some buskers performances on the dock, and did some lazy touristy shopping.

Remaining time in Ottawa:

So since the conference, what have I been up to? Well, there have been some things that are a continuation of what I was doing earlier. I have still been helping on membership renewals, and there have been small projects on CJHP subscription costs, developing a top 10 reasons to volunteer document, continuing to add to (via literature search) and revise the CSHP Research Guideline draft, developing a final report on plagiarism programs that might be utilized by the CJHP editorial board, finishing up a numbering system for CSHP’s official publications, attending one more final meeting to revise the CSHP bylaws, and attending several meetings (eg. the Blueprint Educational Services subgroup). I also wrote a writeup about my own experiences, which will be published in the CAPSIL and in the CSHP eBulletin, and did a self-assessment of my performance during my internship. As you can tell, since I am the only intern with CSHP, I have a hand in a lot of things that the Society does as an association, even though it is often "hands-off" from anything directly dealing with hospital pharmacy. I will admit that I am somewhat worried that I will "forget" some things about hospital pharmacy that I don't want to forget. However, I have definitely still been learning - for example, in Cathy's absence, I took a strong hand to the Research guideline and added a significant amount of additional material (which Cathy ripped up in her re-organization of the guideline anyway), and I also learned a lot about plagiarism detection software in my investigation work for the CJHP editorial board (which was not in my job description).

One thing I have not touched on that is also part of my internship is answering questions that come in through our website. All of them came from foreign students seeking employment and/or licensure in Canada as hospital pharmacists. It is a little bit disappointing that I didn't get more substantive questions. However, through my research, I learned that it is incredibly difficult for IPGs (international pharmacy graduates) to become licensed in Canada. I had had this discussion with Arif, a MBA candidate from McMaster University who is working this summer at the Public Health Agency of Canada, and how it is much easier for immigrants to become licensed in their own fields in the United States than in Canada. To me, it is disappointing how poorly we take advantage of the intellectual capital that we have in Canada. I also think that, in general, we need to more strongly emphasize the importance of English (and/or French) proficiency for our immigrants - not necessarily as part of stricter criteria, but I think they need to demonstrate a commitment to learning the language when they arrive. Judging from the quality of the emails that I received, I would be scared to be treated by them in a hospital, and I think there are too many people in Richmond, for example, that are happy not knowing English. Just a thought.

One notable new piece to my internship after the conference was my external visitations to other organizations – I visited CHEO (Children’s Hospital of Eastern Ontario), The Ottawa Hospital (General campus), CADTH (Canadian Agency of Drugs and Technologies in Health), and CPhA (Canadian Pharmacists Association). My CHEO visitation was organized by Tina, a uWaterloo co-op student who organized for me an exceptional tour of the hospital. The people I met at the hospital were competent but there was a sense that they were happy and driven to keep the atmosphere as positive as possible. Being in a pediatric hospital presents some new perspectives. They have less resources and the conditions they see are quite different from those that dominate a regular hospital, and I would imagine that working in a pediatric hospital, there are more happy and more sad moments. I am impressed by their resilience – especially the nurses I met in Rogers House, a palliative care home (not sure if I am using the right term) for pediatric patients. They even have a “sensations” room with different textures and soothing, slowly rippling lights that reflect off the walls.

The Ottawa Hospital was different. I had a thorough tour of this hospital, starting with distribution, then a chat with the residency coordinator and two pharmacists in succession, then a resident presentation, and finally a shadowing experience with a clinical pharmacist. I was joined by a uWaterloo student and two students from CPhA (somewhat discussed in my previous blog entry). The culture of this hospital within the pharmacy department was supportive, and I also felt it was more driven to improve pharmacists' knowledge and skills. The pharmacists at TOH have a good reputation in most departments of the hospital system, and 10-20 years ago, the pharmacy department in TOH were well-known as the best in Ontario (I hope I am not paraphrasing too much).

The CPhA students, one of their directors (Philip Emberley), and myself also went for a full-day visitation at CADTH. CADTH is a national organization that is funded by provincial governments and smaller health agencies and organizations, and their objective is to provide rigorous, quality assessments of clinical and cost-effectiveness of drugs and health technologies, and to promote the appropriate use of these drugs and technologies (my paraphrasing again). They are currently undergoing a major restructuring project within their organization, so that they will no longer work in silos; instead, the goal is to have a streamlined input system and to funnel things into major topics of interest, such as cardiovascular health. CADTH is well-known for its exceptional information systems framework (by that, I mean how its staff are able to develop search strategies to find every relevant piece of literature, including "grey" or unpublished literature). For me, I was particularly interested in the cost-effectiveness piece, which we do not get taught well at the pharmacy curriculum level.

In addition, I was also very interested in how CADTH has an increasing focus on seeing its recommendations implemented at the practice level via producing point-of-care tools and by supporting the development of focus groups and other educational resources. I need to remember that CADTH's primary 'customers' are the governments. I felt that the tools they produced were basically accessible, layperson-friendly versions of their recommendations, and that CADTH could improve on providing health care providers with the equivalent of counselling tips, in order to communicate these recommendations effectively to patients. I'm not sure I got my point across, so I'll try to explain it here. If I am paraphrasing correctly, most of the CADTH staff felt that a tool that says "if you are a diabetic only taking oral drugs, you don't need routine SMBG" was the means to implementing a cost-effective strategy. In my opinion, what I need as a practicing pharmacist, in addition to knowing what to recommend, is a tool that helps me convince my patients that they don't need routine SMBG (rather than just saying they don't).

Finally, my last visitation was with CPhA and it ended up becoming a full-day visitation because there was so much to learn about. I sat down with all three of the CPhA student interns and they told me about the range of activities and projects that they worked on over the summer. I also met one of the editor pharmacists, their Director of Innovation Philip Emberley, and went around and introduced myself around the office. This summer has been particularly busy for CPhA, which was partly spurred on by recent developments in Ontario. It shows that pharmacy needs to become more proactive and we also need to react to things more cohesively (and not have Shoppers Drug Mart stupidly cancel drug deliveries in London, Ontario, the riding of Deb Matthews, Ontario Minister of Health, for example).

First of all, CPhA is structured quite differently from CSHP. They have many more staff and do a lot of things in-house; and they can afford that because of the revenue their publications (Therapeutic Choices, Compendium of Pharmaceuticals and Specialties, and Patient Self-Care, to name a few) brings them. They also have low membership percentages (out of potential membership), partly because they are not affiliated with the provincial professional associations (eg. BCPhA). In contrast, if you recall, CSHP is highly dependent on its volunteers, we have low revenue and low expenditures, a very small contingent of staff, and a relatively high membership percentage (hovering around 66% of potential membership of hospital pharmacists).

CPhA is heavily involved in the Blueprint for Pharmacy, as the National Coordinating Office is housed at CPhA and they have a dedicated staff member for the Blueprint. I get the sense that CPhA is also looking ahead to two main areas: 1) to push for recognition of pharmacist skills and scope of practice, and 2) to develop CE programs in order to facilitate pharmacist training to practice to their full scope. The first point is very interesting, as in general, advocacy for pharmacists in general has not been very successful. In my opinion, we have trouble differentiating the pharmacy and the pharmacist in the public view, and that perhaps cripples us when we claim that pharmacists are also providing clinical skills. There is also a dearth of literature that supports the effectiveness of pharmacist interventions, and CPhA has been disseminating the literature that is out there in their Translator newsletter. The second point about CE programs is highlighted by their major project right now, the ADAPT initiative, which is geared towards pharmacists that were trained some years ago and want to gain their confidence and skills in the more contemporary and patient-oriented environment that is generally accepted today. After my visitation, I also had dinner with the interns and their classmates who are also in Ottawa at Sweet Basil (Thai restaurant). They are very nice and interesting people, and I only wish I had met them earlier!

As my CSHP internship wound down, I (understandably) didn't get involved in too many new projects and I didn't get much more in the way of learning about hospital pharmacy. As an organization, CSHP is going to take the next few months to work on its bylaws and its strategic plan; another big piece is the implementation of their automated management software (so you can do your renewals online!). We had lunch at Lago's the Thursday of my last week to celebrate the end of my internship (although none of us are happy that I am leaving). Looking back, I certainly wish I had taken more time to learn more in-depth about hospital pharmacy, as I took more of a birds-eye view. However, considering that my internship was abbreviated (only two months) and how busy the staff were preparing for the SES conference, I am very satisfied with my internship and I'm happy I applied and decided to take the job!