By Christopher Chiu
If you asked me a year ago what I would be doing during my time as a Pharmacy Resident, never would I have imagined being redeployed on the front-lines amidst a global pandemic. A hospital residency program is a one-year post-graduate learning experience with rotations in pharmacy practice, education, research, and administration. As a Pharmacy Resident at the University Health Network in Toronto, I was more than halfway through my training with a focus in primary care when things took an unexpected turn.
The number of patients testing positive for COVID-19 was steadily growing in Toronto. I was completing my rotation at the Family Health Team (FHT), where both staff and patients were starting to adjust to the new normal for healthcare during a pandemic. Although patients were still being seen at the FHT, a decrease in ambulatory clinic activity and changes in preceptor availability due to redeployment meant that there had to be a shifting of patient care and service needs. Because of this, I received news that my residency training would be put on hold. I was unsettled by the uncertainty of not knowing where I would be needed or when this pandemic would end.
Because of increased staffing needs, I was redeployed as a clinical pharmacist at the Toronto Rehabilitation Institute. In what seemed like a blink of an eye, I had to quickly adapt from being a learner to an independently practicing pharmacist. I was initially asked to care for patients in a temporary Alternate Level of Care (ALC) unit, which accepted patients from acute care hospitals while they awaited long-term care beds, in preparation for a potential surge of critically-ill patients with COVID-19. Thankfully, that surge never happened. I later spent most of my time working in the Musculoskeletal and Geriatric Rehabilitation Units, a fast-paced environment where patients with musculoskeletal injuries and other complex issues associated with aging were admitted.
The main difference was the level of independence that was expected from me. As a resident, I would discuss therapeutic recommendations with my preceptor and regularly receive feedback on my patient encounters. As a pharmacist, I was fully accountable for my own clinical decision making. Having additional responsibilities was nerve wracking at first, but I soon realized that I had been preparing for this all along. Going through a residency program helped me develop the confidence to communicate my assessments and recommendations to other healthcare providers, and allowed me to think on my feet in order to quickly problem-solve. With that said, I never once felt alone and had plenty of support from my pharmacist colleagues whenever I had questions.
Another difference was the accelerated learning. As a recent graduate, I am constantly looking up new information, whether that be learning about unfamiliar disease states or appraising the literature for evidence-based recommendations. Being a pharmacist in a fast-paced inpatient unit and having a higher patient caseload meant I had to be deliberate and efficient with my information gathering. Nonetheless, being a lifelong learner means that you will never have all the answers, you just need to know where to find them!
One personal challenge was the fear of becoming infected. Every time I would come into the hospital, I had a tense feeling that everything and anyone I came into contact with was potentially infectious. This was due in part to the COVID-19 outbreaks within our institution and other healthcare colleagues who unfortunately tested positive. Although I am relatively young and healthy, the last thing I wanted was to transmit the virus to my older parents who have comorbidities. This feeling gradually lessened over time and I did what I could to feel protected while at work. I was grateful to have access to personal protective equipment and to be working in a clinical area without direct contact with acutely-ill patients with COVID-19.
If I reflect on my time as a redeployed pharmacist, there are three key lessons that I will take away from this experience. First, is accepting what is out of my control. Part of being resilient is understanding that things often do not go as planned and that adapting to changing situations is important to overcome these obstacles. Second, is maintaining a positive attitude. Instead of ruminating on the negative aspects of the situation I was placed in, I began to embrace the opportunities that came my way. The final lesson I learned is making mental health a priority. Getting enough sleep, staying connected with loved ones, and finding temporary respites were so important in helping to manage my own stresses. In the end, this experience meant a lot for my personal and professional growth. Years from now, I will look back on the challenges and opportunities during my residency year, and remember how I rose to the occasion in these unprecedented times.
Christopher Chiu, PharmD is a Pharmacy Resident at University Health Network.