Monday Conference

Pharmacy Degree
In U.S., college students choose their undergraduate major and then decide along the way, or possibly even after finishing college, if they want to pursue a graduate degree.  In Taiwan, students who want to pursue a health professional degree ie medicine, dentistry, pharmacy, need to make that decision at the end of high school.  For medicine, instead of having 4 years of undergraduate studies and 4 years of medical school, it is all lumped into a 7-year program.  Pharmacy is a Bachelor's degree, and therefore, graduates can take the licensure exam right after completion of the 4-year program.  The graduates have the option of doing a Master's program for an additional 2 years, where there is a focus on clinical rotations.  At NTU, there is also a 6-year program (starting right after high school) which is the closest equivalent to the Pharm.D. program in the U.S.  It is currently the only one in the country. 

Informal Discussion
On Monday, 8/20, we were invited to attend what was referred to as an "Informal Discussion".  It was reminiscent of our Monday Conferences at UC Davis, where the students from their Master's program meet to go over patient cases.  The conference is faciliated by two faculty members from the school of pharmacy, one of which is a Pharm.D. graduate from Purdue who did 2 years of residency at the University of Michigan.  Every week, two students present patients and the facilitators ask questions or make teaching points out of the case discussions.  This conference started out with the previous week's presenters following up on questions they had to research.  The students for this week proceeded to present their cases.  Although the majority of the presentation was in Mandarin, many of the diagnoses and treatments were discussed using English terminology.  One thing I noticed about one of the patient cases, and in many other cases where patients have infections, is that they commonly switch antibiotics if the patient spikes a fever without having a target of therapy.  Although a switch in therapy may be warranted, in some cases, I've noticed the microorganism coverage of the new antibiotic is no better than the previous treatment.  It's something I will ask my preceptor about and look into more as I go through more patients. 

Inpatient Pharmacy Overview

From the amount of time we spent searching the hospital on our first day, it is probably apparent that NTUH is a very large hospital.  There are only two inpatient pharmacies that service the 2100 bed hospital.  On average, 19,000 prescriptions are processed per day.  There are approximately 150 pharmacists working at the hospital. Their duties consists of dispensing as well as clinical services such as dose adjustments, drug therapy selection, drug information, adverse drug reaction reporting and patient education.  Legally, pharmacists are the only ones that are allowed to dispense medications.  As a result, the ratio of pharmacist:technician is vastly different from that of the U.S.  In the UDD, there are 45 pharmacists, 10 clerks, and just 3 pharmacy technicians.  With each pharmacist covering 1-2 wards, their patient load is very high and most of the patient monitoring is done from the electronic medical record computer system.  One of the pharmacists I shadowed, 簡郁芳, said she was following about 60 patients.  In contrast, the Intensive Care Units have clinical pharmacists who attend morning rounds with physicians on a daily basis.

Language Barrier

I was born in the U.S. However, the majority of my extended family resides in the country of Taiwan.   The official language of Taiwan is Mandarin. At home, the "official" language my family speaks is Mandarin as well, with some English mixed in there. Ever since I was young, my parents have spoken to me in their native tongue. They sent me to Chinese school every Sunday until the end of high school.  I consider myself a fluent Mandarin speaker. Where I am lacking, as many ABC's (American born Chinese) are, is the ability to read characters. I am fairly confident in my ability decipher menus, billboards, and television advertisements. Reading and understanding medical terminology, however, is a different story and will be the main obstacle on this rotation. I have found, in my first two days, that even figuring out the interface of the electronic medical record system is a challenge. After spending some time clicking around aimlessly, I've noticed that many of the functions are very similar to the Epic system we use at UC Davis Medical Center ie labs, MAR, diagnoses, etc. I did find comfort in the fact that most of the pharmacy resources they refer to are not only, in English, but also, are the exact same resources we use in the U.S.

Getting Oriented

For the next six weeks, I will be doing my international Advanced Pharmacy Professional Experience (APPE) at National Taiwan University Hospital (NTUH). The APPE is split up into two 3-week rotations, allowing me to gain experience in two different hospital departments. My first 3 weeks will be spent in the Unit Dose Dispensing (UDD) pharmacy that services the Family Medicine wards (家庭部常). 

A day after arriving in Taipei, Taiwan, I was scheduled to start my rotation. I had not even oriented myself to the hospital, let alone, the surrounding area. Tina and I left the dorms an hour and a half early to grab breakfast and find the room and somehow arrived only a few minutes early (the dorms are located less than 5 minutes from the nearest hospital building). The first part of the day was a pretty standard orientation:  getting our ID badges, logins for their electronic medical record, figuring out the layout of the hospital, and meeting a few faculty members of the NTU School of Pharmacy. 

After orientation, I met up with my preceptor for the Family Medicine rotation, 陳文慧.  She gave me a tour of the inpatient pharmacy and went over the goals and objectives of the rotation. Every morning, I will be attending Morning Meeting at 7:40 am along with physicians, residents, and pharmacists.  From my understanding, residents will go over either patient cases or topic discussions for educational purposes.  Once a week, there is a Geriatric Interdisciplinary Team Meeting where health professionals from different specialties go over a case for a geriatric patient. At the end of each week, I will be doing formal patient presentations to my preceptor.  By the end of the 3 weeks, I expect to be able to efficiently follow 8-10 patients on the Family Medicine service. I am looking forward to observing the differences between the various aspects of pharmacy between the U.S. and Taiwan, including the electronic medical records, health care systems, pharmacists' roles, health care team dynamics, and treatment approaches.  

Let the journey begin.