What I Wish I Knew - Keeping Up to Date with Non-Psychiatric Material

Chris Paxos, PharmD, BCPP, BCPS, BCGP

Director, Pharmacotherapy

Professor, Pharmacy Practice

Northeast Ohio Medical University

Rootstown, OH

When verifying an order for vancomycin, I realized remaining current in clinical knowledge and skills beyond psychiatry was instrumental for an acute care role in inpatient psychiatry. In addition to psychiatric care, the majority of patients received internal medicine consults. While patients were admitted secondary to serious mental illness, their antibiotic therapy, baclofen pumps, anticoagulation, and antiretrovirals required just as much attention. I soon discovered that attending psychiatrists and internists would equally come to rely on the clinical services provided by the psychiatric pharmacist, PGY1 pharmacy residents, and pharmacy students. We would discuss the implications of psychotropic medication interactions on a patient’s solid-organ transplantation regimen with a psychiatrist, then transition to reviewing medication-induced causes of hyponatremia with an internist. Serving as the interface between psychiatry and other disciplines made me realize general pharmacotherapy knowledge required the same level of attention as psychiatric pharmacotherapy knowledge. The following reviews several approaches that I have taken to maintain my non-psychiatric pharmacotherapy knowledge base.

 

Residency Training

One of the keys to building good foundational knowledge is to build that foundation early. This entailed choosing diverse learning experiences during pharmacy school and residency training. When selecting advanced pharmacy practice experiences (APPEs), I elected to complete rotations in the areas of gastroenterology, cardiology, and critical care. These experiences helped to solidify my understanding in fields where I was less comfortable as a student. When choosing experiences during psychiatric residency training, an internal medicine elective was chosen in order to refine knowledge of pharmacokinetic dosing, antibiotic stewardship, and other important practice points under the guidance of internal medicine clinical specialists. Staffing requirements during residency training meant that I would gain varied experiences while working in the hospital’s pediatric and ICU satellites, oncology specialty, and fast-paced IV room. Diverse APPE and residency experiences can help lay a solid foundation upon which to build.

 

Board Certification

In the partial hospitalization program at my facility, I concluded patient medication education sessions with an open question and answer period. Medication-related questions from patients on topics as diverse as weight loss supplements, RhoGAM® for pregnancy, and multiple sclerosis were common each week. While I first achieved board certification in psychiatric pharmacy (BCPP), I slowly realized that broader certifications in geriatrics (BCGP) and pharmacotherapy (BCPS) would be helpful. They helped to increase knowledge base, familiarity with new medications and guidelines, and overall confidence. While less than 10% of board certified pharmacists hold dual certifications1, I believe additional certifications complement the BCPP credential and sharpen my ability to provide care to patients beyond their psychotropic medication regimens.

 

Several considerations come to mind with board certification. First, I wish I had started the process of dual certification closer to the completion of residency training. While I had earned my BCPP immediately post residency, I waited several years before pursuing the BCPS. This likely increased the amount of studying needed, because it had been several years since concluding my formal training in areas of general medicine. Second, when completing BCPS recertification, I select activities that focus on areas that I routinely encounter in practice, such as endocrinology and infectious diseases. Third, create a plan for tackling recertification. Recertification is spread out over 7-year cycles. When juggling multiple certifications, mapping out how to complete recertification requirements for each one can help avoid converging deadlines. Finally, use a variety of strategies to stay on schedule and to fit recertification into the workday. I have found that recertification activities often make great topic discussions with APPE or resident learners. Additionally, colleagues and I schedule time to meet and discuss recertification activities (following independent completion) to keep each other accountable and on track.

 

Professional Organizations

Professional organizations can be a great way to stay up to date with non-psychiatric medications and guidelines. While the American Association of Psychiatric Pharmacists (AAPP) is my “home” organization, I continue to engage with other organizations for additional professional growth. Local organizations (in my case, the Akron Area Society of Health-System Pharmacists) allow for keeping track of local prescribing patterns or county and state developments in law and medicine. State level organizations (e.g., Ohio Pharmacists Association, Ohio Society of Health-System Pharmacy) provide several avenues for keeping up to date, such as organization bulletins, virtual continuing education, or in person statewide conferences. Benefits of local and state organizations include more frequent opportunities for involvement, such as volunteering to hold office, serving on committees, or delivering presentations. Similarly, national organizations (e.g., American Society of Consultant Pharmacists [ASCP]) can be harnessed to meet professional needs. I have reaped the benefits of active ASCP participation as a BCGP item writer, recertification reviewer, and position statement co-author. Each opportunity allowed me to further hone my patient care skills as they relate to older adult patients.

 

Despite active involvement, several opportunities would enhance how I approach national organizations in the quest to stay current with general pharmacotherapy knowledge. Unlike state organizations, I have not taken advantage of national conferences outside of AAPP and the opportunities those conferences afford for staying up to date. In addition, several organizations have active listservs, websites, and electronic resources for clinicians. While I have integrated AAPP and ASCP into my professional life, I have not been as actively involved with the American College of Clinical Pharmacy (ACCP) or the American Society of Health-System Pharmacists (ASHP). Both organizations provide a broader focus with regard to pharmacotherapy and excellent opportunities for refining non-psychiatric pharmacotherapy knowledge and skills.

 

Resources