Reflections from a University of Maryland School of Pharmacy fourth-year student on his renal transplant rotation at a public teaching hospital abroad.
My fourth-year rotations have been incredibly fulfilling, helping to prepare me to take on the role as one of the most trusted members of the health care team upon graduation this spring. I was even fortunate enough to complete an international rotation from Nov. 6 to Dec. 8, 2017, in a renal transplant ward at The Royal Melbourne Hospital in Melbourne, Australia. The Royal Melbourne Hospital is one of Australia’s leading public teaching hospitals and is heavily engaged in clinical research.
Diving In, Headfirst
As soon as I arrived in Australia, I delved into the professional responsibilities of a renal transplant pharmacist who makes clinical recommendations for kidney transplant patients to an interprofessional team composed of nurses, physicians, dietitians, social workers, and clinical assistants. My mentors provided me with hands-on experience in medication therapy management, patient education, and interprofessional teamwork. Adhering to renal transplant medications can be a daunting endeavor for patients due to the dramatic increase in new medications and subsequent array of adverse effects. I helped educate patients about their new medications by concisely verbalizing dosing instructions at a level that matched each patient’s understanding, while also employing images from the medication chart. I also periodically asked my patients questions to better engage with them.
Outside of direct patient care, I helped manage immunosuppressant drug-drug interactions and monitored therapeutic medication levels, such as the concentration of tacrolimus (an immunosuppressant) in patients’ blood. My preceptor then adjusted each patient’s pharmacotherapy based on our analyses.
Gaining a New Perspective
Something that immediately stuck out to me during my experience was that none of the health care professionals wore white coats in the hospital. I eventually learned that white coats are not typically worn in hospitals throughout Australia, which is notably different from the United States. I appreciated this change because, from my view, normalizing white coats among a select few team members creates social barriers among professionals and patients. Although I have participated in hospital rotations where nearly all health care professionals donned white coats, patients were visibly distinguished as the only stakeholders not wearing white coats, which might hinder their propensity to build rapport with the professionals overseeing their care. I felt that the ubiquitous lack of white coats helped empower teammates and, most importantly, patients by mitigating social barriers to transparent communication.
The rotation also oriented me to the health care system of Australia. Australia provides universal access to a comprehensive range of clinical services, primarily funded through general taxation. “Medicare” is the term used when referring to the universal access to public hospitals and subsidized medical care. According to the Organization for Economic Co-operation and Development, Australian life expectancy is ranked higher than that of the United States, which suggests that Australia’s health care indicators are robust.
Considering an International Rotation?
Students applying for international rotations should plan ahead to achieve a fulfilling experience. Applicants should highlight pertinent leadership, professional, and volunteer experiences in their application. Accepted students should complete site requirements, such as blood testing, immunization records, background check, visa application, and housing plan, several weeks in advance, as instructed by the preceptor. Lastly, I recommend they consult with the UMB Center for Global Education Initiatives for International SOS travel assistance registration and financial aid resources.
An Experience to Remember
I believe that all students can benefit from participating in an international rotation, as the experience will help them develop new, informed perspectives in global health. Through my experience, I learned a lot about how pharmacists can engage with patients and other health care professionals as part of a specialized interprofessional renal transplant team. Ultimately, I am thankful that I had the opportunity to represent the UM School of Pharmacy on an international rotation.
– Mudit Verma, fourth-tear student pharmacist