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Welcome to the RPM podcast. My name is Josh. I'm a current PY 2 PharmD student here in the class of 2027. I'll be your host for this podcast. Today, our topic is authentic practicum experiences in regions outside of the Lower Mainland.
Josh:So we're just hoping today that we'll present a lot of information for you and maybe even open your eyes to experiences outside of Lower Mainland for practicum. And today, we're joined by our wonderful guest, doctor Solomon Chow, who I'll let introduce himself.
Solomon:Hello, everyone. My name is Solomon Chow. I'm a lecturer here at UBC. I primarily teach in third year IA as well as I'm a module co lead for the reproductive health module. A little bit about myself, I graduated from the UBC E2P program back in 2020.
Solomon:And subsequently, I completed a PGY one hospital pharmacy residency with LMPS in 2021. And my career was started at Richmond Hospital and I moved over to Vancouver General Hospital shortly after. And I worked in numerous areas such as internal medicine, clinical teaching units, family medicine units, acute spine emergency medicine, burns trauma high acuity units, as well as the intensive care units ICU. Currently, I am a full time employee here at UBC, but I'm still employed at Vancouver General Hospital as a casual clinical pharmacist primarily in the area of emergency medicine.
Josh:Thank you, Solomon. So yeah, so the our aims of our topic today is to discuss what practicum is like outside in rural areas, because it can be daunting for students like myself to move away from Vancouver or other big cities in Lower Mainland, to these smaller places that often we've never heard of if we, never set foot outside of Lower Mainland. Yeah. It's difficult when we don't know what it's like out there. And I've heard I've been told that it can be really rewarding.
Josh:And I'm hoping that Solomon can talk a bit about that today. We're here to discuss some unique learning experiences that you can take away from rural practicum and offer some insights into what it's like out there. And we hope that you'll be able to reflect on this conversation and find valuable takeaways as you plan and consider your options for experiential learning in the PharmD programme and beyond. So to get us started, can you share just a general overview, maybe your first practicum experience in the pharmacy program? Like, where did you go for that?
Solomon:Yeah. So I guess before before we get into the different areas that I experienced, during my rotations, I think, for a little bit of context, I originally grew up in Toronto, a big city, and then I moved over here to Vancouver for school, Loved it here and ended up staying here where my family is still back home in Toronto. And back then when I was in the pharmacy program, what, what the program required was out of all your rotations that you have from year one to year four, one of those rotations must be outside of the Lower Mainland. And so for myself, growing up in the city, not really knowing what was out there and, you know, outside of really Vancouver, I decided first rotation, I will get this over with, do it outside of the Lower Mainland. It's usually in year one.
Solomon:It's the shortest rotation, so let's get this over with. And so I did a little bit of research in terms of where I really wanted to spend some of my time. And at the time too, I was I've been to the Vancouver Island before. I've been to Nainaimo. I've been to Victoria, and I really didn't know what was out there especially at the Northern part of Vancouver Island.
Solomon:That being said, I did some research. I looked at some areas such as the Comox Valley where it's a little bit bigger and, you know, still not city like, but the population is a little bit larger than some of the other communities that were listed. And then the other one that also caught my eye was Campbell River. Again, a little bit of a bigger community, but the surrounding areas did also have, you know, small communities that was basically supported, by Campbell River. And so for my first year practicum, I ended up going to, a Golf Island just off of Campbell River.
Solomon:It was called Cove Pharmacy, for it was a community pharmacy. And this was located in Kwathiaski Cove on on Quadra Island. And initially, when I when I got the news from eValue, as, you probably accepted, I had no idea, what this place was. I had no idea where where this place was. I didn't even know I selected this this place to begin with but because I think it was close enough to Campbell River which is what what one of the areas that I selected, this is why I got matched to that particular area.
Solomon:So that following summer, not knowing what to expect, I packed my things, I and I made my way to that community. It required two ferries, so I had to take a ferry to Nanaimo, drive, I believe, three, four hours to Campbell River, and then take another ferry across to Quathiaski Cove. And when I went there, it was a rather small community, something that I was definitely not used to. Regardless, I showed up first day on practicum, and I was welcomed with open arms, by the pharmacy staff. I recognize that, you know, because it was a smaller community, a lot of the patients too recognized rather quickly that I was new to the pharmacy.
Solomon:They asked me if I was a new staff, but, you know, I had to mention that I was there only for the four weeks, for that duration. As I learned a little bit more about the pharmacy, I really recognized the different and interesting pharmacy services that they provided. Most notably, they were a telepharmacy, that serviced care to all the surrounding Gulf Islands, so islands that were actually even smaller than Quadra Island. And once a week as well, this pharmacy would also serve some, underserved communities as well, most notably, Gold River and Tassus. These were communities that only had about a 500 or less people in these communities, and really there was only one pharmacy, that that were able to do so.
Solomon:Circling back to some of the Gulf Islands as well, we would do routine medication deliveries because for those smaller islands, there were no dispensing pharmacies, so patients had really no means of getting their medications. And so once a week, we would send pharmacy staff to essentially bring medications to those remote communities, via ferry. So this was really eye opening for me, because, here in the Lower Mainland, I worked at a community pharmacy, and it was a completely different experience. One, I had really no expectations going in into this pharmacy, but two, seeing the the really diverse practice that they have out there, relative to something that I was more comfortable and used to here in the Lower Mainland, that was a very eye opening experience for me. And that's sort of what jump started it all for my subsequent rotations where I decided no more Lower Mainland for the time being, and to really explore the different practices around British Columbia.
Josh:I did a little bit research beforehand and I saw here that that community only has about 2,700 year round residents. So, yeah, what about your second year? How did that go?
Solomon:Yeah. So following that first experience, you know, it was it was a rather good experience and I really enjoyed living on the island, because the benefit too of kind of being in in a new place is there's a lot of exploring that's involved especially on the weekends, especially in the summer where the sun really sets at 09:10PM. So the days are a little bit longer. So once I would finish whatever work I had to do, you know, it was really, really nice to just enjoy what that particular area or place had to offer. So for my second year community rotation, I decided to go to the island again.
Solomon:And so this time I picked another sort of island off of the main island called Powell River. And what was interesting about this rotation was that it really served a lot of the local nursing homes, indigenous communities. And in addition to that, not only dispensing medications to those, particular areas and services, but we would also do site visits quite similarly to my first rotation to these indigenous communities to provide some education. We would do some medication reviews on, you know, Western medicines. And really for me, this was something that was completely new for me, and I was really trying to take in all the culture that was associated with these particular indigenous communities.
Solomon:That being said, because this was all new to me, I really had a very limited knowledge in terms of how to use the correct language, learning a little bit more about, you know, the history of these communities and how, you know, essentially British Columbia came to be. And because I felt a little insufficient in terms of having the appropriate background knowledge, actually, when I went into third year when it was time to pick electives, I ended up actually taking the indigenous health elective to really help me solidify my understanding as well as to how to appropriately provide safe and competent care for these individuals in these communities.
Josh:Were there any specific areas or, like, places to go in these small communities that you really like on the, on Powell River and the Quadra Island?
Solomon:Yeah. I mean, there there's a very long list of, you know, of things to do, especially if the if the area is brand new for you. And so for the for these areas, I would I would say there's nothing really specific I could recommend, but for me, a little bit of background too. I'm a very big hiker. I really enjoy backpacking and camping as well.
Solomon:And so being in these areas, I kind of fit right in and with what nature had to offer in these areas. And so on the weekends, typically, I would explore the area a little bit, perhaps go on some hikes, whether it's alone or at sometimes I actually had the opportunity to go on hikes with some of my preceptors. I still remember my Powell River rotation. We spent one weekend during spot prawn season catching spot prawns, because one of the pharmacy, technicians, her husband is a big fisher. And so we essentially hopped on a boat on the weekend and we did a little bit of fishing, did a little bit of crabbing, but most notably caught a bunch of shrimp, which of course would save me a little bit of cost too when it came to groceries for that following week.
Solomon:So it was a really nice experience. I really enjoyed the tight knit community, the community feel between the different individuals, not only at the pharmacy, but also the patients as well. And so that really kind of tied it all together for me, not only the work aspect of it, but, you know, the after work aspect as well as the weekend, if he so well.
Josh:Yeah, I think that goes that speaks to the unique parts that you can experience when you go to these sort of places. Can't do any prawn fishing in Downtown Vancouver. Yeah, definitely not. So So a bit of a, like, community. Like, these were both small places.
Josh:And you mentioned about sort of being like an outsider being from Ontario, being from an inferior province to British Columbia. But how was it sort of like meshing? You mentioned like going out with the pharmacy staff, like was there like specific challenges and meshing with these communities in the short period of time?
Solomon:Yeah, I think the challenge with always, with anything relocating to a new area is, you know, how to familiarize yourself one with the area itself. Right? So the willingness to get outside of your comfort zone and to see what that place has to offer. Right? It's really it's it's really common for for us and and me me too, especially, when we're just comfortable in our own space.
Solomon:I'm quite introverted in nature and so really getting outside of that comfort zone, being able to explore to see what the what the area has to offer, was a really good experience for me. Certainly, you know, if you asked me five years ago before going on that practicum, I would do something like this, the answer would have been no. But really when I, you know, got into the thick of it and really explored these areas to what I would say would be its fullest potential given the limited time, like, think that is what really made my experience there and the rotation.
Josh:Just continuing on talking a bit about your, third and fourth year rotations. Where did you go for those ones?
Solomon:Yeah. So for third and fourth year rotations, because I did spend essentially half my time, you know, however, the first two rotations on the island, I decided to really try to explore a different area, of British Columbia. I've been to the interior before with my family, know, Kelowna, Kamloops, the bigger sort of communities. So I had a general idea of, you know, in Interior BC.
Solomon:However, I've never actually been up north before. So so I try I did baby steps. So I first did Prince George in third year. Actually, I did in fourth year as well. So for Prince George, I did a Save On Foods up in in Prince George.
Solomon:And then fourth year, I was at the hospital, University of Northern, BC, where I was part of the clinical teaching unit, as part of my inpatient four seventy two rotation.
Josh:Nice. So, with those experiences up in North BC, like, did you notice any remarkable differences between different regions of British Columbia? Like, do you expect to have a different sort of experience?
Solomon:Yeah. So certainly, I think wherever you are and I think even if you're just going between areas or neighborhoods here in Vancouver as well, you will notice that there will be a significant difference in the patient population and the demographic as well. And so the big market difference for me, when I was, up north was a a topic that, you know, I wasn't entirely familiar with at the time, but there was a lot of, addiction medicine that I needed to recall upon, when I was up north. The pharmacy the community pharmacy that I was at was really heavily focused on opioid agonist therapies. So, really, I had to, you know, basically brush up on a lot of the knowledge, that was, you know, covered in class that would serve me well and to help me get through that particular rotation.
Solomon:Another thing another unfortunate thing that was also eye opening for me is, learning about the different over the counter medications that can potentially be abused. And so it was a really good discussion with my preceptor because he was really outlining regular household products or things that you would not typically think about that could be abused and the abuse potential and what are some of the implications of that. So not only did I, you know, gather a lot of knowledge in regards to, you know, pharmaceuticals, but it really extended beyond that from just typical products you would see at, for example, a grocery store, pharmacies that have, you know, an extended selection of products that are not pharmaceutical products and what are, you know, potential things to really look out for to ensure that to ensure the safety of all your patients.
Josh:So looking back, would you would you choose these practicum locations again? Would you do it differently?
Solomon:I don't think I would do it differently. I think, you know, I I think it was because every experience was quite positive for me. I don't think I would trade it for anything else. I do wish that now that, you know, I'm a I'm a few years into my career that I wish I had more time to spend in these areas. But where life is taking me currently, I'm situated here in the Lower Mainland, but I've always had that curiosity in terms of what would life kind of be like out there?
Solomon:You know, if had I now that my career is starting up, what would my practice then look like in those communities? So there's always that curiosity that's at the back of my mind. And I think that, yeah, I don't think I would change anything in regards to where I went because if I didn't have these experiences, it would make my practice, especially at a larger referral center like Vancouver General Hospital, a little bit more challenging. So for example, we routinely actually get patients from the North, from the island for a service that we can only provide here at VGH. And so by knowing what life is like out there, what sort of health supports these patients may have in these communities, it really helped me with some of the planning of the of, you know, how to properly discharge these patients, as well as to set up the adequate supports that they need in that particular area.
Solomon:So for example, not starting a particular drug because perhaps the closest life labs or lab for blood work is four hours away. Things like that will, you know, is something that I do actually keep into consideration whenever we're changing medications and optimizing therapy for patients.
Josh:Were there any other, like, important lessons that you learned from your time out in these communities?
Solomon:Yeah. So important lessons, I think I learned a lot about myself. I learned a lot about trying new things, because, like I mentioned before going into my first ever rotation, because it was a requirement, I just said, you know what? Let's get this over with. But, really, I actually looking back now before going into that first experience, I never gave it a proper opportunity.
Solomon:And so had there had there was no mandatory outside of the Lower Mainland, I think things would have been a lot different in terms of my selection. And so I would say continue being curious, try new things, especially when you're a student because the best time to really try something is when you're a student where, you know, your life may not take you there when your career starts. And so as a student, you know, for especially a rotation, you only have four weeks, you can see if you like it, perhaps maybe it's something that's not for you, then at least you can say, one, I tried this. I don't think this is for me, but at least you have that sort of experience or lived experience if you so will for, you know, trying whatever that thing would be. And this really applies to anything as for you as a pharmacy student.
Solomon:Outside of just practicums, like even just volunteer experiences, you could try new things, try things that you perhaps are a little bit curious about, but never actually gave it too much thought. But it is a really good opportunity and a good time to do so.
Josh:Okay. So a few fun questions to mix it up a bit. Question number one, what is your favorite drug?
Solomon:To be honest, Josh, this was a very hard question for me to think about. But I think one of my favorite drugs one of them, I really don't have a favorite one, but one of my favorite ones is moxifloxacin. I remember and I had really fond memories with this medication because in the intro to ID module, this is what I recommended for essentially everything. The reason being is that it is there's only one dose available, so it's a four hundred milligrams po daily dosing. You don't have to renally adjust.
Solomon:There really is no adjustment for any sort of particular condition, and you can treat things like pneumonias, intra abdominal infections, and, as a off label use too, you can do skin infections. So it'll cover most of your common infections as well. Super easy to memorize the dose. There's no adjustments. You don't have to worry about really much else.
Solomon:Although, as you know, as you kind of go through the program, you then recognise that there are some potential safety considerations that we have to think about, especially with longer term use of this antibiotic.
Josh:That's awesome. It's like a mini NESA thought process rationale for that. Yeah, for sure. A mini ICE tips too. Yeah.
Josh:Yeah. And what's your favorite drug name to say?
Solomon:Favorite drug name to say? Honestly, any any of the drugs that, you know, requires you to say requires a mouthful, I think, is always a fun one to say, especially when patients then ask you, how do you know how to pronounce that? But I think one of my favorite ones to say is nicardipine. I think because it just hits basically all the different corners of your throat when pronouncing that certain medication, nicardipine would be one of my favorite drugs to say.
Josh:Nicardipine, nice. And if you were a pharmaceutical drug company, what would be your new flavor for a medication?
Solomon:New flavor for medication? So for me, I tried taking vitamin D before, because, you know, of course, here in Vancouver, we don't get too much sun. I was very not adherent to the point that the vitamin D, the Jameson one, the the unflavored one expired, to to the point. I think I only took it for perhaps two, three days straight. I forgot about it.
Solomon:It sort of oxidized. It turned a little bit yellow, and then I stopped taking it. But in order to improve the adherence for people like me, I think, you know, if you made it like a matcha flavor, any sort of tea flavor, like Hong Kong milk tea, coffee flavor, something that's, you know, a little more palatable for me, something that is a little more like candy, I think would be something that would be a nice new flavor, especially for nonadherent people like me.
Josh:Yeah. Bubble tea flavor medication that would adhere to the shoot up. Put, like, the medication in the tapioca pearls. No problems with the
Solomon:Yeah. Now I'm flipping the questions back to you, Josh. What's your favorite drug?
Josh:My favorite drug. Good question. How about my favorite drug name to say?
Solomon:Sure. Why don't we start with that?
Josh:I think one of the statins like atorvastatin is a very satisfying like statin.
Solomon:Yeah. So Fair enough.
Josh:I like that one. It's always a bit amusing to hear patients say atorvastatin.
Solomon:Oh, yeah.
Josh:Mix it up.
Solomon:Yeah. You definitely get a wide range of different pronunciations for that medication, but it's always fun to, I guess, try to say it the proper way and then they recognize, oh, yeah. I'm I'm pronouncing that incorrectly, widely incorrectly.
Solomon:Or even better, ezetimibe.
Josh:Yeah, ezetimibe. Yeah, yeah, exactly.
Josh:Different flavors, it's a waste to say that one.
Solomon:Yeah, for sure.
Josh:And a new flavor for medication. Yeah. I agree. Bubble tea. I think that would that would work for me, probably to B Rod's dismay.
Solomon:But Yeah. Exactly. Fair enough.
Josh:Just to conclude, thank you so much, doctor Solomon Chow, for your time. We covered a lot of different topics, a lot of different questions today. We talked about the differences between different regions in British Columbia, the value of your education in these smaller communities and what you can take away. Do you have anything else to add?
Solomon:No. I think just reiterating that, you know, be curious as as a pharmacy student and really utilize that, when you when you are a student to try different things. Right? Whether or not it's community pharmacy, inpatient practice, primary care practice, industry, whatever that may be or what that may look like, try new things. Because I remember as a student, before actually picking, a career in hospital practice, Coming into the program, I had intentions of just working at a community pharmacy, and that was it, not knowing what the other streams or career streams had to offer.
Solomon:And as I was volunteering a little bit more shadowing for hospital practice, I spent also a little bit of time in primary care as well. I found that the higher acuity of inpatient, the rapid changes and things, within the hospital walls was really what gravitated me towards that particular career. So really try new things because you really cannot rule out or you can't say no to a particular thing without trying it first, because things will surprise you, as as it did with the rotations outside of the Lower Mainland.
Josh:Thank you for your time, Solomon, and thanks for sharing your experiences. I hope that this podcast has provided you with a new perspective and better understanding of how diverse pharmacy and life can be outside of the Lower Mainland in these bigger cities. And, I hope you got a lot of takeaway lessons from this, and thank you for your time for listening as well.