“I give you three years.”

During my internship in 2001, life seemed to be just beginning: I was engaged the previous fall, and after completing our clinical rotations, my fiancee and I set off for New Brunswick in search of budding careers. In our brand new black mica Mazda Protege and brains bursting with the latest clinical evidence, it was an open road and the world would be changing because of our passion for pharmacy.

My preceptor was quite the jokester, with a quick wit and impeccable comedic timing. He enjoyed needling me on my ability to recite DINs and got a kick out of how I would make recommendations featuring obscure molecules from my lesson notes (“No, benazepril would not be the first ACEI I’d go with in this case.”) Sensing my eagerness, he did his best to remove the training wheels that guided me through 4 years of schooling. Part of that education was preparing me for the realities of retail pharmacy. He would opine on the relationships built with fellow pharmacists in other settings of work. He implored me not to be discouraged when upset customers took out their frustrations on me even when I was trying my best to help. Most importantly, he stressed that with so much ready information available everywhere, I should not be expected to know every detail or answer, but rather I needed to be an expert on how to find that answer.

His theory is that there is a three year window to transition from a purely academic approach to that of a practical, patient-focused clinician. During this time, the environment where someone works will influence the breadth of knowledge being applied. Pearls you use regularly are cemented, and those that are less frequently seen tend to get blurry. For example, a clinical pharmacist in a specialized hospital department may be much more equipped to handle questions in their field than someone with community experience. Be it paediatrics, transplantation, HIV treatments, cancer therapies, or infectious diseases, immersion in those areas will bring confidence that decisions are being made with the best and most current available evidence. Alternatively, community pharmacists may have more general knowledge of prescribing habits in their service area, new molecules or brands on the market, and comfort in assessing minor ailments for their patients. Pharmacists in advocacy and regulatory positions would presumably be more in tune with government relations and challenges facing other healthcare professions. The point is that it’s called a practice for a reason; to stay current, one needs to have access to the best information and the opportunity to apply that information consistently.

So here I find myself, just passing my third year anniversary in my current position. My last full-time exposure to dispensing was during a stint managing a long-term care pharmacy. At that time, I felt I could hold my own in the world of geriatrics. I was comfortable with eschewing guidelines that had little applicability to institutional settings, and really challenged my thinking when it came to weighing benefit vs risk in the frail elderly population. At the same time, many of those patients had pharmacare, or were admitted from hospital with restrictive formularies. This meant that many designer drugs, even new therapeutic classes, came to market well before I became aware. Other than in hypothetical case-based discussions, I have not had to face clinical questions from patients about the management of contraceptives, or most minor ailments for that matter, for extended stretches of time. If I’ve fallen behind, then it’s on me to correct any deficiencies.

The only way to improve is to recognize these gaps and work to address them. I’ve recently re-introduced myself to the wonderful website hosted by the University of Saskatchewan College of Pharmacy and Nutrition. It features a plethora of guidelines and algorithms to help support minor ailment prescribing. The next step will be to explore real patient cases to shake off some rust. As for where to start, I have always enjoyed studying renal and infectious diseases, so it’s time for me to get back to the basics and hunt some new pearls.

In order to stay current, I guess you have to go with the flow.

Disclaimer: The views and opinions expressed in this article are those of the author(s) and do not necessarily reflect the official policy or position of any agency, employer or affiliation.