Second year MPharm at Cardiff University

Even though it has been a whirlwind of a few months for everyone, I’ve managed to finish my second year studying pharmacy at Cardiff University. Yey! Following suit of last year, I’ve done a breakdown of the modules taught which will include any practicals and placements, and how the exams went.

  • Professional Development

This is a zero credit module the same as first year. We built on the mathematical skills from last year but it was a little more challenging as you had to teach it yourself (I had three different books to help me make sense of it all) but once you understand it, it’s not too bad. I do wish however, that other calculations would be included in the maths exam such as ones relating to ADME.

The other part of this module was placements, which I have discuss in a post from a couple of months ago but to summarise, the placements went down very well for the whole year, especially the chance to shadow a pharmacist working in a GP practice.

  • Clinical And Professional Pharmacy

I’m afraid I have some bad news for you. This module contains a large chunk of what I KNOW is very important stuff for a pharmacist to know but it’s also terribly boring – health & safety, pharmacy business, NHS regulations, and consumer law. Yawn.

The clinical side is where you start getting stuck into proper community pharmacy stuff – services available and how to consult on a MUR and EHC.  The only problem is that you don’t get much of a chance to do role play scenarios which are extremely useful or OSCEs. Therefore, I’d recommend getting into small groups and meet in the library to role play some scenarios that could come up in the OSCE.

You’ll still be doing POP (dispensing) but its focused towards legally and clinically checking prescriptions.  There are held by the brilliant teacher practitioners.  You’ll be split into groups within your workshop groups and you’ll have 15 minutes to legally and clinically check a prescription before feeding back to the group on any issues you found within the prescription. It can be a lot to get through in a short amount of time, but they are only small prescriptions, saying that, I have never seen a community pharmacist take 15 minutes per prescription to check, and so I’m hoping that in third & fourth year it will become more reflective of what actually happens. At the moment we’re heavily reliant on the BNF and EMC. This type of workshop reflects the ‘practical’ exam that you’ll have in the module but due to COVID-19 we only had a mock in this style.

Unfortunately this year we have no RTS workshops and so going into our mock OSCE was a bit daunting as we had no idea what to expect. All I can say is inhaler technique.

Providing Pharmaceutical Care (PPC) workshops are new to second year and are a chance to apply knowledge learned from other modules to real life settings. They’re held as a whole year group but are still very interactive with the teacher practitioners coming around and menti will obviously be used. You’ll be given a case/scenario and taught how to manage drugs and give advice on them, and use this in a different form each workshop e.g. a respiratory patient is admitted to hospital and so you must guess what’s wrong with them. It won’t be hard, you’re not medic or nursing student, so it’ll be something like an acute exacerbation of COPD (you’ll have the patient history not just a set of symptoms).  Then as they have been admitted to hospital, you’ll learn about hospital drug charts and how to read them and then formulate a care plan, something that will come up more in third year so I’m told.

What to expect in the exam – split MCQs full of questions about health psychology, and what’s included in the Health and Safety at Work Act (1974); and the second part containing sort answer questions based on cases seen in community pharmacy such as supply of EHC.

  • Diseases and Drugs 1

I’m not going to lie, this module is my favourite but also one of the cruellest. This year we covered some of the most common diseases of the human body which included: 

  • Asthma, COPD
  • Hypertension, high cholesterol, angina, stroke, arrhythmias, chronic heart failure.
  • Peptic ulcer disease, IBS & IBD, liver disease, oedema, constipation.
  • Diabetes, hormone hypo and hypersecretion, osteoporosis, glucocorticoids.
  • Urinary incontinence, contraception, HRT, male health.
  • Dry eye, conjunctivitis, glaucoma.
  • Hypersensitivity, vaccines.

You may think that it doesn’t seem like a lot, but in the beginning of the year we were given access to an excel spreadsheet which gave a list of over 100 drugs with columns to give indication, dose, adverse effects, contraindication, monitoring requirements, and counselling requirements.  We thought that we had to learn everything.

The COVID-19 pandemic does have its moments, and for me, that moment was during the online exam that we had. Split between MCQ and short answer questions based off case studies I felt prepared – if it was to be anything similar to the first year ‘Human Body Systems’ exam.  But oh no. There was one question on side effects, and that one being the obvious dry cough with ACE inhibitors, several on drugs used for liver disease (which I knew, thankfully) and more than I would like to count on pharmacology. Not nice pharmacology ones either, horrible nit-picky ones and oh, before I forget, two on Cystic Fibrosis…that we haven’t even been taught about (insert exasperated crying noises).

  • Formulation Science

In the series of practicals we start to make our own formulations but many of us seem completely and utterly lost. Sometimes, there is a ‘template’ you can use from previous Pharmacopoeia Monographs but when there isn’t, it becomes a little stressful a few days before the practical workshops where everyone is just adding random preservatives to their mix. There have been a few nice ones such as making calamine lotion in which I was tempted to sneak my phone out cause it was insta-worthy. By using what is called geometric dilution (a very calming process, I might add) I made a light pink mixture and it was just too cute. In the practical exam you will be expected to make two worksheets and then make one product which is doable in the time given but, it needs to be perfect. You can lose a lot of marks very quickly, like 15 marks for putting the wrong expiry date.

The MCQ exam was a little challenging but it would have been a lot worse without my notes. Why do I need to know what a supercritical fluid is? Sometimes in lectures they’ll add an example and tell you ‘it’s an example you don’t need to learn these values’ but they sneakily added them into the MCQs. You definitely need to know details for the module exam – you can’t get away with learning general concepts.

  • Design And Disposition

It covers a lot of last year’s stuff but in more detail. There’s still some organic chemistry that you need to know but it’s not too bad. ‘Human Drug Metabolism, an Introduction’ by Michael D. Coleman is a book worth dragging yourself to the library to get. You’ll be studying ADME again in second year and it has some really interesting chapters such as why drinking grapefruit is such a big deal and the effects of age on drug metabolism.

Last lecture of PH2112 we covered biologics. This particular lecturer’s research area was the use of natural compounds as drugs and said that marine organisms were a good source of antibacterial and anticancer drugs as it’s a competitive place to live in and so the organisms produce toxins to reduce competition.  He was looking into local sponges and found one in particular produced an antibiotic that was more potent than vancomycin, but he had yet to extract sufficient quantities of it to prove and publish – pretty cool right!  But it also made me think of home.  Menai Bridge on Anglesey is the home of Bangor University’s School of Ocean Sciences, nestled right by the Menai straits. We are always told how extraordinary the waters of the straits are, containing incredible species and so naturally I wondered if the department had looked into pharmacological uses, but alas, no.

The exam is tough and usually, I finish around an hour early in exams, but I barely managed to finish and had no time to look over my answers.  It covered pharmacokinetics and dynamic in detail which means that I’ll need to teach myself over the summer to properly catch up.

Overall it has been a tough year even though we have had fewer lectures and more workshops in order to apply what we’ve learned a lot more e.g. making error logs when checking prescriptions, inhaler techniques. I’m both excited and terrified of what is about to happen in third year.

MPharm: Second year Placements

It may shock you to know that pharmacy students get very few placements but thankfully Cardiff University are trying their best to get us some, starting with a week in community pharmacy and two days in a GP practice for second year students.

As I have worked within community pharmacy for a few years now I knew how the pharmacy runs and what to expect. It takes years to figure out the pharmacy but there are other students that had never stepped behind the counter who had to learn the ropes in just five days…good luck. I was allocated Well Pharmacy in Llantwit Major, and I’m naming the pharmacy cause they were absolutely BRILLIANT! I had expected to be on the counter all week, bored out of my mind; but I’ve been so busy and learnt so much it has been incredible.

Volunteering to do something goes a looong way when you’re out on placement.  I hate just standing around so I asked if I could date check, which allowed me into the shop team’s good graces throughout the week.  Even just being in the shop really made the think about processes within community. I have only worked for one community pharmacy company but seeing how Well pharmacy did things it does make you wonder why everyone isn’t doing it that way.

At home, after items are dispensed, they’re placed in a plastic bag and hung by surname alphabetically, and since this is Wales when it comes to finding John Jones’ prescription it takes about an hour to go through all the ‘J’s. Off Site Dispensing (ODS) was also bought in during the summer and patients regularly complained about the 2-3 plastic bags that they were given each month, with the company saying that plastic was used for confidentiality reasons etc. With Well, it’s a little different. And it just makes perfect sense.  All items, including ODS are packaged in paper bags, closed shut with stickers.  Then the bag is scanned with a little hand scanner and allocated an an area to live until its picked up e.g. F9 (shelf F, 9throw down).  Therefore, when John Jones comes in for his prescription, the staff type his name into the scanner and it tells when exactly where it is, so they only have to shift through like 8 other bags to find his. So beautiful, brings tears to my eyes. Plus, environmentally friendly, unlike plastic bags.

On Wednesday afternoon I was allowed into the dispensary and dispensed away the afternoon.  I made a few dispensing errors but the ACT was lovely, and didn’t like condescend me about how I should know better or whatever.

We were given a booklet to complete during our placement and I had thought that I would just be left to fill it in myself but the pharmacist there has been proactive in helping me learn as much as I can, questioning me, making me look up interactions, and allowing me to sit in on consultations.

Before this placement, I was adamant that I was going to avoid a career within community. The daily repetition of checking prescriptions and all the paperwork just…(visibly shivers). I know that I want to become an Independent Prescriber and in my mind I thought that I’d have to specialise in something along the lines of asthma or hypertension but that pharmacist at Well had just qualified as an independent prescriber in contraceptives.  This is an area that I have a strong interest in and suddenly a future where I held clinics within community pharmacy seemed not so bad. I was lucky enough to stand in on a consultation of the ‘morning after pill’ supply.  The pill cannot just be handed over.  Questions must be asked to determine its suitability – how many days have passed since unprotected sex, when their last period was etc.  In this particular case a copper coil was more suitable and so they needed to attend a hospital sexual health clinic.

In some rural areas, taking time off work etc in order to wait for hours at a sexual health/contraceptive clinic which may only occur once a week just isn’t as easy option and so observing such a consultation has shown just how much community pharmacists can help with ease of access to services.

The following week I was at a GP practice and it is only recently that pharmacists have infiltrated GP practices.  They first began as cluster pharmacists – being shared between a group of surgeries but were quickly snapped up due to practices seeing a huge improvement in the management of medicines.  They have quite a varied role and it depends on the skillset of that particular pharmacist.

A new concept that was introduced to me during this placement was that having such a diverse team allowed the practice to triage patients so that they are matched to the healthcare professional which is most qualified/competent for their issue. For example, GP’s were only required to do medicine reconciliation and reviews – something that they (a) don’t have the time for with increased patient lists and pressures, and (b) didn’t know enough about.  Introducing a pharmacist for this role meant that GPs can tackle more complicated patients, leaving the independent prescriber pharmacist to sort less complicated cases, and those related specifically to their medications.

As we are an aging population more and more of us will be on medication, which leads to polypharmacy – a patient won’t just be on one blood pressure medication, they may be on three and a statin and they may need something for joint pain and for bone weakness and type 2 diabetes.  See how quickly patient end up with a shopping list of drugs? This means that its the pharmacists job to decide what is absolutely necessary for them to be on.

We shadowed a nurse while there and she was absolutely incredible.  In pharmacy we are taught things by the book, but in community pharmacy things don’t really work that way.  But this nurse did consultations by the book – she gave all the details to the patient, educated patients on signs of sepsis, and gave resources for patients to help them with their condition. Completely blew me away, AND during consultations made time to explain to us the more intricate details and prescribing issues.

Such experiences deeply enhance student education and allow us to see how knowledge gained within workshops and lectures arise within practice and how they are dealt with.