Overview of the exchange program

8 students from CUHK, together with professors and PharmD students

This exchange program can be divided in to two parts. In the first three days we had the lectures offered by the professors, we also joined the discussion sessions with the forth year students, after they met with their patients in the morning.

In the second part of the program, 8 students from CUHK were divided into 4 groups and we had a rotation in different clinical sites, such as a hospital inpatient pharmacy, satellite pharmacies, outpatient pharmacy, and some specialized care hospitals such as Norris Cancer Center. We shadowed the PharmD students who were having their training in the clinical sites so see their daily routine work, and we joined their discussion with their preceptors in the afternoon. Also the pharmacists there showed us their duties and how they collaborate with other health care professionals. We had chances to join the ward rounds with the physicians and see how pharmacists can help in giving advice in drugs, dosage, etc.

What I learned from the program

In the rotation part I’ve been following the student having their nutrition rotation, I learned briefly how to read patients’ charts, dosing calculations, and adjusting the amount of electrolytes and other nutrition that the patient receive. Also I went to the psychiatry ward, the pharmacists there have to monitor the patients more closely, find out whether the patients have taken their medications on time, and they have to work with the social worker in the ward. I have also been to a cancer center, and I followed a ward round with the physicians, pharmacists and nursing staff.

Pharmaceutical Sciences Centre, at the Health Science Campus of USC

After the pharmacists get their license in the US, they are not good forever. They have to attend lectures/seminars to gather enough “Continuing Professional Education” points in order to renew their license. This can guarantee the pharmacists are equipped with the most update knowledge.

In hospitals, during code blue (patient in an emergency such as cardiac arrest), the pharmacists are part of the resuscitation team. They are in charge of the dosing and reconstitution of the medications. In HK this is usually not the case.

Students there took us to a baseball game

In California, the pharmacists can perform medication administration such as immunizations. They can also write prescriptions and change the details of the prescription (such as the dosage and frequency), under the authorization and the protocols agreed by the physicians. These duties are new to us because only the physicians can write the prescriptions and immunize the patients in HK.

Difference in the health care system between US and HK

To start with, they practice separation of prescribing and dispensing (SPD), the patients get their prescriptions from the physicians and they will take their prescriptions to their pharmacists, who usually have access to complete medical history of the patients, to verify the appropriateness of the prescription. Of course this can provide a check and balance of drug use in patients and increase the effectiveness of health care.

Night at Pasadena, after a delicious dinner

Furthermore, they introduce insurance in their managed care. One of the lectures in the USC makes me understand that this can ensure the patients receive the best medications available. In Hong Kong, most of the citizens rely on the government to provide the health care services with a very low price, or even free of charge. To maintain balance of the budget, the government sometimes cannot provide the best or newest treatment to the patient. If we all purchase a health insurance for us, we will be guaranteed to receive better treatment available if we get sick. At the same time, the price of the insurance will also be reduced, as the number of people purchasing the insurance has increased.

Another thing contributing to better health care in the US is that the health care professionals there have better collaboration. I have joined the ward round once in a teaching hospital affiliated to the USC. During ward round in a hospital, besides the physicians, they will include pharmacists, physiotherapist, nutritionist and nurses in the team. The physician will ask for advice from the other professionals to make up a care plan for the patients. A social worker will also present in the team in some specialized ward such as psychiatry. By doing this, the patients’ case is considered from different perspectives; this can ensure they are being treated in the most appropriative way.

The more important thing is that pharmacists graduating from HK do not have such extensive practical training and clinical knowledge than the graduates from the US. It really impresses me when I realized that they have to work for 1500 hours and go through a whole year of rotation before their graduation. They also require a PharmD degree in order to get a license. The level of sophistication of their knowledge and the clinical experience they gain through their training equip the pharmacists there to work with physicians effectively. The reasons listed above explain why the physicians in the US are more comfortable in communicating with the pharmacists and take their advice in patient care plans. So as a pharmacist in HK if we want to contribute more in health care, we have to better equip ourselves.

Griffith Observatory

As stated above, I think the public health insurance in very important in providing funds for better patient care. It is quite unrealistic to ask the government to pay for the best treatment available to the patients. Together with the SPD, these health policies should be implemented as soon as possible.

What we did after school

Hoover Dam

The students there are really nice. They drove us to different place in LA such as the Disneyland, Griffith Park Observatory, Pasadena, The Grove, etc. We also went to a baseball game, this is the first time I watching baseball and it was much more exciting than I imagined!

What we did after the end of the program

Golden Gate Bridge, San Francisco

After the program ended on Jun 11, we stayed in LA until Jun 17 and we did some sightseeing in those few days. After that we went to a few famous cities in the US: San Diego, Las Vegas, San Francisco and New York.

Conclusion

I would like to thank Prof. Vivian Lee and Prof. Joan Zuo for giving up their personal time organizing this trip for us. And I would like to express my gratitude to School of Pharmacy and New Asia College for subsidizing me to join the program.