The first three years of pharmacy school are primarily made up of classroom time with some learning experiences and smaller rotations scattered throughout.  The fourth year of school is made up of clinical rotations where you are able to interact with patients and gain valuable clinical experience.  Rotation sites and schedules will vary depending on the school you attend, but usually the rotations are divided into a core curriculum (ambulatory, hospital experience, retail, etc...) and electives.  

By now, the fourth year rotations should be in full swing.  Over the years, I've observed a difference in successful students and the students who coast through their rotations.  It wasn't that long ago that I was a student and I'd like to share a few things that made me successful and a few things that did not.  I now serve as a preceptor at a big academic medical center where we host students monthly and there are some characteristics that separate the great students.  

1. Get there early.  This should be a no-brainer.  You want to be prepared!  Look up your patients ahead of time and know their important labs.  Don't be that student who strolls up in the middle of rounds sporting a Starbucks drink.  

2. Don't let your grades or lack of experience lower your confidence.  I saw honor roll students have a very hard time on their rotations because they couldn't apply their knowledge practically.  I've also seen average students excel on their rotations.  People learn and thrive in a variety of settings so don't let past failures or lack of knowledge hold you back.  Of course, don't be over confident and act like you know more than the pharmacists and physicians teaching you! 

When I was working as a clinical pharmacist, we had two students on our cardiology rotation one month.  I think they were both good students academically, but they portrayed themselves on the rotation differently.  
The guy was confident, always acted appeared prepared because he spoke up (even though he may not have been!), and wasn't afraid to make mistakes.
The girl was more timid and afraid to say the wrong thing.  Even if she was more prepared than the guy, she didn't answer a question is she wasn't completely sure of the answer.  I completely related to the girl and talked to her about it - she was comparing herself to the guy on rotation and she was getting more discouraged every day.  I encouraged her to speak up and not be afraid to say the wrong thing.  First of all, don't compare.  We all have different learning styles, abilities, and personalities.  Secondly, even the most knowledgeable clinician was a student once. Everyone starts somewhere so don't be afraid!  

3. Don't be argumentative.  Many students are anxious to start rotations and excited to prove to others how much they know.  Believe me, that will all come out over the course of the rotation. What will hurt you is being overly cocky and argumentative about things you know (or think you know).  Obviously, if it's a patient care, safety, or integrity issue, stand by your point.  But don't be argumentative just to prove to others how smart you are.  

4. Ask good questions.  Try not to ask anything that you can easily google or look up.  A lot of medicine and knowledge comes from experience and your preceptors and attendings will be able to answer many of the "gray" area questions in medicine if you ask.

5. Anticipate.  Proactively anticipate the questions that will be asked of you.  If you are following a patient on digoxin, know the signs and symptoms of digoxin toxicity and if there has been a recent level.  If you patient is on warfarin, know their history and what their INR is.  The best preceptor that I ever had gave me this advice - to be proactive and think ahead about the next question that will be asked (and then you will always appear prepared!).  You will impress your preceptors if you can think ahead and anticipate what needs to be done for your patients.    

6. Put in the work. Some rotations require a lot more work than others and some are easy to slide through.  You will get out early on some rotations and you will stay late on some.  Enjoy the process.  You are there to learn and the experience you gain on your rotations is invaluable.  Be prepared for journal club and know the basics that will be asked....what population was this studied in, what is the indication, what are the limitations, etc....  Go above and beyond with your presentations.  If you don't know what this means or what to do, then just add one more detail to your presentation or project.  That detail could be in the form of knowledge, a graphic, or even a border on the report.  
7. Manage your expectations. Some preceptors are very clear about the rotation expectations and some are not.  If you have one that isn't, regularly talk to them or ask if there is something that they need you to do.  Luckily, pharmacy schools now have very good evaluation forms that make it pretty clear to a student what is expected of them, but there are still some gray areas.  And, remember, you are not just on your rotations to get a good grade.  You are there to get practical, real world experience that will help you in your career.  Learning how to be a critical thinker was one of the most valuable things I learned during rotations, and that is something that is hard to measure with a grade. 

Sometimes, it was hard for me to be motivated because I felt like "free labor" in some of the pharmacies.  But, looking back at my experiences over the last ten years, some of those cakewalk rotations were the ones were I learned the most valuable day to day skills and I have taken those lessons and referred to them throughout my career even though it felt so monotonous at the time!  You may have a preceptor who does not communicate well - take initiative.  If your preceptor is clear about what is expected, do your best to meet and exceed their expectations.  

8.  Unless you are looking up a medication dose on Lexicomp, get off your phone!  You need to be present and engaged on your rotations.  Being glued to your phone or Facebook will not get that message across.  

9. Take the extra step. What separates a good student from a great student is all in the extra details.  Do more than the bare minimum if you want to stand out. Think about someone you would hire - would it be the person who just gets by or would it be the person presenting excellent work and going the extra mile? This could mean reading ahead for your rotation, adding more visually pleasing layouts on your paper or presentation, proactively thinking about what your preceptor will ask....

This concept is hard for some students when the rotation is pass/fail and they know they can get by with the bare minimum.  But, how you portray yourself is your brand.  People you meet in training may turn into future mentors, colleagues, and friends.  You will make a better impression if you produce excellent work.   

10.  Have a little fun and act excited to be there!  Of course, this is about balance - don't goof off when everyone else is being serious.  This is a learning experience and don't take yourself too seriously.  Enjoy the process. 

Lastly, if you feel like you hit it off with a preceptor or someone you worked with, don't be afraid to get their email address and stay in touch.  Pharmacy is a small world and a good recommendation can go a long way!

PracticeJoanna Simmon