Memorable Hospital Attachment at Mackay Memorial Hospital, Taiwan for IMU Pharmacy Students

Two IMU Pharmacy students, Woon Sze Shee and Grace Sen Jing Jing, was given the opportunity to do their electives at Mackay Memorial Hospital, Taipei in Semester 6 of their pharmacy programme. Sze Shee relates their experiences here.

“My friend, Grace Sen Jing Jing and I sent an email request to Mackay Memorial Hospital for the opportunity to do our electives at the hospital. After a few months, we were very happy to receive the approval to carry out our electives at the hospital. On 13 May 2019, my friend and I went to Mackay Memorial Hospital, Taipei for our electives. We were assigned to two pharmacists as our supervisors, Ya-Hui and Wan Chen, who are very friendly and caring. We were also given our schedule of daily activities which had a list of departments and pharmacists that we were assigned to everyday. Furthermore, we were assigned to our own room at a dormitory located at Mackay Memorial Hospital, Tamsui which is around 30 minutes away from Taipei with free shuttle bus services provided for the staff.

Week	Activities
First Week	We were assigned to the Outpatient Department, Emergency Department and also Patient Education Service. The pharmacists for the three departments introduced us to their working environment and also their role as a pharmacist in their respective departments. In addition, we were given the opportunity to ask questions whenever we have anything that we did not understand, thus, through these sessions we learnt a lot of new situations and also medications while also refreshing and applying our knowledge that we have learnt. We were also introduced to the method of preparing powder form medication mainly for children as their doses are smaller. Furthermore, the hospital has technologies like automated pouch packaging, products search engine and also automated secure lockers for dangerous drugs. For the patient education service, the pharmacist gave us pamphlets with informative details regarding different types of inhalers and also insulin pens offered at the hospital. We also get to observe how the pharmacist counsel or help patients with their enquiries. There is a slight difference from the counseling sessions in Taiwan as compared to Malaysia. In Malaysia, the counseling session is given when patients collect their medication at the outpatient pharmacy. However, in Taiwan, patients are first required to collect their medications at the outpatient pharmacy and then proceed to the patient education department for the counseling session. One day during the first week, we had a chance to observe OSCE sessions that was carried for the interns of the hospital. Their OSCE session was similar with ours but as the hospital has a department mainly for treating children, the focus was more for pediatrics.
Second Week	We were assigned to the Warfarin Clinic, Total Parental Nutrition (TPN) Department, Chemotherapy Department and also Inventory Control Department. In TPN Department, we were given a short lecture in the morning about the department and also TPN calculations. In the afternoon, we were introduced to their clean rooms and preparation room where the pharmacist showed us how a TPN is prepared. On top of that, we learnt the proper way of washing hand with a brush and the method of wearing a sterile gown before TPN preparation. This is to avoid contaminating the clean and sterilised environment which might lead to contamination of the product.For Chemotherapy Department, we were also given information and also shown the place of preparation by the pharmacist in charge. Moreover, we were given hands-on experience of replicating chemotherapy reconstitution. We learnt a lot of new tips and were shown the proper method while also applying the methods that I had learnt from the practical session that was carried out for Cancer Chemotherapy module. Another interesting activity that we were assigned to is in the warfarin clinic whereby we get to see the importance role of a pharmacist in assisting the patients. It is mainly a routine outpatient service of warfarin counselling that is provided on every Tuesday with the aim of making the patient understand the effect of the medication, adjusting warfarin dose according to the INR reading, counselling on side effects and precaution after taking warfarin and giving advice about lifestyle modification.

Week

Activities

First Week

We were assigned to the Outpatient Department, Emergency Department and also Patient Education Service. The pharmacists for the three departments introduced us to their working environment and also their role as a pharmacist in their respective departments. In addition, we were given the opportunity to ask questions whenever we have anything that we did not understand, thus, through these sessions we learnt a lot of new situations and also medications while also refreshing and applying our knowledge that we have learnt. We were also introduced to the method of preparing powder form medication mainly for children as their doses are smaller.

Furthermore, the hospital has technologies like automated pouch packaging, products search engine and also automated secure lockers for dangerous drugs. For the patient education service, the pharmacist gave us pamphlets with informative details regarding different types of inhalers and also insulin pens offered at the hospital. We also get to observe how the pharmacist counsel or help patients with their enquiries. There is a slight difference from the counseling sessions in Taiwan as compared to Malaysia. In Malaysia, the counseling session is given when patients collect their medication at the outpatient pharmacy. However, in Taiwan, patients are first required to collect their medications at the outpatient pharmacy and then proceed to the patient education department for the counseling session. One day during the first week, we had a chance to observe OSCE sessions that was carried for the interns of the hospital. Their OSCE session was similar with ours but as the hospital has a department mainly for treating children, the focus was more for pediatrics.

Second Week

We were assigned to the Warfarin Clinic, Total Parental Nutrition (TPN) Department, Chemotherapy Department and also Inventory Control Department. In TPN Department, we were given a short lecture in the morning about the department and also TPN calculations.

In the afternoon, we were introduced to their clean rooms and preparation room where the pharmacist showed us how a TPN is prepared. On top of that, we learnt the proper way of washing hand with a brush and the method of wearing a sterile gown before TPN preparation. This is to avoid contaminating the clean and sterilised environment which might lead to contamination of the product.For Chemotherapy Department, we were also given information and also shown the place of preparation by the pharmacist in charge. Moreover, we were given hands-on experience of replicating chemotherapy reconstitution. We learnt a lot of new tips and were shown the proper method while also applying the methods that I had learnt from the practical session that was carried out for Cancer Chemotherapy module.

Another interesting activity that we were assigned to is in the warfarin clinic whereby we get to see the importance role of a pharmacist in assisting the patients. It is mainly a routine outpatient service of warfarin counselling that is provided on every Tuesday with the aim of making the patient understand the effect of the medication, adjusting warfarin dose according to the INR reading, counselling on side effects and precaution after taking warfarin and giving advice about lifestyle modification.

Week	Activities
Third Week	Our supervisors assigned us to Inpatient Department and also Traditional Chinese Medicine (TCM) department. At the TCM department, we helped the pharmacists to prepare the ingredients for the decoction process which is new to both of us as we did not take up TCM for our selective module in the previous semester. We were also assigned to the Inpatient Department where we had to attend classes in the morning on topics like therapeutic drug monitoring and newborn care as per our request due to our interest in understanding more about these topics. In addition, we had the opportunity to pick and pack medicine under the senior pharmacist’s supervision. We are able to learn different type of diagnosis and medicines that are commonly prescribed.
Fourth Week	We were assigned to Medical Intensive Care Unit (MICU). The pharmacist in charge of the MICU department is required to have a ward round with the doctor every morning and clerk the case in the afternoon in order to identify pharmaceutical care issues and also to provide advice about the choice of medicines for the patients. This shows that interprofessional practice is being applied at the hospital with the aim of improving the quality of treatment given to the patients.

Week

Activities

Third Week

Our supervisors assigned us to Inpatient Department and also Traditional Chinese Medicine (TCM) department. At the TCM department, we helped the pharmacists to prepare the ingredients for the decoction process which is new to both of us as we did not take up TCM for our selective module in the previous semester. We were also assigned to the Inpatient Department where we had to attend classes in the morning on topics like therapeutic drug monitoring and newborn care as per our request due to our interest in understanding more about these topics. In addition, we had the opportunity to pick and pack medicine under the senior pharmacist’s supervision. We are able to learn different type of diagnosis and medicines that are commonly prescribed.

Fourth Week

We were assigned to Medical Intensive Care Unit (MICU). The pharmacist in charge of the MICU department is required to have a ward round with the doctor every morning and clerk the case in the afternoon in order to identify pharmaceutical care issues and also to provide advice about the choice of medicines for the patients. This shows that interprofessional practice is being applied at the hospital with the aim of improving the quality of treatment given to the patients.

From the start of the elective programme, we were given the task of presenting a case report of our choice and we had chosen to present a case report regarding a patient with colorectal cancer. This allows us to observe, apply and share our knowledge on how to present a pharmaceutical care plan in a hospital setting. Through this activity, we are able to discuss with our supervisors to have a better understanding on how the pharmacists in Mackay Memorial Hospital would present a case report and also able to identify the rationale of the treatment for the patient. “Travelling is to find yourself by going through new experiences”. This whole experience has also taught us to be even more independent as being in a different country, we needed to take care of ourselves while experiencing a new culture.

From this elective module, we also got to understand more of the culture and lifestyle of a different country through sharing sessions with the senior pharmacists. We are grateful to be able to carry out our elective programme at Mackay Memorial Hospital as it is a rare opportunity for us to explore and observe the role of a pharmacist in a different country. The whole trip went on very smoothly and as planned with the opportunity to explore Taiwan with our friends during our free time and this ultimately became one of the most memorable trips.”