u/Ainaelewr

Head of clinical practice at a large AMC. No pharmacy residency, which I'm sure some of you will have opinions about.

What I'm seeing consistently is residency-trained pharmacists who are disproportionately hard on students, and not in a way that builds them up. Meanwhile, the professional bar has been obliterated. Programs are accepting nearly anyone, boards are easier to clear (or eliminated? RIP MPJE...maybe?), and the market is flooded. The profession has real problems right now.

So why is the energy going toward making students feel small instead of toward fixing the pipeline? For those of you who went through residency: is this a "that's how I was trained" thing?

Okay okay, just hear me out. I know A+G is old school dogma, but now G doesn't even provide reliable anti-psuedomonal coverage (seriously, per CLSI don't use it).

If the uro guidelines say to treat the culture prior to invasive mucosal damaging procedures, do they not just need standard cefazolin since the bug is erradicated?

I get it, what if we missed something... that's the argument against stewardship.

I think amp + cefazolin is likely adequate for non-complex patients with adequately treated cultures; would even argue against the amp.

Someone please let me know if I'm off the walls!