Brent Hall
Contact:
brahall@ucdavis.edu

Titles:

  • Pharmacist Specialist, Pediatrics
  • Associate Clinical Professor, UCSF School of Pharmacy

Education:

  • B.S., Biology – Purdue University, West Lafayette, Indiana 1998
  • B.S., Pharmacy – Purdue University, West Lafayette, Indiana 1998
  • PharmD – Purdue University, West Lafayette, Indiana 1999

Post-graduate Training:
PGY 1 Residency – Northwestern Memorial Hospital, July 1999 – June 2000

Teaching Philosophy:
Pharmacy is an evolving profession which continues to try to balance its history as the trusted dispensers of medication orders from prescribers retrospectively and its future as the profession trusted to appropriately apply pharmacologic therapies prospectively in conjunction with prescribers. This transitional period, which has been occurring for the better part of five decades, has left pharmacists in a middle ground. The first aspect of our history is one centered on the idea of absolutes. This prescription dose is correct or incorrect, this medication choice is correct or incorrect, I am right, you are wrong. Practitioners are given a background of therapeutics, which is obsolete once it is taught with an inability to actively evolve with the changing landscape. Further compounding this is the inability of many students, residents and young pharmacists to understand disease state physiology, to understand the entire patient, to appropriately evaluate primary literature and to understand prescriber’s ways of thinking and goals in patient care. This mentality does not translate well to the idea of prescribing proactively. At the heart of these issues is the preparation of pharmacists by pharmacy schools and residency programs which continue reaching for the prospective future of pharmacy by utilizing methodologies that are founded in the retrospective past. These methodologies are incongruent and lead to a poorly prepared and wildly inconsistent group of new practitioners. This in turn leads to a lack of general trust between prescribers and pharmacists which limits the profession’s ability to move into the proactive future. My philosophy is to focus on the prospective concepts of proactive practice and using these concepts to teach the retrospective aspects of our profession.

A focus on physiology, as the starting point for the application of pharmacologic therapy, is the foundation of clinical pharmacy. I have heard pharmacist educators tell learners that understanding physiology is not necessary to do a pharmacist’s job. Nothing could be further from the truth. When a practitioner truly understands the mechanisms of disease, it allows for progression beyond looking at a set of guidelines or using common references such as LexiComp. This is what separates a practitioner from an untrained individual who looks up how to treat a disease on the internet. The practitioner is able to understand which med to start, why, the starting and ending points for therapy, when to escalate and when to hold fast and when to back off. Once the disease state is understood, then the pharmacist with their knowledge of mechanisms of action, interactions, monitoring parameters, dosage forms available and insurance issues can tailor therapy more directly to each individual patient under their care. This helps not only with the proactive application of medication but also with the retrospective understanding of medication orders from prescribers. It allows for the nuance in medicine often described as ‘the art of medicine’.

The second aspect of pharmacy practice is the understanding and application of primary literature. Many learners are ill prepared to thoroughly dissect and interpret a piece of scientific literature. Is the question appropriate and valid? Was the study type correctly chosen to answer the question? What is the internal and external validity of the study? Are statistics applied appropriately? Were the correct study endpoints selected correctly? Are the authors conclusions appropriate? Many studies are utilized as sales pieces, sometimes for the company of the drug they are supporting. More often than this thought is for the authors themselves who want their research to be impactful. This contributes to author overreach at times. When this happens, simply reading the conclusion can mislead practitioners to inappropriately apply therapies. Without this vital skill, it is impossible for pharmacist to truly understand if one therapy is superior to another. Sometimes the more expensive therapy is the right one and through appropriate literature interpretation, the pharmacist can make the decision which is in the best interest of the patient. This information further extends to assist the pharmacist in retrospectively evaluating prescription orders, understanding when to speak with providers and when a reasonable selection has been made.

The third aspect is the ability to communicate with prescribers and staff. This is the key to impacting patient care. Learners generally come from a mindset that the prescriber should always be questioned. That it is the pharmacist’s job to prevent them from making mistakes. This is important but should never be the place where the conversation starts. Prescribers are well educated and trained and while there are prescribers who do a poor job, this is far and away the exception to the rule. Pharmacists must act as helpful members of the team and have the understanding and when and how to approach prescribers. When a positive and educated interaction is initiated, there is no limit to the impact a pharmacist can have.

The final aspect is to reassess the approach to a learner and to determine when a change of style is appropriate. Different learners learn in different ways and it is the responsibility of the teacher to find the best way to approach a learner for maximum impact. This requires an interactive approach to teaching where the learner, through questions and critique, helps the teacher to offer the best pathway to enlightenment. There are always vital concepts that the teacher can garner from a motivated learner. Through this sharing of information and approach, an optimal educational experience is much more likely to occur.

This is a brief overview of my philosophy of working with learners to achieve a well-trained clinical pharmacist who can truly benefit not only the patient, but prescribers and the health care system to maximize outcomes.

Rotations Precepted:

  • Pediatric Wards
  • Pediatric Nephro/GI
  • Pediatric ICU
  • Pediatric Cardiothoracic Surgery
  • Research

Bio:
Brent Hall is currently a Pharmacist Specialist in Pediatrics at the UC Davis Medical Center. After completion of his residency, Brent accepted a position at University Medical Center in Tucson, Arizona. This institution served as the teaching hospital for the University of Arizona Schools of Pharmacy, Medicine, Nursing and Public Health. Brent first served as a staff pharmacist in pediatrics before advancing to the position of Clinical Coordinator for Pediatric Pharmacy. Over the 14 years that he spent in Arizona he was able to grow his service from 1 FTE to 4 FTEs with an expanding precepting program for University of Arizona pharmacy students as well as helping to lay the groundwork for the development of a PGY 2 Pediatric Pharmacy Residency Program. Brent was also very active in the Schools of Pharmacy, Medicine and Nursing providing didactic lectures, precepting and course coordination. In 2014, Brent moved his practice to Sacramento, California to help with the establishment of the PGY 2 Pediatric Pharmacy Residency Program and expansion of clinical services. Brent is actively involved with programs at UC Davis Children’s Hospital which include Pharmacy Residency Advisory Committee, Pharmacy Research Oversight Committee, UC Wide Preceptor Development Committee, Acute Care Practice Council Representative, Peer Responder, Co-Chair of the Department of Pharmacy Committee on Education, Pediatric Heart Center Group for protocol development, Pediatric Medication Error Committee and PICU Committee Representative. Nationally he is actively involved in ACCP, PPAG and has worked on the A-F Bundle Project with SCCM as well as Opioid Stewardship programs with Delphi. Brent currently serves as the ACCP Pediatric PRN Education Chair and Core Competency Chair for PPA. Brent’s areas of interest include critical care medicine, cardiology, sedation/delirium management, pain control and precepting.