High school mentorship journal entry No. 2, AILEEN BI

Today’s Date: Aug. 24, 2011

Total Hours to Date: 30 hours

Mentorship Research Journal #2

My visits to the VCU Main Hospital have recently become nearly full-day expeditions.  This second journal entry will document the past two long but busy days spent with Dr. Gravatt.  My Aug. 23 visit to the hospital began with rounds, once again with the team.  That morning, we saw a total of 10 patients. 

Due to the fact that internal medicine deals with all types of diseases, the patients we saw were admitted for a wide variety of reasons, from heart failure to chronic kidney disease to hallucinations.  Thus, we were always on our feet, quickly moving from one hospital floor to another.  We only stopped to listen to the reports from the medical residents, who had come to the hospital very early in the morning in order to check on their designated patients and prepare a health report.  This typically required an overview of the patient’s various lab test results and recent symptoms, as well as a recommendation from the student regarding further action.  The team’s physicians would follow along, ask questions, and make amendments as needed.  Listening to each report, I was able to better understand the obligations that came with fulfilling a residency requirement. 

One patient of interest was a 31-year-old female who came into the hospital, like many other patients, with a history of drug abuse.  She had developed a fungal infection around her calves, so her doctors had prescribed antibiotics to treat it.  However, instead of taking the antibiotics as instructed, she injected heroin into her legs to ease the pain.  This case exemplified one of a doctor’s many frustrations: a patient’s refusal to follow his or her directions.  Thus, it is crucial that the doctor develop a good bed-side relationship with the patient.  If the patient feels she can trust her doctor, she will be more willing to do as he asks. 

Another recently admitted patient was a 60-year-old man.  His wife explained that he seemed to be suffering from acute depression and anxiety following his cancer diagnosis.  He had an extensive medical history, and some members of the team questioned the necessity of taking so many drugs.  Dr. Gravatt took notice of his use of the beta blocker propranolol, which serves to control anxiety, and wondered if it fed into the patient’s depression due to its passing of the brain blood barrier.  She recommended that they take him off several drugs to see if his condition would improve.  This was a case in which a pharmacist could not only recommend prescribing certain medications, but take them away as well. In this situation, less medication would have been more beneficial, and the importance of knowing one’s medical history became evident.

My afternoon consisted of attending lectures presented by both professors and students.  The first class took place in one of the main classrooms of the School of Pharmacy.  The lesson focused on different types of Gram positive bacterium.  Coincidentally, this topic correlated with what I had recently come across while on rounds, as mentioned in the first journal entry.  Dr. Gravatt had informed me beforehand of the two main types of Gram positive bacterium — staph and strep.  Hence, the teacher began the lesson by presenting an NPR recording about MRSA, a bacterial infection that is particularly resistant to antibiotics.  The recording stated that by simply increasing the frequency of handwashing among the staff members, the number of MRSA cases declined.  She then proceeded to cover many types of staph and strep infections, such as streptococcus pyogenes, a tissue infection caused by a virus.  She explained that penicillin is the main treatment of choice for this for this disease, unless the patient is found to be allergic to it. 

The next set of lectures was presented by pharmacy students, who were expected to explain to the audience what they had learned through their experience with an assigned patient case.  Each presentation discussed the reasons the patient was admitted, assessment and lab results, treatment, and details on how the patient responded to said treatment.  These students’ presentations were then analyzed by a panel of physicians and pharmacists.  For example, one student described a pharmacist’s role in treating a woman’s endocarditis, a heart inflammation, by prescribing Vancomycin, an antibiotic used to treat such inflammations. 

I finished that long day realizing that the residency programs truly prepare students for their careers, for their work in such programs closely resembles what they will probably face in the future.  Yet, I was certain there was much more to learn, both in the classroom and out in the field.

On Aug. 24, my day began at 8 a.m., reporting straight to class.  That day, Dr. Gravatt gave a lecture on the basics of infectious diseases.  She began by reviewing the concept of the normal flora, a name for the numerous microorganisms that regularly colonize the human body.  When normal flora is disturbed by immune system dysfunction, skin breakdown, etc., the bacterium can become pathogenic, which leads to infections.  She discussed how the immune system functions and possible causes for immune dysfunction.

Dr. Gravatt explained most of the lesson with theoretical patient cases; she would present a theoretical patient, then describe the step-by-step process students should follow.  She brought up details to be wary of, like the fact that it was possible to have an infection without having a fever.  Overall, I found the class much more direct than my high school classes, simply because the School of Pharmacy’s teaching methods and materials are directly related to the challenges students would face in a hospital or clinical setting. 

The later part of the day was spent focusing my attention toward the students.  The resident pharmacy students had been assigned patients who had actually been recently admitted into the hospital.  The students were responsible for researching these patients’ medical backgrounds and presenting them to Dr. Gravatt as patient cases.  This way, Dr. Gravatt was able to quickly gain information on her patients while teaching her students.  In one of these cases, a woman had been admitted to the hospital after experiencing a 20-pound weight gain.  More importantly, she suffered from heart failure in her right ventricle.  As a result, the left side of her heart had been working twice as hard, leaving this side much stronger than its counterpart.  This unbalance in the organ led to more issues, such as constriction of blood vessels.  A metal rod had been inserted into her chest to compensate for the right heart failure, and so it was imperative that her pharmacist prescribe an anticoagulant drug, or a blood thinner, to protect the patient against possible blood clotting.

All in all, during these past two days, I’ve had the fortune of observing an actual pharmacy class as well as learning exactly what completing a residency entails.  Although I sometimes felt overwhelmed by the medical terms, I found the use of patient cases an interesting method of teaching.  As Dr. Gravatt explained, treating a patient is much like solving a puzzle — you often aren’t entirely sure from what disease the patient suffers, so you must put the symptoms together to try and solve the problem from these clues.

High school mentorship journal entry No. 1, AILEEN BI

Today’s Date: Aug. 18, 2011

Total Mentorship Hours to Date: 18 hours

Mentorship Research Journal #1

This summer I officially began my quest to explore the pharmaceutical field through the mentorship program.  Dr. Ron Ballentine has been serving as my mentor during this time, but as assistant dean of admissions at the VCU School of Pharmacy, he has the means to connect me with several pharmacists in the area who were kind enough to agree to supervise me as well. 

One of these pharmacists was Dr. Tyler Stevens, who works as an assistant professor in the same building as Ballentine.  I worked with him in June to prepareAileen.jpg a lesson for middle school students and, during the school year, he will allow me to observe labs conducted by second-year Pharm.D. students.  Dr. Ballentine also introduced me to Dr. Leigh Anne Gravatt, an assistant professor who also works as an internal medicine clinical pharmacy specialist in the school’s medical campus.  Dr. Gravatt took me with her on patient rounds in the Main Hospital and allowed me to participate in one of her classes and watch presentations by pharmacy students.

Although this is merely my first journal entry, I have already had the privilege to observe both the application of pharmaceutical studies in the classrooms of the School of Pharmacy and in the VCU Main Hospital.  This experience has shown me how the material one learns in school can be directly applied out in the field.  My mentorship experience began on June 10, when I was informed that a group of middle school students would be touring VCU’s MCV campus.  Dr. Stevens and Dr. Ballentine were placed in charge of introducing these students to the pharmaceutical field, and they wanted to brainstorm ideas to garner the students’ attention during the allotted time.  They had prepared a 20-minute introductory video and several speeches for the students.  Dr. Ballentine assigned me the responsibility of delivering one of these speeches, suggesting that I present my story to the students as a high school student interested in the pharmaceutical field.  Additionally, they had planned an activity that would teach the students how to read prescriptions and sigs, which explain how one should take a certain medication.  I suggested that the students may be interested in role-playing, through which they could experience for themselves what it might be like as a pharmacist.  From this, our final plan was formed — we would show students how a pharmacist would research a drug and counsel, or educate, their patients about that drug.

The morning of June 29, I expected to enter a classroom of sleepy students.  Instead, I was pleasantly surprised to find that many were willing to participate; a few were even lively.  First, Dr. Ballentine discussed the journey from college to pharmacy school.  I was surprised to learn that many students entering pharmacy school majored in a non-science subject.  What was actually more important was that the students take all the prerequisite courses before applying to the school. Following my speech, a couple of graduate students delivered speeches as well.  One of these students majored in French, while the other shadowed with many medical professionals before deciding that pharmacy was the best fit for her.  It was interesting how students could come from a variety of backgrounds before taking the same path. 

Dr. Stevens then gave an introductory lesson to counseling.  Clinical pharmacists conduct counseling sessions to ensure that the patients fully understand the drug for they take it.  During each counseling session, the pharmacist must introduce him or herself, explain the purpose of the session to the patient, and use open-ended questions to attain information from the patient and confirm that the patient knew what he needed to know about the drug.  The pharmacist must be able to explain what problem the medication was supposed to alleviate, as well as the correct dosage and frequency of consumption.  She should inform the patient of possible side effects of the drug and answer any question the patient might have.  From his speech I realized how important it was that a pharmacist possess both communication and research skills. 

Dr. Stevens displayed how a pharmacist effectively communicates and introduced the class to Lexi-Comp, VCU’s online database on drugs.  Students and pharmacists use this program because it explains everything they would need to know about the medication in a very convenient fashion.  The students were then separated into groups and assigned a drug, which they then researched, using Lexi-Comp in a computer lab.  The students then showed the class what they learned by taking turns counseling each other.  I considered this experience an introduction to the pharmaceutical field for not only the middle school students, but for myself as well. 

My next mentorship opportunity would not arrive until August, but nevertheless, I was grateful when Dr. Gravatt allowed me to accompany her on rounds in the VCU Main Hospital.  However, I was required to pass a quick VCU course on HIPAA, the Health Insurance Portability and Accountability Act.  The training course serves to explain methods to secure patients’ protected health information, known as PHI, through the Privacy and Security Rules.  Through the training course, I learned that the best way to protect a patient’s information is by following the Minimum Necessary Standard, which requires that the medical worker be aware of exactly who needs the information and just how much to share.  I learned that if a patient does not wish to be included in the Facility Directory, the medical worker should not even acknowledge that the patient is in the healthcare center, even if a family member requests information.  I also learned the process of giving a patient access to his or her medical records and the process of securing these records.  After passing this course, I was permitted to meet Dr. Gravatt and begin my mentorship experience with her.  I was introduced to her August 15. 

Dr. Gravatt explained that she initially planned to major in biology, intending to work as a physical therapist.  After some shadowing, though, she quickly realized this occupation was not for her, so she switched her major and attended pharmacy school after two years as an undergraduate student.  We then talked about why we were interested in the pharmaceutical field.  The focus of our discussion was the variety of jobs in the field, that being a pharmacist did not necessarily restrict you to counting pills at Walgreens.  She also pointed out how the field was female-friendly, because it gave pharmacists the option of working part-time and thus spending more time with their families.  Because I personally cannot see myself tied to my job in 20 years’ time, I felt that our conversation was definitely pertinent to my future goals and was reassured of my choice to explore this field.

My first day in the hospital began on August 17.  I arrived at 8:30 a.m. ready to begin rounds, which is essentially when the medical team travels around the hospital and visits patients one by one.   The team consisted of 10 members, much more than I had expected.  A pharmacy student explained that many of the hospital’s patients did not have the financial means to stay in a private hospital. Thus, staying at a hospital in a learning institution gave them treatment at a lower cost, while giving an opportunity for students to apply their knowledge in the field and complete their residencies.  Although I was a bit overwhelmed by the amount of medical terms thrown about in the team’s conversations, I was able to pick up certain terms as we traveled from patient to patient, such as A1C, which measures the extent at which glucose metabolism in the blood is controlled, and INR, which measures the how the blood clots. 

We visited several patients, but one memorable patient was a 53-year-old female who had developed pancreas inflammation due to excessive alcohol consumption.  She had experienced intense abdominal pain and cramping with urination.  The pharmacists on the team were in charge of monitoring her PCA, a machine that allows the patient to administer her own pain relief.  The pharmacists documented the number of attempts to attain pain relief and the amount of medication the patient actually received.  From this information, Dr. Gravatt and her students could deduce whether or not to increase the patient’s current dosage.  Because the patient’s attempts often did not match up with the amount of times medication was given, the team ultimately decided to increase her dosage of pain medication.  Because the team also noticed that the patient’s glucose levels were high, Dr. Gravatt asked me to research diabetes and the functions of the pancreas and to be prepared to present my findings to her students the next day.

I arrived at the hospital at 8:30 the next morning and finished at 2:30 in the afternoon.  Again, rounding gave me a crash course on many medical processes, such as Gram staining, which can give pharmacists a clue as to what kind of infection the patient might have.  For example, a Gram positive result usually indicates strep or staph infection, and so a pharmacist would be able to prescribe a certain antibiotic to cover those areas.  During these rounds, I noticed that a majority of patients at the hospital suffered from an affliction that related to their history of drug abuse.  I found this observation surprising, as I had not considered this a prevalent problem in our community. By the time rounding was completed, I felt quite weary, largely due to the fact that rounding required that I stay on my feet at all times.  In the afternoon, I attended the students’ presentations, in which they discussed different methods to treat AIDS and HIV.  From these two days at the hospital, I was able to observe a job option I hadn’t considered before — treating while educating.

High school mentorship program 2011: Introduction, RON BALLENTINE

We’d like to share four journal entries Aileen Bi wrote during her time with us. Aileen, a student at Maggie Walker High School in Richmond, was part of the high school mentorship program.

It is obvious from reading her journal entries that she benefited greatly from the time that she spent with pharmacy faculty, clinicians and residents. She has a much better understanding of what pharmacists can (and should) do.