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.

“Early mornings, little sleep, long lines …” JESSICA MILLS, 7/23/11

Early mornings, little sleep, long lines, painful procedures and extreme heat could test the patience of anyone.  But that’s what has surprised me most about both the patients and the volunteers here at RAM: Despite these conditions, everyone is excited, appreciative, friendly and generous. 

The RAM spirit is unbelievable and energizes everyone so they can complete the amazing amount of work that is done in the few days that services are provided.  I knew going into the trip that I would test my communication and clinical skills, but for me this has been more of a test of physical endurance. 

I have proven to myself that I am able to work harder and longer than I ever imagined simply by pushing through and feeding off the appreciation of the patients and the excitement of my classmates.  I am very happy that I was able to attend this event, and I hope to find other events like this to attend so I can help others realize how much their skills and knowledge can help those who need our services.

“The Remote Area Medical service experience …” LINDSAY SAMUEL, 8/9/10

Lindsay and Erika.jpgRAM reflections

 

The Remote Area Medical (RAM) service experience in Wise, Va., was a defining moment in my pharmacy student career and personal life. I was exposed to many different people, professions, private and public service organizations.  Not only did I gain valuable clinical experience, but I was also able to step outside of my comfort area and touch patients in a variety of ways. 

I chose to apply for a spot on the team because I wanted to honor my family by giving back to those in need.  My parents come from a rural community where they lived below the poverty line.  Their access to health care was very limited, and some aspects of their health status now, especially dental issues, stem from their lack of health care during their childhood. 

There are so many aspects of the RAM trip that I could focus on; however, my time in triage was the most emotional part of the trip.  During the patient interview, I was able to catch a brief glimpse into the patients’ lives that we were serving.  What touched me the most were the faces of the young patients in their twenties that looked so much older and patients that looked malnourished because they could not eat a proper diet without teeth or dentures.

The trip also gave me a chance to interact with different health-care professionals and promote the pharmacy profession.  I enjoyed collaborating with the nurses at triage, counseling patients at the pharmacy and talking with patients at the grandstand about general health promotion and disease prevention.  

After talking to a pharmacy resident from the University of Virginia Health System, I opened myself up to the possibility of pursuing a hospital residency.  From this experience, I personally felt that I had a greater appreciation for the struggles that my family went through when it came to accessing health care.  I also learned the importance of being a voice and advocating for patients that fall through the gaps of the health-care system.  I feel that it is my responsibility now and even more in the future to remember the patients that I met and advocate for policies that support patients in similar situations.  

It is hard for me to put into words the many emotions that I carried away from this trip, and I have a lot of respect for the many volunteers that transformed a county fairground into a positive, patient-centered medical experience.

“When I originally decided to participate …” DAVID ALLEN, 8/2/10

RAM reflections

When I originally decided to participate in the Remote Area Medical (RAM) project in Wise, Va., I had no idea what I was getting myself into. It turned out to be long, hard days working in the blistering heat, but luckily the amazing people of Wise County and dedicated volunteers turned it into so much more.

Some of the patients that I had the privilege to help waited in line all night and day, yet they still managed to have the most uniquely positive demeanor. During my time in Wise County, I managed to work alongside a variety of health-care professionals and obtain some clinical experience.

The list of people I met in Wise range from some lovable coal miners to Sen. Mark Warner. I can’t think of any other place where a rising P2 would ever be setting up tents with the director of the VDA, the director of DMAS and a longtime lobbyist in one day. Then the next day get the chance to learn the tricks of the trade from some delightfully passionate nurses. Also in this day I had the privilege of meeting my favorite patient of the entire project.

 I first saw Gloria when I was on my way to the grandstands to do medication reconciliation. She had recently broken her hip and was struggling to get from her wheelchair — which was stuck in the gravel — into a golf cart. I ran up to help her and continued to help her along through check-in and triage. When I did end up leaving her in the dental line, she gave me a hug and was actually in tears. I think she struck a personal note with me because she reminded me of when I would help my late grandmother.

My final day in Wise, I spent a large portion of my time following an endodontist, Dr. Sanjay, and an oral surgeon, Dr. Zogby. It was very interesting to see these masters of their craft at work and see the stark differences in their specialties. I first witnessed Dr. Sanjay and his wife both doing root canals side by side, using an electronic depth finder and constantly changing out various drill bits. I next shadowed Dr. Zogby, who was doing full mouth extractions. It was an interesting contrast going from the precision of a root canal to the brute-force nature of pulling teeth with what were essentially pliers, as well as hammer and chisel when necessary. Both men did a great job of explaining what they were doing and managed to make their highly skilled procedures look simple.

After four long days in Wise County, I left with the desire to give back more. In the end, I feel that RAM was one of the most rewarding experiences I’ve ever had, and I look forward to returning next summer. Until then, though, I will take the things I learned and the friends I made with me.