Swana Thomas, PharmD-MPH Candidate 2018

Dr. Kaley Holmstrom is a 2017-2018 ambulatory care resident at the Fort Defiance Indian Hospital in Fort Defiance, Arizona. In 2017, she received her PharmD degree from The University of Findlay in Ohio.

During pharmacy school, she competed on the varsity swim team and participated in campus ministries, Phi Delta Chi, and numerous community volunteer programs. As a student, she also completed a pharmacy internship in the Philippines where she realized the potential difference a pharmacist could make. During her residency year, she will be researching the impact that pharmacists have on patient outcomes when providing medication therapy management (MTM) services. Afterward, she aspires to obtain her BCPS certification and continue to impact the lives of the Native American population.

Q: Why did you choose to pursue a residency? Why IHS?

A:  I chose to pursue a residency because I wanted to solidify my pharmaceutical knowledge through practice and intense training. I knew that if I were to complete a residency, I would be presented with an abundant amount of opportunities to be challenged, push myself, and learn. I ultimately want to be the best and most qualified pharmacist that I can be and the first step on that road is to complete a residency.

The mission of the Indian Health Service (IHS) is “to raise the physical, mental, social, and spiritual health of American Indians and Alaska natives to the highest level.” Throughout school, I developed a passion to serve underserved communities through my time in the Philippines and volunteering in my local community. My desires to serve those in need align perfectly with the mission of the Indian Health Service. Every single day, I have an opportunity to interact and impact the lives of those who need it most. This is why I chose the Indian Health Service. I also chose the Indian Health Service because of the wide opportunities that pharmacists have within the IHS. Through completing a rotation as a student within the IHS, I was able to experience and spend time in the multiple pharmacy-run clinics, outpatient pharmacy, and inpatient pharmacy. There is a wide range of settings that pharmacists are able to work within the IHS and the opportunities are limitless. Completing a residency within the Indian Health Service also allowed me to become a commissioned officer in the Commissioned Corps of the United States Public Health Service. I have committed to serving this country in the places that need it most. I am excited to see where my career takes me and how I am able to make a difference.

Q: What is the purpose or goal of a pharmacist in ambulatory care?

A: The goal of an ambulatory pharmacist is to team with providers to better enhance the health of our patients. Pharmacists in the ambulatory care setting aim to assess and optimize the treatment that a patient is receiving. This can be done in disease specific clinics or an overall medication therapy management clinic. Pharmacists learn clinical practice skills during their schooling and aim to assist providers in areas that pharmacists are knowledgeable. In our facility at Tsehootsooi Medical Center, pharmacists are able to manage patients in the 

, and nephrology clinics. We team with providers to offer consistent monitoring and treatment of patients with these disease states.

Q: What is the structure of your residency program?

A: My residency structure is very unique because I have the opportunity to train in a wide variety of areas and every day looks different for me. Throughout my training, I will spend a few weeks in each of the following settings: outpatient pharmacy, inpatient pharmacy, diabetes clinic, anticoagulation clinic, pediatric clinic, administration, and ambulatory care. The ambulatory care rotation includes the asthma clinic, smoking cessation clinic, primary care clinic, nephrology, and HIV clinic. I also will complete a longitudinal informatics rotation and residency project. Throughout the year, I attend multiple outside training and conferences to further enhance my learning.

Q: What are the advantages of completing an ambulatory care residency, especially in IHS? What job opportunities are available for ambulatory residents in IHS after completion of a residency.

A: There are many advantages to completing an ambulatory care residency within the IHS. Working in ambulatory care allows you to be a crucial part of the overall care of patients. Pharmacists are a huge asset to the medical field. An ambulatory care pharmacist learns how to effectively communicate with patients and use clinical judgement to better the lives of each person they come in contact with. Ambulatory care pharmacists intensely apply their knowledge to assessing and evaluating the care of patients. Providers are continuing to gain respect for the knowledge and skills that pharmacist have to offer which results in pharmacists gaining more responsibility of patients. This is especially true within the Indian Health Service where providers are often short staffed and rely on the help of the pharmacists. This creates ample opportunity to manage patients and assist the providers in the process.

Completing an ambulatory residency opens the door to work in anticoagulation clinics, diabetes clinics, directly in physician offices, and much more! Completing a residency in the Indian Health Service will prepare you to work at any IHS facility throughout the country or any government-run facility. Due to the wide variety of training that you receive during an IHS residency, there is also ample opportunity to work outside of IHS in hospitals, ambulatory care, or retail.

Q: What do you believe are the top 3 skills that an ambulatory care resident must have to be successful in their field?

A: The top 3 skills I believe a resident would need are:

		Critical thinking skills: It is important to be able to apply critical thinking skills to adequately manage the health of patients

		Effective communication with patients and providers: Being able to communicate effectively with patients and providers is crucial to the success of an ambulatory pharmacist.

		Compassion and understanding: Having compassion and understanding towards patients and their difficulties allows pharmacists to connect and build trust with patients. This will correlate to better health outcomes for patients and is extremely important in ambulatory pharmacy.

Q: What advice do you have for students interested in pursuing an ambulatory care residency in IHS?

A: If you want to pursue a residency in IHS, I would suggest trying to visit an IHS site that has a residency. This will allow you to see in person what IHS is all about and if it is a good fit for you. It is important to note that the application process for IHS is separate from the traditional match. The application opens and closes earlier than the traditional match does so if IHS interests you, review the application process as early as possible. I would also suggest making connections with current residents or residency directors to gather more information about specific programs. This can be done through site visits, e mail, or midyear. As well as looking into the different residency programs, I would also encourage you to research the Commissioned Corps of the United States Public Health Service to gain understanding of what it is and if it is something that you would be interested in pursuing. Although commissioning as an officer is not a requirement to do a residency in the Indian Health Service, it is a great privilege and opportunity! 

Articles

An interview with Dr. Kaley Holmstrom, an IHS Ambulatory Care Resident at the Fort Defiance Indian Hospital in Fort Defiance, AZ 

An Indian Health Service Ambulatory Care Resident Describes Her Experience

 (HEOR) fellow in a 2-year program with Thomas Jefferson University in the College of Population Health and Janssen Scientific Affairs, LLC. In 2016, Dr. Singer received a PharmD degree from the University of North Carolina Eshelman School of Pharmacy, where he was involved in the Academy of Managed Care Pharmacy (AMCP), the American Pharmacists Association - Academy of Student Pharmacists (APhA-ASP), the American Society of Health-System Pharmacists (ASHP), and Phi Delta Chi. After his fellowship, he hopes to work in HEOR at a pharmaceutical company designing, conducting, and managing research, as well as potentially work in a field-based position as an outcomes liaison. Overall, Dr. Singer hopes to participate in population health research and explore how pharmaceutical companies can work with other health care stakeholders to improve outcomes.

Q: Why did you choose to pursue a fellowship and why a fellowship in HEOR?

 Deciding what post-graduate training to pursue was a difficult decision, but ultimately, I concluded that an HEOR fellowship would be the best path for me. I considered managed-care residencies and discussed the idea of pursuing a PhD. After much thought and a very helpful conversation with our AMCP chapter’s faculty adviser, it became clear that an HEOR fellowship would provide the right balance of focused research training, exposure to different settings (academia and pharmaceutical industry), and potential for further didactic learning in the form of a master’s degree.

Q: What is the purpose or goal of HEOR in the pharmaceutical industry?

 HEOR has a growing and ever-evolving role in the pharmaceutical industry as a function that demonstrates the value of products. Often, HEOR groups will develop evidence of the real-world effectiveness of products by conducting studies using claims data, electronic medical record data, and patient registries. Demonstrating the economic impact through modeling and retrospective analyses of claims is another important role that HEOR plays in the pharmaceutical industry. Additionally, HEOR groups may be involved in assessing how a product affects patient reported outcomes (PROs) and the development or validation of PRO instruments. Evidence generated by HEOR is often used by health care decision makers to inform policy.

Q: What is the structure of your fellowship program?

 My fellowship program consists of 2 years spent conducting research and taking courses relevant to HEOR. During the first year, the fellow works at Thomas Jefferson University in the College of Population Health in Philadelphia, Pennsylvania, participating on research studies with faculty and external partners. During the second year, the fellow is located at Janssen Scientific Affairs, LLC, in Titusville, New Jersey, conducting and managing research as a member of the HEOR team

Day-to-day activities vary, depending on research partners as well as the individual fellow’s interests and learning objectives. Days throughout both years often include meetings to discuss research methodology, execution of studies, the most appropriate data sources to answer a research question, and the logistics of disseminating findings through publications. The types of research projects fellows participate in may vary by their interests and previous experience, so the day-to-day of conducting research often reflects the projects the fellow is working on.

Like most previous fellows in this program, I am pursuing a master’s degree in applied health economics and outcomes research at TJU. Over the two years of the fellowship program, fellows can complete all the required courses for a master’s degree and lay the groundwork for the final capstone or thesis project.

Q: What are the advantages of completing a HEOR fellowship, and what job opportunities are available for HEOR fellows after completing a fellowship? 

 A HEOR fellowship typically provides 2 years of focused research training with exposure to strategy and often the opportunity to work in multiple settings. In my program, I have had the opportunity to conduct research in academia and the pharmaceutical industry. HEOR fellowships often provide the opportunity to complete coursework as well. With focused research training and supplemental coursework, HEOR fellows, depending on their interests, can graduate a fellowship prepared for jobs in the pharmaceutical industry, medical device industry, consulting, managed care, and academia. Alumni of our fellowship program are currently working in all of these settings

Q: What are the top 3 skills that HEOR fellows must have in order to be successful in their field?

 To be successful as a HEOR fellow, I think 3 of the most important skills are the ability to learn on your own, communicate effectively, and critically evaluate research. 

Q: What advice do you have for students interested in pursuing a HEOR fellowship? 

 Students interested in a HEOR fellowship should start preparing early. Research experience is valuable as a candidate, as is an understanding of the US health care system. Starting early gives a candidate time to be participate in research, understand the process, and perhaps most importantly, decide if it’s something they like. Often, students don’t get a lot of exposure to the structure of the US health care system, so having time to learn about the complex channels through which medicines and payments flow can be very beneficial.  

Dr. David Singer discusses why he pursued the fellowship at Thomas Jefferson University in the College of Population Health and Janssen Scientific Affairs, LLC.

Have You Heard About HEOR?: A Q&A with a Fellow at the Program

Last year, I had the privilege of joining a group of students and faculty from the University of the Sciences that ventured to Salt Lake City, Utah to attend APhA’s Institute on Alcoholism and Drug Dependencies. It was a once-in-lifetime experience and one that has changed my view on alcoholism and substance use disorder. For anyone who has heard about this at his or her school but was “on the fence” about going, here are 5 reasons that might make you hop over the fence and head to Salt Lake City for this conference

Salt Lake City proved to be a city with much life and much love. Whether it is hiking up its terrain, gazing at the great Salt Lake, or enjoying the all the amazing local eateries such as 

, this trip will color a beautiful picture of the city!

We all have previous connotations of alcoholism, substance abuse, and the infamous word “addiction” that is often tabooed in our society, even today. This conference will allow you to step back and understand the physiology behind addiction, regardless of what the substance may be. You will also learn the various networks and factors related to addition such as the role of codependence in a patient’s life. By the end of the conference, this experience will compel you as health care providers to question whether addiction is a choice or a disease.

Addiction is NOT black and white. It is a story of continuous struggle, temptation, redemption, despair, and hope. From the stories told by guest speakers and recovering addicts, the journey that these individuals have undergone can sometimes seem unbearable and unbelievable to hear or witness. However, please remember: their choice to overcome their cravings or desires for a substance should depict for us as pharmacists their STRENGTH, not their weakness. When they make that recovery decision, let us remember that our job is to support them in whatever way we can to get them one step closer to recovery and relief.

Warning: This experience may cause participants to experience crying fits.

Be prepared to meet A LOT of people! From the guest lecturers that present amazing seminars on alcoholism and substance abuse, recovering addicts and the stories they present, to students and faculty from all over the United States, sharing their own personal stories and advice on how to implement this newfound knowledge into practice, you will leave with a lot of new friends and connections.

The notes you will receive from the APhA Institute are a great resource when you return to campus to share with your teachers and classmates. In addition to this, various chapters Generation Rx from different pharmacy schools will present on how they implemented certain tools in their community. For example, last summer the East Tennessee State University Bill Gatton College of Pharmacy gave a wonderful presentation on being “agents of change” and how they teamed up with their public health department to “volunteer to save a life,” provided naloxone education to the community, and worked with The Boys & Girls Club. They reminded the students to make a “connection through stories” and to “develop a skill set to combat prescription drug abuse and misuse.”

On the last day, a speaker read Luke 12:48: “For everyone to whom much is given, of him shall much be required.” In pharmacy school, it is hard to believe that much is given to us but we have been given an opportunity to serve the public in an extraordinary manner by understanding the therapeutics behind the medicines they take. We as pharmacists should be part of our patients’ antidote of hope to their pain, anxiety, and long-suffering and our profession should be the first to extend a helping hand.

 Annual Session of the APhA’s Institute on Drug Dependencies will take place from June 1- 4, 2017 in Salt Lake City, Utah. Be prepared to learn, experience, and grow!

A special thank you to Dr. George Downs from The Philadelphia College of Pharmacy for making every effort to bring students like me to this event and allowing us to grow even more as future pharmacists! 

Five reasons to attend the APhA's Institute on Alcoholism and Drug Dependencies 

5 Reasons to Attend the Institute on Alcoholism and Drug Dependencies

“I know the material, but when I get to the exam, something happens and I lose it.”

“I get down to 2 answer choices, but I always pick the wrong one.”

“Maybe I’m not cut out for pharmacy school.”

I don’t know about you, but many students, including myself, are aware that they are not proficient at “test-taking.” Whether it is due to anxiety or forgetting all the mnemonics you made to remember the adverse effects/drug interactions of SSRIs, there seems to be a barrier that prevents you from doing your best on an exam even though you are confident in the material. So what can you do to help yourself? Here are some helpful tips that I found when I was searching for an answer:

Bringing Specificity to the Material (Studying for the Exam): 

When studying for the exam, although cramming can be effective for most students, because pharmacy school teaches different materials that build on each other, this method does not always work as one progresses through the program. Studying ahead of time is likely more beneficial. This being said, creating a “study” schedule may prove fruitful during the exam. Mapping out a week-to-week schedule may enable you to balance school, work, and a proper study hour each day for an upcoming exam.

Studies using medical students have shown that hypothesizing what types of questions will be on the exam has prepared students because they study concepts that will most likely be on the exam. For instance, at The Philadelphia College of Pharmacy, students are given a set of objectives with each P&T lecture that will allow them to know which concepts are important for clinical practice as well as the exam.

This specificity to studying can be accomplished by creating study guides, flash cards, or a Q&A paper of the material. Bringing specificity to the material could also involve creating patient case scenarios and discussing them in groups to determine the appropriate therapy option. Knowing what the professors want students to focus on is a key to success when preparing for the exam. The more specific and detailed your studying becomes, the more ingrained the material becomes in your mind as well!

Pre-Living the Exam (Being Prepared During the Exam) 

One strategy that has become more popular according to psychologists is to have students “pre-live” the exam the night before taking it. This includes imagining what you will wear during the exam, what you will bringing, and how they will feel to do well on the exam. This allows the student to overcome the initial rollercoaster of emotions they might be feeling in the first 10 minutes (or longer) of the exam.

The morning of the exam, students have suggested in a series of polls that waking up at least one hour before the exam, eating a well-balanced meal, performing a series of simple stretches, and reviewing the material have helped the morning of the exam.  

Another strategy is to answer questions on material you are the most confident in first, especially if your exams are divided into sections. For example, if you are confident in your understanding of the therapeutics of asthma compared to eczema, tackle the questions on asthma first before moving on to the next topic. This is said to “keep spirits high” if the student feels confident on answering the first set of questions because they are likely to continue with that confidence throughout the remainder of the exam.

The final tip is to come back to questions during an exam that might leave you stuck. Focusing on such questions may take up time during the exam, which may increase a student’s anxiety and hinder them from answering the remaining questions with a clear mind.

While you can’t do anything to change the outcome after the exam, it is important to attend exam reviews (if this is an option at your school) or to review with your professor if your grades are not reflecting your confidence in the material. This is because the teacher may be able to point out mistakes in your logic while answering a question which may help you in future exams. Although it might be painful to relive, it is important to not let history repeat itself.

Whatever you may try to become a better test-taker, do NOT let this make you believe that you are not “cut out for pharmacy school.” Pharmacy school is tough for everyone in different ways but if this is your passion, so keep fighting and pushing forward, because your passion and knowledge will shine through in practice and you will know it was worth it in the end. 

Whether it is due to anxiety or forgetting all the mnemonics, many students struggle with taking tests. 