Leigh Boehmer says he is a student in the College of Pharmacy because when he was diagnosed with testicular cancer at the age of 22, a remarkable pharmacist helped him through the painful months of treatment that led to remission.
“I had a lot of interaction with nurses and physicians during my treatment, and I’ve made lasting friendships with some of them,” Boehmer says. “But my pharmacist in particular struck me. I realized that medications would be the frontline of my battle against the cancer and she held the information to make me confident about my treatment. She was able to communicate—or maybe dumb down—that information into something I could understand and trust.”
Boehmer, now in remission, says he feels “incredibly thankful and blessed” to have had the drugs that were vital to his cure.
“Chemotherapy is not fun to go through,” he says. “I told the pharmacist, ‘I didn’t feel sick before I got here, and now I feel awful. You’re giving me something that is so terrible.’ She would say, ‘This is temporary. What we want is a permanent cure.’ That is why I want to put all this time and effort into becoming an oncology pharmacist myself, so I can help other people as she helped me.”
As Boehmer’s experience shows, pharmacists are assuming a new role as part of the care team, interacting directly with patients. Pills and solutions are likely to be counted and bottled by technicians, or increasingly by machines. Pharmacists help patients make better use of the medications they take—avoiding adverse effects when drugs are mixed with other drugs, herbal supplements, or nutritional products; making sure dosages are correct; and monitoring the effects of the medication.
“We’re starting to function as pharmacists did years ago, when people called them ‘Doc’ and their stores were the first place you’d go if you were ill,” says Jordan Cohen, dean of the college.
Boehmer adds, “The field is more patient care-oriented than it was. The college has to teach students how to fit into that environment.”
There are other changes in pharmacy. When there were only a limited number of drugs that could be used to treat each disease or condition, pharmacists and physicians could remember the properties of many of them. Now there are an estimated 10,000 different medications available. Pharmacists have become the information source, trained to know where up-to-date information on interactions and dosages can be found quickly.
The College of Pharmacy
has adapted its programs and curriculum to give its graduates the best
chance to be successful in this new world. In
recent years, the college has instituted programs that put students into
the community right from the start of their training. The community programs
build up to the students’ fourth year, when they go through 10
rotations in one year to see different kinds of pharmacy settings and
decide which one is right for them.
Preparing to help people
In the first professional year of pharmacy, while they’re taking their first pharmacy courses, students choose a community service project and devote a minimum of 12 hours to it. They see public health and community issues firsthand while helping in a free medical clinic or soup kitchen.
In the second year, after completing several courses, students visit a community pharmacy for two 10-hour shifts to observe the work of community pharmacists and listen to patients’ questions. Lucinda Harms, clinical instructor of pharmacy, says students may learn to teach a patient how a blood glucose monitor works during this experience.
In the third year, students shadow fourth-year students who are doing their clinical rotations in order to experience direct patient contact under supervision.
The fourth-year rotations last four to six weeks and allow students to see different aspects of a pharmacy career. Jennifer Tryon completed one of her fourth-year rotations at the National Association of Chain Drug Stores.
“When I say I’m from The University of Iowa, people in other
areas of the country are very receptive,” she says. “The
college has an excellent reputation. I’m proud that we’re
known to be innovators and leaders.”
Theory into practice
Another opportunity for students comes in Pharmacy Practice Laboratory. Students now take the laboratory course every semester they are on campus, says Harms, an instructor in this key sequence of courses. In past years, students participated in the lab for only one semester, just before they left campus for their rotations.
The lab is set up to look like a modern pharmacy, with actual products and instruments. Each student has a workstation.
“What they learn during the semester in other courses, they apply in the lab,” Harms says. “If, for example, they’re studying diabetes medications in pharmacotherapy, we have them gain experience with insulin pumps and show them how to mix an insulin preparation. We have them count carbohydrates. We have a patient in the lab for a day who is wearing an insulin pump.”
Another experiment works to counteract the impression that the basic scientific information they learn in other courses won’t ever be necessary in the real world, she adds.
“We give them a group project in which they are told to predict the compatibility of an injection of mixed drugs that may have to be delivered through an IV line,” she says. “We choose drugs that have very little written about them, so when they do research, they can’t find much. In order to mix the solution, they have to go back to the chemical structures of the components and work out the effects they will have together.”
In another experiment, students were asked to mix a solution of incompatible components.
“Only three or four students caught the incompatibility,” Harms
says. “So I announced to the others, ‘The patient might have
died as a result of error.’ You don’t ever want to hear those
Out in the world
Linsey Blau received her PharmD degree last May. She is completing a one-year residency in primary care and family practice at the Northeast Iowa Family Practice Center in Waterloo, and says she would like to find a similar permanent position.
“Pharmacy Practice Lab integrated all that we had learned and taught us how to teach people to use an instrument or medicine that they need,” she says.
“I see patients and do a little bit of everything here,” she says. “I do some education, pulmonary rehabilitation, quality improvement projects, and clinical monitoring at Allen Memorial Hospital. For example, if a patient is on coumadin, a blood thinner, I monitor it to make sure his blood is not getting too thin.”
Blau says that the kind of pharmacy work she is doing still is evolving in Iowa and across the country. Younger practitioners are making a difference every day in patient care, while pharmacists educated in an earlier era are gradually implementing many of these vital services. The college,
in conjunction with the Iowa Pharmacy Association, is working with many pharmacists and pharmacy sites to help them reengineer their practices for these new roles.
Dean Cohen says that the college is educating pharmacists for enhanced patient care roles and is especially focused on the 50 percent of the graduates who choose community pharmacy.
“One concern is that our graduates still are not delivering all the patient care that they are being educated to give,” he says. “It’s a struggle for community pharmacists to make money and still take all the time they need to do counseling. But pharmacists who are committed to direct patient care seem very happy. One of the opportunities for them in rural areas is the high at-risk population, the rural elderly. These people do not have good access to health care and they usually are not rich. Their pharmacy plays a big role.”
Cohen says the placement rate in his college has been 100 percent for many years.
“Most students have three to five offers before graduation and the offers are from all over the country, not just Iowa,” he says. “To stay in Iowa, particularly in the rural areas that have high demand, is a real problem for students partly because salaries in Iowa tend to be lower than in other parts of the country.”
Of the 424 PharmD students in the college, 81 percent are from Iowa, Cohen notes. Eleven percent are from Illinois and three percent are international students.
Cohen says in a typical graduating class, half the students choose community pharmacy, with about 60 percent taking positions as chain store employees. Twenty percent will take residencies in a specialized field and eventually work in hospitals or teach, and 20 percent will go into a hospital practice.
But there are other opportunities.
“Pharmacy graduates can work in nursing homes, hospitals, government, the pharmaceutical industry, a managed care organization such as Wellmark, or academic pharmacy. A lot of students tell us they don’t want to work in a drug store. For them, there is a vast array of other possible work locations.”
Tryon says she chose pharmacy instead of medicine because of pharmacy’s flexibility.
“If you go to med school and complete a residency in a field, that’s the field you’ll be in for the rest of your life,” she says. “In pharmacy, you can start out in retail, in a drug store or chain store, and later develop a disease management clinic there. Or you can decide to go into something new, such as hospital pharmacy. The opportunities in pharmacy are endless, and there’s something in the field for everyone.”
by Anne Tanner