New program gives pharmacy students real-world experience

By Ashley Festa

GRACE program

Third-year pharmacy students Amanda Geffert and Amyn Madhani look over the chart of a patient at the DeMatel House at the Village at Incarnate Word.

On staff for slightly more than a year and a half, Cynthia Villarreal, Pharm.D., is already making big changes for students at the Feik School of Pharmacy (FSOP).

As coordinator of Introductory Pharmacy Practice Experience (IPPE) at the FSOP, Villarreal researches and implements new programs to add to the school’s already challenging curriculum. Only six months after her arrival, third-year pharmacy students began a new round of experience outside the classroom in what Villarreal has dubbed the GRACE program.

GRACE stands for Growing Respect and Care for the Elderly and provides an opportunity for students to get real-world understanding of how pharmacists assist aging patients. San Antonio retirement communities Morningside Ministries and the DeMatel House at the Village at Incarnate Word both allowed students to work with residents.

Other universities have similar programs for pharmacy students, but Villarreal says the UIW program is unusual because FSOP students review patient charts and make recommendations based on their interactions with elderly patients.

Students are paired with a classmate and assigned a patient that they’ll be assisting for six weeks, the length of the yearly spring program. Each week, the students review records and ask how their patient is doing. Our bodies change as they age, Villarreal said, and elderly patients may require different dosage or may have different reactions to medicines. So students stay on the lookout for problematic drug interactions or improper dosage, and they discuss any concerns they find with the on-site pharmacist.

The benefits of the GRACE program extend beyond simply finding issues on patient charts. Residents enjoy interacting with the students, and students gain valuable experience in dealing with real situations instead of simply studying cases from a book.

The students act as “another set of eyes and ears for pharmacists that can’t be there all the time,” Villarreal said.

Dr. Cynthia Villarreal answers the students’ questions about information in the patient’s chart at the extended care facility.

“In class, the cases are more simple. But in the real world, we get to ask questions, such as ‘How long have you been feeling this way?’” said Josh Fugate, a fourth-year student who participated in the first iteration of GRACE in Spring 2009. “It’s a slow-paced introduction to what students are going to be seeing in their fourth year.”

Because of the nature of this type of personalized care, some questions students need to ask are quite intimate. The GRACE program provides “an easy way to delve into speaking to people” and starting sometimes uncomfortable conversations, Fugate said.

Communication, Villarreal said, is the key. Especially because the population is aging and baby boomers will soon be the elderly patients these young pharmacists will care for, learning how to talk to and help them is crucial, she said.

“They’re getting to know (the residents), sitting down with them. They’re not just patients; they’re people and they have histories,” Villarreal said.

By their third year, students will have covered about 75 percent of the medications they study in pharmacy school, and they’ve encountered the majority of the drugs their older patients will be using.

Because there is a professional pharmacist supervising the visits, students have resources in addition to what they’ve learned in the classroom. And their visits are longer than what they might have in other types of real-world settings. The teams have a chance to determine the most important questions to ask.

“It helps you think through the important stuff,” Fugate said. “It’s a puzzle that you have to put together because each person is different.”

The scariest part of the program for Fugate was worrying whether he had covered everything and had asked the patient enough questions. He and his partner wanted to be sure the patient was getting the level of care she deserved.

“Do I have all the information to make accurate judgments?” he said. “What other job do you have to have almost 100 percent accuracy?”

As they enter the Feik School of Pharmacy, FSOP students vowed to give the best level of care possible. Even so, some of the residents were hesitant to participate in the GRACE program during its first cycle. But because it turned out to be such a positive experience, residents were lining up this year to participate.

At the end of the six weeks, students present their patient case for professors at the pharmacy school. Presenting their work helps students “get over their anxieties of presenting a patient case; it helps overcome the fear of presenting and doing this on their own,” Villarreal said.

Though Fugate didn’t make any recommendations for change in care for his patient, Villarreal said she was pleased that a few student teams working at Morningside Ministries did. “I don’t expect students to have to make drastic changes right away. Morningside Ministries and the Village are well-managed.”

Fugate agreed that making recommendations is important, even as students. “If we let it go, then the next person will let it go and it’ll never get caught.”

Agreed Villarreal: “It’s a system of checks and balances, to make sure everything is correct and (drug methods are) there for a reason.”

Despite last year being the “guinea pig year,” students were extremely pleased overall with the program, Villarreal said. This year’s third-year students recently completed the second round of the GRACE program, and there was only one big change since the kickoff in 2010. Villarreal scheduled a consultant pharmacist to speak to students in a classroom setting to refresh them on how to handle the hands-on experience at the retirement centers.

In April, Villarreal presented a poster on the GRACE program at the Texas Society of Health System Pharmacists annual seminar in Galveston. Her presentation won first place in the education category.

“I came up with ‘GRACE’ by the grace of God. I felt like it really followed the Mission of the school; that’s what we’re doing,” Villarreal said.

“We’re preparing them for the majority of situations as much as humanly possible. When they leave, they’ll have all the tools they need or they’ll know where to find the information.”