Developing a global medical mission advanced pharmacy practice experience (APPE)—Odd role for a psychiatric pharmacist?
I have the coolest job in the whole world. Not only do I get to practice as a board certified psychiatric pharmacist on an inpatient psychiatry unit and teach neurology and psychiatry pharmacotherapeutics in the classroom to 90 pharmacy students, but I also get to travel to Guatemala for 10 days each summer without taking any paid time off. I make this trip in order to serve as the lead pharmacist and preceptor for pharmacy students on a Christian medical mission that serves the underserved in rural communities around Quetzaltenango, Guatemala.
The opportunity to develop a medical mission APPE for our students in the College of Pharmacy, Nursing and Allied Sciences at North Dakota State University in Fargo, ND, really fell into my lap. For four years, the student organizations in our College had prepared and packaged medications for this trip as a service project. Conversations with the trip's director revealed that the medical team that accompanied these medications did not provide pharmacy services (e.g., patient counseling). As a result, I approached my Dean with the idea of having a faculty member and two pharmacy students join the team. Theoretically, this would serve two purposes—give the medical mission team the expertise they needed and provide a potentially amazing international learning experience for some pharmacy students. My Dean was very supportive of the idea, so I wrote a set of learning objectives, designed a five week learning experience centering around the medical mission trip, recruited Pharmacy students, brushed up on my Spanish, and away we went!
Since then, I have precepted four pharmacy students, dispensed somewhere around 4000 prescriptions, missed many hours of sleep, sweated more than I thought was possible, and got a mysterious cellulitis on my ankle that required antibiotics. However, I have also met some of the most amazing people. Being able to watch dark brown eyes gleam with joy when receiving treatments for their ailments or receiving hugs, prayers, and papayas from beautiful people wishing to express their gratitude is self-fulfillment. Most importantly, I have had the opportunity to guide students and watch them blossom through an undeniably unique experience. The environment before, during and after the medical mission trip is intensely focused on learning and, specifically, “learning while doing”. The medical mission trip gives students a rare opportunity to integrate many of the concepts they study in a real, meaningful way. In the course of filling a prescription for one patient in Guatemala, the students concurrently wrestle with cultural differences, health care disparities, evidence-based treatment guidelines, public health problems, pharmacy workflow issues and formulary management, interprofessional team work, language barriers, health literacy, and patient-centered care. The students also broaden their knowledge about another culture and learn about themselves. They learn that they can work harder than they thought they could, use their knowledge in more ways than they ever dreamed, and care about their patients so much that sometimes it hurts.
Fitting a project like this in with my busy practice and academic responsibilities is not always easy. However, justifications for incorporating such a project into a faculty member's (or psychiatric pharmacist's) work life are not hard to come by. For example, I feel strongly that it is important to maintain my competence and working knowledge about treatment of physical illness and provision of ambulatory care in addition to maintaining my expertise in treating psychiatric illness. This mission trip provides the perfect opportunity and motivation for me to keep on top of “nonpsych stuff.” However, this trip is not void of psychiatric issues since at least a couple of times each day in our mission clinic pharmacy I still get to showcase my “psychiatric pharmacist” hat and teach a patient about their new medication for sleep called “trazodone”.
Fortunately, my colleagues at my practice site are flexible and accommodating of my absence, offering ample support. The academic outcomes of this experience for the students speak for and justify themselves to my academic colleagues and administrators. The APPE addresses several goals and objectives in our PharmD program curriculum as described by the pharmacy educational curricular standards1 emphasizing interdisciplinary teamwork, communication, cultural competence, and public health. In addition, this experience opened up new areas of research, and allowed me to explore some educational and patient-centered care approaches during and after the trips.
Thus far, my efforts to fit this medical mission trip into my annual calendar have been well worth it. I have always felt invigorated by the opportunities that stretch me beyond my perceived limits: this medical mission trip project delivers a very good stretch. It probably sounds cliché, but one of the reasons I became a faculty member is for the opportunity to treat and educate people who sorely need it. These medical mission trips are rewarding beyond most experiences I have had in my life and as a result keep me motivated to go back each year.