An Indian Health Service Ambulatory Care Resident Describes Her Experience

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 diabetes, anticoagulation, asthma, smoking cessation, pediatric, HIV, 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!