Putting Classroom Knowledge into Grassroots Power

Ms. Sax is a freelance writer based in Chevy Chase, Maryland.

The pharmacy profession's future is in the hands of pharmacy students. That is why pharmacy educators are increasing their focus on helping pharmacy students develop the skills they need to be lifelong advocates for their profession.

Acquiring Advocacy Skills

Jennifer McIntosh, PharmD, MHS

"Advocacy is a skill that you build and develop over time. It is important to start early on to develop this repertoire of skills," said Jennifer McIntosh, PharmD, MHS, assistant clinical professor at Northeastern University. "Students need a sense of the bigger picture. The issues that shape pharmacy are also issues that affect the entire health care system."

Betsy Elswick, PharmD, assistant professor at West Virginia University (WVU) School of Pharmacy agrees. "Student advocates of today are defining where the profession is headed. Whether the issues are about payment, scope of practice, or patient care, the decisions made surrounding these issues are really going to have an effect on the profession, and if no one steps up to the plate to help shape decisions, the future of our profession will not be as bright as it could be," she said.

Betsy Elswick, PharmD

In her course, Pharmacy Advocacy and Leadership, Dr. Elswick helps students acquire the skills needed to become advocates for their profession. They learn to identify state and federal issues that affect pharmacy and how to put their knowledge into action by writing letters to legislators, meeting with legislators, and organizing efforts to effect change. "I tell students to step back and ask what is best for the patient, then work toward ways to make that happen," she said.

"Students should have a vested interest in the issues facing the profession of pharmacy. They are going to have a 30- or 40-year career, and they are principal shareholders in the issues surrounding what pharmacists can or cannot do," said Michael Jackson, RPh, executive vice president for the Florida Pharmacy Association. Jackson said that it is vital for students to understand the impact public policy decisions can have on their careers and their ability to treat their patients.

Brian Lawson, PharmD Candidate

Brian Lawson, a PharmD Candidate from WVU School of Pharmacy, said that when student pharmacists learn about the legislative process in courses or through involvement with national, state, or local pharmacy organizations, they are better prepared to develop lifelong skills in communication, problem solving, policy and legislative development, and advocacy and leadership. "These skills complement the science-based skills students learn in the pharmacy curriculum," he said. "All pharmacists, student pharmacists, pharmacy technicians, and friends of pharmacy are guardians of the profession and have personal and professional investment in its well-being."

Lawson said that pharmacists, as one of the most trusted and respected professionals, have an obligation to be a vehicle of change to ensure appropriate medication use. "We want to deliver the best possible patient care and health outcomes," he said. "Pharmacists must voice their concerns to the public and to policymakers in order to positively impact health care."

In the past 4 years, Lawson has visited West Virginia's state capital to discuss with legislators some of the issues facing pharmacists in the state. "My first year in pharmacy school, we influenced the legislature to establish 5 pilot sites throughout the state to demonstrate pharmacist-physician collaborative practice agreements," he said.

In the following 3 years, they advocated for pharmacist-administered immunizations. This past year, the state passed an immunization bill allowing pharmacists to administer influenza, pneumococcal, hepatitis A and B, and shingle vaccines to adult patients.

"Students' voices can be powerful, because they are the voice of the future," said Dr. Elswick. "When students came forward to say that they were more likely to stay in their state and practice if they could provide immunization services, legislators listened."

Putting Advocacy into Action

Michael Jackson, RPh

Last April, pharmacy students from Florida universities traveled to their state capital to support a state house of representatives' bill authorizing pharmacists to administer flu shots. Jackson felt it was an opportunity to educate students on the technical role that pharmacists can play in improving community health care. "A majority of states allow pharmacists to immunize, and in those states, immunization rates are higher, and the incidence of vaccine-preventable diseases is lower, so to us it seemedlike a natural fit to have pharmacists involved in the immunization of patients," he said.

Because Florida does not allow pharmacists to immunize, Jackson thought it would be a good opportunity to get students involved in influencing legislators' opinions. Sixtystudents in white lab coats filled the gallery, while 3 graduating pharmacy students from the University of Florida and Nova Southeastern University gave testimony.

"One of the representatives clearly was not sympathetic to our position, and he asked tough questions. He grilled the students for an hour, but our students made the case thatpharmacists receive adequate training. They did a great job and they won him over," said Douglas Reid, associate dean for accreditation and assessment at the University of Florida College of Pharmacy.

The bill, which calls for pharmacists to follow written protocols under a physician's supervision, is slated for presentation to the state legislature.

"It really lit a fire in some of the students when the committee called into question their training and ability," said Jackson. "In 10 years of advocacy, I have never seen such cohesion of the profession and interest by our young practitioners. Their skills at parrying very tough questions demonstrated their complete knowledge of the issue."

Advocacy Leads to Future Leadership Roles

Students who begin to see what they can achieve become lifelong leaders. "Many of the student leaders we see have continued participation in American Pharmacists Association(APhA) and are leaders in other professional organizations. Those are the folks that set a course for the profession," said Reid.

Lawson, who has been a member of the APhA-Academy of Student Pharmacists, said his advocacy involvement as a student has encouraged him to pursue a position in APhA after graduation.

Educators stress that all students should learn the skills needed to effect change. In her Pharmacy Policy and Advocacy class, Northeastern University's McIntosh discusses pharmacy policy issues and helps students develop hands-on advocacy skills. "Students typically do not get big-picture exposure, so working on advocacy projects gives them a sense of how to work with the community to achieve results that improve the health of the community while advancing the profession. They begin to see that it is a win-win situation."

Getting Started in Advocacy

Students often want to get involved, but they do not know where to start. "I try to create linkages outside of the pharmacy community to help provide students with concrete opportunities," she said. "We try to provide them with a wide range of ideas so theycan find their niche. We also expose students to new areas of the profession that they have not considered."

One key area is nonprofit international work. "When students work with these advocacy groups, they begin to see that they can take a wider view beyond being a domestic healthcare provider."

At the University of Florida, Reid helps pharmacy students get involved in health outreach efforts to developing nations. Closer to home, Reid's students are involved inthe Great Gator Health Fair, an annual health fair that targets fans of the school's football team. "They plan the event, arrange for donations, and do the screenings," he said. "It takes a lot of management and planning, but it gives them a lot of satisfaction. It also gives them a chance to really talk to patients. When studentsare involved at the grassroots level, they begin to really understand the issues facing the profession so they are better able to communicate the concerns up the ladder.