Earlier this year, the Indian Health Service (IHS) announced new Collaborative Agreements between the agency and three American universities: Howard University, Purdue University and the University of Southern California, to participate in the IHS Advanced Pharmacy Practice Experience (APPE) Program. This program provides opportunities for student pharmacists to gain clinical experience at IHS facilities and it also serves to recruit future healthcare professionals to work in rural areas, specifically in Indian Country.
Under these agreements, Doctor of Pharmacy candidates at partner universities will join students from more than 80 universities in 39 states to complete experiential training at IHS direct service facilities.
“Through the IHS Advanced Pharmacy Practice Experience Program, we develop meaningful partnerships with top universities that train the next generation of healthcare professionals, while providing opportunities for students to gain practical hands-on experience,” said Mary L. Smith, IHS principal deputy director. “Upon completion, many return to start their career in providing quality healthcare to the American Indian and Alaska Native community.”
“How Can I Help?”
Students from Creighton University School of Pharmacy and Health Professions are often part of that returning workforce who develop a passion for serving the Native American community. The school offers APPE Ambulatory Care Rotations and a Learning Through Reflective Service: The Native American Experience elective course—where students learn more about healthcare challenges and opportunities within this unique population—in addition to the JRCOSTEP and SRCOSTEP programs offered through the USPHS.
Dr. Maryann Skrabal, director of the Office of Experiential Education at Creighton, sees students’ interest pique in the IHS right away. “When students learn about the needs of the Native American population, it’s a natural place for them to migrate and ask ‘how can I help?’ They see the immediate impact that pharmacists can have and so they will often look for job opportunities and residencies within the system.”
Diabetes, hypertension, hyperlipidemia, and substance abuse disorders are just some of the healthcare needs that exist within the Native American population. A student may need to spend extra time with a patient to provide additional counseling and education and this type of clinical setting allows them to do so, Skrabal said.
Strengthening the Rural Workforce Pipeline
Another unique aspect to working within the IHS is that it’s one of the settings that offers the most interprofessional aspects of a rotation, noted Elizabeth Hall-Lipsy, assistant professor and program manager for health disparities initiatives and community outreach at The University of Arizona (UA) College of Pharmacy. “It’s a great location in which to see the impact of social determinants of health on healthcare delivery and outcomes,” she said. The college offers students the opportunity to complete introductory and advanced placement rotations within the IHS, in addition to the SRCOSTEP and JRCOSTEP programs.
“A lot of our Native American population faces a significant workforce shortage, and the best way to get students and graduates to those areas is to give them some familiarity with them,” said Hall-Lipsy. “By giving students the opportunity to explore these areas in a short-term, low-risk setting—where they see the value, and learning and practice opportunities—it can work to prime the pump to get that workforce out into the areas that could really use their expertise.”
Hall-Lipsy, who also manages UA’s Rural Health Professions Program for the College of Pharmacy, believes that the state’s growing success in rural pharmacy practice can be attributed to students’ experiences with the IHS and similar sites. As of October 2015, 33% of RHPP pharmacy graduates practice in a rural setting, and 44% practice in an underserved community.
One UA graduate working in an IHS setting was recently appointed a preceptor for incoming students, which Hall-Lipsy says is ideal. “This enriches the pipeline, and continues the thinking that this is where a student can go and be of the most good and the most service.”
Small Changes Yield Big Outcomes
In addition to the immediate impact students have by providing much-needed patient care, they also have the opportunity to implement new systems or solutions that effect real change in the long run. Skrabal recalls a project in which a Creighton student developed a sticker program for schools to use to help improve children’s eating habits over time.
“Our students see that these areas may not have adequate resources, so they get excited about the impact they can make,” she said. “And they want to stay with it because they feel like they can go back there and make a difference right away.”
Working with this unique population creates a more well-rounded individual and practitioner, Skrabal added. “It’s beneficial for students to see these patient care opportunities that are available, but it also helps them learn more about the Native American culture and meet different people within our country, which ultimately creates better citizens and professionals for the future.”
Additional reporting by Maureen Thielemans,
associate director of communications and
Kyle R. Bagin, digital media manager.