Salem Veteran Affairs Medical Center

There are many Veteran Affairs Medical Centers across the country, but our school gave us the privilege of doing a rotation at the Salem, VA location. Veteran Affairs Medical Centers are serviced by the US Government, and only provide medical services to our military veterans of all ages. At the VA centers, these vets are able to receive acute care in the Emergency Room and ICU, inpatient ambulatory care, as well as long term treatment with skilled nursing facilities. Majority of the Veterans serviced here are older, at least 50+ years, where they’ve served in the Korean War, Vietnam, and the Gulf War, and also include younger vets who’ve served in Iraq and Afghanistan.

The majority of the medical problems these veterans suffer from, are from what they’ve acquired while serving, such as hepatitis, HIV, Tuberculosis, various cancers and Diabetes Mellitus from the herbicidal warfare of “Agent Orange”, conducted during the Vietnam War. Also, a large portion of the veterans are being treated for PTSD, which allows for pharmacists to specialize in a PGY2 Psychiatry residency.

Here at Salem VA, the opportunities for student rotations are ambulatory care, acute care, and infectious diseases. For my rotation, I got a chance to be with the Infectious Disease pharmacist. The ID pharmacist is in charge of monitoring antibiotic regimens and making sure the patients are receiving the correct drug at therapeutic doses, along with working with the ID physicians to determine the best antibiotic therapy for new disease diagnosis, that coincides with the hospital’s formulary. When I came on as a student, my preceptor explained that by the end of my rotation she wanted me to be skilled in all the things that she did everyday. The first thing she wanted me to do was a “patient work-up”, where I would review a patient’s chart, analyze their current medication list, their disease history, and lab values. I was to present the patient to her afterwards, and give my assessment of the physician’s treatment plan. After doing these patient work-ups each day, I learned how to adequately present a patient case, even doing multiple patient cases at once. I would make notes to the doctors, giving my assessment and recommendations. I was also doing Vancomycin trough dosing, IV to PO changes, and de-escalation assessments.

I also got to round to patient rooms with the medical students and the ID physician. While doing rounds, each medical student is assigned multiple patients that they have to present to the ID physician. We stop by the patient’s room and before we go inside to check on the patient, the medical student will present their chief complaint, illness history, and their current treatment plan. I was also able to present patients to the rounding team and practice what I learned with my preceptor. Presenting patients is a great skill to have, because as a Pharmacy resident, you’ll have to do rounds and present patient cases to a team of physicians while being able to evaluate their therapy.

One of my favorite parts of the rotation was working with my preceptor on the Antimicrobial Stewardship Committee and establishing 2 new protocols for helping physicians de-escalate patient’s antibiotics and evaluating cost effectiveness of at-home IV antibiotic treatments. I did a month long research on these 2 projects and was able to present my ideas and plan to the Committee at the end of my rotation.

There are several ID rotations that we’re able to do, but the VA is different in that you’re dealing with veterans. Their personal and disease history is very unique, and usually compounded with the war they’ve served in, and the lack of access to adequate healthcare for so long. This often leads to them being in a very bad condition by the time they realize they can come to a Veteran Affairs Center. Often, many have to travel far just to get to one of the hospitals. Thus, you’ll see a lot of amputations from severe osteomyelitis.

I would definitely recommend this rotation if you’re thinking about doing a residency. It’s a great experience, and you’ll have plenty of opportunities to get involved with projects to prepare you for applying to residency, as well as ample research opportunities to do a poster presentation at the ASHP midyear conference.

This pic is of me and the wonderful PGY1 Residents