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Medical and pharmacy students jointly tackle health care’s most pressing dilemmas
Inquiry Immersion course challenges future clinicians to think scientifically and grapple with uncertainty
By Levi Gadye, PhD / Fri Feb 22, 2019
This January, Susan Miller, PhD, a UCSF School of Pharmacy faculty member, and Scott Oakes, MD, a UCSF School of Medicine faculty member, jointly greeted an auditorium of UCSF medical and pharmacy students with a challenge instead of a syllabus: to explore.
The course, called Inquiry Immersion, brought together—for the first time—students from UC San Francisco’s doctor of medicine (MD) and doctor of pharmacy (PharmD) degree programs to tackle pertinent issues in health care, and to use problem solving and critical-thinking skills to seek knowledge and create new insights on the topics.
“In Inquiry Immersion, we frame everything as a question,” said Miller, who is a researcher in the pharmacy school’s Department of Pharmaceutical Chemistry. “We want our students to get into the mindset of how to recognize and research a dilemma, controversy, or gap in knowledge, and to get accustomed to dealing with grey areas.”
“Science is changing rapidly, and so is our understanding of diseases and their underlying biology. We need to be training our clinicians to keep up with that rapid pace, to keep up with the literature, and to see that they can do some science to fill in the gaps,” Miller added.
Three years ago, the School of Medicine debuted the Inquiry Immersion course for its medical students. This year, students from the School of Pharmacy, which is revamping its PharmD curriculum to one based on scientific thinking, joined the program.
The course structure previews the students’ professional futures, in which doctors, pharmacists, and other health professionals work together in teams to best serve patients and advance health care knowledge.
Grappling with controversy
On most afternoons during Inquiry Immersion, students came together in groups of four to twelve to investigate a particular, pressing topic in health care under the guidance of faculty members from one or both schools. These topics ranged from the opioid crisis to the clinical applications of DNA sequencing, and most of these “mini-courses” contained a balance of both MD and PharmD students, giving both the chance to grapple with the unknowns of health care using their complementary skill sets.
One mini-course, titled “Should all FDA-approved medications be covered by health insurance plans in the U.S.?” was led by Rosa Rodriguez-Monguio, PhD, a School of Pharmacy faculty member in the Department of Clinical Pharmacy, and director of the pharmacy school’s UCSF Medication Outcomes Center.
The course brought students up to speed on pharmacoeconomics—the scientific field that compares the value of one drug or treatment to another—before challenging them to brainstorm ways to maximize health outcomes while considering cost in the health care marketplace.
At the final meeting of the course, Rodriguez-Monguio asked the mini-course students to consider the problem of “orphan drugs,” which benefit patients with rare diseases but often entail disproportionate spending from drug developers, health insurance providers, and patients themselves, compared to drugs that treat more common diseases.
She explained that while some life-saving therapies might end up helping a few thousand patients, the evidence of effectiveness and safety of these therapies might not be robust. Furthermore, these therapies might ultimately cost millions of dollars to patients, third party payers, and society at large.
“Our goal is to balance economic incentives to stimulate development of orphan drugs without threatening affordability,” she explained. “The question is, how much are we, as a society, willing to pay for [these therapies]?”
One student suggested prioritizing preventative care, which could save money for insurance companies and improve outcomes in the long term. Another suggested that insurers invest in palliative care and use the health care savings to better fund pediatric care.
“Remember, we are not just asking patients what they want or need, or what health care providers may want—we are striking a balance between these groups in pursuit of better health care outcomes for patients,” Rodriguez-Monguio reminded the students. “You’ll each have to deal with these challenges, big and small, in your careers.”
Building professional bonds for a lifetime of collaboration
For both the MD and PharmD students involved in Rodriguez-Monguio’s mini-course, the experience was illuminating.
“From my experience as a pharmacy technician in a community setting, there were times when issues with patients could have been avoided if there had been better communication between their health care providers,” said Cindy Trac, PharmD Class of ’21.
Eleanor Kang, an MD student, also gained a newfound appreciation for the complementary roles that pharmacists and doctors play in health care. “I found it interesting that the pharmacy students engage in mock pharmacy and therapeutics cases [that determine which drugs a hospital or insurer is willing to provide], which I think most medical students are unaware of,” Kang said.
And for Shafat Selim, PharmD Class of ’21, the experience taught him not only how to deal with challenges in health care, but also how to collaborate in his future work environment. “Pharmacists and doctors each become more effective providers when they communicate,” Selim said.
Each group of students capped their respective mini-course by making a three-minute video highlighting what they had learned. Rodriguez-Monguio’s students used the opportunity to show how every group involved in health care—patients, doctors, pharmacists, economists, and more—may have its own take about which pharmaceutical drugs should be prioritized for insurance coverage or hospital provision.
While two weeks is only enough time to touch on the complexities of a topic like pharmacoeconomics, the purpose of Inquiry Immersion was to inspire students to think like scientists, to learn to digest technical literature, and to converse across the clinical aisle with future colleagues.
“Our combined faculty team was uniformly enthusiastic about working with students from the two schools,” said Miller. “The students were just as enthusiastic, and the synergy of their mini-course discussions really shined through in their final videos. This classroom camaraderie is bound to translate as these students embark on their careers as clinicians."
About the School: The UCSF School of Pharmacy is a premier graduate-level academic organization dedicated to improving health through precise therapeutics. It succeeds through innovative research, by educating PharmD health professional and PhD science students, and by caring for the therapeutics needs of patients while exploring innovative new models of patient care. The School was founded in 1872 as the first pharmacy school in the American West. It is an integral part of UC San Francisco, a leading university dedicated to promoting health worldwide.