As a third-year pharmacy student at the University of Utah College of Pharmacy, I was ready to gain new experience in the world of clinical pharmacy, and emergency medicine looked like a great option. In March 2019, I applied for the VALOR pharmacy intern position offered each year by the Salt Lake City (SLC) Veterans Affairs (VA) Medical Center. I had worked as a technician and intern at Walgreens for the past few years and wanted to get more clinical experience before starting fourth-year rotations and a future residency. Thankfully, my application and interview were competitive, and I was accepted; also, despite my concern that this would be a large leap from community to emergency medicine, I was eager to get started.

It has been a year since I made that leap to a more clinical role in emergency medicine, and I have to say, it was definitely worth it. My experience at the VA was more beneficial than I could have dreamed. It was very challenging and difficult work, particularly in the beginning. I realized quickly that there were a lot of small therapeutic concepts I could barely remember, but over time, they began to come more naturally. My two pharmacy preceptors really pushed me to apply everything I learned on a consistent basis, and I’m truly grateful for that. I feel more ready than ever to start clinical rotations and ultimately apply for a PGY1 residency – hopefully at a VA.

My experience at the VA itself was also very eye-opening. I had rarely been inside a hospital, and at first, I was unsure how to interact with the veterans. Working on the centralized inpatient side part of the time, I got to know the facility well. At our VA, we don’t have pneumatic tubes or a sophisticated way of delivering medications, so we do it the old-school way – hand-delivered to the patient’s room. This afforded me plenty of opportunities to chat with the veterans as I delivered medications on the floors. Through those experiences, I had the chance to hear many stories and interact with veterans from all the different military branches – even those who had served in different wars. I relish these experiences and the times I was able to share a laugh or simply provide some reassurance during a difficult moment.

For the ED side of the job, I did a ton of medication reconciliations. I became quite familiar with atrial fibrillation, myocardial infarction, stroke, heart failure, VTEs, COPD exacerbations, and many other disease states. Some of my favorite experiences were just listening to veterans’ stories about how they ended up in their situation. Some would just laugh off their problems with a genuinely positive and carefree attitude. These conversations were always fun and made my day a little brighter – I came to realize that they simply trusted the VA to take care of them, so they weren’t really that worried. In addition to the fun chats, I got to experience many clinical presentations that I never would have expected to see, such as lisinopril-induced angioedema, cardioversions, intubations, a widespread sulfa rash, a gangrene-infected diabetic foot, and many more. I have to thank the ED physicians for always taking me along for the ride to see something “cool.” In the ED, I learned how to take a thorough medication history, despite all the chaos, and come up with a comprehensive care plan for the patient with recommendations and monitoring for each major problem. For me, this is the selling point of the internship, and it made all the difference in boosting my confidence for my upcoming acute care and critical care rotations.

Besides the fun and unique cases, there were the occasional serendipitous moments when a regular old “med rec” became a sensitive and personal discussion. I remember one veteran, in particular, who was moved by how kind I was and how respectfully I was treating him despite his reason for admission. He then began sharing about how he finally felt ready to apologize to his kids, whom he hadn’t talked to in many years. I reassured him that he would never regret genuinely apologizing and asking for their forgiveness; if anything, he would know that he did all he could to save the relationships – he was more than appreciative. As I left the room, we were both wiping away a few happy tears. I truly felt I had made a difference, and it didn’t have to involve medicine – just empathy and a listening ear.

My experience as the VALOR pharmacy intern is now ending. I am so grateful for my experience in the ED and for the friends I’ve made, the professional relationships I’ve built with pharmacists and residents, and, most of all, my experiences working with a patient population now near and dear to my heart – our country’s veterans. I’m looking forward to this next year of rotations (I even have a few rotations back at the SLC VA) where I can put all that I’ve learned to the test.

My advice for those of you looking for a clinically challenging and unique work experience during pharmacy school is to reach out to your closest VA. Many VA locations across the country offer this paid VALOR internship. The VALOR program affords students the chance to embrace the challenges and rewards that come with working with this unique patient population. It also provides the chance to fulfill the ultimate mission of the VA, which is to fulfill President Abraham Lincoln’s promise “to care for him who shall have borne the battle, and for his widow, and his orphan, by serving and honoring the men and women who are America’s veterans.”

For younger students who may not know which direction they want to take in their pharmacy career, or for those interested in everything, here is my advice on how to self-assess your personal pharmacy interests and set yourself up for success on rotations:

1. Whatever year in school you are, it’s never too late to reevaluate your personal goals. This may sound like a cliché, but taking 10 minutes to jot down what you want out of your pharmacy career can really help set the right perspective while maintaining your motivation during the never-ending challenges of the pharmacy program. Over time, these goals may change, as is expected. Continue to update these goals and reflect on them regularly. By doing so throughout your pharmacy education, you’ll have a better feel for what your primary interests are. This will help you make meaningful decisions when selecting rotations and possibly a residency program.
2. Don’t be afraid to try new things. Especially for first-year students, getting involved with different professional pharmacy organizations or volunteer opportunities will help you figure out your personal interests. You’ll learn what you like and what you don’t like. This will also make a big difference later. Try out flu clinics or blood glucose testing events (do you like the hands-on or hands-off aspect of pharmacy?). Get involved with your state’s legislation, such as on pharmacy legislative day (perhaps you’re privy to the world of policy?). Each activity will help you better understand what gets you excited versus what feels like an obligation.
3. For those possibly interested in clinical pharmacy, the sooner you can gain clinical experience the better. This can mean applying and interviewing for an actual job at a hospital or clinic while in school (highly recommended, though not feasible for everyone). It can also mean shadowing faculty members or other pharmacists you know in your potential field of interest. For example, if you think ambulatory care would be a good fit, make sure you try out different pharmacists and different locations. Don’t let one single experience dictate the entirety of how you view that field. Plus, you can’t know that you like (or don’t like) something if you’ve never experienced it. Working and shadowing are some of the only ways to get a real feel for what the actual job might be like before rotations.
4. Talk to multiple pharmacists in your field(s) of interest. This goes with the above statement to gain clinical experience. Shadowing will probably be most helpful for you as an inquisitive student. Even in the midst of the pandemic, pharmacists are still willing to be flexible and provide more information about what they do. You might ask to set up an informal “interview” or “Q&A” with them. Asking questions of faculty, residents, or even other pharmacy students in different fields will help you clarify and narrow down your interests.
5. Participate in an activity that you may have already “written off.” Have the courage to try out the things you think you won’t like, and you may be surprised. There are plenty of success stories with this approach. And again, this will save you valuable time and energy when selecting rotations and a direction for residency.
6. Make a list. Most pharmacy students tend to like lists. Make a list of which pharmacy career attributes you think you currently like and a list of things you’ve found you don’t like (i.e., patient population, level of patient interaction, location, etc.). Over time, this list will grow and change. Ultimately, the goal is to find a career path that aligns with your personal interests and helps you feel fulfilled, motivated, and confident.
7. Be okay with not knowing yet. Pharmacy school is challenging enough; be patient with yourself if you don’t feel you’ve found your “perfect fit” yet. Taking the above steps will help any student get pretty close while maintaining a level of self-confidence.

Even though the pharmacy curriculum constantly feels busy, taking the time to invest in yourself throughout your didactic years will truly pay off later. It will give you the confidence and reassurance that you did everything you could to prepare and set yourself up for success. It will also take the stress off making these big decisions later on when they matter most. Finding your perfect fit may not be easy, but these steps will get you one step closer.