2018 REHPS Molly Schrempp

Week 1:

The Landmann-Jungman Memorial Hospital it located on the western edge of Scotland, South Dakota. Attached to the hospital you will find the Scotland Medical Clinic, Scotland Pharmacy, and West Winds Apartments, an independent living community. I arrived in town on June 24th, the evening prior to the start of my REHPS experience. After getting settled in, my coordinator, Melissa, took me to the baseball field where I participated in watching “sports day” (a Sunday full of baseball and softball games).
Our first morning on site, we sat down with Melissa and discussed all of the activities we wanted to participate in or experience through the REHPS program. We were given ample amount of services available at the clinic and hospital to observe, as well as community events to get involved with during our stay in Scotland. The second half of my day I spent at the pharmacy, becoming acclimated to the process of small town pharmacy that also takes care of a critical access hospital pharmacy.
The second morning at LJMH was spent at a department head meeting that included every department in the hospital, clinical, and pharmacy. I found this meeting to be quite eye opening and a tremendous learning experience. We were able to hear positive, productive discussions among all of the departments and how they truly try be a team and make sure everyone is working harmoniously together. One thing that stuck out to me was the discussion from each department head on how their area has a specific project. The goal of these projects is to improve on certain areas that are lacking or have proven to be problematic in the past. The remainder of my day was spent at the pharmacy, where I learned the ins and outs of the Pixus and MediTech system that is used on the hospital side of the pharmacy. That evening, we had our first community event, Tour of Gardens. The event was a fundraiser and an incredible opportunity to meet and get to know people from the community.
Over the course of the next three days, I spent most of my time back in the pharmacy learning their system and daily processes. The times I was not in the pharmacy I was able to have new and exciting learning experiences. One morning we spent with a provider who travels from Parkston to complete evaluations on patients who reside in the local nursing home. I was also able to spend a few hours in the emergency department with patients who came in for a cardiac event and a minor trauma. Being that Scotland is very rural, they utilize TeleMed in the emergency department, which is basically “skyping” with a medical doctor located at Avera McKennan who watches and helps guide the nurses and the PA on how to treat the patient. The TeleMed service has brought an incredible amount of stability and preparedness to rural communities that might otherwise have to wait 30 minutes or more for a physician to arrive on site.

Week 2:

Week two at LJMH was much different than week one. We had opportunities to rotate around to various departments in the hospital and clinic and chat with them about their daily process and how their puzzle piece helps complete the patients overall experience.
Monday morning we were in the lab for a few hours, which is a department that was completely new to me. The director of the lab made the comment “we have to be part-time mechanics back here or nothing works the way it needs to”, and that has truly stuck with me.Large, expensive machinery has become a necessary part of what it is the lab technicians rely on to provide accurate results for patients. Although they do occasionally have to get out the microscope and examine their specimens more thoroughly, a vast majority of the time they take the specimen they have harvested and place it in a machine to do more of the heavy lifting. I learned that the lab spends an extensive amount of time insuring all of the machines are calibrated correctly and in proper working order. They must comply with very high standards to maintain accreditation.
Later that Monday, we spent a bit of time in the business office and scheduling area of the clinic. This too was an area I have never had an opportunity to observe. So much of the scheduling aspect of their jobs is customer service based, because they spend a good chunk of their day answering phones and speaking with patients when they check in or check out. Much of the rest of their day is spent going through paperwork and bank statements for bill collections and other such payments. They must have open communication with the chief financial officer (CFO) for their daily processes to work smoothly on the business and billing side.
Tuesday morning we spent with the directory of radiology. They did not have any patients during our time there, but we had ample opportunity to discuss with the direct how their various machines work (CT, x-ray, and ultrasound). We also reviewed old scans from the various machines and learned how to analyze their contents. Although it is unlikely I will be asked to analyze the results of a CAT scan, I found it very helpful to have a better of understand of what exactly a radiologist might be looking for in a scan and how they use those scans to diagnose the disease states I will likely be giving patients a medication for down the road in the treatment.Tuesday afternoon we had the opportunity to attend a town chamber meeting. I truly enjoyed being able to see the comradery among various community members. Their team work has led to amazing community building and funds they can utilize to improve their town. I also was able to spend the remainder of my afternoon with the physical therapist seeing patients. I felt I learned an extensive amount about how the therapist works with the patient to help diagnose the root cause of their aches and pains. It was also fun and a bit inspiring to watch my partner work with her physical therapy preceptor and learn to assess her patients and work with them. It was almost like I could see the gears turning in her head as she took in all of the things the therapist said and did. The remainder of week two I spent in the pharmacy. I had a lot of opportunity to learn more about the less glamorous but necessary part of a retail pharmacy like ordering medications and doing price comparisons.

Week 3

During week three I began and ended my week working in the pharmacy. Between those days, I spent all of my time with the various providers in the clinic. I spent a full day and one morning with the primary PA, Carrie, and the clinic nurses. In such sort time I feel as though I gained a wealth of knowledge from these ladies. I was able to see the clinic side of nursing and what their day-to-day tasks and activities look like. I had the opportunity to sit in on almost every patient visit, which allowed me learn bits and pieces about a variety of illnesses. Carrie was wonderful about quizzing my knowledge of treating certain disease states. She also gave a few tips and tricks for some more simple ailments that I might be able to recommend to a patient that one day enters my pharmacy. Carrie primarily works in the clinic, but she is also in charge of rounding on any hospital patients at LJMH, as well as covering the ER when someone comes in. There is truly no such thing as an “easy day” when you have to wear so many different hats throughout your work day, and I must commend her on wearing them so incredibly well!
On Thursday of this week I spent the afternoon in the clinic and ER with the CNP that comes every Thursday, Brandi. Brandi is a professor at SDSU in the CNP program, so she too wears many hats throughout her week, and I felt very welcomed in the clinic while she was there. It was interesting to me to watch how she assessed her patients and be able to compare and contrast the two providers I spent time with. Naturally, what was supposed to be a stereotypical afternoon at the clinic turned into a full schedule, a patient coming into the ER, who then got admitted for observation, and a clinic patient on the verge of needing admitted and needing a large lab work up.
There were two providers that came to the clinic and hospital this week that were doing some outreach work. The first was Dr. Kampman, an orthopedic surgeon from Mitchell, SD. We spent the afternoon in the clinic with him seeing both post-operative patients, potential surgery candidates, and a few things in between. Come to find out orthopedic medicine is definitely not my calling! However, Dr. Kampman was extremely kind and extremely intelligent. Even though we both knew orthopedics was not my “thing”, he helped me to understand why he was assessing the patients in a certain way and how he solving the story problems of their aches and pains. The other provider was Dr. Serck, a general surgeon from Yankton. Dr. Serck comes to LJMH one a month for “colon day”. You guessed it, a morning full of colonoscopies and endoscopies! Thankfully, all of the patients he worked on that morning had a clean bill of health and looked very healthy on the scope, but Dr. Serck took the time to explain to me what he would be looking for and how things will look wrong during those exams.
This week was also packed full of community events. Monday night we sat at the baseball fields taking money at the gate for the “teeners” tournament that Scotland was hosting. Tuesday we drove out to Menno, SD with the physical therapist, Erin, and two of her children to go to the sale barn. We got to learn all about the livestock market while we watching bidding wars over hogs, a miniature horse, and lots of baby goats. Wednesday night we participated in the county disaster preparedness training exercise. Then Thursday night we were invited out to the hospital administrator’s house for a little barbecue.

Week 4

My last week at LJMH did not look a whole lot different from previous weeks. I spent a fair amount of time in the pharmacy and the clinic. I was able to see yet another provider who occasional travels to Scotland to help fill the gaps when the primary providers are gone. This
particular provider was pretty fresh out of school and very up-to-date on current trends in healthcare. He seemed to have that natural teaching ability and tested my knowledge on drug facts and treatment options, which I both appreciate and enjoy! I was also able to spend a bit more time in the clinic with Brandi, and she was not afraid have me get hands on the patients that day! She does a pretty substantial amount of women’s wellness checks, and one particular patient had a variety of previous disease states. One of which, led to a slightly enlarged thyroid. I had to opportunity to actually feel what an enlarged thyroid was like and compare and contrast one side to the other. That simple exam was intriguing to me, because thyroid medications are one of the most commonly prescribed in the United States, and as a pharmacist we speak with patients daily about the medications and thyroid disorders. It made it all sort of come full circle, as far as what the provider is looking for on a physical exam, to what lab tests for the TSH and free T4 and T3 levels, to how we medicate the patient to correct in inappropriate lab level.
Our community activities this week consisted of a tour of the Maxwell Colony, a Hutterite community, a tour of the POET Research Facility, and our community project. The colony tour was extremely eye opening for me. We have seen members of the colony every single day at LJMH, and of course I know they lived a very different lifestyle from mainstream America, but to see and hear first-hand from two girls that were my age was incredible. The POET tour was also eye opening for me, because I know very little of the ethanol industry. The vast majority of processes they discussed went right over my head! However, I felt I did learn some interesting things and POET is a huge part of the Scotland community so it was good to see what that was all about.
Our community project was based on the HPV epidemic that has hit the U.S. We screened a documentary, “Someone You Love”, and had a small panel of providers there to discuss any questions or concerns that cropped up after the viewing. The turnout was less than ideal, but I felt we gained a lot of personal knowledge about HPV and the importance of educating others and getting the public vaccinated.