Credit: Nick Romanenko
Enid Morales, center, a clinical
associate professor at Rutgers’ Ernest
Mario School of Pharmacy, mentors
students on clinical rotations at the
Eric B. Chandler Health Center in New
Brunswick. Morales interviews a patient
as Hasham Khawaja, right, a Rutgers
pharmacy student who recently completed
a clerkship at center, listens. Khawaja
says that the educational experience has
been invaluable: “It is one thing to
hear about cases in lectures, it is
another to see – and actually help – the
Students in their final year at Rutgers’ Ernest Mario School of Pharmacy who hope to someday work in clinical care don’t have to travel very far to apply the lessons of the classroom to the needs of patients.
They are getting training in the real world of family health at the Eric B. Chandler Health Center, an outpatient center on George Street in New Brunswick. The center, affiliated with the Robert Wood Johnson Medical School, provides health care to families in the greater New Brunswick area, regardless of their ability to pay.
The relationship between the center and pharmacy school program began just over a year ago with a grant from Johnson & Johnson to fund a full-time clinical pharmacy faculty member at the clinic. Enid Morales, a clinical associate professor at the pharmacy school, signed on in October 2004. She provides clinical services at the Chandler center and at the Robert Wood Johnson Medical School’s Thrombosis Center of New Jersey, another site where pharmacy students on clinical rotations can get real-life experience.
“What is unique about the program is that students get exposed to the barriers that affect health care and medication compliance in underserved populations. The clinic experience is an eye opener; they learn to deal with so many different situations,” says Morales, who mentors students at the Chandler center three days a week.
The center averages about 33,000 patient visits per year and the patient population is diverse – 40 percent Hispanic, 37 percent African-American and 18 percent Caucasian. About 50 percent are Medicaid recipients. A significant portion of patients have chronic illnesses, such as hypertension, diabetes, heart disease, asthma and HIV/AIDS.
Morales, who is fluent in Spanish and lectures on the topic of pharmaceutical care for underserved populations, was a natural choice to serve as the program’s coordinator. She grew up in Puerto Rico, earned her bachelor’s of science at the University of Puerto Rico School of Pharmacy and came to the United States to pursue a Pharm.D. degree at the University of Maryland. After completing a residency in internal medicine at the Medical University of South Carolina in Charleston, she joined the Rutgers faculty in 1991.
Morales attributes her career choice to the summers she worked in her uncle’s community pharmacy. “I’ve always liked science. At one time,” she says, “I thought about becoming a physician.” She decided to pursue a career in pharmacy after discovering the variety of professional options and practice settings the profession offers.
The pharmacy school’s six-year program, leading to a Pharm.D. degree, requires that students spend their last year in nine rotations of five-week clerkships, which may include work at hospitals, pharmacies, community health centers or industry. Students who wish to practice in an ambulatory care setting can apply for a clerkship at the Chandler center, where they work in internal medicine with adult patients. The center accepts two students – chosen via a school lottery – per five-week rotation; 14 students have trained since the program began.
Students participate in the day-to-day therapeutic decision process with physicians, nurses, social workers and nutritionists. They begin by logging medications and researching drug interactions; later, they monitor and adjust medications and help patients navigate the complex maze of insurance plans and patient assistance programs.
Dr. Eric Jahn, medical director for 11 of his 13 years with the clinic, says that at the same time that the rotation expands the clinical teaching abilities of the pharmacy school, it also extends the programs the clinic can offer patients. The clinic does not have a pharmacy, he says, and Professor Morales and her students are an integral part of a team.
Disease management has become complex. “More and more, the therapies we offer require chronic disease management,” Jahn says. “The amount of medicine we recommend for conditions, such as diabetes, HIV or ADD in kids keeps expanding exponentially. A clinician alone cannot handle this – it takes a pharmacist to be part of a team just as nurses, social workers and nutritionists are.” Morales’ students even put together a newsletter for nurses and house staff that announces updates and highlights issues that come up in the pharmaceutical arena. “This has led to better patient care,” Jahn says.