ETSU Pharmacy White Coat Radio

On this episode of White Coat Radio, we're joined by two specialty pharmacists making an impact in Tennessee. Dr. Tabitha Sineath ('24), an ETSU Bill Gatton College of Pharmacy alumna who earned both her PharmD and MBA through the college's dual degree program, now serves as Lead Pharmacist at Walgreens Specialty Pharmacy in Nashville, where she is the Clinical Lead for Transplant and Chronic Inflammatory Conditions. She is joined by Dr. Katie Cox, who manages Walgreens Specialty Pharmacy in Knoxville. Together, they share insights into careers in specialty pharmacy, their work in women's health, and the real-world applications of their training.  Full transcript: Tabitha Sineath Because you take back bits and pieces from every experience, whether that be as a student on rotations to your first job or what you ultimately grow into. It's the bits and pieces that you know as part of your experience that truly kind of define you over time. So don't. My advice to students is don't give up on that and continue to kind of seek those out because you know in your heart where your passion lies, you have to make the pathway. Michele Williams Welcome to White Coat Radio, a podcast from East Tennessee State University. Bill Gatton College of Pharmacy in Johnson City, Tennessee. Each episode, we cover a wide range of topics about the pharmacy school experience, from study tips to deep dives with faculty and student pharmacists. I'm one of your hosts, Doctor Michelle Williams, assistant professor and director of academic success. Stephen Woodward And I'm Stephen Woodward, marketing and communications manager. Today we welcome Doctor Tabitha Sign at the 2024 alumna from Gatton, who, in addition to earning her PharmD, also completed our dual degree program to earn a master of Business Administration while she was here. That prepared her to now serve as leave pharmacist at the Walgreens Specialty Pharmacy in Nashville, Tennessee, where she is a clinical lead for transplant and chronic inflammatory conditions. Stephen Woodward But today, we have not one but two specialty pharmacies joining us. Doctor Katie Cox, who manages Walgreens specialty Pharmacy in Knoxville, also stopped by. Let's hear from them now. Doctor Cox, doctor Sineath welcome to White Coat Radio. Thank you all for coming out today. Katie Cox Thank you for having you. Stephen Woodward Can you start by telling us about your roles at Walgreens and where you work? Katie Cox Yeah. Tabitha Sineath So I am, lead pharmacist at our specialty site in Nashville. And, oversee primarily our transplant in chronic inflammatory condition patients. Stephen Woodward Okay. Katie Cox So I work at Walgreens as well. I manage the, specialty pharmacy structure at Walgreens is a little bit different. I mean, it's the site that's in Knoxville. And, what's called registered manager, local specialty. So I'm over the whole site. I'll own kind of your accreditation and specific accreditation, not just for specialty pharmacies, but it does apply, within the specialty pharmacy field. Katie Cox Then there's an M.O., which is a pharmacy manager, and what we traditionally think of as a pharmacy manager. And then they're all kind of structured differently, which is what I love about specialties. It's like each side is a snowflake. It looks a little bit different. So the Nashville site has care. Teams are a little bit larger site. We are a newer site. Katie Cox I launched our site in 2023. And then we've got five pharmacists now, but we don't have a specific care team, so we kind of all share and own the disease state since we've structured a little bit differently than Nashville. Tabitha Sineath Yeah. And we talk about care teams a little bit. That's just kind of a delineation of what type of disease state we're managing. So in in Nashville, we're a little more bucketed. We have a virology and oncology pharmacist who oversees those patients, neurology, who oversees, like migraine and seizures. And, I oversee chronic inflammatory in our transplant, which includes not only solid organ but stem cell. Tabitha Sineath And we have a unique partnership with Sarah Kane and clinic across the street, as part of the tri star network, to help those patients. And then we have a lot of miscellaneous specialty that kind of filters in, that don't really fit nicely into a bucket. So that's kind of where we all cross-train and help out. Stephen Woodward Okay, cool. Thank you. Michele Williams Yeah, that sounds great. So can can each of you tell us a little bit about what led you to specialty pharmacy? What it is about your your background, your work experiences, those kinds of things. And, Tabitha, if we could start with you, that would be good. Sure. Tabitha Sineath I started out, as a pharmacy technician for Walgreens, many years ago. I'm not going to say save a year, but, a few decades back, and, my path has not been linear in that sense. But I advance kind of to the top of my level as a technician and wanted to go back into pharmacy to get my pharmacy. Tabitha Sineath And always had been that drive in that pull for me. And finally just took the dive. But I think the catalyst for me was more of like a personal experience that led me to specialty. When I was trying to start our family and a lot of family planning, we realized that we would need a lot of additional help. Tabitha Sineath So in terms of, fertility specialty, we had to go through in vitro fertilization. And with that came a lot of specialty medications that, there was not great education around. And these are really expensive medications. And I, I said to myself, you know, there's got to be a better way to handle this for patients. And so that was really my draw to say, you know, this is this is my niche. 00;05;24;09 - 00;05;31;21 Tabitha Sineath This is where my passion lies. And that's really what I want to do. I want to help those patients, and have great outcomes. Michele Williams That's wonderful. Yeah. Katie Cox So, I also have a very nontraditional path towards pharmacy. When I was in undergrad, I studied chemistry and biochemistry, and I did research for the government on, carbon nanotube technology. I went to medical school, and I got, my medical doctorate, and then I had some health issues, and was trying to figure out how to restructure balanced life. Katie Cox For someone who is a high achiever, that can't work less than 120%, and we give you a lot of leeway for the optimal work life balance. I did not know I would have the additional years that I got so thrilled and pharmacy kind of looked like a great career to dovetail my chemistry biochemistry interest, along with what I had learned in medicine. Katie Cox And so, I finished pharmacy school and I went and graduated in 2016, and I started in, management. So I started out as a staff pharmacist, was not there very long and then started managing. I mean, it's 5 or 6 different sites, kind of jokingly say I was like the cleaner where they would send me to a pharmacy that maybe needed to implement better workflow or had some structure issues, or maybe had lost a really good leader and was trying to kind of figure out how to get back to where they were. Katie Cox And so I would kind of get us realigned and going well. And then specialty pharmacy, which I think is a great topic to talk about because I think a lot of times when you think of Walgreens, you don't necessarily think of specialty pharmacy. But it is a huge section of Walgreens. And I even when I started working for Walgreens, I did not know that we had specialty pharmacies. Katie Cox At that time, there was not one in Knoxville on the closest ones were either Nashville or Bristol, Kingsport. And so I took the opportunity to go and shadow at those sites and kind of see what it looked like. And it was a really great niche sort of space and community where you still do a lot of clinical work. Katie Cox And have long term interactions with your patients. I similarly had a fertility journey when my husband, we were trying to have our daughter and so helping patients navigate some of the fertility and understanding how much of the communication gets dropped off between the patient walking out of the physician's office and then coming into the pharmacy or getting the medications, and how probably a lot of the issues with our health care system are kind of this lack of continuity of care or like regular check ins with the same person who knows your history. Katie Cox And so I feel like specialty pharmacy fits so great into that space. And it's kind of under utilized in some capacities for patients both with billing access and then like long term management. And so I always like to include to you, like when I talk to students, they say, well what is specialty pharmacy like? Why is it special? Katie Cox And I kind of always joke, you know, it's it's an interesting and really great question to ask because there's not technically a specific definition of specialty pharmacy. Right. Medicare, Medicaid, our two biggest payers don't actually define specialty pharmacy, which kind of means that it ends up being defined by third party payers in some capacity, by manufacturers and access points and by some capacity, because there's drugs that are limited distribution drug, you can only get certain places. Katie Cox But a really good point like definition would be highly expensive, medications or medications that potentially would have chronic issues or adverse events that could occur because of the conditions that we're managing would make it more difficult to distinguish between like maybe an adverse event versus something that's happening with like multiple comorbidities. So it helps with tracking for data. Katie Cox So we learned in school, you know, about the four phases of studying drugs. And so I'll always talk about specialty pharmacy really fits into that post-marketing phase of study. And so always ask my students like how how did you decide. We tell patients 5% of patients have migraines, right? It probably wasn't the thousand patients we looked at in phase three is probably when it hit the market. Katie Cox And we were looking at phase four. Where do we where does that data come from? Right. And so specialty pharmacies usually provide data points. That go towards far more manufacturers and really also help us as pharmacists or clinicians tell patients about what to expect with the medications. But a lot of that is related to the adverse event reporting that we do. Katie Cox So we do track patients very much long term, talk to them on every refill, track adherence, track side effects, and then report that back so that that data can be used to help, you know, benefit patients in the future. And so it's really helpful. So you're kind of participating in the research around drug habit in specialty pharmacy, whether you recognize it or not, because there's so much data reporting that we do within the pharmacy industry, which is helpful in the long term for us to determine which patients should be optimally on that therapy, especially if it's an orphan drug or an unusual one that's going to have a small patient population using it. Katie Cox How do we get enough data to make that tractable for us to make better decisions in the future, when we're setting up guidelines or taking care of patients? Michele Williams I hadn't realized, although. Yeah. Stephen Woodward What does this what does your sites look like physically? Are they like the Walgreens on the corner, or does it look like something else? Tabitha Sineath Yeah, they're I mean, they're open door. So it's not, closed door pharmacy. We have patients that can come in and fill antibiotics if they want to. But primarily we serve more like a mail order type facility. Okay. Probably 95% of everything that we do goes out the door via Fedex. And that's just our courier that that we use. Tabitha Sineath But everything is communicated with those patients and, basically effectively shipped, so. Okay. But yeah, we have patients that walk in, in Nashville, we are situated very close to Vanderbilt University. So we have a lot of students that, even though there are two community sites that kind of flank us on either side, patients tend to find us either via walking route or some other way, but typically, our sites don't appear like a normal Walgreens, so you may pass it or you may just not even notice it in general, it's kind of very indiscreet. Stephen Woodward Okay. Tabitha Sineath And we don't have the big neon out front. And, you know, we always try to tell patients that are coming in to pick up either because of, you know, a delay. They don't want to wait for overnight delivery. I want to get started on therapy immediately. They're welcome to come in and pick that up, and we'll make those arrangements. Tabitha Sineath But we always for that visit. This is not your run of the mill big box. Stephen Woodward Yeah, I want to yeah. Katie Cox There's two. So there's two flavors of Walgreens specialty pharmacies. There's health systems and then there's community based. So health systems, what it sounds like do you located within the health system, usually inside a hospital. So within Tennessee we have one at Bristol. So the Bristol Regional Medical Center and then we have one in Kingsport. Those are both inside a hospital. Katie Cox Otherwise they're most often close to a campus, except for my site, which was the first or site in the company where a pharmacist flipped a retail site to a specialty site. So most specialty sites are built organically because the the structure inside the building looks different. I started with what was called a Cooper site, which was an ideal Walgreens had, where a lot of the, the, profit is made in the pharmacy. Katie Cox So it was a shrunken front end with a pharmacy and the main portion of it. And so we ended up converting that. So so what did we do? We gutted the front. So when you walk in. So ours is located in the strip mall, you'll notice, a lot of the community, specialty sites are located in the strip mall. Katie Cox And they'll say it'll say Walgreens Specialty pharmacy. But when patients walk in is when they notice a difference. So they might say, oh, Walgreens on the swing in here. And then they walk in and go, where's where's all your stuff, you know, and no, we have no friends. There's nothing. So there's just a counter. And then it's like, oh, I'm sorry, we only have like prescription medications here for you. Katie Cox And we do about the bulk of what we do. We also originally had a drive thru. We would close to that drive thru because, an a hole tell students when you come in and when you go to a normal retail site, where's the hustle and bustle? It's in the fill zone, right? Like if we're filling, we're checking prescriptions. Katie Cox We're counting at the window. When you're in a specialty site, the bulk of what we're seeing, the stress to you is a phone list that you're doing. And so you're going to see way more desks. You're going to see way more people on the phone. There's still patient interactions. It just looks a little bit different. And so anytime someone's been a traditional Walgreens pharmacist and they come to Cross-train in specialty, we kind of joke within the first hour, really high level, community pharmacists will go, oh, I see my skill set does not necessarily apply here because I'm used to the workflow structure being so different. Katie Cox And so it looks a lot different. So I always tell people, if you I hope you really enjoy talking to patients and having longer conversations, because that's kind of what we do here. And spend a good bit of time in doing a consultation with the patients. So before we dispense a drug, we do what's called an initial. Katie Cox And you may be on the phone with a patient for 30, 45 minutes, you know, very extensive discussions around the medications and what it might look like. And like we talked about before, continuity of care. Sometimes we're the first person really having a conversation with the patient about the diagnosis that they may have received. We have just found out I have multiple sclerosis. Katie Cox I've just found out that I've got Parkinson's. I've just found out I have cancer, you know, and now I'm talking to you all trying to navigate the drug aspect of this. And you're telling me very large numbers and lots of side effects, right. And so sometimes we call it kind of like a, we jokingly call it can like the specialty come down like you come in on the phone and then at the end we hope that you feel like, oh, I now understand a little bit of what I'm what I'm about to do and have some ownership in the process, being the patient in this and not feeling like I'm just kind of Katie Cox getting subjected to a lot of information and not knowing how to take like actionable next steps on it. And so example of that would be in specialty, which I think is a little bit different than a retail pharmacy is. We set a goal with the patient for every drug. And so how do we decide that that's the drug's working for you as an effective is it not effective. Katie Cox What does that look like? You know, we might have drugs that are very specific, like, oh, we're going to see a lowering of this lab, but you're not going to feel different versus another drug that might be, hey, this drug only allows you to live to a life of that. Right? So that's a good example I give to my students all the time, is that's a really specific drug that maybe we want a lot of adverse event data on, because while the drug is designed to let you live a little bit longer, unfortunately the condition that you have, most likely you will pass away when you're on this medication. Katie Cox So we want to make sure to tell them exactly specific of what to expect, what, how many days we think we're going to get and set a realistic and like logical goal for the patient. So maybe for a long drug, it might be I want to be able to play on Saturday when my grandkids come over, a lot of our pulmonary drugs, it's, my laundry room is downstairs. Katie Cox I can't do my laundry because I get out of breath. I have to sit down for an hour. So I want to be able to go down and come back up. And so I think it's really helpful in creating conversations for patients to determine, like, how do I decide this is going well, and then how do I use it appropriately to try to get the results that I'm talking to you guys about that are possible. Katie Cox And then even more so, maybe setting realistic expectations, right? Sometimes we feel like, particularly in this day and age, that we might have a cure all with a medication, and being able to set realistic expectations like, hey, this drug is going to help, with your liver, liver fibrosis, but we're also going to have to do like diet and exercise for you to achieve the goals that we're talking about and things like that. Katie Cox So that I feel like they really understand the process and can define what good would look like and how that might be different between different patients. Michele Williams That's very cool. So it's like really, really specific patient counseling relationships, talking about how the medication is really to a very specific degree. Katie Cox And then kind of gauging it based on the individual. Right. Something that we don't always in a lot of health care settings have the time to do. And that's one of the things I like about specialty pharmacy is you kind of have unlimited time. So I always joke to to my students, I'm like, it's like something so fantastic is something so terrifying, right? Katie Cox So somebody might go, oh my gosh, I can sit on the phone as long as I want. That sounds fantastic. And another person might go, oh, it sounds terrible. You know, I don't know where it's going to end. Right. And so it's like we're yeah, figuring out how to optimize it for what you feel like and how you want to be a pharmacist. Katie Cox And and that's one of the beautiful things about specialties. I feel like, like especially at a site like in Nashville, where you've been established for a really long time, you've got a lot of varied pharmacist roles at your site, and you can kind of gauge based on some of these goals and like what makes them happy at work, where you're going to pocket them for how much interaction they have with with patients and counseling versus leading to a team members versus, you know, like compounding or. Katie Cox Right. So you know, it's a beautiful profession because you can decide exactly what makes you happy during the day and then cater the role towards what you would you would want to get out of the day. Tabitha Sineath And there's so much variability even to between our care teams. I mean, I think the skill set for virology and oncology is very different from, say, miscellaneous specialty or somebody who's doing, a cardiac medication. And then we have, you know, non non-sterile, compounding that, we also do and we ship to ten different states. So with our site, we're dealing with patients from Maryland to Ohio to North Carolina. Tabitha Sineath I mean, it just varies all the way down to the south, Louisiana and Mississippi and Georgia. So our patients truly are all over, and really, I think you kind of hit on that. The beauty of what we do is the relationship building, because that in a sense, not only gets patients access, but it gets them engaged not only in their care, but also kind of what that outcome for them looks like. Tabitha Sineath And we can partner that with a lot of resources that we have the time and the functionality to do. And some of that is like the financial aspect because these medications are crazy expensive. Some of our neurology medications are about $100,000. Our, you know, hepatitis C treatment. You're looking at anywhere from 30 to 90,000, depending on which avenue in which vein we go down. Tabitha Sineath So, you know, in terms of like the payor aspect, you have to have great control, which is why access as many times is restricted just as specialty because of payers are going to be investing in that medication for that patient. They want to make sure that their outcomes are positive. So we do a lot of education and a lot of resource, facilitation with those patients to make sure that, you know, my goal is for them to walk out with zero. Tabitha Sineath So there's no out-of-pocket expenses to them. And we have access to grants and different foundations that can also kind of help funnel and provide those resources to make that happen. So when you talk to a patient who, you know, has a make applied prescription, that's $100,000, Tabitha Sineath That financial burden down to zero. I mean, that's that's the difference between, in some cases, life or death for these patients. Wow. Michele Williams So, thinking about our current students here again, what what sort of advice would you give? Student pharmacist who would be interested in going into specialty pharmacy? Tabitha Sineath I always say, if you can shadow get your foot in the door. Certainly work as a technician. Work in the field. That's going to give you the best access. You not only find out, is this really where you want to be? Because that's the most and part, the most important part of it. Nobody wants to, you know, show up day in and day out. Tabitha Sineath If that's not where your passion lies. Yeah. So finding that niche I think early on, is really helpful. But a lot of that begins with the proactive nature of that student. And then you have to step out of your comfort zone and say, this is something I'm interested in. How can I help facilitate that? You should network this around you. Tabitha Sineath Talk to people who are in that field. You know, we all have we all have connections. So it's really kind of navigating who, you know, and, drawing those, those webs together. Katie Cox You know, I get asked this question a lot by my students, and it's evolved over the last decade of me being a pharmacist. So I think when I was a newer pharmacist, I used to give the advice of like find a really good. And it's still not wrong advice. It's just evolved a little bit. I think in the beginning it was fun, a really good mentor and and make sure that you're like, find somebody who you feel like optimized in their career the way that you want to be, and then ask those questions and figure it out. Katie Cox And I think as I've been in the profession and trained a lot of students, I precept for for schools, I've recognized maybe two, just like how I define that for them, because we don't do a fantastic job in grad school, we're very focused on like making sure we enter the profession well, right. We're going to be good professionals. Katie Cox We want to learn what we have. And I kind of joke like we have we're really good at herd mentality, right? Like you're joining the profession of pharmacy, right? We're all joining this together. But self-awareness and like an individualized approach to your career is a trickier thing. And it makes sense because that's how we kind of do education. Katie Cox But I think a different way of saying find a good mentor is doing what you would like to in your career is saying find out, like become more self-aware of what makes you happy. So I always tell students when you're on rotations, and I know, you know, I always ask them their biggest fears to not like great on rotation around, but typically ask the question that I don't know the answer to. Katie Cox Well, let me tell you, you're going to get asked a question that you don't know the answer to. Precept. Every month I've teed you up so that I can teach you with the question. Right? So get over that hurdle and start thinking about what days when you're on rotations, do you leave and think, because we all have a day at work out where you leave and you're like, oh, I picked the right job. Katie Cox I'm so happy. I love what I do. This is a great day. And then equanimity of life, right? There's another day where you leave and you think, oh, oh shit, that's something else. I wish I'd opened that little shop I should have, like, learn how to do interior design. So you like, you know, it's like equanimity, right? It's both of those days. Katie Cox But I think there's if you can track like some trends to that, especially on rotation. That's the idea of rotations, right? The joke at school was always the moment you felt comfortable with where you were going, was the moment you were going to stop going there. Right about week 3 or 4, you start getting comfortable. You love the team you're with and and boom, it's like, oh, 48 hours later, you get to go on and like learn how to like adjust another month. Katie Cox That's a really great life skill to build on. And then recognizing when you're on those rotations, when you love the day or hate the day, what was it? Was it what you did? Was it who you were with? Was it your schedule? Was it the environment? You know, and then figuring out when with self-awareness like what that looks like, which is really hard with how we do grad school. Katie Cox Right? Like I joke, when I have most students, especially when I have a couple of them, I'll say before you make a decision, what do you do? Right? What do you do? You call your friend and you go, hey, I was thinking about doing this. Tabitha, what do you think about me doing this? You think I should do this? Katie Cox You think you should do this rotation? Do you think I should go and do this internship? You think I should take this job, right? We vet it from someone else. But. So I'll give the example. We have five girlfriends that all are pharmacists. We all have different jobs, we all live in different states and we all have different personalities. Katie Cox And so we all, so we have one who works at Kaiser Permanente. She's an inpatient doing it there. I have one who worked in a nonprofit HIV community clinic, that helps patients there. I have, me that means in a specialty pharmacy, I have someone else who manages a retail site. And we all have equal complaints because work is work, right? Katie Cox It's not one or the other, but we all have different personalities. So one of us loves talking to patients all day. Wonderful. One of us is like, no, I'm good on that. I'd like to lead over here in the office and not do that right. And she loves that. Right. And so I think sometimes we lose that in school, a little bit of of utilizing the APIs to learn about ourselves we get so stressed about like especially here at Gatton, like you're good, you're going to pass for that. Katie Cox Like you're going, you're going to be a pharmacist. So focus on being your happiest and best self and then figuring out how to use those APIs to figure out what is your best day look like. And then how do I figure out how to create a career for myself where I have the best day? And so I always tell my students, I'm like, I'm sure anyone can think of that one disgruntled person, right? Katie Cox He's like, well, I can't believe you went to pharmacy school, which I went through here, you know, waste your time. But it's probably not because of pharmacy, right? It's probably because they're not optimized to like, their self-awareness or their happiness. And so figuring that out early on and and then the other thing that I think is a really great piece of advice is careers aren't where they used to be. Katie Cox This is in the 40s and 50s where you picked your job, and that first job is the job you retired from, right? Like, you can move around in your career. And while change is hard for us as humans, I think it's great to be able to explore. So you're just looking for your first job, right? And then figuring out what you use that to leverage to the next. Katie Cox I'm actually my first job as a staff pharmacist, and I became a manager. Then I managed a bigger pharmacy. Then I decided I wanted to do specialty pharmacy. Now I manage a specialty pharmacy, and I'm hoping to launch that into managing more specialty pharmacies over different states. But so what's that next growth moment and like space moment for you and then figuring out how to optimize it for you as an individual. Katie Cox Instead of feeling like you need to fit yourself into the career of pharmacy. Tabitha Sineath I think those breadcrumbs along the way to kind of help like define what that pathway looks like, because you take big bits and pieces from every experience, whether that be as a student on rotations to your first job or what you ultimately grow into. It's the bits and pieces that you know as part of your experience that truly kind of define you over time. Tabitha Sineath So don't. My advice to students is don't give up on that and continue to kind of seek those out because you know in your heart where your passion lies, you have to make the pathway, but you have to be proactive about it. Katie Cox Yeah, I think when I was younger, I thought lifelong learner meant drugs. And now I'm like, no, no, no. It means so much more than that. It's not just the knowledge for like what you're doing in your work, but it's also like lifelong learner about myself, about my profession, about how to interact with patients and engage them and advocate for them and give them agency and what that looks like. Katie Cox And it changes over time as you change, but like recognizing that so that you don't get in there in a rut and think, well, I'm not happy now when I was well, you've evolved, you know, evolve your profession with you and you'll always be happy. Michele Williams That's such great advice. Yeah, that's really good advice. Stephen Woodward We've we really appreciate you all being here. I think that was a great note to end on. But, thank you all and hope to see you again soon. Katie Cox Absolutely. Thank you. Tabitha Sineath All. Thanks. Stephen Woodward Thanks for listening to White Coat Radio. If you haven't already, be sure to subscribe and leave this review. To learn more about ETSU Bill Gatton College of Pharmacy, visit us at ETSU.edu slash pharmacy or follow us on social media at ETSUpharmacy. We'll see you next time.  

We're joined in this episode by Dr. David Stewart, Associate Dean of Assessment and Academic Affairs. Dr. Stewart led Gatton's efforts to improve NAPLEX pass rates, resulting in the college ranking among the top five accredited pharmacy schools nationwide for the Class of 2025, as well as No. 1 in Tennessee and No. 2 in the Southeast. He shares his thoughts on the excellence of our student pharmacists, alumni, faculty, and staff, as well as the collaborative efforts that led to this success.   Transcript Introductory Teaser: David Stewart I think for a student that's either here at the College of Pharmacy or maybe thinking about coming to the Gatton College of Pharmacy. I hope it gives them confidence that when they finish our curriculum, they go through our training program, they're going to have the tools that they need to be successful as a pharmacist. They're going to be able to pass those exams. Main Episode: David Stewart They're going to be able to get a license. Michele Williams Welcome to White Coat Radio, a podcast from East Tennessee State University Bill Gatton College of Pharmacy in Johnson City, Tennessee. Each episode, we cover a wide range of topics about the pharmacy school experience, from study tips to deep dives with faculty and student pharmacists. I'm one of your hosts, Doctor Michele Williams, assistant professor and director of academic success. Stephen Woodward And I'm Stephen Woodward, marketing and communications manager. Today we welcome Doctor David Stewart, associate dean of assessment and academic affairs, as well as professor of pharmacy practice. He is an inaugural faculty member at Gatton, joining the Department of Pharmacy Practice in 2007. Doctor Stewart led the college's efforts to improve its NAPLEX Pass rates, and today he shares about that process, as well as his thoughts on the excellence of our curriculum, our students and alumni, as well as faculty, staff, and the collaborative efforts that led to the college's success. Stephen Woodward Doctor Stewart, welcome to White Coat Radio. David Stewart Well thank you. Thanks for having me as a guest today. Stephen Woodward So we have some big news that happened at the college a few weeks ago. Demanded just tell us what happened. David Stewart Yeah. So every January we get a report from the National Association of Boards of Pharmacy or in NABP and they give us licensing reports on our licensure exams, the NAPLEX, and North American Pharmacy Licensure Exam, as well as the Multi-State Pharmacy Jurisprudence Exam, also known as the MPJE. And these are the two exams that students need to take in order to get licensed as a pharmacist. David Stewart And so we're able to compare our results against the results of schools across the nation. And so for the second time in three years, we had a really high pass rate. I'm proud to say that our class of 2025 was the number five, school in the country for first time pass rate on NAPLEX amongst all accredited schools in the United States. David Stewart Also was the number one school in Tennessee and number two in the southeast with a 97.7%, first time pass rate on the network's exam. Michele Williams That's amazing. Stephen Woodward That amazing. David Stewart Yeah. And then, you know, the cherry on top of that is that exam I mentioned the MPJE, our in-state first time attempt, pass rate on that. We were number four in the country, number one in the state and number two in the southeast again. So really strong work from our graduates in the class of 2025 for sure. Michele Williams They really did a great job. David Stewart Yeah. And I think the exciting thing for me is this is a, you know, just one group. It's it's mostly the students. We tend to celebrate a lot around here. But really see, alumni from the class of 2025 that did all the hard work and took the exam. But it does represent a team effort. It's the, you know, the students, the graduates taking the exam are faculty, staff working as a team to set them up for success. David Stewart So really, really proud of everyone's effort. Michele Williams So, you mentioned the people behind the, the, pass rates, including our amazing students and our faculty and staff. But these successes also reflect some recent changes to Gatton's curriculum. Right? And so, what kinds of changes have taken place that sort of led to this success? David Stewart Yeah. So really, a couple of things. First, you know, we set out on a curricular revision. We've really been planning that revision since before the Covid 19 pandemic. Going back to the 2018, 2019. That did kind of put a damper on things. But in about three years ago, we launched a new curriculum. So our current P3 class is the first class that's, completely going gone through that new curriculum. David Stewart However, I will say that along the way, as we identified things that like foundational things that we needed to do better on a lot of that feedback from students after taking the exam or after going through our curriculum. Our faculty were really good, integrating small changes into our legacy curriculum. So I think that what we're seeing, even though these graduates weren't necessarily graduates of our new curriculum, they're graduating with a new curriculum philosophy in mind from the people that are delivering that curriculum to them. David Stewart So I do expect that things will only get better as we see graduates coming through our our revised curriculum, with our first class graduating in the new curriculum from, in 2027. Stephen Woodward And these recent results, as I've done, in my opinion, it's not just a one off like a few a couple of years ago, the class of 2023, they were ranked number two in the country for accredited pharmacy schools and number one in Tennessee and our region in the southeast. Right. So this is kind of part of continuing on from just incredible national recognition. David Stewart Yeah. And I think if you look back on the history of the Gatton College of Pharmacy, we've always been, you know, kind of at or above average, if you will, when about 4 or 5 years ago, we had, what I would say was a low point for us. I mean, we were right around the national average. David Stewart And, if you ask anyone here, our faculty and staff, no one's happy with average. We want to we want to have excellence in all that we do. And so we really embarked on this journey to improve our student success on those exams. And yeah, I think that class of 2023 that you referenced, there is a direct correlation with with some of those changes that we started 4 to 5 years ago about how to better prepare students for the exams. David Stewart Cool. Michele Williams So, what do you think these successes mean for the college and for students pursuing pharmacy? David Stewart Well, I think for a student that's either here at the College of Pharmacy or maybe thinking about coming to the Gatton College of Pharmacy, I hope it gives them confidence that when they finish our curriculum, they go through our training program, they're going to have the tools that they need to be successful as a pharmacist. They're going to be able to pass those exams. David Stewart They're going to be able to get a license. One of the newest things that we are doing that started last year with this class of 2025, is that we bring them back a month early, so they actually start their fourth year rotations or APPEs or advanced pharmacy practice experiences. In the month of April of their three year and then during the month of April of their four year right before graduation, we spend about four and a half to five weeks preparing them for the exam. David Stewart And that allows us to slow that process down and make sure that they have all the fundamental tools they need to be successful on that exam. I think the initial feedback, and that's been very positive, and of course, the results from this first class going through that model are very encouraging as well. So again, that's just another example of things that we're constantly changing and improving. David Stewart So if you're a student in our program or come into our program, you can rest assured that we're going to prepare you. And my goal, I tell them, in that training program, is that they're ready to walk across the stage and go the next week and take their exams and be licensed as a pharmacist without delay. Michele Williams So, Doctor Stewart, I know that this is a team effort. Certainly. But you were really the architect of this preparation program that you just described. Can you tell us a little bit more about your, your objectives in developing this program and, and how you put that program together? David Stewart Yeah, that's a that's a great question. And, and really speaks to I think it's something that's really important that we had to talk about and work through as a faculty and staff. I mentioned earlier about our our faculty and staff are always focused on excellence. And I think one of the initial, you know, knee jerk reactions when you start talking about exam prep is making sure you're not just teaching an exam, but we want our students to get the necessary skills that they need to go out and be successful. David Stewart Pharmacists in making a positive impact on health care and the profession of pharmacy. And so I feel like we really found a sweet spot where we made sure that what we were teaching in the classroom, was, was sound that we were getting those fundamentals in. But as we talked to students, one of the things I did early on is we started revision to this program was just gathered data. David Stewart What were the barriers that students were facing as they struggled with these exams? And there's just so many factors out there. Things like, for example, many students come to us now without taking the traditional standardized exams. A lot of folks don't know that. You know, SATs and Acts are not necessarily required for college admissions anymore. Several years ago, they, took away the, PCAT exam, which is the equivalent of the mCAT exam for medical school. David Stewart So some of our students, we realized, had never actually taken a high stakes external standardized exam before. So some so a lot of this wasn't necessarily that they didn't have the knowledge that they needed. They didn't necessarily know how to tackle a 5 to 6 hour, really large, standardized exam. And so some of the things we did was just prepare them for that exam process. Michele Williams So the environment you try to mimic that testing environment to give them a sense of so they're not surprised by it or they're not thrown off by it. David Stewart Yes. When we collected data from our first class that went through some of the revisions I've talked about, and this was about four years ago, one of the things they rated as the most effective in our program was a simulated nap. And at that point in time, we were able to put that together through practice exams that were offered through NABP David Stewart And now there's a new product from NABP called the NAPLEX Advantage, which we use for our students. It gives them more data. It gives us more data based on their performance. But it's basically a practice exam so they can take a simulated Nap exam beforehand. In addition to just taking that practice exam, we really strive to simulate the entire experience so the student knows what it's going to be like from the time that they pull up in their car, in the parking lot of that testing center, to the time that they walk out, that they're not surprised by anything in there. David Stewart So they're prepared and they can focus on the exam, in performing at the level that that they can perform at, versus being distracted by things that, that they didn't necessarily know were going to happen, like, oh, they're going to take my phone and put it in the locker. Oh, I have to turn my car keys in. David Stewart Oh, I forgot my driver's license. It's in the glove box of the car. It's just those little things that can get students flustered on exam day. And what we were hearing from students that weren't used to that or didn't expect that, is that made a big impact on their ability to think and perform well on the exam. Michele Williams That can really throw you off your game if you don't know how regimented that environment is. David Stewart Well, if you look at, you know, any you get high performing athletes. As an example, you can bet that they're simulating the game environment. They're preparing for that big game, whether it's the Super Bowl or the World Series or whatever. And we're trying to do the same thing for our students. We want to simulate that environment. And have them as prepared as possible for those things so they can focus on doing what they need to do. David Stewart And that's, using their knowledge to perform at their highest level on the exam. Michele Williams I think that's great. And then how did you put together the other elements of the the preparatory program? David Stewart Yeah. So the very first class, that, that I helped to go through the exam process, we did an assessment after the fact. And one of the things, that that is unique about, our data set, and we're in the process of publishing these data so that others can benefit from this is there's a lot of information getting students opinions and perceptions. David Stewart Preparatory materials or courses as they're in school before they take their exam. We actually surveyed our graduates after they sat for the NAPLEX exam. So their perspective may be different. And we found in some ways it offers additional information than a student who hasn't taken the NAPLEX exam. So then we use the information we got from those graduates after they took their knapsacks, asking them what components of our program set you up for success? David Stewart What was effective? What was less effective? And then each year in an iterative process, we make minor changes. But really the things that they said were the highest impact. The back to the the simulated exams, and then some of the, preparatory content that we provided for them. And then things that were less effective, like, for example, at one point we had faculty meeting with students every week during their fourth year. David Stewart The students told us that's really not effective. We don't feel like it helped as much as other things. So we've taken that away. It's less burdensome for the students. It's less burdensome for the faculty. Yet we're seeing a continual rise in our scores because we're focusing on the high impact interventions that we can make. Michele Williams So that constant feedback from students and at various points along the way have really informed the way you put this program together. David Stewart Yeah. We've really we've really room for a data driven approach to do all that we do. And looking at, you know, not just what do other people do but other people who have successes, what are they doing? You know, looking at your data from people that are in a position to tell us this is what was helpful for me to be successful on this exam. David Stewart And we're incorporating those things. Not that other perceptions aren't important, but we feel like those perceptions are more valuable in getting the outcome that we want, which is our students being successful on those exams. Michele Williams So it sounds like it's about a lot more than just, you know, the the content, the questions. It's it's the totality of the experience of being prepared for the exam. David Stewart It is. And I want to reiterate that this is really a curricular experience that starts in the P1 year. Yeah. And some of the things that we do are actually going back and reinforcing things like pharmacy calculations. Yeah. They're oftentimes questions on the exam are mirrored in the practice models that students are in in their fourth year. David Stewart And so we want to make sure that they know how to do those types of calculations. And if and when they show up on the exam. We also recognize that there are some things that our students do over and over and over and get really good at. But, for example, they probably are really good at taking care of patients with diabetes and heart failure. David Stewart Those are chronic diseases that we see a lot here in rural Appalachia. But not all of our students feel, real comfortable about, calculations around, nutrition support in an inpatient hospital setting. Yet there are questions about that on the exam. Had it in the curriculum, but they've not practiced it day in and day out. So we're just getting them. David Stewart I would I would say we're getting them reps on the types of things that they may not be doing every single day on rotations, that that we know are going to be on that exam so that when they see those questions, they're comfortable and able to appropriately, you're accurately answering them. Michele Williams So sort of a broader approach so that they don't get, you know, too much of a certain type of question, but kind of broader look at the content. David Stewart One of the things that I will tell the students is you can't re learn everything in our curriculum during your fourth year. There's a lot of things that you already know, as a fourth year student pharmacist, one of the goals of our program is to help our students self-assess what they know and then what areas they need to work on more, and then encourage them to focus their study time on the areas that they need to, that they need more work in. David Stewart And so it's not going to be the same for everyone. So while our program is somewhat of a one size fits all in that they all go through it in the same way, a lot of what we're coaching them and mentoring them on throughout the year is that self-assessment of don't waste your time studying the things that you know and are comfortable with. David Stewart I think, Doctor Williams, you probably see this in your own work as director of academic success and in my experience with students on rotation, was if a student understood, say, the pathophysiology and treatment of diabetes really well, they always wanted to talk about diabetes. They wanted to do their their presentations about diabetes. They wanted to pick up all the patients in the clinic or on the service that had the disease, diabetes, because they were comfortable with that. David Stewart One of my goals in this preparatory program is to get them to start focusing on the things they're comfortable in, and spend more time studying the areas that they're uncomfortable with so that they're prepared for that rigorous broad exam that ask questions across a plethora of disease states. Stephen Woodward Well, it's been really great talking with you, Doctor Stewart and seeing how Gatton is leading in licensure pass rates not only at the state level but on the national level. This is just been that's really exciting news. So we appreciate you coming out today. David Stewart Yeah. Well thank you. Thank you for having me. And again, just a shout out really to the graduates. Just the class of 2025. And we mentioned our graduates from the class of 2023 as well. They put in a lot of time and a lot of hard, hard work. So, the huge congratulations to any of our alumni that are out there listening today. Stephen Woodward Yeah, absolutely. Thanks for listening to White Coat Radio. If you haven't already, be sure to subscribe and leave this review wherever you listen to podcasts. To learn more about East Tennessee State University Bill Gatton College of Pharmacy, visit us at etsu.edu, slash pharmacy or follow us on social media @ETSUPharmacy. We'll see you next time.

We're joined in this episode by Dr. Ralph Lugo, Senior Associate Dean and Professor at East Tennessee State University Bill Gatton College of Pharmacy. He has been with the college since its founding, joining in 2006 as the founding Chair of the Department of Pharmacy Practice and serving in that role for 17 years before being promoted to Senior Associate Dean. Dr. Lugo discusses the role of AI in pharmacy education, including both the benefits and risks of the technology. He also reflects on the college's 20th Anniversary, how Gatton has grown and evolved over the years, and where he believes it is headed in the future.

In this episode we chat with first-year student pharmacist Maddie Stacey, who found confidence — and a community — through ETSU Gatton College of Pharmacy's Early Admission Pathway. A native of Kingsport, Stacey learned about the college's EAP program while in high school. For her, the program has made the adjustment to pharmacy school much easier.  Open to high school seniors and first-year ETSU students, the Early Admission Pathway enables students to earn both a Bachelor of Science and a Doctor of Pharmacy degree in just six years. EAP students also join the college's Pre-Pharmacy Student Organization, designed to introduce them to different specialties in pharmacy and to foster connections with their classmates. Learn more at www.etsu.edu/RxEarlyAdmit.

The Student Success Coordinators at ETSU Bill Gatton College of Pharmacy are dedicated to supporting pharmacy students throughout their academic journey. Whether through connecting students with tutoring, setting up labs, or offering general support to students and faculty, the coordinators play a crucial role in fostering a positive and successful experience for all of pharmacy students. Hear from Justin White (P1 Coordinator), Kerstin Kromker (P2 Coordinator), and Lindsey Feltman (P3 Coordinator) in this episode.

In this episode we chat with Steve Ellis, Assistant Dean of Student Affairs at ETSU Bill Gatton College of Pharmacy. After Gatton was founded in 2005, Ellis played a key role in the college's early development, officially joining in 2008 to lead the Office of Student Affairs. This office supports students throughout their entire journey—from recruitment efforts starting as early as high school, to current student services, and even alumni engagement after graduation. Ellis also serves on the college's Executive Committee and has held leadership roles at the university level. Steve recently celebrated his 30th anniversary working at ETSU and was honored with a special scholarship in his name to support students. You can support this scholarship by visiting our Gatton donor page: Under Designation, select "Write In Your Choice," and type in "Steve Ellis Scholarship."

In honor of American Pharmacists Month, we sat down with Dr. Anthony Pudlo, Chief Executive Officer of the Tennessee Pharmacists Association (TPA). Dr. Pudlo leads an organization that advances, protects, and promotes high-quality, pharmacist-provided patient care in the state of Tennessee. In this interview he talks about the importance of TPA, the state of the profession, and advice for students. Learn more about TPA on their website, tnpharm.org, or on social media.

In this interview with Dr. Jim Thigpen, Associate Professor of Pharmacy Practice at East Tennessee State University Bill Gatton College of Pharmacy, we discuss his pharmacotherapy course and how to succeed, leadership in pharmacy, and Dr. Thigpen's favorite pastime: fly fishing!

Check out Part 2 of our interview with Dr. KariLynn Dowling-McClay, Assistant Professor of Pharmacy Practice at East Tennessee State University Bill Gatton College of Pharmacy. Dr. Dowling-McClay discusses some of the exciting research opportunities for student pharmacists.

Check out Part 1 of our interview with Dr. KariLynn Dowling-McClay, Assistant Professor of Pharmacy Practice at East Tennessee State University Bill Gatton College of Pharmacy. Dr. Dowling-McClay explains professional identity formation, imposter phenomenon, and the role those play in the lives of student pharmacists. She also shares her own journey to becoming a professional pharmacist. 

On this episode we chat with Dr. Chris Lopez, co-owner and lead pharmacist of Mooney's Pharmacy in Johnson City, Tennessee. He is a Class of 2014 alumnus of East Tennessee State University Bill Gatton College of Pharmacy. Among the wide range of topics we cover, Dr. Lopez dives deep into what it's like being a community pharmacist, how the profession has changed, steps to become a community pharmacist, and the impact his pharmacy made in partnership with Gatton on Hurricane Helene relief efforts in the region. For the video version of this interview, visit www.YouTube.com/@etsupharmacy and head over to our White Coat Radio playlist. 

We continue our conversation with Dr. Jessica Burchette, Associate Professor of Pharmacy Practice at East Tennessee State University Bill Gatton College of Pharmacy, and dig deeper into the pharmacotherapy and patient care course. She is a clinical pharmacist who helped lead the recent curriculum changes at the college.

Check out Part 1 of our interview with Dr. Jessica Burchette, Associate Professor of Pharmacy Practice at East Tennessee State University Bill Gatton College of Pharmacy. She is a clinical pharmacist who helped lead the recent curriculum changes at the college. 

Hear from Dr. Shelby Brooks, one of the newest editions to faculty in the Department of Pharmacy Practice at East Tennessee State University Bill Gatton College of Pharmacy, and learn about her clinical interests as well as her obsession with Harry Potter!

Listen to this interview with Class of 2022 alumna Dr. Kaitlyn North, who returns to her beloved East Tennessee State University Bill Gatton College of Pharmacy not to visit but as one of the newest editions to faculty in the Department of Pharmacy Practice.

In this episode, we talk with Dr. Alex Surbaugh, one of the newest editions to faculty in the Department of Pharmacy Practice at East Tennessee State University Bill Gatton College of Pharmacy.

In this special bonus episode, we hear an inspirational speech from alumna Dr. Melissa McCall, who graduated from the inaugural Class of 2010 and recently spoke to the Class of 2028 at their White Coat Ceremony in August 2024. Dr. McCall serves as the Pharmacy Professional Services Manager at Food City/KVAT Foods and oversees daily operations for 31 Food City Pharmacy locations.     In addition, she completed her undergraduate pre-pharmacy coursework at ETSU and holds a Master's Degree in Business Administration from Milligan University. In 2018, former Gov. Bill Haslam appointed her to one of the highest pharmacy positions in Tennessee— serving on the Tennessee Board of Pharmacy.   

In this episode, we talk with Carolina Davis, a third-year student pharmacist at ETSU Bill Gatton College of Pharmacy who recently served as the inaugural Executive Intern at the Tennessee Pharmacists Association (TPA). TPA is a membership organization serving all pharmacy professionals, student pharmacists, and pharmacy technicians in Tennessee and advances, protects, and promotes high-quality pharmacist-provided patient care in the state. Our student pharmacists frequently have opportunities to attend TPA meetings throughout the year, which are important for professional and leadership development.

In this episode, we talk with Mary Little, Director of Disability Services at East Tennessee State University. Little is the point of contact and a vital resource for our students and faculty when determining student eligibility for accommodations at ETSU Bill Gatton College of Pharmacy.

In this episode, Michele and Dan talk with our new Student Success Coordinators at ETSU Bill Gatton College of Pharmacy. Get to know Justin, Kerstin, and Lindsey, and learn more about what they do to help students succeed in pharmacy school.

In this episode, we talk with Dr. Stacy Brown, Professor of Pharmaceutical Sciences at East Tennessee State University Bill Gatton College of Pharmacy about the Process Oriented Guided Inquiry or "POGIL" teaching strategy.  In addition to being a POGIL expert, Dr. Brown is an award-winning educator and researcher.  She teaches Medical Biochemistry and Medicinal Chemistry and serves as the Interim Chair of the Department of Pharmaceutical Sciences at Gatton.  

On this episode, Dan and Michele talk with Dr. David Cluck, Associate Professor in the Department of Pharmacy Practice at ETSU Gatton College of Pharmacy.  He specializes in Infectious Diseases Pharmacotherapy, and is the course coordinator for the Infectious Diseases course in the Integrated Series  Dr. Cluck shares his advice for success in this challenging course! 

Bienvenidos al White Coat Radio! a podcast from East Tennessee State University Bill Gatton College of Pharmacy, in Johnson City, Tennessee. In this episode, Dan and Michele talk with Gatton student pharmacists from the beautiful island of Puerto Rico to learn more about why they chose Gatton. 

This episode features Dr. Lori Mills, a clinical psychologist who is an expert on mood and anxiety disorders, as well as positive psychology. In addition, she provides counseling services to our student pharmacists at ETSU Bill Gatton College of Pharmacy. Dr. Mills shares valuable advice on how to manage stress and anxiety in order to thrive in pharmacy school.

Michele and Dan continue the conversation with Dr. David Stewart, Interim Associate Dean of Academic Affairs and Institutional Excellence and Professor of Pharmacy, about his role as the head of Academic Affairs at ETSU Bill Gatton College of Pharmacy. In this episode, we discuss services the department provides including insights into academic progression and student course evaluations. 

In this episode, Dr. David Stewart, Interim Associate Dean of Academic Affairs and Institutional Excellence and Professor of Pharmacy Practice, talks with Michele and Dan about the Integrated Series at ETSU Bill Gatton College of Pharmacy and offers important context and advice for success in his cardio course. 

On this episode of White Coat Radio, we learn the steps to better sleep for pharmacy students. Dr. Sarah Melton, a board certified psychiatric and ambulatory care pharmacist, and Dr. Jeff Gray, who specializes in the care of advanced age patients with acute and chronic conditions are both professors in the Department of Pharmacy Practice at East Tennessee State University Bill Gatton College of Pharmacy in Johnson City, Tennessee. They offer insights into the effects of poor sleep hygiene on learning and performance, as well as practical advice for sleeping well.  Note: This episode discusses medication and health conditions and is for informational purposes only. Proper diagnosis and treatment of health conditions depends on a number of factors. Your doctor or other licensed health care provider is the best person to address your individual health care needs.  

In Part 2, Dr. Katelyn Alexander, Director of Experiential Education at ETSU Bill Gatton College of Pharmacy in Johnson City, Tennessee, goes deep into the context and purpose of experiential education and offers insights and perspective from the preceptor's point of view.

In this two-part episode, we hear from Dr. Katelyn Alexander, Associate Professor of Pharmacy Practice, who serves as Director of Experiential Education at the ETSU Bill Gatton College of Pharmacy in Johnson City, Tennessee. In Part 1, Dr. Alexander gives us a comprehensive introduction to Experiential Education and what students need to know to get the most out of all of their IPPE's and APPE's.

In this episode – The “Pond” Cast, Dan and Michele talk with Dr. Brooks Pond, Professor of Pharmaceutical Sciences the Bill Gatton College of Pharmacy and recipient of ETSU's Distinguished Faculty Award. Dr. Pond talks with us about her fascinating research into the effects of psychostimulant use on the brain, and tips for being successful in her Human Physiology course.

In this episode, Dan and Michele interview Dr. Adam Welch, Associate Professor of Pharmacy Practice at the Bill Gatton College of Pharmacy and nationally recognized vaccine expert. We learn more about his Medication and Terminology Course as well as his work providing COVID-19 vaccinations to thousands of East Tennesseans through multiple vaccine clinics in the region.

Dr. Ashana Puri talks about her fascinating research into transdermal drug delivery systems and keys to success in her Pharmacy Calculations course.

Our inaugural podcast welcomes the Class of 2026 to the Gatton College of Pharmacy with advice, encouragement, and inside info.