In 2019, we live in a world where drugs are manufactured for the masses. There is a pill for all kinds of common diseases, and many drugs are virtually a copy of each other. Scientific breakthroughs result in lifesaving medications and all the patient has to do is pop a pill. Back in the early days of pharmacy, however, medications were compounded by the pharmacist and dispensed to each patient as solutions, elixirs, tinctures, and creams. Rather than a standard pill, the active ingredient and its dosage form were individualized, or compounded, to meet each patient’s specific needs. While we are currently in this phase of mass manufacturing medications, futurists predict that as we uncover the secrets hidden in each person’s genetic make-up and develop new technologies, we will be able to more efficiently personalize medication regimens. We are learning why not everyone has the same response to a drug; with greater efficacy in one patient and more side effects in another. This is all due to detailed differences in our bodies and as we learn to read the markers in DNA, we will be able to, once again, return to that patient-specific approach to medicine. 

 

Just as the origins of pharmacy are rooted in the practice of compounding, my professional beginnings stem from compounding as well. Compounding is simply defined as “To combine so as to mix to form a whole.” The process of compounding begins with an ingredient list and instructions, much like a recipe. The compounder becomes more skillful with practice and learns how to move artfully from step to step as they produce the final product. SCCP 790 taught me that compounding medications allows pharmacists to create a final product that recognizes and meets the need of each patient. Furthermore, the process is about blending the right ingredients together in the right way. These concepts were personified in the leadership challenges I experienced when I became a teaching assistant for this very same lab the following year. 

 

As a teaching assistant (TA), I was suddenly on the other side of the student-faculty relationship and had an inside look at the leadership and work that goes into ensuring a group of individuals comprehends the course material. As the students compounded medications in the lab each week, it was up to me to answer any questions the students may have and help them produce appropriate final products by the end of the class. This was not always easy and often times the same students were struggling each week. Some students were prepared and professional about their work, while others were disorganized or distracted by their friends throughout the lab. I quickly realized that I would need to individualize my approach to each student’s learning to maximize their progress in the class. Metaphorically speaking, I needed to individualize my approach to each student and create a blend of competent students resulting in a satisfactory class as a whole- just like compounding!  

 

When I look at the instructions for a compounded medication, my brain naturally assesses each step and comes up with the most efficient way to create the medication needed. If I have to heat the cream’s base for 3 minutes, I look ahead at the next step or two to see what else I can be doing while the ingredient heats. Maybe I clean up the mess I’ve already made or answer a question on the accompanying worksheet. No matter what, I am always optimizing my time. When I began paying more attention to one struggling student, I realized they were standing idly by during some time-consuming steps in the instructions. By offering suggestions about how to optimize these moments, the student eventually began thinking ahead and working more efficiently. I realized that as a leader it’s important to not make assumptions about the capabilities of your teammates. By talking to this student, I was able to recognize how I could help change her thinking to optimize her capabilities and be there to check in if she needed reminders to stay on track.

 

By approaching each student on an individual basis and reserving my judgements, I was able to become a better advocate for my students in the future. An example of this was when another student in the class always struggled on the weekly quizzes. Our professor began to take notice of the less than stellar grades and we began to interpret poor performance as a lack of ambition and respect for the material. One day I saw the student outside of class and tried to get to know her better. During the course of the conversation, she expressed concern about passing the class and shared that she worked a long shift the night before lab each week. We discussed strategies to plan ahead or consider changing her schedule at work. The next time I was in lab, the professor was deciding whether to bring the student in for a discussion about her quiz scores.  I was able to advocate for the concern the student showed and the changes she was trying to make. By taking the time to explore the needs and barriers facing my students, I improved as a leader and an advocate. It wasn’t until the following summer that I connected how a similar approach is needed to serve patients as a pharmacist. 

 

Toward the end of my year as a TA, the professor asked if I would attend a conference in June that allowed pharmacists and student pharmacists to advocate for patients who rely on compounded medications. After the New England Compounding Center distributed harmful compounded injections to patients across the country, federal regulations were swiftly enacted as a way to protect patients from potentially harmful compounding practices. As a result of these hasty regulations, some patients were actually unable to get the compounds they relied on in the past. During this conference I had the opportunity learn about regulatory issues in Washington, D.C. and hear patient stories. Their needs and the barriers they face were not well understood by the government, and it was up to me to play a role in bridging that gap on behalf of the patients. After two days of learning about the issues and hearing from key stakeholders, I had the opportunity to advocate on Capitol Hill for these patients, and the pharmacists who provide for them. Just as some of my students needed individualized attention in class, there were patients out there who needed to maintain access to these specialized medications in order to stay healthy. Being a teaching assistant taught me how to advocate for the needs of others, and I will continue to fight for my team as a leader throughout my career.