The Impact of COVID-19 Through the Eyes of a Fourth-Year Pharmacy Student

Abstract

This commentary, written primarily by a recent pharmacy graduate, discusses the impact of COVID-19 on the class of 2020. Everyone has been impacted by COVID-19, but pharmacy students have been affected by and experienced COVID-19 in unique ways. This was the first class to complete pharmacy practice experiences in an online format, miss out on milestone events including graduation, and face uncertainty about becoming licensed and entering the job market in the midst of a pandemic. However, instead of discouraging them, these events have in many ways strengthened the resilience of the class of 2020. Additionally, COVID-19 has highlighted the importance of continued advocacy for the profession and articulation of the pharmacist’s expanded role and value to the health care team, and inspired the class of 2020 to join the ranks of colleagues nationwide in raising awareness in these areas. Nevertheless, uncertainty over their future and that of their peers lingers as COVID-19 has forever changed pharmacy education and practice.

I grew up crawling on the floor of my parents’ pharmacy, so you could say pharmacy is in my blood. After four fast years, I found myself “graduating” from pharmacy school and writing this commentary about the effects of the COVID-19 pandemic from a student’s viewpoint. Graduation for the class of 2020 will always be in quotes because finishing pharmacy school amid the COVID-19 pandemic made it different. My peers and I were looking forward to completing our last advanced pharmacy practice experiences (APPEs) and to the celebrations that surround graduation, but our time together was cut short. For students still completing the didactic portion of their curriculum, learning the already difficult material was made more challenging by the abrupt shift to online delivery. As I look forward to my career as a new graduate and early career pharmacist, I can see how this pandemic has impacted academic life for pharmacy students, including myself, changed my perception of the pharmacy profession, and created new hope moving forward.

An inability to complete my APPEs was the first significant change I personally experienced as a result of the COVID-19 pandemic. All APPEs were halted because of safety concerns and shortages of personal protective equipment. Many students nationwide were pulled from APPEs in hospitals and other clinical areas, missing valuable experiences they had looked forward to for months, like my international APPE to experience community pharmacy in another country. Other students remained at theirrotation sites for longer while the true scope of COVID-19 was being realized. Truthfully, I am not sure which students felt more awkward. My classmates and I were forced to quickly adapt to an online experiential rotation format in order to complete the required hours to graduate. We are grateful for the hard work of school administrators, pharmacy faculty members, and preceptors to create this experience seemingly out of thin air and for not having our careers and plans further altered by a delayed graduation. However, this transition was not without cost. Online learning and working remotely were challenging, especially re-envisioning how to collaborate on and deliver patient care. Additional challenges included the lack of camaraderie, and the difficulty of finding a work-life balance for many of us who had to move back to our childhood homes.^1,2 The physical isolation, worry for loved ones, and anxiety for the future caused by this pandemic have taken a toll on pharmacy students’ mental and physical well-being. The class of 2020 faced this in addition to the usual stresses that accompany graduation, such as meeting licensure requirements. Those students, like myself, who have been removed from experiences that required live patient contact have felt guilty for staying safely in quarantine and not serving our community alongside our pharmacist mentors and soon to be peers. Our final online assignments seemed inconsequential in the midst of a pandemic, given the knowledge and training that we possess. This passionate desire to help people is at the very core of why I and many other students chose this profession. As COVID-19 is transforming our profession and future, we aspire to become involved in patient care and engaged in the community.

As previously mentioned, the COVID-19 pandemic altered the final chapter of my pharmacy education. Milestones and a spring calendar full of celebratory events including residency match day parties, awards ceremonies, and graduation were canceled, although some were held virtually. These celebrations, in themselves, are important because they give meaning to our efforts and allow us to recognize individual and collective achievements.³ The absence of these celebrations also prevented me from having closure because I was unable to congratulate my peers, embrace my friends, and thank my mentors. It does not even feel like the class of 2020 “graduated.” It felt surreal, like a dream we would eventually wake up from, but instead it is reality. It is strange reflecting on complaints we once made like only being issued “11 tickets” for family and friends to attend our graduation, a number of people which ironically would now be in violation of social distancing orders that only allow small groups of 10 or fewer.⁴

As I look past graduation to becoming a licensed pharmacist, several questions linger. Almost immediately there was concern surrounding fingerprinting requirements for licensure during quarantine. With public places being closed this made being fingerprinted impossible and even with restrictions lifted social distancing further complicated getting fingerprinted. This only increased the chances for postponements to licensure, which could impact graduates’ income, residency status, etc. Furthermore, the pandemic has made communicating application questions to state boards of pharmacy more difficult because people from those offices are also working remotely. Simple questions that could have been answered by a phone call now take days to get answered. Finally, many testing centers for the North American Pharmacist Licensure Examination have been closed or are operating at a lower capacity. Fortunately, many testing centers have opened to provide “essential services” among which administering the pharmacy licensure examination was included. As a result, in many instances, the ability to practice as pharmacists has also been delayed for many Doctor of Pharmacy (PharmD) graduates. This is worrisome and has made our situation as new graduates difficult because our future employment and career plans that we have worked toward for years require that we be licensed. Equally concerning is the uncertainty incoming PharmD students and those who were in earlier years of the program when the pandemic began must feel given that pharmacy education in the fall will probably remain a large question mark right up until classes start.

Becoming more self-aware and reflecting on the difficulty of living through this experience, I know that I have grown personally and professionally during this time. I have cultivated greater intentionality with friends whom I previously merely spoke with in passing. As fourth-year students, we were scattered across the state, country, and even the world while completing our APPEs. This made getting together with classmates difficult even last fall, before the pandemic began. I would like to think if we had known at that time what the future held, we would have been more deliberate about getting together and savored our last times together as a group regardless of circumstances. I have learned that human connection matters more than how it takes place. Finally, I have learned the importance of focusing on things for which I am grateful and with the impact of gratitude on my wellbeing.⁵ I am grateful for the opportunity to spend this time at home with family before moving across the country to begin my residency. I am grateful to be able to continue my postgraduation plans. I am grateful that the reason being separated from my pharmacy circle hurts so much is because I have relationships worth keeping. I am grateful for the four amazing years I was able to spend with mentors and classmates. That is the thing about this pandemic, it has emphasized the important aspects of life, things we may have taken for granted in the past.

In the midst of this self-reflection and personal growth, there are also opportunities for progress as a profession. The COVID-19 pandemic has highlighted the fact that we are an overlooked part of the health care team.⁶ Even though pharmacists are the most accessible health care members,⁷ no one can seem to articulate what pharmacists actually do and the value we bring to the medical community. As pharmacies remain open and pharmacists, patients, and customers attempt to maintain appropriate social distancing, misperceptions of the pharmacist’s role and necessity are perpetuated. These misperceptions only add to and expose the fissure lines seen in our profession, particularly regarding the pharmacist’s role in community practice. It angers me that pharmacists are being placed in situations where they are asked to practice without additional staff members, proper cleaning supplies, or even adequate personal protective equipment.⁸ It saddens me to know that pharmacists are on the front lines living in fear of what contracting COVID-19 could mean to them and their family members. For my parents, it would mean closing our family business and the loss of employees' jobs. For other pharmacists, it could mean not being able to find anyone to take over their shift and, subsequently, the loss of their job. Many pharmacists cannot stay home because of financial pressures, while others feel they cannot abandon their patients. The pressure to continue working while sick is evident. It is equally frustrating that policy leaders seem largely unaware of pharmacy’s contribution to health care. In April 2020, Senator Chuck Schumer revealed his plan for the Heroes Act in which he defined pharmacy as an “essential service” but not part of the “medical profession.”⁹ As an Academy, these events illustrate some failures and should be our ultimate call to action. Legislators who draft policies that affect our profession do not understand our importance and value to the health care team. The profession must do a better job of advocacy. It is time to talk to legislators, educate them, and make sure our voices are heard. This period of uncertainty may prove to be the time to reinvent our profession. I hope we become a profession that clearly articulates and ardently advocates for the value we bring to patients and the health care team. For far too long we have let this misconception of our practice slide and the class of 2020 is eager to join alongside our pharmacist colleagues in correcting this.

In spite of the challenges posed by COVID-19, there have been positive outcomes. For instance, part of the difficulty in pharmacy school is learning resilience. Pharmacy schools often struggle to teach beyond surface concepts in areas like problem solving, advocacy, leadership, and innovation.¹⁰ Students may inadvertently develop additional traits like resilience and motivation during pharmacy school, but such traits usually cannot be formally taught and, rather, must be experienced.¹¹ It is truly a testament to the resilience of both students and faculty members to have successfully made the transition to online APPEs and online pharmacy education as a whole in about two weeks. The pandemic has given the classes of 2020 through 2023 ample opportunities to develop grit and resilience and become better problem solvers, advocates, leaders, and innovators for our profession if we choose to. In this case, necessity may truly have been the mother of invention for myself, my classmates, pharmacy educators, and the pharmacy profession.

Learning through COVID-19 has proven that we can adapt and be successful. It is through this experience that I went from crawling on the floor of my parents’ pharmacy to taking my first professional steps as a pharmacist. These steps will carry me out into the community and in service of our profession. While the future is “fluid” and uncertain, experiences like COVID-19 are crucible moments that have trained us.¹² For the class of 2020, we lost our opportunity to hug our friends and mentors one last time at graduation. We never got the chance to say goodbye, but then again do you ever really say goodbye? As for our profession, this is an opportunity to advocate for our skills and broadly expand the realm of practice across the country. I hope COVID-19 events and, maybe in some small way, this commentary serve as a wakeup call for us to change the perception of our profession. The pandemic has forever changed pharmacy practice; let us make it for the better.