Rotation 4: Nuclear Medicine

Posted by Alison Van Kampen at Sunday, October 28, 2012

My fourth rotation this year was at Covance Laboratories in Madison, WI.  This was a unique experience because I not only learned a lot about nuclear medicine but also about Phase 1 research.  I spent the majority of my time at the Clinical Research Unit where they primarily conduct research in humans examining the AME properties of new products.

In this setting I was able to observe how radio-labeling is used to detect drug serum concentrations, route of administration, route of excretion, and length of time that the medication is in the body.  The role of the pharmacists in this setting was primarily drug preparation, determining if and how client specifications could be met, and participating in meetings with clients for quality assurance.  The pharmacists also were responsible for ensuring equipment integrity and that all staff were knowledgeable and followed standard operating procedures.  

I learn a lot about how phase 1 research is carried out, about imaging studies, precautions that are taken during preparations with radioactive or "hot" material, and why and how these products are used.  While I was there I primarily attended client meetings with my preceptor, observed preparations, helped with equipment qualification, worked on projects, and went on "field trips."  

Client meetings were interesting because I was able to see all the work that goes into setting up research.  Several times each week, a company with a new product that is currently working with or may work with Covance on a study, will have a teleconference with employees at Covance.  This meeting can be anything from going into great detail about how the study will be conducted (number of participants, types of participants, route of administration, special monitoring, etc) to periodic checks during a study for quality assurance.

The preparation was different for each study and so each presented it's own challenges.  Each study needed to have a mock preparation that was evaluated for appropriate strength, purity, and contamination.  They prepared sterile and non-sterile as well as "hot" (radioactive) and "cold" (non-radioactive) products.  Products were prepared on regular lab benches, in vertical flow hoods, and in ISO class 5 glove boxes, which, by the way, are very difficult to use. Just putting on the three pairs of gloves was  very difficult on it's own, let alone try to avoid contaminating the products.  I also did a qualification of two of the pipettes.  Twice a year they need to check all of their equipment to ensure that it is working properly and is accurate.  This was a way that I could learn and contribute to the clinic, and I am proud to say that I was able to pass both of the pipettes, which is more difficult that it sounds.

I was also given some small and large projects to work on during the rotation.  The main projects that I worked on were two journal clubs that were related to nuclear medicine and that I presented to the pharmacists, medication coordinators, and the physicians working at the clinic.  I also had two other presentations to give which were related to some of the work being done at the clinic.  One presentation was on appropriate aseptic technique using non-sterile product and the other was a large project about vaccines, specifically influenza vaccine produced in tobacco plants. This second project I found to be especially interesting and was comparable to a second seminar presentation.  So even though this was a lot of work, I now have two projects that I can possibly present, should it be required in any future interviews.  Not a bad deal. :)  I also had a few small projects like calculating the amount of hot and cold drug needed for a study, calculating how much radioactivity each patient would receive per dose, and looking up information on different radioactive products.

Finally I was sent on "field trips." The field trips were day trips to nuclear pharmacies so I could see how radio-labeled products were used in imaging and treatment of certain disease states. This was really cool when I visited the University of Wisconsin Hospital and saw not only how they prepared the products but all the imaging equipment and even where they were able to create radioactive particles in their cyclotron.  I know sounds like a mad science project and that is what it looked like too, but it was really neat.

Last thing, Madison is a really cool city.  There are a lot of fun things to do there and even though the rotation has a lot of projects, you get time to work on them during the day and can still spend time enjoying the city.  Cool things to do include going to the free zoo, Saturday farmers market, Wisconsin football games, trails near Picnic Point, lots of bars and restaurants down town Madison, and you must try cheese curds, delicious.  Overall, this was a pretty good rotation, very different and very interesting.

A road less traveled

Posted by Akin at Tuesday, March 09, 2010

After Jeff and Shannon's post, it would only be fitting if I also talk about what I am doing after graduation, especially because it is one of the less common paths. Similar to Jeff, I considered fellowships although mainly academic-based as opposed to industry-based. I was looking for an opportunity to enhance both my clinical and research skills and thought of doing a residency followed by a fellowship. Supportive faculty mentors who knew me well suggested I also look into PhD programs at colleges of pharmacy that are geared towards translational research. These programs turned out to be precisely what I was looking for.

These programs are specifically designed for pharmDs because the clinical experience that we gain in our 4 years is a definite advantage in translational research. What is translational research? Basically, translational research aka bench-to-bedside research begins with understanding the molecular/cellular processes that underlie a disease then translating this information to the level of the patient and vice versa. For example, as a student in a program like this, I would be trained to do basic research in a lab (i.e. studying mechanisms of a drug on a particular disease state in an animal model) and then I could translate these finding into the clinic (i.e. human research on the same drug based on the data from the animal research). Another appoach would be to identify problems that one sees while practicing pharmaceutical care in a clinic or hospital and conduct basic research to answer the questions. Ultimately, the goal is to completely translate findings into clinical practice and directly impact patient lives. Because as PharmD students we get that training in pharmaceutical care, we have a better idea of what type of drug research is clinically applicable to a patient compared to a basic researcher and are thus more equipped for translational science. What I will learn from a program like this is how to ask these relevant questions and what techniques we can use to answer them.

The opportunity to provide care as a licensed pharmacist in a hospital and/or clinic is another key difference that is available at most of theses programs. I knew that I only wanted to attend a graduate program that recognized me as a someone who already had professional training and would allow me the chance not only to maintain and stay up to date with new trends in practice, but enhance the skills that I have developed for the past 4 years in pharmacy school. One of the programs that I talked to at midyear even boasted to offer enough clinical experience to graduate a student with both a PGY1 residency certificate and a PhD. In addition to research and clinical training, chances to build on teaching skills are also generally available.

Upon graduation, I hope to secure a faculty position at a college of pharmacy or medicine and immediately begin to do independent translational research. These kind of programs would specifically train a student to be able to compete for federal funding and start doing productive research as soon as that tenure clock starts ticking. In addition to research/teaching/mentoring/committee duties I would hope to not be completely removed from patient contact (i.e. clinical practice and/or clinical research).

The academic pathway attracts me because it would allow me the freedom to research topics that are most interesting to me. But these training programs also would prepare one for a career in industry. A translational researcher would help a pharmaceutical company develop drugs by translating pre-clinical data through all phases of testing in human subjects in a cost-efficient and timely manner. Skills learned like grant writing may not be directly used, but would be applicable to other duties such as making the best use of internal funding and developing protocols to coordinate various industry projects. Graduates of translational PhD programs are thus highly sought after by pharmaceutical companies. Positions in government like with the FDA or NIH are further opportunities for graduates of these types of programs.

Depending on who you ask, there are only about 10 - 20 graduate programs in the country that claim to have a translational component. This made narrowing down schools much easier. The three programs that seemed to me to be the most established and universally most well-respected were at UKentucky, UPitt, and UNC. There are also several emerging programs such as those at Ohio State, UTexas at Austin, and here at Michigan that also seemed to be promising. Each appeared to offer a unique opportunity. I narrowed the schools down to 4 to apply to and interview at. I don't think I could have gone wrong with any of the schools that I applied to, but I chose UNC which seemed to be the best match for me.

I have no regrets upon choosing to pursue graduate studies. I am confident that ultimately this will allow me to pursue a career that I will find both challenging and enjoyable everyday. On top of being paid to go to school, a final perk is (instead of beginning a residency/fellowship on July 1st) getting the chance to relax this summer before fall enrollment. This gives me some much needed time to take my boards, get situated in Chapel Hill, and watch the World Cup before resuming the role of student on another long, yet exciting adventure.