My Journey as Commissioned Corps Junior Officer

Shana Shriber, PharmD Class of 2021 shares her experience as a Commissioned Corps Junior officer in the U.S. Public Health Service.

Through navigation of the detailed application process, to being tentatively selected, to progressing past the medical and background checks, to the excitement of receiving notification of my site assignment, to achieving ultimate satisfaction when my duty orders arrived, and knowing that all the preparation and diligent work were successful, my Junior Commissioned Officer Student Training and Extern Program (JrCOSTEP) journey was an adventure.

I was selected to serve as a Commissioned Corps Junior officer through the Junior Commissioned Officer Extern Program with the U.S. Public Health Service. My assigned location was highly desired as I was selected to work at the largest Indian Health Services facility in the nation, Phoenix Indian Medical Center (PIMC). Located in downtown Phoenix, PIMC is a large facility consisting of a 127-bed hospital, urgent care, and ambulatory care service unit. Although there are over 20 registered Native American tribes in Arizona, American Natives and Alaskan Indians travel from all over the nation to utilize PIMC as their community pharmacy, for primary medical care, and for other specialized needs. Currently there are six separate pharmacies operated on the PIMC campus including two in-patient pharmacies, primary care, pediatric, and specialty care pharmacies. The main pharmacy is utilized by the majority of the patients as their local community pharmacy. Pharmacy teams at the main clinic process approximately 400 prescription refills every day. 

Upon my arrival, I was asked what areas I was specifically interested in while spending my summer at PIMC. “Everything!” was my reply, and my preceptors went above and beyond to tailor my experiences accordingly. I had the opportunity to witness remarkable practices such as:

  • Observing intravitreal injections by an ophthalmologist
  • Watching a trans-tympanic injection by an otolaryngologist
  • Assisting with an Unna boot wound-care dressing while shadowing a very experienced nurse during out-patient wound clinic
  • Witnessing a rare diagnosis of bullous pemphigoid during dermatology clinic 

Another significant inclusion was a COSTEP exchange with the students assigned to the Whiteriver Service unit. My week-long excursion was packed with adventure and encompassed community engagement, immunization administration, medication requisition, home-visits for high risk infants, and shadowing pharmacists in the emergency department, while in-patient, and during pharmacist-run clinics.

I am amazed at how well the pharmacy staff integrated into the ambulatory patient care teams. With four specialty clinics (Rheumatology, Oncology, HIV and Hepatitis C) as well as six pharmacist-run clinics (Tobacco Cessation, Cardiovascular Risk Reduction, Anticoagulation, Latent Tuberculosis, Contraception Care, Immunizations), pharmacy plays a big part in patient care at PIMC. I had the fortune to participate in all the pharmacist-run clinics, to work in each of the different pharmacy locations, and was afforded many additional unique opportunities. To name a few:

  • I performed bed-side medication requisition for a newly admitted hospital patient 
  • I compounded nifedipine lubricant
  • I counseled patients on medications for colonoscopy preparation
  • I dispensed medications in the emergency department to discharging patients by shadowing an overnight emergency department pharmacist

Opportunities to expand my learning and assist the staff were plentiful. Pharmacy improvement projects I completed incorporated the creation of a United States Phamacopeia (USP) 795-compliant compounding record for 1:1:1 mouthwash, compiling data for a research project following use of empagliflozin, preparing drug information sheets for Pharmacy and Therapeutics review, and performing a gap analysis for USP 800 compliance updates. I traveled to an off-site clinic on the Yavapai Apache reservationand completed inventory in their pharmacy and assisted pharmacists in the pharmacy-run clinics. 

I was able to enhance my public speaking skills by presenting a patient case-related S.O.A.P. note, by leading a journal club on a recent diabetic trial, and by giving a topic presentation on cystic fibrosis. [Thank You, Dr. Phan!] 

Some of the greatest knowledge I have accrued over the many weeks at PIMC came directly from speaking with the other pharmacists about their experiences working with Indian Health Services and the Federal Bureau of Prisons. I knew before I arrived that I was highly interested in a career in the ambulatory care setting following graduation. Not only has this experience reinforced my goal to follow patients in a clinic-based setting, it has also solidified my desire to serve the U.S. Public Health Service Commissioned Corps and to seek a SrCOSTEP to progress towards this ambition. 

I knew that my time at PIMC would be challenging and educational, yet the phenomenal staff made the expedition extraordinary, priceless, and full of warm memories. I will cherish my PIMC JrCOSTEP journey for many years and am extremely grateful to all those that made an impact on my future. 

The best news yet? I have been tentatively selected to serve as a SrCOSTEP!

Pictured, from left to right:
CDR Jing Li, PharmD; LCDR Abigail Petrulis, PharmD (both pharmacists at Phoenix Indian Medical Center); Megan Day, P3 student pharmacist from Campbell University in North Carolina, Shana Shriber, P3 student pharmacist from UA College of Pharmacy.