Commitment to developing student pharmacists and teaching excellence sets Forbes apart

By Katie Gerhards

In the emergency room of your local hospital, a patient who is suffering from sepsis, a life-threatening complication of an unchecked infection, is admitted. A registered nurse, physician, and even a staff technician come to the patient’s aid. But there’s also another important member of the health care team in that room: a pharmacist. 

Melissa Forbes (PharmD ‘10), clinical pharmacist with Gundersen Lutheran Medical Center in La Crosse, Wis., is one of those pharmacists, tending to critical care situations in the emergency room and intensive care unit, as well as infectious disease.

Working in this atypical environment, Forbes also precepts for student pharmacists, coordinates student rotations at Gundersen, and leads the hospital’s antimicrobial stewardship program, while also ensuring patients have the medication and information they need during transitions of care.

“Pharmacists can play a larger role in patient care through optimizing medication therapy, looking for opportunities to provide education to patients, and integrating our knowledge on the health care team to impact patients’ lives,” says Forbes.

For her dedication to the development of pharmacy students and her work to expand the role of pharmacists, the University of Wisconsin–Madison School of Pharmacy’s Pharmacy Alumni Association (PAA) named Forbes the 2018 Young Alumnus of the Year.

“Pharmacists can play a larger role in patient care through optimizing medication therapy, looking for opportunities to provide education to patients, and integrating our knowledge on the health care team to impact patients’ lives.” –Melissa Forbes

Ryan Miller (PharmD ’07), on PAA’s board of directors, says it’s Forbes’ commitment to student and resident education that sets her apart. “In her young career, she has trained and educated many new to the pharmacy profession with a firm but nurturing spirit that will have a lasting impact on the practices of her learners,” he says. “She is a quiet but assertive leader in her practice area and in her exemplary leadership in promoting and advancing clinical services.”

“This award means a great deal to me,” says Forbes. “My ongoing involvement with the School and precepting student pharmacists is because of the great preceptors I had while doing my rotations as a student. This is a way to give back to the School and the community to help develop the education of future pharmacists.”

Discovering a passion for pharmacy and precepting

In high school, Forbes knew she had an interest in science, math, and health care, but it was her mother, a nurse, who first suggested a career in pharmacy.

“I went to one of the UW–Madison School of Pharmacy’s open houses and learned a bit more about career options, and that’s when I knew that pharmacy was what I wanted to do,” says Forbes. “The School pulled me in early and got me hooked.”

After earning her PharmD at the UW–Madison School of Pharmacy, Forbes went on to complete a residency at Gundersen, where she found her niche in critical care and infectious disease.

“I like the fast-paced environment, being able to think on your feet,” says Forbes. “Having to distill a lot of evidence-based information into a decision to determine the right course of therapy for a patient is something that excites me. There isn’t always a right answer, but it’s the discovery and discussion of therapeutic options that interests me.”

Even in an environment where time is of the essence, Forbes makes time to precept for about 10 pharmacy students each year, about half of whom are the School’s PharmD students on their Advanced Pharmacy Practice Experience (APPE) rotations, including the residency-track APPE. She also precepts for student pharmacists during their Introductory Pharmacy Practice Experience (IPPE) rotations, for which she won the 2017 IPPE Clinical Instructor Excellence Award in recognition of her outstanding qualities, ethics, professionalism, teaching ability, and communication skills as an instructor.

“Precepting in this environment offers a lot of different learning opportunities and it reinforces clinical decision-making, and sometimes it’s easier to have that discussion about sepsis when you have the patient there with you,” says Forbes. “There might not be as much dedicated downtime to have a conversation or topic discussion, but you can take any moment and make it a learning opportunity.”

Like many preceptors who have strong relationships with student pharmacists, Forbes says part of what she loves about precepting is that it keeps her informed of new literature and new options for treating disease states, and it allows her to think processes and treatments through in a new way. “We’re very much sharing the learning together,” Forbes says.

In part, her love of working with student pharmacists echoes the influence of a mentor she had while in school: Karen Kopacek, associate professor in the School’s Pharmacy Practice Division.

“Dr. Kopacek instills a love of teaching, and I still think of her as a mentor,” says Forbes. “She’s still someone that I look up to in terms of her teaching ability and the relationships she builds with her students.”

As the student rotation coordinator at Gundersen, Forbes considers more than each students’ top selection for their rotation’s area of focus. Instead, she looks at their overall interests, what they excel in, and what they need to work on, and matches them with rotations that will help to develop their unique skill set.  

“One of the biggest things I enjoy about working with students is seeing their progression and growth as clinicians throughout the course of their rotation,” says Forbes. That growth is particularly pronounced with the APPE RT students, who are with Forbes for six months.

“The APPE RT allows students to be able to see how health systems function on a deeper level, including processes, computer systems, and even the hospital’s culture.” Near the end of their rotation, the residency-track students are often helping orient new students, which builds precepting and teaching skills early in their careers.

Leading pharmacy into new territory

While student pharmacists are with Forbes on rotation, she makes sure that students are exposed to a broad spectrum of patient care. For example, she is closely involved in ensuring patients receive the medications and information they need to take the medications correctly during transitions of care.

“When I have students, I get them involved in the process and let them see the full continuum of patient care, from admission to discharge, and how pharmacists are involved in reducing medication errors,” she says.

“In her young career, she has trained and educated many new to the pharmacy profession with a firm but nurturing spirit that will have a lasting impact on the practices of her learners.” –Ryan Miller

Another area Forbes is exploring through her practice is medication allergies—specifically, penicillin, which can have implications across a family of antibiotics, including amoxicillin and cephalosporins. Patients who have a penicillin allergy are at a higher risk of receiving antibiotics that might not be the optimal treatment, which can lead to worse outcomes. In some cases, this allergy is recorded on patient health histories based only on family members’ previous reactions.

At Gundersen, she and her colleagues are looking at how pharmacists can help in clarifying those allergies when patients are admitted, and possibly referring patients for allergy testing if they would need an antibiotic that they wouldn’t otherwise be able to receive due to the allergy.

“As medication experts, we are probably the best-equipped member of the health care team to do some of this work with allergies,” says Forbes. “People might not automatically think that pharmacists would be involved, but as the health care field is changing, it’s one of many opportunities we have to share our expertise.”

Learn more about Forbes’ award-winning precepting for IPPE students.

Read about another graduate of the UW–Madison School of Pharmacy being honored by the Pharmacy Alumni Association: Franklin “Rocky” La Dien, 2018 Alumnus of the Year.