Narrator - Dr. Abel 00:00 Welcome to HelixTalk, an educational podcast for healthcare students and providers, covering real life clinical pearls, professional pharmacy topics and drug therapy discussions. This podcast Narrator - ? 00:11 is provided by pharmacists and faculty members at Rosalind Franklin University, College of Pharmacy. Narrator - Dr. Abel 00:17 This podcast contains general information for educational purposes only. This is not professional advice and should not be used in lieu of obtaining advice from a qualified health care provider. Narrator - ? 00:27 And now on to the show. Dr. Sean Kane 00:31 Welcome to HelixTalk, Episode 78 I'm your co host, Dr. Kane. Dr. Khyati Patel 00:35 I'm Dr. Patel, and we don't have Dr. Schuman here today, but we have a very distinguished guest with us today. She is the Dean of Student Affairs at our College of Pharmacy, Dean Winnike. Thank you for joining us today. Thanks for inviting me. And the title of our topic today is transitioning from school to practice advice for new practitioners. So we're moving away from some of the clinical topics and kind of talking on the professional issues that pharmacists or per se new practitioners face when they join the practice force. Dr. Sean Kane 01:05 And before we get into that advice that Dean Winnike you would have for our new graduates and new practitioners, I think it's important that the listeners have a better idea of who you are, where you've come from, and what your background is. So could you kind of just fill us in a little bit Speaker 1 01:19 with that? You bet, before I joined Rosalind Franklin, I've been here five years in the Student Affairs Department. I worked for Albertsons, which many listeners may know, is a national community pharmacy chain, and I spent over 20 years at that company. I worked in the stores for about five years, practicing my pharmacy skills, learning how to be a manager, working in 24 hour stores, low volume, high volume stores. Then I had the opportunity to work for the Midwest and the East Coast sections of that company for about six years as their trainer, and that was so much fun. I got to work with students, develop and work on our summer intern program, train new pharmacists that were coming on board, as well as pharmacy manager training. It was an awesome experience for me professionally, because I did a lot of face to face training, did a lot of distance learning training, and then I worked with our clinical programs to develop the Albertsons community pharmacy residency program. Then I actually had the opportunity to become the director of recruiting and college relations, and that's where I spent the last 11 years at Albertsons, and I had the responsibility of coast to coast hiring or pharmacists as well as student interns. Had the opportunity to manage a great team, sometimes up to 17 people, which was a challenge, but great as we were, again, a national company, and I partnered with key colleges around the country for hiring of interns as well as pharmacists working with them on their scholarship needs, diversity efforts and as well experiential education needs. Dr. Khyati Patel 02:48 So wow, that sounds like you have tasted all the waters of community pharmacy and going from management to recruitment to even student involvement and interactions. That's That's amazing. So Dean Winnike, you talked about your previous role at Albertsons. Can you tell us a little bit about what do you currently do as the Dean of Student Affairs here at college? Speaker 1 03:09 Sure, the student affairs department here, our role is really to promote and develop the university's core values in our student pharmacists, attributes behaviors such as embracing diversity, excellence in general, Respect for others, teamwork and leadership and the office is responsible, and we coordinate a lot of events to enhance and work on those skills for students, as well as their professional development. And then finally, in my role, I am just a resource for students, whether they need advice and guidance in their personal life or their professional life, I enjoy and take that part of my role very seriously as well. Dr. Sean Kane 03:49 And I think it's fair to say that you've had your fair share of experiences with these new graduates or new practitioners in terms of them transitioning from that student life into the practitioner life, then Speaker 1 03:59 absolutely you know, when I decided to make a career change, it seemed like a logical transition, because my role at Albertsons had an opportunity to work with people, manage a team, help new pharmacists as they joined the company, or even work with interns as they were deciding if they wanted to try community pharmacy out. So it seemed like a great opportunity for me to continue to get to work with, in this case, students here at Rosalind Franklin University, really something that I knew I loved from my time at Albertsons. Dr. Sean Kane 04:28 And I think it goes without saying, based on your personal story, but we hear this time and time again about the versatility of a PharmD degree, the fact that you're able to test the waters. Go through these different occupations that are still pharmacy centric, but are vastly different in terms of the skill set your day to day activities and things like that. And I think that's a great example. Speaker 1 04:48 It really is a great example. I didn't necessarily use all of my clinical skills. I've worked hard to keep my clinical skills up to speed, but I was able to use a lot of those people skills that a pharmacist needs in day to day. Practice in a business type setting and working with a group of people to meet strategic goals. So thinking about transitioning. Dr. Sean Kane 05:08 Clearly, we've talked about you transitioning your career, but again, the focus of today's podcast is to think about how students transition from the student mindset to the now I'm in the workforce mindset. So clearly some things are kind of Givens in terms of working full time and things like that. But what are some of the other things that students should be thinking about as they transition from that student to practitioner mindset, right? Speaker 1 05:32 Well, I think one of the things is APPEs definitely help prepare students for the real life, but there's a mental and a physical side of needing to work eight to 12 hour days that pharmacists, as they transition, just need to be aware of. It's important, I think, for students to as they transition, to try to get on a more regular routine. I know we see students here and they've been up super late because they don't have class till 10, or they're sleeping all night, or they're doing bad things, such as staying up all night to study, and so as you as a student, transitions to a pharmacist role, they really need to think about getting on a more regular routine, just for sleep and wake to help them be productive. I think it's easy to become really tired at the end of a shift. This is when I talk with pharmacists, and you can't be tired mentally at the end of the shift. You've got to be able to make important decisions, be on your game with your clinical knowledge, and so coming up with a good sleep wake routine, I think, is an important thing for students, and APPEs help with that. I also think working weekends can be hard, especially if a student did not work while they were in pharmacy school, because most APPEs are Monday through Friday, but most pharmacy jobs coming out of school are not Monday through Friday, and they're not nine to five. There are some exceptions, but working those weekend or evening shifts can be hard again, especially for students that are not used to that. And then socially, you got to be able to say no to your friends, right? You can't work on a Sunday morning and go out late on a Saturday night, or you can't, you know, do the 4K or 5K run on Saturday because you have to work. So I think that can be hard, and something that students need to think about. You've got to say no to some of your friends and activities for the weekend. Dr. Sean Kane 07:14 So clearly, I see a transition from the P3 to P4 APPE student, in terms of them appreciating the importance of taking care of patients and things like that. But I think that same transition happens again when they transition from the APPE year to an actual practitioner, where they're staying late, you know, to take care of a patient because they have to. They are the kind of last line and what is going on with that patient, versus they work their hours for their APPE, their preceptor can kind of help clean up at the end of the day. They are that preceptor at that point. They are the person that has to stay there. Dr. Khyati Patel 07:48 And all those things you talked about, about work life balance and making sure they are fitting into the new schedule, and, you know, adjusting their social schedules accordingly. It's important. But I think I remember the time I transitioned from fourth year to residency year and then after residency to actually come in practice, I think my biggest fear was, Wow, I'm making these decisions on my own. It is my license. Now nobody is watching me. Nobody is correcting if I'm making any mistakes, so I better be really sure of the decisions and the recommendations that I'm making, Speaker 1 08:22 there is no doubt. Dr. Patel, some students really do struggle the first time they're responsible for that final check of the prescription or the dose. And I remember students calling, you know, who I worked with as an intern, who now are licensed, and they were kind of in that freak out mode, right? Because as a student, you may have been relying on the pharmacist, as Dr. Patel, you said, for that final check, and now they are the pharmacist. So I really help students while they're in school here, say, come up with the process for checking your prescription or checking the order when you get a job, find out what the company's process or protocol for that is. But practice your routine for checking the order checking the prescription practice it over and over and over. So when you do become licensed, you don't have all these new things going on, as well as being that final check. Dr. Sean Kane 09:10 I think to piggyback on that in addition to like, what is your process, something as simple as patient counseling. Again, we talked about how an Illinois patient counseling is now mandated unless the patient opts out of it. What are your three counseling points that you love to pull out for? You know, the top 200 drugs, things like that. I think that if you have that familiarity, you're not trying to think on the spot of, what do I want to counsel on? You just know, these are the most important pearls that I think about. Simvastatin. Then that takes some of that stress away, because now you're prepared, right? And that preparation is going to help with that anxiety that may come from. Holy cow, what am I going to talk about with this drug that I'm going to see, you know, 50 times a day. At some point, you have to be prepared. It can't just be a look up every time. Otherwise you are not going to be an efficient pharmacist. Speaker 1 09:53 I was just going to say that, Dr. Kane, you know, I've been out of school for, you know, 30, almost 30 years. And I can still tell you a lot of things about those top 200 drugs. And when I work with students, they're like, Well, you know, Professor Winnike, I can look that up. And I'm like, No, you need to know that, because that is your job to be the subject matter expert on these things that you see each and every day. Yeah. Dr. Khyati Patel 10:16 And I think another important thing is to also understand and realize that what we teach them in school is something called lifelong learning. That's an early start as a practitioner to make sure that they're keeping up with the new material, the new updates, the new clinical updates that are coming out. So in addition to work life balance and taking the responsibility of that independent practitioner, something that they have to keep up with is, hey, where are my CE hours? Am I doing those? And in for that, they may have to be part of, you know, local organizations so they can do in person, ces correct, or they have to somehow get ces done through their work. Or so, what kind of advice do you have so that students are or new practitioners, excuse me, are on their top of the game. Speaker 1 11:06 There is no doubt that promoting and advocating lifelong learning is essential, I think, in the colleges of pharmacy, throughout the curriculum, because as a pharmacist, we all know we are going to be learning our entire career. The top 200 drugs, as we were just talking about, for me, are definitely not the same top 200 drugs, some of them aren't even used in practice, or the medical conditions that we primarily see for ambulatory care patients, for example, are going to be different. And so you have to be committed to knowing that the things you know and learned now as a student are not going to be the things you're going to be helping patients with 10 years from Dr. Sean Kane 11:41 now, and I've already heard that from current p4 students, saying, when Dr. Patel taught me hypertension as a p2 I had the old guidelines. Now there's new guidelines, and I haven't even graduated yet, and it just blows their mind how crazy that is and how important it is that even in their p4 year, they have to have this lifelong learning mindset that no one's going to hand them on a silver platter. What they need to know as a practitioner for the next 30 years, they have to invest in themselves and their and truly in their patients, to have optimal care, right? Dr. Khyati Patel 12:12 And whatever that involves, you know, keep updating their pocket brains, you know, add new pages to it so they can stay on top. Speaker 1 12:19 And I think another thing students have to think about is not only now, as a new practitioner, do you have to keep your clinical knowledge up, but you've got to stay up to date and follow the company's policies, procedures, know their expectations. Students coming out of school, I found, are very competent from a clinical knowledge standpoint, but they also have to do all of the administrative work that comes with the pharmacy position, or work with their technicians, or whoever helps them with those types of positions. So I like to remind students, you've got to do that administrative type of role in most pharmacy jobs, and while it might not be your favorite, you've got to figure out how to be good at it in order to really be valued and recognized by the company that you're working at. Dr. Sean Kane 13:02 So de Monika, in your experience, what are some of those kind of corporate policies or metrics or things like that that students typically do struggle with that would be a good heads up or red flag for those students to appreciate? Speaker 1 13:13 Well, I think they are going to vary, probably by practice site, but for me, it's the little things, right? If you're not doing the little things, whether it's making sure your refrigerator is at the right temperature via the technician check or doing your accounts that are required by your company or by the DEA for your C-IIs. I'm thinking about the weekly budget reports, or things that you have to report in for your dashboard, again, they're going to vary by company, or just things like making sure that the pharmacy looks the way it is supposed to look, in a professional, clean manner that meets your company's expectations and yours. These aren't the fun things. These aren't the things that took you four plus years of school to know how to do. But really, students, as they transition, if they're not doing the small day to day things, well, they're going to be overlooked for those other positions that they might be striving for in their career. Dr. Khyati Patel 14:07 Yeah, and some examples on the hospital practice side would be, you know, following appropriate sterile compounding procedures, you know, make sure that they're up to date on the training, make sure they're getting ready for the Joint Commission visits and knowing the policies and procedures of the hospital pharmacy, including some PMT recommendations and things Dr. Sean Kane 14:27 like that, I would definitely second that. I think that at most inpatient centers you're going to have a lot of policies and procedures, and if you don't know them, that's a huge problem, because now you're practicing at a different type of care than your colleagues and your colleagues are expecting you to have a certain type of care, and if there's a discrepancy there that could potentially harm a patient, where you're not doing what you are supposed to be doing, or other people are expecting you to do something and you're not, and that's a big deal. And oftentimes there's a lot of policies, and it does take time to learn, but it's also your responsibility to know what those. Policies are, Speaker 1 15:01 you know, I think another one that I would add related to companies, expectations, policies, procedures is just having students be knowledgeable of their social media presence. That doesn't mean that students, as they transition, should not have a social media presence. In fact, we need pharmacists to have a social media presence and promote our profession. But know what the company's policies and procedures are related to social media and any post that you might want to make related to your job, so that you don't get yourself in a in a pickle. Dr. Khyati Patel 15:31 And I think it's a really important advice. We usually ask students while they're in pharmacy schools to keep a clean, quote, unquote, you know, social media presence. And I think that's important that kind of follow that practice along when they're practitioners. So we learned a lot about, you know, what they should and should not be doing as new practitioners. But how do some of these schools and colleges of pharmacy prepare students ahead of time, while they're in the curriculum, to do some of these things, you know, early on, you know, Speaker 1 16:01 one of the things that I was thinking about are those teamwork, team based projects. And while sometimes students roll their eyes, they want to scream, because they're on a team project, they're going to be working on a team their entire time as a practitioner, regardless of the site. And so I think that's a great way that pharmacy school can prepare them, getting them used to working with a team that works well, but most importantly, figuring out how to work with a team that's maybe a little dysfunctional, and how to manage that and still get the results or the project done. And so I find those skills and such very helpful in the curriculum to prepare students for real life, Dr. Khyati Patel 16:42 and I'm going to put a plug for IP education over here, which Rosalind Franklin University, kind of, you know, strives and excels in, is making sure that they're not just used to working with another pharmacist colleague or a pharmacy team, but they're working with other healthcare Professional as a functional and optimal team as well. Dr. Sean Kane 17:02 And I think that oftentimes we see that eye rolling, because sometimes in a curriculum, you have to build kind of an artificial team with an artificial project. But I think as they transition toward their p4 year, they're going to have a lot more real life, quote, unquote, patient cases and things like that, where they are truly working on an interprofessional team. And I think that some of that bad taste in their mouth that they get from some of the early experiences, and my experience gets much better as they kind of see the value in it and see how they can help each other and things like that. Speaker 1 17:32 You know, adding on to that, I talk with students all the time about the things you learn on the APPE rotations, the experiences you have that are not positive are going to help shape you and prepare you to be a new practitioner, just as the experiences you have, even once you're licensed, you learn so much from a practitioner who maybe isn't doing exactly what you want to do. And so I help students also just recognize that's a learning opportunity, and to take advantage of that opportunity. Dr. Khyati Patel 18:00 Yeah, and not to sound morbid over here, but I'm going to quote one of my preceptors from residency here that you know, you should always go by the motto, what doesn't kill you makes you stronger. So in a way, if they're learning bad lessons, that's going to be turning into a good lessons for you in their future practitioner lives, Dr. Sean Kane 18:18 at least in my experience, most pharmacy students throughout all of the country, not just in a particular school, are often ill equipped to deal with their their new six figure salary combined with their oftentimes six figure debt that they come out of school with. Dean Mikey. In your experience, what are some common pitfalls regarding the financial, almost personal finances, of being a new practitioner. Dr. Khyati Patel 18:41 And then tell us also about how schools prepare students ahead of time to deal with some of these things, Speaker 1 18:47 you bet. So there is no doubt the appy students are so excited to get licensed and make that six figure salary and not be a poor quote, unquote student anymore, but most of our students are coming out of school with significant debt, and so I we talk with our students all the time, and they work closely with their financial aid office. In fact, all of our students here at Rosalind Franklin University go through an exit interview with financial aid, and I think that's fairly common for other programs as well, to talk about how to best pay down that debt. And so if there are any students listening, I would make sure that you have that on your radar before you graduate, and that will be very helpful. The other thing that I would say is don't overspend when you first get out of school. Students want that new car, they want to go on the big vacation, they want a really nice apartment. But I tell students, hey, just sit tight, even for six months, maybe a year, if they can, is ideal, but at least sit tight for six months and get used to that budget cycle of a pharmacist, so that you can figure out what are your normal spends in and out, and then you can figure out what do you want to pay for a monthly car payment? What do you want to pay for a monthly rent or. Mortgage, but get used to your ins and outs a little bit before you make those The other thing that I talk with students about, or anyone who's practicing contribute to the company's 401, K or retirement process, I tried to tell students, it's pre tax. You're never going to know it's gone. And even if you can put some money in there while you're paying down student debt, do it and then max it out as much as you can so that you're prepared for retirement. It's an amazing way to grow a nest egg, Dr. Sean Kane 20:31 especially if the company has matching where they will give you free money if you contribute to that 401 K or equivalent retirement fund, it's absolutely free money. You should take it, even if you're still paying down that student loan. That's one of the easiest things that you can do to get yourself set for later on in life, in terms of your retirement, Speaker 1 20:52 absolutely and some employers do have programs to help students pay down their loan or debt. They may come with some ties to working for that employer. But that's something that students can surely look into, especially if they are confident that this is the place or employer that they want to practice with. Dr. Khyati Patel 21:10 So also not to forget that, you know, when students are graduating and taking their NAPLEX certification and stuff, they do have that additional cost waiting for them right, registering at their State Board of Pharmacy, applying for NAPLEX, etc, etc, and if they are going to take multiple licenses, you know that's additional money. So keeping all that in mind, students should know that they have that six months of grace period before they can start paying off their federal loans. But also to consider some of the other options for federal loan payment, which is the income based payment, and especially if their employer is a non for profit, there are programs for loan forgiven is out there. So we encourage new practitioners to take a look into that as well. And as you mentioned, Dean Mickey, depending on the employer, there could be an arrangement made about paying the loan. That's a personal arrangement between the employer and the employee. Dr. Sean Kane 22:06 So in thinking about that transitioning student again, what are some of the other common scenarios that a student needs to be prepared to have or do in order to make that transition to the current practitioner? Speaker 1 22:18 You bet I think one of them is, as an APPE student, you're probably getting a lot of feedback from your preceptor. That's the preceptor's role with you. You have set evaluations. You might be receiving feedback even on a daily basis, but for sure, mid-APPE as well as the end of the APPE. But when you move into the work environment now, it's going to vary a little bit, don't get me wrong, but students oftentimes are not getting the amount of feedback that they're used to or that they want, and so I encourage students ask for that feedback, right? Ask them, especially ask someone that you respect and that you work with on a daily basis. Hey, Dr. Kane, how did I do with that interaction with the physician? It felt a little clunky to me, but how did I do ask if students don't ask in many environments, they're not going to get that. And I know I used to do that when I would counsel patients, because my background in school was working in a hospital, but I want community, so I needed to make sure I felt really practiced in over the counter counseling, for example. So that would be one of the first things. Dr. Khyati Patel 23:20 And then, you know, when the students graduate, they work with people from many different walks of life, right? Some people are probably 3040, years into that having that job, and I think keeping that relationship and learning from those who are seasoned in the practice is important. What do you have to say about that? Speaker 1 23:38 Exactly, I would say that, as a seasoned practitioner, I learned so much from a new practitioner, and I really believe that new practitioners have a lot to learn from a seasoned practitioner. So find that pharmacist practitioner that you're working with, that you respect, that you want to practice like and take them as just someone that you trust, respect that you can use as a mentor if you like that word, or some people aren't fans of that word, but use those folks to help develop yourself and develop your self identity as a pharmacist, I'll Dr. Sean Kane 24:12 definitely second that. I think that it's a two way street for that mentorship, so that new practitioner maybe is more in tuned with newer guidelines or newer drugs that have been just recently approved to the market, whereas that more seasoned clinician is going to have the historical perspective of everything from the clinical side of, why don't we use this old drug anymore, all the way to what were these corporate policy or hospital policies like back in the day? And why are they the way that they are now? There's so much back and forth that can happen Speaker 1 24:41 from that absolutely and the other way that you can really help make sure that you're working with practitioners of varied backgrounds and varied amount of time. Being a pharmacist is to just stay involved. Stay involved at your state or national level. I know I love going to meetings and seeing folks that I. Worked with, you know, 1520, years ago, who maybe are now retired, but that's when I get to see them. So stay active. And I think I always try to, you know, cheer lead for students, spend that it's not a lot of money. Stay involved. Join whatever organization is most appropriate or that you have a passion for. But it really is a great way to stay up to date as well clinically, it's a great way to meet others that have similar interests to you, and really just stay connected with preceptors classmates and those that you respect and really want to emulate in your profession. Dr. Sean Kane 25:35 So Dean Winnike, the last thing that I wanted to really cover, which is, in my mind, the elephant in the room, if you were to go on student doctor.net, or any of these kind of more social media discussion based forums, there are a ton of pharmacy clinicians, both on the hospital side and the retail side, that are just unhappy with their job. And if you were a prospective student and you're going through these forums, you would think that pharmacy is one of the worst careers possible. And I don't think that's the case, but clearly there's a good number of very vocal pharmacists who are not happy with their job. What advice would you have for that soon to be clinician or practitioner who may be at risk for poor job satisfaction or just being unhappy in general? Right? Speaker 1 26:20 You know, one of the things that when I get to see the P4s when they're back on campus here at Rosalind Franklin University, one of the things that I've kind of lived by my entire career, and I share with students, is your life shouldn't be your job, but if you're not happy with your job, you're probably not happy with your life. And I tell students you are not going to love your job every day, but you really need to find a job that makes you happy and fulfills you professionally on most days, most of the time, and we have that responsibility to ourselves to make our work environment the best thing it can be. And we need to be realistic. Students didn't love school every day, all the time and every subjects. And I think students, as they transition, need to be realistic about that in the workplace as well. You're not going to have perfect days all the time, but I find that if I'm in a role where I like most of the things I'm doing most of the time, this helps me feel satisfied. And I tell students as well, you know, you need to have a positive attitude to have a great work environment, you need to focus on collaboration, focus on the things that are frustrating you, and help problem solve those complainers and those that only point out problems in a in their role really are not going to be happy. We need problem solvers with potential solutions to our challenges, as well as students who are going to work together to improve the profession. Dr. Khyati Patel 27:45 And perhaps that translates to finding that mentor who has the positive attitude about the profession and the progression and kind of working with those positive people so you can uplift not just yourself, but the profession of pharmacy altogether, Speaker 1 27:59 one of my former co workers, one of the people that I would consider a mentor. We used to always say at work, at the leadership meetings, that the only constant in this world is change, and students need to recognize that healthcare is changing at a very fast rate. Dr. Kane, you mentioned it right. P4 is recognized that some of the medications they learned about are even different, or the guidelines have changed since they've been in school. And so I think for students to also just transition and be happy in their workplace is to recognize and embrace the change and realize it's going to be occurring at a very fast rate for probably their entire Dr. Sean Kane 28:37 career, and kind of piggybacking on both of the things in terms of positive attitude and change sometimes you can be the change agent, as long as you have that positive attitude. So if you identify a corporate policy problem or a hospital policy problem, instead of just complaining about it, you can be the person that makes the change that makes everyone's life better, because you have now identified a problem and actually come up with the solution, as opposed to just being the complainer about it helps your satisfaction. It helps everyone around you that you're, you know, instituting that change. But it takes that person to say, this is not the best way to do it. Let's figure out a better way. As opposed to sitting around the water cooler and complaining Speaker 1 29:19 Absolutely it does no good. You should be the one raising your hand to say, I'll pilot the new process and provide feedback on what worked what didn't work. Your attitude has such an impact. Think your overall happiness in life, professionally as well as personally. Dr. Sean Kane 29:34 So Dean Winnike, thank you so much for joining us today. Unfortunately, Dr. Schuman couldn't be with us as well, but we really appreciate your time and your expertise. Dr. Khyati Patel 29:42 Yes, thank you so much for sharing your pearls. Well, Speaker 1 29:44 thank you very much. It's been a pleasure to be here, and I hope preceptors, as well as students find this information helpful. Dr. Sean Kane 29:50 For anyone who wants to review some of the show notes for today's episode, we're at HelixTalk.com episode 78 we're also on Twitter at HelixTalk, and we've. Love the five star reviews, and Dr. Khyati Patel 30:01 I'm going to change the ending here a little bit. I'm going to say study hard as well as practice hard. Thank you. Narrator - Dr. Abel 30:07 If you enjoyed the show, please help us climb the iTunes rankings for medical podcasts by giving us a five star review in the iTunes Store. Search for HelixTalk and place your review there Narrator - ? 30:18 to suggest an episode or contact us or online at HelixTalk.com thank you for listening to this episode of HelixTalk. This is an educational production copyright Rosalind Franklin University of Medicine and Science.