RECENT TRENDS IN PHARMACY EDUCATION Dr. Mohammad Ismail Hamed Distinguished Professor of Clinical Pharmacy & University Academic Advisor Misr University for Science & Technology, Sixth of October City, EGYPT
INTRODUCTION I. Quotations • Pharmacists are involved in the management of pharmacotherapy in clinical scenes more extensively than they did ever. Changes in medical environments such as collapse of doctors' paternalism, the rising role of patients' autonomy in the decision making on their own medical therapy, and the increased accountability of medical care givers to patients have obliged pharmacists to participate in pharmacotherapy as patient's advocates. • To meet these social needs the education of students in pharmaceutical colleges should be reconstructed extensively from a traditional research-oriented system to a patientcentered system. In particular the education of applied pharmacotherapy is to be strengthened and enforced. A drastic reform of pharmacist education should be brought in effect.
INTRODUCTION, Contin. I. Quotations. • Pharmacists have extended their influence on medication safety from accurate dispensing to prescribing, patient monitoring, and patient education. This broader professional focus benefits us all.
• The involvement of a pharmacists on rounds in intensive care and general medicine units reduces preventable adverse drug events. Also, pharmacist-managed anticoagulation therapy is safer than traditional care. • Clinical pharmacists have certainly become integral members of the health care team and have expanded their influence to include safe, appropriate, and cost-effective medication use. • The pharmacy academy is well positioned to prepare graduates to become more proactive in creating a safer health care environment for patients. None of these roles requires major curricular revisions.
Morbidity & Mortality Rounds on the Web, 2006
INTRODUCTION, Contin. II. Rising Professional Criteria • The Center for the Advancement of Pharmaceutical Education (CAPE) recommendation to Implement Changes in Pharmaceutical Education defined 3 sole educational outcomes, comprising (1) Pharmaceutical Care, (2) Systems Management, and (3) Public Health. • Pharmacy education is constantly changing and evolving; as such, updates of the CAPE Educational Outcomes are paramount. • It is questionable, however, whether schools of pharmacy are prepared to meet these broad goals in their present curricula.
INTRODUCTION, Contin. II. Rising Professional Criteria • Lifelong learning for community pharmacists is shifting from continuing education (CE) towards continuing professional development (CPD) in some countries. • A literature search and an Internet search on the web sites of professional pharmacy associations and authorities in 8 countries. showed that the concept of CPD has been implemented primarily in countries that have a long tradition in lifelong learning, such as United Kingdom. However, most countries have opted for the CE approach, e.g. France, or for a combination of CE and CPD, e.g. New Zealand. This approach combines the controllability by regulatory organizations that CE requires with the advantage of sustained behavior change seen in successful CPD programs. American Journal of Pharmaceutical Education 2007; 71 (3) Article 52.
INTRODUCTION, Contin. II. Rising Professional Criteria • Pharmacists are required to collect a minimum number of credit points in a defined period of time, usually 3 to 5 years. The credit points are reflection of the time spent on an approved activity, e.g. 1hour lecture or 3-hour practice results in 1 credit point. • The term accreditation is commonly used for both CE and CPD programming. In Germany and the Netherlands, the term accreditation refers to approved CE activities whereas in the United States accreditation refers to approved CE providers.
• Systems that are based on CPD tend to have comprehensive competency standards, against which pharmacists have to compare their own level of competence as an integral part of the CPD process.
Shifts in the Pharmacy Profession Toward More Patient Care • The Pharmacy Manpower Project’s 2009 National Pharmacist Workforce Survey indicate shifts in the pharmacy profession toward more patient care. • The pharmacy profession currently has, and will continue to build, capacity for contributing to the reforming healthcare system to meet patient care needs that are rooted in improving the effectiveness, safety and value of medication therapy. • Female practicing pharmacists have increased significantly, comprising 46% of the workforce in 2009, up from 31% in 1990.
• An aging population of pharmacists with 37% over age 55 in 2009, compared to 30% in 2004 and only 21% in 2000. Business Services Industry, March 01, 2010
Pharmaceutical Education & Biotechnology • Pharmaceutical biotechnology, pharmacogenomics, combinatorial chemistry, screening technologies, and bioinformatics are major advances that give a new direction to pharmaceutical sciences. • To meet with this new dynamic era of pharmaceutical research and health care environment, pharmaceutical education has to set new priorities to keep pace with the challenges related to genomic technologies. • Educators and pharmacy school members have the responsibility of deciding how, to what extent, by which methods, and/or in which way these changes and new directions in the education programs should be developed.
Eur. J. Pharm. Sci. 15, 243-250, 2002
Pharmacy Education in Selected Countries • In Canada, the education of pharmacists is built upon a foundation of strong, research-intensive publicly-funded universities and a universal health-care system that balances government and private financing. • Current challenges include the need to better integrate internationally educated pharmacists within the domestic workforce and professional development and maintenance of competency of practitioners. • Academic pharmacy is currently debating how best to manage the need to enhance the pharmacy curriculum to meet current and future skills needs, and whether a doctor of pharmacy (Pharm D) degree ought to become the standard entry-topractice qualification for pharmacists in Canada. Am J Pharm Educ. 2008 December 15; 72(6): 128.
Pharmacy Education in Selected Countries, Contin. • In Japan, The six-year system of pharmaceutical education has started in 2007. This new system is expected to raise the level of pharmaceutical care in the national medical care system. The practical training for pharmaceutical care that future pharmacists will have is an important safety measure for pharmaceuticals in the medical care system, so that producing qualified pharmacists would be supported by the people. • For this purpose the authorities will help to improve the training system, and the circumstances where future pharmacists will be able to provide their ideal pharmaceutical care. “Perspectives on educational reform of pharmaceutical science, Yakugaku Zasshi 2007 127(2):227-30.”
Pharmacy Education in Selected Countries, Contin. • In United Kingdom. • Challenges for UK pharmacy education over the coming years are the prevention of easy access to MPharm* programs by graduates of other subjects; the possibility of a shortage of employment opportunities for pharmacy graduates; the potential for accelerated progression of pharmacy technicians to pharmacy graduates and the possibility of providing parttime courses in pharmacy. In addition, the requirement to introduce more therapeutics into the courses to cater for the new roles of supplementary and independent prescriber must be faced, at the same time debating the relative weighting of science and practice within the course. * “undergraduate masters program,” that permits registration with the Royal Pharmaceutical Society of Great Britain
Pharmacy Education in Selected Countries, Contin.
• In China.
• Pharmacy in China involves the preparation, standardization and dispensing of drugs; its scope includes cultivation of medicinal plants, synthesis of compounds of medicinal value & analysis of medicinal agents. Pharmacists are responsible for the preparation of different drug dosage forms. • There are two streams of pharmacy practice, traditional Chinese medicine and modern pharmacy. Around 50 colleges offer pharmacy education, half of which provide a Western medicine approach and the other half traditional Chinese medicine. Both types of colleges offer a four-year curriculum with options for specialization. • Recently, clinical pharmacy services in China have been developed. Curricula with specialization in clinical pharmacy had begun.
Pharmacy Curricula in a Developing Country: Thailand • The curricula for both the bachelor of science degree (BS Pharm) and doctor of pharmacy (Pharm D) degree programs included the minimum content required by the 8 competency domains.
• The dominant content area in BS Pharm degree programs was product-oriented material. The content ratio of patient to product to social and administrative pharmacy was 2:3:1, respectively. However, the content ratio suggested by the Thai Pharmacy Council was 3:2:1, respectively. • The predominant content area in the Pharm D programs was patient-oriented content. Social and administrative pharmacyoriented content was low in both the BS and Pharm D curriculums. • As Thai pharmacy schools further revise their curricula, it may be useful to decrease the product-oriented content and expand patient-oriented material. Am J Pharm Educ. 2008 February 15; 72 (1): 9.
Ranking of Colleges of Pharmacy in USA Ranked in 2008
Rank College Name 1 University of California—San Francisco
Score 4.7
2
University of North Carolina—Chapel Hill
4.4
3
University of Minnesota
4.3
4
University of Texas--Austin
4.2
5
Ohio State University
4.1
5
University of Kentuky
4.1
5
University of Michigan—An Arbor
4.1
5
University of Washington--Seattle
4.1
9
Purdue University
4.0
9
University of Arizona
4.0
List of Top 10 Pharmacy Schools in America Ranked in 2009/2010
• Purdue University: The College of Pharmacy, Nursing and Health Sciences. • Ohio State University: The College of Pharmacy. • University of California: The School of Pharmacy University of California, San Francisco. • University of Cincinnati: College of Pharmacy. • University of Kentucky: College of Pharmacy. • Ferris State University: College of Pharmacy. • University of Minnesota - Twin Cities: The College of Pharmacy. • University of North Carolina: Eshelman School of Pharmacy. • University of Tennessee: College of Pharmacy. • University of Oklahoma: College of Pharmacy.
Strengths of Pharmacy Curricula: The Case of University of California • Development of Interdisciplinary Programs: 1) At UCSF, major changes began in 1970 with a required 4th year clerkship to expand the role of pharmacists as members of the clinical care team. Students combined required and elective courses (e.g. chemotherapy and clinical oncology). 2) The UCSF in 2002 revamped its professional curriculum to allow students emphasize one of 3 areas: Pharmaceutical Care, Pharmaceutical Health Policy & Management or Pharmaceutical Sciences. It has also launched joint degree programs (Pharm D/MPH, Pharm D/PhD). 3) At UCSD, pharmacy students take many basic science courses with medical students developing common preclinical knowledge. Following a year of distinct course and training for each profession, pharmacy and medical students share common clinical experience in UCSD hospitals and clinics.
Strengths of Pharmacy Curricula: The Case of University of California, Contin 4) In 2005, UCSD launched a Pharm D/PhD program and a Pharm D/MBA program 5) In 2009, the mission of both colleges adopted the follwing goals: • Preparation of Future Pharmacy Faculty. This is achieved through accredited advanced level training including residency and fellowship programs. • Advanced-Level Clinical Training for Practicing Pharmacists. • Professional Preparation of Industry Leaders and Researchers. UCSF & UCSD through their broad-based curricula and advanced training achieve this goal.
The Case of School of Pharmacy, University of Purdue • The professional curriculum leading to the Pharm. D. requires four years of study and admission into this program requires completion of the Pre-Pharmacy requirements. • A new Pharm. D. curriculum and Pre-Pharmacy curriculum were approved in 2009 for students entering the professional program beginning in 2012. The entire curriculum is highly structured, allowing time for only a modest amount of elective study. • Also, to complete the professional program in four years, students must consistently be successful in their completion of all of the required courses in each year of the program. • In addition to the required practical experience, students have the
option of gaining experience in research. Several research fellowships for undergraduate research are available on a competitive basis.
Vision & Mission of Selected Colleges of Pharmacy • University of Arizona: Vision: To be the Preeminent college of pharmacy in education, research and service. Mission: To promote the health and well-being of our citizens. • University of Minnesota: Vision: Through our program of innovative teaching, research and scholarship, we will achieve the distinction of being a premier college of pharmacy. Mission: To educate professionals who will address the pharmacy-related needs of society.
Vision & Mission of Selected Colleges of Pharmacy • University of Michigan: Vision: To be the most respected academic clinical pharmacy as measured by the quality of our graduates, professional and clinical service and scholarly contributions. Mission: To create, disseminate and apply knowledge regarding drug therapy. • University of Illinois: Vision: The College of Pharmacy enhances individual and community health through preeminent pharmaceutical education, research, service and entrepreneurial activity. Mission: The College of Pharmacy provides leadership in education, research, public service, entrepreneurship and business activities, and patient care to guide and serve the pharmaceutical care needs of the society.
Vision & Mission of Selected Colleges of Pharmacy • University of Southern California Vision: In keeping with a long tradition of innovation in pharmaceutical education and research, the USC School of Pharmacy shall be the global leader in the development of new paradigms for pharmacy practice; pharmaceutical and interdisciplinary health care education and research that emphasizes pharmacotherapeutic planning, management and outcome assessment; as well as the creation of new therapeutic agents, targeting strategies and monitoring modalities. Mission: By creating a curriculum that balances the basic knowledge components of pharmacy-biomedical sciences, pharmaceutical sciences, social and administrative science, clinical sciences and experiential training, the School provides students with a multidisciplinary educational experience which prepares them for contemporary pharmacy practice .
Vision & Mission of Selected Colleges of Pharmacy • University of Purdue: Vision: Providing education that enables students to acquire in-depth expertise in the pharmaceutical, social/economic management, and related sciences, Serving the community leading to improvements in healthcare delivery and enhance health outcomes, Fostering innovation in research through interdisciplinary collaboration and Contributing to the profession of pharmacy by participation in leadership roles in pharmaceutical organizations and community programs
Mission: Is to demonstrate excellence through performance in the areas of discovery, learning, and engagement. The experience and knowledge of the faculty provide students with excellent didactic and experiential training necessary to become well-rounded practitioners.
DETAILED MISSION, UCSF • UCSF is dedicated to improving human health worldwide and advancing scientific discovery . The school: • Conducts exceptional pharmaceutical research, including basic science, translational science, clinical science, health policy, and health services research. • Delivers world-class education to our Doctor of Pharmacy, graduate, postdoctoral students and others. - We educate Pharm D students to be leaders and effective team members in health care and to be lifelong experts in the safe and effective use of medicines. - We educate graduate students to be outstanding researchers across the spectrum from the basic to the health sciences. • Develops
and
delivers pharmaceutical care.
outstanding
and
innovative
• Serves the community by sharing our expertise with the public, industry leaders, and policy makers.
The Case of MUST College of Pharmacy MUST Pharm D Program Fourth Level • First Semester: BIOC PHLG PHCT PHCL MICR PHCM
BUAD
421 411 411 431 421 431
411
Clinical Biochemistry Pharmacology II Sterile Preparations Pharmacotherapy I Public Health & Hygiene Pharmaceutical & Medicinal Chemistry II Pharmacy Administration
3 (2+1) 4 (3+1) 3 (2+1) 3 (2+1) 3 (2+1)
Total
20
2 (2+0) 2 (2+0)
MUST Pharm D Program Fourth Level • Second Semester: PHID PHCL PHCL PHCT PHCG ELEC PHCL
412 432 412 432 432
424
Industrial Pharmacy I Pharmacotherapy II Clinical Pharmacy Practice Design & Formulation of Dosage Forms I Biotechnology in Drug Production I Elective Pharmacy Practice II
3 (2+1) 2 (2+0) 4 (3+1)
Total
21
3 (2+1) 3 (3+0) 3 3 (0+3)
MUST Pharm D Program Fifth Level • First Semester: PHLG PHCL PHID PHCT PHCL
ELEC PHCL
531 531 511 541 521
523
Toxicology & Forensic Chemistry Pharmacotherapy III Industrial Pharmacy II Community Pharmacy & Pharmacy Practice Clinical Laboratory & Physical Assessment Techniques Elective Clinical Pharmacokinetics
Total
4 (3+1) 3 (2+1) 4 (3+1) 3 (2+1) 3 (2+1) 2 2 (1+1)
21
MUST Pharm D Program Fifth Level • Second Semester: PHID MARK PHCL PHCL PHCT ELEC ELEC
521 512 532 534 542
Pharmaceutical Quality Control Pharmaceutical Marketing Drug-Poison Information & Interactions Pharmacotherapy IV Hospital Pharmacy Elective Elective
3 (2+1) 2 (2+0)
Total
19
4 (3+1) 3 (2+1) 3 (2+1) 2 2
MUST Pharm D Program Fifth Level • Summer Semester: PHCT
545
PHCL
534
Community Pharmacy Practice Rotation 5 (0+5) Drug & Poison Information Rotation 3 (0+3)
Total
8
MUST Pharm D Program Sixth Level • First Semester: PHCL PHCL PHCT PHCL PHCT
621 623 645* 661 691
ELEC
Ambulatory Care Rotation Critical Care Rotation Community Pharmacy Practice Rotation Analysis of Current Medical Literature Seminar on Integrated Therapeutics I Elective
5 5
Total
19
5 1 1 2
*An elective rotation and can be replaced by one of the elective rotations listed in the program.
MUST Pharm D Program Sixth Level • Second Semester: PHCL PHCL PHCT
PHCL PHCT ELEC
632 652 642
662 691
Paediatric Care Rotation Oncology Care Rotation Hospital Pharmacy Practice Rotation Pharmacotherapeutics Research Seminar on Integrated Therapeutics II Elective Total
5 5 5 2 1 2 20
N.B. Each rotation must be completed with a grade C or better.
MUST Non-Traditional Pharm D Program First Professional Year • First Semester: PATH PHCL PHCL BIOC PHCT PHCL PHCL ELEC
321 431 432 324 541 521 523
Pathophysiology Pharmacotherapy I Pharmacotherapy II Clinical Nutrition Community Pharmacy & Pharmacy Practice Clinical Laboratory & Physical Assessment Techniques Clinical Pharmacokinetics Elective
Total
2 (2+0) 3 (2+1) 2 (2+0) 3 (2+1) 3 (2+1) 3 (2+1) 2 (1+1) 2
20
MUST Non-Traditional Pharm D Program First Professional Year • Second Semester: PATH PHCL PHCL PHCL PHCL ELEC ELEC
312 531 532 532 542
Pathology Pharmacotherapy III Pharmacotherapy IV Drug-Poison Information & Interactions Hospital Pharmacy Elective Elective
2 (2+0) 3 (2+1) 3 (2+1)
Total
19
4 (3+1) 3 (2+1) 2 2
MUST Non-Traditional Pharm D Program First Professional Year • Summer Semester: PHCT
545
PHCL
534
Community Pharmacy Practice Rotation 5 (0+5) Drug & Poison Information Rotation 3 (0+3)
Total
8
MUST Non-Traditional Pharm D Program Second Professional Year Same as the Traditional Pharm D Program
The Experiential Program Required Contents
Communi Ambulatory ty Care
Formal Case Presentation Special Project for Presentation
X
Critical Care
Pediatrics
X
X
Oncology
X
Clinical Interventions
Hospital Pharmacy
X
X (10)
X (10)
X (10)
Patient Councelling
X (20)
X (10)
X (10)
X (20)
Patient Medication History
X (20)
X (10)
X (10)
X (20)
The number in parentheses is the minimum requirements for rotations.
Example for Student Learning Outcome Evaluation Module Rotation: Ambulatory Care Students will be evaluated based on the following activities: 1. Formal presentations (1) or Journal Club (1). 2. Clinical Interventions (10). 3. Patient Counseling Sessions (10). 4. Patient Medication History (10). 5. Attendance.
Thank you Prof. M. Ismail