The focus of the academic pharmacy session on September 14 was the recruitment, retention and motivation of pharmacists. Persectives were given from hospital pharmacy (Professor Graham Sewell, University of Bath), from industry (Mr Adrian Bone, Eli Lilly & Co) and from academia (Professor Mike Rubinstein, Liverpool school of pharmacy)
Professor Graham Sewell (professor of clinical pharmacy and pharmacy practice, department of pharmacy and pharmacology, University of Bath, formerly research and technical services manager, Plymouth Hospitals Trust) presented the hospital pharmacy perspective. He outlined hospital pharmacy technical services as production (sterile and non-sterile manufacture), centralised intravenous additive services, quality control and quality assurance, and research and clinical studies.
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Graham Sewell: lack of research lamented |
Quality control and assurance were very useful in these days of bench-marking, and clinical studies were now integrating well with technical services. However, Professor Sewell lamented the lack of research into hospital pharmacy technical services: "We are underachieving in this area, particularly in comparison with pharmacists from countries such as Australia."
The current situation
Professor Sewell's view was that new pharmacy graduates had a lack of interest in and a poor knowledge base of pharmacy technical services, and that reteaching and retraining might be necessary. He referred to an unpublished study of preregistration trainees' ability to perform pharmaceutical calculations in which the mean score achieved was 36 per cent (range 0–82 per cent). "People not only need to be taught pharmaceutical sciences - they need to be inspired," he said.
The lack of training in pharmaceutical sciences led to difficulties in recruitment and retention. Professor Sewell estimated that the shortfall in hospital pharmacy was not 15 per cent as has been suggested, but that it was closer to 50 per cent. Problems with recruiting pharmacists skilled in pharmacy technical services led to posts being changed to technician posts, and increasing demands made on existing staff made it difficult to retain them, hence expertise was frequently lost to the NHS.
Professor Sewell went on to describe the skills and knowledge that he thought were necessary in order for pharmacists to be skilled in technical services.
Strength in the pharmaceutical sciences was essential - pharmaceutical chemistry, pharmaceutical microbiology, pharmacology, qualitative and quantitative research methods in pharmacy, and particularly pharmaceutics, which was "unique to our profession". Professor Sewell's view was that "we have to rationalise what we are teaching and how we teach it".
Also key was the ability to apply science to practice. According to Professor Sewell, if the profession was to gain the respect it would like, it needed to be recognised that pharmacists were medicines managers and that they could make a huge contribution to therapeutics. There were several areas of pharmacy practice that required scientific expertise: production and CIVAS, quality control and quality assurance, stability, compatibility and formulation, clinical pharmacokinetics, audit, pharmacoeconomics, systems design, development and validation, and risk management and clinical governance.
The expertise that pharmacists had was unique and complementd that of medical colleagues, but, in some areas, the expertise had fallen away. For example, many pharmacists would not become involved in the formulation of neonatal total parenteral nutrition. "In many ways, this is a professional cop-out," Professor Sewell stated.
Another example was that of preparations of wild-type p53 which were under trial in the UK. Professor Sewell questioned how many pharmacists knew how to handle these preparations, how to label them correctly and so on. He further illustrated his point by describing a case where a paediatric patient with one venous access point had required nine infusions, including TPN, and where information on physical, chemical, physiological and pharmacological compatibilities had been needed. Pharmacists should know the answers to these sorts of questions and be able to respond quickly to medical colleagues, Professor Sewell said.
Questions for academia
Professor Sewell warned that there was a risk that the balance of teaching in schools of pharmacy was becoming too strong in abstract rather than pharmaceutical sciences. He posed some questions for academia. Were they teaching the "right" science? Did the course material reflect the needs of practice? Was the course material based on practice? Were teaching and learning facilities of high quality? Had schools and departments the expertise to apply science to practice?
Pharmacy needed to ask itself some very searching questions, such as what would happen if it did not change? The answer for hospital pharmacy technical services was simple - it would not have pharmacists in it. "At present, we are really only maintaining the service, not planning for the future. There is no option but to change . . . and it is the undergraduate course we should be addressing," Professor Sewell believed.
In his view, the MPharm course needed to maintain a relevant science base and apply it, to have a vocational, practice and clinical focus, to integrate course material and to use problem-based learning.
The approach at the university of Bath to bringing practice into the undergraduate course had included building a state-of-the-art aseptic suite which would be licensed and run as a commercial aseptic laboratory. It had also included the use of technology, telematics and computer-assisted learning for undergraduates and postgraduates, hospital visits and placements, and the use of teacher-practitioners.
Summing up, Professor Sewell said: "I think pharmacy can make a huge clinical contribution by applying the pharmaceutical sciences. Pharmaceutical sciences are invaluable to hospital practice; if we don't take them on, who will?"
Mr Adrian Bone (Eli Lilly & Co Ltd) discussed the industry perspective during his presentation entitled "New opportunities for pharmacists in industry - the changing manpower situation".
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Adrian Bone: emphasise the role of the pharmacist |
With regard to the employment of pharmacy graduates, as far as industry was concerned, their strengths included a good scientific background and ease of transition across industry roles.
However, their weaknesses tended to be a lack of commercial focus and a lack of knowledge about what industry did, Mr Bone said.
Furthermore, changes in the emphasis in the undergraduate course, particularly the trend away from practical pharmaceutics, had had some impact. "Courses with little patient focus are not applicable for the wider range of industrial jobs," he said.
Mr Bone said that the available literature regarding industrial careers for pharmacists needed improvement; it was particularly important to emphasise the role of the pharmacist through the entire process from drug discovery to patient supply. Teaching staff would also benefit from greater knowledge of current industry practice so that this could be passed on to undergraduates; the use of teacher-practitioners needed to be considered.
Concluding his presentation, Mr Bone stated that the Royal Pharmaceutical Society and schools of pharmacy should have an interest in maximising job opportunities for pharmacists in the pharmaceutical industry. Undergraduate training should provide pharmacists with an ideal platform for entry into industry through certain jobs.
"In order to be competitive, we must be contemporary. . . . The pharmacy curriculum must adapt to industry changes," he declared.
Presenting the academic perspective, Professor Mike Rubinstein (Liverpool John Moores university) began by considering the proportion of core staff in schools of pharmacy who had a first degree in pharmacy. In 1997, of 508 core staff, 60 per cent were registered pharmacists (n=287) or had a degree in pharmacy but were not registered pharmacists (n=19); the remaining 40 per cent did not have a pharmacy degree. This compared poorly with medical, dental and nursing schools.
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Mike Rubinstein: Society should lobby the Government |
"Overall, schools of pharmacy are not attracting enough pharmacists into academic posts," Professor Rubinstein told the audience.
Professor Rubinstein went on to present data on the 929 research students (in 1997) undertaking MPhil and PhD degrees in schools of pharmacy, either on a full- or part-time basis. Of these, only 322 (34.7 per cent) held a degree in pharmacy and, of these, over 18 per cent were from countries outside the European Community. By contrast, if all students undertaking full- and part-time postgraduate education in schools of pharmacy were considered (n=2,392), those with a pharmacy degree comprised 65 per cent of all such students. However, these data suggested that "the number of pharmacists who could aspire to an academic post is limited", Professor Rubinstein said.
An obvious part of any solution was to encourage more pharmacists to undertake PhDs. Professor Rubinstein suggested that the Royal Pharmaceutical Society could initiate the establishment of more research studentships to help achieve this.
Another key component to increasing numbers of academic pharmacists would be to improve pay. The Society should lobby the Government for enhanced salary status for pharmacists, as was the case for doctors and dentists appointed to clinical teaching posts, with the ultimate aim of the inclusion of a pharmacists' scale on academic pay scales, Professor Rubinstein stated.
Concluding his presentation, Professor Rubinstein declared: "We do need more pharmacists to go into academia, and we need to address this urgently."
During discussion, Professor Sewell said that all academic pharmacists should still be involved in practice or have a "relevant" application base. Adding to this, Professor Rubinstein pointed out that practice could be brought into the undergraduate course by the use of teacher-practitioners, placements and sandwich courses. Addressing these points, Dr Ian Wong (university of Bradford) said that the university environment did not cater for academics to be involved in practice. While he was totally supportive of the work of teacher-practitioners, there was the danger of creating a two-tiered system, since lecturers with PhDs were paid less than teacher-practitioners.
Commenting on the employment of non-pharmacists in academia, a member of the audience said that the demands of the research assessment exercise were such that it was necessary to attract the best scientists and that whether they were pharmacists or not was not the issue. Furthermore, if students were being taught molecular biology, for example, should the not be given the opportunity to be taught by a molecular biologist?
A final suggestion was that a practice-based, scientific qualification such as a PharmD should be available. At present, the only PharmD offered in the UK was from the University of Derby (a university without a school of pharmacy). That course was accredited by an American university.