The author makes some radical suggestions about the way pharmacists might be trained in the next century
Crystal balls are at a premium as we begin 2000 and this cameo account of pharmacy education in the next millennium is a highly personal (most likely biased and possibly bigoted) view. In most organisations and institutions, strategic plans are usually made on a five-year basis. Within such a time frame, one need not be a seer to predict that the infant four-year undergraduate pharmacy degree programme will be extant more or less in its current form.
However, most academics will agree that, although moves for a four-year programme had been under way for many years, when the green light was finally given the schools of pharmacy were largely caught on the hop. Consequently, the current courses are the result of a rather rushed job and continuing refinement of details in the teaching programme will occur for some years to come. One issue of particular contention is the inclusion of a data generating exercise (euphemism for project) for all students in the final year. This is a requirement laid down by the Royal Pharmaceutical Society. In these times of academic financial stringency, such a component could well break the piggy bank of some less well funded schools. The Society should carefully review its policy in this respect.
A popular strategy to minimise the increasing demands on academic staff teaching time necessitated by the four-year programme is the use of computer assisted learning (CAL). This was encouraged by the real success of the introduction of CAL in the previous three-year degree. However, my impression is that, in the new structure, this technology may be being overplayed as I find that many students are becoming either unhappy or bored, working through a variety of CAL packages. This shows the limitation of the current application of computer technology. However, by using interactive assessment packages, specifically tailored courses of study will be generated for each student in the future (bespoke education).
Even in the so-called linear courses that were offered in the past, students tended to relegate knowledge and information of earlier years to the backwoods. My impression is that this phenomenon has been exacerbated by modularisation and this will need vigilant monitoring by academics and the Society.
To respond to the question of the longer term future of pharmacy education requires an understanding of the unfolding of developments in health care generally and in pharmaceutical practice in particular. The ailing National Health Service continues to be of concern to the government, health care professionals and the community alike. Past and current initiatives by the government to maximise the effectiveness of available resources has resulted in a host of plans, directives and variously coloured papers of varying successful outcome. It is evident that the approach of tinkering with the service in a piecemeal fashion is set to continue into the foreseeable future, hopefully to greater effect. What is certain is that these initiatives and edicts will have to be taken seriously by all health care professionals. My impression is that, overall, pharmacy and pharmacists have been rather slow or reluctant to take a signal role in studying and responding to such documents in a constructive manner; of course there are important and shining examples to the contrary.
On a number of occasions, I have heard it said that the profession has much responsibility but little authority. To some this has been a stimulating challenge but for others it appears to have been a reason for not "taking up the gauntlet". The latter strategy is no longer a luxury that can be tolerated if pharmacy and pharmacists are to exercise their important and pivotal role in the clearly developing team approach to health care at all its levels. In this, the knowledge base and skills required by the pharmacist will be heavily weighted towards the clinical end of the practice spectrum. It is the common experience among pharmacists that rarely are they called upon to exercise the "secundum artem" and that in many, if not most, situations properly qualified pharmacy support staff are able to act efficiently and reliably in a dispensing capacity. This must have its implications for pharmacy education. Yes, this is not new and is well recognised but it is given only cursory regard in undergraduate courses.
Significant changes in health care systems worldwide have instigated a critical examination of how health care professionals are educated and trained, and what they learn and how. An action-orientated consultation of experts in pharmaceutical education and pharmacy practice was convened in Vancouver in 1998 by the World Health Organisation to explore the topic of "preparing the future pharmacist". The starting point was that, as pertains at present, the future pharmacist must have specific knowledge, attitudes, skills and behaviour in support of his or her roles. The "seven star pharmacist" (an expression coined by the expert panel) would need to be a care provider, a decision maker, a community leader, a manager, a life-long learner and a teacher. Schools and faculties of pharmacy have an obvious central part to play in realising this goal. They also must respond to the challenge by reviewing their input into the health process, judging their educational services and scholarship against the core parameters of relevance, quality, equity and cost effectiveness.
Paul Nicholls is professor of pharmacology and deputy head of the Welsh school of pharmacy. He has been chairman of the Academic Pharmacy Group for eight years and a member of the Council's Education Committee for seven years. He is a member of the Pharmaceutical Sciences Group and is a former Conference Science Chairman