From Mr A. Nathan, MRPharmS
SIR,-As a teacher of pharmacy practice in a school of pharmacy and a member of the Royal Pharmaceutical Society's registration examination board, I share the concerns of the National Pharmaceutical Association's board of management about the ability of undergraduates and preregistration trainees to perform calculations and make extemporaneous preparations (PJ, 8 April, p530), but I feel that the NPA's criticism is directed at the wrong targets.
There is no doubt that, in common with undergraduates in other science and medical disciplines, many of today's pharmacy students have difficulty with the kind of basic arithmetical calculations that their counterparts of a generation ago used to take in their stride. However, the fault lies, I believe, not with the training given at university but with primary and secondary level education policies and methods of recent years. Students reach university with a lower level of numeracy than in the past, and with an almost total reliance on calculators which has led to an inability to judge the order of number, so that students will accept as correct an answer that is incorrect by a factor of 10, 100 or 1,000. In our school of pharmacy, as I am sure in others, we provide remedial mathematics teaching and intensive practice in pharmaceutical calculations, and try to discourage overdependence on calculators.
In response to the poor performance of candidates in calculation questions in the registration examination the board of examiners has progressively increased the proportion of such questions, which now stands at 20 out of the 170 questions on the two papers. We also now provide a calculation test paper to preregistration tutors and ask them to set it to their trainees under examination conditions, with the recommendation that they should not be entered for the registration exam if they do not attain a mark of at least 80 per cent. Evidence from the most recent examinations shows that the situation seems to be improving, but the board of examiners is keeping the situation under constant review and may consider setting a calculation pass mark within the overall pass mark for the examination if the improvement is not maintained.
The other issue raised by the "peppermint water case" is not so much the ability of students and trainees to make extemporaneous preparations, as the difficulty in accessing the information needed to make them. The Boots case turned on the relationship between concentrated chloroform water and double strength chloroform water and, as far as I can ascertain, this information is not available in any current reference source that would be expected to be found in a community pharmacy. The only sources still reasonably at hand are the information departments of the Royal Pharmaceutical Society or the NPA.
Pharmacists are being called upon to make extemporaneous preparations less and less frequently, but while there is still any demand at all the necessary information should continue to be readily available. My own solution would be to restore this kind of formulation information to Martindale, where it has not appeared since the 30th edition published in 1993, and to introduce into the British National Formulary a section giving information on pharmaceutical formulations including diluents and vehicles.
Alan Nathan
King's College, London SE1