There are two schools of pharmacy in the Netherlands — one in Utrecht just south of Amsterdam, the other in Groningen in the north of the country. A few months ago, Pamela Mason visited the university in Groningen and discovered some of the similarities and differences between the Dutch and British systems of education for pharmacists
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| Groningen University |
One of the main differences between pharmacy education in the Netherlands and the UK is that in the Netherlands it takes six years to qualify. Moreover, there is no preregistration year as such, but a period of six months’ practical experience, which is undertaken during the final year at pharmacy school.
Course duration
Education is split into two main parts — the first four years, which have
a strong emphasis on basic and pharmaceutical sciences, and the last two years,
during which practical skills are taught. After the first four years, students
can take an interim examination, successful completion of which leads to a master’s
degree, although the master’s degree can also be obtained after the sixth
year. In addition, students can, at the end of the fourth year, decide not to
complete their pharmacy training and go into research instead. Most, however,
do complete the six-year programme and qualify as pharmacists, gaining a diploma,
which is similar to the US PharmD qualification.
Admission
Admission to a pharmacy education programme depends on students having a secondary
school diploma and they need to have taken science — usually chemistry
and physics, but biology, mathematics and English are also desirable. At the
conclusion of high school, pupils take examinations set by the school and the
state, and they have to pass both to gain the diploma that will allow them university
entrance. For pharmacy school, no particular grades are required, although this
is not the case for courses such as medicine and dentistry.
Unlike in the UK, many students gain entry to pharmacy school with little intention
of becoming pharmacists. More often than not these students have failed to obtain
a place at medical school and they start the pharmacy course hoping to transfer,
but only about 10 per cent of the total entrants achieve this. A few even train
in pharmacy and then later go on to do medicine.
The total number of pharmacy students in the Netherlands is about 1,900 at present,
and the number has increased by more than 50 per cent in the past 10 years.
Pharmacy is a popular profession because of the good salaries and large number
of jobs. There used to be four schools of pharmacy, but two were closed because
the government felt that there were too many pharmacists. The situation has
now changed and the two schools of pharmacy, which at the end of the 1980s were
equipped to cope with about 200 first year students between them, now have about
400. There are slightly more women (55 per cent of the total pharmacy student
population) than men.
Both schools of pharmacy have close ties with the medical and dentistry schools,
and the pharmacy school in Groningen, which, at the time of my visit, had been
in the same location since 1964, was about to move over the road to join the
medical school.
Course structure
Pharmacy education is divided into discrete blocks of study of which there are
around 15 in an academic year. But there are no terms and no semesters. The
academic year consists of 42 weeks’ study with a break of a couple of weeks
at Christmas and, providing students have no examinations to retake, a break
of eight weeks in the summer. Bank holidays are taken in addition to these breaks.
At the end of each study block, which lasts two to three weeks, students take
an examination. A problem with this approach is that during the study block
students focus on one subject only, and while this makes it easy to learn by
rote and pass the examination, integration and application of learning is very
difficult and students often struggle with this.
Grants
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| The school of pharmacy will soon move into the Groningen university's medical school |
As everywhere else, it is difficult for students to manage financially at university, but Dutch students still get grants from the state. The basic grant is about DFl5,000 (about £1,400) a year, paid monthly, from which the student has to pay the course fees of DFl3,000 a year. Depending on parental income, a top-up grant can be obtained, but few students take out loans. As in the UK, many work at weekends and in the evenings in bars and restaurants and some are employed as laboratory assistants in the faculty. But only rarely do they pay bus fares, not only because there is subsidised public transport for students but also because most get about by bicycle. The Netherlands must be one of the few countries in the world to have a reputation for having more bikes than people.
Theory to practice
Many, if not most, Dutch pharmacy students — like some in Britain —
have little appreciation of what it is like to be a pharmacist. Although the
first year is intended to give an overview of the whole six-year programme,
one student I spoke to felt that it did not entirely achieve this aim. The last
two years, during which the emphasis changed from theory to practice, was a
real shock to the system, she said, particularly for those who enjoyed learning
technical science, and there were numerous complaints every year.
Moreover, few students work in a pharmacy until their final year of training
— students tend not to work in pharmacies during their vacations —
and although compounding is taught during the first four years, there is no
practical dispensing until the fifth year. The pharmacy student associations,
which exist at both national and university level, are pushing for change in
these areas and they hope to introduce students to pharmacies during the third
year.
Change is in any case starting to occur gradually, although there is some resistance.
Professor Dick Tromp (professor in pharmacy practice, Groningen university)
explained that increasing the emphasis on practice was difficult in a course
which contained four years of solid science. However, in his additional role
as director for the quality institute for pharmaceutical care in Kampen (about
80 miles from Groningen), he is keen to introduce pharmaceutical care into the
curriculum, although Groningen has, so far, no pharmaceutical care laboratory
like Aberdeen, he says.
The pharmacy game
Professor Tromp has, however, introduced something called “the pharmacy
game” into the fifth year. Students are divided into teams of five or six,
provided with a computer and are set questions relevant to establishing a pharmacy,
which they have to answer. They are also provided with contact details for people
who role play patients, doctors and health insurance companies. Basically the
team of students has four weeks to establish a “virtual” pharmacy
with 7,000 satisfied patients — 7,000 being the minimum number considered
to make for a viable pharmacy in the Netherlands. At the end of the four-week
period, each team is given a score and if the pharmacy is unsuccessful, it is
deemed closed down.
The science shop
Another new idea is the so-called “science shop”. A Dutch invention,
which has spread to the US and Denmark, the science shop is a department within
the school of pharmacy that has strong links with patient associations and self
help groups. The idea is that these groups influence university research by
identifying issues that are important to patients — issues such as adverse
drug reactions, compliance with different pharmaceutical formulations and so
on. Such issues form the basis of research questions and students help with
the research in their fourth year projects. Recent projects have included investigating
patients’ experiences with medication for HIV and thyrotoxicosis.
Practical experience
The six months of practical experience in the sixth year must be divided between
three pharmacies — two community pharmacies and one hospital pharmacy.
Although the student qualifies as a pharmacist at the end of this period, few
would be in charge of a pharmacy for a another few years. Indeed, to run a hospital
pharmacy, pharmacists must by law undergo a further three years of on-the-job
training.
Although community pharmacists can legally be in charge after qualification,
this is discouraged and most complete at least a further two years as an assistant
pharmacist. This is made possible because Dutch pharmacies are relatively large
compared to those in Britain, with, on average, one pharmacy for 9,000 people,
and a greater proportion of pharmacies employ assistant pharmacists than do
those in Britain.
Lifelong learning
As in Britain, growing attention is paid to lifelong learning and continuing
education is provided by the schools of pharmacy, the pharmaceutical associations
and the industry. Distance learning, however, is quite a rare means of delivering
education, partly because the Netherlands is a small country — one can
easily get from end of the country to the other by train in under three hours
— so most pharmacists can attend face-to-face training sessions. In addition,
pharmacists are forced to keep up to date, not only for practising pharmacy
in the pharmacy itself but also because they provide regular pharmacotherapeutic
updates for doctors. This has been a regular part of a pharmacist’s activities
in the Netherlands for the past 10 years and most pharmacists are involved.
Conclusion
The Dutch pharmacy curriculum is thorough with a strong emphasis on science.
However, practice elements are increasingly being introduced, although at a
somewhat slower pace than in Britain. There is also a need, which, to be fair,
is well recognised, for pharmacy students to gain an earlier appreciation of
what the job is about, and learning, at least from what I heard on my visit,
to be less compartmentalised and better integrated. As everywhere else, the
curriculum needs to be constantly assessed to take account of future practice.
Pamela Mason is a pharmacist and freelance writer