The Pharmaceutical Journal Vol 267 No 7158 p115-116
28 July 2001

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Why the four-year MPharm is a success

In 1997 the pharmacy degree in England and Wales changed from a three-year bachelor degree course to a four-year course leading to a master of pharmacy degree. The first cohort of students are now graduating from the new course. How have schools of pharmacy coped with the transition, and what changes have been made to the course? Harriet Adcock finds out

Pharmacy students graduating in England and Wales this year are the first to have the title of Master of Pharmacy. Their degree has taken four years to complete. The extra year has meant that schools can include newer disciplines within the curriculum: genomics, proteonomics, biotechnology and more advanced molecular and cellular biology are all subjects that have found their way into the syllabus. New teaching and assessment methods have also been introduced. To cope with the increased numbers of students and the new demands on lecturers’ time, many schools have reassessed how they deliver their courses.

The Cardiff experience

The importance of students being able to apply their scientific knowledge in practice has been widely recognised. Dr Dai John, head of clinical pharmacy, law, ethics and practice at the Welsh school of pharmacy, says that one of the most significant changes to the pharmacy degree course at Cardiff University has been the introduction of a module called “Problem solving in pharmacy practice”.

The module brings together clinical, professional and social pharmacy and the science that students have learnt throughout the course. A second problem-solving module in pharmaceutical sciences is being planned for 2002. It will concentrate on the integration of knowledge of pharmacology, toxicology, chemistry, formulation sciences and biotechnology and its application to individual products, regimens and patients.

Objective structured clinical examinations or OSCEs, which are widely used in medicine, are also being used by some schools of pharmacy to assess their students’ understanding of course material. OSCEs involve problem-solving and role playing between students and lecturers, and allow lecturers to gauge how well students can communicate their understanding of a particular subject. This method of assessment is time consuming, so, in addition to formal examinations, some schools are relying more heavily on computer-based assessments, which can help cut down on staff marking.

At Cardiff, lecturers are using transcriptions of taped conversations between pharmacists and their staff, customers and patients in real-life situations as teaching aids. “These conversations, which reflect real life, are used as part of the students’ course work, as well as in exams,” says Dr John.

The four-year course has allowed students to gain more exposure to clinical and professional pharmacy earlier than was previously possible. More time can also be devoted to helping students develop their communication and presentation skills, which educators recognise as being important for professional practice.

Extra teaching time

The extra time available for teaching has had important implications, says Dr John. “Rather than getting students to learn in chunks, we now have the time to allow them to reflect on, and apply their knowledge.” For example, within the BPharm course, there was not enough time to talk to students about patients with multiple diseases. In the past, many students might have learnt about individual drugs and the conditions for which they are used and would only have considered what happens when a patient has several diseases after they have graduated.

One message that comes through clearly is that extension of the final-year research project has been a huge success. For many schools the structure of the four-year course means that the taught component of the degree is completed around Christmas time of the final year. This allows students more time to reflect on their projects. Time is also being allocated to teaching students about research methods. Statistics, data analysis, methods of searching the literature, and writing and poster presentation skills can now be included more formally within the syllabus.

The extra summer vacation that students of pharmacy now enjoy means that there is more time for them to gain experience in pharmacy practice outside their course. Students at Cardiff are encouraged to undertake placements in different areas of pharmacy practice, and are expected to produce a record of their experiences twice a year. This helps them when they have to decide which area of pharmacy they want to work in during their preregistration year.

Some students graduating this summer have not enjoyed their “guinea-pig” status. Being the first cohort of the MPharm course has meant that students have not had access to past papers, nor have there been students in the year above who were able to tell them what they could expect.

Some students initially perceived this as putting them at a disadvantage: “However, by the end of the course, students recognised that having to work things out for themselves was a positive thing,” says Dr John.

Modular system in Nottingham

The pharmacy school at Nottingham University has run a modular system for its degree course since 1992. This means that a student’s workload is credit-weighted and credit load per year is prescribed. Transferring from a three- to four-year course has meant an extra year’s work was required to be injected into the course, says Dr Nick Shaw, course director at Nottingham.

For example, in the first year the cellular biology and biochemistry content of the course has been increased, and modules dealing specifically with transferable skills, such as oral and written communication and information technology, have been introduced. In the later years, more pharmacy practice and clinical pharmacy has been included in the course and the size of the research project has doubled.

“We wanted to consolidate the scientific knowledge base and give students the skills to help them apply their knowledge. For example, we have blended together some of the pharmacology components of the course with pharmacy practice elements,” he says.

Nottingham has also introduced more clinical pharmacy modules, such as “Diseases and goals of treatment”, which allow students to work on case studies. Initially, the school had hoped to include medical students in the workshop scenarios that form part of the modules. This has not been possible because of timetabling difficulties, but will be considered again for future years.

Translating the academic content of the course to master’s level has not been a problem for Nottingham, where a number of taught master’s courses already existed as models. The students have found there to be a heavy workload but the results this year have been as good as, if not better than ever, says Dr Shaw.

When the four-year course was introduced there were concerns across the sector that the extra year would not be adequately resourced. “As it is, Nottingham has acquired more students, and with that has come extra resources,” says Dr Shaw.

Course leaders at Nottingham met recently to review the MPharm course. One area that was considered was how the course is delivered. Modularisation, by its nature, tends to compartmentalise subject areas. Students tend to learn and revise in units and sometimes may not make links between the units. The school is now looking to fuse some of the modules into bigger units so that themes can be developed and this problem addressed.

Portsmouth and student numbers

Dr David Brown, MPharm course leader at the University of Portsmouth, says that the biggest impact of the four-year course has been the increased number of students. Portsmouth has had an injection of additional staff but there is still a need for more to cope with the sheer physical presence of students.

The way in which the course is delivered has changed to reflect the increased workload. The school has piloted group final-year projects and is looking closely at this as a way to relieve pressure on project supervision. Group work in general has also increased. In the past, students were set individual assignments but now two or three students might work on an assignment together. “I do not have a problem, academically, with this, as it reflects real life and prepares the students for practice,” he says.

Additional computer-aided learning programmes are also being used in the course. Many programmes are directed private study and are not directly assessed.

The school is now considering how each of the final-year units of the pharmacy course fits the new requirements for master’s level degrees. “We will probably increase the size of the final-year project to make it more master’s like. We are keen to make sure that the project is robust and gets the students thinking and generating their own data,” says Dr Brown.

In terms of syllabus changes, Dr Brown says that they will have to wait to see what the Society requires in their new accreditation criteria (see Panel below). One way that the school will adapt to any changes is to look at more directed private study in the final year.

One thing that the school reviewed early on in the new course was the inclusion of pharmaceutical calculations as part of the syllabus in the first semester. This ensures that the students are up to speed on calculations, which can then be applied throughout the course.

In the third year, a unit called “Career and professional development” is run for the students. It incorporates presentations from the different sectors of the profession, which have traditionally been part of the undergraduate course.

In addition to this, students write their own curricula vitae and letters of application to advertisements that they might have seen in The Journal. This is assessed and is part of the core curriculum. In the past, the school had always done this informally, as there was not room in the three-year structure. The four-year course has allowed the unit to be formalised, which means that all students are exposed to the options that will be available to them during their preregistration year.

Feedback from the students at Portsmouth has been, on the whole, encouraging. In general they have found the course relevant to their own learning objectives and relevant to the careers they are about to embark upon. One criticism from some students is that certain lectures have to be held between 5pm and 6pm on weekdays. The need to timetable lectures at such times is driven by the increase in student numbers, says Dr Brown.

Changes in Scotland to four year MPharm

There have also been changes to the Scottish pharmacy degree courses, which were four-year courses even before the introduction of the master’s level degree in England and Wales.

Professor Kathleen Kane, acting head of school at Strathclyde University, Glasgow, says that the biggest change to the course at Strathclyde has been the introduction of a data-generating research project in the final year of the degree. Previously, students were required to complete a project involving a literature review but did not have to generate their own research data. Feedback from the students about the new research projects has been positive.

The course at Strathclyde has been completely reorganised, and is now in line with a master’s programme. “Because of the change to a master’s level degree we have had to include extra elements,” says Professor Kane. To accommodate these changes some of the basic chemistry and biology, and subjects that are peripheral to the subject of pharmacy have been taken out.

Professor Kane points out that there was some debate as to whether all schools of pharmacy had revised the academic level of the pharmacy degree when it changed from a bachelor’s to a master’s level degree.

The introduction of the National Qualifications framework, earlier this year, means that all schools of pharmacy will have to ensure that their curricula meet national standards for master’s level degrees.

Society view of MPharm

Dr Robert Dewdney, head of the Royal Pharmaceutiacal Society’s education division, says that one of the main successes of the four-year course has been that most schools have met requirements for students to receive structured and meaningful contact with patients.

Another success has been the enhancement of the final-year project. The four-year course has allowed schools to extend the project, which was not been a requirement in terms of the Society’s accreditation criteria. Student participation on student exchange schemes has also been achieved by some schools, which the Society welcomes.

Moves to allow students to undertake more self-directed study have been enabled by a less straightjacketed course structure. Dr Dewdney says that most schools are excited by the graduates they have produced and think employers will be pleased.

Is the profession prepared?

Over the past 10 to 15 years, pharmacy educators have made massive advances and reforms. Pharmacy as a profession has been sold to students, and the pharmacy degree prepares them to deliver pharmaceutical care.

Recent letters to The Journal suggest that maybe the educators have done too good a job. Students are eager to deliver pharmaceutical care and practise the skills that they have been taught. The profession needs to take note of this and provide opportunities for its new graduates before their disillusionment becomes too great.

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Harriet Adcock is on the staff of The Pharmaceutical Journal