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Kevin Taylor is reader in pharmacy and Ian
Bates is head of educational development at the School of Pharmacy, University of London
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Over the past 20 years, student intakes into schools of pharmacy in the United Kingdom have more than doubled. Nevertheless, the demand for pharmacists remains high, with shortages in both community and hospital sectors.
The existing schools of pharmacy will continue to increase their enrolments
to maximise income and address workforce shortages. Moreover, seven universities
are at various stages of establishing new schools of pharmacy, with the
first having recruited students this year, and many others have also
contacted the Royal Pharmaceutical Society expressing a desire to establish
pharmacy schools.
In 2002 the number of applicants to study pharmacy decreased. New schools,
in new locations, may attract additional applicants. However, if more
students are sought from a stationary or shrinking pool there are inevitably
implications for the quality of the applicants, with students having
poorer academic ability than was previously the case being recruited
to fill available university places. Pharmacy lecturers already complain
that many students lack basic competencies in mathematics, in chemistry
and in their use of English. If less able students, or those from non-traditional,
less academic backgrounds, are recruited, a fundamental reassessment
of course content and teaching methods will be essential.
The breadth and complexity of pharmaceutical and clinical science has
increased exponentially in the past decade or so. This together with
the demands of modern professional practice has led to the pharmacy degree
programme being extended from a three-year bachelor to a four-year master
level degree, as defined by the Quality Assurance Agency (QAA) for Higher
Education. The degree then, must now be taught at master’s level
necessitating the requisite high academic standards of course content
and student achievement. The paradox is that as academics strive to ensure
MPharm programmes meet the necessary indicators, the widening access
to pharmacy university education produces a significant risk of lowering
overall outcomes. As pharmacy places proliferate, will there be sufficient
applicants capable of undertaking first degree master’s higher
education? Will there be an inexorable decline in expectations as universities
cope with a gradual lowering of student entry quality?
Some will claim that widening access will have the opposite effect: stimulating
competition for the best candidates, hence forcing up standards of teaching
and curriculum design. However, as all current schools of pharmacy scored
highly in the QAA’s subject review (a review of university teaching
quality), this argument is largely spurious. Although the experience
of learning may vary between schools, the quality, overall, is already
high (certainly in comparison with many subject areas in higher education).
The only way is down.
While student entrants have more than doubled, in the past 20 years the
number of academic pharmacists has declined by approximately one-third.
Increasing enrolments into existing schools, and opening of new schools,
will stretch this resource even further. Moreover, clinical teaching
by National Health Service staff may become over-stretched, especially
as there is no clear funding stream for such teaching.
There are advocates of the new learning technologies who claim that IT
and e-learning will revolutionise the way higher education can be provided,
bringing the classroom to the learner, as an alternative to traditional
modes of educational delivery. However, our experience is that, with
some exceptions, e-learning will inevitably divorce the student from
the teacher. “How will this reduce my teaching time?” is
usually the first question when academics are told to prepare for the
e-revolution. Perhaps the one lesson we should learn from medicine and
nursing education is that learning and teaching in pharmacy needs a human
focus, one that cannot be substituted by virtual learning environments
and virtual tutors. Even hardcore medicines technology needs a human
face, and student professionals need adequate exposure to professional
practice.
One attraction of a pharmacy degree course is that on graduation students
are practically ensured employment, particularly important in an era
of tuition fees and student loans. However, in the future, 100 per cent
employment on graduation may not be guaranteed, as the number of available
pre-registration places is not increasing in line with the rising intakes
into schools of pharmacy. This then may prove the bottleneck between
the many more pharmacy graduates and increasing numbers of vacant pharmacist
positions, as multiple pharmacies, with long opening hours, continue
to proliferate.
It can be argued that having more pharmacy graduates than available preregistration
places, and ultimately pharmacist positions, will improve standards,
with positions being secured by the most able individuals, or those from
universities whose courses best equip them for contemporary practice.
However, surplus graduates will ultimately drive down salaries, reduce
opportunities for pharmacists who are already practising and, in the
long term, depress student numbers.
Currently, it is rare for MPharm graduates not to proceed to a preregistration
position. Consequently, the degree programme, while combining scientific
and professional subjects, is oriented towards equipping students for
their preregistration training. However, if in the future a significant
proportion of students will not secure a preregistration position, and
are instead destined for unemployment, or employment as a pharmacy technician
or a position requiring a general “scientific” training,
then the content of the degree will need to be addressed, in a direction
contrary to that of the past 10 years. Perhaps we will see the start
of two-tier pharmacy education: a bachelor’s or foundation level
technical pharmacy course (for the masses), and a master’s level
practitioner pharmacy course (for the few).
There are shortages in the pharmacy workforce. However, the future is
uncertain: will the market for pharmacists ultimately become saturated
as new graduates are pumped on to the market and pharmacy technicians
take over activities that were traditionally pharmacists’ remit?
Will constraints on preregistration place numbers jeopardise the desired
expansion in pharmacist numbers and the career aspirations of pharmacy
graduates?
Pharmacy student numbers will increase substantially in the near future.
The implications for educational standards, course content and the long-term
viability of all schools of pharmacy (both new and long-established)
may be enormous.
There remain many unanswered questions
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