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Pharmacy education
If science does not underpin clinical practice, what does?
From Professor A. T. Florence, FRPharmS
I was intrigued and not a little aerated to read the reported comments
of Duncan McRobbie of St Thomas’ Hospital, London, (PJ, 8 May,
p582) on the failure of UK pharmacy education which, he avers, trains
pharmacists as scientists rather than clinicians at the undergraduate
level. Yet others at the same meeting (of the International Congress
on Clinical Pharmacy), such as Gilles Aulagner from a French hospital,
are concerned about the dilution of scientific training and give the
reasons why. Many industrial pharmacists in this country have similar
concerns. Mr McRobbie advocates training graduates as clinicians first
then “if they choose” to train as scientists later. So clearly
he believes that pharmacy does not apply science to clinical problems.
The problem surely is not the training — not to mention education — of
our graduates but the placing by commentators of clinical practice and
science at two ends of a spectrum. If science does not underpin clinical
practice what does? It is intriguing that in a recent issue of The
Lancet there is a discussion of the word “clinic” and “clinical”.
As far back as the 19th century the word “clinical” became
a descriptor of some opprobrium, in the same way as some of our leading
practitioners now seem to feel about science. Physicians then wished
to see clinical medicine underpinned by science, and not anecdote. This
is not to say that in pharmacy all science is appropriate. It must be
applicable science, science that illuminates the present and the future,
laying the foundations for practice perhaps 30 years ahead. Today’s
practice does not do that; today’s science may just point the way
to the future nature and form of medicines and medication. Science is
best learnt as a foundation, but not as some unwelcome preparation for
practice but as an integral part of it, and an integrated part of any
pharmacy curriculum.
It is here that the letter of Charles
Butler (PJ, 15 May, p605) on the
new schools of pharmacy is of interest and relevance. The unplanned growth
of new schools happening before our eyes, with neither the funding councils,
the Royal Pharmaceutical Society nor the Department of Health able to
think in any joined up fashion, does jeopardise the future. If seven
new schools — and there seem to be more hovering — require
at least 20 academics each (we have 48 full-time academics here at the
School of Pharmacy), then where are these 140 fully fledged, experienced
and committed academics to come from? Mr Butler suggests, if I read him
correctly, that never mind the lack of academic pharmacists, just be
grateful that there are many pure scientists ready and waiting to fill
those many posts that are being advertised in the pages of The Pharmaceutical
Journal. Might they not be the best to orient their science towards the
future practice of pharmacy? I would be intrigued to hear of the in-depth
debates that the Council has had on these issues.
Perhaps to avoid simplistic polarisation, we, as pharmacists regardless
of our area of practice, should begin to map in some detail the science
that underpins clinical pharmaceutical decision-making, the science that
underpins patient care and the science that underpins industrial pharmacy.
There is of course a danger in this: atrophied science cannot be used,
but it must be done if we are to contribute anything unique to the health
care arena.
A. T. Florence
Dean
The School of Pharmacy,
University of London
Top-up fees could worsen lack of preregistration places
From Mr R. Taggart
I write in response to a letter from Charles
Butler (PJ, 15 May, p605)
concerning the issues about pharmacy education raised by Robert Dewdney.
I agree with Mr Butler and I am also concerned by the admission there is
no real plan for the expansion of the numbers studying pharmacy.
I welcome the increase in the number of pharmacy schools as a positive
development. However, the solution to the shortage of pharmacists cannot
simply be to make a massive increase in the number of students that graduate
overnight. The Royal Pharmaceutical Society has a responsibility to ensure
that pharmacy education is of the highest standard and that these extra
students have the opportunities to become practitioners. The Society must
take measures to ensure that there are enough preregistration places available
for this increase in numbers. I think that Mr Butler was quick to dismiss
Dr Dewdney’s concerns about this.
Mr Butler said in his letter that “employment is largely a matter
of supply and demand” referring to academic staff. This could be
considered the same for the preregistration situation. I would like to
highlight that the new university top-up fee system will mean pharmacy
graduates will be demanding higher salaries to compensate for these higher
tuition costs, whereas the increased demand on the limited number of preregistration
placements could mean that salaries are reduced. This would leave newly
qualified pharmacists to begin their profession with large debts. Alternatively
top-up fees could cause the number of preregistration places to fall even
further as the demand for higher salaries puts pressure on employers.
Moreover, the increased financial burden on future pharmacy graduates could
cause even more graduates to seek employment in other sectors or abroad,
causing further shortages.
A plan should be implemented to increase the availability of preregistration
placements. Mr Butler suggested that the number of preregistration places
is returning to the level it was a few years ago, but even if this were
the case, I do not consider this to be enough. More financial support should
be given to pharmacies to introduce training and pressure should be placed
on larger employers to increase the number of places they offer. Perhaps
there should even be a ruling that chains of pharmacies should offer a
minimum number of placements based upon their size.
Richard Taggart
Pharmacy Undergraduate
University Of Manchester |
The
Pharmaceutical Journal