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Pharmacy education
MPharm courses should concentrate on pharmacy practice
From Mr D. S. D. McRobbie, MRPharmS
I obviously struck a nerve for daring
to suggest that UK pharmacy undergraduate
programmes fail to prepare future pharmacists for practice (PJ, 29 May,
p671).
I think I should substantiate my argument and defend my comments made at
the International Congress on Clinical Pharmacy in Paris (PJ, 8 May, p582).
Pharmacists in French hospitals have significantly different roles and
responsibilities. These include responsibility for the central sterile
supply department and biochemical laboratory results — not something
usually found in the job descriptions of UK hospital pharmacists. As these
are important roles in this context, the alleged decrease of “science” and
the increase of “clinical” were obviously concerns for them.
I would argue this is not so for UK pharmacists.
The vast majority of UK pharmacy graduates will go on to deliver some form
of direct patient care, at least in the early stages of their career. Let
us for the sake of argument call this “clinical” work. The
dictionary definition of “clinical” is “pertaining to
the bedside” (from the Greek — klinicos). Also “pertaining
to or founded on actual observation and treatment of patients as distinguished
from theoretical or basic sciences”.
Last year’s census shows 94 per cent of registered working pharmacists
are in either community or hospital pharmacy.1 This clinical work occurs
in both these areas on a regular basis. Pharmacists’ skills are sought
for the management of minor ailments, to educate patients on their medicines
and to ensure the appropriateness of medicines. I would suggest that they
are rarely, if ever, asked for advice on “synthesis or isolation
of drugs, their physical and chemical properties, or methods of analysis” (taken
from the programme outline, School of Pharmacy webpage, www.ulsop.ac.uk,
accessed June 2004).
We presented data at the 2002 British Pharmaceutical Conference identifying
the tasks that we thought pharmacists leaving university should be able
to perform in order to ensure patient safety.2 These data demonstrated
that at the beginning of their preregistration year less than a third could
undertake simple patient counselling, provide routine health promotion
or basic therapeutic drug monitoring. Less than a quarter could take a
drug history and only 11 per cent could do simple dose conversions.
Unlike many of our health care colleagues, let us take doctors and nurses
as an example, pharmacy undergraduates have limited (if any) exposure to
patients. Educational experts will tell us that learning best occurs when
the subject matter is placed in context. The cynic in me believes that
denying pharmacy undergraduates exposure to the real jobs they may be doing
(and patients they will be treating) allows the “scientists” to
perpetuate the myth of the importance of their science to the profession.
What most graduates realise in their early days of practice is that this
is not so.
One solution may be for schools of pharmacy to focus on those skills most
important for the majority of practising pharmacists, leaving the specialist
science, which is no doubt important to colleagues in technical and industrial
areas, to be learned as and when the need for this knowledge arises. After
all it was Hippocrates who said, “A clinician’s role is to
cure rarely, comfort mostly but to console always.”
However, I share A. T. (Sandy)
Florence’s concerns regarding the
uncontrolled increase in the number of schools of pharmacy (and undergraduate
numbers). The resources required to produce graduates are no doubt considerable.
The effort required during the preregistration year to make them safe practitioners
is also considerable. Due in some degree to the educational effort required,
the number of preregistration places is not increasing at the same pace
as the number of graduates. Concerns regarding their ability to gain a
preregistration place will surely have knock on effects on the number of
school leavers choosing pharmacy as an option.
Duncan McRobbie
Principal Clinical Pharmacist
Guy’s and St Thomas’ Hospital Trust
References
1. Hassell K, Shann P. Pharmacy
workforce census: overview of main census
findings The Pharmaceutical Journal 2003:270;314–5.
2. McRobbie D, Fleming G, Ortner M, Bates I, Davies JG. Measuring clinical
competence in preregistration trainees using OSCEs. International Journal
of Pharmacy Practice 2002:10(suppl):R7 (PDF 60K) |
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