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Pharmacy education
Integration, not balance, of science and practice is required
From Dr A. W. Smith, MRPharmS
Both Patrick Wilson and Ivan
Stockley (PJ, 3 July, p19) raise questions
about the fourth year of the MPharm degree programme and the preparedness
of future pharmacists for practice. The fourth year, taught at master’s
level, provides the opportunity to take students to the forefront of
the discipline and to enable them to reach judgements in complex scenarios
where data may be incomplete and where there is uncertainty. So, for
example, in my own school of pharmacy, a significant component of the
fourth year is clinical pharmacy and ward-based teaching where students
consider medicines management for patients with multiple conditions in
exactly the same way as colleagues face in practice every day. The additional
year has also enabled a clinical placement to be included in the third
year, together with opportunities for interprofessional learning alongside
medical and nursing students. These, too, offer context to the fourth-year
studies.
Two issues are relevant to the current discussion. First, who teaches
in our schools of pharmacy? The schools are not ivory towers populated
by pharmacist and non-pharmacist academics with little understanding
of, or interest in, the practice of the profession. Rather, they comprise
an integrated group of academics and practitioners who collaborate closely
in planning, delivering and assessing all aspects of the MPharm degree.
The second substantive issue is that of the science/clinical practice
debate. The profession must move on from talking about the balance between
science and practice in the undergraduate curriculum. Balance suggests
that the two are different and set against each other. They are not.
The talk must be of integration, for without the underpinning molecular
and pharmaceutical sciences there is no foundation upon which to build
clinical practice.
Others in these columns have commented on frequently questioned topics
such as drug synthesis, molecular structure determination, thermodynamics
etc. It is true that the challenge for schools of pharmacy is to ensure
these topics have a clinical context, however these “hard” sciences
should not be abandoned in favour of verbatim cramming of the current
issue of the British National Formulary. In delivering a master’s
level qualification, the schools of pharmacy have to consider the long
term as well as the short-term “oven-readiness” of graduates.
In particular, the schools must take account of knowledge half-life and
focus on those concepts that will sustain postgraduation learning and
development well into the mid-21st century. It is a truism that medicines
usage and pharmacy are always changing, but this is never more true for
today’s graduates, whose careers will be defined by the era of
genomics. If pharmacists are to be relevant to medicines development,
utilisation and patient care in the genomics era, then they must continue
to understand what makes drugs work at the molecular, cellular, tissue
and whole patient level.
With time and continuing professional development, today’s pharmacy
graduates more than ever before have the underpinning knowledge and skills
to come out from behind the BNF, stop being passive bystanders and really
contribute to the advancement of patient care.
Anthony Smith
Head, Department of Pharmacy and Pharmacology,
University of Bath
There are no shortcuts on the long journey to expertise
From Mrs L. M. O’Loan,MRPharmS
I have been following the science versus practice in pharmacy education
debate with great interest over the past few weeks. I am currently undertaking
an Open University MA in Education, and would like to offer my view from
an educational perspective.
The “theory-practice divide” is well established in the field
of education.1 Theoretical knowledge, which is abstract in nature and
is often acquired in a classroom setting,2 has historically enjoyed a
higher status than practical knowledge,3,4 which develops through participation
in “real world” practices.1,2,5 It has been suggested that
greater emphasis should be placed on practical knowledge to reduce the
problem of “knowing without doing”,1 but that this should
not be done at the expense of theoretical knowledge, otherwise the problem
could become reversed.1,2
Expert knowledge is both theoretical and practical.5 Indeed, it has been
noted recently that experts in clinical pharmacy “need extensive
knowledge both of the literature and from experience”.6 So how
can we integrate theoretical and practical knowledge? Various solutions
to this question have been proposed, including highlighting the relevance
of theoretical concepts to the “real world”,1 employing “real
world” problems to “problematise” theoretical subjects,7 and using simulated work experiences,8 all of which are useful but do
not provide the definitive answer.
It has been suggested that “an understanding of the context is
critical to make sense and use of the theoretical and abstract knowledge
of science”.1 This would lend support to Larry
Goodyer’s
view that “the only way to produce graduates more oriented towards
the health professions is to ensure a reasonable level of patient contact
throughout the undergraduate period” (PJ, 3 July, p19). While this
approach could help students to link theoretical and practical knowledge,
the issue of how (and whether) knowledge is transferred from one setting
(such as the classroom) to another (such as the workplace) remains contentious.8,9
My view from an educational perspective, therefore, is that, although
we should be aiming to integrate theoretical and practical knowledge,
there is unlikely to be a shortcut on the long “journey to expertise”.6
Laura O’Loan
Annual Programme Co-ordinator
London Pharmacy Education & Training
References
1. McCormick R. Practical knowledge: a view from the snooker table.
In: McCormick R, Paechter C (editors). Learning and knowledge. London:
Paul Chapman Publishing; 1999. pp112–35.
2. Sfard A. On two metaphors for learning and the dangers of choosing
just one. Educational Researcher 1998;27:4–13.
3. Lewis T. Valid knowledge and the problem of practical arts curricula.
In: Moon B, Murphy P (editors). Curriculum in context. London: Paul Chapman
Publishing; 1999. pp130–47.
4. Young M. The curriculum as socially organised knowledge. In: McCormick
R, Paechter C (editors). Learning and knowledge. London: Paul Chapman
Publishing; 1999. pp56–70.
5. Glaser R. Expert knowledge and processes of thinking. In: McCormick
R, Paechter C (editors). Learning and knowledge. London: Paul Chapman
Publishing; 1999. pp88–102.
6. Shulman R, Lovejoy A. Assessing clinical pharmacy expertise. The Pharmaceutical
Journal 2004;273:26–28 (PDF 90K)
7. Hiebert J, Carpenter TP, Fennema E, Fuson K, Human P, Murray H et
al. Problem solving as a basis for reform in curriculum and instruction:
the case of mathematics. In: Murphy P (editor). Learners, learning and
assessment. London: Paul Chapman Publishing; 1999. pp151–70.
8. Gruber H, Law LC, Mandl H, Renkl A. Situated learning and transfer:
implications for teaching. In: Murphy P (editor). Learners, learning
and assessment. London: Paul Chapman Publishing; 1999. pp214–30.
9. Wallace M. When is experiential learning not experiential learning?
In: Murphy P (editor). Learners, learning and assessment. London: Paul
Chapman Publishing; 1999. pp230–44.
If pharmacists have no communication skills, knowledge is wasted
From Mr B. Shooter, MRPharmS
A. T. Florence (PJ, 3 July, p18) makes valid points about the importance
of the scientific content of the MPharm course and how it will vary to
suit the perceived present and future needs of the profession and its
members. Pharmacy itself is surely the dissemination of this knowledge
to those who require it whether they be patients or professionals.
Where should the skills needed to manage and communicate this knowledge
be acquired? During the course, during the preregistration year or by
experience while practising?
I have the great privilege of being able to combine the practice and
management of community pharmacy with the teaching of these aspects of
the profession. The students with whom I have contact are given tuition
in communication skills, and are encouraged to gain work experience during
vacations, to make full use of their preregistration year and to participate
fully in continuing professional development once they are qualified.
Unless pharmacists have the will and skills to communicate, their scientific
knowledge may well be wasted.
Barry Shooter
Romford,
Essex
The extra year is for integrating science and practice
From Professor M. Heinrich
In response to the important and intensive discussion on the curricula
in schools of pharmacy, I am concerned that a four-year degree course
is seen as one which is only there to prepare for practice (see letter
from Patrick Wilson, PJ, 3 July, p19).
One of the strong aspects of a course like pharmacy is the integration
of (basic and applied) science with practice. Getting the balance right
is difficult but, while a university will be able to lay the groundwork
for “clinical practice”, the everyday and continuous experience
(and training) will have to come during the preregistration year and,
of course, afterwards (through continuing professional development).
The complexity of modern science requires a profound understanding of
a multitude of basic scientific concepts relating pharmacy to other and
diverse sciences (eg, biology, chemistry, material sciences). It is this
multidisciplinary nature of pharmacy which makes it unique, provided
that we are able to focus on the core tasks of pharmacy: the formulation,
pharmacological effects, quality, clinical use, discovery and other aspects
of medicines. Clinical practice without understanding the scientific
basis of these medicines would be a worrying risk to patients, but also
implies serious risks to the profession. If graduates have problems in
the area of drug monitoring, this is as much a challenge to improving
the training in the natural sciences as in clinical pharmacy. It will
be essential not to underestimate the complexity and diversity of the
scientific knowledge base required.
Lastly, we should remember, that schools of pharmacy today train people
who will be dispensing medicines for 40 to 50 years and, for example,
in order to profit from continuous professional development, they will
need a profound understanding of the relevant areas of science.
Michael Heinrich
Centre for Pharmacognosy and Phytotherapy
School of Pharmacy,
University of London
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