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Pharmacy education
Pharmacists are scientists and clinicians
From Dr J. P. Malkinson, MRPharmS
I have read with much interest the recent exchange of correspondence
on the education and training of pharmacists. I share the responsibility
of teaching organic chemistry to pharmacy undergraduates and ensuring
that they appreciate the importance of chemical and physical properties
of drugs to their day-to-day practice as pharmacists. These properties
are, after all, undeniably at the heart of pharmacy, from the ability
of a drug to interact with its target, its formulation and dose, to its
route and frequency of administration.
I attach enormous value to my knowledge of science in my (albeit occasional)
practice as a clinical pharmacist. Similarly, my clinical skills help
me to be a better scientist. Pharmacists are necessarily both scientists
and clinicians; I do not believe the two are mutually exclusive as seemingly
implied by Duncan McRobbie (PJ, 26 June, p802). I am sure his expertise
as a specialist cardiac pharmacist (PJ, 10 July, p56) includes an in
depth knowledge of how cardiac drugs work, ie, the science behind their
pharmacology. The comment regarding the perpetuation by “scientists” of
the “myth of the importance of [their] science to the profession” seems
rather short-sighted at best. Future pharmacists will need a knowledge
of their fundamental science to interpret, understand and anticipate
potential problems (eg, with formulations, interactions, incompatibilities,
adverse drug reactions) that may arise during the use of newly developed
drugs with which there is limited clinical experience. If anything, the
importance of science to the profession of pharmacy can only increase,
taking into account factors such as tailoring drug therapy to an individual’s
genetic profile, the increasing complexity of cancer therapeutics, the
development of antibacterial/antiviral resistance and the use of multidrug
regimens (to name but a few).
The public and our fellow health care professionals reasonably expect
us to be experts on drugs and their use, not just their use. We are uniquely
qualified to offer expert advice because we possess a knowledge that
doctors and nurses lack. There is an inherent danger of depriving future
pharmacists of this knowledge by diluting the science content of the
MPharm degree, which will do little to detract from the perception of
us by some as tablet counters and shopkeepers.
John Malkinson
Lecturer in Pharmaceutical Science Applied to Practice
School of Pharmacy,
University of London
Let us strengthen postgraduate education
From Dr S. Dhillon, MRPharmS
I have read with interest the debate on science and practice in pharmacy
education and would like to expand the discussion from a postgraduate
point of view, which is endorsed by a number of my colleagues from the
university sector. It is vital that we ensure the robust scientific professional
discipline of pharmacy. We cannot look at the MPharm degree and preregistration
year in isolation from postgraduate education and training. The 1980s
and 1990s have seen the real strength of postgraduate diploma and MSc
programmes deliver today’s leading edge practitioners, specialists,
academics and managers.
Pharmacy education must start with an integrated science and practice
undergraduate degree. My belief is that the undergraduate degree could
be further strengthened if the preregistration year was more integrated
with the final years of the MPharm degree programme. The profession needs
to be clear about the purpose of an undergraduate degree and preregistration
year. In such a short time we cannot produce a graduate who can deliver
the breadth of expertise required from pharmacists entering the NHS or
industry or academia. We must recognise the value of postgraduate education
and training. I would argue we need at least two to four years’ postregistration
experience underpinned by a platform of postgraduate diploma/MSc programmes
and continuing professional development to produce, first, a general
level practitioner who is then confident and mature enough to determine
their pathway towards clinical specialisation or to broaden their practice.
At this stage the pharmacist is able to develop a career pathway which
may also embrace management or academia.
The NHS knowledge and skills framework is enabling us to recognise clearly
the three levels of pharmacist from a general level to advanced and consultant
practitioners. We need to look at the medical model for education. There
is an urgent need to look at the similarities that exist for pharmacy
education and establish these pathways more clearly. I urge academia,
our emerging specialist groups and the Royal Pharmaceutical Society to
work together to strengthen the postgraduate education pathways for pharmacy.
Let us not just look at the undergraduate programmes in isolation, undervalue
the scientific expertise required from a pharmacist or devalue the scientific
and professional basis of pharmacy practice.
Soraya Dhillon
Director of Taught Postgraduate Studies
School of Pharmacy,
University of London
Pharmacists' value derives from the science they learn
From Miss E. M. Graham-Clarke, MRPharmS, and Mr J. P. Bleasdale, FRCA
We have been following the recent correspondence regarding pharmacy
education with interest.
It is to be regretted that the addition of the fourth year to the pharmacy
degree has not been universally successful in increasing exposure to
clinical practice (whether in hospital or community). However, we strongly
believe that the science basis of pharmacy must be maintained. As A.
T. Florence states (PJ, 3 July, p18), clinicians do not need pharmacists
to be walking BNFs, for they can read just as well as pharmacists can.
What is required is the ability to interpret the information in the clinical
setting, and this requires the underpinning scientific knowledge.
Unfortunately no course, whether it be medicine or pharmacy (or any other
teaching a skill), can enable the trainee to move straight into the role
without some feeling of inadequacy. Situations will be faced that have
not been covered previously because there is no substitute for experience,
and even the most experienced among us will still find situations they
have not encountered before.
Communication skills and clinical experience can be developed over the
first years of clinical practice and it is time that employers recognised
and planned for this. If we have pharmacists who have a good grasp of
the science behind pharmacy, then we can give them the experience and
the training and allow them to develop fully. What we are in danger of
having instead are pharmacists who think they ought to know everything,
now, and therefore feel hopelessly inadequate when they discover they
do not.
As intensive care professionals, we work together to provide the best
care for the patient. The medical assessment will highlight the problems
faced by the patient, while the pharmaceutical input should be looking
to optimise treatment. This may require diverse skills, such as interpretation
of blood levels of drugs, compatibility issues or identification of adverse
effects. It requires pharmacists who are able to utilise the available
information using their scientific background, to interpret the facts
in a proactive and timely manner and to give a balanced opinion that
may well fall outside the boundaries of routine medicine.
In a roundabout way, we are trying to say that Professor Florence is
correct: it is the added value that pharmacists give to the facts in
the BNF that set them apart, and that derives from the science they learn.
Emma Graham-Clarke
Locum Consultant Pharmacist Critical Care
John Bleasdale
Lead Clinician Critical Care
City Hospital, Birmingham
Clinical skills need to be upgraded
From Mr C. O. Agomo, MRPharmS
My only fear in the present debate on pharmacy education is that I doubt
if pharmacists in Britain, particularly those in the community sector,
are in the best position to deliver the new futuristic clinical services
efficiently without a drastic modification of both the pharmacy training
and the structure of practice, which presently involves much dispensing,
depending on where one works.
I wish to suggest that modifying our training to reflect the present clinical
needs, such as the introduction of the doctor of pharmacy degree offered
in the US and which has also being adopted by many overseas schools, including
the University of Benin, Nigeria, will go a long way towards equipping
pharmacists in Britain to meet these expectations. The present training
to become prescribers might not be enough, considering the serious and
diverse nature of patients’ needs in the community sector. There
is also a need to ensure that the new pharmacy schools are started only
in those universities that are already training would-be doctors and nurses
to allow early clinical exposure and the development of interaction skills.
The programme at the University of Benin not only trains students to become
clinically skilled on graduation, it also allows qualified pharmacists
to become clinically skilled through its three-year weekend programme.
A two-year, part-time programme might be sufficient for the needs of pharmacists
in Britain. The benefits would be many, in that the Government, the public
and other health care professionals would be impressed with the quality
of our graduates. This is in line with the arguments of Geoffrey Harding
and Kevin Taylor, who wrote in their article (PDF
95K) “Power, status and pharmacy” (PJ,
28 September 2002, p440), that a “strategic response to some of the
challenges to pharmacists’ privileged status is to pursue what has
been termed ‘a professional project’ to persuade the state
and public of the value of their work”.
Chijioke Agomo
London N7 |
The
Pharmaceutical Journal