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Geoffrey Harding and Kevin
Taylor are from the School of Pharmacy, University of London
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Pharmaceutical science’s place in the undergraduate curriculum
and its relevance to contemporary pharmacy practice are inextricably
linked and impact
directly on the profession’s future development.
This issue, which has been vigorously debated in recent issues of The Pharmaceutical
Journal, mirrors debates about the appropriateness of medical training, in which
medicine’s traditional foundation, comprising basic medical sciences such
as anatomy, biochemistry, pathology and physiology, has been questioned. Indeed,
some medical schools have now all but abandoned formal teaching of the basic
medical sciences, instead preferring knowledge of these subjects to be
acquired through self-directed or problem-based learning. Critics, however, have
argued that such an approach risks producing newly qualified doctors with insufficient
detailed knowledge to practise effectively and safely.1
Similarly in pharmacy, what is at stake is the character of pharmacists’ skills
and knowledge and their ability to practise effectively in the future.
Recent initiatives to extend pharmacists’ functional activities, as with
for example supplementary prescribing, maps a route through uncharted waters — which,
rather than consolidating pharmacists’ unique knowledge base, may be considered
as blurring the traditional boundaries between pharmacists and the medical profession.
But the novel is often extremely attractive and one new pharmacy school has already
indicated that supplementary prescribing will be at the heart of its MPharm course.
In an era of rapid and turbulent change for pharmacy, it is all too tempting
to throw the baby out with the bathwater and label the traditional pharmaceutical
science that was once the hallmark of “chemists” as obsolescent and
out of touch with contemporary practice.
Science at the core of pharmacy
Science can lack the same immediate level of applicability to pharmacy
practice as, say, law and ethics or therapeutics yet all pharmacy schools
still include pharmaceutical science in the curriculum. This is because
pharmaceutical science embodies the underlying philosophy of a pharmacy
education, and science remains at the core of pharmacy, being the skeletal
outline on which is overlaid the principles for applying this science
to practice. Yet science and practice are now portrayed as difficult
bedfellows in both pharmacy education and practice.
For pharmacy teachers, a tension exists because the imperative to impart
this core scientific knowledge must be balanced with the necessity to
prepare students adequately for practice. At face value, a significant
proportion of the science taught may seem unnecessary or even redundant,
and reducing the science component of pharmacy degrees to enhance clinical
content may appear desirable for preparing students for the pharmacy
workforce. But such an approach, we believe, sacrifices capacity for
capability — producing students with clinical capabilities but
reduced capacity to trade on what historically has been pharmacists’ unique
knowledge base. This could ultimately undermine the sustainability of
pharmacists’ contribution to health care.
To avert this scenario, science has to be seamlessly welded to practice,
imparting in pharmacy undergraduates the imperative of underpinning pharmacists’ actions
with scientific knowledge. Knowledge into action
Pharmaceutical services are increasingly patient-centred, as exemplified
by the widespread adoption of the terms “pharmaceutical care” and “medicines
management”. To understand and meet patients’ needs requires
pharmacists to blend clinical, scientific and social skills — considering
the patient’s health state, the scientific principles of their
medication and, ultimately, that it is the patient who largely decides
his or her own fate.
Science cannot be divorced from the practice context, and analytical
chemistry, colloid science, autonomic pharmacology or microbiology, if
taught to pharmacy students, should have clear applications to pharmaceutical
service delivery. If teachers cannot justify to students and colleagues
why their subject area is important, then it can have no place in the
curriculum.
Perceived relevance will be a particularly important issue in the future
as students pay higher tuition fees and more pharmacy schools with increased
numbers of available places seek to recruit students. However, this is
not to say that, because a community pharmacist working in a pharmacy
with a high prescription turnover or a hospital pharmacist on a ward
round does not directly use his or her scientific knowledge, it should
be condemned as “irrelevant”.
Lack of direct application does not necessarily negate a subject area’s
potential value. So for instance, in all UK pharmacy schools students
learn how to formulate and manufacture pharmaceutical suspensions.2 Because
most pharmacists no longer make suspensions in practice, this does not
render the under-lying formulation science and knowledge of excipients
and drug delivery irrelevant or useless. Such knowledge, whether or not
it is drawn upon in daily practice, is critical in delineating pharmacists
as the medicines experts in health care. Unique contribution to health care
Many new roles are being advocated for pharmacists, particularly as
the skills of pharmacy technicians and computer technology are more extensively
used. If in order to undertake these roles, pharmacy seeks to divorce
itself from its scientific roots, then in the current political climate
which is promoting the breakdown of demarcations between health professionals
and a “skills escalator”, pharmacists risk finding their
knowledge base being largely indistinguishable from that of other members
of the health care team.
One consequence may be the undermining of pharmacists’ claim to
professional status by limiting their ability to draw on a unique knowledge
base which, combined with their experiential knowledge, permits them
to make professional judgements. Pharmacists, through their education
and training can consider (and conceptualise) a drug molecule, together
with its formulation and delivery as a medicine. They have an in-depth
knowledge of pharmacology and therapeutics, physicochemical properties
of drugs and excipients, biopharmacy and pharmacokinetics, adverse drug
reactions and drug interactions. It is this complex, varied and integrated
expert knowledge that qualifies them, and them alone, to make professional
judgements relating to medicines.
Pharmacy education is a blend of pharmaceutical, clinical and social
scientific knowledge and each pharmacy school will strike a balance differently.
However, as pharmacy undergraduate courses must necessarily evolve to
ensure students are equipped for both contemporary and future practice,
the uniqueness of pharmacists’ knowledge base must be maintained. References
1. Williams G, Lau A. Reform of undergraduate medical
teaching in the United Kingdom: a triumph of evangelism over common sense.
BMJ 2004;329:92–94.
2. Chowdhury T, Taylor KMG, Harding G. Teaching
extemporaneous preparation in UK schools of pharmacy. Pharmacy
Education 2003;3:229–36. |
The
Pharmaceutical Journal