The Pharmaceutical Journal
Vol 275 No 7373 p549-550
29 October 2005

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What the APPLET project has done to progress law and ethics teaching

In 2003, the Advancing the Provision of Pharmacy Law and Ethics Teaching project team reported on their preliminary survey of pharmacy law and ethics teaching. As the project reaches a close, in this article the team reports on what has happened since

The home page and many of the higher level pages of the APPLET website are freely accessible. Some teaching material and the e-mail facility is password protected. Teacher of pharmacists or pharmacy students are invited to e-mail Joy Wingfield (Joy.Wingfield@nottingham.ac.uk) for access.

The Advancing the Provision of Pharmacy Law and Ethics Teaching (APPLET) project has its roots in preparing pharmacy students for practice. Whereas for many decades a thorough knowledge of the Medicines Act and an acquaintance with the Code of Ethics may have sufficed to equip pharmacists for their role as suppliers of medicines, today’s practice is different and the stakes are higher. Some examples of modern dilemmas are given in Panel 1. The aim of APPLET is to support teachers in schools of pharmacy to help students explore these and other legal and ethical challenges.

There are no courses specifically designed to support teachers of pharmacy law and ethics. A few lecturers have undertaken courses in health care law and ethics but these rarely include reference to pharmacy practice. APPLET also aims to bridge this gap and provide support for teachers of pharmacy law and ethics.

Scope of the APPLET project

The Higher Education Funding Council for England (HEFCE) funded APPLET as part of government policy to promote quality in teaching and learning across the whole higher education sector in England. Similar bodies exist for the other home countries. From the outset, however, APPLET was allowed to include all UK schools in its work. The consortium schools of pharmacy (Nottingham, Aston and De Montfort) were in England. The funding was for three years, from October 2002 to September 2005, and followed a demanding two-stage bid process in competition with bids from a range of health care institutions in higher education providing courses in subjects such as nursing, public health and health care ethics.

The objectives of the APPLET project may be summarised as follows:

· To raise awareness among teachers of pharmacy law and ethics as to the possible range and depth of topics that would support preparation for practice

· To put teachers of pharmacy law and ethics in touch with each other and create an active community

· To draw on the experiences of those who train other health professionals

· To develop a consensus core curriculum of what topics should be taught and at what level

· To provide an interactive website through which to exchange ideas, post teaching material (both existing and new) and identify resources for teachers

We made a start on the first two objectives in autumn 2002 by having a discussion with an academic from each school of pharmacy through a personal visit, where possible, or by telephone. We established key contacts and an e-mail list of interested teachers. We then used the biennial meeting for teachers of law and ethics held at the Royal Pharmaceutical Society as a platform to expand on our objectives and to check whether or not they were supported by the teachers, who then discussed in workshops how the objectives might be achieved. There was clear diffidence about sharing teaching materials and a reluctance to take on additional commitments when there were already many demands on time. However, considerable enthusiasm was expressed for sharing information about what was taught, and at what level, so we focused on developing a core curriculum.

Scope and depth of what we teach

There is guidance from the Society on the indicative syllabus for accreditation of the MPharm degree. However, in the area of pharmacy law and ethics, it is not easy to translate the specification into exactly what should be taught and, in particular, to what level. For example, the indicative syllabus includes “statutes and main regulations related to medicines and poisons” and “the political and legal framework, requirements and processes relevant to pharmacy”. But what does this mean? Does it include the operation of the courts, civil law and clinical negligence, pharmacists’ disciplinary processes, administrative law and the NHS? The indicative syllabus also contains “the duty of care to the patient and the wider public: concept, scope and application of professional ethics, the code of ethics of the RPSGB”. Does this mean either ethical values (eg, paternalism, autonomy and justice) or ethical applications (eg, consent, abortion, human rights, confidentiality, genetics, research and resource application), or both? Such questions generated considerable debate among the teachers.

In mid-2003, almost all schools of pharmacy sent two members of staff to workshops on the pharmacy law and ethics curriculum. These workshops were facilitated by a non-pharmacist teacher of health care law and ethics, and provided valuable data on the breath and depth of topics that should be taught in the undergraduate programme. The outputs of the workshops were then used to construct a questionnaire, which was sent to the teachers involved in teaching law and ethics and to a range of external stakeholders, including the Society, the Department of Health and representatives of employers. Finally, the responses were analysed and a list of topics and subtopics, each with a suggested depth of teaching, was produced. Panel 2 shows the main topic headings and further details are available on the APPLET website

Resource for teaching

Creating a consensus curriculum was only one of many goals set out in the APPLET project plan for completion within the three years. The most visible was the establishment of a dedicated website for dissemination of new teaching material developed by the APPLET project and for sharing examples of teaching provided by members of the pharmacy law and ethics community, and as a central resource of relevant news, information and web links for teachers of law and ethics. Towards the end of the first year, the website carried modest amounts of teaching material and resource, largely supplied by the consortium team members themselves.

We needed to be a little more proactive so we commissioned teaching material on topics that teachers had identified as presenting the greatest challenges. This included: material on the legal basis for the operation of the NHS in Scotland; lectures, a video and a workshop to encourage students to think about the risks of poor practice and wrongdoing in real life and how they would respond to the situations portrayed in the video; and a set of teaching materials and briefings for teachers on aspects of professional ethics and moral philosophy based on workshops with practising hospital pharmacists to identify ethical challenges in their practice. The commissioned material on professional governance procedures was tried out in eight schools of pharmacy and both teachers and students were asked to evaluate the material.

Using the findings from the curriculum work, APPLET relaunched its website at the beginning of the year, using a diagrammatic view of the topics for ease of navigation. A search engine was added to help with locating teaching and assessment material. Links to book reviews and useful websites were also added. An e-mail group reaching around 50 teachers is being used to generate a dialogue. A “What’s new?” link, updated monthly, is also provided to summarise relevant new law and consultations.

Delivery of law and ethics teaching

One of the arguments to support our bid for funding reflected the nature and work patterns of the teachers themselves. Few schools retain teachers with postgraduate qualifications in either medical law or health care ethics and many use part-time teacher practitioners. This contrasts with the teaching of pharmaceutical sciences. A long-term goal for pharmacy teaching should be to encourage more specialist teachers into the pharmacy law and ethics field. Some schools have experimented with the use of experts in medical law or ethicists to supplement their teaching but the lack of familiarity with pharmacy practice can limit the usefulness of this approach. Arguably, it is better to take pharmacy practitioners and develop their knowledge of health care law and ethics than to familiarise lawyers and ethicists with the scope of pharmacy practice.

One need expressed by many teachers was to have help making their teaching relevant to pharmacy students. Although many teachers can draw on their own current or former practice for case studies and scenarios to bring law and ethics alive, exposure to practice and the opportunity to discuss issues with practising pharmacists from an early stage in the course is important to complement theoretical concepts. Scope to achieve this compares rather unfavourably with the training of medical and nursing students, largely because of differences in the funding infrastructure and organisation of the courses. Although these limitations have been long acknowledged, the fast growth in clinical roles for pharmacists has highlighted the need for increased awareness of legal and ethical issues, which is helped by significant exposure to practice.

As the project progressed it became evident that a number of areas were worthy of research in themselves, such as:

· How might the APPLET resources be extended to students and in what form?

· What methods of teaching are most effective for different areas of law and ethics?

· How should professionalism be assessed?

· How can the relevance of undergraduate teaching to postgraduate training and post registration practice be ensured?

However, the terms of the HEFCE funding meant that APPLET had to focus on the development of teaching and assessment, but could not undertake significant amounts of research. Moreover, pharmacy as a health care profession still has a relatively low profile within most centres of scholarship and research. It is hoped that this is set to change as the work of APPLET is disseminated and the findings from research commissioned by the Society are published.

What more could be done?

A project of this nature is something of a gamble. It was a requirement of the bidding process that goals and outputs for the three years were included in the project proposal. Achieving goals and outputs might be relatively easy within a fixed organisation with employees who could be required to undertake tasks but this project was first and foremost a voluntary, collaborative effort, undertaken largely on top of participants’ existing workload. It is, therefore, a credit to all contributors that the project will come in on target, within time and under budget.

For teachers, during 2006, APPLET will be delivering residential short courses on law and ethics, and workshops on assessment in areas of health care ethics which are difficult to assess (eg, behaviours, values and attitudes).

Since the start of the project, several new schools of pharmacy now offer or will offer an MPharm degree. Further modest funding, separate from the original APPLET grant, has been secured to transfer the APPLET work to these new schools during 2006. However, future development or even maintenance of the APPLET resource beyond 2006 remains an issue. Funding for academic leadership and input, and for monitoring and development of the APPLET website, will still be needed.

There are many examples of developments in practice for which greater familiarity with legal and ethical components of risk management, liability and patient care would be valuable. It follows, therefore, that the pressures from changes to practice apply equally to the content and quality of training delivered in the preregistration year and in continuing professional development programmes for practising pharmacists. Opportunities to learn from the approaches taken by other health professionals should be identified and incorporated into post-qualification practice.

We hope that the APPLET project will continue to support a significant component of the training and development needed for pharmacists to contribute as an integral part of the health care team.