The Pharmaceutical Journal
Vol 275 No 7377 p667-668
26 November 2005

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Bologna agreement

Does the Bologna agreement provide an opportunity for pharmacy in the UK?

The Bologna agreement In June 1999 European ministers of education convened in Bologna, Italy, and agreed to construct a European higher education area (EHEA) based on fundamental principles of university independence and autonomy to ensure that higher education and research in Europe adapt to the changing needs of society and advances in scientific knowledge. The EHEA would work to increase the international competitiveness of the European system of higher education and would aim to adopt a system of comparable degrees comprising two main cycles, undergraduate and graduate, with the latter leading to a master’s degree or doctorate. A transferable system of academic credits would also be introduced. The Bologna agreement would thus move Europe toward comparable degrees and cooperation in quality assurance. The target date for full implementation is 2010.

The Academy of Pharmaceutical Sciences is an independent professional body which aims to provide scientific training through conference and seminar programmes, support focus groups for networking in specialised subject areas, collaborate with other organisations in Europe and the US and represent views nationally and internationally. The academy works in partnership with the Royal Pharmaceutical Society in a formal agreement to co-develop programmes for scientific events, including the British Pharmaceutical Conference science programmes. Further information on joining the academy and the benefits of membership can be found on its website at www.apsgb.org The Academic Pharmacy Group is open to pharmacists and other academic staff who make a significant contribution to pharmacy teaching and research in a UK school of pharmacy or a recognised pharmacy academic practice unit. Contact: Damian Day at the Royal Pharmaceutical Society (tel 020 7572 2215; e-mail damian.day.@rpsgb.org).

We are now past the half-way point between the Bologna declaration (1999) and the planned completion of the EHEA in 2010, said Terry Mitchell, of the University of Dortmund, Germany, and “Bologna promoter”, who explained that the principles had been developed and confirmed at further meetings in Berlin (2003) and Bergen (2005). The next meeting would be in London in 2007.

A simple framework has been developed wherein the first cycle is essentially the bachelor’s degree with 180 to 240 credits (on the European system) and the second cycle is the master’s degree with 90 to 120 credits. A third cycle would equate to a doctorate. For each cycle the so-called “Dublin descriptors” were drafted by the Joint Quality Initiative consisting of representatives of quality assurance bodies and ministries. Degree outcomes are defined by descriptors related to knowledge and understanding, the application of knowledge and understanding, making judgements, communication, and learning skills.

Accreditation of international degree programmes is not at present possible because accreditation rules are not homogeneous across Europe and programme accreditation is unknown in some countries. These problems could be tackled by establishing international subject-based accreditation, such as the European Quality Improvement System (EQUIS) for business schools.

The EHEA envisages the development of national and European frameworks for qualifications as an opportunity further to embed lifelong learning in higher education. To achieve these objectives, doctoral level qualifications need to be fully aligned with the EHEA overarching framework for qualifications using the outcomes-based approach. The core component of doctoral training is the advancement of knowledge through original research but universities should ensure that their doctoral programmes promote interdisciplinary training and the development of transferable skills, thus meeting the needs of the wider employment market. Over-regulation of doctoral programmes, however, must be avoided.

Taking stock on progress for the next ministerial meeting in London in 2007, progress will be looked for in implementation of the standards and guidelines for quality assurance as proposed in the report of the European Association for Quality Assurance in Higher Education, implementation of the national frameworks for qualifications, the awarding and recognition of joint degrees (including degrees at doctorate level) and creating opportunities for flexible learning paths in higher education, including procedures for the recognition of prior learning.

Implementation of the Bologna agreement is taking place as part of a tuning project, which defines nine subject areas (chemistry, physics, mathematics, geology, history, business, education science, nursing and European studies) and 11 thematic networks (architecture, geography, medicine, law, sport, political science, languages, social sciences, engineering, landscape planning and agriculture). The development of this detail could be the starting point for implementing the Bologna agreement for pharmacy, suggested Professor Mitchell, always assuming the EU directives allow a sensible reform.

Damian Day, head of accreditation at the Royal Pharmaceutical Society, reviewed the issues for pharmacy in the UK in relation to the aim of the EHEA: free movement of academics, students and qualifications by 2010. The current structure of the MPharm qualification is essentially three years at bachelor level and one at master level corresponding to the two cycles proposed by the Bologna agreement and thus, although it is a four-year integrated degree, the MPharm conforms to the Bologna model. Additionally, there is a possibility of exit at three years with a bachelor degree. Mr Day stressed that the MPharm is not an undergraduate course; it is part of an education strategy to provide a workforce fit for the purpose. The MPharm needs to be vigorously promoted through the Universities UK Europe Unit.

In law, the UK is already obliged to recognise qualifications obtained in member states and in this area pharmacy is ahead of the Bologna agreement. However, there is a conflict between the Bologna agreement and European directive 85/432, which governs the granting of pharmacy qualifications. There is a basic mismatch between the learning outcomes parameter of the Bologna agreement and the time stipulation of the directive. Mr Day emphasised that the MPharm must be four years and full-time and that this is the law. It could not be bent to accommodate the Bologna principles. However, the directive is dated 1985 and may be in need of review. A simple way forward would be to reconvene the Advisory Committee on Pharmaceutical Training, which could then change the stipulation to so many hours credited rather than elapsed years. It was noted that the committee last met in 1994 and a reconvened body will be much larger with 25 member states.

Educators’ perspective

Ian Bates, of the University of London, and Keith Wilson, of Aston University, in providing a joint perspective of the Bologna agreement from pharmacy educators, characterised it as a silent revolution. Most countries in Europe have already signed up to the goal of a European Higher Education Area by 2010 with an overall degree structure in place, transferable credits and a system to transfer national loans and grants.

The proposed two-cycle system, of a two-to-three-year first cycle and one-to-two-year second cycle, already fits the academic systems in countries such as the UK and Sweden, but not, it should be noted, in Germany and Austria. The two-cycle system becomes a three-cycle system with the inclusion of doctoral studies. Higher education is not an EU competence and hence this is a voluntary multilateral agreement based on mutual trust with a shared sense of urgency. With the globalisation of higher education an increased European profile is needed, especially one with enhanced mobility. A problem is that there are more systems than there are countries. The silent revolution aims not at harmonisation, but compatibility. The MPharm degree is on the whole compatible, although the preregistration year necessary to register and practise as a pharmacist in effect extends the integrated four-year course to five years.

The Bologna agreement did not include the views of students, but this is now being rectified through ESIB, the National Unions of Students in Europe. Students’ motivation and their ratings of schools are important factors in planning education systems. Students have expressed some reservation about the interpretations, as some thought it would be used as an excuse to bring in tuition fees. The Bologna model could also be seen as promoting a career ladder that could enable science graduates to progress from pharmacy technicians to specialist pharmacists.

Professor Bates and Professor Wilson favoured the introduction of a pharmacy road map, rather than a syllabus, a map being a way of getting from A to B by a variety of interesting routes, but still with a sense of purpose: the outcome, not a learning objective. The silent revolution offers variety for students, autonomy for learners, and wider opportunities for faculties; it would be a loss to UK pharmacy if the Bologna agreement were not enthusiastically embraced.

Professor Wilson added further thoughts as a head of school. The Bologna agreement is an opportunity for pharmacy, he said. This is despite relative indifference to it from academia, possibly because of a lack of detailed awareness and low priority with government and agencies. Relatively few institutions are fully engaged, and there are many distractions, such as the research assessment exercise and student fees. The Bologna agreement may not be seen as a threat but neither are the opportunities recognised.

Higher education is increasingly an international activity and the EHEA can be a major international player offering scope and diversity, increased opportunity for staff and student mobility, development of life-long learning, increased understanding within Europe, and progress towards harmonisation through mutual understanding.

Despite the EU directives, pharmacy should be involved. Directive 85/432/EEC is past its sell by date, with outcomes expressed only in terms of adequate knowledge. Study is defined mainly by volume, with a prescribed curriculum for minimum theoretical and practical training in 14 subject areas.

The concept of the EHEA offers the opportunity to develop a true common currency in pharmacy education, to learn from best practice across the EU, to promote student and staff exchange, to develop institutional co-operation and, in research, to obtain the benefits of alignment of the EHEA and the European Research Area.

The challenges that need to be faced include the twin-level qualifications in pharmacy, the position and educational level of the registered technician in the UK, the role of UK foundation degrees, and the future roles of the UK technical workforce as described in the Health Bill 2005. The EHEA framework offers pharmacy the opportunity for change to an integrated degree leading to professional qualification, the definition of postgraduate awards for specialised roles and a true definition of the educational endpoint for pharmacy technicians and assistants.

Academic workforce and preregistration

Any change in education policy, such as that envisaged by the Bologna agreement will have an impact on the academic workforce. The current and possible future scenarios for pharmacy were reviewed by Sue Ambler, head of practice research at the Royal Pharmaceutical Society.

The aim of education in pharmacy at all levels is generally to support the Society’s mission to improve the health and health care of the population and specifically to ensure that all registered pharmacists are competent and fit to practise pharmacy. The Society administers systems for the registration of pharmacists to control their entry to, and continuation in, pharmacy practice. Currently the Society sets and monitors standards for undergraduate programmes, preregistration training, and post-registration supplementary prescribing and continuing professional development. A change in policy would require new primary care contracts and re-evaluation of the knowledge and skills framework, the agenda for change, the skills escalator, and patient safety and clinical governance.

At present pharmacy graduates are assessed on clinical competence according to their competence in dispensing, law and practice, knowledge and understanding of important recent changes in law and professional requirements, managing dispensing, providing advice to patients and professionals, constructing and using medication histories, and managing minor ailments. In the future the pharmacy graduate will be assessed on making clinical decisions based on evidence gathered, assessing patients’ problems with medicines and formulating investigation and management plans, recording decisions and outcomes, breaking bad news, helping vulnerable people and prescribing. Assessment may be at graduation, at registration, or at revalidation. Assessment will be on the continuum of “knows, knows how, shows how and does”.

The future academic workforce will embrace academic staff, joint appointments and teacher practitioners, preregistration tutors, clinical mentors and supervisors, Centre for Pharmacy Postgraduate Education tutors, technicians, other health care professionals and patients. The issues to be addressed are how many are required, who are they, and where are they, concluded Dr Ambler.

Participants’ views

The breakout sessions gave participants a chance to discuss their views and concerns on the academic workforce and on preregistration placements. With the increase in the numbers of schools of pharmacy in the UK, there is an increasing pressure on preregistration placements in the traditional areas of community pharmacy, hospital pharmacy, academia and industry. There was a view that the capacity issue needs to be sorted out and supervision was problematical, particularly if the supervisor had his own job to attend to. Funding was an issue, particularly in non-NHS placements. Industry is reluctant to sponsor preregistration placements if only a small part can be spent in the industry itself. There needs to be proper regulation of tutors.

In general, it was thought that a cross-sectional experience should be aimed for. A major crisis was looming, reported one group, in the provision of science education for pharmacists. The current staffing level of pharmaceutical scientists was decreasing rapidly with many approaching retirement age.

Summing up the day, the chairman Bill Dawson said that the initial question could be answered with a resounding “yes”: the Bologna agreement is an opportunity for pharmacy.

The MPharm already fits the Bologna model but we need to look forward and act to reap the benefits. The profession needs to lobby other professions to increase appreciation of the Bologna agreement within health care education and the Society also needs to look at the education system. There will be no shortage of pharmacists, concluded Professor Dawson, but they have to be trained for what we want them to do.