The Pharmaceutical Journal
Vol 277 No 7431 p747
16 December 2006

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Pharmacy education in the UK needs an overhaul

In this article, Alan Nathan explains why fundamental changes to pharmacy education are needed

The way in which pharmacists are educated in the UK puts pharmacy at a disadvantage with respect to other health professions, according to research sponsored by the Royal Pharmaceutical Society’s Pharmacy Practice Research Trust (PPRT) (PJ, 2 December, p671). David Wright and Martin Loftus from the school of chemical sciences and pharmacy at the University of East Anglia (UEA), compared pharmacy with medicine, dentistry and optometry courses in the UK, and with pharmacy courses in Australia, New Zealand, the US and Canada. Dr Wright was formerly a pharmacy practice lecturer at the University of Bradford, where preregistration training consists of two six-month placements at the end of the second and beginning of the final year of the MPharm course, rather than as a single one-year block following graduation. He found Bradford students who had completed their first period of practical training to be more interactive, professionally focused and more able to apply knowledge than UEA students at an equivalent stage of the undergraduate course. He also found that all other UEA health profession courses integrated practical experience with academic education and, as a result, while pharmacy students considered themselves comparable to other health profession students in inter-professional courses in their first year, by the second year they began to feel inadequate. Dr Wright’s experience led to the PPRT-sponsored research.

Need for a competency-based approach

Health profession courses in the UK and many overseas pharmacy courses are based on competency, rather than competence as are UK pharmacy courses. Competence equates to “can do” (ie, showing that a task can be performed to an appropriate level) as determined by assessments such as practical tests. Competency, on the other hand, equates to “does do” (showing that tasks can be performed appropriately and repeatedly in a real environment) and is based on workplace assessments, such as portfolios and observation by experienced practitioners. UK medicine and dentistry courses are competency-based, with provisional professional registration granted at graduation. UK pharmacy courses have outcome- or competence-based curricula. Competency is acquired during preregistration training and registration is conferred at the end of the training year.

Without significant provision of practical experience a university cannot work to a competency framework. In general, overseas pharmacy courses offer more integrated clinical practical experience. For example, American and Canadian degree programmes include clinical placements. Pharmacy education programmes in Australia have a similar structure to those in the UK but about a quarter of the total practical experience is incorporated into the degree.

Although many community and hospital pharmacists spend most of their time doing NHS work, UK pharmacy undergraduate courses are classed as science degrees and are structured and funded in the same way as other non-vocational degrees. Medical and dental courses are structured differently and substantially higher funding is provided by the NHS. Most medical schools provide a totally integrated five-year academic and clinical training programme. The more traditional institutions have an initial two year university based training, although with clinical experience integrated from the outset, followed by three years of mainly practical, clinically-based education. In dental schools extensive teaching and practice of clinical skills occur throughout the five-year course with up to four years of clinical funding — around £20,000 per student per year provided by the NHS, compared with the £8,000 per year coming from the UK higher education funding councils for a pharmacy student.

Need to develop professionalism early

Dr Wright and Dr Loftus’s research and another PPRT-funded project conducted by Geoff Harding at the Peninsula School of Medicine and Dentistry, Exeter, and Kevin Taylor at the School of Pharmacy, University of London, examined the approach to teaching, and students’ concepts, of professionalism in pharmacy. Wright and Loftus contend that university education can improve moral reasoning and professional attitudes, but role models are also important — both practical placement supervisors and university teachers could play a part. In addition, for assessments of professionalism to be valid, they should be made in different environments and by different assessors.

At present in pharmacy there is no official link between student discipline in universities and professional regulation, whereas in other health professions students are subject to professional scrutiny from the start of their courses. For example, the General Medical Council requires medical schools to have fitness to practise boards to deal with unprofessional conduct by students. In the overseas pharmacy schools studied, professionalism usually exists as a separate section within competency frameworks. Strategies to ensure the development of a professional attitude among students include providing student codes of conduct; “white coat” induction ceremonies to promote professional pride and commitment; holding faculty meetings to discuss students’ professional behaviour; assessments via placements; scenario-based practical tests and role plays; and registration of students with the national pharmacy body early in the degree course. Harding and Taylor’s research involved focus group discussions with UK pharmacy undergraduates to discover what contributed to the development of a professional attitude on a pharmacy course. Barriers to developing a professional identity are listed in the Panel (below).

Conclusion

UK pharmacy is far behind on the professionalism agenda compared with health professions in this country and pharmacy overseas. To produce pharmacists with the right professional attitude, pharmacy education needs to be reconfigured to include greater integration of theoretical knowledge and practice, with more clinical experience and use of task- and problem-based learning to encourage resourcefulness and team-working skills.

To achieve a competency-based approach, meaningful placements would have to be provided within the undergraduate course with much greater, and ideally complete, integration between undergraduate and preregistration education. But these changes are not possible without considerable extra funding, and pharmacy is currently the poor relation of health care education. A change in higher education funding from science to clinical for at least one year of the undergraduate course is required, but in the current climate of financial stringency in the NHS persuading the Government of this will be no easy task. However, unless pharmacy education changes radically, soon the profession, and community pharmacy particularly, risks being left confined to the margins of health care.