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Andrew Husband is senior lecturer at the University
of Sunderland
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The concept of the educational requirements required for a modern pharmacist is once again at the forefront of our thoughts as a profession. The recent valedictory address from Sandy Florence, former dean of the University of London School of Pharmacy (PJ, 28 October 2006, p516), suggested that the constant erosion of science from our undergraduate courses is a dangerous thing and that the replacement of science with practice-based topics may well have an adverse effect on future pharmacists' abilities and the reputation of our pharmacy schools.
This is a concern as the profession considers what we should be teaching
undergraduate students to equip them with the necessary knowledge and
skills in order that they can effectively contribute to patient care.
The modern pharmacy undergraduate student will often question why particular
parts of the syllabus exist and suggest that time would be better spent
teaching them things which they “will actually use when I qualify”.
In my experience this attitude is widespread and raises the question
of exactly what does a student who aspires to become a registered pharmacist
think he or she needs to know? More to the point, as undergraduates do
they actually know what they will need to know when they are faced will
the myriad of questions which may present to any pharmacist during the
working day. The answer to this, as Professor Florence opines, possibly
resides with the fact that most students and indeed the public formulate
their idea of what a pharmacist does based on the model of community
pharmacy that they see on the high street. However pharmacy education
is not a training programme for community pharmacy.
There is no doubt that most pharmacists will graduate and eventually
practise in the community but this is not exclusively the case. Registration
as a pharmacist allows for practice in an ever growing number of areas,
including the hospital sector, primary care, industry or even academia.
The strength of the current MPharm degree and its predecessors is that
the qualification lends itself to this diversity and the ability for
graduates to call on a wide educational base.
My own experience as a clinical pharmacist in hospital practice demonstrated
the fact that a pharmacist can often be the only member of the team able
to offer a complete piece of information on matters relating to formulation,
chemistry, pharmacokinetics etc. This, along with our extensive understanding
of pharmacology, was often the knowledge that was most commonly called
upon during ward rounds.
In my mind, more central to this argument is why the distinction between
what is science and what is practice has been created. Indeed some academics
would argue that practice without science is just what Professed Florence
suggests it is — a soft subject with little definition and possibly
little outcome.
As a subject, pharmacy practice has certainly become a much greater part
of the MPharm syllabus and it is incumbent upon us to ensure that the
subject has rigour and clearly defines its purpose. The purpose of pharmacy
practice teaching or, possibly more appropriately, clinical pharmacy
is certainly to introduce students to the work of a pharmacist. But more
importantly it should be used to put the “science” base of
the course into the context of patient care and therapeutic decision
making. The complexity of modern day medicine is such that a thorough
understanding of the reasons why particular therapeutic manoeuvres are
made is vital for a profession promoting itself as the experts in medicines.
Along with this detailed knowledge of drug delivery systems, how they
work and how they may be affected by patient factors, disease factors
or concomitant medication is essential, and in the health service context
is unique to the pharmacist.
How we do this within the time and resources allocated is the challenge.
The use of case-based material, possibly in the clinical environment,
to teach students is important and does help to clarify the various roles
of pharmacists working in different sectors. This is often reinforced
by using clinical guidelines as a description for how to treat a disease
in line with current best practice.
While this is of relevance and is clearly important, it is not a substitute
for a thorough understanding of how drugs are administered, how they
interact with their target site and how they are eliminated. Guidelines
may come and go depending on governmental changes but a solid foundation
of education in the pharmaceutical sciences, including pharmacy practice,
is applicable in any vision of the future NHS. We must add a research
ethos so that our graduates leave us with the intention of ensuring that
our future role as a profession is supported and clarified by a robust
and technically appropriate research base. It is this knowledge, put
into context by thorough, up-to-date practice teaching, which may be
used to oppose opinions aligning our advisory skills in relation to medicines
with that of employees of a garage forecourt.
It is clear that pharmacy education is changing and has changed over
a number of years resulting in certain areas of the syllabus being consigned
to history. Others, such as folding powders and extemporaneous preparation
of suppositories, have a dubious place in the modern education of a pharmacist
in the eyes of some commentators, possibly correctly so.
As we reformulate the education of pharmacy undergraduates we should
take care not to lose what makes us unique. That said, to label newer
subjects as undefinable or without academic rigour, based on the fact
that they are not perceived to be part of the traditional pharmaceutical
sciences, is unwise. Pharmacy practice, including clinical pharmacy,
should be the glue that holds the various strands of science together
and places them into the context of the patient ensuring that our students
are aware of the complete reasons for why we treat disease the way we
do.
It is a popular opinion to oppose extended pharmacist involvement in
prescribing, for example, on the basis that we lack training in diagnostic
skills. Although this is correct maybe we should, as Professor Florence
suggests, blast our trombones and highlight the expertise in therapeutics
and all that it entails which could contribute immeasurably to the care
of patients and the effectiveness of the NHS. |
The
Pharmaceutical Journal