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Michael R. W. Brown, DSc, FRPharmS,
is professor of pharmaceutical microbiology at the school of applied
sciences,
University of Wolverhampton. He is a past chairman of the UK Heads
of Schools of Pharmacy
Committee and was science chairman of the 1975 British Pharmaceutical
Conference
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The MPharm curriculum should be built upon basic sciences |
The recent White Paper on health professional regulation proposes a
General Pharmaceutical Council, the end of elections for professional
members of all health regulatory councils and a likely royal college
for pharmacy. These changes are the latest to require adaptation. I wish
to argue that our ability to adapt is determined by our research-based,
integrated, multidisciplinary, scientific education. Our own PJ should
play an important, integrating role in this. The quality of our first
degree curriculum and of our teaching is vital: so is our research.
Who should teach our curriculum, how should students learn and
what should they be taught? Regarding the who, our precious students, our life-blood,
learn from those in university faculties who are characterised by three
main qualities: their ability to develop their subject by research or
another scholarly activity; their ability to devise a cutting-edge course;
and their exceptional intellects. Nothing can substitute for these three
attributes, including the possession of a formal teaching qualification.
Students meet academics who can challenge their ideas — sometimes
in small groups and, at least occasionally, on a one-to-one basis. Practical
classes can provide much of this valuable one-to-one interaction.
With regard to non-pharmacist, specialist teachers, it is not necessarily
a problem if the teaching and research have a focus on drugs and medicines.
Pharmacy is not a trade union.
What proportion of the faculty should be allocated to each discipline? Allocating staff according to the subjective preference of the head of
department is, in my view, not the best way. Professors leave or retire
and disproportionate staffing is unhelpful. Staff numbers should be allocated
and balanced broadly according to the teaching needs as in the syllabus
and appointments made strongly bearing in mind the research strengths
or weaknesses of the receiving discipline.
How should students learn? Honours (and especially master’s) degrees
are characterised by intellectual rigour. Students are encouraged to
avoid superficiality, even to develop an allergy to it. Also, a rigorous
way of learning, of questioning, of requiring evidence, acquired from
teachers, can last a lifetime. We should learn in a liberal way. Rather
than rely on external courses intended to add a liberal dimension to
the curriculum, I favour a liberal approach to the pharmacy curriculum
itself. Students would benefit from learning about the history and philosophy
of their
disciplines.
As to the what? This is perhaps less about named subjects than about
habits of thought: how to learn about the unknown, the complex. The honours
degree curriculum and, even more so that for the master’s degree,
should emphasise material with a long “half- life” and with
cutting-edge content. We should avoid teaching ephemera because there
is so much basic material to cover. How do we decide on the proportion
of the course occupied by the various subjects? It should not be decided
by the proportion of pharmacists working in a particular practice segment
but by a subject’s contribution to a deep understanding of all
aspects of drugs and medicines.
In my view, chemistry is the main subject. Mechanisms underpinning biological
phenomena are explained in chemical terms: the chemical nature of the
drug, the formulation of the medicine. In terms of biological phenomena,
molecular genetics has become increasingly important, not least in diagnostics.
Regardless of discipline, projects can help students learn how to explore
the unknown. Inculcating a rigorous approach to exploring the unknown,
by staff engaged in the same task, could well be the most valuable lesson
learnt. My view on course content is a traditional one in that the bulk
of the curriculum should be occupied by the basic scientific areas of
chemistry, pharmaceutics, pharmacology and microbiology. As mentioned
above, I advocate a liberal approach, including, for example, the history
and philosophy of science. Preferably all subjects should give, at least,
an indication of their origins.
A word about my own discipline: microbiology. It is moving rapidly, with
numerous dramatic advances, especially in molecular genetics. In terms
of the profession, the proportion of prescriptions for anti-infectives
is high and the proportion of queries in practice for anti-infectives
is also high. We are faced with multidrug resistance, fears about vaccination
and the dangers of bioterrorism. Yet, in some pharmacy schools, the teaching
of microbiology is, alas, unfashionable and dwindling. It is vital that
our students study microbial physiology, biochemistry, molecular biology
and genetics (the application of genomics in disease and therapy), infection
and immunity, vaccines (theory, manufacturing, usage), sterilisation
technology (monitoring, spores, aseptic manipulations, air hygiene),
preservation and spoilage of pharmaceuticals, biocides, antibiotics and
their modes of action, clinical aspects of antimicrobial resistance and
antibiotic pharmacokinetics.
I would like to say a special word about pharmacy practice and
its integration with our science base. By definition, practice is largely about the present
and is in diverse areas. With the current, desirable focus on greater
involvement with primary care, we must not overlook the pharmacy spectrum
which includes academia and teaching, government and regulation, industry,
hospitals, health centres and community. Given the certainty of change
within a four or five-year undergraduate period, even with only the current
proposals, “practice” should feature little at first, but
increasingly as the course and students’ knowledge progresses.
In any knowledge-based occupation or profession, practice without knowledge
is an oxymoron. Indeed, it could inculcate superficiality: appearance
without the reality. Pharmacy practice essentially is about the actual
exercise of responsibility for and judgement about medicines and their
use. It involves integrating knowledge from diverse subjects in informing
that responsibility and judgement. We are uniquely qualified for this.
Without the scientific base, we are not.
Clinical pharmacy involves influencing therapeutic decisions about patients
directly or indirectly. Diagnosis generally requires a medical education
but pharmacists are highly qualified to play increasing roles in therapy
management, perhaps delegating the medicines supply chain to others.
It seems likely and desirable that independent and supplementary prescribing
will increase. The undergraduate course must reflect this by covering
human physiology, clinical pharmacology and chemotherapy. Clinical pharmacy
should come into its own, mainly in the fourth year. There is a case
for it being entirely postgraduate and under the aegis of a new royal
college. The optimum setting is in hospitals and with ward-based teaching,
facilitated by close collaboration with practitioners, including medical
practitioners. The fourth year, if not earlier, should also allow some
inter-professional learning with medical and other health professionals.
Provision of clinical funding per student, as opposed to laboratory science
funding, is crucial and could well offer a means of the government influencing
numbers entering the profession.
Pharmacy education is not a choice between science or practice;
it is the integration of both. As students acquire knowledge, increasingly
they can put together and integrate various aspects of the curriculum,
eg,when making judgements about the formulation of a medicine or the
pharmacokinetics of a drug in a patient or when receiving a prescription
(and not simply the techniques of dispensing). Similar integration occurs
when designing a new medicine: activity, toxicity, stability, availability,
incompatibilities and formulation. Pharmacy practice, as for all parts
of the course, could also contribute to a humanising and liberalising
influence. Practice parts of the course include aspects of the UK health
service and its origins. This could also cover health provision elsewhere
and throughout history. Comparative information about the curricula of
other health professionals should be taught briefly, to provide context.
Pharmacy law could be preceded by considerations of the origins and intellectual
basis of legal systems. Help should come from sociologists, historians
and lawyers.
In addition to the current White Paper, is it inconceivable that
other big changes will occur? The Government accurately sees us as highly qualified,
conveniently in every hospital and on every high street and, in the latter
case, probably under-used in terms of health provision. We can envisage
that we will be called upon (and paid) to play a bigger role in public
health and health education: not only in hospital pharmacy, but in the
community, too. Suppose the “war on drugs” changes direction
and local pharmacies on the high street are asked to help in a way similar
to the battle against cigarette smoking as opposed to the current, punitive
criminalisation? Suppose our highly educated graduates are asked to be
involved more prominently in responses to bioterrorism or to give advice
on numerous other possible infections or vaccines. With little change
to our course curriculum or short courses we could do it. Suppose we
are asked to have greater involvement in evidence-based advice on nutrition
or on contraception. Again, we could do it. Provided we maintain our
quality science base and our research, we can respond to such social
needs.
University faculties, by carrying out diverse research and scholarship
on medicines and drugs, are simultaneously monitoring our scientific
environment so that the course curriculum can become progressively enriched.
Research is not an optional extra for an ideal world. Without it our
profession is blind and deaf.
Currently our graduates have an education second-to-none among health
professions. No profession is even close in terms of the depth and spread
of knowledge regarding the science of medicines and their action and
usage. It is the solemn and vital duty of the Royal Pharmaceutical Society
and any future GPC or royal college to maintain and enhance this scientific
basis to our profession and to ensure that all our schools have facilities
(and time) to do this.
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The
Pharmaceutical Journal