The Pharmaceutical Journal
Vol 280 No 7498 p467-468
19 April 2008

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Cautious welcome for education reform

The recent pharmacy White Paper sets out proposals to develop undergraduate education so that future pharmacists have the clinical, professional and leadership competencies to deliver the services of the future.
Dawn Connelly (on the staff of The Journal) explores how the proposals have been received by the profession

An overhaul of undergraduate pharmacy education in England is one of the proposals made in the new pharmacy White Paper (PJ, 12 April 2008, 430).

The Government wants to see “meaningful clinical context and experience” throughout the undergraduate programme and suggests that this could be maximised by integrating the degree course with the preregistration training year. Pilots of this new approach are expected to be in place by October 2010.

The news has received a cautious welcome from academics and employers, who are enthusiastic about the proposal but realistic about the challenges it will throw up in terms of getting the infrastructure and funding right.

Anthony Smith, dean of the School of Pharmacy, University of London, says that he is enormously excited about the opportunities that the White Paper presents to reform pharmacy education. “I particularly welcome the strong emphasis on the science of medicines. I am also very pleased that we will be able to explore the integration of the preregistration year and I hope the School of Pharmacy, University of London, will be one of the pilot sites,” he says.

However he believes that it will present academics, employers, students and the funding agencies with significant challenges to change their thinking. “But I believe the goal of seamless progression from undergraduate to competent professional practitioner is totally commensurate with the vision for pharmacy described in the White Paper,” he adds.

Richard Guy, head of the Department of Pharmacy and Pharmacology, University of Bath, is also excited by the idea but cautious about how it will develop: “While an integrated five-year programme incorporating the preregistration experience makes a great deal of educational sense, the logistics of establishing this new model and, importantly, the necessary funding to ensure its efficient and effective operation, are essential prerequisites which are yet to be put in place.”

Society’s review

Graham Phillips, chairman of the Royal Pharmaceutical Society’s Education Committee, emphasises that an appropriate educational infrastructure will be a critical support if the profession is to deliver on the ambitious, patient-focused vision set out in the White Paper.

“For the past two years the Royal Pharmaceutical Society has been working on a major root and branch review of its education policy. The review began with establishing and agreeing a set of education principles and is culminating in a review of its education standards, including the preregistration performance standards and accreditation criteria,” he explains.

The new standards will be consulted on later this year and will define clear practice-based outcomes. “For the first time the undergraduate and preregistration standards will be integrated, with key assessments of capability in years 4 and 5. The recommendations made in the White Paper to pilot integrated provision of education and training across the five years, and the recognition that there should be meaningful clinical context and experience supported by appropriate funding capacity development among the academic workforce, will be a great help in successful implementation,” says Mr Phillips.

One school of pharmacy that has nearly 40 years of experience in this area is Bradford. John Purvis, Bradford’s head of school, says that he is delighted to see the Government’s intention to encourage pilots of curricula that integrate the degree course with preregistration training but he is surprised that it has taken so long. “Bradford School of Pharmacy has been doing this, through its thin-sandwich course, since 1971; our current students spend semester 2 of the third year and semester 1 of the fifth year in practice,” he says.

Professor Purvis adds that Bradford is committed to the concept of practice-based education. He believes that knowledge is fundamentally influenced by the activity, context and culture in which it is used.

“A problem with the traditional four-year curriculum is that much of the knowledge gained is ‘unsituated knowledge’; things are taught out of the context of their potential use to students. Thus there is a motivation problem in that learners often do not see the point of what they are learning. There is an inertness problem; learners have no idea how to apply much of what they learn to the problems that arise in practice. There is also a retention problem: it is hard to remember abstractions if one never uses the knowledge.”

Professor Purvis says he has no doubts that integrating the degree course with the preregistration training year provides an approach that is well suited to development of the consultation, clinical reasoning and decision-making skills needed by pharmacists in the 21st century.

Steve Chapman, head of the School of Pharmacy at Keele University, says that, as a new and developing school, Keele has the opportunity to adopt the recommendations from the White Paper and already has several in place.

“We will be using small group case-based teaching and problem-based learning for the clinical and therapeutics aspects of our course. We have already seen the benefit of sending our students out on placements, and using real and simulated patients in the university, as early as the first semester of year 1 of the course,” he explains.

Professor Chapman believes that strengthening collaboration and reinforcing the current links between academic institutions and clinical practice will ensure that students leave university more “fit for purpose” than they do when clinical and professional aspects are left to be refined in the traditional preregistration year.

“In addition, it reduces the uncertainty some students face about preregistration placements which is bound to increase with the increasing number of students. This will help both academic institutions and our colleagues in the health service to plan more strategically for preregistration provision,” he says.

Students

Gemma Donovan, public relations officer for the British Pharmaceutical Students’ Association, says that the association supports the idea of an integrated degree in principle. She explains that if a five-year degree programme leads to greater practice commitment then it is in tune with BPSA policy.

“Many healthcare professionals, such as doctors and nurses, have integrated undergraduate courses as the norm. Theory-based learning is put into practice and the relationship between the two is enhanced. Many students cannot see the relevance of some modules at university to their role as a pharmacist. An integrated course would benefit these students and enable them to grasp and relate to the concepts they are learning about in the classroom,” she says.

However, Ms Donovan agrees with the White Paper that science is fundamental to the MPharm course. She says that BPSA members want to go into diverse spheres of practice once they graduate and although the majority strive towards clinical roles, those who wish to pursue a career in the pharmaceutical industry do not want fundamentals removed from the course that might narrow future opportunities.

Another area that would concern students is the financial impact of integrating preregistration training with the undergraduate course. “With the rising amount of debt that students are faced with, we have concerns about the financial implications for students and would be opposed to this system if it added more financial burden on students who are already struggling with debts and increased tuition fees and living costs. We would feel more comfortable with a system where students are able to be financially reimbursed for the preregistration component as part of a five-year course,” Ms Donovan argues.

Employers

Integrating preregistration training with the degree course will also bring huge changes for employers.

Jane Lumb, training manager at Numark, says: “One of the key challenges to face newly qualified pharmacists is applying their clinical training to the real world and real patients. As to the future of the profession, anything that would increase their practical skills and therefore give them more meaningful clinical experience would certainly benefit the profession.”

However, she adds that fully integrating the preregistration year into the undergraduate programme should be considered with caution. “Without an adequate practical programme within an actual pharmacy we could still find that our newly qualified [pharmacists] are not prepared for all that pharmacy entails and, more importantly, the reality of practice.”

She argues that the ideal way forward could be better integration between the undergraduate programme and practitioners and more support for those who wish to share their experience by taking on a preregistration trainee.

Stephen Thomas, deputy superintendent pharmacist, and Sandra Hutchinson, education, training and recruitment manager, Rowlands Pharmacy, say that, while they see the benefits of an integrated programme, they are cautious over the practical input that employers would have to the new proposals.

“We invest a great deal of time, energy and, of course, money into our preregistration training programme to ensure that we deliver a course which is of the highest standard. Our aim with preregistration training is to mould our preregistration trainees into professional pharmacists who are ready to meet the wide ranging demands of the profession. We believe that the preregistration training programme we have at the moment achieves this, but accept that there are always further opportunities to develop any programme.”

Susan Sanders is director of London Pharmacy Education and Training, which is responsible for providing vocational education and training to NHS pharmacists and preregistration trainees in London and the East of England. She welcomes the move towards common outcomes and increased links between theory and practice.

“The Government’s assurances of an appropriate funding framework and sufficient capacity and infrastructure, along with careful planning and management of both trainee numbers and logistics, will be essential if we are to successfully train our future pharmacists to deliver high quality NHS pharmacy services,” she says.

A step forward

Mr Phillips believes that the White Paper announcements are a great step forward and says the Society is looking forward to working with chief pharmaceutical officer Keith Ridge and others to bring its hopes and aspirations for pharmacy education to fruition over the next few years.

“The opportunities to achieve our long held ambition to embed clinical skills alongside a profound knowledge of medicines and how they are formulated are now very real indeed. It is important that clinical skills are built and developed on a solid science base. The possibility that in the next few years we will be registering pharmacists whose practice is truly medicines-focused and patient-centred and who have the confidence to seize the clinical opportunities presented in this White Paper is a source of great personal and professional satisfaction,” he says.