FIP Congress 2006
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Public demand for innovation places a considerable
burden on health care providers. The four symposia of the congress's
pharmacy practice programme examined innovations in patient treatment,
innovative health care delivery, using innovations to improve patient
safety (reported by Pamela Mason) and innovations in learning and
education (reported by Steven Kayne) and described possible solutions
that are being developed
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 The World Congress of Pharmacy and Pharmaceutical Sciences,
the 66th International FIP Congress, was organised by the International
Pharmaceutical Federation in association with the Federal
Council of Pharmacy of Brazil.
It took place in Salvador da Bahia from August 26 to 31, 2006
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Innovations in health care will require innovations in learning and education
Associated with all the dramatic innovation being introduced in health
care there is a need to upgrade the various aspects of learning and education
to accommodate new thinking.
Four speakers examined the implications for patients and health care
professionals in a symposium entitled “Innovations in learning
and education”.
The concepts of patient empowerment, learning and enabling have all undergone
basic changes during the development of information technology, said
Bodil Jönsson, professor of rehabilitation engineering and design
at Lund University, Sweden.
This has yielded substantial operational changes in the health care and
medical sectors; better information, second opinions, electronic prescribing
and new forms of distribution are all contributing to a changing environment.
A
patient should no longer be viewed as a case for diagnosis and treatment
or merely in need of information and better medication. Patients have
a genuine insight into their own diseases, a fact that could be adapted
for teaching.
Professor Jönsson suggested that the focus should be upon the problems
that are experienced daily and the needs, wishes and dreams of a better
life. She reminded the audience that humans are not simply chemical and
biological reactors but cultural beings living in environmental contexts.
A good example of partnership working is provided by concordance. That
could be promoted by starting with the patient’s requirements and
arranging professional behaviour and interventions in line with them
rather than by issuing a standard set of instructions for all.
Expert patients and stronger patient organisations are important steps
towards recognising the patient as the key person. However more needs
to be done, and the Swedish Apoteket has produced a book entitled “Is
the medicine helping?” (by Stefan Carlsson, Eva Fernvall and Bodil
Jönsson) as a start, she said. Professor Jönsson added the
book is directed primarily towards the daily users of medicines and deals
with placebos, safety, compliance and side effects. One chapter is devoted
to elderly patients and their experiences of
medicines. A common curriculum
Turning to student education, Adriana Mitsue Ivama, regulation and
health surveillance specialist, Brazilian National Health Surveillance
Agency,
posed the question: “A common undergraduate curriculum for all
health care professionals — dream or reality?” She said
that the education of health care professionals is generally centred
on:
• Diseases — and not on health care
• Curative health care — and not on health promotion and protection
• Individual care — and not on the community
• Biological aspects — and with little relationship to people’s
social concerns
• Content — and not on significative learning for the development
of competencies
• Procedures — and not on “action–reflection–action”
• Specific professional knowledge — but with few multiprofessional
settings during undergraduate study
Dr Ivama said that in many countries pharmacists education comprised:
• Basic sciences, instead of pharmacy
practice
• Drug manufacturing, instead of promoting effective use of medicines
• Practice in isolation rather than as part of a health care team
Following higher education reform in Brazil, national curricular guidelines
were established for undergraduate education and a common profile for
all health professionals was defined. The following competencies were
included:
• Decision making
• Communication
• Leadership
• Administration and management skills
• Lifelong learning
Institutional structures and power disputes across teaching boundaries,
together with a scarcity of teachers able to deliver new teaching methods,
are causing some difficulties in the design and implementation of a
new curriculum, said Dr Ivama. Core competencies
The theme of core competencies for health professionals was also addressed
by John E. Murphy, professor and associate dean at the University of
Arizona College of Pharmacy. Starting his presentation by discussing
the context of health care delivery in which education functioned,
Professor Murphy said that medicines have the ability to improve morbidity
and mortality, improve the quality of life, give symptomatic relief
and prevent or mitigate complications. There are also a number of indirect
benefits, including reduced absenteeism at work and improved productivity.
However,
according to the World Health Organization 2004 publication, “The
world medicines situation”, approximately 30 per cent of the
world population in 1999 did not have access to essential medicines
(1.3 to 2.1 billion people). This lack of access was symptomatic of
wider problems relating to the way health services were organised,
financed and delivered, and appeared to be correlated to disability
and adjusted life expectancy.
In the US, there are substantial underutilisation problems. For example
only 27 per cent of patients with hypertension have their condition under
control and only 46 per cent of people with
diabetes have HbAlc levels below 7. Professor Murphy quoted
from the WHO World Health Statistics 2006: “The world will experience
a dramatic shift in distribution of death from younger to older ages
and
from communicable to non-communicable diseases during the next 25 years.” It
is vital that health care professionals change and improve their way
of working — and the key to this is education, he declared.
Professor Murphy went on to say that there is a commitment to improve
US health care in six key areas. It should be safe, effective, patient-centred,
timely, efficient and
equitable.
Unfortunately there are currently deficiencies in the skills of many
health professionals. These include: • Insufficient ability to work in teams suitable for the treatment of
chronic disease
• Lack of training in the use and application of evidence-based information
• Inability to address diverse populations
• Inability to analyse root causes of errors and quality problems
• Lack of training in how to use informatics properly in the care of
patients
In order to rectify these problems a major overhaul of education is
necessary. Essential skills for all health professionals include
problem solving, communication, literature evaluation, innovation and
creativity (entrepreneurship) and effective use of informatics. Promotion
of these skills will ensure a more patient-centred approach to health
care, said Professor Murphy.
Another education challenge is the prevention of medication errors. At
least 1,500,000 preventable adverse drug events occur annually in the
US at a cost of $3.5bn — and this is just in hospitals. The US
Institute of Medicine has recommended that the health system should educate
patients better and encourage them to take a more active role in their
care. There is also a need
to improve the labelling and packaging of medicines.
Considering the pharmacy curriculum, Professor Murphy said that graduates
must be able to identify and implement changes needed in pharmacy practice
and health care delivery. The curriculum should promote knowledge founded
on good science, develop professional skills, attitudes and values, and
ensure students have the ability to apply this knowledge to current pharmacy
practice and the advancement of the profession.
“Education should not cease on graduation,” he declared. “Life-long
learning is
essential.”
The growth of new information is almost exponential and much of what
we “know” today will be “wrong” in five years.
Reading the literature, structured clinical exposures and attendance
at continuing education sessions should ensure that pharmacists meet
patients’ expectations to keep up to date, said Professor Murphy.
An innovative educational tool in the Netherlands
 Han
de Gier, professor of pharmaceutical care at Groningen University,
The Netherlands, described new tools available for enhancing
learning and education. He began by explaining that modern experiential
learning theory defined learning as “the process whereby knowledge
is created through the transformation of experience”.
A four-stage
learning cycle was involved: concrete experiences -> reflections
-> new implications for action -> testing and creating new
experiences. Professor de Gier said that the fundamental challenges
in sustaining
new developments in education is to integrate science, social sciences
and managerial science into systems thinking.
Currently the most common way of providing “reality” and
helping students understand the processes that go with particular
circumstances is provided by case study analyses and student internships.
In the latter case students often accept the existing pharmacy
practices without thinking about the possibilities of alternative
ways of working.
Professor de Gier introduced the idea of playing
games to give students
a far more realistic experience by generating “safe” learning
experiences and offering the opportunity to test alternative solutions.
If the games were well prepared, well executed and well evaluated
their value could be significant.
The pharmacy practice game developed in Groningen is known by the
mnemonic GIMMICS, standing for the Groningen Institute model for
management in care services. The game lasts four weeks full-time
and involves four or five teams per game with five students per
team. Each team has its own classroom and is responsible for running
its
own “pharmacy”.
They have to complete a number of routine
assignments (eg, dispensing prescriptions, counselling patients
and dealing with tricky situations generated with the help of actors)
and longer-term projects (eg, discussions with physicians and negotiating
care home contracts). A visit from a “pharmaceutical inspector” is
thrown in for good measure.
Outcomes of assessments are not explained — students have to
reflect on their own actions both as individuals and as a team. At
the end of the game there is a debriefing and the most successful
team is announced. Students have said that playing GIMMICS allows
them to integrate the knowledge and skills they have acquired during
their course and is great fun. |
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The
Pharmaceutical Journal