ATTN Pharmacy Students: Here’s How You Can Keep up with Our Shifting Industry
For pharmacists, trust appears to be conferred on physicians based on title, As with any type of human relationship, trust is implicit in the structure and .. are a function of many different factors starting with simple chemistry. Your “chemistry” with your pharmacist: choose a pharmacist with whom you feel comfortable Your relationship with your pharmacist is above all based on trust. chemistry is the heart to pharmacy,without chemistry,pharmacy failed,so pharmacist must respect the profession of chemistry not ignore it,everywhere in.
Early commitments to health professions education in the United States began with the private universities and included only the study of medicine. While the provision of health services with public funds began with the creation of the United States Public Health Services in the late s, there was not a broad-based, publicly funded commitment to the preparation of health professionals across a wide-array of health professions until the late s and well into the s.
Social policy and publicly funded mandates for the preparation of health professionals in the United States is therefore a relatively new phenomenon. Indeed, it was not until the enactment of Medicare and Medicaid publicly funded health insurance programmes for the elderly and indigent inthat major national policy for the creation of a health professions workforce was beginning to be formulated.
These policies were largely driven by the demands that the new legislative enablements for health services to the elderly and the poor placed on the nation as a whole. Beginning in and lasting untilfederal funds were appropriated to universities and their respective health sciences colleges including medicine, dentistry, nursing, pharmacy, public health, allied health, podiatry and veterinary, medicine for facilities, curricular planning and reform, new instructional technologies and expanding the enrollments in all of the fields of study in the health sciences.
The federal funds were required to be matched by state commitments to meet the national needs stimulated by the Medicare and Medicaid mandates. As a result of these national and state policies, the size and scope of the health professions workforce, including pharmacy, was substantially enlarged. New occupations, especially in the allied health areas, were also encouraged. In the case of pharmacy, in addition to expanding the size and scope of the workforce, planning for clinical pharmacy teaching was also mandated in the federal grant requirements.
In addition to responding to public policy mandates regarding the expansion of the health professions workforce, American universities with health sciences degree programmes have also attempted to respond to a variety of other societal needs. As might be expected, the degree and kind of responsiveness has been largely a result of local or state needs rather than broad-based national need.
This is to be expected since most universities receiving public funds do so from state rather than federal sources. Commitments to primary care, community health, rural health services, telemedicine, preventive health care and patient education and the expansion of minority enrollments in health professions schools have been part of the health sciences unit agendas in public universities.
A number of private universities have initiated such priorities well in order to be equally responsive to social need.
Formal pharmaceutical education began in the United States in when the Philadelphia College of Pharmacy and Sciences was founded as a private enterprise by pharmacy practitioners in the Philadelphia area.
This school represented the first organized curriculum in pharmacy to be offered in the United States. It began and continues to this day as a free-standing school after being rebuffed by the University of Pennsylvania which opined that pharmacy was not a recognized discipline worthy of university studies nor was it compatible with the directions of the School of Medicine at this institution. The United States presently has seventy-nine 79 schools of pharmacy. Four of these schools are free-standing institutions; that is, they are comprehensive schools that do not have a governance attachment to a university.
Thirty-seven 37 schools arc located in and are part of comprehensive health sciences centres in Universities. Of the seventy-nine schools, twenty-four 24 are part of private universities while the remainder are part of public universities. In the fall ofthese schools enrolled a total of 33 students.
During this academic year, students received undergraduate professional degrees in pharmacy. Of this number, 77 percent graduated with the Bachelors Degree in Pharmacy while the remainder received the Doctor of Pharmacy degree. In addition to offering undergraduate professional degree programmes, 60 schools of pharmacy also offer programmes leading to the Master of Science and Doctor of Philosophy in the various sub-disciplinary areas of the pharmaceutical sciences.
The latter degree programmes are typically offered in collaboration with or under the supervision of the Graduate College of the University. In order for graduates of the professional programmes in pharmacy to be licensed by the states to enter the practice of the profession, they must meet several qualifications, including a graduating from an accredited programme b passing a national licensure examination and c meeting other requirements as stipulated in state law.
Accreditation of the pharmacy programme is therefore a critical element of assuring the public that the programme meets minimum educational standards as promulgated by the American Council on Pharmaceutical Education ACPE. The ACPE is presently in the process of finalizing a new set of standards which focus on the offering of only the Doctor of Pharmacy degree.
It is the stated intent of the ACPE to only accredit Doctor of Pharmacy degree programmes by the year ; hence, requiring the phase out of the Bachelor of Science degree programme offerings in the United States.
While the policy shift in undergraduate professional education in American pharmacy has been a long and arduous consensus process, it also represents more a reconstructive than reflective social policy. Specifically, the articulation of new educational standards for Doctor of Pharmacy degree programmes represents certain and specific views about the nature and content of the pharmaceutical curriculum in the United States.
It specifies a set of intended curricular outcomes that stress the clinical skills of pharmacists as they provide pharmaceutical care services to their patients in the American health care system. These standards also mandate a knowledge and skill base that will be utilized by pharmacist in meeting state and national health goals particularly as these relate to appropriate utilization of medicines by the American public. The standards are also reflective in their philosophy insofar as they attempt to respond to the more traditional needs of the public.
The adoption of the Doctor of Pharmacy degree as the minimum professional degree requirement in American pharmacy is one of the most important reconstructive acts that pharmacy education has taken in the latter part of the twentieth century. Following previous decisions to move from a two-year programme to a three-year programme, from a three-year curriculum to a four-year degree programme and then from a four-year programme to a five year university course of study, the new directions that define a professional doctoral degree programme are hoped to advance the capabilities of the profession to meet increasing expectations in American society for enhancing the rational and appropriate use of medications in all settings of pharmacy practice.
Indeed, right along with these movements has been a call in some sectors of the profession for expanded postgraduate education in the form of residencies and fellowships. This follows the medical model of education; that is, a provisional doctoral degree followed by a residency in the specialty areas of medicine. Major shifts in the methods and processes of medication distribution and the management of the drug supply in the United States are presently being seen.
Increased mechanization of the prescription filling process, coupled with extensive application of computer technologies related to labelling, record keeping and creation of patient focused educational materials to accompany prescriptions, are contemporary trends that continue to evolve and refine. Along with these developments is the ever increasing need for pharmacists to provide direct to patient pharmaceutical care services in both the acute care and ambulatory care setting.
The growing number and complexity of medicinal agents as well as their increased usage, particularly among the elderly, places strong demands in the US health care system for a large cadre of clinically competent practitioners. Additionally, there are several major disease areas that represent priority health challenges in the US e.
As more initiatives in the treatment of patients with these chronic diseases are brought forward, it goes without saying that more extensive medication treatment will be seen. If history can be an indicator of the future with respect to the evolution of pharmacy practice in the US, it is probably safe to say that the profession will position itself so that it continues to meet social needs. Positioning will as well be driven by effective academic leadership that is well attuned to pervading social need.
It should be noted however, that appropriate positioning will not occur spontaneously.
There must be a willingness and effective processes in place to achieve it. As one surveys the seventy-nine schools of pharmacy in the US, there is evident diversity in the depth and breadth by which each school responds to social need in the context of its more traditional mission of education, research and service. This is a valued characteristic and indeed, represents a major strength of pharmacy education in the US.
If the profession of pharmacy did not exist for example, how would the drug supply be managed and how would appropriate medication use be assured?
Would other health professionals be able to meet these social needs or would a pharmacy-like occupation be created? What types of personnel would staff the various areas of the pharmaceutical manufacturing and distribution industry? Where would fundamental discoveries related to drug design, product formulation, pharmacology and pharmacodynamics and other applications of the pharmaceutical sciences occur?
The research missions of the various schools and colleges of pharmacy have been relatively well aligned with social needs. This is particularly true of those members of faculty who have competed effectively for grants and contracts from governmental research agencies that have established national basic science research priorities.
Ranging from priorities in defence and national security to health priorities of the nation, a number of American schools of pharmacy have been competitive in garnering financial research support.
Pharmaceutical scientists educated and trained in pharmacy programmes have also taken on leadership positions in the pharmaceutical industry, governmental laboratories and private research institutions. These have all been important contributions to meeting societal needs in the scientific and research sectors. Schools of pharmacy in the United States have also educated and trained a workforce for pharmacy practice in its varied forms in an admirable manner.
To be sure, the graduates of American schools of pharmacy have, for many decades, found career opportunities in an extensive array of venues. Consequently, the financial and professional rewards of an intensive and competitive educational and licensure requirements have borne fruit for many pharmacists.
Bat these outcomes do not tell the whole story. For many reasons, some clear and others not well understood, the practitioner workforce in pharmacy is grossly underutilized.
There are many health priorities in the United States that are not being met. Likewise, there is marked inconsistency in the quality and quantity of professional skills applied by pharmacists to the care of patients in all settings of practice. Are these gaps and inconsistencies results of less optimal education offered by schools of pharmacy?
The answer is likely to be equivocal; that is, while schools of pharmacy cannot wash their hands of their contribution to these problems, they also cannot bear the entire burden associated with these deficiencies. Other factors contributing to this challenge include restrictive laws, lack of value clarification within the profession itself about what its social purpose is, boundary challenges by other health occupations, perverse compensations systems, weaknesses in professional leadership and a lack of uniform and broadly applied standards of care.
Schools of pharmacy generally do not adhere to a consistent philosophy of practice and patient care and as a result there is little socialization focus on the development of the ethos and values associated with such a philosophy. Conflicts among faculty members with respect to the definition and application of a philosophy of practice are prevalent. The processes of education that are so prevalent in American pharmacy education today also augur against the development of a set of values and behaviours that are linked to a caring philosophy so necessary for the delivery of patient care services.
Few faculty members work assiduously to be mentors to their charges during the formative stages of professional education. Even fewer faculty members arc committed to the constant reform and renewal of pharmacy practice, say nothing of their own curricula.
The latter perspective may be harsh, particularly to those faculty members who are prominent and engaged in mentoring, applying high ideals and stimulating a reconstructive philosophy in education and practice. However, the realities of much of American pharmacy practice are ample evidence of the points previously asserted. High rates of morbidity and mortality associated with medication misadventures are a reality, inappropriate and missing consultation with patients and prescribers on appropriate medication prescribing and utilization are rampant and leadership for assuring improvements and quality enhancements in the medication use system in the United States is scarce.
Trust in interprofessional collaboration
Fundamental standards of patient safety are being violated when automated dispensing systems no longer rely on the quality checks traditionally provided by pharmacists. Basic standards of sterility and product quality are violated when pharmacists are not directly involved in the preparation of small and large volume parental agents.
Long standing societal covenantal commitments are skirted when patients are handed their medications by clerks and are not privately consulted by the pharmacist on the premises. There is indeed a significant gap between what pharmacy education preaches, what pharmacy practice aspires and advocates and the realities of a competitive marketplace in which quality and cost oftentimes negatively compete.
While some examples of progress are evident in these regards, substantial challenges still remain. This paper has been constructed to stimulated discussion, critical analysis and planning.
A specific attempt has been made to put forward a number of themes and issues that are not often discussed or acted upon by educational leaders in pharmacy. It is hoped therefore, that a broader view of the linkage between social need and the philosophy, purpose and calling of higher education in pharmacy might emerge.
It is clear from the American experience that the role and utilization of the pharmacist as strictly a purveyor of drug products and sundries is time limited. The search for consistent quality in the offering of pharmaceutical services, equity in geographic and economic access to pharmaceuticals and the services of the pharmacist and demonstrated relationships between efficiency and quality still continues.
My response reflects the Canadian point of view which is not very different from the American one, except that Canada offers its citizens a universal health care coverage supported and financed mainly by the federal and provincial governments. Trends in Health Care Delivery The financial limitations imposed by large national debt bring a decrease and a rationalization in the expenses for health care.
The restructuring of the health care system and of the institutions will favour the development of a community-based health care system in which the community pharmacist can play an important role because of its availability and its capacity to respond to primary health care problems. Technology will make available new dosage forms and new biotechnology products which will require from the pharmacist new skills in the conservation, distribution and administration of these products.
Communication and information technology will change considerably the way physicians prescribe, the way pharmacists provide pharmaceutical services and the way pharmacists update their skills and competencies through long distance learning.
The amount of biomedical knowledge is now so large and its accessibility increased so much by the information technology, namely Internet, that health professionals have to work together in teams to provide the best health care services to the patients. The ageing of the population, at least in the developed countries, will change the priorities of health care.
Chronic diseases and drug use will increase. Responses of University And Profession Education Our pharmacy graduates must develop life-long learning abilities considering the rapid expansion of knowledge in the biomedical sciences and its accessibility by the information technology.
Student-centred approach in education can best provide these life-long learning abilities. The schools of pharmacy and the profession should put emphasis on community-based pharmaceutical services in response to the trends mentioned earlier and on pharmaceutical services to the elderly.
Interdisciplinary training is a necessity considering the extent of biomedical knowledge and the diversity of health care professionals. Our students and pharmacists, through continuing education, should receive a good formation in pharmaceutical biotechnology to optimize the use of the new dosage forms and the new biotechnology products.
They should also be familiar with the information and communication technology so that they can use it to provide pharmaceutical services and for long distance learning.
Research Research in pharmacy practice should be developed to optimize pharmaceutical care. Service Universities should be involved in international collaboration to improve the level of pharmaceutical services in every country.
The communication and information technology has a great impact on pharmacy practice and continuing education and can be a powerful tool to help developing countries improve the level of pharmaceutical services. These roles exist in a dynamic environment within which they are continuously redefined by the changing need of the society.
The societal responsiveness of a profession, in turn, determines the very existence and the nature of the profession over time. The profession of pharmacy has evolved in an ever-changing environment. Changes in the profession occurred in the US, in Thailand, and in other countries with the schools of pharmacy as a leading force.
As Dr Manasse points out, schools of pharmacy play a critical role in determining the quality and quantity of the members the profession, and thus, the capacity of the profession of pharmacy to meet societal needs depends on the capacity that the schools have to prepare the workforce that can meet these needs.
Education is an enterprise for the future. It takes years from the time a new role is envisioned to development of a new curriculum, to the teaching processes, to the time when the graduates under a new curriculum enter the workforce, and to the time the impact of change materializes. Hence, a change made today in the enterprise of education will be realized only after many years.
As a consequence, the university must take a reconstructive role in order for the profession to be responsive to the change in its environment. The history traced by Dr Manasse provides valuable examples of the roles the schools of pharmacy in the United States have played in shaping the nature of the profession.
The long process of the articulation of the policy towards clinical pharmacy also reflects careful consideration of trends in societal needs and the accumulation of around two decades of experience since clinical pharmacy teaching was first mandated as pan of federal grant requirements.
The reconstructive perspective and the process of bringing about this major shift in the policy provides valuable experience from which one can learn how institutions of professional education define values and determine the future of the profession.
Increasingly, pharmacist roles in clinical drug use have been recognized and performed in a number of hospitals. This new clinical role coexists with, rather than replaces, other more traditional roles. As a result, today the roles of pharmacist in this country have become more diverse than before. How well the profession can meet and shape this wide range of demands depends on the capacity of pharmacy education to define societal values and to prepare a competent and conscientious workforce for the society.
It remains a tremendous challenge for the university and the pharmacy profession in Thailand to recognize trends in the demand made by the society and to identify the direction for the future of the profession. Trinca This paper describes how pharmaceutical educators in the Americas are adapting today for the future needs of their people. For this reason, I have chosen to divide this assignment into two parts: A Case Study of the United States: It is a business which employs one out of every 11 Americans.
But in spite of its resources in dollars, workforce, talent, and technology, over 15 percent of the US population, or 45 million people and one million more people each month do not have an insurance plan for regular health care. Over five years ago, when the Administrative Branch of our Federal government began in earnest to reform the health care system, President Clinton focused on three themes: And, as one would expect in a free-market economy, the market appears to be the short-term winner, zeroing-in on cost and attempting to squeeze every excess provider dollar out of the system while guaranteeing fat returns on the investments of their shareholders.
But, even these forces are sporadic and regional in nature. Some parts of the United States, such as California, have virtually all its insured population covered by some form of managed care; other states are virtually untouched to date; while most states find themselves somewhere in between.
Equally important is the movement of Federally supported care for the indigent e. The impacts of this brief scenario have had profound influence on the delivery of health care in the United States, and has begun to effect the education and training of health professionals, including pharmacists.
According to the Pew Health Professions Commission, and now others, it may ultimately affect the number of graduates, and their distribution within the workforce, by downsizing programmes and shifting away from specialization to primary care and mid-level professionals, such as nurse practitioners and physician assistants.
Unfortunately, the story does not end here. Today, these same three themes, perhaps packaged slightly differently for the academic temperament, are emerging in the world of higher education: Most in the academy simply prefer to viewthese themes as mere inconveniences, something for the amusement of administrators. But the real sleeper, just as in health care, is the market. More and more, the public in general and employers more specifically are dissatisfied with the products of higher education.
It takes too long, costs too much, produces the wrong set of knowledge and skills, and is too confining for innovation and experimentation. Many businesses claim the need of retraining the new graduate immediately upon hiring, and have established their own in-house educational centres. Entrepreneurs such as the University of Phoenix, Mind Extension University and Microsoft University have entered the sacred world of higher education, and are bringing the vision of the virtual university to reality.
California higher education, including the University of California, California State University and California Community College systems is the largest, best funded, and possibly the most productive in the world. Effectively, this has the ability to put our world-class universities out of business. What I have just described can now, virtually, occur anywhere in the world. Fortunately, the United States began preparing for the future education of pharmacists long before health care reform began, and even before we recognized the power of market forces on the educational systems which prepare health professionals.
Fortunately pharmaceutical education also chose several innovative methods in addressing its future since our professional and educational literature remains relatively shallow, somewhat redundant, and mostly unsubstantiated. Inand profession-wide strategic planning conferences were convened under the theme, Pharmacy in the 21st Century. Notably, it was during the conference that Doug Hepler introduced his vision for pharmaceutical care.
The first Pew Health Professions Commission was established in And, last but certainly not least, also marks the date of the first planning meeting for the Pan American Conference on Pharmaceutical Education. We will return to this activity later. For those of you who are not, I would be pleased to see that you receive copies of all reports and follow-up activities.
From its outset, the report was intended to be a road map, a path to the future; it was not intended to sit on a shelf, collecting dust. Second, the Commission took logical pauses in its work to present, discuss and debate its findings with pharmaceutical educators and the profession.
Third, the Commission began at the beginning. Pharmaceutical education is responsible for preparing students to enter into the practice of pharmacy and to function as professionals and informed citizens in a changing health care system. It is responsible for generating and disseminating new knowledge about drugs and about pharmaceutical care systems.
Fourth, the Commission examined the curriculum, but not in the typical way. Rather than propose course work, it stressed desired curricular outcomes expressed as competencies.
Rather than limit these competencies to conceptual competence the ability to understand the theoretical foundations of the profession and technical competence the ability to perform skills required in the professionit ventured to propose integrative competence the ability to think critically; communicate effectively; and possess aesthetic sensitivity, professional ethics, professional identity, and leadership and career marketability as exhibited by adaptive competence, the scholarly concern for improvement, and motivation for continued learning.
The Commission also believed that the process of education is fundamental to future learning; that is, formal lectures are too confining and must be supplemented with developmental discussions, simulations, faculty and student interaction, early practice experiences, presentation, and assessment methods which offer opportunities for self- and peer-evaluation.
Fifth, the Commission made specific recommendations about how pharmaceutical education should change in order to prepare for the future practice of pharmacy in the United States -how education can be both proactive and responsive to contemporary market needs. Sixth, the Commission was not afraid to subject its work to repeated scrutiny even after its work was apparently complete.
Init published an updated version of its work in the context of a health care system which had undergone dramatic changes since Overall, the original observations and recommendations of the Commission stood the test of time; the major emphasis of the updated report focused on better defining the health Care environment or market, and the mandate to proceed with implementing institutional change at an even more rapid pace.Trust Your Feelings
First, pharmacy tends to be insular. We talk to ourselves, we complain to ourselves, we attend meetings with other pharmacists, most of us practice in pharmacies isolated from other health care professionals.
The same applies to pharmacy educators. For example, in borrowing from my work as a Pew Health Professions Commissioner, I have learned that all health professionals, including pharmacists, must have certain core competencies: Beyond these competencies, however, there are issues of multi- and cross-disciplinary student learning, faculty collaboration in practice and research, and a multitude of other opportunities we have been sloth in exploiting. Second, a portion of my current responsibilities at Western University of Health Sciences demands that I plan strategically for the university.
As a result of market change, health science universities must dramatically reinvent themselves in order to remain financially viable and accomplish the mission of education, scholarship, patient care and public service.
The more people who trust you, the more opportunities will come your way. Right now in pharmacy school, this may not seem true. When you graduate, that all ends. No one trusts you unless you have a relationship. Make it your objective to meet one new person a week.
May sound hard, but introducing yourself to one person in your school would take you five minutes. Your pharmacy experience determines what jobs you can successfully apply to. However, experience predicts whether or not a pharmacist candidate will receive a job offer. Experience determines where you can go with your career. The PharmD is just the ticket to entry. The more currency you have, the more rides or jobs you can play on. Your college career is the foundation for all following job opportunities.
Now is your time to create currency. One thing many schools do poorly is helping students pick a career path based on your unique ability, a topic I cover greatly in my upcoming book. Of the two situations below, which do you think a manager would choose for a compounding pharmacy job: Four years of compounding pharmacy experience during pharmacy school 6 months of compounding pharmacy experience during pharmacy school Obvious answer.
And yet, so few students quickly pick a pharmacy field. Set a deadline for when you will choose a path. Your future career depends on it. The place where competition is highest happens to be the inner city. The best candidates receive the following information to persuade them to take the low offer: On the other side, if you wish to stay in the city, be willing to do more than your competition.
Avoid Companies That Betray Their Staff There are pharmacies that offer jobs to new pharmacists, stating the job will be full time with benefits, but after they start the job, the company rescinds the offer and makes their job part-time, thus losing benefits. Obviously, these are horrendous business practices.
The Pharmacist-Patient Relationship
Companies betray our trust and should be reprimanded. Rumors of this sort spread fast. Your best info source will be upperclassmen or recent alumni. Ask them about job offers, and if they know of great companies or ones to avoid. Imagine yourself a partner with a professor whose role is to train you to be an excellent pharmacist.
Your role is to learn as much as you can in an active capacity. An active capacity means you find ways to practice your unique ability, thus gaining experience.