Education experts, pharmacy professionals and Pharmacy Council of India have almost fifteen years back taken notice of possible changes in working of pharmacy profession and designed and implemented ER 91 (Education Regulation 1991). The objective of the ER 91 is to change recognition of pharmacist from manufacturers and traders of medicinal products to pharma health care provider. To achieve goal of patient oriented practice the ER 91 included studies of health education and community pharmacy, modern aspects of dispensing, patient counselling, biochemistry and clinical pharmacy, hospital and clinical pharmacy, drug store business management etc. However, till today, pharmacy profession is away from patient and the main reason is industry oriented teaching, inferior study material and lack of correlation with pharma business.
Most of the D. Pharm holders enter in medical shop business, therefore their subjects like Pharmaceutics-II (dispensing pharmacy), community pharmacy, drug store business management, hospital and clinical pharmacy, biochemistry and clinical pathology must be taught in focus of patient. The success of curriculum is not output of printed syllabus but it requires understanding of the motive and theme of the syllabus, identification and utility of flexibility component of syllabus and vision to correlate the curriculum with current business.
Among the subjects mentioned above, pharmaceutics is one of the most important subjects for patient focused practice. The Pharmaceutics-I explore the concept of dosage forms and drug delivery systems. The content of Pharmaceutics-II is based on compounding and dispensing aspects. The diminished practice of compounding, coupled with ready to use manufactured formulations has changed role of the pharmacist. Thus the modern syllabus of pharmaceutics-II rests not only on accurate supply of medication, but also on checking of fact that the medication is appropriate for the patient and on counselling the patient about its appropriate use.
To keep pace with continuous changes in pharmacy profession sufficient flexibility is provided in the syllabus to study novel and modern techniques. The points mentioned in the syllabus such as, 'Modern Methods of Prescribing', 'Adoption of Metric System' and directives about minimum use of Latin terms' gives clear indication of modern view of the syllabus. In addition concrete statements such as 'special lable and storage conditions', 'Special precautions in handling and storage.' support the patient orientation of the syllabus. Thus, practical covered in existing syllabus of Pharmaceutics could be exploited and used for maximizing patient care.
Change in orientation of practical
Practical section of these subjects is really in accordance with the theoretical aspects and modern practice of pharmacy.
Pharmaceutics I
Practical of this subject deals with physicochemical principle, types, applications, direction to use and storage of various dosage forms. Along with basic manipulative techniques and physicochemical principles, pharmacy students should be familiar with information about patient advice and it should be explained for all formulations covered in the practical. But fact is that students have been studying 'compounding' of the same formulations both in Pharmaceutics I and II. This is observed in majority of textbooks presently used by D. Pharm students.
Metrology and pharmaceutical calculations
On 3rd March 1969 it become illegal in Great Britain to use weights a measures except the metric system and it was amended to remove the imperial system. It is also reflected in the well-known reference books that published worldwide since 1987. ER 91 also insisted the same with wording 'adoption of metric system'; means the imperial systems are restricted only to calculations including conversion from one system to another system. All other calculations mentioned in Pharmacetics I and II should follow Metric System.
Calculations mentioned in Pharmaceutics II are related to calculations involved in dispensing, Since the Pharmaceutics II syllabus is based on compounding and dispensing aspects, the calculations should cover calculation of working formula, strength of ORS and parenteral electrolytes, quantity of product to be dispensed, reconstitution of dry syrups, dilutions etc. The calculations covered under Pharmaceutics-I are preliminary calculations such as conversion of imperial systems into metric system, percentage calculation, isotonic solutions. However, actually it does not look so. Overlapping of same calculations is observed in both Pharmaceutics I and II. Therefore, the practical of these subjects should include modern exercises, currently used formulas and dose calculations based on the points mentioned in ER-91.
Prescription handling
Usually, the teaching of this point is only restricted to definition, parts of prescription. Prescription handling, which is main job of community pharmacist, is overlooked. The ER-91 also says, ' Reading and understanding the prescription. In addition, hospital and clinical pharmacy (HCP) has a separate topic 'Modern dispensing aspect', which includes pharmacists and patient counselling, advice for the use of common drugs and medication history. Since dispensing of drug is part of pharmaceutics-II, it is better to cover applications of modern dispensing aspect under this subject.
Latin terms should be studied as 'art of compounding' and should have minimum value in the current practice. The formulas written in Latin and using units like grains, minims, ounce are no more exist in any international literature after 1987.
'Dispensing of at least 100 products', which is part of Pharmaceutics II, should not be considered only as a 'compounding' of 100 products requiring just a manipulative skill; but they should explain prescription handling, therapeutic incompatibility, patient counselling, use of pictograms, development of Product Information Leaflets in local language etc. In 2006, the D. Pharm students are still studying formulas mentioned in 11th edition of Cooper and Guun's Dispensing Pharmacy, which is out of print from 1994. It is more appropriate to study official formulations as example of dosage forms. It will keep more uniformity in syllabus and such well-proven formulations are easily available for referencing. Many of such official preparations are still manufactured and marketed commercially.
For India like country use of the pictograms during patient counselling and sticking pictograms on dispensing pack of medicament would be more helpful. Written health and medicinal information, Product Information Leaflet (PIL) should be provided to patients in the local language along with visual material such as pictogram. Student should prepare PIL for commonly used drugs.
Labels of dispensing pack usually mentions two non-existing person named 'Dr. XYZ' and 'Mr. ABC'. Instead of that the prescription should mention any appropriate name of doctor and patient and journal should contain patient medication records. The pharmacy students should prepare PMR during practical work, which includes information about patient, his medication history, allergies, signa etc. Generation of Patient Medication Record (PMR) during dispensing of medication is best suitable way to minimize therapeutic incompatibility.
By preserving the status of ER 91 one can do these improvements. The positive attitude to provide current knowledge of good dispensing pharmacy to the budding pharmacist is need of present days.
MSBTE laboratory manuals
With aim of simplification and uniformity in practical studies many authors have published practical books and from the current academic year MSBTE (Maharashtra State Board for Technical Education) also published Laboratory Manuals for D. Pharm. practical. No doubt, regarding the D. Pharm. curriculum and its implementation the Pharmacy Council of India is the apex body; but this manual is mandatory for the colleges in the Maharashtra to conduct the practicals. Definitely the task committee might have taken opinion of experienced pharmacy teachers, note of recent developments in the pharmacy practice and theme of the ER-91. Though the attempt is good to provide readymade literature to the pharmacy students and teachers, if the following points would have taken in to consideration the activity could have got willingly acceptance.
"Many of the exercises included in the manual of different subjects are not having logical background.
"No utilization of flexible components of syllabus to introduce examples of modern practice in place of outdated exercises.
"Official preparations having standing in present market are not taken as examples in Pharmaceutics. The student of 21st century has to study the outdated formulas of 1980's.
"Though the imperial system of calculation is nowhere followed in the world, the advanced state of India, Maharashtra feels importance of it. Similar is the case about Latin terms.
"No any attempt has been made change orientation of teaching mainly for prescription handling, patient counselling, medication records etc., which is core concept of modern pharmacy practice.
"In general, laboratory manual should exploit modern view of the syllabus and it should be guideline for teachers and students, but it should not be a journal. As writing improves understanding of terms, technical sentences and principles, the practical book of any course must be hand-written by students. The principle involved in formulation should not be mentioned in manual but students should search for it.
Conclusion
Pharmacy practice in India is taking turn from pharma traders to the pharma care. The profession has to take challenge of globalization and compete with chain medical stores that would be set shortly not only by Reliance but other multinationals. The upgradation of pharmacy syllabus keeping patient in view would be no doubt need of present days but at least attempt should made to provide best possible literature and exposure to logical practicals.
(The author is Professor of Pharmaceutics, BVDU Poona College of Pharmacy,
Erandwane , Pune 411038.)
E-mail: p_atmaram@rediffmail.com