Pharmacy curriculum in the US
The professional pharmacy curriculum is designed to educate pharmacists to:
1 Counsel patients on the proper use of medications
2 Promote public health
3 Develop and manage medication distribution and control systems
4 Manage pharmacy practice
5 Plan and perform ongoing evaluations to provide patients with the best drug
therapy for their individual healthcare needs
In the history of mankind, social development has always been closely interlinked with healthcare achievements. Therefore healthcare education has a significant impact on the health improvements of a nation. It is worth pointing out that the pharmacy professionals represent the third largest healthcare professional group in the world. The history of pharmacy profession in the western world has the evolving fusion of knowledge and responsibility designed to provide safe and effective medicines. During 18th and early 19th centuries, in most European countries, the pharmacy profession was recognized as a noble one, and the pharmacists were highly respected in a society. Very early in the evolution of pharmacy in the developed world, one became pharmacist by apprenticing oneself to an apothecary. During that time the applicant for apprenticeship had to meet high social, financial and educational requirements. Around the middle of the 16th century in Italy, a candidate had to serve 5 years as an apprentice and another 3 years as a clerk; finally he was required to pass a tough examination after which he became a pharmacist. Later on as academic studies in the University level became established mode of modern pharmacy education, experience became less important.
Winds of change in the international arena: The role of pharmacy and the professional role of the pharmacist have been in flux during most of the second half of the 20th century. With industry taking over the role of compounding of medicines, the role of pharmacists changed to being focused not the medicine itself but on the medicine user. This led to the reestablishment of experimental learning as a critical component of pharmacy curriculum. The change took place was much successful in the sense that the pharmacy profession prospered in the developed nations. Today pharmacy is consistently ranked as one of the respected professions in the US and most European countries. The Gallop poll in the US confirms every time the supremacy of the pharmacy profession.
Pharmacy in developed nations: The goal/objective of pharmacy course of a typical UK University can be found in its prospectus that claims a successful baccalaureate in pharmacy knows: what are drugs and medicines; what they do and how they do; and finally the most appropriate treatment schedule of a disease.
In the US, there is currently only one professional degree in pharmacy: the Pharm. D., which usually requires 6 academic years (a minimum of two years pre-pharmacy and four years of professional education) .The baccalaureate in pharmacy degree (B.S. Pharm. or B. Pharm.), is no longer get licence to practice pharmacy. However there are research degrees in various disciplines of pharmaceutical sciences.In order to provide students with the opportunity to develop a strong foundation on which to build the above mentioned skills, the curriculum emphasizes inculcation of knowledge relevant to professional functions and stimulus for intellectual growth of students.
To practise pharmacy in the US, one must earn Pharm. D. degree and pass state pharmacy licensure examination, usually NAPLEX (North American Pharmacist Licensure Examination) and serve an internship of total 1500 hours duration. The pharmacist's educational experience does not end upon being licensed. Most states in the US require licensed pharmacists to take continuing education courses every year in order to maintain their licences to practise. Approximately 65-70% of pharmacists work in community pharmacies in the US and Europe, while only 2-2.5% in the pharmaceutical industry.
Pharmacy in India: With this backdrop of the above scenario, there is no doubt that pharmacy education in India has not only shortcomings but also has failed to contribute significantly to national healthcare. Much has been debated during the past decade about pharmacy curriculum and the role of pharmacists. Quality, curriculum design and objectives of pharmacy education in India are major concerns. Today, though the number of educational institutions imparting pharmacy courses is adequate and still growing, the institutions are primarily in the self-financing sector, and are localized in four States - Karna-taka, Maharashtra, Andhra Pradesh and Tamil Nadu.
Our practising pharmacist in India, unlike in the US or Canada, is a Diploma holder who have studied two years after completion of higher secondary examination. Today, however, to become similar licensed pharmacist in the US, the requirements are very high. To practise pharmacy there, a prospective Indian must be an M. Pharm. (Beginning January 1, 2003 the pharmacists must have graduated from a five year degree programme), passes TOEFL and TSE (Test of Spoken English) with prescribed score, passes FPGEE (Foreign Pharmacy Graduate Equivalency Examination) and thereafter NAPLEX and should have 1500 hours of internship or its equivalent. As a result, in spite of a steady growth of educational institutions, our country falling behind other countries in terms of professional pharmaceutical contributions to healthcare system. This view has been echoed by many during past decades and in many forums including IPC sessions.
Indian pharmacy education scenario:Some events/facts can be used to illustrate the scenario to compare pharmacy education to other contemporary Indian engineering and technological education. Government's statistics on the health care professionals in the national health policy (www.mohfw. nic.in/np2002.html) does not mention number of pharmacists in our country. The weakness in pharmacy curriculum has marginalized pharmacy profession and hindered consolidation of pharmacists' role in society and obviously social recognition. Indian science congress proceedings do not have pharmaceutical science section. Number of pharmacy graduates who have successful in IAS and CAT is insignificant. Till today only one pharmaceutical scientist has received young scientist award. No pharmaceutical scientist/ academician has received prestigious Shanti Swarup Bhatnagar award. Except NIPER, no institute of pharmacy at Government level or University department was established during past two decades. Unlike engineering graduates, pharmacy graduates do not have ample and attractive job opportunities. Whereas for postgraduates, the target is a job in a pharmaceutical company, where they end up in documentation procedures of the company, and mostly are underemployed. All these need to be discussed, as there is direct link of outcome of an educational programme to its input of students, course curri-culum, academic programme design, faculty strengths and evaluation methodology.
Pharmacy curriculum reform agenda needs paradigm shift: A metamorphosis of the Indian pharmacy curriculum is needed. The curriculum should be based on the competencies desired for the professional graduates keeping in mind the societal needs of our country. There is much being said the American-type Pharm. D. curriculum. Yet the fact is that the degree or postgraduate degree holder pharmacists' careers are oriented toward pharmaceutical industries and is considered in India a rewarding career. It is necessary to reexamine the present curriculum and search for a list of attributes that are supposedly hurdles of the reaching greater heights. The attributes, in my view and many may agree with me, proceeds in the following steps.
Mathematical orientation: A time has come to overhaul pharmacy curriculum toward mathematical orientation of subjects. The old method of memorizing subjects would not help any more. Pharmacy graduates should come out from University with strong basic knowledge, problem-solving abilities and critical thinking abilities. During 1980's many of our hostel mates pursuing engineering graduate often branded us (pharmacy graduate students) jokingly as uncultured because of our unavailability to attend many cultural functions due to more time needed for memorizing descriptive subjects.
Reduction of load of pure and general chemistry subjects: The overall basis of pharmacy curriculum is still extrabiological having many preliminary and unrelated chemistry subjects resulting a crowded curriculum. The syllabus overemphasizes these subjects, which have been cut down in the west to accommodate areas such as molecular pharmacology, biomedical sciences, pharmacy management, pharmacoinformatics, pharmacogenomics etc.
Burden of practical component: A detailed examination of the syllabus of western countries and a few Asian giants has shown the curriculum contains on an average one integrated laboratory component per semester. In sharp contrast we have 4/5 Laboratory components per semester that indicates we spend more time conducting and evaluating practical subjects. Some practical components have although different names but the substance and content have little difference among them.
Evaluation methodology: The success of an educational programme along with curriculum contents is also dependent on evaluation of the programme. System of examination in a professional course including pharmacy needs special attention since its outcome relates professional responsibilities to society. Teaching, question paper setting and valuation are divorced in pharmacy curriculum. Recently I acted as external examiner of an important practical component in an institute of repute. Lot of exercises was conducted in the class. However, it was difficult to select an exercise for evaluation, as every exercise requires more than one working day to complete. The evaluation could not be done by quantitative method but on the basis of simple completion of work and presentation of data table and/or graph. An almost obsessive focus on the number of exercises with an almost total neglect of purpose and credible objective of evaluation, do not augur well for the course of a curriculum.
Education and curriculum design is basic to renewal and progress in any profession. Pharmacy is no exception. A curriculum in pharmacy should produce men not only skilled in pharmacy profession but who are well integrated individuals. The curriculum especially health related discipline needs to include basic purpose of education in addition to training. It, therefore, also needs to focus on the good human values so that graduates understand what is good for them, for their society, and country. Future comes from education and curriculum design, and therefore a broad minded approach is essential to redefine the role of pharmacy, focusing development of effective curriculum for educating pharmacists capable of responding to challenge ahead.
(The author is reader in Pharmacy, Annamalai University, Tamil Nadu)