Pharmacy education like any other system needs constant maintenance, upgradation and revision to keep pace with the changing times and technology. Pharmaceutical scenario in India is witnessing a paradigm shift and pharmacists have a key role to play in the healthcare system. Today, the thrust of the healthcare segment is on patient care profile and clinical and hospital patient sitting. As a result, subjects like clinical pharmacy, pharmacy practice and community pharmacy are finding more importance in the curriculum of many pharmacy colleges of the country.
Demographic changes, disease patterns and rapid advances in pharmaceutical science have resulted in the use of more drugs and more expensive drug delivery systems. Such changes are challenging the pharma educators, who are responsible for educating the future pharmacy practitioners of the country. Due to the rapid proliferation of pharmaceutical agents, pharmacy has to face the brunt of this impact. Recognizing this fact, the existing system of pharmacy education and training must be reviewed, since the outcome should reflect the needs of the society.
A curriculum is not simply the list of topics to be studied and time in hours required for teaching the topics. A curriculum should be designed to fulfill the objectives of the course. Hence, objectives should be defined first. To achieve these objectives effectively, the instructional methods must be specified. Apart, it is essential to select appropriate assessment methods to assess whether the objectives are attained or not. To be more specific, ideally a curriculum should consist of:
● Objectives
● Topics
● Instructional pedagogy
● Scheme of evaluation
Objectives
To devise and revise the curriculum, it is essential to have a clear understanding of the objectives of pharmacy education. Education inevitably plays one of the important roles in shaping the destiny of any profession. Education and training imparted to students must provide the scientific technical know-how, social awareness and communication skills with balanced emphasis on each. The education should provide the function necessary for pursuing excellence in the profession throughout lifetime.
The pharmacy education in general has got certain objectives. They are:
● To generate and disseminate knowledge and to promote technological innovations and know-how so as to prepare the pharmacy graduates to meet the emerging needs of the society, local industries and profession
● To produce creative pharmacists possessing knowledge, skills and attitudes with integrity, character, imagination, creative thinking and capacity for sustained hard work
● A pharmacist must be educated to have the knowledge of preparation, distribution, action and uses of drugs and medicines as well as to train himself in the field of production management, quality control, market research, community pharmacy and other related fields. The pharmacy graduates must be trained to work as an active member of the healthcare team
Also, the pharmacy education has certain particular objectives. They include:
● To know physical, chemical, pharmacological and therapeutic properties of drugs of synthetic, natural and biological origin
● To know the properties and uses of such substances useful as pharmaceutical additives
● To understand the preparation, standardization, analysis, packaging, storage and utilization of pharmaceutical dosage forms, cosmetics and allied substances
● To know the rules, regulations and ethics concerning the practice of pharmacy profession
● To impart knowledge of other areas such as communication skills, management principles and accountancy that are useful for becoming a perfect pharmacy professional ● To acquaint with the newer trends in the pharmaceutical sciences and knowledge base to sustain the research capabilities
Need for reversing curriculum
Traditionally, pharmacy education focuses more on drug products, emphasizing chemistry, pharmaceutics and the control and regulation of drug product delivery systems. However, the changing health care delivery system and the increasingly prominent role of pharmaceutical agents in the diagnosis and treatment of diseases are turning the focus to a broader role for pharmacy graduates.
The drawbacks of the existing pharmacy curriculum are:
● Lack of uniformity in the curriculum of undergraduate pharmacy programme in Indian universities
● Curriculum imbalances in the existing system, which leads to overlapping and repetition in teaching
● Lack of information regarding advances in the pharmaceutical technology taking place across the globe
● Inclusion of outmoded and unnecessary elements in the present curriculum
● Inadequate emphasis on imparting communication and inter-personal skills
● The quantum of practical training is not well defined and is not uniform
● Lack of exposure of students in humanities, entrepreneurship and management principles
● Lack of proper interaction between industry and the academia
● The present curriculum tends to be too academic and theoretical. There is stereotyped nature of the laboratory practices. The students do not get ample opportunities to experiment, to use case studies to understand the advanced techniques in pharmacy.
● Majority of the topics of degree syllabus are outdated or not in current practice in pharmaceutical industry
● No knowledge of latest manufacturing procedures, regulatory affairs and good manufacturing practices
● The students are not exposed to upcoming branches of pharmacy like clinical pharmacology, pharmacogenomics, chronopharmacokinetics and nanotechnology
● Lack of identification of national needs
● Absence of committed determination on the part of pharmacy education planners and continuity, agenda and working plan
● Limited resources and the perception that little will be lost if nothing happens
● Political grandstanding
Need for innovations & reforms
The present pharmaceutical scenario in the country demands more competencies to excel in the profession. The four important areas of competencies for a pharmacist of tomorrow are:
● Conceptual competence: Understanding the theoretical foundations of the profession
● Technical competence: Ability to perform skills required for the profession
● Integrative competence: Ability to meld theory and skills in the practical setting
● Career marketability: Become marketable as a result of education and training
Hence, a diploma in pharmacy would no longer meet the changing needs of the pharmacy profession and health care system. Hence, graduation should become the entry level credentials for the profession. The graduation programme is of four academic years with two years of pre-pharmacy coursework, as a foundation for the upper level professional curriculum. In overall perspective, the degree programme should enable the student to think critically, communicate with ease, apart from providing them with aesthetic sensitivity and professional ethics.
The concept of pharmacist sharing responsibility for patient drug therapy outcomes is known as 'pharmaceutical care'. Due to growing emphasis on clinical pharmacy in the country, there will be increasing opportunities and societal mandate for pharmacists to take a more responsible role in managing the therapeutic outcomes of the patients. An appropriately trained pharmacist can make a meaningful difference in patient care.
The present day B.Pharm. curriculum in the country is outmoded and indifferent to the pharmacist's needs. The academic pharmacy community has failed to meet the current challenges facing the profession. Pharmaceutical education continues to be heavily dominated by a factual product based, knowledge focused curriculum confined to the walls of a classroom.
The objective of pharmacy education must be to develop a core of pharmacy personnel for efficient upkeep of various vistas of pharmaceutical sciences like manufacturing and industrial pharmacy (production), clinical pharmacy and pharmacy practice, drug research and development, pharmaceutical marketing and pharmacy academics.
Broadly speaking, the curriculum restructuring of the pharmacy graduation programme should be done from the entry level of profession. There should be two specialisations at B.Pharm. level.
● B.Pharm. with industrial orientation
● B.Pharm. with clinical orientation
B. Pharm with industrial orientation
This course will be useful for the students who would like to pursue career in pharmaceutical industry. The curriculum reforms in this programme should include:
● Subjects of contemporary interest to suit the ever changing environment of pharmaceutical industry
● Integrated teaching should be practiced. Integration of theory and laboratory procedures should be utilized for problem solving
● Modern techniques of learning like group discussions, panel discussions, project works, role play and case studies should be incorporated in the regular syllabus
● Constituting an autonomous body 'curriculum restructuring committee' for periodical review of syllabus for identifying outdated topics and to infuse new blood into the course content. The committee should have experienced persons from all walks of pharmacy profession like teaching, industry and research
Some of the important subjects that should be incorporated in the proposed B.Pharm. syllabi are:
● Regulatory affairs and cGMP
● Advances in drug delivery technology
● Pharmacovigilance and drug safety
● Nano drug delivery systems
● Gene therapy
● Proteomics
● Recent advances in formulation technology
B.Pharm with clinical orientation
There is a strong need for B.Pharm. with clinical setup in the present Indian health context. An ideal syllabus should be designed on patient centered therapeutic knowledge. There would be a major shift in emphasis on pharmaceutics and pharmaceutical chemistry. The graduate pursuing this programme should be capable of solving problems and adapting to changes in healthcare. The graduate should be able to contribute to positive healthcare outcomes through effective medication use and collaborate with patients, physicians, nurses and other healthcare practitioners. Community outreach programmes or service learning activities should be the core curriculum. In addition to acquiring the knowledge and skills for the pharmacy practice, pharmacy graduate from this stream should also acquire knowledge and skills to practice pharmacy within the broader healthcare and social environment.
The graduates in this specialization should be trained in:
● Protocol driven therapies
● Collaboration regarding drug therapy decisions
● Counseling patients about their drug therapies
● Monitoring patient response to drug therapies
● Educating the public about drug related information
● Providing pharmaceutical care in non-hospital setting such as ambulatory care and long term care
● Complicated drug regimens
● Demands for cost effectiveness in drug therapy
● Continuing advances in information systems and pharmaceutics
There are certain things to be care of while framing B.Pharm. (Clinical) syllabi. The ideal protocol for this must be:
● Curriculum that engenders competencies essential to pharmaceutical care like critical thinking, communication, ethical behavior, teamwork, leadership and caring
● Provision in the curriculum to develop systems of peer review and evaluation that include documentation and review of care delivered, analysis of outcomes of care and efforts to ensure the continuing quality and effective coordination of care
● Curriculum which helps to develop and promote medication use information system for application to the ambulatory care setting
● Curriculum that stresses more on clinical pharmacy system management and working with other health care providers
● Develop a sufficient number and variety of ambulatory clinical training models and sites to provide ample educational opportunity for pharmacy students in the delivery of pharmaceutical care
The prominent topics which need to be included in the syllabus are:
● Effective patient, provider relationships / communications
● Patient teaching / education
● Outpatient / ambulatory care
● Health promotion / disease prevention
● Population based healthcare
● Managed care
● Electronic information system
● Patient therapy, cost effectiveness
● Geriatric therapy
● Long term chronic illness care
Practical training & project works
Industrial / Hospital training should be made compulsory in the degree curriculum. These training can be conducted in parts starting in III B.Pharm.. A period of six months to one year practical exposure / training is a must. Exposure to the clinical environment during hospital training is essential.
Students of final B.Pharm. may be assigned a project work from the selected areas of their specialization. It would help the students develop problem solving, creativity and decision making skills. The project should be relevant, feasible and beneficial to the students, institution and collaborating industry or hospital.
Due to technological innovations and communication revolution, lots of changes are taking place in every sphere of human activity. Due to opening up of Indian economy and India being a signatory to GATT agreement, Indian pharmaceutical industry is going global. So is the Indian healthcare scenario. In this context, Indian pharmacy curriculum requires drastic pruning, reshaping and reassessment to suit the needs of the day.
(The author is principal of Veerayatan Institute of Pharmacy and dean of Faculty of Pharmaceutical Sciences, K. S. K. V. Kachchh University, Kutch)