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Preliminary Experiences With Mandatory Continuing Education
Preliminary Experiences With Mandatory Continuing Education By Max A. Lemberger
Max A. Lemberger is assistant dean of professional education and director of the division of continuing professional education, college of pharmacy , University of Florida. From 1947 to 19~6, he practiced pharmacy in Milwaukee, Wisconsin . . In 1966 he was appointed director of the Wisconsin Pharmacy Internship Board. He joined the University of Florida in 1971 and serves the J. Hillis Miller Health Center as chairman of the health sciences continuing education council.
T
here is general agreement for the need for continuing pharmaceutical education to upgrade the competence and to develop new abilities in the pharmacist. What effect will mandatory continuing education have on the attainment of these objectives seems to be the most frequently asked question. Since Florida was the first state to require continuing education as a prerequisite to relicensure for pharmacists, its experiences with mandatory continuing education may be helpful in giving direction to the application of basic concepts for continuing education. In recounting these experiences we should examine1. The fundamental structure for implementing mandatory continuing education ; 2. The number of hours the Florida pharmacists participate in formal continuing education; 3. Preliminary experiences with methods and techniques employed. The Fundamental Structure
Whether voluntary or mandatory, all continuing education must be planned and implemented following a set of guidelines which incorporate the fundamental principles for instructional dynamics. 1 In 1965 Florida implemented mandatory continuing education and in doing so, established a philosophy and guidelines in Laws of the State of Florida, Chapter 465 as follows-
No annual renewal certificate shall be issued by the board for the ye!1r 1968 and any following year until such time as the applicant submits proof satisfactory to the board that subsequent to the issuance of his certificate of registration or last renewal thereof, he has completed at least fifteen hours of continuing professional education, including postgraduate studies, institutes, seminars, lectures, conferences, workshops, extension studies, approved correspondence courses or such other form of continuing professional education as may be approved by the board. If the renewal fee for any pharmacist's certificate be unpaid by June 20· of any year, the holder thereof may be reinstated as a registered pharmacist only upon payment of a penalty of five dollars and all lapsed fees and proof of compliance of all other provisions of this act; provided that actual retireme!1f from the profession by any registered pharmacist for a period not exceeding five years shall flot deprive him of the right to renew the registration upon payment of lapsed fees and proof of compliance of all other provisions of the act. Provided, however, that any applicant for a renewal certificate who is age sixty-five or older shall be exempt from the continuing professional education requirements of this subsection. 2
In 1969 the Circuit Court of Palm Beach County, Florida, ruled that portions of the professi()nal education subsection were unconstitutional and since they were not severable, the entire subsection was held unconstitutional. The b~sis for the decision was that the subsection was discriminatory in excluding the 65 and older age practitioners and
too vague in defining the content for continuing professional education. In 1970 the following subsection which reflects the court's fuling was passed by the Florida legislature(3) (a) No annual renewal certificate shall be issued by the board for the year 1971 or any following year until the applicant therefore submits proof satisfactory to the board that during the calendar year preceding his application for renewal he has participated in not less than fifteen hours of approved courses of continuing professional education as herein defined. (b) The continuing professional pharmaceutical education courses shall consist of postgraquate studies, institutes, seminars, lectures, conferences, workshops, extension studies or such other form of continuing professional pharmaceutical education as may be approved as herein provided. Such courses shall consist of subject rrzatter pertinent to the following general areas of professional pharmaceuticaJ education1. The socio-economic and legal aspects of health care; 2. The properties and actions of drugs and dosage forms; and 3. The etiology, characteristics and therapeutics of the disease state. The specific subject matter of such courses may include but shall not be limited to the following: pharmacology, biochemistry, physiology, pharmaceutical chemistry, pharmacy administration, pharmacy jurisprudence, public health and communicable diseases, pharmaceutical marketing, professional practice management, anatVol. NS13, No.8, August 1973
409
TABLE I
omy, histology, and such other subject matter as represented in curricula of accredited colleges of pharmacy. (c) The content of each course which shall be offered for credit under this continuing professional education program shall be approved in advance of offering the course by a committee composed of equal representation from the board of pharmacy, the colleges of pharmacy in the state, and practicing pharmacisis in the state. The number and members of the committee shall be selected by the board of pharmacy and shall serve for a period of two years. (d) In the initial year of the application of this subsection the board may reduce the number of hours participation based upon the number of days its requirements are in effect during the initial calendar year. The board may make exemptions from its operation or in this subsection in emergency or hardship cases. The board of pharmacy may, consistent with the requirements of this subsection, promulgate rules and regulations necessary to implement or administer this subsection . .. 3
1971 Hours of Continuing Education Reported Number of Hours
Less Than
15
15
16--20
21-25
26-30
30
Totals
Frequency
27
161
284
52
33
43
600
5
27
47
9
5
7
100
Percent
More Than
TABLE II
1971 Methods for Obtaining Continuing Education Number of Times Reported Correspondence courses Institutes, seminars, etc. Lecture series Audio-visual program Presentation of paper Reading journal· Journal article quiz Academic courses
Totals
Percent of Total
72 526 10 68 19 477 219 15
5 38 1 5 1 34 15 1
1,406
100
* In 1971, a maximum of three hours was accredited for reading journals. This rewritten subsection eliminated the discriminatory clause, clearly defined the content for continuing education and established a procedure for accrediting course offerings.. In accordance with this subsection 3c, a Continuing Education Tripartite Committee was established. The comm~ttee is composed of two members from the Florida Board of Pharmacy, one member from Florida A & M school of pharmacy, one member from the University of Florida college of pharmacy, and two pharmacist-practitioners. The committee's function is to review each program for which a registered Florida pharmacist can receive continujng education credit. The sponsor of the program files with this committee information concerning the program con-
If a pharmacist wishes to use some form of study which involves audiovisual programs, audiotapes, videotapes, etc., he has three procedures available for certification1. The sponsor of the program must
certify that the pharmacist has participated- and certification must be attached to the pharmacist's license renewal application. 2. If other pharmacists wish to use the tapes of another and the holder of the tapes is willing to accept the responsibility as "group 1eader" then as the group leader he must certify the participation of his fellow colieagues.
"The most popular method for continuing education is the seminar or conferences." tent, the length of the program and the program format, e.g., speakers, audiotapes, videotapes, etc. This information is reviewed by the committee which advises the sponsor of the action taken. The approval notice to the sponsor states the number of credit hours appropriate for the program. . Once the program is approved it is the responsibility of the sponsor to establish a procedure for certifying that the pharmacist has participated. The certification, regardless of its form, must be attached to the license renewal application which is filed with the office of the secretary by each person seeking license renewal . 4 410
3. The pharmacist may submit a notarized statement attesting that he has participated in certain tapes. The guidelines developed by the Tripartite Continuing Education Committee are designed to a,ssure the quality of accredited programs and are sufficiently flexible to provide easy access to educational programs by all pharmacists. Hours of Continuing Education In 1971, which was the first full year of continuing education participation
Journal of the AMERICAN PHARMACEUTICAL ASSOCIATION
under the revised statutes, the Florida Board of Pharmacy issued 6,058 license renewals. To gain insight to the Florida pharmacists' continuing education activities, a random sample of 600 pharmacists' records were selected from this pool and reviewed for hours of continuing education reported and methods through which these hours were attained. Table I (above) presents the data on hours of participation. There were 27 pharmacists who reported less than 15 hours. Of these, five were given medical exemptions, four were on active military duty and 14 were midyear licenses who needed only seven hours to satisfy their 1971 continuing education requirement. Three out of the remaining four reported 14 hours and one reported 11 hours of participation. Table I indicates that 68 percent of the population (47 percent 16-20 hours and 21 percent over 20 hours) reported activity in excess of the required 15 hours. This may give some indication that once the pharmacist becomes involved in continuing education and finds the experience to be a personal satisfaction, hours of participation do not remain the sole criterion for participation. Table II (above) presents data on the methods ~sed for continuing education participation. The most popular method for continuing education is the large group activity represented by seminars, institutes, conferences, etc. Second to this is reported journal readings. It will be of interest to note the changes in 1972 as journal readings will only be ac-
credited if accompanied by a quiz prepared by the author of the article. There also has been a low frequency of reporting activity in the lecture series. At this time Florida does not have a mass media education system such as the educational telephone network or closed circuit television. Therefore, implementing a lecture series and making it available in geographic areas representative of the high density population is impossible at present. In February 1971 the college of pharmacy of Florida, established a division of continuing professional education. Its first activity was to concentrate on the short-range goals which were immediate educational needs of the pharmacist and the structure through which continuity of continuing education could be made available to the entire population of Florida pharmacists. Meetings were arranged with pharmacy organizations and with individual pharmacists through which feedback was obtained about the perceived needs and desired program designs. Two broad categories of needs were identified. First were the clinical needs expressed in the subject matter of pharmacology, toxicology, drug interactions, disease states and therapeutics. Jurisprudence and management programs were the second category. The more desired program design was expressed as the Sunday six-hour seminar. The initial project of the college resulting from this feedback was to plan a series of six-hour seminars with specific educational objectives and to employ techniques which would actively engage the participant in the learning process. During the Spring of 1971 a
SEMINAR I
SEMINAR II
The Pharmacist and PatientOriented Care
Jurisprudence and Management 1st hour
1 st hour 2nd hour 3rd hour 4th hour 5th hour 6th hour
Evolution of Change in the Pharmacist's Role Patient's Medication Habits Laws and Their Influence on the Pharmacist's Role Pharmacology of Drug Interactions Pharmacist's Role in Drug Interactions (Problem Solving Case Study) Formats of Medication Records and Drug Information Retrieval Systems
2.
To identify factors and services essential to the changing role of the pharmacist. To apply principles of pharmacology to monitoring medication habits.
The first question, formulated to give feedback of relevancy of program content, asked the participant to indicate if the information available in the seminar was very useful, not very useful, or useless in his daily practice. There was a 97 percent positive response (very useful, 44 percent and useful, 53 percent). The goals for 1972 included expanding the out-reach on the Sunday seminars to all Florida pharmacists and to accommodate both the clinical and managementjurisprudence needs. Requests had been received to place at least one seminar in each of the six Florida Pharmaceutical Association districts. A cooperative relationship with the Florida Pharmaceutical Association
"Experience indicates that mandating continuing education can serve as a stimulus for the goal-oriented learner." clinical seminar series "The Pharmacist and the Patient-Oriented Care" was packaged for presentation in three Florida Pharmaceutical Association districts (above). The philosophy of patient-oriented care introduced in the first hour served as the program context. The cognitive content covered interaction dynamics, pharmacology, ' jurisprudence and record system hardware. The format of each seminar utilized audio-visual reinforcement, handout materials and audience participation In problem solving case studies. At the end of each six-hour seminar, evaluation forms were distributed, completed by the participants and col- . lected. Out of the 495 participants, 264 (53 percent) evaluation forms were returned. The forms were designed so that the respondent remained anonymous.
Objectives: 1. 2.
Objectives: 1.
What's on the Health Care Horizon 2nd hour InveN.tory Systems Come Alive 3rd hOllr "It Works for Me"~Panel of Pharmacists 4th and 5th hours Change and Impact of Pharmacy Law-Problem Solving Case Studies
offered a structure through which continuity in planning and presentation of these seminars could be accomplished. This concept was presented to the Florida Pharmaceutical Association; the latter appointed an education committee composed of four pharmacists, two pharmacy students, one member from the Florida A & M school of pharmacy and one member from the University of Florida college of pharmacy to plan these seminars. The scope of this FPA Committee allowed for greater input to the planning process by the pharmacist, and expanded the availability of program resource persons to inlude , practicing pharmacists along with faculty from each of the educational institutions. Two seminar packages with different educational objectives were developed, each to be presented three times (above, right). The placement of these seminars
To identify the effects of state and federal programs on Florida pharmacy. To evaluate effects of these changes on traditional pharmacy management principles.
SEMINAR III
Therapeutic Principles for Pharmacists 1 st hour
Pharmacology of Anticholinergics 2nd hour Prophylactic Use of Sunscreens 3rd hour Asthma-Disease and Treatment 4th and 5th hours Pharmacology of Sedatives 6th hour Pharmacy Grand RoundsCase Presentation and Problem Solving Objectives: 1. 2.
To identify tnerapeutic principles that are applicable to monitoring patient medication regimens. To evaluate the pharmacist's role and responsibilities.
in alternate districts made it possible for the pharmacist to attend one format in his district and the other format in his neighboring district. Both seminar formats used the techniques employed in the 1971 series. In the 1972 evaluation forms an additional category-somewhat useful-was added. Out of the 455 participants at Seminar II, 163 (36 percent) returned evaluation · forms. The responses of participants wereVery useful Useful Somewhat useful Not very useful Completely useless No answer
24 31 24 10 4 7
percent percent percent percent percent percent
Seminar III was presented to 891 pharmacists with 300 (34 percent) returning evaluation forms. The responses wereVery useful Useful Somewhat useful Not very useful Completely useless No answer
37 percent 29 percent 14 percent .6 percent 1 percent 13 percent
Vol. NSI3, No.8, August 1973
411
The results of the evaluations, though not conclusive, do indicate seminars of this nature are of relevance to the majority of participants. While we must remain sensitive to the response of the minority and continue to reevaluate the content of these seminars to meet the expectations of this group, we do have some indication and assurance that attendance motivated by a mandatory requirement does result in a positive learning experience. This approach of six-hour seminars provided a structure through which program offerings could be made available to a large population of Florida pharmacists and serve some of the immediate educational objectives.
Projections
The college of pharmacy, while actively engaged in these educational offe~ings to meet the pharmacists' immediate needs, also focused on longrange goals and identified five main educational objectives to be served. 1.
To provide expanded clinical facilities for advanced pharmacy students.
2.
To provide continuing professional education to practicing pharmacists.
3. To provide educational opportunities
for practicing pharmacists to advance their training in new areas of health care.
Strengthening Professional Competence (continued from page 405)
pharmacy will again become fragmented with little if any quality control being exerted. It is not enough, however, only to recommend what courses should be given. The next step must followaccreditation of continuing education programs. Just as schools of pharmacy are now accredited, so must the programs be certified, because, without accreditation, there is no guarantee as to the quality of the courses offered. It is not enough for a national organization to recommend what courses should be offered. The quality of the courses must also be assured, quality in terms of subject matter content and quality in terms of teaching; to do less would negate all of the accomplishments. What I have briefly sketched, then, is a proposal for a strategy toward continously improving the profession of
4. To provide the opportunity for practicing pharmacists to obtain advanced professional degrees. ,5. To provide educational opportunities
for those pharmacists who do not meet present educational requirements for licensure. These objectives can be satisfied by the development of two distinct educational approaches, both proven to be of value in the education of health . professionals. The first is the establishment of interdisciplinary clinical training environments ' throughout Florida. The second approach to be implemented is the establishment of an educational telephone network through which the entire potential of the five colleges (medicine, dentistry, pharmacy, nursing and health related professions) in the J. Hillis Miller Health Center can be made available to students and health practitioners.. at remote sites. While the desired objectives are varied there is an identifiable core of didactic material common to all. The commonality of the core of didactic material and the utilization of the above two educational approaches will allow the college to attain these long-range goals.
The first, or as they will be called, the
goal-oriented are those who use education as a means of accomplishing fairly clearcut objectives. The second, the activity oriented, are those who take part because they find in the circumstances of learning a meaning which has no necessary connection, and often no connection at all, with the learning or the announced purpose of the activity. The third, the learningoriented, seek knowledge for its own sake. These are not pure types; the best way to represent them pictorially would be by three circles which overlap at the edges. But the central emphasis of each subgroup is clearly discernible. 5 ,
These preliminary 'experiences seem to indicate that the mandating of continuing education can serve as a stimulus for the goal-oriented learner; therefore, the agepcies responsible for continuing education must be concerned with the philosophy, educational objectives, methods and techniques of the educational experience if continuing education for the pharmacist is to m'eet its objectives. • References
The experience with mandatory continuing education in Florida leads one to look more closely at the orientation of the learner in continuing education as identified by Cyril O. Houle-
1. " Guidelines for Continuing Pharmaceutical Educa tion," AACP Section of Teachers of Continuing Educa tion, Amer. J . Pharm . Educ., 36, 634 (Nov. 1972) 2. Laws of the State of Florida, Chapter 465.091 (3), 2294 (1967) 3. Laws of the State of Florida, Chapter 465.091 (3) , 387 (1970) 4 . Bevis, H .F ., " Florida Boa rd of Pha rma cy's Role in Continuing Educa tion," Proceedings, NABP a nd AACP Third District, 73 (1972 ) 5. Houle, C.O. , The Inquiring M ind, University of Wisconsin Press, Madison, Wis., 15 (1963)
pharmacy by (l) Defining the standards which practicing pharmacists should satisfy; (2) Developing and making available to all practicing pharmacists a national examination embodying the standards; -(3) Developing continuing education courses that would embody subject-matter content related to the formulated standards; (4) Establishing a mechanism through which continuing education programs can be accredited. I have emphasized the point that national leadership will be required to accomplish all of this. I should like to underscore this, again, because without national leadership it will not be possible to develop standards that can be applied throughout the profession. The alternatives to a national approach are state laws and regulations which will provincialize pharmacy to a point where it can no longer legitimately claim the title of a profession. Granted, we must live with existing laws pertaining to mandatory continuing education in pharmacy. The tragedy is
that such laws were considered necessary in the first place. To do nothing to demonstrate clearly and unequivocally that the profession is dedicated to maintaining and to strengthening standards is to invite even more restrictive laws. If mandatory continuing education is a fact of life, is the prospect of mandatory re-examination with failure to pass the examination a reason for licensure revocation far behind? My intuition tells me it is closer at hand than we suspect. It is a reality which may ,be hastened unless pharmacy takes some positive action-unless pharmacy fulJy accepts its professional responsibility to define, to maintain and to improve standards of professional competence. What I have offered is but one course of action. I am confident -that even better and more appropriate alternatives can be proposed. What I am seeking is an approach that will continue the existence of pharmacy as a vital and viable profession, the profession I know and respect. •
Conclusion
Max A. Lemberger is assistant dean of professional education and director of the division of continuing professional education, college of pharmacy , University of Florida. From 1947 to 19~6, he practiced pharmacy in Milwaukee, Wisconsin . . In 1966 he was appointed director of the Wisconsin Pharmacy Internship Board. He joined the University of Florida in 1971 and serves the J. Hillis Miller Health Center as chairman of the health sciences continuing education council.
T
here is general agreement for the need for continuing pharmaceutical education to upgrade the competence and to develop new abilities in the pharmacist. What effect will mandatory continuing education have on the attainment of these objectives seems to be the most frequently asked question. Since Florida was the first state to require continuing education as a prerequisite to relicensure for pharmacists, its experiences with mandatory continuing education may be helpful in giving direction to the application of basic concepts for continuing education. In recounting these experiences we should examine1. The fundamental structure for implementing mandatory continuing education ; 2. The number of hours the Florida pharmacists participate in formal continuing education; 3. Preliminary experiences with methods and techniques employed. The Fundamental Structure
Whether voluntary or mandatory, all continuing education must be planned and implemented following a set of guidelines which incorporate the fundamental principles for instructional dynamics. 1 In 1965 Florida implemented mandatory continuing education and in doing so, established a philosophy and guidelines in Laws of the State of Florida, Chapter 465 as follows-
No annual renewal certificate shall be issued by the board for the ye!1r 1968 and any following year until such time as the applicant submits proof satisfactory to the board that subsequent to the issuance of his certificate of registration or last renewal thereof, he has completed at least fifteen hours of continuing professional education, including postgraduate studies, institutes, seminars, lectures, conferences, workshops, extension studies, approved correspondence courses or such other form of continuing professional education as may be approved by the board. If the renewal fee for any pharmacist's certificate be unpaid by June 20· of any year, the holder thereof may be reinstated as a registered pharmacist only upon payment of a penalty of five dollars and all lapsed fees and proof of compliance of all other provisions of this act; provided that actual retireme!1f from the profession by any registered pharmacist for a period not exceeding five years shall flot deprive him of the right to renew the registration upon payment of lapsed fees and proof of compliance of all other provisions of the act. Provided, however, that any applicant for a renewal certificate who is age sixty-five or older shall be exempt from the continuing professional education requirements of this subsection. 2
In 1969 the Circuit Court of Palm Beach County, Florida, ruled that portions of the professi()nal education subsection were unconstitutional and since they were not severable, the entire subsection was held unconstitutional. The b~sis for the decision was that the subsection was discriminatory in excluding the 65 and older age practitioners and
too vague in defining the content for continuing professional education. In 1970 the following subsection which reflects the court's fuling was passed by the Florida legislature(3) (a) No annual renewal certificate shall be issued by the board for the year 1971 or any following year until the applicant therefore submits proof satisfactory to the board that during the calendar year preceding his application for renewal he has participated in not less than fifteen hours of approved courses of continuing professional education as herein defined. (b) The continuing professional pharmaceutical education courses shall consist of postgraquate studies, institutes, seminars, lectures, conferences, workshops, extension studies or such other form of continuing professional pharmaceutical education as may be approved as herein provided. Such courses shall consist of subject rrzatter pertinent to the following general areas of professional pharmaceuticaJ education1. The socio-economic and legal aspects of health care; 2. The properties and actions of drugs and dosage forms; and 3. The etiology, characteristics and therapeutics of the disease state. The specific subject matter of such courses may include but shall not be limited to the following: pharmacology, biochemistry, physiology, pharmaceutical chemistry, pharmacy administration, pharmacy jurisprudence, public health and communicable diseases, pharmaceutical marketing, professional practice management, anatVol. NS13, No.8, August 1973
409
TABLE I
omy, histology, and such other subject matter as represented in curricula of accredited colleges of pharmacy. (c) The content of each course which shall be offered for credit under this continuing professional education program shall be approved in advance of offering the course by a committee composed of equal representation from the board of pharmacy, the colleges of pharmacy in the state, and practicing pharmacisis in the state. The number and members of the committee shall be selected by the board of pharmacy and shall serve for a period of two years. (d) In the initial year of the application of this subsection the board may reduce the number of hours participation based upon the number of days its requirements are in effect during the initial calendar year. The board may make exemptions from its operation or in this subsection in emergency or hardship cases. The board of pharmacy may, consistent with the requirements of this subsection, promulgate rules and regulations necessary to implement or administer this subsection . .. 3
1971 Hours of Continuing Education Reported Number of Hours
Less Than
15
15
16--20
21-25
26-30
30
Totals
Frequency
27
161
284
52
33
43
600
5
27
47
9
5
7
100
Percent
More Than
TABLE II
1971 Methods for Obtaining Continuing Education Number of Times Reported Correspondence courses Institutes, seminars, etc. Lecture series Audio-visual program Presentation of paper Reading journal· Journal article quiz Academic courses
Totals
Percent of Total
72 526 10 68 19 477 219 15
5 38 1 5 1 34 15 1
1,406
100
* In 1971, a maximum of three hours was accredited for reading journals. This rewritten subsection eliminated the discriminatory clause, clearly defined the content for continuing education and established a procedure for accrediting course offerings.. In accordance with this subsection 3c, a Continuing Education Tripartite Committee was established. The comm~ttee is composed of two members from the Florida Board of Pharmacy, one member from Florida A & M school of pharmacy, one member from the University of Florida college of pharmacy, and two pharmacist-practitioners. The committee's function is to review each program for which a registered Florida pharmacist can receive continujng education credit. The sponsor of the program files with this committee information concerning the program con-
If a pharmacist wishes to use some form of study which involves audiovisual programs, audiotapes, videotapes, etc., he has three procedures available for certification1. The sponsor of the program must
certify that the pharmacist has participated- and certification must be attached to the pharmacist's license renewal application. 2. If other pharmacists wish to use the tapes of another and the holder of the tapes is willing to accept the responsibility as "group 1eader" then as the group leader he must certify the participation of his fellow colieagues.
"The most popular method for continuing education is the seminar or conferences." tent, the length of the program and the program format, e.g., speakers, audiotapes, videotapes, etc. This information is reviewed by the committee which advises the sponsor of the action taken. The approval notice to the sponsor states the number of credit hours appropriate for the program. . Once the program is approved it is the responsibility of the sponsor to establish a procedure for certifying that the pharmacist has participated. The certification, regardless of its form, must be attached to the license renewal application which is filed with the office of the secretary by each person seeking license renewal . 4 410
3. The pharmacist may submit a notarized statement attesting that he has participated in certain tapes. The guidelines developed by the Tripartite Continuing Education Committee are designed to a,ssure the quality of accredited programs and are sufficiently flexible to provide easy access to educational programs by all pharmacists. Hours of Continuing Education In 1971, which was the first full year of continuing education participation
Journal of the AMERICAN PHARMACEUTICAL ASSOCIATION
under the revised statutes, the Florida Board of Pharmacy issued 6,058 license renewals. To gain insight to the Florida pharmacists' continuing education activities, a random sample of 600 pharmacists' records were selected from this pool and reviewed for hours of continuing education reported and methods through which these hours were attained. Table I (above) presents the data on hours of participation. There were 27 pharmacists who reported less than 15 hours. Of these, five were given medical exemptions, four were on active military duty and 14 were midyear licenses who needed only seven hours to satisfy their 1971 continuing education requirement. Three out of the remaining four reported 14 hours and one reported 11 hours of participation. Table I indicates that 68 percent of the population (47 percent 16-20 hours and 21 percent over 20 hours) reported activity in excess of the required 15 hours. This may give some indication that once the pharmacist becomes involved in continuing education and finds the experience to be a personal satisfaction, hours of participation do not remain the sole criterion for participation. Table II (above) presents data on the methods ~sed for continuing education participation. The most popular method for continuing education is the large group activity represented by seminars, institutes, conferences, etc. Second to this is reported journal readings. It will be of interest to note the changes in 1972 as journal readings will only be ac-
credited if accompanied by a quiz prepared by the author of the article. There also has been a low frequency of reporting activity in the lecture series. At this time Florida does not have a mass media education system such as the educational telephone network or closed circuit television. Therefore, implementing a lecture series and making it available in geographic areas representative of the high density population is impossible at present. In February 1971 the college of pharmacy of Florida, established a division of continuing professional education. Its first activity was to concentrate on the short-range goals which were immediate educational needs of the pharmacist and the structure through which continuity of continuing education could be made available to the entire population of Florida pharmacists. Meetings were arranged with pharmacy organizations and with individual pharmacists through which feedback was obtained about the perceived needs and desired program designs. Two broad categories of needs were identified. First were the clinical needs expressed in the subject matter of pharmacology, toxicology, drug interactions, disease states and therapeutics. Jurisprudence and management programs were the second category. The more desired program design was expressed as the Sunday six-hour seminar. The initial project of the college resulting from this feedback was to plan a series of six-hour seminars with specific educational objectives and to employ techniques which would actively engage the participant in the learning process. During the Spring of 1971 a
SEMINAR I
SEMINAR II
The Pharmacist and PatientOriented Care
Jurisprudence and Management 1st hour
1 st hour 2nd hour 3rd hour 4th hour 5th hour 6th hour
Evolution of Change in the Pharmacist's Role Patient's Medication Habits Laws and Their Influence on the Pharmacist's Role Pharmacology of Drug Interactions Pharmacist's Role in Drug Interactions (Problem Solving Case Study) Formats of Medication Records and Drug Information Retrieval Systems
2.
To identify factors and services essential to the changing role of the pharmacist. To apply principles of pharmacology to monitoring medication habits.
The first question, formulated to give feedback of relevancy of program content, asked the participant to indicate if the information available in the seminar was very useful, not very useful, or useless in his daily practice. There was a 97 percent positive response (very useful, 44 percent and useful, 53 percent). The goals for 1972 included expanding the out-reach on the Sunday seminars to all Florida pharmacists and to accommodate both the clinical and managementjurisprudence needs. Requests had been received to place at least one seminar in each of the six Florida Pharmaceutical Association districts. A cooperative relationship with the Florida Pharmaceutical Association
"Experience indicates that mandating continuing education can serve as a stimulus for the goal-oriented learner." clinical seminar series "The Pharmacist and the Patient-Oriented Care" was packaged for presentation in three Florida Pharmaceutical Association districts (above). The philosophy of patient-oriented care introduced in the first hour served as the program context. The cognitive content covered interaction dynamics, pharmacology, ' jurisprudence and record system hardware. The format of each seminar utilized audio-visual reinforcement, handout materials and audience participation In problem solving case studies. At the end of each six-hour seminar, evaluation forms were distributed, completed by the participants and col- . lected. Out of the 495 participants, 264 (53 percent) evaluation forms were returned. The forms were designed so that the respondent remained anonymous.
Objectives: 1. 2.
Objectives: 1.
What's on the Health Care Horizon 2nd hour InveN.tory Systems Come Alive 3rd hOllr "It Works for Me"~Panel of Pharmacists 4th and 5th hours Change and Impact of Pharmacy Law-Problem Solving Case Studies
offered a structure through which continuity in planning and presentation of these seminars could be accomplished. This concept was presented to the Florida Pharmaceutical Association; the latter appointed an education committee composed of four pharmacists, two pharmacy students, one member from the Florida A & M school of pharmacy and one member from the University of Florida college of pharmacy to plan these seminars. The scope of this FPA Committee allowed for greater input to the planning process by the pharmacist, and expanded the availability of program resource persons to inlude , practicing pharmacists along with faculty from each of the educational institutions. Two seminar packages with different educational objectives were developed, each to be presented three times (above, right). The placement of these seminars
To identify the effects of state and federal programs on Florida pharmacy. To evaluate effects of these changes on traditional pharmacy management principles.
SEMINAR III
Therapeutic Principles for Pharmacists 1 st hour
Pharmacology of Anticholinergics 2nd hour Prophylactic Use of Sunscreens 3rd hour Asthma-Disease and Treatment 4th and 5th hours Pharmacology of Sedatives 6th hour Pharmacy Grand RoundsCase Presentation and Problem Solving Objectives: 1. 2.
To identify tnerapeutic principles that are applicable to monitoring patient medication regimens. To evaluate the pharmacist's role and responsibilities.
in alternate districts made it possible for the pharmacist to attend one format in his district and the other format in his neighboring district. Both seminar formats used the techniques employed in the 1971 series. In the 1972 evaluation forms an additional category-somewhat useful-was added. Out of the 455 participants at Seminar II, 163 (36 percent) returned evaluation · forms. The responses of participants wereVery useful Useful Somewhat useful Not very useful Completely useless No answer
24 31 24 10 4 7
percent percent percent percent percent percent
Seminar III was presented to 891 pharmacists with 300 (34 percent) returning evaluation forms. The responses wereVery useful Useful Somewhat useful Not very useful Completely useless No answer
37 percent 29 percent 14 percent .6 percent 1 percent 13 percent
Vol. NSI3, No.8, August 1973
411
The results of the evaluations, though not conclusive, do indicate seminars of this nature are of relevance to the majority of participants. While we must remain sensitive to the response of the minority and continue to reevaluate the content of these seminars to meet the expectations of this group, we do have some indication and assurance that attendance motivated by a mandatory requirement does result in a positive learning experience. This approach of six-hour seminars provided a structure through which program offerings could be made available to a large population of Florida pharmacists and serve some of the immediate educational objectives.
Projections
The college of pharmacy, while actively engaged in these educational offe~ings to meet the pharmacists' immediate needs, also focused on longrange goals and identified five main educational objectives to be served. 1.
To provide expanded clinical facilities for advanced pharmacy students.
2.
To provide continuing professional education to practicing pharmacists.
3. To provide educational opportunities
for practicing pharmacists to advance their training in new areas of health care.
Strengthening Professional Competence (continued from page 405)
pharmacy will again become fragmented with little if any quality control being exerted. It is not enough, however, only to recommend what courses should be given. The next step must followaccreditation of continuing education programs. Just as schools of pharmacy are now accredited, so must the programs be certified, because, without accreditation, there is no guarantee as to the quality of the courses offered. It is not enough for a national organization to recommend what courses should be offered. The quality of the courses must also be assured, quality in terms of subject matter content and quality in terms of teaching; to do less would negate all of the accomplishments. What I have briefly sketched, then, is a proposal for a strategy toward continously improving the profession of
4. To provide the opportunity for practicing pharmacists to obtain advanced professional degrees. ,5. To provide educational opportunities
for those pharmacists who do not meet present educational requirements for licensure. These objectives can be satisfied by the development of two distinct educational approaches, both proven to be of value in the education of health . professionals. The first is the establishment of interdisciplinary clinical training environments ' throughout Florida. The second approach to be implemented is the establishment of an educational telephone network through which the entire potential of the five colleges (medicine, dentistry, pharmacy, nursing and health related professions) in the J. Hillis Miller Health Center can be made available to students and health practitioners.. at remote sites. While the desired objectives are varied there is an identifiable core of didactic material common to all. The commonality of the core of didactic material and the utilization of the above two educational approaches will allow the college to attain these long-range goals.
The first, or as they will be called, the
goal-oriented are those who use education as a means of accomplishing fairly clearcut objectives. The second, the activity oriented, are those who take part because they find in the circumstances of learning a meaning which has no necessary connection, and often no connection at all, with the learning or the announced purpose of the activity. The third, the learningoriented, seek knowledge for its own sake. These are not pure types; the best way to represent them pictorially would be by three circles which overlap at the edges. But the central emphasis of each subgroup is clearly discernible. 5 ,
These preliminary 'experiences seem to indicate that the mandating of continuing education can serve as a stimulus for the goal-oriented learner; therefore, the agepcies responsible for continuing education must be concerned with the philosophy, educational objectives, methods and techniques of the educational experience if continuing education for the pharmacist is to m'eet its objectives. • References
The experience with mandatory continuing education in Florida leads one to look more closely at the orientation of the learner in continuing education as identified by Cyril O. Houle-
1. " Guidelines for Continuing Pharmaceutical Educa tion," AACP Section of Teachers of Continuing Educa tion, Amer. J . Pharm . Educ., 36, 634 (Nov. 1972) 2. Laws of the State of Florida, Chapter 465.091 (3), 2294 (1967) 3. Laws of the State of Florida, Chapter 465.091 (3) , 387 (1970) 4 . Bevis, H .F ., " Florida Boa rd of Pha rma cy's Role in Continuing Educa tion," Proceedings, NABP a nd AACP Third District, 73 (1972 ) 5. Houle, C.O. , The Inquiring M ind, University of Wisconsin Press, Madison, Wis., 15 (1963)
pharmacy by (l) Defining the standards which practicing pharmacists should satisfy; (2) Developing and making available to all practicing pharmacists a national examination embodying the standards; -(3) Developing continuing education courses that would embody subject-matter content related to the formulated standards; (4) Establishing a mechanism through which continuing education programs can be accredited. I have emphasized the point that national leadership will be required to accomplish all of this. I should like to underscore this, again, because without national leadership it will not be possible to develop standards that can be applied throughout the profession. The alternatives to a national approach are state laws and regulations which will provincialize pharmacy to a point where it can no longer legitimately claim the title of a profession. Granted, we must live with existing laws pertaining to mandatory continuing education in pharmacy. The tragedy is
that such laws were considered necessary in the first place. To do nothing to demonstrate clearly and unequivocally that the profession is dedicated to maintaining and to strengthening standards is to invite even more restrictive laws. If mandatory continuing education is a fact of life, is the prospect of mandatory re-examination with failure to pass the examination a reason for licensure revocation far behind? My intuition tells me it is closer at hand than we suspect. It is a reality which may ,be hastened unless pharmacy takes some positive action-unless pharmacy fulJy accepts its professional responsibility to define, to maintain and to improve standards of professional competence. What I have offered is but one course of action. I am confident -that even better and more appropriate alternatives can be proposed. What I am seeking is an approach that will continue the existence of pharmacy as a vital and viable profession, the profession I know and respect. •
Conclusion