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Undergraduate Education—A Look to the Future
A Look to the Future By LAWRENCE C. WEAVER Many forces, both internal and external, are working to change pharmacy practice and pharmacy education. Primary among these are the shifting relationships between health care professionals and the public, and the public's views on what constitutes health and illness and what medicine's role ought to be. The recent focus on self-medication (see June 1980 American Pharmacy) is a predictable response to the never-ending rise in the cost of health care. Self-care creates a need for health information-particularly drug information-and the pharmacist must be prepared to respond.
Lawrence C. Weaver, PhD, is dean of the University of Minnesota College of Pharmacy, Minneapolis , MN 55455. 24
Accompanying this back-to-basics movement has been the growth in numbers of nonphysicians who believe that they can take care of one or another medical problem as well as, or even better than, physicians. Never before this current era of general public mistrust has there been a national atmosphere so conducive to the rejection of scientific medicine and the search for substitutes that promise more economical, better, and/or more humane care. Pharmacists are among those vying for expanded health care roles. Over the past decade or so we have come to recognize that one of society's greatest needs is a take-charge professional for drug use and control. (Evidence is abundant that patients misuse and abuse drugs to a considerable extent, and unfortunately, some health professionals often contribute to this considerable problem.) Since pharmacy is the profession most prepared to serve this drug use and control function,
we have sought ways to make the pharmacist more effective and efficient in an area now called clinical pharmacy. Pharmacy education has spearheaded this move. In recent years we have introduced more and better course work in pharmacokinetics, biopharmaceutics, and other clinical subjects. In our enthusiasm to accomplish expanded pharmaceutical services through education, we have created a gap between pharmacy education and pharmacy practice. This has posed difficulties for pharmacists who do not find themselves on the frontiers . Further, pharmacy education continually produces pharmacists who are prepared to practice in a more sophisticated manner than is generally believed by the public. The frustrations created are a part of the necessary thrust to produce useful and desirable change . Pharmacy education broke with tradition less than two decades ago and was an important factor in the rapid change of pharmacy practice in the 1970s. We have made a successful start, but much greater change is yet to come. As pharmacy educators and practitioners work closely together to develop even higher standards for the profession, the service roles will expand and gain acceptance at a fast pace during the remainder of this century. And we will experience the successes that result from a united effort directed toward the maintenance and re-establishment of health for all the people. In its efforts to respond to evolving needs of pharmacists and future pharmacists as they expand patientoriented pharmaceutical services, experimental and ihnovative programs will be developed, evaluated, and often adopted. This will result in a changing profile of pharmacy education. It is the intent of this article to identify potential trends in pharmacy education, particularly as they may occur during the 1980s. Pharmacy Degrees
There certainly will be an accelerated movement toward a single professional doctor of pharmacy degree
American Pharmacy Vol. NS20, No.9, September 1980/512
program. This is desirable and hardly unexpected. To date, 16 institutions have or are planning the move to the PharmD as the first professional degree. Increasingly, it will be possible to permit the separation of education from time. Students will be able to accomplish the required competencies for a degree at their own pace. Some students will be able and permitted to complete the requirements for a degree in pharmacy in much less time than the standard six years generally required for the PharmD program. Conversely, students needing more time because of finances, family problems, and other constraints will be able to obtain an extension. While it seems a small advance, this development will shake the very foundations of higher education. Traditionally, education has been tied to a time frame. Students, for the most part, were forced to fit the mold. Much more flexibility in education will be required. Perhaps more important, for the next decade or so it will permit practitioners desiring a PharmD degree to enter the educational system taking full advantage of all their competencies. Present systems penalize people whose learning was accomplished in other than academic courses. College of Health Sciences The preprofessional requirements for dentistry, medicine, pharmacy, and other allied health fields are quite similar. Thus it would be possible to admit students into health science status without immediately applying the career label that encourages students to act the perceived role of the profession selected. Such labeling creates constraints to thinking and activities of students. This move-already under way at more than a dozen universities-should help expand the thinking of young people about the career possibilities in other biological and social service professions as well as the major health professions. Such programs serve the needs of students at least through the period of the first professional year of any health degree program
and should result in a better use of educational resources. Another important trend, especially in health science centers, is an increasing emphasis on interdisciplinary education (multiprofessional education). Present efforts in complex health science centers have had limited success. However, sufficient experience has been gained to suggest that there are advantages when students from pharmacy, medicine, and nursing (and selected other health fields) take course work together. Barriers to cooperative effort are lowered, and respect for each other's expertise starts to develop. We begin to see the buds of future health teams which can flower in the delivery of health care. Human Interaction Skills Clinical roles for pharmacists will be in the forefront as we complete the last two decades of this century. Pharmacy education must give even greater emphasis to communications and the social and behavioral sciences if we are to be effective in drug use control. We will need to introduce patients earlier in pharmacy education. This will help students make use of the knowledge from the behavioral sciences to develop interviewing skills and to better understand the power of pharmacist-patient and pharmacistphysician relationships. It will also make students more aware of their own attitudes and how they affect the care of others. Understanding the patient, knowing what is going on within the patient's brain and psyche as well as his or her physiology, is as much a matter of science as is the study of drugs. Ways of dealing with feelings, attitudes, or aberrant behavior can now be predicted on reliable data and are amenable to validation and scientific study. If we can teach humanism more scientifically and put more understanding of its uses into the hands of those who deliver health care, pharmacists will be able to respond better to the problems that trouble people most about health professionals. Such humanistic skills might also permit young pharmacists to cope more ef-
American Pharmacy Vol. NS20, No.9, September 1980/513
ficiently with their personal anxieties and attitudes and allow them to deal more comfortably with health and social problems that increasingly confront them. Liberal Education Pharmacy education, like other professional programs, has concentrated too much effort on the technical aspects of the profession. Only in the most recent decades has any consideration been given to alert the student to "other" opportunitiestheater, music, art, astronomy, sports. Preparation to enjoy the extras in life is surely worth the effort. College faculties are more and more supporting of those cultural extras that are a part of a well-rounded person and professional. One of the unsolved problems of pharmacy education-perhaps the profession-is the very narrow career choice for all but a few pharmacy graduates. The trend in thecareers most often selected in the past several years has been a decrease in the number of graduates entering community practice and graduate studies and an increase in hospital (institutional) practice. In graduate studies this continued dearth of available qualified pharmacy graduates can have a substantial effect, particularly on pharmacy education in the future. A majority of faculty members without pharmacy experience is not in the profession's best interest. Career opportunities such as working as medical service representatives formerly attracted many pharmacists. Despite some reversal of the trend toward non pharmacists in these positions, the number of pharmacists entering remains small. Fortunately, the greater pharmacy family recognizes the need for more diversification of pharmacists in society. That is, there is a need for pharmacists to apply their talents toward leadership positions in other areas as well-business management, politics, government service, pharmacy industry, and a multitude of other fields. Pharmacy education and practice will formally address this problem -probably for the wrong reason. If
25
f a surplus of pharmacists exists or develops, as some already believe, pharmacy's stand could be defensive. Nevertheless, I would like to believe that many leaders will recognize that pharmacy education prepares one for a kaleidoscope of career opportunities . Approaches to broadening students' career horizons should become a significant activity in pharmacy schools. Practice Experience During the past decade, great efforts were directed toward the development of clerkships (practical experience) in the institutional environment. Clinical pharmacy can most easily be experimented with, controlled, evaluated, developed, and accepted in an environment where other health professionals practice and the patient is controlled. The next emphasis will be the development of community
'The new look to pharmacy education will bring together the educator and the practitioner to share their knowledge.'
pharmacy clerkships. However, it is in the noninstitutional environment that the greatest need exists for the pharmacist to practice drug use control. Through this development will come increased patient expectations for expanded patient-oriented pharmaceutical services. The pharmacist will be expected to have many of the skills needed in the institutional setting as well as human interaction skills. With the successful development of the community clerkship the presently required internship will become integrated into the curriculum. In fact, there will be no pressing need for an internship, and the
26
student, on completing the pharmacy education program, will be qualified for licensure. Competency assessment procedures will assure the success of this integration. The basic sciences should be increasingly interwoven with practice experience. Because many of the basic sciences germane to pharmacy assume increasing importance in students' minds only after they are faced with some clinical problems encountered in the third and fourth years, a number of schools will be reintroducing basic science courses during the latter half of pharmacy school. Many schools are experimenting with programs that bring patient exposure into the first professional year. Increased integration of basic and clinical offerings throughout the professional program is highly desirable. Specialization Despite the likelihood that specialization will increase the cost of pharmaceutical services, it will occur because of the inability of a general practitioner in pharmacy to attain the desired skills needed in fields as complex as nuclear pharmacy or geriatrics. Track systems will be developed that will allow a variety of career options, thus limiting the time needed to specialize. These options will make the pharmacist more effective and careers more rewarding. This move also will give pharmacy education an opportunity to address concerns of practice in areas such as business preparation. It is difficult to justify the inclusion of required business-oriented courses to the degree desired by those seeking pharmacy managers. However, a track that permits a combined pharmacy and business degree would fulfill the needs of students with this orientation as well as those in practice who later recognize the need for more business preparation. In the early years of this decade, specialization will be accomplished by a required postdoctoral year of education in the practice arena. Pharmacy schools simply cannot afford to continue the practice of
lengthening the curriculum. It may be that accomplishing specialization within a "six-year program" will still be a goal at the end of the decade. Education as a Continuum The process that has been developing in pharmacy has reflected a movement outside the "wall:> of ivy." With competency assessment for relicensure, pharmacy education will play a greater role in instilling in students an understanding of the need and opportunities for lifelong learning. Students traversing the system will really never leave it. At various points along the continuum they will be considered competent to practice . Lifelong learning attitudes learned early will keep them a viable part of the pharmacy education system throughout their careers. Using various educational approaches (correspondence, programmed instruction, clinical clerkships, etc.), practitioners will be able to maintain competency without great hardship . The new look to pharmacy education will bring together the pharmacy educator and the pharmacy practitioner to share their knowledge and expertise in a manner that will permit learning to take place. The primary learning environment will remain the university. But it will increasingly encompass all those places where health care is the major thrust. Competency, new teaching methods, new involvements, and real challenges will make it possible for a student to prepare and maintain that preparedness throughout life. This will make the pharmacy career more rewarding in all ways than it has ever been in the past. o ·
Suggested References W.S. Apple, APhA Weekly. 19(23), 2 (1980). E.M . Burns, " H ealth Services for Tomorrow," Dunellen,
New York, 1973. The Proprietary Association, "Self-Med ica tion: The New Era" (co nde nsa tion of papers and discussions), Washington , DC, 1980. D.E. Rogers, " America n Medicine: Challenges for the 1980's," Ballinger, 1978. J.P. Swazey, " Hea lth, Professionals and the Public: Toward a New Social Contract," Society for Health Values. Philadelphia, 1979.
American Pharmacy Vol. NS20, No. 9, September 1980/514
Lawrence C. Weaver, PhD, is dean of the University of Minnesota College of Pharmacy, Minneapolis , MN 55455. 24
Accompanying this back-to-basics movement has been the growth in numbers of nonphysicians who believe that they can take care of one or another medical problem as well as, or even better than, physicians. Never before this current era of general public mistrust has there been a national atmosphere so conducive to the rejection of scientific medicine and the search for substitutes that promise more economical, better, and/or more humane care. Pharmacists are among those vying for expanded health care roles. Over the past decade or so we have come to recognize that one of society's greatest needs is a take-charge professional for drug use and control. (Evidence is abundant that patients misuse and abuse drugs to a considerable extent, and unfortunately, some health professionals often contribute to this considerable problem.) Since pharmacy is the profession most prepared to serve this drug use and control function,
we have sought ways to make the pharmacist more effective and efficient in an area now called clinical pharmacy. Pharmacy education has spearheaded this move. In recent years we have introduced more and better course work in pharmacokinetics, biopharmaceutics, and other clinical subjects. In our enthusiasm to accomplish expanded pharmaceutical services through education, we have created a gap between pharmacy education and pharmacy practice. This has posed difficulties for pharmacists who do not find themselves on the frontiers . Further, pharmacy education continually produces pharmacists who are prepared to practice in a more sophisticated manner than is generally believed by the public. The frustrations created are a part of the necessary thrust to produce useful and desirable change . Pharmacy education broke with tradition less than two decades ago and was an important factor in the rapid change of pharmacy practice in the 1970s. We have made a successful start, but much greater change is yet to come. As pharmacy educators and practitioners work closely together to develop even higher standards for the profession, the service roles will expand and gain acceptance at a fast pace during the remainder of this century. And we will experience the successes that result from a united effort directed toward the maintenance and re-establishment of health for all the people. In its efforts to respond to evolving needs of pharmacists and future pharmacists as they expand patientoriented pharmaceutical services, experimental and ihnovative programs will be developed, evaluated, and often adopted. This will result in a changing profile of pharmacy education. It is the intent of this article to identify potential trends in pharmacy education, particularly as they may occur during the 1980s. Pharmacy Degrees
There certainly will be an accelerated movement toward a single professional doctor of pharmacy degree
American Pharmacy Vol. NS20, No.9, September 1980/512
program. This is desirable and hardly unexpected. To date, 16 institutions have or are planning the move to the PharmD as the first professional degree. Increasingly, it will be possible to permit the separation of education from time. Students will be able to accomplish the required competencies for a degree at their own pace. Some students will be able and permitted to complete the requirements for a degree in pharmacy in much less time than the standard six years generally required for the PharmD program. Conversely, students needing more time because of finances, family problems, and other constraints will be able to obtain an extension. While it seems a small advance, this development will shake the very foundations of higher education. Traditionally, education has been tied to a time frame. Students, for the most part, were forced to fit the mold. Much more flexibility in education will be required. Perhaps more important, for the next decade or so it will permit practitioners desiring a PharmD degree to enter the educational system taking full advantage of all their competencies. Present systems penalize people whose learning was accomplished in other than academic courses. College of Health Sciences The preprofessional requirements for dentistry, medicine, pharmacy, and other allied health fields are quite similar. Thus it would be possible to admit students into health science status without immediately applying the career label that encourages students to act the perceived role of the profession selected. Such labeling creates constraints to thinking and activities of students. This move-already under way at more than a dozen universities-should help expand the thinking of young people about the career possibilities in other biological and social service professions as well as the major health professions. Such programs serve the needs of students at least through the period of the first professional year of any health degree program
and should result in a better use of educational resources. Another important trend, especially in health science centers, is an increasing emphasis on interdisciplinary education (multiprofessional education). Present efforts in complex health science centers have had limited success. However, sufficient experience has been gained to suggest that there are advantages when students from pharmacy, medicine, and nursing (and selected other health fields) take course work together. Barriers to cooperative effort are lowered, and respect for each other's expertise starts to develop. We begin to see the buds of future health teams which can flower in the delivery of health care. Human Interaction Skills Clinical roles for pharmacists will be in the forefront as we complete the last two decades of this century. Pharmacy education must give even greater emphasis to communications and the social and behavioral sciences if we are to be effective in drug use control. We will need to introduce patients earlier in pharmacy education. This will help students make use of the knowledge from the behavioral sciences to develop interviewing skills and to better understand the power of pharmacist-patient and pharmacistphysician relationships. It will also make students more aware of their own attitudes and how they affect the care of others. Understanding the patient, knowing what is going on within the patient's brain and psyche as well as his or her physiology, is as much a matter of science as is the study of drugs. Ways of dealing with feelings, attitudes, or aberrant behavior can now be predicted on reliable data and are amenable to validation and scientific study. If we can teach humanism more scientifically and put more understanding of its uses into the hands of those who deliver health care, pharmacists will be able to respond better to the problems that trouble people most about health professionals. Such humanistic skills might also permit young pharmacists to cope more ef-
American Pharmacy Vol. NS20, No.9, September 1980/513
ficiently with their personal anxieties and attitudes and allow them to deal more comfortably with health and social problems that increasingly confront them. Liberal Education Pharmacy education, like other professional programs, has concentrated too much effort on the technical aspects of the profession. Only in the most recent decades has any consideration been given to alert the student to "other" opportunitiestheater, music, art, astronomy, sports. Preparation to enjoy the extras in life is surely worth the effort. College faculties are more and more supporting of those cultural extras that are a part of a well-rounded person and professional. One of the unsolved problems of pharmacy education-perhaps the profession-is the very narrow career choice for all but a few pharmacy graduates. The trend in thecareers most often selected in the past several years has been a decrease in the number of graduates entering community practice and graduate studies and an increase in hospital (institutional) practice. In graduate studies this continued dearth of available qualified pharmacy graduates can have a substantial effect, particularly on pharmacy education in the future. A majority of faculty members without pharmacy experience is not in the profession's best interest. Career opportunities such as working as medical service representatives formerly attracted many pharmacists. Despite some reversal of the trend toward non pharmacists in these positions, the number of pharmacists entering remains small. Fortunately, the greater pharmacy family recognizes the need for more diversification of pharmacists in society. That is, there is a need for pharmacists to apply their talents toward leadership positions in other areas as well-business management, politics, government service, pharmacy industry, and a multitude of other fields. Pharmacy education and practice will formally address this problem -probably for the wrong reason. If
25
f a surplus of pharmacists exists or develops, as some already believe, pharmacy's stand could be defensive. Nevertheless, I would like to believe that many leaders will recognize that pharmacy education prepares one for a kaleidoscope of career opportunities . Approaches to broadening students' career horizons should become a significant activity in pharmacy schools. Practice Experience During the past decade, great efforts were directed toward the development of clerkships (practical experience) in the institutional environment. Clinical pharmacy can most easily be experimented with, controlled, evaluated, developed, and accepted in an environment where other health professionals practice and the patient is controlled. The next emphasis will be the development of community
'The new look to pharmacy education will bring together the educator and the practitioner to share their knowledge.'
pharmacy clerkships. However, it is in the noninstitutional environment that the greatest need exists for the pharmacist to practice drug use control. Through this development will come increased patient expectations for expanded patient-oriented pharmaceutical services. The pharmacist will be expected to have many of the skills needed in the institutional setting as well as human interaction skills. With the successful development of the community clerkship the presently required internship will become integrated into the curriculum. In fact, there will be no pressing need for an internship, and the
26
student, on completing the pharmacy education program, will be qualified for licensure. Competency assessment procedures will assure the success of this integration. The basic sciences should be increasingly interwoven with practice experience. Because many of the basic sciences germane to pharmacy assume increasing importance in students' minds only after they are faced with some clinical problems encountered in the third and fourth years, a number of schools will be reintroducing basic science courses during the latter half of pharmacy school. Many schools are experimenting with programs that bring patient exposure into the first professional year. Increased integration of basic and clinical offerings throughout the professional program is highly desirable. Specialization Despite the likelihood that specialization will increase the cost of pharmaceutical services, it will occur because of the inability of a general practitioner in pharmacy to attain the desired skills needed in fields as complex as nuclear pharmacy or geriatrics. Track systems will be developed that will allow a variety of career options, thus limiting the time needed to specialize. These options will make the pharmacist more effective and careers more rewarding. This move also will give pharmacy education an opportunity to address concerns of practice in areas such as business preparation. It is difficult to justify the inclusion of required business-oriented courses to the degree desired by those seeking pharmacy managers. However, a track that permits a combined pharmacy and business degree would fulfill the needs of students with this orientation as well as those in practice who later recognize the need for more business preparation. In the early years of this decade, specialization will be accomplished by a required postdoctoral year of education in the practice arena. Pharmacy schools simply cannot afford to continue the practice of
lengthening the curriculum. It may be that accomplishing specialization within a "six-year program" will still be a goal at the end of the decade. Education as a Continuum The process that has been developing in pharmacy has reflected a movement outside the "wall:> of ivy." With competency assessment for relicensure, pharmacy education will play a greater role in instilling in students an understanding of the need and opportunities for lifelong learning. Students traversing the system will really never leave it. At various points along the continuum they will be considered competent to practice . Lifelong learning attitudes learned early will keep them a viable part of the pharmacy education system throughout their careers. Using various educational approaches (correspondence, programmed instruction, clinical clerkships, etc.), practitioners will be able to maintain competency without great hardship . The new look to pharmacy education will bring together the pharmacy educator and the pharmacy practitioner to share their knowledge and expertise in a manner that will permit learning to take place. The primary learning environment will remain the university. But it will increasingly encompass all those places where health care is the major thrust. Competency, new teaching methods, new involvements, and real challenges will make it possible for a student to prepare and maintain that preparedness throughout life. This will make the pharmacy career more rewarding in all ways than it has ever been in the past. o ·
Suggested References W.S. Apple, APhA Weekly. 19(23), 2 (1980). E.M . Burns, " H ealth Services for Tomorrow," Dunellen,
New York, 1973. The Proprietary Association, "Self-Med ica tion: The New Era" (co nde nsa tion of papers and discussions), Washington , DC, 1980. D.E. Rogers, " America n Medicine: Challenges for the 1980's," Ballinger, 1978. J.P. Swazey, " Hea lth, Professionals and the Public: Toward a New Social Contract," Society for Health Values. Philadelphia, 1979.
American Pharmacy Vol. NS20, No. 9, September 1980/514