Chapter 1: Introduction and background 1
2.3 Pharmacy education 16
2.3.1 International and national perspectives 16
There are numerous perspectives on the roles and responsibilities of higher education in preparing future pharmacists. The American College of Clinical Pharmacy report in 2002 suggested that academics need to place more emphasis on preparing students for life-long, self-directed learning, problem solving and critical thinking and clinical reasoning. This was based on the belief that a discrepancy between pharmacy education and the actual environment in which they would practice was likely to exist (Cisneros, Salisbury-Glennon & Anderson-Harper, 2002). Anderson et al. (2008) focused on the shift towards preparing life-long learners with greater emphasis being placed on “knowing how” rather than “knowing all”. Noble, O’Brien, Coombes, Shaw and Nissen (2011, p. 1), meanwhile, described the role of pharmacy education in terms of providing “students with the knowledge and skill they require to practice as a pharmacist”. Nemire and Meyer (2006) focused on the professional role of pharmacists, believing that they should emerge from their education able to meet the needs of the profession and those served by the profession. The World Health Organisation (WHO) presents an all-encompassing approach, stating that future pharmacists need to possess knowledge, skills and behaviours that support their roles (Azhar et al., 2009).
The International Pharmaceutical Federation (FIP), the global federation representing pharmacists and pharmaceutical scientists worldwide, views pharmacy education as an important aspect of the profession (Anderson et al., 2008; Anderson et al., 2012), and includes all of the issues raised above as being necessary for developing the professional pharmacist. The FIP is responsible for setting global pharmacy standards through scientific and professional guidelines, policy statements and declarations, in
partnership with the other international organisations such as the World Health Organisation and other United Nations (UN) agencies (FIP, n.d.).
One such collaboration between the WHO and the FIP in 2000 saw the development of the concept of the seven-star pharmacist. The seven-star pharmacist’s roles and functions of being a leader, life-long learner, caregiver, teacher, communicator, decision-maker and manager are included in the FIP’s policy statement regarding Good Pharmacy Education Practice. In South Africa, higher education graduates are also required to demonstrate critical cross-field outcomes which include life-long learning, critical thinking abilities, effective and professional communication and integration of knowledge (Suleman, 2012). These outcomes are similar to those outlined for the seven-star pharmacists. Weidenmayer et al. (2006) extended the seven-star concept to include researchers as well, which is also reflected in the South African scope of practice for pharmacists, that includes active engagement and conducting of pharmaceutical research (South African Pharmacy Council, 2010).
Yanchick (2008) also highlighted the importance of research components featuring in the curriculum, and stated that students needed to develop a scholarly approach to inform their clinical practice. This research-driven approach will provide students with the ability to identify problems and address these with best evidence-based practices, thereby ensuring the safe and effective use of medication in patient treatment.
Global competency frameworks also guide education by providing general and specific professional competencies. Originally global competency frameworks were developed in a medical context, but have since extended to other fields in global education serving in developing, training and accrediting healthcare professionals (Bruno, Bates, Brock & Anderson, 2010). The Canadian Medical Education Directions for Specialists’ (CanMEDs) framework outlines knowledge and describes a comprehensive set of generic competencies required by physicians (Frank, Snell &
Sherbino, 2015). The framework includes a combination of competency constructs from theory, best practices and practical daily practice and describes seven roles for physicians, with medical expertise at the centre, accompanied by roles of communicator, collaborator, leader, scholar, advocate and professional (Frank et al., 2015).
The FIP Global Competency Framework is driven by the belief that a foundation of competencies16 is necessary for developing professional pharmacists, improving clinical care and serving the needs of society, as well as for advancing science and research. Several defining competencies are grouped under the four major competency categories: pharmaceutical public health competencies; pharmaceutical care competencies; organisation and management competencies and professional and personal competencies. Located within these major categories are detailed competencies and abilities such as patient care falling within pharmaceutical care competencies (FIP’s Global Competency Framework, 2010).
The Pharmacy Education Task Force (PET), which was developed by major stakeholders (FIP, WHO and UNESCO) is tasked with overseeing development and training within higher education and the workforce. The FIP-PET relies on the cooperation, partnership and consultations within institutional stakeholders and within countries. The Global Pharmacy Education Action Plan 2008–2010, similarly addressed the role of all stakeholders working together in serving local needs and developing a qualified and competent workforce. The action plan covered four priority domains: vision for pharmacy education; academic and institutional capacity;
quality assurance and competence framework. In addition, the FIP Education Initiative is a new directorate tasked with strengthening all of the FIP’s educational projects and actions in partnership with the WHO and the United Nations Educational Scientific and Cultural Organisation (UNESCO).
While global frameworks work to develop competencies that are applicable and relevant to the profession, they serve as guidelines and are not intended to be prescriptive for all countries as it is acknowledged that health care systems and demands vary widely between and within countries (Anderson et al., 2009). Anderson et al. (2009) acknowledged the benefits of general frameworks from a macro perspective, but pointed out that universal systems are unrealistic and unsustainable at a micro level. They therefore advocated for a needs-based approach allowing for flexibility and adaptability within local contexts and environments, which the FIP-
16 Competencies refer ‘‘to the knowledge, skills, attitudes and behaviours that an individual develops through education, training and work experience’’ as defined by the FIP’s Global Competency Framework (2012, p. 2).
PET promotes in developing pharmacy education globally. Needs assessments are conducted within communities with the purpose of assessing the needs of its community and then developing or adapting educational systems accordingly to address these specific needs (Anderson et al., 2009; Anderson et al., 2012; Zeitoun, 2011). Along the lines of a needs-based approach, Alsharif (2012) argued against following western education as a norm for learning, saying that local needs should be the driving force. Both of these are taken into account in the design of the undergraduate pharmacy qualification in South Africa. SAQA describes the Bachelor of Pharmacy as being designed to take local needs into consideration, as well as embed the standards and guidelines of the FIP and international organisations in their learning programmes (SAQA, n.d.). Although the SAPC fairly recently voluntarily joined the International Pharmaceutical Federation (FIP), they continue to largely operate independently while keeping international standards and guidelines in mind.
2.3.2 Regulation and changes to pharmacy education
There is a need for a constant revision of curricula globally in light of the rapid changes in health care with new knowledge and technological advances (Asiri, 2011).
Over the last 20 years, emphasis has also been placed on changing pharmacy curricula taking into account problem-solving, critical thinking and self-directed learning in order for pharmacists to practice in the modern pharmaceutical environment (Williams, Brown & Etherington, 2013). Yet Blouin, Joyner and Pollack (2008) described curricular change in higher education as a typically passive endeavour, usually resulting from academics or faculties responding to a call for change. In most cases the call for change comes from regulatory boards. Most pharmacy programmes, world-wide, have governing bodies that regulate or exert some influence over how educational programmes are implemented or revised. For example in the United States, two organisational and regulatory bodies are responsible for the change of curricula over time. These are the Accreditation Council for Pharmacy Education (ACPE) and the American Association of Colleges of Pharmacy (AACP) (Nemire &
Meyer, 2006). A similar trend is evident in India, where the Pharmacy Act of 1948 led to the regulation of the minimum standard of educational qualification for pharmacy education, the practice and the profession. The Act has been implemented through two regulatory bodies operating in India: The Pharmacy Council of India (PCI) and the All India Council for Technical Education (AICTE).
In South Africa, similar roles and responsibilities of pharmacists with an emphasis on patient care are dictated by the scope of practice of the pharmacy profession, as prescribed in terms of Section 35A of the Pharmacy Act, of 1974, as amended (“the Pharmacy Act”) (SAPC, 2015). The Pharmacy Act places responsibility on the SAPC for establishing, developing and maintaining control over pharmaceutical education and training. The SAPC introduced curriculum changes to the B. Pharm qualification and higher institutions of learning responded to calls from the SAPC and the White Paper on Post Secondary Education and Training. The previous curriculum guided by unit standards was replaced with exit level outcomes (covered in greater detail in Chapter 5) to guide the B. Pharm curriculum to ensure graduates have greater scope across sectors (Suleman, 2012). Various institutions in South Africa (Boschmans, 2014; Danckwerts, 2014; Malan, 2014; Walker, 2014) have presented their accounts of implementing these curricula changes and accompanying pedagogical changes.
2.4 Pharmacy curricula
The focus on clinical patient care has impacted on educational systems, leading to the training of more clinically oriented pharmacists. Anderson and Futter (2009, p.1) attributed the move to a more clinical degree to the “magnitude of medication-related problems”, the arrival of more complex drugs on the market and an increase in aging populations with medical conditions. These have impacted on pharmacists’ roles and functions, where hospital pharmacy has also changed, moving pharmacists into wards and clinics and out of dispensaries (Anderson & Futter, 2009). This change has impacted on pharmacy education and Asiri (2011) described patient-focus as an essential component of pharmacy education in the 21st century, especially for developed countries such as the United States of America (USA) and the United Kingdom (UK). Various studies compare pharmacy education in developed countries with developing countries (Babar et al., 2013; Ghayur, 2008; Shah, Savage &
Kapadia, 2005). Babar et al., (2013) went into more detail about how trends of a more patient-focused curriculum are more prevalent in high income or developed countries (such as the UK, USA, Canada and New Zealand). Ghayur (2008) described differing roles of pharmacists in different parts of the world with developed countries such as Britain, Scotland and Canada already allowing pharmacists limited power in prescribing and altering existing prescriptions due to their training. In developed countries, academics also place emphasis on preparing students for future specialised
fields in pharmacy whereas developing countries curricula are more patient focused and based on developing generalist pharmacists rather than specialists (Anderson et al., 2012).
Babar et al.’s (2013) bibliometric review of pharmacy education in low to middle income countries reveals that the majority of country-specific publications are about Greater Asia, and the Middle East. Eastern Europe and Central, South America and Africa are less represented. The literature on developing countries and knowledge about the status of pharmacy education is also not as widely reported (Babar et al., 2013). Curricula in many pharmacy schools in India and South Asian countries, such as Pakistan, do not have a clinical focus17, with clinical experiential learning components being absent due to a lack of hospitals for training and a shortage of academic clinical expertise (Ghayur, 2008). In Africa, only Ghana is included because its relationship with a university in Scotland is viewed as an example of remaining current with trends in pharmacy education (Babar et al., 2013).
In Zimbabwe, the pharmacy curriculum has not been reviewed for the past 12 years due to a lack of funding and senior academic expertise. The Zimbabwean Regulatory Pharmacist Council has called for a review of the curriculum in order to align pharmacy training with global trends. In Zimbabwe, the introduction of an undergraduate degree in Pharmaceutical Sciences is also being planned (FIP Education Global Report, 2013).
Shah et al. (2005) cited numerous undergraduate pharmacy programmes in developing countries which had inadequate application of knowledge to patient care.
Programmes in developing countries are also depicted as being heavily reliant on traditional pharmaceutical sciences. Babar et al. (2013), also raised concern about some developing countries implementing or changing educational systems to become more clinical based on western models, with little application for the context in which they are adopted. However, this is not always the case; the B. Pharm programme in Tanzania, with the assistance of the University of California’s San Francisco School
17 Clinical focus refers to pharmacists moving away from their traditional role of only dispensing medication to a more patient-focussed role involving aspects of medical diagnosis, treatment and patient education.
of Pharmacy, revised their curricula and pedagogy in 2011, offering a more clinical and integrated curriculum (Youmans, Ngassapa & Chambuso, 2012) in addition to taking local needs into consideration. Anderson et al. (2009) also highlighted pharmacy education, partnerships and international collaborations being combined with local needs in Kenya (University of Nairobi School of Pharmacy) and the United States (Purdue University of School of Pharmacy). Anderson et al. (2009) described training pharmacists in developing countries to internalise their role of helping poor communities in less urbanised areas as being crucial. Many new and innovative education ventures have evolved to address this gap. In South Africa, for example, Rhodes University pharmacy students work with patients in their homes with translators to address patients’ medicine-related needs, in addition to providing patient education (Anderson et al., 2009).