Curriculum topics in pharmacy education: Current and ideal emphasis

American Journal of Pharmaceutical Education,  Summer 1999  by Graber, David R,  Bellack, Janis P,  Lancaster, Carol,  Musham, Catherine,  Et al

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Curriculum Topics in Pharmacy Education: Current and Ideal Emphasis1

This study assessed the current and ideal emphasis for curriculum coverage of 33 generalist curriculum topics in PharmD programs and evaluated barriers to curriculum change. These topics reflect a wide range of recommendations for curriculum change in a number of health professions. This study was part of a larger study of 11 health professions education programs. A 46-item survey using a 5-point scale format was mailed to the curriculum directors at all U.S. pharmacy schools affiliated with the American Association of Colleges of Pharmacy that offer the PharmD degree (n=71). The ordinal scores for current emphasis and ideal emphasis for each of the 33 topics were compared for differences between current and desired emphasis. The ratings of barriers to curriculum change were also analyzed. The four topics rated highest for ideal emphasis by pharmacy respondents were "Effective patient-provider relationships/communication," "Patient teaching/ education? "Outpatient/ ambulatory care,' and "Use of electronic information systems." Topics related to community health and health care for the underserved were not ranked highly for ideal emphasis. The most significant barriers to curriculum reform were "Limited availability of clinical learning sites" and "An already crowded curriculum". Responses indicate an awareness by pharmacy curriculum directors of the need for significant improvements in the coverage of broad, generalist competencies in the PharmD curriculum. The curriculum directors were most concerned about increasing the emphasis on "Accountability for cost-effectiveness and patient outcomes;' "Health promotion/disease prevention," "Population- based health care;"Managed care," and "Use of electronic information systems." A movement toward primary and outpatient care and better relationships and communication between pharmacists and patients were evident in the curriculum directors' responses.

INTRODUCTION

In the past decade the U.S. health care system has undergone major change, shifting from a professionally-driven fee-forservice model to a market-driven managed care model. Demographic changes, disease patterns, and rapid advances in science and technology have resulted in the use of more drugs and more expensive drug delivery systems. Such changes are challenging those who are responsible for educating the nation's future pharmacy practitioners. Because of the rapid proliferation of pharmaceutical agents, pharmacy has especially felt the impact of these broad system changes.

For nearly a decade, the Pew Health Profession Commission(1-3) has recommended preparing health professions students to be more adaptable and better prepared to work in different environments and within interdisciplinary teams. The Commission's 1993 and 1995 reports(2,3) challenged pharmacy schools to prepare graduates for practice in the changing delivery system by refocusing the curriculum toward such areas as protocol-driven therapies, collaboration with patients and other health team members about drug therapy decisions, counseling patients about their drug therapies, monitoring patient responses to drug therapies, educating the public about drug-related information, and providing pharmaceutical care in such non-hospital settings as ambulatory care and long-term care. Challenges such as the burgeoning elderly population who often require complicated drug regimens, changes in the organization and financing of health care, demands for cost-effectiveness, the increase in chronic illness, and continuing advances in information systems and pharmaceutics must be addressed in the pharmacy curriculum as well(3).

The Pew Health Professions Commission's 1993 report(1) recommended the following changes in the pharmacy curriculum: (i) initiate curricular reform that engenders competencies essential to pharmaceutical care (e.g., critical thinking, communication, ethical behavior, teamwork, leadership, and caring); (ii) develop systems of peer review and evaluation that include documentation and review of care delivered, analysis of the outcomes of care, and efforts to ensure the continuing quality and effective coordination of care; (iii) develop and promote a medication-use information system for application to the ambulatory care setting; and (iv) develop a sufficient number and variety of ambulatory clinical training models and sites to provide ample educational opportunity for pharmacy and other health professional students in the delivery of pharmaceutical care. The Commission's 1995 Critical Challenges report(3) suggested that schools of pharmacy "focus professional pharmaceutical training even more on issues of clinical pharmacy, system management, and working with other health care providers."

Traditionally, pharmacy education has focused on drug products, emphasizing chemistry, pharmaceutics and the control and regulation of drug product delivery systems. The dramatically changing health care delivery system and the increasingly prominent role of pharmaceutical agents in the diagnosis and treatment of disease is shifting this focus to a broader role for pharmacy practitioners. This broader role demands a set of generalist competencies to augment traditional discipline-specific competencies in order to assure that pharmacy practitioners are prepared to practice effectively in the changing environment.