Canadian University Faculties of Pharmacy: Undergraduate curriculum survey of geriatric content

American Journal of Pharmaceutical Education, Fall 2001 by Misiaszek, Brian C, Borrie, Michael J, Grymonpre, Ruby E, Brymer, Chris D, Et al

Available resources for undergraduates with an interest in geriatric issues were highly varied from school to school. Understandably, not all pharmacy schools have the benefit of having medical school faculty available for traditional teaching due to geographical constraints. However, several faculties of pharmacy in close proximity to faculties of medicine had no formal interaction between the two undergraduate schools, suggesting that there are opportunities for joint teaching ventures on geriatric topics. The curriculum content also showed variability in the emphasis placed on particular geriatric medical topics. Topics organized by medical systems show that while all topics are covered, there was a wide divergence in the number of undergraduate hours devoted to these topics. Special geriatric topics such as polypharmacy and the pharmacodynamic changes that occur with ageing were discussed at many but not all schools. Only in some schools was there the option of undergraduate pharmacy students to participate in clinical experiences in long term care settings, geriatric assessment units and geriatric rehabilitation units. Only one school had a mandatory placement rotation in a long-term care setting, with three other schools offering elective geriatric placement experiences by chance not choice.

The ability to interpret and apply the skills of critical appraisal, particularly towards geriatric practice guidelines(15,16), were discussed at many, but not all schools. Discussion of inappropriate medication prescribing practices in the elderly, however, took place at all nine schools.

Identified innovative strategies included "Standardized Patients and Families" (i.e., role-playing), geriatric therapeutics "hot-lines" operated by pharmacy students, geriatric education modules, and placements in geriatric rehabilitation or assessment units. Unique resources included faculty with a strong interest in geriatrics and geriatric pharmacy textbooks written by pharmacy faculty.

An area which was not specifically addressed in this survey was the extent to which geriatrics was taught in the context of pharmaceutical care, specifically the recent trend in pharmacy practice towards greater patient focussed care. In addition to learning new information about therapeutics in the elderly, students must develop the essential skills required in the provision of comprehensive pharmaceutical care including conducting medication histories, assessing client data to identify potential and actual problems, and developing and documenting a strategy for intervention and follow-up. Future surveys of the undergraduate pharmacy curriculum should identify innovative teaching strategies of this new philosophy of practice. It is interesting to note that U.S. licensing exams and associated preparatory materials are increasingly being used by Canadian pharmacists to enhance and test their clinical knowledge of geriatric topics. There are other ways to achieve these goals. Increasing the number of geriatric questions on medical licensing exams has been one strategy that has been successfully used to change medical residency curricula, and this same strategy could be used on Canadian pharmacy licensing exams. If students are to be tested on geriatric topics, the curricula will change to ensure that such topics are covered in all schools. There was interest from most of the responding academic pharmacists to include more geriatrics related content in the undergraduate curriculum. There is clearly interest in partnerships between academic divisions of geriatric medicine and clinical pharmacologists to help meet these goals, through the promotion of shared teaching and rotations.