Pharmaceutical care education at the University of Chile

American Journal of Pharmaceutical Education,  Summer 2002  by Ruiz, Ines,  Jiron, Marcela,  Pinilla, Elizabeth,  Paulos, Claudio,  Et al

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The study of Pharmacy at the University of Chile has been continuously adapting to the scientific developments and change in the practice of pharmacy. The University of Chile has considered, since 1997, the internship as one of the final activities in the pharmacy curriculum. In 1998, some modifications were made in the objectives and contents of this final activity. The purpose of these modifications was to include and develop the concept of pharmaceutical care. The present study shows some results obtained through these modifications. Between 1998 and 2000, 187 students completed the new internship experience. Of this total, 143 (76.5 percent), worked directly with patients, with a maximum of 80.6 percent (50 students) in the year 2000. Between 1998 and 2000, 118 students (63 percent) preferred to have these practice experiences at adult and children's hospitals. Changes in the internship motivated students to formulate and to develop pharmaceutical care plans. This new type of internship has been evaluated as a very stimulating activity.

INTRODUCTION

Chile is a South American country of about 16 million inhabitants. In 1998, there were five universities where pharmacy was taught in this country. Recently, three other universities have begun to offer a pharmacy curriculum. Each year, about 200 students receive the professional degree of pharmaceutical chemist. This degree qualifies the graduate to work in the pharmaceutical industry and in hospital and community pharmacies, clinical laboratories, universities, and regulatory agencies. To accommodate these job opportunities, the curriculum includes basic science courses and pharmacy subjects.

Chilean pharmacy curricula include five years of regular course work, followed by another year for the ending activities. All five-year programs are quite similar at the universities, but the final activity to receive the pharmacy degree varies between the universities. At the University of Chile, these activities include an apprenticeship in community pharmacy (240 hours), an internship (210 hours and another apprenticeship (six months) or a titled thesis (six months or longer). In 1985, pharmacy studies at the University of Chile finished with the public defense of a thesis work of a supervised research study that usually took one year.

The University of Chile is the oldest Chilean university, its pharmacy program having first started in 1833. From its beginning and up to the 70's, Chilean pharmacy studies were influenced by the curricular pharmacy programs offered by European universities. In 1971, the faculty at the University of Chile, with the counseling of some members of the University of California in San Francisco, introduced clinical pharmacy activities into the curriculum. The approach included lectures and seminars on clinical pharmacy (clinical pharmacy course), and experiential activities in a hospital setting (hospital internship). This curriculum finished with two short professional practice experiences (one month each) and the development and defense of a one-year thesis.

The new pharmacy curriculum at the University of Chile included clinical pharmacy as a subject in the second half of the fifth year and consisted of 90 didactic hours. This course provided the basic concepts to be applied by the students in an internship of 150 hours. This first internship first started in 1974 and in 1987 was developed in hospital settings. The internship required students to follow the patient's disease state, obtain drug histories, attend clinical rounds, discuss disease cases, and provide drug information to health professionals and students (Table I).

In 1987, the last important modification of the curriculum took place, (see Appendix). The clinical pharmacy course remained at the same level with the same amount of hours, but the internship became one of the final activities and was increased from 150 to 210 hours. Despite these changes, teachers had a feeling of frustration and both they and the students felt that the activities did not develop what was needed for community pharmacy practice. Since 60 to 80 percent of students will work in community pharmacies following graduation, this criticism was of concern.

Chilean pharmacy faculty, in collaboration with colleagues at Washington State University School of Pharmacy, and the University of California in San Diego, formulated their concept of pharmaceutical care that was introduced into the curriculum in 1998. The content and objectives of both clinical pharmacy and internship subjects was reformed to improve the skills needed community pharmacy practice of pharmaceutical care. The present study describes the changes introduced, and the activities done by the students during the period, 19982000.

REFORMS

The clinical pharmacy course changes that were oriented to pharmaceutical care, and their objectives are listed in Table II. These reforms were implemented through lectures and seminars about pharmaceutical care of patients with different clinical conditions. For example, some topics included pharmaceutical care of patients with hypertension, diabetes, asthma, and other diseases. Furthermore, during the time allotted to seminars, students went to hospitals for the first time in their studies. There, they first obtained information about patients, their health problems and drug therapies in order to identify present or possible drug or lifestyles-related problems. The students then proposed interventions or actions for preventing or solving the detected problems, and also proposed and discussed monitoring and evaluation parameters. During the last week of the clinical pharmacy course students presented a proposal of a pharmaceutical care plan.