21st Century Issues in Pharmacy Education in the United Kingdom

American Journal of Pharmaceutical Education, 2003 by Sosabowski, Michael Hal, Ingram, Matthew J

Keywords: accreditation, United Kingdom, legislation, research assessment, fees, student expectations

In the United Kingdom (UK) the discipline of pharmacy is clearly expanding, with student intakes into schools of pharmacy more than doubling in the last 20 years.1 There are currently 16 UK schools of pharmacy, with a combined output of approximately 1600 graduate students per year. To contextualize these facts for the Journal readership, the UK population is 60 million people. The schools deliver the 4-year master of pharmacy (MPharm) program that confers upon successful candidates the right to practice as a pharmacist subject to subsequent successful completion of the preregistration year and examinations.2 MPharm graduates also enjoy the right to mutual recognition of their pharmacy qualification across the European Union (EU), subject to completion of satisfactory "transition" procedures (normally peer observation). The MPharm is the only qualification that the Royal Pharmaceutical Society of Great Britain (RPSGB) recognizes as suitable for entry into their preregistration year (the equivalent of the United States' internship) and consequent entry into the register as a pharmacist. Normal practice is for students to take the preregistration qualification after completing the MPharm program; however, 3 pharmacy schools have a gap-year program, which allows the students to spend a year in the field before completing their final year. Currently, 74% of MPharm graduates become community pharmacists, 26% become hospital pharmacists, and 12% go into industry or academia, with the latter group normally also required to hold a relevant PhD.3 (The 112% total reflects that some pharmacists have two occupations, for example part time teaching/part time hospital pharmacy.) All 16 schools of pharmacy deliver a version of the "indicative syllabus," a framework of learning outcomes that the RPSGB sets, and with which accredited schools must comply, based upon EU requirements. Until recently, the RPSGB was empowered to dictate the maximum number of students permitted to enter the MPharm programs across the UK each year, effectively controlling the supply of pharmacists. This power has now been removed, making the supply of potential pharmacists deregulated and subject to market forces.

All the current schools of pharmacy are now expanding student numbers; however, this has not been mirrored by the number of preregistration places available. This is at variance with the stated shortage of qualified pharmacists in the hospital and community sectors, and is caused in part by the high training cost of the preregistration year to companies and hospital trusts. Several other UK universities are in the process of opening schools of pharmacy. In addition to these long-term chronic demographic issues, there are several more acute issues currently under debate.

Increasing student expectations of service delivery and how we might address them. We have observed that as students are directly paying an ever-increasing contribution toward their tuition (rather than indirectly by means of deferred taxation, as was the case previously), they are becoming more conscientious consumers. They are requiring increased input into their own destiny and more platforms by which they may express their wishes and views. We have aimed to address these with projects such as student focus groups and by enhancing means of student support, such as the personal tutor system.5

Complementary and alternative therapies. Complementary and alternative therapies are becoming more ubiquitous in the community, but may not be formally taught in the MPharm curriculum.

The conflict between expanding student numbers and the maintenance of absolute standards. The mere fact that more students are being drawn from a demographic pool that is constant or shrinking leads to the inescapable conclusion that a higher proportion are going to be academically less able to deal with the challenge of the MPharm degree. Moreover, due to the shrinking number of preregistration places highlighted by Taylor and Bates,1 an increasing number of students are bound to be unable to secure a preregistration place and will end up working outside the field or not working at all. Might this be the advent of a two-tier system?

External legislation affecting current practice. The process of increasing "federalization" of Europe has introduced "federal" legislation (eg, the Human Rights Act) that is on occasions at variance with national and/or local legislation. Moreover, national legislation can often follow the "law of unintended consequences," for example, the new UK Freedom of Information Act 2000 and Data Protection Act 1998 allow students access to data concerning them.6 Such data include the examiners' comments written on examination answer papers but, incongruously, not the student's original answer (the comments about which are of course completely meaningless without the original examination answer paper). This fact notwithstanding, it appears that students apparently want the right to look at their examination answer papers per se more than they actually want to look at the papers, and once granted this right, they often do not exercise it.7 This example is an issue of two competing forces, the wish of the students to obtain formative feedback by seeing their examination answer papers in the "cold light of day," versus the apparent reluctance of educators to comply with this wish, for fear of inviting endless queues of students after examination time, and protracted discussions with them about mark allocations on their examination papers. The example also illustrates the wider issue of national and international legislation impacting upon local practice.