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Published on 12 April 2011

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A new specialisation curriculum for hospital pharmacists in Finland

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Carita Linden-Lahti
MSc (Pharm)
Education Planner

Marja Airaksinen
PhD MSc (Pharm)
Professor
Division of Social Pharmacy
Faculty of Pharmacy
University of Helsinki
Finland

The basic pharmacy curriculum in Finland, as in many other countries, is designed to develop competencies required mainly in community pharmacies and the drug industry. However, growing demands for pharmaceutical services to ensure safe and rational medication use are coming from hospitals and various types of inpatient care units in the social and healthcare sectors. In Finland, these demands have been recently reinforced by the Ministry of Social Affairs and Health which has put the emphasis on patient and medication safety.1,2 Since 2006, the Ministry has required all healthcare units providing pharmacotherapy for their patients to set up in-house guidelines for safe medication practices. In addition to these general guidelines, special requirements have been set for assuring safe medication use among the elderly.3 Current norms emphasise multidisciplinary collaboration as a basis for improved practice.

At the moment, the hospital pharmacy practice in Finland is focused on compounding and logistics. Ward pharmacy and drug information services are provided to some extent and there is a growing demand for extending these services. Since 2005, pharmacists have been trained to conduct comprehensive medication reviews in collaboration with physicians.4 The country is divided into five university hospital districts providing specialised care. Within these districts, there are 21 central hospitals for secondary care. Each municipality is obliged to provide primary healthcare for outpatients and inpatients. All these units need pharmaceutical services that need to be provided by hospital pharmacies or smaller pharmaceutical service units situated in hospitals or healthcare centres.

Finland’s national hospital pharmacy training programme was run by the University of Kuopio in the 1990s. However, the programme was terminated in 2001 because of a lack of resources. In 2006, the Finnish Pharmacists’ Association and the Association of Finnish Pharmacies established a working group to make a proposal for re-organising specialisation training and enhancing coordination between the three specialisation areas defined by the legislation (hospital pharmacy, industrial pharmacy and community pharmacy practice). The new hospital pharmacy curriculum is based on that proposal and was developed during 2009–2010 with the financial support of the Ministry of Education (2009) and the University of Helsinki (2010). The aim of this article is to describe the curriculum development process and the key features of the new curriculum.

Steps in curriculum development
The goal of the curriculum development process was to integrate competency needs from working life to academic setting. Our goal was also that the pedagogic methods used in the specialisation programme, would meet the expectations of adult learners who will be working while studying. We wanted to have a strong input from international experts to learn from best practices in hospital and clinical pharmacy training. Philosophically and theoretically we wanted to base the curriculum on a systems approach to medication safety.5 The development was made in coordination with all three universities that are responsible for pharmacy education in Finland. Accordingly, the curriculum development consisted of five steps:

1. Identification of training needs and core content from the hospital pharmacy practitioners’ perspective
The most important tool for assessing training needs and core content of the training was a survey of hospital pharmacists. This was a national e-survey of Finnish hospital pharmacists with an e-mail address available via the Finnish Hospital and Health Care Pharmacy Association (n=296) and chief hospital pharmacists (n=18). The aim of the survey was to gather information about the core content and feasible teaching methods that the hospital pharmacists saw as relevant to the specialisation programme. The response rate in the survey was 24% (n=75). The key areas for the programme that came to light in the survey may differ from the needs of other countries (Figure 1).6

We also used expert panels, site visits and seminars to discuss and reflect the curriculum structure, content and pedagogic implementation.

2. Benchmarking good specialisation training practices in other universities and disciplines
The benchmarking of training practices was done nationally and internationally. In addition to learning about organising the curriculum, we were also able to create a network of experts to collaborate with in the future. This network will be essential in delivering the curriculum but also to initiate research projects in hospitals and clinical pharmacy.

3. Inventory of courses and training that could be integrated into the curriculum
All three pharmacy schools in Finland involved in the curriculum development project created courses suitable for the hospital pharmacy curriculum. This was done to integrate hospital pharmacy training with existing training and to avoid parallel course delivery to optimise the allocation of resources.

4. Constructing the preliminary curriculum proposal
The preliminary curriculum proposal was discussed in the faculty meetings, expert panels, during site visits to hospitals and in seminars with different audiences so as to verify its content.

Expert panels were also used to develop the content of individual courses. The results from the survey became a basis for the expert panels which continued to develop the curriculum and this was complemented by topics raised from recent international trends in hospital pharmacy development and patient safety.6

We were able to visit personally 13 central hospital pharmacies and four smaller pharmaceutical service units. During our visits, we introduced our specialisation programme proposal for the hospital pharmacists and received comments about it. Taking these comments into account, we made some minor changes and additions to the curriculum.

5. Piloting the training programme (starting in September 2010)

The structure of the curriculum
Our specialisation programme (Figure 2) will consist of both contact and distance learning, and residency periods according to the expectations of Finnish hospital pharmacists.6 In other countries residency programmes are concentrated more on specialisation in the hospital environment and some programmes are mainly based on distance or e-learning. The 10 students on the pilot course will begin their studies in September 2010.

Discussion and conclusions
The development process, which we have seen as useful, is one possible way of developing a new academic specialisation programme. This example of a developing model has been appreciated by hospital pharmacists because they have submitted their input into the development process and their needs have been taken into account in the early phase. We hope this has increased the relevance to working experience in the programme and we will fulfil the expectations and needs of the hospital pharmacists. There has to be an academic standard as a framework for the specialisation programme, but the programme has also to meet the real need for specialisation.

In our case the small number of hospital pharmacy participants (universities and hospital pharmacists) has been an advantage which may not be the case in all countries. On the other hand, we had to create the network and form of cooperation with hospital pharmacies during this developing programme. This cooperation with universities and hospitals may have a stronger tradition and basis in other countries that facilitate the development process.

Our specialisation programme is at the piloting phase and our next step is to continue curriculum development with the pilot group. There is also a need to plan an evaluation of the programme, especially as it is important to prove the programme’s outcomes to ensure further financial support. There already exist some papers about education evaluation in the public domain,7 but more studies and case descriptions are needed in this field.

References
1. Ministry of Social Affairs and Health: Safe pharmacotherapy. Publication 2009:10. Available online at: www.stm.fi/en/publications/publication/_julkaisu/1416919.
2. Ministry of Social Affairs and Health: Promoting patient safety together. Finnish Patient Safety Strategy 2009 – 2013. Publication 2009:5. Available online at: www.stm.fi/en/publications/publication/_julkaisu/1383571.
3. Ministry of Social Affairs and Health: Safe medication in the elderly: obligations for municipalities [in Finnish]. Available online at: www.stm.fi/tiedotteet/kuntainfot/kuntainfo/view/1236539 .
4. Leikola S, et al. DOSIS 2009;25:181–85.
5. Council of Europe: Recommendation Rec(2006)7 of the Committee of Ministers to member states on management of patient safety and prevention of adverse events in health care. Available online at: wcd.coe.int/ViewDoc.jsp?id=1005439&BackColorInternet=9999CC&BackColorIntranet=FFBB55&BackColorLogged=FFAC75.
6. Lehto T, et al. DOSIS 2010;26:20–27.
7. McConnell KJ, et al. Am J Pharm Educ 2009;73:87 (see http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2739070/pdf/ajpe87.pdf).

Acknowledgements
The research report of developing a postgraduate training programme for hospital pharmacists was originally published in the Finnish pharmaceutical journal DOSIS 2010;26:20-27.

We would like to thank the University of Eastern Finland and Åbo Akademi’s successful cooperation, and the Finnish Hospital and Health Care Pharmacy Association for their support in the e-survey. We are also grateful to our international colleagues for their support and advice.



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