A lively debate is currently ongoing on which topics schools of pharmacy should be teaching undergraduate pharmacy students. One side of the argument, which comes from those working mainly in hospital pharmacies, is that, since over 90% of all pharmacy graduates end up working in community or hospital practice, they should be taught to be practitioners. The implication is that too much science is being taught. After graduation, few pharmacists use any of the physical, organic and medicinal chemistry and chemical analysis they study. Similarly, in pharmaceutics, few will use subjects such as emulsion science or surface chemistry. A lot of this should be dropped to make way for more practical skills and competencies such as patient assessment, communication skills, clinical knowledge and application or critical appraisal. This will make pharmacists better practitioners, which is what the vast majority of them will be. The protagonists of this argument also put forward a sound case for the minority of pharmacists who move into a career in pharmaceutical science, whether academia or industry. These individuals, due their academic ability, will be able to move forward in their chosen area of study in the same way as practitioners do at the moment – that is, they will study further as part of a diploma, Master’s or doctorate.
The traditional side of the debate comes primarily from the well-established schools of pharmacy, particularly those with a good research reputation. Their argument is that science underpins all that pharmacists do; thus, all pharmacists need to have this knowledge to apply their practice skills. In addition, the UK pharmacy course is a five-year course: four at university, leading to an MPharm degree, and a further year in practice of structured professional training. This training, supervised by an accredited pharmacist, has a syllabus and performance standards. To complete it successfully, students must satisfy their tutor by meeting the performance standards and pass an examination. This preregistration year, they say, is where the knowledgeable pharmacy student they have educated should be taught to become a practitioner – by practitioners, not academics. The riposte from the revisionists is to use the simile of driving a car. To drive a car effectively and safely you do not have to know how it works – you have to know how to use it to its maximum effect. Some people want to know how it works and find out, but that does not make them better drivers!
So the debate goes back and forth, with little sign of either side giving way. It strikes me that there must be a middle way. Yes, some of the unnecessary science could be removed and replaced with more pharmacology and therapeutics and sociological subjects, but let’s not remove essential science. However, who decides what is necessary and what is not? How can we be sure that this approach will produce better practitioners? Should we look to the US model of the PharmD qualification? As someone who has just taken up a post as professor of pharmacy practice, I find this whole debate fascinating. Both sides have valid and cogent arguments. Yet we do have to acknowledge that 90% of pharmacy students, at least in the UK, never pick up a burette or operate a spectrophotometer after they qualify. We have to acknowledge that over 90% of the pharmacist’s work is with patients, yet, for many, contact with patients during the degree is minimal. It would be interesting to know whether similar situations, opinions and/or debates occur elsewhere in Europe. Although, within the EU, the pharmacy qualification is deemed equivalent between nations, there are major differences in the way pharmacists are trained and, indeed, in the way they practice. We would be delighted to receive your views on this issue, from both sides of the debate, to take this whole discussion forward ([email protected]).
Chris Cairns, Consultant Editor