Listening to pharmacists telling me their degrees failed to prepare them for their modern-day role, I completely understood.   As a recent pharmacy graduate, I shared some common ground. When I started my undergraduate degree eight years ago, the pharmacy course was predominantly science-based, and crammed with theory I have rarely found useful. When I started practising, I had no leadership or delegation skills, and no idea how to deal with troublesome substance misuse patients.   But my experiences were better than some. For pharmacists who completed their studying earlier, subjects such as public health, holistic care, leadership and patient interviewing were virtually non-existent.   It's now widely accepted that pharmacists need more than just scientific knowledge to meet the challenges of today's NHS. If pharmacists are to tackle sub-therapeutic medicines use, low adherence levels and unnecessary A&E admissions, an undergraduate pharmacy syllabus should help students deliver outcomes from day one of their careers. This was the thinking behind the new education standards released by the General Pharmaceutical Council (GPhC) in 2011, which aimed to integrate practical skills more closely with scientific knowledge. The learning outcomes are now being reviewed to make sure pharmacists are prepared to take on the role of professional, scientist, leader and clinician (see News p6). So have the changes finally brought the degree in line with the reality of pharmacy?  

Blinded by science

Today's students would barely recognise the pharmacy degree of 25 years ago. John Smart, professor of pharmaceutical sciences at the University of Brighton and former chair of the Pharmacy Schools Council, says the emphasis was strongly on science. "You just had to know enough stuff, basically: a bit of chemistry, a bit of physiology, the cardiovascular system," he tells C+D.

This, of course, was to cater for a vastly different era of pharmacy. "When I started practising pharmacy, medicines were passed through a hatch and there were no further instructions," Professor Smart explains. "I would make up various creams and morphine mixtures. I used to spend lots of time in my working day knocking things up." Even in this environment, though, he felt his degree had failed to prepare him for the workplace. His first locum shift was a "complete nightmare" and "frightening", as he had never seen an FP10 at university and didn't know what to do. Since then, Professor Smart has witnessed immense changes to pharmacy practice. Pharmacists are no longer in the "back laboratory"; they are encouraged to be patient-facing, he says, where they can give advice and support. In the past 25 years, there have been various endeavours to adapt the pharmacy degree to these changes. But the GPhC's 2011 standards, which encourage a greater emphasis on outcomes and integrating science with practical skills, are arguably the most fundamental. The regulator's standards specified that the curriculum should be anything but "formulaic", and should include a mix of teaching methods to support independent learning skills. They also recommended that practical experience should increase year on year.  

A practical advantage

Professor Smart believes these standards have pointed universities in the right direction. The GPhC's "laudable" efforts to integrate chemistry, clinical practice, therapeutics and formulation from day one will produce better practitioners, he says. Although he is keen to point out that pharmacists' scientific knowledge is their "unique selling point" and must not be abandoned, he agrees with the fresh emphasis on practical skills such as communication. "The degree is moving much more towards the professional and clinician role, while not losing the science part," he tells C+D. "The student at the end of four years has to have achieved a level of competency and learning outcomes." Universities appear equally enthusiastic about the benefits. The University of Nottingham's School of Pharmacy says it "significantly overhauled" its programme to adapt to the changing environment (see below right). Its syllabus is now much more clinically focused, and students have the opportunity to go on placements from year one. Stephanie Allen, associate professor in molecular biophysics, says the university has already received positive feedback about its placement students, who have appeared "much more advanced" than their years. She strongly believes the new approach is the right way to prepare aspiring pharmacists for their increasingly complex roles. "In terms of the increased amount the government is asking pharmacists to do, they have to be very flexible and they have to have really good clinical training, and be adaptable for all sorts of careers," Professor Allen explains.   At the University of Bradford's School of Pharmacy it is a similar story. Not only has its MPharm curriculum been overhauled to meet the GPhC requirements, but its way of teaching has also changed to invite more discussion (see below left). "I think we were really lucky to start with a brand new piece of paper," says lecturer in pharmacy practice Alison Hartley. "That's what we needed, to be honest, because we're not often given the opportunity to take a proper look at it quite objectively." She explains that scientific learning is now weaved into every unit of every module so that students can see the relevance to practice. The volume of content has also been reduced to allow students to learn a topic in depth rather than carrying out "surface learning". She believes the new curriculum has undoubtedly made a difference to students. "The depth of conversations our students are having about a whole range of subjects is phenomenal," she says. "Whether it is practice-based or science-based, it's way above what we've ever heard before." She's pleased to see students discussing ethical dilemmas and professional decision-making from their first year of study. "The way they explain their reasons for their choices is demonstrating more knowledge than we've seen before," Ms Hartley says. Her argument is backed up by current students at the University of Bradford. Student Sofiya Hussain says she enjoys everything from "utilising our knowledge in real-life situations to writing detailed reflections". Fellow undergraduate Alykhan Kassam believes the course encourages students to learn for their future practice rather than "learning simply for assessment".  

Limited experience

Despite these encouraging signs, pharmacy education still faces limitations. The degree remains shackled by the constraints of current funding, says Professor Smart. Unlike medicine or dentistry, the MPharm course is funded as a science degree and does not receive a clinical supplement towards clinical teaching and experience.   It has been estimated that an average of £90,000 is spent on educating and training a pharmacist, according to a report by the England government-commissioned Modernising Pharmacy Careers (MPC) board, which reviewed undergraduate and pre-reg training in April 2011. Although doctors spend longer in training, their average spend of £175,000 per person on the degree alone seems staggering by comparison. Professor Smart, who sat on the MPC board, says this "natural disadvantage" for pharmacists fuelled its recommendation for them to receive clinical funding (see What next for the pharmacy degree?, above). Like nurses, doctors, physiotherapists and podiatrists, he believes pharmacists should have the chance to work with patients from day one. Although he acknowledges the benefits of simulated wards and robotic ‘sim' patients in pharmacy schools, he says they are no substitute for "clinical face-to-face patient experience".

"The new degree prepares you in parts for the job that exists, but it doesn't give you the patient focus that you would get if you were doing any other healthcare professional programme," he argues. "Pharmacists really miss out [because] when they come into the workplace they haven't had very much patient contact, assuming they haven't worked over summer."

But Professor Smart remains optimistic about the future of pharmacy graduates. The pharmacy profession has got a real opportunity to move "onwards and upwards" if the training is right and graduates gain further confidence in their skills, he says. Of course, the first lot of graduates from the new degree programmes are yet to come into the workplace. Their calibre remains to be seen but, looking at the components of the new syllabuses – in particular skills for communicating with the public and healthcare teams, creating treatment management plans for patients and increasing patient contact – there are reasons to be optimistic they will be comfortable in the workplace from day one. Whatever the outcome, it will depend ultimately on their level of commitment to the degree (as my tutor liked to remind me and my coursemates). "The reasons why people are successes or not at university has more to do with commitment than it does to how or what one is taught," he said. "One ‘reads' for a degree, so there is a need to read around the topic to make the most of four years at university."

How students learn today – two pharmacy schools compared

 

Teaching methods Students at this pharmacy school are taught through team-based learning and work almost exclusively as part of a team of four or five from the first day of their degree course. Before lectures, students receive pre-reading packs including facts and figures on the subject, scientific information and the practicalities of working as a pharmacist in that area. Once the students arrive at the lecture, they complete a multiple choice test and case studies to apply the knowledge to practice. Syllabus In year one, students are taught about broad aspects of health such as beliefs, adherence and behaviours, which are revisited in every topic thereafter. In year four, students home in on their consultation skills and medicines optimisation. Placements Placement opportunities are given throughout the course. When it comes to the pre-reg placement, students can either split the 12 months between year three and year five, or complete the placement in one go at the end of the four years.

 

Teaching methods Lecturers teach using the Drug, Medicine and Patient (DMP) approach, which involves students completing in-depth case studies on patient scenarios and disease management. Teaching is a combination of lectures, workshops and e-learning. Syllabus In the first semester of year one, students are introduced to the role and responsibilities of the pharmacist before diving straight into a disease-focused module on dyspepsia. The dissertation project is in the third year, allowing the final year to be dedicated to the role of a pharmacist – looking at future medicines, patients with complex medical conditions, pharmacy leadership and management and advanced drug discovery. Placements Students are required to complete two day-long hospital placements and one day in a community pharmacy each year. As at Bradford (see left), students can split their pre-reg year into two six-month placements or complete it at the end of the course. Nottingham also offers students the opportunity to spend part of their course at its Malaysian campus.  

What next for the pharmacy degree?

The government-commissioned Modernising Pharmacy Careers (MPC) board made a number of recommendations for England's pharmacy degree in 2011, which could shape the future of the industry: ● A single five-year period of teaching, learning and assessment leading to graduation and registration ● A joint responsibility for universities and employers to deliver the integrated degree programme, including a joint sign-off of satisfactory completion of training ● Split pre-reg placements dispersed between year four and five, after which students proceed directly into registered practice ● At least 12 months' of clinical funding for the MPharm degree in addition to the existing funding as a science-based subject.

Source: MPC report to Medical Education England Board, April 2011