Where is the pendulum
Curriculum changes like many other changes in education, science, and the practice of pharmacy seem to go in cycles that can be compared to the swings of a pendulum. Sometimes the pendulum is at one extreme or another as the result of the push of forces for change. Pharmacy education and practice are dynamic in nature and both catalyze change and respond to change. The opportunity to participate in the catalysis and the responses are exciting features of being a pharmacy educator. Pharmacy education proceeded through a series of remarkable changes during the 20th Century involving changes in content and length of the educational experience. An educational program culminating in an academic degree, e.g., a BA or a BS, is an educational foundation for one's future career. A pharmacy college graduate, often less than 25 years old, could anticipate a 35 or 40 or 45 year career before retirement and needed a foundation on which to not only enter that career but to grow and develop and respond to scientific, medical, and technical advances throughout that career. Information and technology change and improve so rapidly that it is impossible to predict the nature and scope of the future, one just has to understand and respond to those changes and continue to learn through various means of continuing education built on the original educational foundation.
In the 50's and 60's, most of the schools and colleges of pharmacy were graduating students from a five-year BS in Pharmacy professional program. The pharmacy curriculum was comprised of a series of pharmaceutical sciences courses that educated the graduate while fulfilling the graduation requirements of the educational institution and the accreditation requirements. Graduates were prepared to enter practice, work in the pharmaceutical industry, or proceed to post-graduate educational opportunities, post-baccalaureate PharmD or PhD programs, with many of these graduates entering academia. Pharmaceutical sciences courses in pharmacy administration (later also known as Social and Administrative Sciences) and clinical pharmacy courses in pharmacotherapeutics began to grow in number and academic credit during the 60's and 70's. An increasing emphasis developed to prepare BS graduates not only to enter practice, but also to enter post-baccalaureate PharmD programs. A trend also developed to incorporate some of the training and experience of the internship requirements for licensure into the BS in Pharmacy program. Thus, the educational program took on an additional aspect of training "for preparation to begin practice." During this same timeframe, scientific and medical breakthroughs were developing at a rapid pace which produced expanded numbers of antibiotics and various chemotherapeutic agents for cancer, bacterial, viral, fungal, and parasitic diseases. Additional new drugs were discovered and introduced for the treatment of chronic diseases, e.g., cardiovascular diseases, asthma, diabetes, arthritis, as well as, various diseases associated with the central nervous system (CNS). The pharmaceutical sciences courses in the curriculum began changing rapidly in content in anticipation of and in response to the scientific and medical breakthroughs and new drugs, but also the perceived needs of the courses as pre-requisite preparation for the developing courses in pharmacotherapeutics. In the 80's and 90's, as more and more pharmacy curricula changed from fiveyear BS in Pharmacy to six-year entry-level PharmD curricula, the corresponding increases in courses and credits in pharmacotherapeutics and experiential training rotations encompassed most of two academic years. The corresponding substantial changes in course content among the pharmaceutical sciences (pharmaceutics, pharmacology, pharmacy administration, pharmacognosy and medicinal chemistry) courses were often made along with a reduction in the number of courses and/or the total number of credits associated with those courses. Where is the pendulum?
The curricular revolution to develop and implement Standards 2000 is now essentially complete. Only entry-level PharmD programs in new or existing schools and colleges of pharmacy are accredited by ACPE. The last class of students admitted to an ACPE accredited BS in Pharmacy program has matriculated into the professional program and is expected to graduate in 2004. Who are the faculty? Pharmacology in many pharmacy schools/colleges is taught by faculty members from "outside" of the school or college of pharmacy. Many pharmacy schools/colleges, new and established, have very few or no faculty members in the areas of pharmaceutics, pharmacognosy, and/or medicinal chemistry at present. Social and Administrative Sciences faculty members often struggle to achieve "critical mass" while teaching multiple courses. Large numbers of pharmacy practitioners have been recruited and trained to serve as preceptors on a volunteer/adjunct/affiliate basis to implement the large training/experiential component of the "new entry-level PharmD" program. Where is the pendulum?
The scientific and medical advances continue at an increasing pace. The potential for diagnosis and treatment of disease resulting from the Human Genome Project is beginning to be realized. The emerging opportunities in pharmacogenomics, proteomics, and bioinformatics are growing at a very rapid pace. Small molecule and macromolecule drugs that are being discovered and developed through advances in biotechnology are providing significant new approaches to treatment and cure of diseases and an increased expectation that a drug will be available to treat a disease or genetic condition where none has existed. Also, the Institute of Medicine Reports of 1999 and 2001 have identified medical errors and drug related problems that can often be anticipated and/or prevented resulting in the saving of thousands of patients' lives. There is now an increasing focus on evidence-based medicine and evidence-based pharmacy as the rationale for making decisions regarding patient care. Are the graduates of our schools and colleges of pharmacy prepared to understand, establish, measure, and utilize the evidence for optimal patient care? The pharmacy curriculum has now developed a considerable focus on training in preparation to practice at an entry-level using today's existing drug therapies, rather than building on an educational foundation to understand the basis of new scientific and medical advances, to develop new knowledge, and to make patient care decisions based on individualized problem-solving decision making. The focus is now on entering the job market not on the educational preparation to succeed over a 40 to 45 year career. Is this short-term thinking good for the profession and practice of pharmacy? Where is the pendulum?
Fewer graduates of PharmD programs are now entering PhD programs, residencies, and fellowships in preparation for academic careers at a time when there is an increasing demand for faculty members in order to expand enrollments and open new schools and colleges of pharmacy to meet the demand for new graduates. Thus, the number of potential faculty members in the pipeline is already too small at a time when we increasingly realize that large numbers of current faculty members in all of the academic disciplines of the pharmacy academy are within 10-15 years of retirement, if they don't leave academia for financially lucrative positions in practice or the pharmaceutical industry prior to retirement. What will be the source of the new generations of faculty? Farmers for centuries have known the importance of setting aside the "seed" for next year's crop. Where is the pendulum?
The demand for numbers of pharmacy graduates has never been higher. The variety of environments where pharmacists practice their profession and provide patient care services has never been greater. Newly installed AACP President Milap Nahata in his speech on July 9, 2001 at the AACP Annual Meeting in Toronto stated "Regardless of the nature of the task we undertake, we should never compromise quality. Quality must drive all of our initiatives and efforts in education, research, practice, and service." This is absolutely true. How are we going to deliver?