Pharmacy education — toward a more clinical care model

Six years. That’s how long it usually takes for any candidate to earn the Doctor of Pharmacy degree, or PharmD, now required to practice as a licensed pharmacist. In addition, PharmD graduates also must pass state licensure examinations required by state boards of pharmacy in all 50 states.



That puts pharmacists on par with nurse practitioners and physician assistants in terms of the level of advanced classroom and residency requirements needed to achieve professional status as a health provider. And particularly since 2004, when the six-year PharmD degree was fully implemented as the minimum level of education required, pharmacists have broadened their scope of practice to include a wide array of clinical skills in such areas as preventive health care, disease management, medication therapy management, immunization therapy and wellness counseling.



“The education of student pharmacists is shifting to meet the envisioned and evolving role of the pharmacy profession,” the American Pharmacists Association reported. “As practicing pharmacists have assumed greater roles in patient care, ... introductory and advanced pharmacy practice experiences are now critical elements of future pharmacists’ education and training.”



Ronald Jordan, dean of the Chapman University School of Pharmacy, describes the demanding level of preparation required to reach professional status. “The Doctor of Pharmacy degree involves approximately eight semesters of rigorous training with approximately 140 graduate school-level required course credit hours of work,” he explained. One-third of these hours are experiential in nature via prescribed types of clinical practice mentoring.



“This professional program is usually following a minimum of at least four semesters ... of required undergraduate college-level work in the sciences (chemistry, biology and psychology), math and [such humanities courses as] ethics, communications and economics,” Jordan said.



This “minimum of six years of professional education ... reflects an evolutionary change for pharmacy education that mirrors the evolution in pharmacy practice to a more patient-centered focus,” the National Association of Chain Drug Stores reported. “It is the goal of all pharmacy schools to prepare pharmacists who can assume expanded responsibilities in the care of patients and assure the provision of rational drug therapy.”



Indeed, said Eric Wright, associate professor of pharmacy practice at Wilkes University, “schools of pharmacy in the United States have been training pharmacists to be active members of a patient care team since before the institution of the entry-level Doctor of Pharmacy degree over a decade ago.”



“Our education is patient care-focused with the goal of producing competent pharmacists ready to work with the rest of the healthcare team in maximizing the benefits from the use of medications,” Wright said. “In addition to more classroom coursework, the education of pharmacists is increasingly experiential in nature, with about one-third of the curriculum being learned at practice sites like community pharmacies, hospitals, outpatient clinics and long-term care facilities.”



What’s more, said Javad Tafreshi, professor and chair of the department of pharmacy practice at Loma Linda University School of Pharmacy, “Recent trends in the pharmacy profession have seen more demands for pharmacists with additional training and experience over and above the PharmD degree.”



“The profession has changed substantially in the last decade or so,” Tafreshi said. “Years ago, the PharmD was recommended, but not required; now it is a basic requirement. Today, we are seeing more and more positions where both general and specialty residencies are required, along with the PharmD degree.”



The nation’s 133 schools of pharmacy — every state except Alaska and Delaware are home to at least one of them, according to the Accreditation Council for Pharmacy Education — have stepped up their degree requirements in direct response to the acute and growing demands by the U.S. health system for a more cost-effective, accessible and responsive level of patient-centered care.



“While we continue to prepare pharmacy students to provide medication-related expertise, we also prepare them to accept responsibility and accountability for the overall care of the patient,” said Scott Stolte, dean of the College of Pharmacy at Roseman University of Health Sciences. “Pharmacy students learn aspects of public health, disease prevention, patient history-taking and interviewing, physical assessment and many other topics that prepare them to accept a role in affecting the health-and-wellness of the patients we serve.”



Increasingly, effective patient care is driven by a team-based approach, with pharmacists working with and sharing privacy-protected patient information with physicians, hospitals and other team members on behalf of the patient. Pharmacy education reflects that approach, Stolte said.



“In classroom and practice settings, pharmacy students now work alongside students of other health professions, including medicine,” he noted.



The new health paradigm puts patients at the center of this hub-and-spoke model of integrated care. “Modern doctor of pharmacy curriculums are designed to provide knowledge, skills and behaviors that put the patient and the public at the center of healthcare delivery,” said Jeff Goad, professor and chair of the department of pharmacy practice at Chapman University School of Pharmacy. “The pharmacy school graduate today is both a self-sufficient independent provider and a valuable member of the healthcare team who expertly provides disease prevention and the pharmacotherapy of disease management.”



“Pharmacists also are lifelong learners who actively impact people’s lives in measurable consistent ways, from birth to death, and in every setting where pharmaceuticals are used,” Goad added. Recognition of pharmacists as fully qualified and highly trained members of the modern patient-care team will continue to grow as the nation’s health system continues to evolve, said Don Klepser, PhD, associate professor in the department of pharmacy practice at the University of Nebraska Medical Center College of Pharmacy. “Given their education and accessibility, pharmacists are an underutilized resource, but you can ... see that changing as those trained in modern pharmacy curricula begin to push for an expanded role in today’s patient-centered care teams,” he said. “A lot of the credit for that goes to pharmacy educators who not only train students, but also lead the research that shows how pharmacists can positively affect patient care when given the opportunity practice at the top of their license.”



Even before they’ve completed their PharmD requirements, said Michael Malloy, dean of the School of Pharmacy at MCPHS University, “our students are nationally certified while in school in the areas of immunization and medication therapeutic management.” That certification, Malloy said, “enables them to provide direct health care in conjunction with other healthcare professionals. If one combines this education and certification with the accessibility to patients via the community pharmacy system throughout the United States, we have created a professional who can meet the needs of our current and future healthcare system.”