Problem-based teaching in UPC: Technikon Pretoria experiences
Mr S. Hamman, Lecturer, Technikon Pretoria University, South Africa
Mr Hamman presented problem-based pharmacy teaching as an alternative to the traditional method of lecturing. A paradigm shift should be made in order to adopt the problem-based teaching approach. The changes involve moving away from trainer-centred, fixed pace, subject-based learning and towards student-centred, individual pace learning and outcome-based teaching. This will allow students to develop their own learning style.
Practice-based attachments in UPC: University of Zimbabwe experiences
Dr C.C. Maponga, Pharmacy Department, University of Zimbabwe
Dr. Maponga introduced his topic by highlighting three components of professional education:
• Attitudinal development - to foster the development of attitudes compatible with progressive and humanitarian pharmacy practice;
• Cognitive learning - to enhance the students' factual knowledge of health care in general and drug therapy in particular;
• Psycho-motor skills development - to enhance the students’ skills of good pharmacy practice through their own experiences.
The field attachment programmes focus mainly on psycho-motor skills development. Dr. Maponga explained the various types of attachment at the University of Zimbabwe, such as rural setting, hospital (ward and pharmacy), community pharmacy and the pharmaceutical industry.
Rural setting attachments
Rural setting attachments originated from the primary health care strategy adopted after independence in 1980. Then the pharmacist was expected to be a hospital pharmacist/secretary of a district hospital. The current student learning objectives are to explore the role of the pharmacist in the rural health care system, to solve some health care problems in the rural areas, to work in a multi-disciplinary health care team, and to provide multi-disciplinary, primary care-oriented pharmacy education. The attachment is a one-week period in the second and fourth years. The attachment programme covers the work of the district pharmacist, the district medical officer, the district nursing officer, the community nurse and village health workers.
Hospital (ward and pharmacy) attachments
Hospital attachments originated from the fact that the UPC of 1973/4 was mainly clinically biased. The current student learning objectives are to: manage different disease status with special emphasis on drug treatments for in- and out-patients; to handle drug information requests from patients and health care personnel; to counsel patients on their drug therapies; to undertake research projects on drug supply and rational use problems; and to develop good relationships with other health care professionals. The attachment is a six-week period of full-time clinical orientation followed by weekly attachments in the final year. The attachment programme covers the medical, paediatric and psychiatric wards, the hospital pharmacy and the drug information service.
Community pharmacy attachments
Community pharmacy attachments originated because the best way to get acquainted with over-the-counter (OTC) products is in a retail pharmacy setting. The student learning objectives are to work under the supervision of qualified pharmacists in a community pharmacy, to carry out projects on OTC products, and to solve community-based health problems with emphasis on pharmaceutical care issues. The attachment programme covers the areas of work of health clinics and general hospitals.
Pharmaceutical industry attachments
Pharmaceutical industry attachments originated from a shortage of state of the art equipment in the university laboratories and the need for a good relationship with the pharmaceutical industry. The student learning objectives are to explore the role of an industrial pharmacist, and to become familiar with pharmaceutical manufacturing processes and equipment. Students make one-day visits to pharmaceutical companies.
Dr. Maponga concluded by saying that the various field attachments focus on the development of psycho-motor skills and are important for promoting team work, problem-based learning and multi-disciplinary teaching.
The balance between the natural and clinical sciences in UPC
Dr B. Summers, School of Pharmacy, MEDUNSA, South Africa
Dr. Summers introduced her topic by reflecting on pharmacy education, with its objective of producing competent professionals capable of adapting their roles, to change practice methods, to handle the information explosion, and to become a life-long learner. Therefore, UPC in the 21st century must be able to deal with changes.
She continued that the sciences relevant to pharmacy education can be divided into natural sciences (systematized knowledge of nature, including biology, chemistry and physics), applied sciences (to work out practical problems) and clinical sciences (to observe and treat patients). Other sciences such as behavioural and communication sciences are equally important.
The ‘balance’ between natural and clinical sciences has to be addressed. Deliberations should include the quantity (length of course, time spent on subjects); juxtaposition (linear or modular courses); contents; teaching methods (lectures versus problem-based learning); and student activities (e.g. practicals, tutorials, site visits, ward rounds, reports, portfolios, diaries, projects).
Moreover, Dr Summers stressed that curriculum topics must be relevant, appropriate, applicable to the local setting, up-to-date and outcome-oriented. To find the ideal balance between the various sciences in pharmacy education can be complex and may be heavily influenced by the professional needs of a particular country. She concluded that it might not be relevant or possible to work towards a core UPC with core contents and harmonized degree standards, as professional requirements vary from country to country.
Veterinary pharmacy in UPC
Mrs R. Hove, Medicines Control Authority of Zimbabwe
An introduction to veterinary pharmacy was given by Mrs Hove of the Medicines Control Authority of Zimbabwe (MCAZ), which registers all human and veterinary medicines. Product files submitted for market authorization should be reviewed by a professional who has both pharmaceutical and clinical backgrounds. Therefore, pharmacists should have some basic understanding of animal anatomy and physiology in addition to biochemistry, Mrs Hove told participants.
In Zimbabwe, anyone involved in drug dispensing needs to be licensed. MCAZ, the licensing authority, recognizes that pharmacists are the custodians of medicines. Ideally, pharmacists should be the only dispensers of medicines but often situations dictate that other health and veterinary practitioners should be allowed to dispense. Medical practitioners located not less than 5 kilometers from the nearest pharmacy may have dispensing licences. This does not apply to veterinary practitioners yet.
Pharmacists are not always keen on stocking veterinary medicines because they may not be familiar with these treatments and products, which are generally bulky and occupy a lot of storage space.
Most retail pharmacies are located in urban areas and clients rarely require medication for their pets. The focus is more on food producing animals, as Zimbabwe is an agricultural country. Therefore, sale transactions of veterinary medicines take place more in farming and communal areas. Farmers tend to be knowledgeable about animal treatments. Due to the scarcity of pharmacies, MCAZ had to allow normally prescription-only veterinary medicines to be classified as OTC medicines, with the result that veterinary practitioners deal with very few prescription-only medicines. In addition, an increased number of drug stores are opening to make veterinary medicines more widely available in rural areas.
The issue here is whether a pharmacist or a veterinary practitioner should supervise drug dispensing. On the one hand pharmacists are licensed to dispense medicines but have limited knowledge of veterinary medicines, and on the other hand veterinary practitioners lack adequate pharmaceutical knowledge. MCAZ has approved that veterinary practitioners can supervise these drug stores.
Mrs Hove concluded that if pharmacists are to be the custodians and distributors of veterinary pharmaceuticals, the following components of veterinary medicine should be included in UPC: insect control, mastitis and dairy hygiene, infectious diseases in cats and dogs, management of veterinary wounds, management of helminthes in sheep, cattle, pigs, poultry etc., vaccines for poultry, cattle and canines, and chemicals for crop protection.
Pharmacist prescribing: implications for UPC
Dr D. Ball, Department of Pharmacy, University of Zimbabwe
Dr. Ball introduced his topic by highlighting that prescribing and dispensing functions are divided among health care professionals. This separation has been influenced by factors such as historical roots, conflicts of interest, training and specialized skills.
The cost of health care is increasing and budgets are limited or constrained in the public, and to some extent, in the private health care system. This calls for evolving roles, better management of cost reduction and maintenance. One way to achieve this is to reduce patient visits and costs to conventional prescribers (medical doctors) and to increase the use of alternative prescribers, such as pharmacists. In this respect the pharmacist should be allowed to treat minor ailments. However, the pharmacist is not yet recognized as a prescribing authority.
Dr Ball quoted from a 1994 WHO document that recognizes the need for pharmacist prescribing, “The pharmacist receives requests from members of the public for advice on a variety of symptoms and, when indicated, refers the enquiries to a medical practitioner. If the symptoms relate to a self-limiting minor ailment, the pharmacist can supply a non-prescription medicine, with advice to consult a medical practitioner if the symptoms persist after more than a few days. Alternatively, the pharmacist may give advice without supplying medicine.”4
4 WHO. The role of the pharmacist in the health care system. Geneva: World Health Organization; 1994. WHO/PHARM/94.569.
Different countries present different scenarios. For example, in the UK, the Crown Review on the prescribing, supply and administration of medicines led to a recommendation for “dependent” and “independent” (medically qualified) prescribers within recognized institutions. In the USA, pharmacists in some states have prescriptive authority by protocol (dependent prescribers), which allows them to get involved in therapeutic decision-making. In Zimbabwe and other developing countries, nurses prescribe drugs, mainly due to the lack of health professionals outside urban areas. Moreover, the law in Zimbabwe allows for certain pharmacist-initiated treatments.
Dr Ball concluded that the level of prescribing authority will depend on a country’s specific needs. Moreover, the acceptance of pharmacist prescribing will have implications for pharmacy training programmes; especially in providing the additional skills and competencies needed to become a prescriber pharmacist.
Evidence-based pharmacy practice and medical informatics
Dr K. Tisocki, Clinical Pharmacology Department, University of Zimbabwe
Dr Tisocki explained that evidence-based pharmacy practice is an integral component of evidence-based health care. It is centred on information and the skills needed to find this information. Essential clinical informatics skills are based on information retrieval and critical appraisal of available evidence, and communicating and applying new knowledge. The collection of new knowledge can be undertaken by information retrieval from all available sources.
As medical knowledge evolved continuously, self-directed learning should be the way to maintain knowledge and to keep up-to-date. The application of new knowledge requires a basic understanding of logical and statistical models of diagnostic processes, skills to interpret uncertain clinical data, the adaptation and application of new clinical decisions to individual patients, and the adaptation of local treatment guidelines.
Dr Tisocki explained further that efficient communication is based on three components. Firstly, the ability to structure and record clinical data in such a way as to communicate effectively with colleagues. Secondly, the selection and use of an appropriate communication method for a given task, e.g. face-to-face conversation, telephone, videoconference, e-mail, or printed materials. Thirdly, the selection and use of a suitable communication medium for an identified recipient.
Pharmacy practice: the ugly duckling
Professor B. Futter, Rhodes University, South Africa
Professor Futter reflected that pharmacy practice has been viewed as an “ugly duckling” and wondered whether this duckling would turn into a swan and fly one day. Traditionally, UPC was focused on three subjects, namely pharmaceutical chemistry, pharmaceutics and pharmacology. Subjects that could not be fitted into these topics, such as forensic pharmacy, ethics, communication and business, were “dumped” into pharmacy practice.
The philosophy behind pharmacy practice is pharmaceutical care. It also has to do with quality assurance based on competence, outcome-based education, academic pharmacy practice and research, and the integration of pharmacy practice and pharmacology. However, pharmacy practice remains fragmented, with no clear agreement on what it is, and therefore it needs to focus on role clarity.
UPC should produce pharmacists who are distributors, educators, diagnosers, and prescribers, and who are able to make cost-effective decisions. Pharmacy practice should focus on the identification of and responses to the drug-related needs of the community and the individual patient. Additionally, it should enable pharmacists to understand and influence the attitudes and behaviour of patients, prescribers and policy makers.
The course structure of pharmacy practice should cover subjects such as pharmaceutical chemistry, pharmaceutics, pharmacology, pharmacotherapy, social pharmacy (law, ethics, sociology, psychology, anthropology), administrative pharmacy (drug supply management, pharmaco-economics). In other words, behavioural and social sciences should underpin pharmacy practice.
Professor Futter also said that the challenge for the future would be to develop activities to improve professional competencies and to further develop UPC to ensure these competencies are acquired. The criteria for success for pharmacy practice are academic and professional credibility, integrated UPC, an increased number of pharmacy practice staff and relevance to national needs. He concluded that pharmacy practice must change from an ugly duckling and become a swan.
Pathophysiology in UPC
Dr T. A. Morton, Department of Pharmacy, University of Zimbabwe
Dr Morton introduced his presentation by emphasizing that pathophysiology is a patient-oriented subject. Training of students must focus on how to improve and enhance patient care. The aim of pathophysiology is to introduce the students to the functions of organs involved in diseases, and to teach them vocabulary and terminology. A course in pathophysiology should be problem-based, and enhance students' communication and practice skills. It is an important component of UPC as it forms a bridge between science and patient care. Pathophysiology was introduced after the revision of UPC in Zimbabwe.
Dr. Morton pointed out that in the early 1960's in the USA, the pharmacy profession lost an opportunity to assist anaesthesiologist/surgeons in their operating theatre work, with drug interactions and drug administration. At that time, treatments were “hidden” from patients because prescriptions were written in Latin, and patient counselling was uncommon.
It is still unclear in Zimbabwe and other Southern and Eastern African countries what role pharmacists should have in patient management. Most pharmacists work in retail or hospital pharmacies, but are not involved in clinical services. The current “brain drain” of nurses and medical doctors leaving the country creates opportunities for pharmacists to step into this gap. Some pharmacists in Harare have taken the challenge to become more involved in clinical work.
The current trend in the USA is that pharmacists run clinics for diabetes, hypertension, asthma and anticoagulation under doctors’ supervision. To perform such tasks pharmacists need to be properly trained. Policies and practice guidelines are needed in Southern and Eastern African countries to meet these new opportunities.
The profession should declare that pharmacists, together with doctors and nurses, are equally responsible for patient care, and the focus should be shifted from mainly drug supply activities to patient care. Dr Morton concluded that UPC changes are needed to train students to become competent specialists in this field. Pathophysiology provides the scientific foundation for the specific knowledge and skills needed by pharmacists involved in patient care.
Pharmacognosy/natural products in UPC
Professor M. G. Gundidza, Department of Pharmacy, University of Zimbabwe
Professor Gundidza indicated that the practice of traditional medicine is on the increase worldwide - a trend that is expected to continue. In many African countries, traditional medicine practitioners have no formal training and work without any type of registration or licensing. This situation means that they cannot practice officially without drawing protests against their unlawful practices from allopathic medical practitioners.
Professor Gundidza pointed out that when a pharmacy school wants to train students in pharmacognosy, it should be included in UPC and integrated with other topics taught in pharmacy. In addition, a continuous education programme should be developed on traditional medicine.
The aims of a pharmacognosy course are to:
• stimulate interest in the cultivation and use of medicinal plants;
• encourage natural unprocessed foods and organic gardening;
• promote the general health and well-being of the whole community;
• provide a recognized qualification for natural medicine practitioners;
• consolidate natural medicine knowledge and promote research;
• promote cooperation between all health professionals, including traditional healers;
• prevent incidences of toxic poisoning from plants and animal products.
The general objectives of a pharmacognosy course are to teach students to:
• identify a wide variety of medicinal plants and animal products;
• investigate medicinal plants and their effects;
• tabulate the main medicinal characteristics of medicinal plants and animal products;
• know the growing conditions required for various medicinal plants;
• manufacture various natural medicinal plant products;
• use medicinal plants for anaesthetic purposes and crafts;
• define natural medicine practitioner terminology
• draw and label botanical structures
• draw and label diagrams of the human anatomy
• use various forms of massage
• diagnose various illnesses
• use essential oils effectively
• understand the concepts of diet and disease.
Antimicrobial resistance and infection control
Ms M. Everard, WHO/Essential Drugs and Medicines Policy
Due to time constraints, copies of Ms Everard's presentation on the impact of antimicrobial resistance on mortality, morbidity and cost of health care as a result of misuse of antibiotics were handed out. The presentation also outlined WHO's strategy on the surveillance and containment of antimicrobial resistance.
Distance learning and web-assisted learning programmes - a medium for delivery of postgraduate training and continued professional development Mr W. Basson, Potchefstroom University, South Africa
Distance learning and web-based learning programmes progressed in line with other developments in pharmacy education in South Africa. Pharmacy schools in South Africa started to implement the new UPC based on unit standards in 1998.
The development of postgraduate programmes at Potchefstroom University for Christian Higher Education commenced in January 1998. This was followed by the introduction of distance learning courses in June 1998 and web-based learning courses in June 2000.
Because of the changing standards for pharmacists entering the profession, the need for continued professional development in the fields of management, pharmaceutical care, clinical pharmacology, pharmaceutical information systems, pharmaceutical production and pharmaceutical services in hospitals became apparent.
Potchefstroom University identified two non-residential delivery systems, Internet and web-based learning programmes, and distance learning programmes. These programmes have a flexible, modular structure. The programmes' target population is pharmacists in practice, pharmaceutical technologists, medical practitioners, dentists and other pharmaceutical personnel. The programmes' objectives are to improve health services provided by pharmacists and other health care professionals, in support of South Africa's national health policy. This will be done through continued professional development courses, to create opportunities in practice for pharmacists and other health care professionals nationally and internationally.
Admission requirements include degrees, such as B.Pharm or B.Sc Pharmacy, MB ChB, B.ChD or approved equivalents. Pharmacy Diploma holders can enrol for two modules and after successful completion can progress to degree level. The courses involve 1280 study hours. The minimum study period is one year full-time or two years part-time with a maximum study period of three years. The final qualification upon completion of all modules is an honours degree.
Mr Basson concluded with an example of one of the University's distance learning programmes that had attracted 24 pharmacy technologists from Evelyn Hone College in Lusaka, Zambia. These students enrolled for modules of the industrial pharmacy programme, a non-pharmacist required training course.
Pharmaceutical biotechnology in UPC
Professor D. J. Chetty, School of Pharmacy & Pharmacology, University of Durban-Westville, Durban, South Africa
Professor Chetty introduced his presentation by defining biotechnology as the application of molecular biology and recombinant DNA technology to influence specific biological processes that are largely related to human needs. Biotechnology is not new and has been used in the past to produce pharmaceuticals and vaccines derived from microorganisms.
The recent expansion of South Africa's biotechnology industry is shown by the tripling of the number of companies since 1987, with the sector now employing over 300,000 people. There are about 20 approved recombinant or synthetic protein drugs, and more products are being clinically tested at the moment.
The essential components of pharmaceutical biotechnology include therapeutic products of recombinant DNA technology, peptide and protein drug delivery, gene delivery and ethical issues. The production of therapeutic products of recombinant DNA technology makes use of various techniques such as cloning, transcription and translation.
Ethical issues present a major challenge to pharmaceutical biotechnology as general concern is raised about human genetic manipulation and genetic screening. Another current debate concerns the fact that scarce resources are allocated to biotechnology that could be better spent on prevailing health problems.
A pharmaceutical biotechnology course in UPC should cover cell biology, molecular biology, pharmaceutical microbiology, biochemistry and genetics. Teaching materials should be relevant and up-to-date as the technology is changing rapidly.
Professor Chetty concluded that biotechnology provides new scientific opportunities for the development of novel therapies for cancers, genetic defects and viral infections. UPC should make future pharmacists aware of the potential, applications and implications of biotechnology in health care.