(1994; 60 pages)
5.4 Undergraduate education related to the pharmacist’s role in the rational use of drugs
Traditionally, pharmaceutical courses have been divided into four subject areas - namely pharmaceutics, pharmaceutical chemistry, pharmacognosy and pharmacology - and schools of pharmacy have been organized accordingly. However, the academic foundation for pharmacy practice demands an integrated approach to the teaching of those four traditional subjects. This can be encouraged by designing the course to include the three elements of pharmaceutical sciences described below. This would mean the integration of substantial parts of the teaching in each of the three subject areas with corresponding parts in the others. By doing so, schools of pharmacy would enable students to appreciate more readily the relevance of the pharmaceutical sciences to the practice of pharmacy.
Chemical and physical properties of drugs
The structure and properties of chemical substances of natural and synthetic origin used in medicine, their relevant stereochemistry and biological activities; relevant physico-chemical aspects, including chemical kinetics and thermodynamics; quality control by physical, chemical and biological techniques.
Pharmaceutical aspects of medicines
Physical and physico-chemical properties of substances used in medicine and their application in the formulation and production of medicinal products; the influence of formulation on the biological availability of substances; the evaluation of products and pharmaceutical processes with particular reference to uniformity, quality and stability of products; the principles of sterilization and of aseptic procedures; immunological products; microbiological aspects of the contamination and preservation of pharmaceutical products; radio-pharmaceuticals; surgical dressings; the dispensing and storage of medicines.
The action and uses of drugs and medicines
Human and mammalian physiology and biochemistry as a basis for the understanding of the pharmacology of drugs, including experimental pharmacology and biological methods of measurement of activity; chemical, physical, biochemical and biological aspects of the action of drugs in man and animals; plant biology in relation to natural sources of drugs and medicines and in relation to pesticides; microbiology in relation to immunology, disease and chemotherapy, the presentation, uses and adverse reactions of drugs and medicines, including some Opportunities to observe and study the clinical effects of drugs on diseases; an understanding of the principles of disease processes; medical terminology; sources of information on drugs and medicines.
The emphasis placed on the topics included in these three elements of the degree course will vary with educational needs, objectives, resources, and developments in health care, but the three elements should receive approximately the same emphasis. However, the growing importance of the pharmacist’s role in promoting the rational use of drugs by patients, and in advising other health professionals, must be reflected in the teaching of pathology and therapeutics related to both community and hospital pharmacy.
A fourth element in the pharmacy course should deal with national legislation related to pharmacy, and introduce the subject of international control mechanisms. A specialized part of the course should be devoted to professional ethics, which should at the same time permeate the entire course. While the entire course should be seen to be relevant to practice, there should be two units or modules devoted to the rational use of drugs and the prevention of misuse and abuse, and to the application of pharmaceutical sciences to aspects of practice.
Additionally, pharmacy students should be made aware of their countries’ general health policies and strategies, particularly for the control of their principal public health problems, such as malaria, leprosy, tuberculosis and AIDS, and for the care of mothers and children, including family planning.
Besides the principles of the pharmaceutical sciences - the main purpose of a pharmacy degree course - some subjects associated with pharmaceutical practice can be introduced; these are, mainly, behavioural sciences, and communication and educational techniques, with particular reference to health education of the public. Pharmacists practice within the social environment of their country and in relation to the behaviour and attitudes of health professionals and those of the public. Another important element of the undergraduate course must therefore be designed to assist students acquire the awareness and understanding of professional and other kinds of social behaviour that influence the practice of pharmacy, by means of a grounding in the principles, methods and applications of the social and behavioural sciences. In Denmark, for example, this is called “social pharmacy” and is an obligatory part of the curriculum.
These aspects of education have become particularly relevant as the emphasis on manipulative techniques has been superseded by the pharmacist’s advisory function. Their introduction at this stage will provide the basis for further training and experience during the preregistration period and the early years of professional practice. Principles of management could be introduced also in the undergraduate curriculum, as a basis for later training in drug management.
In relation to all aspects of the pharmacy programme there should be a module dealing with the general principles of the rational use of drugs. This should be introduced early in the undergraduate programme and should be designed to introduce students to the basic competencies - the clusters of knowledge, attitudes and skills - for performing the pharmacist’s several roles related to the rational use of drugs, including advising physicians and patients, monitoring of prescribing, reporting of adverse drug reactions, advising on drug interactions in relation to individual patients and within national schemes, and the training of other health professionals. These basic competencies should be gradually expanded and strengthened throughout the remainder of the course. In Great Britain, the relating of academic knowledge to practice situations normally occurs in the final undergraduate year and the pre-registration year.
Independent reviews of pharmacy in recent years, including the Nuffield Foundation inquiry into pharmacy in the United Kingdom (2) have highlighted the advisory role of the pharmacist vis-à-vis health professionals and patients. Many schools have introduced courses on interpersonal and communication skills. All schools need to introduce modules dealing with the principles of communication, written and oral, and providing for learning and evaluation methods by which students may acquire and develop these skills.
An understanding of national pharmaceutical legislation and of its underlying philosophy will continue to be an important objective of pharmacy programmes. In the context of international control, all students should learn the concept of, and appreciate the reasons for, international control mechanisms.
More important, however, undergraduate education must at all times inculcate high standards of professional conduct. This will ensure that pharmacists can supplement the minimum legal requirements by standards of conduct which ensure that the greatest possible help and protection is given to the public in relation to the supply and use of drugs.
A satisfactory standard of pharmaceutical education, which is a prerequisite for a satisfactory pharmaceutical service to satisfy legitimate public needs, depends upon a sufficiency of suitably qualified academic staff, and an adequate provision of equipment, textbooks and other learning materials. Government strategies should provide for, and give priority to, these resources, as they are the foundation of the pharmacist’s contribution to the cost-effective use of quality medicines.
The pharmacy board, or the registration authority, may also be involved in establishing acceptable minimum standards for the structure, facilities, and equipment of schools of pharmacy, including laboratory and other educational facilities and equipment.