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Schools increase focus on patients, outcomes, economics, and leadership.
As the role of today’s pharmacists expands beyond the counter and takes its place in the changing landscape of healthcare, the question arises: How well are pharmacy schools meeting their responsibility to prepare the next generation of pharmacists for the latest trends in the profession and industry?
Drug Topics sought the insights of a diverse group of individuals representing professional organizations, industry observers, experienced pharmacists, recent pharmacy school grads, and current students to get their take on the situation. The result is a snapshot of where pharmacy schools are today, along with some candid suggestions for ways they can better educate their students for the future.
Outcomes, EPAs, and Standards
How does a school of pharmacy guide its PharmD students in four short years to sufficiently help them find the areas of pharmacy that most interest them? Lucinda Maine, RPh, PhD, executive vice president and CEO of the American Association of Colleges of Pharmacy (AACP) says the challenge is one of both depth and breadth, due at least in part to the increasingly rapid pace of change in therapeutics.
“Schools of pharmacy can’t begin to believe that they can teach the students all the knowledge that they’re going to potentially access in their career,” Maine says. She adds that the complexity of many therapeutic areas-and the complexity of being a successful researcher, manager, or leader-requires students to choose the path for which they have the greatest passion and drill into it.
“Unequivocally, every school should have faculty who are equipped to teach 21st century skills like informatics and pharmacogenomics at some basic level of exposure. And yet we know that there are likely not sufficient faculty resources to effectively address this at the right level across every curriculum,” she adds.
In 2013, AACP published the latest iteration of its Center for the Advancement of Pharmacy Education (CAPE) Educational Outcomes, which are intended to provide a target toward which pharmacy curricula should be aimed. The current CAPE Outcomes focus on four specific areas: foundational knowledge, practice and care essentials, practice and care approach, and personal and professional development.
AACP recently offered additional curriculum guidance for pharmacy schools with its entrustable professional activities (EPAs) for new pharmacy graduates. Released in 2017 and patterned after a similar document for medical students entering residency, it identifies practices, procedures, and guidelines to assist faculties in developing students to their maximum potential. Validation of the 15 EPA statements was published late last year in the American Journal of Health-System Pharmacy.
The CAPE Outcomes were subsequently adopted by the Accreditation Council for Pharmacy Education (ACPE) as an integral part of its Standards 2016, which established the minimum standards that professional PharmD degree programs must meet to achieve and maintain accreditation. The standards focus on the required educational outcomes and their assessment, structural, and process-related elements necessary to implement evidence-based outcome measures that document achievement of the standards, and areas where programs can experiment and innovate within their curricula to meet the required CAPE Outcomes.
ACPE Executive Director Peter Vlasses, PharmD, says input from a consensus conference of accredited stakeholders-including pharmacy colleges and schools, professional pharmacy organizations, and student pharmacist organizations-greatly influenced the new standards. Two messages that came through loud and clear were that graduating students should be practice ready (able to directly contribute to patient care) and team ready (able to work in collaboration with other healthcare providers).
Vlasses notes that today’s pharmacy students spend 300 hours during their first three years of pharmacy school gathering practical experience in community and hospital pharmacies or in other available opportunities, such as industry.
“Basically, we heard that we need to make sure that students finish those three years and enter the fourth experiential year-the advanced pharmacy practice experience, or APPE-ready,” he explains. “They need to be actively engaged within the law and under the supervision of preceptors in the care of patients, and to apply the knowledge, skills, and abilities that they gained in the first three years in a controlled but active way so they get first-hand experience in doing the kinds of things they’ll be required to do on graduation.”
Emphasis on Entrepreneurship
The 2016 standards specifically mandate that entrepreneurship be taught in all pharmacy school curricula by 2019. It’s a move that’s applauded by George Zorich, CEO of ZEDpharma, and author of Entrepreneurs in Pharmacy and Other Leaders. He believes that existing core courses need to be adapted to make students more marketable when they graduate.
“Let’s get more entrepreneurs out there. If we do, we have a good chance of building businesses that create jobs and could benefit healthcare and society,” he says enthusiastically. “Let’s realize that big box retail will not be creating the same number of jobs in 2030 as they do today.”
Erin Albert, PharmD, JD, MBA, and senior director of education at the American Society of Consultant Pharmacists (ASCP), also advocates for curriculum expansions that emphasize leadership, entrepreneurship, and self-awareness.
“Most schools have electives in these areas, but few mandate these types of training,” she explains. “The irony is that we used to be almost all entrepreneurs, and we’ve done a 180 [degree turn] to being employees. But I’m starting to see the pendulum swing back the other way.”
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Programs like the Master of Science in Pharmacy Business Administration (MSPBA) at the University of Pittsburgh School of Pharmacy are leading the way in that reversal. It offers core business fundamentals like financial accounting, financial management, and strategic management while also focusing on healthcare and the business of pharmacy. The program allows students to work full-time while going to school full-time.
“We’re looking for anybody working in the pharmacy sector of healthcare with at least two years’ experience,” says Bridget Regan, RPh, MBA, director of pharmacy business programs at Pitt. “We’re looking for somebody who wants to take on leadership roles within the industry or their current organization, be entrepreneurial, or look at other opportunities within healthcare to take on those skills and lead the changes that are happening.”
Twenty-one students have completed Pitt’s year-long MSPBA program since 2016, including recent grad Mark Thomas. After earning his PharmD in 2013 from Lake Erie College of Osteopathic Medicine, he joined a major pharmacy healthcare provider where he now works as a clinical advisor helping employers identify patterns in their drug spending. His work experience and the Pitt program opened his eyes to the business side of pharmacy, which he says was not part of his PharmD curriculum.
“The biggest deficit that we have right now in our profession is understanding and following the healthcare dollar. We’ve really lost sight of that because it has become pretty complex,” says Thomas. “Doing due diligence to understand how the healthcare dollar works is critical.”
Changing the Curriculum
Today’s pharmacy school students are tomorrow’s industry leaders. So what can the schools do to ensure that the future is secure and bright for both pharmacy and its practitioners?
Stephen J. Allen, RPh, MS, and retired CEO of the ASHP Research and Education Foundation, maintains that while schools do a solid job of preparing students to enter practice, their ability straight out of school is limited. He acknowledges that changing curriculum is a slow and deliberate process, particularly since the components are stipulated, evaluated, and accredited by ACPE.
Allen points to other challenges facing pharmacy academia like the availability of faculty to teach new subjects and an overabundance of schools that he predicts could glut the market and result in many unemployed pharmacists inside a decade. He proposes several subject areas that need additional focus, including verbal and written communication, healthcare economics, and niche pharmacy. As an example of the latter, he points to three programs that his alma mater, the University of Maryland School of Pharmacy, is developing to expose students to the fields of THC, regulatory science, and leadership.
“Students who are getting a PharmD degree must understand healthcare economics, and they must be able to lead,” he concludes. “If they want to be in a practice that can establish patient care plans, follow up and monitor a care plan, and collaborate as part of the interprofessional team, they have to show their value.”
ASCP’s Albert notes that savvy schools are hiring career coaches and experts in nontraditional pharmacy to share a wider bandwidth of experience. “But many faculty have only done hospital or community practice in their own careers, so it is critical for schools to hire professionals who have experience outside of these two settings,” she stresses. Other options that she says would be helpful for students are conferences on career alternatives, mentoring programs, and one-on-one career development counseling by trained professionals who have worked in a variety of settings.
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Griffin Budde, president of the Class of 2020 at the University of Wisconsin School of Pharmacy, agrees that the curriculum should be as diverse as possible. Issues he’d like to see addressed include how automation and technology are going to affect pharmacy practice and the leadership role of pharmacists.
“Pharmacy schools are preparing their students well when it comes to hard science, but I believe there is room to improve in areas of entrepreneurship and critical outside-the-box thinking,” he adds. “The ability to get people to buy into you is not an easy one to train, and I don’t know if it can fit into a curriculum, but I do think that’s the kind of skill we need.”
The Last Word
ACPE’s Vlasses says declining enrollments, more competition for job openings, and cutbacks in state investment in education are major challenges facing the profession as a whole and pharmacy schools and their students specifically.
“The crux of the change of pharmacy education is moving from product orientation to patient plus product, but even more than that to chronic disease management and preventative care,” he concludes. “The approach to the patient is one where you have to be a problem solver, you have to be able to educate audiences, and you have to be an advocate for your patients’ best interests. This whole interprofessional collaboration is the future.”