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As specialized pharmacy education has evolved through the years, the value that pharmacists contribute to healthcare has increased exponentially.
As we consider how the profession of pharmacy has changed over the last 160 years – and how much it might change in the near future – I want to note the profound changes in pharmacy education over these 16 decades.
Elements of our history seem to be coming full circle. Physicians played a key role in formalizing pharmacy education in the mid-19th century, because they were concerned with the quality of drug products. They recognized the importance of ensuring the integrity of medicines, and they took the initiative in molding a profession with the skills and knowledge needed to prepare and distribute high-quality medications. Today, physicians increasingly recognize the need to take advantage of pharmacists’ expertise when faced with the complexity of medication management - especially for patients with multiple chronic conditions.
The changes in education over just the last 60 years underscore that we have, indeed, advanced as a profession. This becomes clear in the context of the APhA Code of Ethics, which from 1929 until 1969 stated: “Pharmacists should never discuss the therapeutic effect of a physician’s prescription with a patron or disclose details of the composition which the physician has withheld.”
After decades on the front lines of patient care, pharmacists were told to stop “counterprescribing” - and state law even prohibited placement of drug names on the prescription labels.
This was a challenging time in pharmacy practice, a time when more prefabricated medications were coming to market and when the effectiveness and actions of many medicinal products were often unclear.
As pharmacists found their compounding duties shrinking, pharmacy educators began to reimagine the curriculum. And education and practice leaders began to accumulate evidence indicating that medication errors could harm patients when pharmacists’ roles were limited.
A multiyear study of the profession, released in 1949, represented a turning point in thought leadership about pharmacy education and practice. The report recommended increasing the pre-pharmacy coursework to increase both scientific rigor and general education requirements. It also encouraged an evolution of the core pharmacy curriculum in keeping with changes in other professions. By the early 1960s, the degree advanced from a four-year BS to a five-year degree.
In 1969, the APhA Code of Ethics revision markedly changed the profession’s ethical commitment to patients and society, stating, “A pharmacist should always strive to perfect and enlarge his knowledge. He should utilize and make available this knowledge as may be required in accordance with his best judgment.”
The change from “should never discuss” to “should make available” was a 180-degree shift for the pharmacist and patient care. Fortunately, pharmacy education had begun to introduce important changes that would help prepare graduates for their new role.
California schools did not make the four-year-to-five-year BS transition; instead, in the late 1950s they introduced the six-year Doctor of Pharmacy curriculum, thereby ushering in the clinical pharmacy movement.
In the 1970s, fueled by federal funds to stimulate enrollments across the health professions, schools of pharmacy hired the first clinical faculty members and began to expand the focus on therapeutics within the curriculum. Many schools began to offer post-baccalaureate PharmD degrees as well.
In the late 1990s, the issue of credentialing that had been raised in 1949 was finally resolved. A single degree standard affirmed that a doctoral level of education was necessary for 21st century pharmacy professionals. A more proactive patient management role for pharmacists was beginning.
The last revision of the APhA Code of Ethics, released in 1994, stressed the evolution in education and practice: “Considering the patient-pharmacist relationship as a covenant means that a pharmacist has moral obligations in response to the gift of trust received from society. In return for this gift, a pharmacist promises to help individuals achieve optimum benefit from their medications, to be committed to their welfare, and to maintain their trust.”
Contemporary pharmacy education is grounded in this relationship and in the role of the pharmacist as a patient advocate. As we say, “Pharmacists help people live healthier, better lives.”
Lucinda Maine is executive vice president & CEO, American Association of Colleges of Pharmacy.