Towards clinically-oriented pharmacy education

Pharmacy education in India cannot remain isolated and should reinvent and change according to the global needs, says Anantha Naik Nagappa

Pharmacy has a broad diversified professional domain. Its manifestation in activities pertaining to drugs and its usage has given a special status to profession. The manufacturing related activities of drugs engineering oriented and its usage part is clinical and community oriented. These are the major diversifications of profession worldwide. The advents of new research and development in technology have a profound effect on professional practices.

In fact it is very much true that global recent trends are tilting towards clinical and community practice where the industrial practice opportunities getting almost stagnant. The manpower requirement in manufacturing related activities are on decline due advent of robotics and mechanisation of manufacturing processes.

On the other hand irrational use of drugs, illiteracy regarding safe use of medication, vigorous marketing practices and complexities of drug action has escalated the requirements of timely education of the patient and information for doctors .The WHO has formed a forum called alliance for health care, which emphasizes on team work of physician, pharmacist and nurse for a comprehensive health care. Despite of these international trends, in the developing countries, the health care issues are slow in adopting the changes.

The pharmacy education, which is the genesis of profession, has remained dormant over decades and gradually becoming unfocussed. There is an at most urgency to update with the global trends, as India being member of world trade organization, and pharmacists with clinical and community background will have tremendous job opportunities worldwide.

Although the modern profession of pharmacy has a history of five centuries, Indian pharmacy is just five decades. The British colonial rule, the chopra committee, enactment of Drugs and Cosmetics Act, Pharmacy Act are in fact milestones in advent of Indian pharmacy. India soon after its independence wanted to establish a strong industrial base in view to achieve self-sufficiency in its drug requirements it encouraged industrial pharmacy by establishing public sector, private sector and as well multinational.

So it encouraged in an education system orienting towards industrial pharmacy. This has led to the uneven growth of profession, wherein a world-class industrial pharmacy practices with a mismatched, substandard clinical and community pharmacy practices. India is exporting formulations to developed countries like USA, Canada etc, and many of the Indian facilities for manufacture of formulations are accredited by US FDA and Europe commissions.

Background

The pharmacy education in our country comprises two-year diploma, four-year bachelor, 18 months to 24 months masters and research programme leading to doctoral degree. The diploma mainly focuses on community pharmacy and B Pharm focuses on industrial pharmacy where as M Pharm leading to specialization likes pharmacology, pharmacognosy, medicinal chemistry and pharmaceutics. The overall objectives of the above programs are to prepare a professional for services of practice. The above programs are neither focused nor modernized. Let us discuss one by one.

The D Pharm course, which is the minimum qualification for practice of pharmacy, is not preparing a competitive community pharmacists. The current curriculum needs to be revised briefly to appreciate how the course is failing to meet its primary objective. The D Pharm consists of courses concentrating on all aspects of pharmacy. It is almost a condensed B Pharm course of two years.

The training, which is an integral component of professional practice, is very short and is not conducted in its true spirit. The outcome is the pharmacist with a qualification but with out much competence. The pharmacists of this country are lacking in knowledge of drug effects, adverse reactions, and irrational ue of drug. This leads to a compromise regarding the safety aspects on use of medication.

The pharmacist comes out with little motivation and competence for service of the public at large.. He ultimately modifies him self into a commercial retail pharmacist. There are very few opportunities existing for a community pharmacist to learn and update his knowledge, which he requires for giving a competent professional service. The public image of retail pharmacist is of a businessman rather than of patient welfare provider.

The concern for the patient regarding the safety use of medicines is grossly missing among the retail pharmacists. Otherwise, why the pharmacists of this country are indulging in selling of medicines to public with out prescriptions? We see the so-called professional associations of community pharmacists are interested in issues concerning control of trade and lobbying the government not upgrade the qualifications of practice from diploma to degree.

The content of curriculum of degree programme in pharmacy can be best described as all theory and no practice. The tragedy of the present curriculum is, it has too many subjects, which are unlikely to be useful in practice of profession. It is unfortunate that the students of our country are still studying oriental dispensing pharmacy and making formulations of tinctures and ointments containing mercury and sulphur, which are irrelevant to the current therapeutics. The every time the syllabus being revised with additions and with out deletion of obsolete topics.

As result of this a pharmacy student will study lot of subjects new and old. The curriculum is rich in topics focusing on industrial opportunities and less on clinical areas. On the contrary, in developed countries like USA the industrial oriented pharmacy is offered no more, but instead they have innovated curricula which is more pro clinical and community pharmacy. This was necessary due to rapid changes happenings in the society. The industrial opportunities on one hand were declining but service oriented opportunities for pharmacy are increasing. Even in our country clinical-related opportunities are on the rise of astronomical scale.

The drug discovery companies, clinical research companies, and contract research companies offer huge growth potential in terms of employment. The India and China are considered as hot beds for clinical research due to the scientific resources and economical considerations.

The current curriculum aims at making young pharmacist with jack-of-all-trades and master of none. The curriculum contains range of range of subjects like tutorial pharmacy, dispensing pharmacy to latest subjects like clinical pharmacy, pharmacy practice biotechnology etc. The policy makers of education should look at the changing scenario regarding the skills and application of the knowledge they are imparting and also that is going to be useful.

The critical look at the postgraduate curriculum and professional opportunities reveals a clear case of mismatch. The specialisation in pharmaceutical chemistry, pharmaceutics, pharmacology and pharmacognosy were conventional programme and the pharmaceutical analysis, pharmacy practice and pharmaceutical biotechnology or the recent additions. The industry, which is under constant change, requires manpower with multiple skills. The carrier opportunities for specialization based qualification is getting thinner in industry like quality control, production, R&D manager, formulation specialist.

The event based opportunity like drug discovery, regulatory fields, contract research bio analytical research, clinical studies has made to rethink the relevance of specialization of postgraduate education. Is it not wise to focus on relevant skills instead of mere theoretical exposure? The communication, project management and computation skills, which are highly relevant and are in high demand in the industry, are seldom addressed in the present education system. The need for multi skilled professional is become in more critical and hence there need forre orientation of the current education system.

Changing global scenario

The opportunities in conventional practices of manufacturing and formulations are having a paradigm shift due to advent of technologies like robotics and information technology. The drug discovery has also had revolutionary changes due to pressures from society and competition. For example the drug discovery, which was a strong domain of pharmacology and medicinal chemistry for several decades to, has become a multidisciplinary domain.

Conventionally, molecules were synthesised by medicinal chemists and were screened by pharmacologists for a therapeutically relevance. Quite recently technologies like chemical genomic and clinical research has focused on multidisciplinary approach to drug discovery. Quite recently, the drug discovery companies are utilizing the various complementary technologies to invent new drugs.

The opportunities in clinical research, bioequivalence studies are likely to scale up of a mammoth proportion. The demand for ethnic medicine, like Ayurveda and herbal medicine are also increasing quantum of exports. The India being a signatory to WTO, with its huge number o trained professionals are likely to get employment worldwide among WTO countries.

In the developed countries especially in USA the basic pharmacy education has changed form industrial practice to clinical and community practice. The doctor of pharmacy or Pharm D is the latest programme, which orients the pharmacist to take up clinical and community pharmacy jobs. The very important component of this programme is a hospital internship, which makes the pharmacist to learn special skills, required in intelligent drug use and enrich the health care practice.

Changes required

Although wishful thinking is that the pharmacist start playing the roll of therapy manager however, practically it may take several decades to reach to such a status. The world health organization has emphasized the comprehensive health care team is to be made up of a doctor, pharmacist and nurse doctor is to diagnose pharmacist is to check the prescription and nurse is to provide nursing care. In the USA and other developed countries, a pharmacist with strong clinical and communication skills is contributing as therapy manager.

Many of the therapeutic situations are complicated and are to be decided quickly there is also chance of error if doctor alone has to manage whole therapeutics situations which may lead to drug accidents and irrational use of drugs. Hence the presence of the pharmacist in a health care team is going to minimize the errors and irrational use of drugs. The clinical and community pharmacist at diploma/under graduate level with training in hospital dealing with patients and doctors is in immediate requirement. The following pattern of syllabus although suggesting but not complete in a sense.

The following strategy may be adopted Table 1

The D Pharma integrate to three or five years diploma/degree programme

1st year2nd year3rd and 4th year5th year 1. Human Anatomy & Physiology 2. Biochemistry 3. Pharmaceutics 4. Communication and Computer Skills 5. Bio Statistics 1. Pharmacology 2. Microbiology 3. Pathophysilogy 4. Drug Store management 5. Natural Drugs 1. Pharmacy Practice 2. Biopharmceutics 3. Biotechnology 4. Patient counseling electives 5. Drug Discovery 6. Clinical Trials 7. Internship 1. Internship 2. Hospital Management 3. Project Management Table 2 The B. Pharma integrate to 5 years degree programme 1st year2nd year3rd year4th & 5th year Biochemistry Microbilogy Human Anatomy & Physiology Pharmaceutics Communication SkillsPharmacology Pathophysilogy Pharmaceutical Analysis Microbiology Pharmaceutical ChemsitryClinical Pharmacy Modern Pharmaceutical Analysis Pharmacoepidemicology IPR and Clinical Studies Biomedical Analysis Project management Thesis Hospital Internship Table 3Masters in Pharmacy integrate to 3/4 semesters PG (without specialization ) 1. Advanced Pharmacology 2. Dug Designed 3. Pharmaceutical Technology 4. Quality Assurance 5. Clinical Pharmacy 1. Clinical Pharmacy and Therapeutics 2. Communication Skills 3. Formulation 4. Intelactual Proprietary Rights 5. Regulatory Affairs

1. Clinical Research 2. Pharmacoepdimelogy 3. Pharmacy Practice 4. Internship Internship and project management

Conclusions

Pharmacy Education needs to focus on current process like community and clinical pharmacy.

The opportunities on industrial pharmacy are having a downward trend where as there is a upward trend in service oriented opportunities like community pharmacy and clinical pharmacy.

The boom in clinical and bioanalytical studies are likely to offer huge opportunities for contract research organisation.

Drug discovery companies are emerging as cost effective and with IPR regime are likely to herald a change in paradigm shift of drug discovery from huge companies to cost effective focused companies.

The pharmacy education cannot remain isolated and mute to the above dynamics should reinvent and change according to the global needs.

The writer is with Pharmacy Group, Birla Institute of Technology and Science, Pilani, 333031 E-mail: anantha@bits-pilani.ac.in