The Experience of Changing Pharmacy Education to a Six-year Curriculum (PharmD) in the United States

1. The Experience of Changing Pharmacy Education to a Six-year Curriculum (PharmD) in the United States Matthias C. Lu, Ph.D. Professor of Medicinal Chemistry Assistant Head for Curricular Affairs UIC 1995 Excellence in Teaching Award UIC 2001 Teaching Recognition Program Award Golden Apple Awards from 2000, 2001, 2003 & 2005 Classes

2. Objectives • Introduction • Discuss AACP 2004 Task Force’s report on “Best Evidence Pharmacy Education” • Discuss Current ACPE "PharmD-Standards 2000" and the Proposed New Standards for 2010 and Beyond. • Discuss Curricular Philosophy and Approaches to Curricular Development at UIC. • Brief Discussion of the Old 1-4 & 2-3 BS Programs, the Add-ON PharmD and the Non-integrated PharmD Curriculum • Conclusion.

3. Introduction • Approximately 170,000 licensed pharmacists in the US • 43,000 pharmacists work in community/ambulatory pharmacies • 18,000 employed in hospital pharmacies • 1,200 employed in manufacturing or wholesale businesses • Balance in other areas (academia, industry, governments, managed care, etc)

4. Trends in US Pharmacy Practice • Many changes in the health care system • Vast expansion of opportunities in the profession • Robotics and technology have changed the pharmacist’s role

5. Today’s Pharmacist Competes on expertise……………not on products! Product Oriented Patient Oriented

6. Today’s Pharmacist Product Oriented Patient Oriented • Patient-centered therapeutics knowledge • Manager/Coordinator of drug therapy processes • Collaborative, Team-oriented practice; system involved performance • Product knowledge - factual basis • Legal guardian/Dispenser of drug supply • Professionally isolated

7. The Pharmacy Education in the United States • The Doctor of Pharmacy (PharmD) degree is the highest level of professional education in pharmacy and has been approved by the American Council on Pharmaceutical Education (ACPE) as the sole entry-level degree for the pharmacy profession. • The PharmD curriculum is designed to produce a scientifically and technically competent pharmacist who can apply his/her education in such a manner as to provide maximum health care services to patients. • The PharmD degree program requires at least 2-years of specific pre-professional (undergraduate) coursework followed by 4-academic years (or 3-calendar years) of professional study.

8. AACP Report on Best Evidence Pharmacy Education (July 2004) The Task Force on Best Evidence Pharmacy Education at the 2004 Annual Meeting of AACP has identified eight specific areas that pertinent for pharmacy educators. • Communication Skills • Professionalism • Student Learning and Retention • Faculty Development • Integrated Courses • Distance Education • Early Clinical Experiences • Clinical Relevance The Task Force also recommends that these topics be the focus of the Teacher’s Seminar at the 2005 Annual Meeting

9. Curricular Goals & Objectives in the US Pharmacy Education is… • Emphasizing a patient-centered course of study • Developing our graduates into a reflective practitioners that are able to • Anticipate change • Evaluate and modify current practices • Providing students with a core of : • Knowledge • Skills • Abilities • Attitudes • Values

10. The Curriculum in Pharmacy The program prepares students to: • Enter into the practice of pharmacy to serve society as ethical and caring professionals • Apply knowledge of drugs and drug therapy to solve problems and make decisions on behalf of their patients • Educate, communicate, and collaborate with patients, colleagues, and other health professionals • Learn—professional practice is a lifelong learning experience • Practice pharmacy in traditional and nontraditional settings • Assume a leadership role in the future direction of the profession.

11. The Curriculum in Pharmacy The organized program of study should provide students with opportunities for selection of courses and professional experiences in keeping with their particular interest and goals. The need for lifelong learning should be reflected as an integral theme of the curriculum.

12. ACPE PharmD “Standards 2000” : The Development Process • Intiated in 1989 • Open hearing, multiple drafts • “Standards 2000” adopted June, 1997 • Implementation Procedure ratified in August, 1997 • Effective date of July, 2000 • Revision of “Standards 2000” begins in July, 2004 • Open hearing begin in July 2005 at the AACP Annual Meeting in Cincinnati, Ohio ACPE : Accreditation Council for Pharmacy Education (http://www.acpe-accredit.org/) AACP: American Association of Colleges of Pharmacy (http://www.aacp.org/)

13. ACPE “Standards 2000” for Professional Programs A total of eight areas consist of 30 criteria and 71 guidelines • Mission, Planning, and Assessment • Organization and Administration • Curriculum • Students • Faculty • Library and Learning Resources • Physical and Practice Facilities • Financial Resources

14. Professional Competencies and Outcome Expectations (from Standards 2000) Professional competencies that should be achieved through the College or School of Pharmacy’s curriculum in pharmacy are an ability to: • evaluate drug orders or prescriptions, accurately and safely compound drugs in appropriate dosage forms, and packaging dispensed dosage forms • manage systems for storage, preparation, and dispensing of medicines, and supervise technical personnel who may be involved in such processes • manage and administer of pharmacy and pharmacy practice • apply computer skills and technological advancements to practice • communicate with health care professionals and patients regarding rational drug therapy, wellness, and health promotion • designed, implement, monitor, evaluate, and modify or recommend modifications in drug therapy to insure effective, safe, and economical patient care

15. Professional Competencies and Outcome Expectations Continued • identify, assess, and solve medication related problems, and provide clinical judgment as to the continuing effectiveness of individualized therapeutic plans and intended therapeutic outcomes • evaluate patients and order medications and/or laboratory tests in accordance with establish standards practice • evaluate patient problems and triage patients to other health professionals as appropriate • administer medications • monitor and counsel patients regarding the purposes, uses, and effects of their medications and related therapy • understand relevant diet, nutrition, and non-drug therapies

16. Professional Competencies and Outcome Expectations Continued • recommend, counsel, and monitor patient use of nonprescription drugs; • providing emergency first care • retrieve, evaluate, and manage professional information in literature • use clinical data to optimize therapeutic drug regimens • collaborate with other health professionals • evaluate and document interventions and pharmaceutical care outcomes Outcome expectations for student performance in the professional competencies stated above should be set forth and measured by the College or School. The process of measuring outcome expectations should include student self assessments of performance in the stated professional competencies.

17. Areas and Content of the Curriculum in “Standards 2000” • Biomedical Sciences • Pharmaceutical Sciences • Behavioral, social, and administrative sciences • Pharmacy practice • Professional experience

18. Biomedical Sciences • Includes content in anatomy, physiology, pathophysiology, microbiology, immunology, biochemistry, molecular biology, and biostatistics Pharmaceutical Sciences • Includes content in medicinal chemistry, pharmacognosy, pharmacology, toxicology, and pharmaceutics which encompasses physical/chemical principles of dosage forms and drug delivery systems, biopharmaceutics, and pharmacokinetics

19. Behavioral, social, and administrative sciences Behavioral, social, and administrative pharmacy sciences should provide the basis for understanding and influencing human behavior in health and disease, in the management process of pharmacy, and in pharmacy's interrelationships with health care systems. • Health care economics • Pharmacoeconomics • Practice management • Communications applicable to pharmacy • The history of pharmacy • Ethical foundations to practice • Social and behavioral applications • Laws pertaining to practice

20. Core Curriculum in the Pharmacy Practice • Prescription processing • Compounding and preparation of dosage forms, including parenteral products, drug distribution and drug administration • Epidemiology, pediatrics, geriatrics, gerontology, nutrition, health promotion and disease prevention • Physical assessment • Emergency first-care • Clinical laboratory medicine and Clinical pharmacokinetics • Patient evaluation and ordering medications • Pharmacotherapeutics and disease - state management • Outcomes documentation • Self care/non-prescription drugs • Drug information and literature evaluation

21. Core Curriculum – Professional Experiences The professional experience should be of adequate intensity, breadth, and duration so as to support achievement of stated competencies as demonstrated by assessment of outcome expectations. The core professional experiences should includes: • Introductory pharmacy practice experiences should be acquired throughout the curriculum • Advanced Pharmacy Practice Experiences should provide active participation and in-depth experience to acquire skills and judgement in a variety of practice settings The duration of the Advanced Pharmacy Practice Experiences should ordinarily be the equivalent of one academic year.

22. Core Curriculum – Optional Practice Experiences • Differentiated Practices (long term care, home health care, hospice) • Specialized Practices (nuclear pharmacy, pharmacotherapy, nutrition support) • Outpatient Health Care Settings (community health clinics, satellite settings) • Medical Specialties (outpatient or inpatient) • Nontraditional Experiences (industry, wholesale, management, teaching)

23. Pre-pharmacy Curriculum Requirements • General Education - Oral and written Communication Skills; Social Sciences; Behavior Sciences; Humanities; Computer Literacy and information technology • Basic Physical and Biological Sciences and Mathematics - Mathematics including Calculus; General and Organic Chemistry; Physics; Cell Biology and Microbiology • Biomedical Sciences - Anatomy; Physiology; Biochemistry /Molecular Biology; Immunology; Biostatistics

24. Current Accreditation Issues for Professional Degree Programs • New delivery methods, distance education • Outcomes assessment • New applications, focused visits • Resources – Faculty, finance, and space • Enrollment increases; new campuses

25. Transition to new standards for 2010 • To assure that the College or School’s curriculum provides a thorough foundation in the sciences and prepares graduates with the competencies to enter and contribute to the profession of pharmacy throughout their career. • To assure that pharmaceutical sciences are integrated part of the curriculum and taught by faculty in the science departments • To assure that clerkship experiences are optimal with appropriate ratio of clinical practioners and students in each module • To assure there are appropriate mechanism for outcome assessment to measure and evaluate and improve student learning. • To assure that students receive proper education to deliver patient-centered care as members of an inter-professional team, emphasizing evidence-based pratice, quality improvement approaches and informatics.

26. Professional Competencies in “Standard 2010” • The College or School should ensure that graduates are competent to: • patient-center care • provide population-based care • manage human physical, medical, informational, and technological resources • manage medication use systems • assure the availability of effective quality health and disease prevention services and health policy

27. Outcome Expectations in “Standard 2010” • The graduate must be able to: • communicate and collaborate with prescribers, patients, care givers, policy makers, etc to engender a team approach to patient care • Retrieve, analyze, and interpret the professional, lay, and scientific literature to provide drug information to patients, their families, and other health care providers • carry out duties in accordance with legal, ethical, social, economic, and professional guidelines • maintain professional competence by identifying and analyzing emerging issues, products, and services

28. THE UIC CURRICULUM

29. Pre-pharmacy Requirements Written and Speech Communications 8 hours General Biology, with laboratory 8 hours General Chemistry, with laboratory 8 hours Organic Chemistry, with laboratory 8 hours Physics, with laboratory 8 hours Calculus (integral and differential) 3 hours Human Anatomy (all organ systems) 4 hours General Education9-13 hours including the following: Social or Behavioral Sciences 3 hours, Economics 3 hours, Humanities 3 hours, Electives 0-4 hours TOTAL 60 hours

30. First Year Curriculum Fall SemesterHours PHAR 331-Fundamentals of Drug Action I 5 PhyB 301-Human Physiology and Pathophysiology I 5 PHAR 321-Drug Delivery Systems I 3 PHAR 341- Roles, Environments, and Communications 4 TOTAL 17 Spring Semester Hours PHAR 332-Fundamentals of Drug Action II 4 PhyB 302-Human Physiology and Pathophysiology II 5 PHAR 322-Drug Delivery Systems II 3 PHAR 400-Pharmacokinetics 3 PHAR 342-Experiential I 1 Electives* 0-2 TOTAL 16-18

31. Second Year Curriculum Fall SemesterHours PHAR 333 - Fundamentals of Drug Action III 4 PHAR 323-Drug Delivery Systems III 3 PHAR 401-Principles of Drug Action and Therapeutics I 3 PHAR 402-Principles of Drug Action and Therapeutics II 4 PHAR 352-Experiential II 2 Electives* 0-1 TOTAL 16-17 Spring SemesterHours PHAR 324-Contemporary Pharmacy Practice 3 PHAR 343-Pharmacy Systems Management 2 PHAR 355-Drug Information and Statistics 4 PHAR 403-Principles of Drug Action and Therapeutics III 3 PHAR 404-Principles of Drug Action and Therapeutics IV 3 PHAR 344-Social and Behavioral Pharmacy 2 Electives* 0-1 TOTAL 17-18

32. Third Year Curriculum Fall SemesterHours PHAR 405-Principles of Drug Action and Therapeutics V 3 PHAR 406-Principles of Drug Action and Therapeutics VI 3 PHAR 345-Pharmacy Law 3 PHAR 346-Pharmacy Services and Reimbursement 2 PHAR 353-Experiential III 3 Electives* 2-5 TOTAL 15-18 Spring SemesterHours PHAR 407-Principles of Drug Action and Therapeutics VII 4 PHAR 408-Principles of Drug Action and Therapeutics VIII 3 PHAR 354-Experiential IV 2 PHAR 365-Non-Prescription Pharmaceuticals and Herbal Medicinal 3 PHAR 356-Principles of Pharmacoeconomics and Drug Treatment Outcomes 2 Electives* 2-4 TOTAL 16-18

33. Fourth Year Clerkships • 7 Clerkships(each 6 weeks, 4 credit hours) TOTAL 28 Hours • 4 - Required Clerkships: • Ambulatory Care Hospital • Community Practice Medicine • 3 - Elective Clerkships – chosen from the following list: • Administrative Geriatric • Advanced Ambulatory Care Home Health • Advanced Community Practice Kinetics • Advanced Medicine Nutrition • Advanced Specialty Pediatric • Critical Care Psychiatry • Drug Information Surgery

34. Advanced Specialty Clerkship • The students who are interested in pursuing a academic teaching and/or research careers are encouraged to take this six weeks elective clerkship rotation with select faculty mentors. • The students also to combine two elective rotations into a research rotations to gain research experience for their combined Pharm D /PhD degree programs which were approved and started in the fall of 2004.

35. History of the UIC College of Pharmacy Curricular Revision UIC College of Pharmacy is the third oldest college of pharmacy with a continuous charter in the US, and the oldest academic unit of the University of Illinois. • In 1932, it offered a four year course: one year of college education + 3 year professional program leading to a Bachelor of Science degree. • In 1960, the five year course: one year of college education + 4 year professional program was introduced. • In 1972, the specialization tracts was introduced along with taking students for a 2 + 3 options. • In 1980, an advance professional degree program (Add-on PharmD, 1+3+3) was introduced for a limited number of selected students and pharmacists. • In 1984, curriculum changed to a six years program (2 years pre-pharmacy + four years professional program. Doctor of Pharmacy (PharmD) degree introduced as the only professional degree awarded. • In 1986, the Continuation Curriculum Option nontraditional PharmD pathway introduced for practicing pharmacists.

36. Curricular Development at UIC • The Doctor of Pharmacy degree program was instituted as the entry-level degree at the UIC College of Pharmacy in 1984 (it took 10 years of planning). • A pioneering, nationally available, nontraditional curricular pathway for baccalaureate pharmacists was also introduced in 1986 (This pathway was phased out in the fall of 2002). • As a result of the 1996 American Council of Pharmaceutical Education (ACPE) evaluation’s report, a new revised Pharm.D. curriculum was instituted with the entering class in the fall 1997 and was phased in over three years. In 2001, we graduated the first class under this new curriculum. • A series of team leader-course coordinator meetings were held during the summer of 2000 and recommendations for curricular revisions were developed. • The re-sequencing of the courses were approved by the faculty in December 2000 which took effect in fall 2001. • The College’s Curriculum Committee (EPC) begins to assess our terminal competencies with the practice-based outcomes in 2004. • We are re-examine the pre-pharmacy courses and also how to improve the pathophysiology courses in the P-1 professional curriculum.

37. Continuing Curriculum Option (Nontraditional Pharm D Pathway) This program was originally designed to allow practicing pharmacists who would like to obtain their PharmD through distance education for all their didactic courses. Since 1986 more than 300 practicing pharmacists had received their PharmD degree from UIC through this nontraditional pathway. "At the College of Pharmacy faculty meeting in November 2001, it was decided that the Continuing Curriculum Option (CCO) will be phased out. The last students were accepted and admitted for the Spring 2002 semester."

38. CCO’s Curriculum ADVANCES IN PHARMACY (1 credit) • Covers new advances in pharmacy, with emphasis on their application to pharmaceutical care. BIOTECHNOLOGY FOR PHARMACISTS (2 credits) • Introduction to recombinant DNA, monoclonal antibodies, immunoassays, gene therapy, and biotechnology therapeutic agents. Emphasizes application to pharmacy. PATHOPHYSIOLOGY (3 credits) • Emphasis on etiology, pathogenesis, and pathophysiology of diseases of the human organ systems. CLINICAL PHARMACOKINETICS (2 credits) • Applications of the concepts and techniques of pharmacokinetics to the rational design of individual dosage regimens in patients with various disease states which may affect the absorption and disposition of drugs

39. CCO’s Curriculum continued • PHARMACOTHERAPEUTICS l, ll, lll (4,4,3 credits) Drug therapy of common disease states based on pathophysiology and concepts of drug action. Emphasis on rational drug product selection and use of monitoring parameters. • Fluids, electrolytes, nutrition, cardiology, nephrology, GI, endocrine, and pulmonary disease states • Neurology, psychiatry, immunology • Rheumatology, hematology, oncology, ophthalmology, dermatology, pediatrics, and geriatrics • PHYSICAL ASSESSMENT (1 credit) A study of the basic physical assessment techniques necessary to determine patient response to drug therapy.

40. CCO’s Curriculum continued • PHARMACOECONOMICS (2 credits) Basics and applications of drug treatment outcomes and pharmacoeconomic concepts in pharmaceutical care. • DRUG INFORMATION AND STATISTICS (2 credits) Overview of drug information resources and statistics used in health care research, including systematic approaches to critical evaluation of the literature and effective communication of information. REQUIRED CLERKSHIPS • AMBULATORY CARE CLERKSHIP (4 credits) Clinical pharmacy experience in patient interviewing, patient monitoring, and drug therapy. Emphasis will be placed on disease states and their treatment in ambulatory patients.

41. CCO’s Curriculum continued • MEDICINE CLERKSHIP (4 credits) Clinical pharmacy experience in patient interviewing, patient monitoring, and drug therapy. Emphasis will be placed on disease states and their treatment in general medicine patients. • CLERKSHIP ELECTIVES (3 electives/4 credits each) Choose from the following clerkships: Advanced Medicine, Advanced Specialty (association work, community, government, managed care and pharmaceutical industry), Critical Care, Drug Information, Geriatric, Nutrition, Pediatrics, Pharmacokinetics, Psychiatry, and Surgery

42. The Traditional Non-integrated PharmD Curriculum (1984-1996 on the semester system) Core Courses in Pharmacy Administration: • Role and Environments, 2 credits • Statistical Methods, 3 credits • Behavior Pharmacy, 4 credits • Pharmacy Law, 3 credits Core Courses in Pharmacodynamics: • Pathophysiology I & II, 5 credits each. • Pharmacology I & II, 5 credits each • Pharmacokinetics, 3 credits • Clinical Pharmacokinetics, 2 credits

43. The Traditional Non-integrated Pharm D Curriculum Continued .. Core Courses in Medicinal Chemistry and Pharmacognosy: • Medicinal Chemistry I (organic medicinal chemistry, 4 credits • Medicinal Chemistry II (Biochemistry), 4 credits • Bioanalytical Chemistry, 3 credits • Chemical Aspects of Drug Action I & II, (5 & 4 credits, respectively) Core Courses in Pharmacy Practice: • Drug Information, 2 credits • Pharmacotherapeutics I, II, & III, 4 credits each Required Clerkships: • Intro (4), Ambulatory Care (5), Community (5), Hospital (5) & Medicine (5), total 24 credits. Elective Clerkships:Two out of 14 choices

44. The Add-on Pharm D Curriculum (1980’s) • Admission to this program was selective based upon applicant’s academic record, motivation, emotional maturity, communication skills, and potential for leadership in professional service and education. • Student enrolled in the BS program at the UIC College of Pharmacy will be eligible to enter this program at the beginning of the fourth professional year at the College of Pharmacy. Admission were also available for qualified individuals holding a BS degree in Pharmacy from an accredited college. • Preference were given to applicants residing in Illinois or who plan to practice in State of Illinois.

45. The Add-on Pharm D Curriculum Fourth Professional Year: • Drug Therapy II, 4 credits* • Pharmacy Law, 4 credits* • Prescription Practice & Lab, 4 credits* • Pharmacy in the Health Care System, 4 credits* • Clinical Pharmacy Practice, 5 credits* • Drug Information & Literature Evaluation, 3 credits • Disease States and Drug Therapy I & II, 10 credits • Pharmacy in the Health Care system II, 3 credits • Clinical Pharmacy Clerkship I, 12 credits • Electives, 9 credits* Total 61 credits hours in a quarter system * Indicates courses required in the BS Pharmacy degree Program in Pharmacy

46. The Add-on Pharm D Curriculum Fifth Professor Year • Disease State and Drug Therapy III-V, 15 credits • Drug Toxicity, 4 credits • Clinical Pharmacokinetics, 3 credits • Current Topics in Clinical Pharmacy I & II, 8 credits • Clinical Pharmacy clerkships II –V, 24 credits (6 credit hours for each rotation) • Electives, 9 credits Total 63 credits hours in a quarter system

47. The Add-on Pharm D Curriculum Sixth Professional Year: • Seminar in Clinical Pharmacy, 3 credits • Clinical Pharmacy Clerkships VI-IX, 24 credits (6 hrs each) • Clinical Pharmacy Clerkship X, 12 credits • Electives, 9 credits Total 48 credit hours in a quarter system

48. CONCLUSION • There is NO “one size fit all” PharmD Curriculum. Each Pharmacy School is unique in its mission in Pharmacy Education and therefore each school should determine what their visions and missions before making any curricular changes. • The faculty “buy in” from each school is one of the most important component of any such revision. They are the one that determine the outcome of the new curriculum. • There are many barriers for curricular changes needed to be overcome (e.g., faculty shortage, P & T issues, research vs. teaching, etc.) • Curricular changes should BE done progressively and NOT by a quantum leap. So, take it slow!

49. UIC College of Pharmacy (built in 1954 & 1968 (the lab addition)

50. UIC College of Pharmacyin 1859 in Downtown Chicago