The life of pharmacists is simply the story of people with a purpose “to produce new and better remedies in man’s fight against diseases and malnutrition”. Thus pharmacist is the key element of any country’s pharmaceutical spectrum and pharmacy education is the base foundation on which the edifice of the whole pharmaceutical industry, technology, research and clinical pharmacy are built. The primary purpose of pharmacy education is to develop technical human resources, novel approach and vision with respect to teaching, research and development and training future health care professionals in the field of drugs and pharmaceuticals.
If we look back at the history of pharmacy profession or practice in India, we will have to go back to the year 1811 when Scotch M Bathgate opened a chemist shop in Kolkatta. This was probably the beginning of pharmacy practice in India. In 1824, the east India Company felt the need to train Indians for medical practice and establish medical colleges for their own interest. Though, at that time pharmacy practice was established in England, no initiative was taken to train Indians for effective pharmacy practice. Subsequently, in the Bengal Municipal Act, 1884, a provision was made for having some qualifications to dispense medicine. As per the provision, a one-year course was introduced for training persons for dispensing medicine. In 1899, the compounder-training course was introduced in Chennai. In 1928, the State Medical Faculty of Bengal started a two-year course for training compounders.
In 1932, at Banaras Hindu University (BHU), Prof. Mahadeva Lal Schroff with his chemical technology back ground, urged Pt. M. M. Malviyaji to start a separate branch of Pharmaceutical Sciences at BHU. Pt. Malviyaji realized its importance and Schroff was given the green signal to organize this new discipline in India, for the first time Prof. Schroff introduced Pharmaceutical Chemistry as the principal subject in the BSc Course in 1932 in BHU. From 1934 an integrated 2-year BSc course with the subjects-pharma chemistry, pharmacy and pharmacognosy, was introduced, which later from 1937 turned into a full-fledged three-year B. Pharm course at BHU for the first time in India.
This was the first and foremost creation of Prof M. L. Schroff, which earned him the title of the pioneer and father of Indian pharmaceutical education. In 1937, the first full-fledged degree course was started in Andhra University. On March 4, 1948, a statutory control was imposed on pharmacy education with the enactment of Pharmacy Act, 1948. For registration as a pharmacist under the act, the PCI recommended a two-year diploma course in pharmacy after matriculation with science as the mandatory qualification.
BITS, Pilani, was the first institution where D. Pharm was started in 1950. This two-year course seemed to be the best option under the circumstances existing at that time, as there was a dearth of pharmaceutically qualified persons in the country. On March 9, 1949, the Pharmacy Council of India of Technical Education (PCI) was constituted to fulfil the objectives of Pharmacy Act. On December 23, 1987, the All India of Technical Education (AICTE) Act 1987 was enacted and pharmacy education was also included under its purview.
India, has a strong academic base in terms of student’s enrolment for the pharmacy profession. There has been an exponential growth in the number of teaching institutions over the past 10-12 years. At present there are about 350-375 diploma (2 years post HSC) institutions producing over 20,000 pharmacists annually. Around 250-260 institutions are producing almost 8000-10,000 pharmacy graduates (4 years post HSC) while 800 postgraduates (2 years post B. Pharm) students are coming from 40 PG institutions annually.
Apart from that, there are about 120-150 doctoral degrees (3 to 5 years post M. Pharm) given to the pharmacists every year. For several decades pharmaceutical education has had a strong and relatively clear set of values underpinning its professional education programs. Derived from both education and practice, these values have in substantial measure driven the educational process in such diverse areas as admissions criteria and decisions, curricular structure, faculty research focus, and the structure and content of licensure examinations.
They have significantly influenced the nature of the work that pharmacists perform and in many ways, have molded the image and responsibilities of pharmacists in their minds and the minds of the public. These values have generally served us well and the values primarily were:
- Emphasis on learning and retaining factual knowledge about drug products, including their chemistry, pharmacological actions, generic and trade names, and related information.
- Curricula driven by the “evidence-based hard sciences” of chemistry; biochemistry, microbiology, pharmacokinetics, etc.
- Inculcation of an ethic in graduates that they are “the legal guardian” of the medication supply, often placing them at odds with other practitioners and patients who view medications as tools in the provision of care, not objects to be guarded and
- Emphasis on independence and competition in the educational process, professional practice, and business operations. As a result of our sincere endeavor, the traditional value system was sound enough to meet the indigenous needs.
Due to technological innovation, communication and revolutions everywhere lot of changes are taking place. The field of Pharmacy is not an exception to such changes. In the absence of a national statistics of professional opportunities and new avenues, the curriculum continues to be highly industry oriented. At the same time the patents, intellectual property rights; WTO and GATT regime have started dictating the global developments in pharmaceutical sciences and trade. Thus, its time to evolve in a timely manner to reflect the global needs of health care and drug therapy.
With globalization and economic liberalization and with the emergence of the so-called knowledge based economy and ‘learning society’, the term ‘life-long learning’ is now rivaling ‘thinking’ and ‘quality’ as educational buzzwords. To meet the global requirements every efforts are to be made to improve the standard of learning, level of understanding. This is now having direct impact on the education system making it one of the important aspects requiring a much needed revamping.
Harmonization of pharmaceutical education has to be made a global agenda to harness the developments that have taken place in basic, medical and pharmaceutical sciences and technology in pursuit of serving the societal needs and expectation. Our society is increasingly becoming technology literate and technology driven. The health policy makers all over the world have recognized ever-increasing role of pharmacist in the health care delivery and cost effective management of therapy.
It has become necessary to horizontally integrate the development in science, technology and social needs and expectations into the fabric of pharmaceutical education in the preparation of a future pharmacist. The pharmaceutical leaders and educators in the developed countries realized the changing need of the society in a highly technology literate and technology driven environment and affected with new diseases, particularly age related, newer modes of drug discovery and types of remedies and increasing cost of therapy and carved out a central role for the pharmacist in the health care team.
A mission “Pharmaceutical Care” was declared, strategic plan for education and training was worked out and accomplished over the years in USA. But then neither the society nor the Government of India has ever realized the real role that the pharmacist is supposed to play in the health care, even if realized its only in books and papers. No proactive step towards implementing the same. The words community pharmacy, pharmacy practice and hospital pharmacy have become a matter of discussion. In India academic pharmacy today finds itself in a dynamic and difficult environment.
Forces and changes both within and external to the academic milieu are challenging institutes in their efforts to ensure the development and delivery of quality professional degree programs while simultaneously evolving to meet the ever changing needs of the health care environment and patient care. The biggest question today is whether the quality of pharmacy education is “keeping up” during pharmacy degree program expansion or not. It would be better to see our current state of pharmaceutical education, despite all the simultaneous forces at play, as a “cup half full” rather than one “half empty.
” It is unfortunate for the profession of pharmacy that two statutory bodies PCI and AICTE are controlling one professional course without clear demarcation of their activities. In the absence of such clarification, the two statutory bodies are working without co-ordination. As a result of which pharmacy education has been badly affected and a number of legal battles were fought by college authorities, students and the two statutory bodies. It may be noted that while the PCI is under the Health and Family Welfare ministry, the AICTE is under the Human Resources Development ministry.
Due to absence of demarcated jurisdiction of AICTE and PCI, pharmacy education has greatly suffered. For the growth and control of a professional course, it is always desirable to have a single statutory professional body. In this case, the obvious choice is in favor of the PCI. But the PCI which is a 50 plus year-old body, failed to provide the nationwide infrastructure, as provided by AICTE, an 18-year-old body. Further, the PCI has no role in providing the financial assistance for development of institutions and encouraging research activities.
These are the reasons for hue and cry among pharmacy people to segregate pharmacy from AICTE. To brief, the situation is cart before the bull rather than bull before the cart. There is lack of clear vision as that been at the birth of pharmacy profession. To date India has not produced another Schroff who could be the guiding star to this profession. Just as India experiences change in weather, similarly there is change in Government. Some or the other nucleus pops out and by the time it develops into crystal there is a CHANGE!!!.
Pharmacy education in India in fact has to fight the cancer within and outside (i. e. internationalization) Looking into the present scenario in India, the Indian universities with diverse geographic and infrastructure variation to shift the under graduate curriculum from industry to patient care is a herculean task. Some glaring drawbacks observed in the existing undergraduate pharmacy curriculum in India. The curriculum does not embrace published statement, formulation within an ethical context, of its mission, goals and objectives in the areas of education, research, service and pharmacy practice.
Thus, the first step towards the process of harmonization is the preparation of statement, congruent with the mission of the University. The statement to include a fundamental commitment to the preparation of its students for practice of pharmacy with provision of the professional competencies necessary to the delivery of pharmaceutical care and educational preparedness of its students for a health professional career. Goals to be compatible with the general and specific objectives of pharmaceutical education in keeping with the
scope of pharmacy practice. The undergraduate curriculum utilizes professional tools, which are less practiced in pharmaceutical industry, application of computer skills and technological advancement to a superficial level, lack of multidisciplinary approach in curricula. The curriculum does not prescribe any training of pharmacist in the hospitals or with the members of other health care team. Thus, the insight of the present curriculum does not fulfill the professional competencies necessary to the delivery of pharmaceutical care.
Pharmaceutical departments and colleges have been historically situated either in the University campus, polytechnic, science colleges and a few in medical colleges. In essence they are away from health science premises or environment. Further, at the University level pharmaceutical courses are traditionally under either the faculty of science, engineering and technology, medical sciences or a few under the independent faculties of Pharmaceutical Sciences.
Although the curriculum is updated from time to time and newer courses like biotechnology, computer application in pharmacy, clinical pharmacy and clinical pharmacology and toxicology have been incorporated in the undergraduate course the professional integration (horizontal) has not taken place for the simple fact that places of learning (Colleges/ Universities) are away from work place (hospital). Unless there is an integrated learning with other health professionals the status of the pharmacist in the health care team will not be recognized.
A revised model for education in pharmacy is needed to meet the challenges presented by the changing health care system. In particular, pharmacy institutes must become true “activists” in health care policy, services delivery, and research in order to effectively achieve their missions in professional education. Employing the analogy of the pharmaceutical industry, the following fundamental areas of emphasis for institutes are suggested:
- The need for enhanced research and development activities related to the provision of, compensation for, and outcomes of pharmaceutical care.
- Sustained curricular reform efforts that assure successful “manufacturing” of competent and caring pharmaceutical care providers.
- Working in collaboration with the profession of pharmacy to promote the delivery of pharmaceutical care and foster enhanced practice/education partnerships and
- Continuous interaction with the pharmacist, after they leave the institute and step into the professional field, to assure that graduates can and will continue to provide effective clinical, humanistic, and economic outcomes in the course of their professional careers.
There are certain fundamental actions that must be taken immediately within the academy to assure the future success of our professional programs and graduates within the evolving health care system. Some of them are:
- Completion of the evolution of the “values system” of pharmaceutical education toward producing graduates who are patient-centered providers of pharmaceutical care.
- Active involvement by administrators and faculty of institutes in health care system, decision-making, policy determinations, and research activities and
- Creation by institutes of action-oriented business plans that result in effective partnershipswith practice organizations and health care delivery systems.
The emerging health care system is characterized as being:
- Managed with better integration of services and financing.
- Accountable to those who purchase and use health services.
- Aware of and responsive to the needs of enrolled populations.
- Capable to use fewer resources more effectively.
- Innovative and diverse in how it provides for health.
- Concerned with education, prevention, and care management and less focused on treatment.
- Oriented towards improving the health of the entire population and
- Reliant on outcomes data and evidence.
These challenges faced by the health professions ultimately infiltrate into education system as it produces health professionals for the future and a need to address the challenge to the profession and academics by:
- Redesigning the ways in which health professional work is organized in hospitals, clinics, private offices, community practices, and public health activities.
- Re-regulating the ways in which health professionals are permitted to practice, allowing more flexibility and experimentation, but ensuring that the public’s health is genuinely protected.
- Right-sizing the health professional work force and the institutions that produce health professionals. For the most part this will mean reducing the size of the professions and programs and
- Restructuring education to make use of the resources that are allocated to it. Thus, need of the hour is that pharmaceutical education faces these specific challenges by moving beyond analysis and rhetoric, towards action plans that position the academy, individual institute, and their graduates to be successful in a continually changing health care system. It is a time for doing!
To implement change in pharmaceutical education successfully it is must to integrate mission, goals, objectives, and revised curricular outcomes, needed curricular and educational process changes in pharmaceutical education. The possible remedy to the big question is to design present curriculum based on clearly defined mission, goals and objective to be achieved. Goals should be compatible with the general and specific objectives of pharmaceutical education in keeping with scope of pharmacy practice and as reflected in the accreditation standards and guidelines.
The institute should have strategic planning that is ongoing, broadly based, including students and practitioners, and considers financial and academic planning within the context of societal and professional changes occurring and contemplated to facilitate and continuously improve achievements of the institutes mission, goals and objectives. The institutes should establish and maintain a system that assesses the extent to which its mission, goals, and objectives are being achieved.
Information regarding the effectiveness of the professional program in pharmacy, particularly in the form of student achievement, should be gathered systematically from sources such as students, alumni, pharmacy board and other publics, professional staff of affiliated practice facilities, and a variety of other practitioners. Formative and summative indicators of achievement should be identified and employed in a continuous and systematic process evaluating the outcomes of the educational, research, service and pharmacy practice programs.
The institutes should have adequate financial, physical, faculty, and administrative resources so as to enable them to meet required professional program responsibilities, to ensure program stability, and to insure continuous program quality improvement. There should be a provision to support the development of suitable relationships with other academic and service units for instruction, research, and patient care and to expand affiliations with various pharmacy practice settings external of the university.
The institutes should be organized in a manner, which facilitates the accomplishment of their overall mission, promotes the goals and objectives of the professional program in pharmacy, supports pharmacy disciplines, and effectively deploys resources. The organizational and administrative structure should clearly identify lines of authority and responsibility. There should be an evidence of a spirit of collegiality as well as evidence of mutual understanding and agreement among the faculty and administrative body on its mission, goals and objectives as well as evidence of acceptance of the responsibilities necessary to their achievement.
The goals and objectives of the curriculum in pharmacy should embrace the scope of contemporary practice responsibilities as well as emerging roles that ensure the rational use of drugs in the individualized care of patients as well as in patient populations. The organized program should provide students with core of knowledge, skills, abilities, attitudes, and values that are necessary to the provision of pharmaceutical care and should provide opportunity for selection by students of courses and professional experiences in keeping with particular interests and goals.
The need for life-long should be reflected as an integral theme of the curriculum. The professional competencies that should be achieved through the curriculum in pharmacy are ability to:
- Accurately and safely compound drugs in appropriate dosage forms, and package and dispense 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 a 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.
- Design, implement, monitor, evaluate, and modify or recommend modifications in drug therapy to insure effective, safe, and economical patient care.
- Identify, assess, and solve medication-related problems, and provide a 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 established standards of practice.
- Evaluate problems of patients and triage patients to other health professionals as appropriate.
- Monitor and counsel patients regarding the purposes, uses, and effects of their medications and related therapy.
- Understand relevant diet, nutrition, and non-drug therapies.
- Recommend, counsel, and monitor patient use of nonprescription drugs.
- Provide emergency first care.
- Retrieve, evaluate, and manage professional information and literature.
- Use clinical data to optimize therapeutic drug regimens.
- Collaborate with other health professionals; and evaluate and document interventions and pharmaceutical care outcomes.
- Market the drugs.
- Develop standards for indigenous drugs and
- Rationalize drugs related to alternate systems of medicine (e. g. Ayurvedic, homeopathy)
The areas and content of the Pharmacy curriculum should provide the student with a core of knowledge, skills, abilities, attitudes, and values, which, in composite, relate to the professional competencies and outcome expectations. The areas and content of the curriculum in pharmacy should be in phase with one another and should be balanced in accord with the institutions mission, goals, and objectives.
The areas and content of the curricular core should embrace biomedical sciences, including content in anatomy, physiology, pathophysiology, microbiology, immunology, biochemistry, molecular biology, biostatistics and bioinformatics; pharmaceutical sciences, including content in medicinal chemistry, pharmacognosy, pharmacology, toxicology, and pharmaceutics which encompasses physical/chemical principles of dosage forms and drug delivery systems, biopharmaceutics, and pharmacokinetics; behavioral, social, and administrative pharmacy sciences, including content in health care economics, pharmacoeconomics, practice management, communications applicable to pharmacy, the history of pharmacy, ethical foundations to practice, and social and behavioral applications and laws pertaining to practice; pharmacy
practice, including content in 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, clinical pharmacokinetics, patient evaluation and ordering medications, pharmacotherapeutics, disease-state management, outcomes documentation, self care/non-prescription drugs, and drug information and literature evaluation; and professional experience, including introductory and advanced practice experiences acquired throughout the curriculum as a continuum, progressing from the introductory pharmacy practice experiences through the advanced pharmacy practice experiences in a variety of practice settings. India has a large endemic flora, which has not been systematically evaluated for potential therapeutic use.
The pharmaceutical curriculum should address phytomedicine, clinical validations through human trials and patenting of herbal remedies. The curriculum should imbibe in the essential drug policies. Essential drugs are those that satisfy health care needs of the majority of the population, available at all times in adequate amounts, and in the appropriate dosage forms, at a price that individual and the community can afford. This would lead to careful selection of a limited range of essential medicines resulting in a higher quality of care, better management of medicines (including improved quality of prescribed medicines), and more cost-effective use of health resources.
Evaluation measures focusing on the efficacy of the curricular structure, content, process and outcomes should be systematically and sequentially applied throughout the curriculum in pharmacy by a curriculum committee or other appropriate body with well-defined authorities and responsibilities. Evidence should exist that evaluation outcome, including student achievement data, are applied to modify or revise the professional program in pharmacy.
The committee should assess the extent to which innovative teaching methods are effectively deployed, and outcome measures are systematically applied for purposes of improvement. The education process should promote life-long learning through emphasis on active, self-directed learning and the fostering of ethical responsibility for maintaining and enhancing professional competence.
Evidence of harmonious relationships between faculty and students should be demonstrated. Faculty should mentor students in their academic pursuits, nurture a positive attitude about the provision of pharmaceutical care, provide guidance on various career pathways and encourage student involvement in affairs of the profession.
The institute should provide an environment and culture that supports the professionalization of students, is conducive to good student morale, and inculcates attitudes, ethics, and behaviors congruent with professional standards. Faculty/student interactions should facilitate through informal activities. Faculty attendance at student functions, both professional and social, is urged as an effective means of fostering harmonious relationships and serving as role models.
The institutes should have sufficient faculty and staff resources to meet their mission, goals, and objectives in the areas of education, research, service, and pharmacy practice. Established criteria and a defined process should exist for the measurement of performance of each faculty member and for promotion and, where applicable, tenure consideration.
Faculty should be evaluated for quality and effectiveness utilizing academically accepted indicators appropriate to the established responsibilities of individual faculty members. In this respect the 360 degree appraisal becomes very relevant.
The 360-degree performance appraisal process is an instrument to provide right feedback to the teaching faculty from students, superior, peer as well as through self-assessment, to make suitable course corrections to provide an excellent teaching learning experience. This will also enable the faculty members to sketch their own jo-hari window to analyze the known self, blind self, unknown self, hidden self and other’s perception about individuals. This will lead to self-introspection.
Digital library networking and other educational resources should be available and accessible to the institutes that are sufficient to support the professional program in pharmacy and to provide for research and scholarly activities in accord with the mission. Financial resources should be adequate so that continuing operation of the professional program in pharmacy is assured at an acceptable level.
A budget should be available that provides for programmatic needs, including faculty resources, materials and supplies, faculty development, and evaluation for purposes of assessment of achievement and to insure program effectiveness. Financial resources are necessary to provide for appropriate and well-maintained physical facilities.
A program should be established to acquire extramural funds through endowment income, grants, contacts, and other fund raising mechanisms. The performance evaluation of technical institute by analytical hierarchy method would make the institutions more responsive, which is a step towards total quality management.
The method can be easily extendable to comparison of any number of institutions and serve as a benchmark regarding comparison of institutions, faculty and infrastructure facilities as fixed by monitoring agencies like UGC and AICTE. This would be a big driver for improvement. Quality and quantity need not be mutually exclusive. What is essentially required is a quality culture, as well as pride in one’s institution, department and academic activities.
The international certification of quality, accreditation by NBA/NAAC have definitely created an awareness of quality in education, and the situation demands proactive step to these challenges to achieve world class excellence of pharmacists horizon. If the ingredients are properly mixed with the flavor of self-discipline, ideology, innovation, commitment and self-respect it can turn out to be a feather in the cap of the pharmacy institute. Globalization causes the disappearance of the sense of belongingness to one’s own country, and the person is getting detached from his belongings.
However, he attains universal belongingness. On the other side of the coin, there has been a possibility that the brilliant young pharmacists are united, for the noble cause of national growth. The development of pharmacy profession would be on the verge of ever-on going process.
With the coming in of information technology, impact of Internet in our day-to-day life, the consumer (patient) has become knowledge oriented. Knowledge has no geographical border or any barrier of system, as it is easily available. Therefore, any educational system particularly pharmaceutical education and training, in this context has to be made dynamic so that our future pharmacist responds to the needs of the profession and the changing expectations of the society. In an environment of globalization and information technology the profession has to have global vision and global approach in its attitude and practice. The journey must begin in earnest.
The revamp of curriculum, if implemented using two-tier education system would cater the need of Indian situation and simultaneously meet the global requirement and to export quality pharmacist to the global market. A big and dedicated responsibility will thus lie upon the governing body (PCI or AICTE) for harmonization of the two parallel courses. Step by step implementation will not only yield fruitful results but also lead to a strong foundation in health professional career.
At present the link is weak and needs to be identified and welded so that it becomes the strongest. Everyone is well aware of the fact that a litre capacity matka can hold a litre of water. It can’t hold more – it will overflow and the precious water will go down the drain.
Thus overall view is to participate proactively in globalization but focusing the vision of Indian environment. It is high time the profession should respond positively to the changing needs of the hour. Thus in order to match the global standards, the product offered by the Indian pharmacy profession should be of highest quality. Making team learning and team working with other members of health care are the immediate needs to be defined for the ideal role and social relevance of the pharmacist in the health care system in India.
The curriculum formulated within an ethical context, of its mission, goals, and objectives in the areas of education, research, service,and pharmacy practice. The past is gone forever. The present exists as flickering moment. Future is today. What we plan today in terms of our strategic approach for reviving pharmacy curriculum shall certainly have a long lasting impact on pharmacy profession of tomorrow. Alvin Toffler, famous author of the book “ Future Shock” says, “To help avert future shock, we must create super education system and to do this, we must search for our objective methods in the future rather than the past ……education must shift into future tense….. ”.