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Preparation For Practice

Recent Developments in the BSc(Pharm) Program

To call it a revolution might be overstating it, but the 1980s have certainly brought about a significant change in pharmacy education at the University of Alberta.

While the four-year program leading to the bachelor of science degree in pharmacy continues to be built around a thorough investigation of the scientific basis of the profession, considerably more attention is now being given to the ways in which that scientific knowledge is applied to Datient care.

Not only are professional practice courses now integrated into the very first year of the basic program, pharmacy students can now be found learning about their chosen profession far from the campus, in hospitals, nursing homes, corner drugstores-anywhere in Alberta where pharmacy is practiced.

"It was a case of changing with the times," says John Bachynsky, who became dean of the Faculty of Pharmacy and Pharmaceutical Sciences in July 1981. According to the dean, a number of factors led to the change.

"There was a general recognition among the staff that more attention should be given to the clinical and practical aspects of the profession," he says.

Graduates also played a role, letting the faculty know that they felt they were not entirely prepared for the demands placed upon them as they entered the profession. Then, too, the profession itself was changing, he says, not fundamentally, but empirically. "The relative importance of pharmaceuticals has grown from 35 to 20 per cent to closer to 40 per cent of a typical pharmacy's trade," he says. At the same time, today's consumer is wanting more information and is turning to the pharmacist for it.

In response, in 1982 professional practice courses were introduced into the first three years of the BSc(Pharm) program. Students began learning how to dispense drugs long before they had any idea about what exactly the drugs were or how they worked. But they were learning skills they would later depend upon, and most importantly, they were beginning a socialization into the profession. They were beginning to feel a part of the world of pharmacy.

Not only did the students respond very well, so did the pharmacy community, says Dean Bachynsky. Practicing pharmacists were invited to take part in teaching the professional practice courses and proved eager to participate. As the practitioners became involved, they developed an interest in the students and in the Faculty, something which has proven extremely positive, says the dean.

"More people are actively involved now, and they can serve as role models for the students," says Dr. Bachynsky 'The students see these people and see what pharmacy is all about."

In 1983 the professional practice element in the program was taken a giant step further with the introduction of a program of clinical rotations in the final year of study. The second semester of the fourth year is now organized into two timetabling blocks: six weeks for classes and six weeks for practical experience in pharmacies.

Each student, regardless of her or his career plans, gets exposure to the practice of pharmacy in a community pharmacy, in an acute-care hospital, and in an extended care environment (typically a nursing home). The block timetabling allows for the rotations to be arranged throughout the province.

By the time the pharmacy students begin the clinical rotations, they have not only gained a thorough grounding in the science of pharmacy but have also developed some important technical and interpersonal skills.

In the first year of the program the professional practice emphasis is on the basic technical skills of dispensing and calculation and on essential communication skills. Dispensing labs are taught by practicing pharmacists and workshops deal with such aspects of communication as how messages are transmitted, the describing of feelings, and non-verbal communication.

In the second year, the students continue their exposure to the various aspects of pharmacy practice with particular emphasis on the laws that govern the profession. An exploration of these laws is done in co-operation with the Faculty of Law, which is currently engaged in a health law project.

The development of communication skills also continues in the second year through an 18-hour public speaking program organized in co-operation with Toastmasters International. This program has been "very successful," says Dean Bachynsky.

In the third year, the communications emphasis is on counselling and interviewing skills, with particular attention given to empathy. In addition, assigned presentations and seminars help the students maintain and build upon the public speaking skills they had previously developed.

Communication skills are also important in the third-year dispensing labs, which are organized by therapeutic topic. These labs involve actual patients, who are interviewed by the students. Working in groups of six to eight, the students elicit information about the patient's condition, its symptoms and effect on his lifestyle, the medications taken, and the effect those medicines have. After the interviewing is complete, each group presents its patient to the rest of the class.

The co-operation from the patients is great, says the dean. "The patients come back from year to year-they really enjoy it."

Armed with the basic technical and communication skills they have acquired and a good deal of "book-learning," the fourth year students report for their clinical rotations, their first step into the everyday world of the profession they hope to enter shortly.

The co-ordinator of the clinical rotations is Cheryl Cox, an energetic University of Saskatchewan graduate who completed a hospital pharmacy residency in Univer sity Hospital, Saskatoon and worked in an Alberta community pharmacy before joining the University of Alberta pharmacy faculty in the fall of 1982. It is her responsibility to annually arrange placements for each of the more-than 60 fourth year students, three placements for each student: two weeks in a community pharmacy, two weeks in an acute-care hospital, and two weeks in an extended-care environment.

As can well be imagined, it is no small undertaking, but the community response has been positive and, to date, no student has been without a placement.

Ms. Cox says that there is a good deal of satisfaction in her work. "One of the most rewarding aspects is hearing students talking about how all of the assignments and projects they have been doing contribute to patient care."

Many of the students will be going to work in community pharmacies upon graduation and gain valuable experience in this environment on their clinical rotations.

"It is very satisfying to them," says Ms. Cox. "They gain skills from the practitioners but also contribute. They get to start using all of the information they have stored up—but in the company of a practitioner to help them make those first decisions."

During the community pharmacy phase of their clinical rotations, students often have the opportunity to interact with the wider community in which they are placed, making presentations to prenatal class groups, kindergartens, seniors groups, social service departments, and so forth.

In the acute-care hospital environment, the students primarily focus on drug monitoring. "They are able to see how patients are diagnosed, the rationale of prescribing, and then follow the patient's progress and see how the medicine has affected them," says Ms. Cox. There is also an opportunity to work with hospital staff in contributing to patient care. All of this provides an awareness that the drug distribution system—"getting the right drug to the right patient at the right time'—is a major aspect of hospital medicine, says Ms. Cox.

In the extended-care environment, nursing homes and similar institutions, the major focus is on the teamwork involved. "Here, the whole team sits down and discusses the health of the patients," says Ms. Cox. The pharmacy student has his understanding broadened as he sits down with the team and hears other health care professionals, such as nurses, occupational therapists, and dieticians, contribute their views.

Jeff May, who graduated from the faculty this past spring, echoes the enthusiasm expressed by Dean Bachynsky and Ms. Cox. "It was just a great experience," he says of the clinical rotations.

Mr. May is now working in an Edmonton pharmacy. While it had always been his intention to practice in a community pharmacy—"It's a good independent situation, where you can do what you want and be a professional at what you are doing."—he appreciates the wide exposure he gained from the different aspects of his clinical rotations.

"It gave such a broad overview of pharmacy practice," he says, "It shows that you have to take all that you have learned over the previous four years and put it to practical use. And you see people who are actually taking all of that knowledge and using it every day, every minute of the day."

He also speaks highly of the exposure provided by the professional practice courses which preceded the rotations: "It gives you an idea of what you are shooting for. It counteracts, he says, the tendency to get "really bogged down in the coursework."

That the increased emphasis on preparation for professional practice is viewed favorably in Alberta's pharmacy community is amply testified to by the comments Mr. May often received from graduates of earlier years: "Why couldn't I be graduating now?" or "I wish they would have had this when I was a student."

As for Mr. May. Could he imagine graduating into the profession and beginning work without the background provided by the professional practice courses and the clinical rotations?

"I couldn't imagine it."

Published Autumn 1985.

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