The task of revamping pharmacy education in Nigeria to make it more functional to address the societal needs and contemporary global best practices is enormous and pharmacists who are desirous of advancing their practice and improve the image of the profession must embrace the philosophy of lifelong self-directed learning, eminent pharmacist, Professor Azuka C. Oparah has said.
Prof. Oparah said this while delivering a keynote address on the topic, ‘Advancing Pharmacy Through Strategic Workforce Development in Practice Settings’, at the International Conference Centre, Abuja, during the 88th Annual National Conference of the PSN held in November.
The Professor of Clinical Pharmacy at the University of Benin (UNIBEN) urged Nigerian pharmacists to think globally and act locally, adding that the mindset that created a problem cannot be used to solve it.
He further stated that revamping pharmacy education in Nigeria requires a disruptive innovative approach and strong collaboration among the regulators to connect all the levels of the pharmacist’s training, from basic to a specialist practitioner.
This, he said, would only be possible with visionary and committed leadership occurring simultaneously along the strata.
“To bring about change within a diverse profession such as pharmacy, one needs a critical mass pull in the same direction; one needs general agreement about the best direction in which to move and defining and agreeing on this direction has been the greatest challenge,” he said.
Below is the full text of Prof. Oparah’s keynote address:
Introduction
I am grateful to the President and Members of the 88th National Conference Planning Committee of the Pharmaceutical Society of Nigeria for the honour to be keynote speaker today. The objective of this discourse is to explore how to elevate pharmacy practice in diverse settings using the tool of strategic workforce development.
Access to quality medicines and competent, capable health care professionals are fundamental aspects of any health care system. Pharmaceutical human resources should ensure the uninterrupted supply of quality medicines to the population, their management, and responsible use, as vital components in improving the health of nations (FIP Workforce Report, 2012).
Pharmacy workforce comprises pharmacists, pharmacy technicians, counter assistants, and pharmaceutical scientists. Pharmacists practice their profession in diverse settings which we have often identified the major ones as academia/research institutions, hospital, community, industry, and regulatory agencies.
Introspection into pharmacy practice in Nigeria reveals promises that have yet to be delivered. Academic pharmacists, who are producers of pharmacists seem isolated from the real world and have been described as Pharisees because they do not have opportunities to practice what they teach. Hospital pharmacy is largely focused on supply of medications with minimal patient counselling during dispensing and fragments of pharmaceutical care. Community pharmacists supply medications, with great opportunities for helping community dwellers use medications responsibly, as well as expand their frontiers to health promotion and disease-prevention, especially with an aging population.
Industrial pharmacists are experts in pharmaceutical marketing and dosage formulation. Manufacturing of active pharmaceutical ingredients and developing new remedies for emerging diseases represent huge opportunities for research and development. The regulation of pharmacy education, pharmacy practice, and pharmaceutical products makes pharmacy a profession that promises no harm to the public; when the public does not have access to safe medicines, there is a breach of trust. Pharmacists should fight circulation of fake/substandard drugs, drug faking is corruption; fake people cannot fight fake drugs.
Pharmacist workforce density
Pharmacists represent the third largest health care professional group in the world. The pharmacists-to-population ratios vary widely from less than five pharmacists per 100,000 population to as high as over 200 pharmacists per 100,000 population in some countries. The average ratio in the Western Pacific countries is about 25 times more than that of the countries in the African region and has the highest ratios compared to other regions.
The ratio is also related to the economic status of the country, with the low income countries having the lowest ratio and high income countries having the highest ratio (FIP Global Pharmacy & Migration Report, 2006). As at September 2015, 20,000 pharmacists were registered with the PCN and about 580 pharmacists have died in the past five years (PCN, 2015).
Given that some pharmacists engage in non-pharmaceutical jobs and some have migrated, Nigeria has a density of about 125 pharmacists per 100,000 population. There is inequitable distribution between urban and rural areas and even among the cities. Roughly 1,600 young pharmacists from Nigerian and overseas schools will be released yearly into the labour market as from 2015. We are heading towards a glut and fall in market price; time has come to place the cap.
Pharmacist workforce development
Pharmacist workforce development is undertaken in the following layers:
* Undergraduate training
* Internship training
* Postgraduate training (academic and professional)
* Continuing professional development
* Lifelong self-directed learning
* Mentoring
- Undergraduate training – Pharmacy education affects pharmacy practice; both the education and practice are regulated by the Pharmacists Council of Nigeria (PCN) in pursuance of the enabling act. The standards of pharmacy education are also set by the National Universities Commission (NUC). The International Federation of Pharmacists (FIP) recommends global standards for local adaptation. Pharmacy is an international profession and training practitioners using a global template enables global workforce mobility.
Some issues regarding undergraduate training that need strategic attention are:
- Curriculum accreditation – Both NUC and PCN undertake programme accreditation. Pharmacy faculties are required to satisfy both bodies. This process results in duplication and wasting of scarce resources. Joint accreditation between PCN and NUC is recommended for Schools of Pharmacy in Nigeria. Furthermore, so far, accreditation criteria have focused on the relevant structures, but there is now need to focus on the processes and learning outcomes as ICT makes it possible to produce good students using compact but complex structural and process models.
- 2. Training curriculum – Over the years, we have grappled with an overloaded pharmacy curriculum that renders our students more confused than they were before they entered pharmacy schools. The curriculum also leaves our students with low self-esteem, as even the best graduating students in Pharmacy will tell you that they struggled to p
Each time we talk about curriculum review, some faculty members will vehemently defend their territories and may allow you to add a few new courses. Because we add without dropping, we end up overloading the curriculum to the extent that some undergraduate and postgraduate syllabuses are the same. We urgently need to revamp the training curriculum. In fact, I suggest a 30 per cent reduction, so as to allow the students some time to reflect and apply themselves.
The mindset we used to create problems cannot be used to solve them. Reviewing and updating pharmacy training curriculum requires courage and foresight on the part of the regulators. To this end, I wish to observe that the proposed BMAS for PharmD has confused the past with the future and needs to be revamped, so that the second error will not be greater than the first.
- Structure of pharmacy faculties – The traditional 5- or 6- department structure is overdue for expansion to promote professional growth and development. I recall that the 2012 PSN Pharmacy Education Summit adopted three new departments: Public Health Pharmacy, Social & Administrative Pharmacy, and Agricultural & Veterinary Pharmacy.
Furthermore, we need to pursue the creation of more directorates at practice level and rotate the headship of pharmacy departments among chief pharmacists and above, as we have in the universities, if we are to embrace innovative practice. Ironically, Pharmacy is a faculty in school but shrunk to one department in practice; that creates structural interactive dissonance.
- 4. Doctor of Pharmacy (PharmD) degree programme – The nomenclature of entry to practics degree in pharmacy has seen an evolutionary trend from Diploma to BSc, to BPharm, to PharmD or MPh This change is accompanied with upwards review of curriculum and duration of training. Only the University of Benin was courageous to start the programme in 2000 and after 15 years, no other school has. Despite the reasons offered, these other schools need help.
The University of Benin model has local adaption of retaining the basic pharmaceutical sciences and terminal clinical focus. The American Educational Credential Evaluators Evaluation Report in 2009 indicated that the University of Benin (Uniben) PharmD degree is equivalent to the US PharmD degree. Therefore, holders of Uniben PharmD are currently recognised in the US and other countries. But they are begging for recognition in Nigeria because we did not speak with one voice when we should have done so, and in line with scriptural quotes, a man’s greatest enemies are members of his own household. In Luke 4:24 and Mark 6:4: Jesus said to them, “Prophets are respected everywhere except in their own home town and by their relatives and their family.”
Ghana joined the world league in 2012 when Kwame Nkrumah University of Science & Technology transited from BPharm to PharmD degree. In transiting from BPharm to PharmD, we have to accept to change the way we think and the way we act regarding pharmacy education and practice. This change entails new attitudes, new mindsets, acquisition of new knowledge and skills and most importantly, willingness to give up some of our so called traditional or conventional ways of doing things.
We must respond to change and the only way to become relevant with time is to embrace new ideas rather than sticking to our traditional comfort zones. Pharmacy is a global profession and there are changes that have occurred worldwide in response to changes in healthcare delivery systems, technology and consumer behaviour. Such changes include transition from BPharm to PharmD and moving from product-oriented practice to pharmaceutical care practice.
Nigerian Pharmacy Schools should stop offering BPharm degree that has been phased out by those who introduced pharmacy education to us. It is like sticking to your old black and white television when the colour television has become ultra-thin. I therefore call on the National Universities Commission and the Pharmacists Council of Nigeria to formally recognise the establishment of the Doctor of Pharmacy degree programme in Nigerian Pharmacy Schools, so that the training of Nigerian pharmacists will be at par with what obtains in the contemporary world.
- 5. Pharmaceutical care education – Pharmaceutical care is the current philosophy of pharmacy practice worldwid It affects the way pharmacists think and the way they practise, irrespective of the practice-setting. Pharmaceutical care represents both a paradigm shift and disruptive innovation in health care. The pharmacist becomes a problem solver rather than a mere dispenser of medications. The overall gains include assurance of the quality of the prescribing of physicians, improving quality of life of the sick within realistic costs and maintaining the quality of life of the healthy population.
The world-wide acceptance of pharmaceutical care as the mission of the pharmacy profession is shaping pharmaceutical education and practice. As a result, pharmaceutical care was adopted as the focus of good pharmacy education (FIP 1998). Our study indicates that Nigerian pharmacists have positive attitudes towards pharmaceutical care and favour a combination of pharmaceutical care and traditional pharmacy practice; with a gradual introduction of pharmaceutical care in different practice settings (Oparah, et al., 2005)
Pharmaceutical care education in Nigeria should start with training the trainers, developing practice sites and should be student-cantered and outcome-oriented. Approaches to improve pharmaceutical care education include early introduction of pharmaceutical care in the pharmacy curriculum, use of actual patients to teach in the classroom, exposing students to shadow experience at practice sites, and use of virtual patients, especially where access to real patients is a barrier (Oparah, 2010).
Internship training
A mandatory requirement for registration of fresh pharmacists is that they undergo a period of 12-months supervised training in an approved site or split sites. For this training to be outcome-oriented, the required competences should be clearly spelt out to guide both the trainees and their preceptors.
With 17 accredited pharmacy schools and five awaiting accreditation, there is a growing number of prospective internees: 1008 (2012), 1197 (2013), and 1505 (2014) plus pharmacists trained overseas: 80 (2012), 73 (2013), 104 (2014), and 123 (2015). However, there are 208 accredited internship sites as at this review period (PCN 2015).
The implication is that most fresh pharmacy graduates will stay at home for 1-2 years before they can secure a place for internship. Nobody should expect these young professionals suffering early professional frustration to love their profession. Before we preach to them to think of what they should do for their profession, their profession should first think of what to do for them. Therefore, the PCN and PSN should actively search out and accredit more internship centres and also assist interns with placement in available centres.
Pre-registration examination
Pre-registration examination is an international practice. In Nigeria, it is necessary to guarantee the quality of entrants to pharmacy profession for the common good of the society. With the advent of several public and private schools of pharmacy, there is a wide variation in the quality of students on admission and the quality of graduates; pre-registration examination will become the final clearance house for all. Therefore, the PCN should clearly define the syllabus and guidelines for the pre-registration examination ahead of its commencement. Introduction of pre-registration examination was adopted in PCN’s Pharmacy Education Conference in 2001 and PSN’s Summit in 2012. Let us not become active members of “NATO – No Action, Talk Only” according to Prof. Fola Tayo.
Postgraduate training
Most pharmacists call themselves experts on drugs. Please note that a first degree can hardly produce an expert. Pharmacists should therefore seek further education after the pharmacy degree. The global trend in health care is for professionals to specialise; the future offers little hope for generalists.
While the schools of pharmacy can produce higher academic degrees, they are not suitable for professional degrees. This is where regional and national colleges such as the West African Postgraduate College of Pharmacists will come in to produce Fellows, who can, on appointment, function as specialists and consultants in practice settings.
Pharmacists can train and specialise as Antibiotic Pharmacists, Oncology Pharmacists, Cardiovascular & Renal Pharmacists, Nutrition Support Pharmacists, Psychiatric Pharmacists and Diabetes Educators etc. The future of hospital pharmacy practice lies in creating several areas of specialisation rather than employing everyone as just pharmacist, where there will be no distinction in the job description of different cadres of pharmacists.
Furthermore, qualifying bodies such as the West African Postgraduate College of Pharmacists only certify their Fellows. It is the duty of the professional regulator to issue licence to practice. Therefore, the PCN should develop a credentialing system for specialised pharmacists and not give everyone the same annual licence to practice as a pharmaceutical chemist.
Continuing professional development
The FIP Statement on Good Pharmacy Education Practice states that Continuing Professional Development must be a lifelong commitment for every practicing pharmacist. The concept of Continuing Professional Development (CPD) can be defined as “the responsibility of individual pharmacists for systematic maintenance, development and broadening of knowledge, skills and attitudes, to ensure continuing competence as a professional, throughout their careers” (FIP,
2000).
Continuing Professional Development is not more than participation in Continuing Education (CE) which, on its own, does not necessarily lead to positive changes in professional practice nor does it necessarily improve healthcare outcomes. CE is, however, an important part of a structured CPD programme, personalised for each pharmacist. CPD is a continuous cycle of reflection on learning needs, planning, action and evaluation. Based on identified national needs, the individual pharmacist should to learn how to draw up SMART plans (Specific, Measurable, Achievable, Realistic and Timed) for a personalised programme of CPD.
The Continuing Professional Development Process involves 5- step cyclical process of Self- Appraisal, Personal Plan, Action (Implementation), Documentation, and Evaluation. From the foregoing, it means that what we are currently doing is not CPD but it is mandatory to the extent of regulatory requirement for registration.
Lifelong self-directed Learning
In the real sense, learning whether structured or not occurs throughout lifetime and we literally die the day we stop to learn. Professionals should not only learn to maintain competence to practice but also to fit into societal expectations. In addition to professional literatures, we should read newspapers and magazines, books on leadership, entrepreneurship & resource management; politics and economics. We should listen to network news and watch football matches and also watch home videos to know the trends in our society.
Mentoring
Mentoring is a one–to-one relationship of professional development, usually between someone seeking professional progression and a more experienced practitioner. This could include someone seeking to develop a new expertise and a practitioner already active in that area (Goundrey-Smith 2011). Mentoring helps to develop confidence and skills of both the mentor and the mentee. Pharmacy profession in Nigeria will benefit from a structured mentoring scheme and I challenge the leadership of the Pharmaceutical Society of Nigeria to undertake this project.
Conclusion
The task of revamping pharmacy education in Nigeria to make it more functional to address the societal needs and contemporary global best practice is enormous. This requires a disruptive innovative approach and strong collaboration among the regulator, PCN, Faculties of Pharmacy, and the West African Postgraduate College of Pharmacists to connect all the levels of pharmacists’ training, from basic to a specialist practitioner. This will only be possible with visionary and committed leadership occurring simultaneously along the strata.
To bring about change within a diverse profession such as pharmacy, one needs a critical mass of people pulling in the same direction. Before one can get such a critical mass pulling in the same direction, one needs general agreement about the best direction in which to move and defining and agreeing on this direction has been our greatest challenge.
The mission of the profession of pharmacy is to improve public health through ensuring safe, effective, and appropriate use of medications. Contemporary pharmacy practice reflects an evolving paradigm from one in which the pharmacist primarily supervises medication distribution and counsels patients, to a more expanded and team-based clinical role providing patient-centered medication therapy management, health improvement, and disease prevention services (Webb 1995). Pharmacists should learn to make effective use pharmacy technicians to free time for their involvement in expanding roles in health care delivery.
Education stimulates change in practice. There is a shift in the pharmacy practice philosophy and education which we must embrace: from drug product to drug therapy, from pharmacy to bedside, from dispenser to caregiver, from solo to team, from knowledge to information, from as ordered to as best prescribed, and from drug distribution to pharmaceutical care; where pharmacists promote access to safe medications and their responsible use.
To become responsive, pharmacy education needs to change in three fundamental domains: the teachers should change, the curriculum should change, and mode of delivery and evaluation should change. Teachers need training and re-orientation to reflect on the purpose of pharmacy education which is to produce competent practitioners and not to give abstract knowledge. Revamping the training template entails a competency-based learning rather than compartmentalisation into pharmaceutical chemistry, pharmacology, pharmaceutics, pharmacognosy and clinical pharmacy. In my mind these departments should be structures with an integrated function; this integration further extends to biomedical & medical departments.
Based on the global competences for pharmacists, the competence pyramid (Miller 1990) of knowing it, knowing how to do it, showing how to do it, and doing it will expect the pharmacist to acquire competences in pharmaceutical care, public health, management, and production/quality assurance of medicines. The new approach to student-centered teaching indicates active learning, problem solving, communication skills and teamwork; evaluation then assesses the outcomes of specific competence objectives.
Finally, pharmacists who want to advance their practice should embrace the philosophy of lifelong self-directed learning. We must think globally and act locally; the mindset that created a problem cannot be used to solve it. The pharmacist of tomorrow is one with specialised knowledge and skill to solve society’s problems. As long as mankind takes medications, there will always be a future for the pharmacist. A former US President, JFK Kennedy in a speech in 1962 described “the pharmacist as an indispensable link in the chain of national health protection and promotion. If we did not have the pharmacist, it would be necessary to invent him.”
REFERENCES
Akubue PI, Adenika FB (2001) Eds. Pharmacy Education in Nigeria; Proceedings of the Pharmacy
Curriculum Conference Organized by the Pharmacists Council of Nigeria.
International Pharmaceutical Federation (FIP). Statement on Good Pharmacy Education
Practice, 1998
International Pharmaceutical Federation (FIP) Global Pharmacy & Migration Report 2006
International Pharmaceutical Federation (FIP) Global Pharmacy Workforce Report 2012
International Pharmaceutical Federation (FIP) Policy Statement on Good Pharmacy Education
Practice, Vienna 2000
Goundrey-Smith S (2011). How to ensure effective mentoring. Available at www.pjonline.com
Accessed 17/03/2015
Miller GE. The Assessment of Clinical Skills/Competence/Performance; Acad Med (1990); 65 (9):
63-67.
Oparah AC (2010). Barriers to the implementation of pharmaceutical care In: Essentials of
Pharmaceutical Care; Lagos Cybex Publications 155-167.
Oparah AC, Eferakeya AE (2005). Attitudes of Nigerian Pharmacists towards pharmaceutical care. Pharmacy World and Science; 27 (3): 208 – 214.
Webb E. Prescribing medications: Changing the Paradigm for a Changing Health Care
System Am J Health-Syst Pharm. 1995;52:1693–5.
Why pharmacists should embrace lifelong learning – Prof. Oparah
The task of revamping pharmacy education in Nigeria to make it more functional to address the societal needs and contemporary global best practices is enormous and pharmacists who are desirous of advancing their practice and improve the image of the profession must embrace the philosophy of lifelong self-directed learning, eminent pharmacist, Professor Azuka C. Oparah has said.
Prof. Oparah said this while delivering a keynote address on the topic, ‘Advancing Pharmacy Through Strategic Workforce Development in Practice Settings’, at the International Conference Centre, Abuja, during the 88th Annual National Conference of the PSN held in November.
The Professor of Clinical Pharmacy at the University of Benin (UNIBEN) urged Nigerian pharmacists to think globally and act locally, adding that the mindset that created a problem cannot be used to solve it.
He further stated that revamping pharmacy education in Nigeria requires a disruptive innovative approach and strong collaboration among the regulators to connect all the levels of the pharmacist’s training, from basic to a specialist practitioner.
This, he said, would only be possible with visionary and committed leadership occurring simultaneously along the strata.
“To bring about change within a diverse profession such as pharmacy, one needs a critical mass pull in the same direction; one needs general agreement about the best direction in which to move and defining and agreeing on this direction has been the greatest challenge,” he said.
Below is the full text of Prof. Oparah’s keynote address:
Introduction
I am grateful to the President and Members of the 88th National Conference Planning Committee of the Pharmaceutical Society of Nigeria for the honour to be keynote speaker today. The objective of this discourse is to explore how to elevate pharmacy practice in diverse settings using the tool of strategic workforce development.
Access to quality medicines and competent, capable health care professionals are fundamental aspects of any health care system. Pharmaceutical human resources should ensure the uninterrupted supply of quality medicines to the population, their management, and responsible use, as vital components in improving the health of nations (FIP Workforce Report, 2012).
Pharmacy workforce comprises pharmacists, pharmacy technicians, counter assistants, and pharmaceutical scientists. Pharmacists practice their profession in diverse settings which we have often identified the major ones as academia/research institutions, hospital, community, industry, and regulatory agencies.
Introspection into pharmacy practice in Nigeria reveals promises that have yet to be delivered. Academic pharmacists, who are producers of pharmacists seem isolated from the real world and have been described as Pharisees because they do not have opportunities to practice what they teach. Hospital pharmacy is largely focused on supply of medications with minimal patient counselling during dispensing and fragments of pharmaceutical care. Community pharmacists supply medications, with great opportunities for helping community dwellers use medications responsibly, as well as expand their frontiers to health promotion and disease-prevention, especially with an aging population.
Industrial pharmacists are experts in pharmaceutical marketing and dosage formulation. Manufacturing of active pharmaceutical ingredients and developing new remedies for emerging diseases represent huge opportunities for research and development. The regulation of pharmacy education, pharmacy practice, and pharmaceutical products makes pharmacy a profession that promises no harm to the public; when the public does not have access to safe medicines, there is a breach of trust. Pharmacists should fight circulation of fake/substandard drugs, drug faking is corruption; fake people cannot fight fake drugs.
Pharmacist workforce density
Pharmacists represent the third largest health care professional group in the world. The pharmacists-to-population ratios vary widely from less than five pharmacists per 100,000 population to as high as over 200 pharmacists per 100,000 population in some countries. The average ratio in the Western Pacific countries is about 25 times more than that of the countries in the African region and has the highest ratios compared to other regions.
The ratio is also related to the economic status of the country, with the low income countries having the lowest ratio and high income countries having the highest ratio (FIP Global Pharmacy & Migration Report, 2006). As at September 2015, 20,000 pharmacists were registered with the PCN and about 580 pharmacists have died in the past five years (PCN, 2015).
Given that some pharmacists engage in non-pharmaceutical jobs and some have migrated, Nigeria has a density of about 125 pharmacists per 100,000 population. There is inequitable distribution between urban and rural areas and even among the cities. Roughly 1,600 young pharmacists from Nigerian and overseas schools will be released yearly into the labour market as from 2015. We are heading towards a glut and fall in market price; time has come to place the cap.
Pharmacist workforce development
Pharmacist workforce development is undertaken in the following layers:
* Undergraduate training
* Internship training
* Postgraduate training (academic and professional)
* Continuing professional development
* Lifelong self-directed learning
* Mentoring
- Undergraduate training – Pharmacy education affects pharmacy practice; both the education and practice are regulated by the Pharmacists Council of Nigeria (PCN) in pursuance of the enabling act. The standards of pharmacy education are also set by the National Universities Commission (NUC). The International Federation of Pharmacists (FIP) recommends global standards for local adaptation. Pharmacy is an international profession and training practitioners using a global template enables global workforce mobility.
Some issues regarding undergraduate training that need strategic attention are:
- Curriculum accreditation – Both NUC and PCN undertake programme accreditation. Pharmacy faculties are required to satisfy both bodies. This process results in duplication and wasting of scarce resources. Joint accreditation between PCN and NUC is recommended for Schools of Pharmacy in Nigeria. Furthermore, so far, accreditation criteria have focused on the relevant structures, but there is now need to focus on the processes and learning outcomes as ICT makes it possible to produce good students using compact but complex structural and process models.
- 2. Training curriculum – Over the years, we have grappled with an overloaded pharmacy curriculum that renders our students more confused than they were before they entered pharmacy schools. The curriculum also leaves our students with low self-esteem, as even the best graduating students in Pharmacy will tell you that they struggled to p
Each time we talk about curriculum review, some faculty members will vehemently defend their territories and may allow you to add a few new courses. Because we add without dropping, we end up overloading the curriculum to the extent that some undergraduate and postgraduate syllabuses are the same. We urgently need to revamp the training curriculum. In fact, I suggest a 30 per cent reduction, so as to allow the students some time to reflect and apply themselves.
The mindset we used to create problems cannot be used to solve them. Reviewing and updating pharmacy training curriculum requires courage and foresight on the part of the regulators. To this end, I wish to observe that the proposed BMAS for PharmD has confused the past with the future and needs to be revamped, so that the second error will not be greater than the first.
- Structure of pharmacy faculties – The traditional 5- or 6- department structure is overdue for expansion to promote professional growth and development. I recall that the 2012 PSN Pharmacy Education Summit adopted three new departments: Public Health Pharmacy, Social & Administrative Pharmacy, and Agricultural & Veterinary Pharmacy.
Furthermore, we need to pursue the creation of more directorates at practice level and rotate the headship of pharmacy departments among chief pharmacists and above, as we have in the universities, if we are to embrace innovative practice. Ironically, Pharmacy is a faculty in school but shrunk to one department in practice; that creates structural interactive dissonance.
- 4. Doctor of Pharmacy (PharmD) degree programme – The nomenclature of entry to practics degree in pharmacy has seen an evolutionary trend from Diploma to BSc, to BPharm, to PharmD or MPh This change is accompanied with upwards review of curriculum and duration of training. Only the University of Benin was courageous to start the programme in 2000 and after 15 years, no other school has. Despite the reasons offered, these other schools need help.
The University of Benin model has local adaption of retaining the basic pharmaceutical sciences and terminal clinical focus. The American Educational Credential Evaluators Evaluation Report in 2009 indicated that the University of Benin (Uniben) PharmD degree is equivalent to the US PharmD degree. Therefore, holders of Uniben PharmD are currently recognised in the US and other countries. But they are begging for recognition in Nigeria because we did not speak with one voice when we should have done so, and in line with scriptural quotes, a man’s greatest enemies are members of his own household. In Luke 4:24 and Mark 6:4: Jesus said to them, “Prophets are respected everywhere except in their own home town and by their relatives and their family.”
Ghana joined the world league in 2012 when Kwame Nkrumah University of Science & Technology transited from BPharm to PharmD degree. In transiting from BPharm to PharmD, we have to accept to change the way we think and the way we act regarding pharmacy education and practice. This change entails new attitudes, new mindsets, acquisition of new knowledge and skills and most importantly, willingness to give up some of our so called traditional or conventional ways of doing things.
We must respond to change and the only way to become relevant with time is to embrace new ideas rather than sticking to our traditional comfort zones. Pharmacy is a global profession and there are changes that have occurred worldwide in response to changes in healthcare delivery systems, technology and consumer behaviour. Such changes include transition from BPharm to PharmD and moving from product-oriented practice to pharmaceutical care practice.
Nigerian Pharmacy Schools should stop offering BPharm degree that has been phased out by those who introduced pharmacy education to us. It is like sticking to your old black and white television when the colour television has become ultra-thin. I therefore call on the National Universities Commission and the Pharmacists Council of Nigeria to formally recognise the establishment of the Doctor of Pharmacy degree programme in Nigerian Pharmacy Schools, so that the training of Nigerian pharmacists will be at par with what obtains in the contemporary world.
- 5. Pharmaceutical care education – Pharmaceutical care is the current philosophy of pharmacy practice worldwid It affects the way pharmacists think and the way they practise, irrespective of the practice-setting. Pharmaceutical care represents both a paradigm shift and disruptive innovation in health care. The pharmacist becomes a problem solver rather than a mere dispenser of medications. The overall gains include assurance of the quality of the prescribing of physicians, improving quality of life of the sick within realistic costs and maintaining the quality of life of the healthy population.
The world-wide acceptance of pharmaceutical care as the mission of the pharmacy profession is shaping pharmaceutical education and practice. As a result, pharmaceutical care was adopted as the focus of good pharmacy education (FIP 1998). Our study indicates that Nigerian pharmacists have positive attitudes towards pharmaceutical care and favour a combination of pharmaceutical care and traditional pharmacy practice; with a gradual introduction of pharmaceutical care in different practice settings (Oparah, et al., 2005)
Pharmaceutical care education in Nigeria should start with training the trainers, developing practice sites and should be student-cantered and outcome-oriented. Approaches to improve pharmaceutical care education include early introduction of pharmaceutical care in the pharmacy curriculum, use of actual patients to teach in the classroom, exposing students to shadow experience at practice sites, and use of virtual patients, especially where access to real patients is a barrier (Oparah, 2010).
Internship training
A mandatory requirement for registration of fresh pharmacists is that they undergo a period of 12-months supervised training in an approved site or split sites. For this training to be outcome-oriented, the required competences should be clearly spelt out to guide both the trainees and their preceptors.
With 17 accredited pharmacy schools and five awaiting accreditation, there is a growing number of prospective internees: 1008 (2012), 1197 (2013), and 1505 (2014) plus pharmacists trained overseas: 80 (2012), 73 (2013), 104 (2014), and 123 (2015). However, there are 208 accredited internship sites as at this review period (PCN 2015).
The implication is that most fresh pharmacy graduates will stay at home for 1-2 years before they can secure a place for internship. Nobody should expect these young professionals suffering early professional frustration to love their profession. Before we preach to them to think of what they should do for their profession, their profession should first think of what to do for them. Therefore, the PCN and PSN should actively search out and accredit more internship centres and also assist interns with placement in available centres.
Pre-registration examination
Pre-registration examination is an international practice. In Nigeria, it is necessary to guarantee the quality of entrants to pharmacy profession for the common good of the society. With the advent of several public and private schools of pharmacy, there is a wide variation in the quality of students on admission and the quality of graduates; pre-registration examination will become the final clearance house for all. Therefore, the PCN should clearly define the syllabus and guidelines for the pre-registration examination ahead of its commencement. Introduction of pre-registration examination was adopted in PCN’s Pharmacy Education Conference in 2001 and PSN’s Summit in 2012. Let us not become active members of “NATO – No Action, Talk Only” according to Prof. Fola Tayo.
Postgraduate training
Most pharmacists call themselves experts on drugs. Please note that a first degree can hardly produce an expert. Pharmacists should therefore seek further education after the pharmacy degree. The global trend in health care is for professionals to specialise; the future offers little hope for generalists.
While the schools of pharmacy can produce higher academic degrees, they are not suitable for professional degrees. This is where regional and national colleges such as the West African Postgraduate College of Pharmacists will come in to produce Fellows, who can, on appointment, function as specialists and consultants in practice settings.
Pharmacists can train and specialise as Antibiotic Pharmacists, Oncology Pharmacists, Cardiovascular & Renal Pharmacists, Nutrition Support Pharmacists, Psychiatric Pharmacists and Diabetes Educators etc. The future of hospital pharmacy practice lies in creating several areas of specialisation rather than employing everyone as just pharmacist, where there will be no distinction in the job description of different cadres of pharmacists.
Furthermore, qualifying bodies such as the West African Postgraduate College of Pharmacists only certify their Fellows. It is the duty of the professional regulator to issue licence to practice. Therefore, the PCN should develop a credentialing system for specialised pharmacists and not give everyone the same annual licence to practice as a pharmaceutical chemist.
Continuing professional development
The FIP Statement on Good Pharmacy Education Practice states that Continuing Professional Development must be a lifelong commitment for every practicing pharmacist. The concept of Continuing Professional Development (CPD) can be defined as “the responsibility of individual pharmacists for systematic maintenance, development and broadening of knowledge, skills and attitudes, to ensure continuing competence as a professional, throughout their careers” (FIP,
2000).
Continuing Professional Development is not more than participation in Continuing Education (CE) which, on its own, does not necessarily lead to positive changes in professional practice nor does it necessarily improve healthcare outcomes. CE is, however, an important part of a structured CPD programme, personalised for each pharmacist. CPD is a continuous cycle of reflection on learning needs, planning, action and evaluation. Based on identified national needs, the individual pharmacist should to learn how to draw up SMART plans (Specific, Measurable, Achievable, Realistic and Timed) for a personalised programme of CPD.
The Continuing Professional Development Process involves 5- step cyclical process of Self- Appraisal, Personal Plan, Action (Implementation), Documentation, and Evaluation. From the foregoing, it means that what we are currently doing is not CPD but it is mandatory to the extent of regulatory requirement for registration.
Lifelong self-directed Learning
In the real sense, learning whether structured or not occurs throughout lifetime and we literally die the day we stop to learn. Professionals should not only learn to maintain competence to practice but also to fit into societal expectations. In addition to professional literatures, we should read newspapers and magazines, books on leadership, entrepreneurship & resource management; politics and economics. We should listen to network news and watch football matches and also watch home videos to know the trends in our society.
Mentoring
Mentoring is a one–to-one relationship of professional development, usually between someone seeking professional progression and a more experienced practitioner. This could include someone seeking to develop a new expertise and a practitioner already active in that area (Goundrey-Smith 2011). Mentoring helps to develop confidence and skills of both the mentor and the mentee. Pharmacy profession in Nigeria will benefit from a structured mentoring scheme and I challenge the leadership of the Pharmaceutical Society of Nigeria to undertake this project.
Conclusion
The task of revamping pharmacy education in Nigeria to make it more functional to address the societal needs and contemporary global best practice is enormous. This requires a disruptive innovative approach and strong collaboration among the regulator, PCN, Faculties of Pharmacy, and the West African Postgraduate College of Pharmacists to connect all the levels of pharmacists’ training, from basic to a specialist practitioner. This will only be possible with visionary and committed leadership occurring simultaneously along the strata.
To bring about change within a diverse profession such as pharmacy, one needs a critical mass of people pulling in the same direction. Before one can get such a critical mass pulling in the same direction, one needs general agreement about the best direction in which to move and defining and agreeing on this direction has been our greatest challenge.
The mission of the profession of pharmacy is to improve public health through ensuring safe, effective, and appropriate use of medications. Contemporary pharmacy practice reflects an evolving paradigm from one in which the pharmacist primarily supervises medication distribution and counsels patients, to a more expanded and team-based clinical role providing patient-centered medication therapy management, health improvement, and disease prevention services (Webb 1995). Pharmacists should learn to make effective use pharmacy technicians to free time for their involvement in expanding roles in health care delivery.
Education stimulates change in practice. There is a shift in the pharmacy practice philosophy and education which we must embrace: from drug product to drug therapy, from pharmacy to bedside, from dispenser to caregiver, from solo to team, from knowledge to information, from as ordered to as best prescribed, and from drug distribution to pharmaceutical care; where pharmacists promote access to safe medications and their responsible use.
To become responsive, pharmacy education needs to change in three fundamental domains: the teachers should change, the curriculum should change, and mode of delivery and evaluation should change. Teachers need training and re-orientation to reflect on the purpose of pharmacy education which is to produce competent practitioners and not to give abstract knowledge. Revamping the training template entails a competency-based learning rather than compartmentalisation into pharmaceutical chemistry, pharmacology, pharmaceutics, pharmacognosy and clinical pharmacy. In my mind these departments should be structures with an integrated function; this integration further extends to biomedical & medical departments.
Based on the global competences for pharmacists, the competence pyramid (Miller 1990) of knowing it, knowing how to do it, showing how to do it, and doing it will expect the pharmacist to acquire competences in pharmaceutical care, public health, management, and production/quality assurance of medicines. The new approach to student-centered teaching indicates active learning, problem solving, communication skills and teamwork; evaluation then assesses the outcomes of specific competence objectives.
Finally, pharmacists who want to advance their practice should embrace the philosophy of lifelong self-directed learning. We must think globally and act locally; the mindset that created a problem cannot be used to solve it. The pharmacist of tomorrow is one with specialised knowledge and skill to solve society’s problems. As long as mankind takes medications, there will always be a future for the pharmacist. A former US President, JFK Kennedy in a speech in 1962 described “the pharmacist as an indispensable link in the chain of national health protection and promotion. If we did not have the pharmacist, it would be necessary to invent him.”
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Goundrey-Smith S (2011). How to ensure effective mentoring. Available at www.pjonline.com
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