PharmD Course in India - Kind Attn: Dr. Santosh

[Guest guest]

Dear Dr. Santosh:

Thanks a lot for your kind words. It is people like you who are keeping this discussion vibrant and alive. Hope to see even greater participation from your end in days to come. Meanwhile I am reproducing an article from the American Journal of Pharmaceutical Education below, written by Seema Mangasuli for the interest of all. Article dwells upon the decade long journey of pharmacy practice curriculum in India.

Dr. Geer M. Ishaq

Assistant Professor

Dept. of Pharmaceutical Sciences

University of Kashmir

Srinagar-190006 (J & K)

Ph: 9419970971, 9906673100

Website: http://ishaqgeer.googlepages.com

A Decade of Pharmacy Practice Education in IndiaMangasuli, Seema With a decade of introduction of pharmacy practice education in India, there has been a paradigm shift in the practice of pharmacy in the country. In spite of this, pharmacy practice education faces many challenges before it can transform the pharmaceutical care practice in India from a product-oriented approach to patient-oriented care. Pharmacy education in India is mainly industry oriented. The curriculum at the undergraduate level is more or less designed for preparing students towards industry rather than for patient-oriented services like hospital, clinical, and community pharmacy. To train the graduate pharmacists to provide patient-oriented services, a pharmacy practice course was started at a postgraduate level. Pharmacy practice curriculum enters its tenth year in India since its beginning in 1997.

1 The curriculum trains the postgraduates in rational therapeutics, patient counseling, pharmacovigilance, therapeutic drug monitoring, clinical research,and toxicology to name a few. With the efforts being on introducing the advanced clinical-based courses of the doctor of pharmacy (PharmD) degree in India, there is a need to contemplate where the profession stands at this juncture.

2 As of today pharmacy practice is at a crossroads in India, facing numerous challenges that need to be addressed before marching further. This letter is an effort to identify deficiencies, vis-a`-vis regulatory requirements, and evaluate the current status of pharmacy practice education in India.

The decade long journey of pharmacy practice curriculum in India provides some key insights:

(1) The profession is restricted only to the hospitals linked to a pharmacy practice school. With the completion of a decade there are few pharmacy schools providing specialization in pharmacy practice. Due to lack of job avenues, prospective postgraduates cannot opt to work as a clinical pharmacist in Indian hospitals as the value of clinical pharmacy services is not recognized.

(2) Regulatory framework does not recognize the need for clinical pharmacist at the national level. There are no regulatory guidelines for having qualified clinical pharmacists in an Indian hospital. Even if the regulations are framed in due course, a point to ponder is whether there will be any experienced pharmacists left to practice in the clinical set up as there is a mass migration of trained clinical pharmacist to pharmaceutical industry. Though clinical pharmacists have gained the confidence and acceptance of the medical fraternity, that acceptance alone will not help to overcome the shortcomings, like lack of a regulatory framework or scarce job opportunities as a clinical pharmacist. Pharmacy councils and professional leaders need to take initiative by lobbying with relevant government authorities to create a position in the hospital set-up where a trained clinical pharmacist can fit in.

(3) Exodus of trained clinical pharmacists toward industry as there is almost no opportunity in the hospital setting. As there is no recognition of the job done by the clinical pharmacist at the regulatory level, the profession failed in to create job opportunities in hospitals for qualified clinical pharmacy postgraduates. Students are forced to either seek jobs in in dustries (clinical research) or continue in academics, at times teaching subjects which are out of scope of clinical pharmacy (as not many university hospitals have pharmacy practice school). The last option being to move to countries where the pharmacy profession is well recognized. (A chart depicting the career model for a pharmacy practice postgraduate in India is available from the author.)

(4) The need for adding industry relevant topics in course curriculum - Dilemma of Dilution vs Evolution. There is a widening gap between the number of students graduating from pharmacy practice institutions and the number actually employed as pharmacy practitioners. There is a need to take key steps to either create a niche for clinical pharmacy professionals in the hospital or make them competent to take up other challenging jobs in the industry. There is a need for introducing specific roles that include training in pharmacogenomics, pharmacokinetic-pharmacodynamics, and medical informatics, which are job-oriented skills. Before the academic move to the next step of bringing PharmD courses, there is a need to augment the acceptability for existing courses. In an evidence-based health service, it is not just sufficient to propose new roles for clinical pharmacist without adequate evidence of benefits. Services should not only be clinically cost

effective but also acceptable to patients and other health care colleagues.

This situation helps the profession to learn the difficulties in implementing patient-oriented services when the health care system does not recognize the need for clinically trained pharmacists. The experience in the past decade helped to understand the lacunae within the profession, especially on the regulatory side. This situation calls for the sustained effort by academic leaders to work with government authorities to bring suitable changes in regulation that will help the profession grow towards patient care. Working on regulatory issues with the respective government authorities is an important task for profession leaders as the regulatory environment is one of the important factors that determine the growth of health professions like pharmacy.

To summarize, clinical pharmacy education in India after a decade is at a crossroads. The pharmacy educators are in a dilemma as to whether the course will evolve by incorporating industry relevant components or progress into a clinically relevant course with the help of regulatory changes. This dilemma may resolve with time.

REFERENCES

1. Parthasarathi G, Ramesh M, Nyfort-Hansen K, Nagavi BG. Clinical pharmacy in a South India teaching hospital. Ann Pharmacother. 2002;36:927-32.

2. Arjuna P. Dutta. India to introduce five-year doctor of pharmacy program. Am J Pharm Educ. 2007;71:38.

Seema Mangasuli, M Pharm

Surulivel Rajan, M Pharm

Sohil Ahmed Khan, M Pharm

Department of Pharmacy Practice

S S Cancer Hospital and Research Centre

Karnataka, India

From: drsantosh74 <drsantosh74@...>netrum Sent: Friday, 5 December, 2008 8:22:34 PMSubject: Re: PharmD Course in India - Kind Attn: Dr. Shazia Jamshed

Dear all,Wow what a discussion is this turning about.All credit goes to Dr.Geer for moderating and putting a lots of inputs.By going through the various posts i came to know the various possiblities of the Pharm D course.I also agree that the course fee is bit high but there is the alternative given by Dr.Anupama that it can be taken over by government sectors too.Anyway Clinical pharmacists are the need of the hour and this will go a long way in improving patient care.Keep the good work Geer saabDr.SantoshIn netrumgroups (DOT) com, "Geer M. Ishaq" <ishaqgeer@. ..> wrote:>> Dear Shazia Jamshed:> Thanks for the compliments and your enriching remarks about the topic of current discussion. You have hit the nail right upon its head by stating

that time has come when the pharmacist should change his role from a mere dispenser to a caregiver and decision maker. That is precisely the reason why the initiative taken by PCI is appreciated by one and all. Somewhere the beginning has to be made. So far pharmacists in India have not been able to carve out a niche in so far has their direct involvement in healthcare delivery is concerned. Many experts blaim the faulty education and training that has so far been more industry oriented and less inclined towards pharmacy practice. Even mandatory training at the end of the B.Pharm. course was being imparted in an industrial set up rather than a hospital setting. Under these circumstances a dire need was perceived for a fully clinical oriented course that could exhaustively train the aspiring students in> patient healtcare delivery and hence PharmD Course. The remedial

measures suggested by you to bring the existing dilapidated system back on track are quite laudable and significant. I fully endorse the same. Besides there is need for regular exposure of PharmD students to clinical setting right from their very first year rather than during final year of their course. PharmD candidates should be constantly exposed to the interface that they are ultimately going to serve from the very beginning of their course. I have seen a few letters from your university published in American Journal of Pharmaceutical Education on this very issue. Can you kindly throw some light over the assertions made in those communications and the situation existing in and around the place of your study vis-a-vis pharmacy practice.> With regards> > Dr. Geer M. Ishaq> Assistant Professor> Dept. of Pharmaceutical Sciences>

University of Kashmir> Srinagar-190006 (J & K)> Ph: 9419970971, 9906673100> Website: http://ishaqgeer. googlepages. com> > > > > ____________ _________ _________ __> From: shazia jamshed <shazia_12@. ..>> netrumgroups (DOT) com> Sent: Friday, 5 December, 2008 7:37:35 AM> Subject: Re: Re: PharmD Course in India - Prospects & Constraints> > > > > Dear Dr Ishaq, > > Congrats for taking up this issue of Pharm D course in India-Prospects and Constraints. > > This morning I read the enlightened postings which energize me to write something on this issue. >

> As we all know pharmacists being the health information custodian and the third largest group of health care providers seep into the changing dynamics of healthcare environment where now patient is both demanding and receptive for information even on minor illnesses. To be precise the profession of pharmacy embraces a novel concept of ‘Pharmaceutical Care’ thus changing the image of a pharmacist from a dispenser to a decision maker and caregiver. Still a lot of work is needed to be done to establish the true status of this underrated healthcare group in the eyes of other stakeholder; be it a doctor, nurse or a patient. > A panegyric attempt to provide due recognition to pharmacists as well as to ascend their numbers pharmacy education has taken strides with more number of pharmacy institutes in the recent years. > India will be a role model to follow for developing countries in

terms of Pharmacy Education. > As per Gazette of India, Part III, Section 4, dated 10th May 2008the Health Ministry has paved the way for Indian pharmacy practice training and education by giving formal approval for Pharm D. regulations. The Pharm D course comprises of six academic years with five years of study and one year of internship and residency in speciality units with six months in General Medicine Department and two-months each in other speciality departments. The clerkship coupled with a research project covering areas of biostatistics and research methodology as well as concepts of pharmacoeconomics and clinical research is also in place. Still the fruitful implementation of any such program in Indianeeds coherence of many factorsbut for developing countries to follow the same track is not a bitter pill to swallow. > > To produce a worldly competitive Pharm D

graduate, Pharmacy Education System in will exercise following remedial measures both in curriculum, its implementation as well as pharmacy practice > * Incorporation of courses of Pharmacoepidemiolog y, Pharmacoeconomics and Social Pharmacy with Clinical Pharmacy as a separate entity > * Formation of an Internal Quality Assurance Committee (IQAC) within each pharmacy institute ensuring the delivery of laid down components of the curriculum> * “Training of the Trainers†by interactive, hands-on workshop with the help of international faculties to generate excellence in novel and innovative aspects of curriculum> > > Thanks and Regards > Shazia Jamshed > > > > > Add more friends to your messenger and enjoy! Go to http://messenger. / invite/>

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