Education - Do we have a choice?

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PharmaCon2007 Congress, Dubrovnik, Croatia "New Technologies and Trends in Pharmacy, Pharmaceutical Industry and Education" http://www.pharmacon2007.com …

PharmaCon2007 Congress, Dubrovnik, Croatia "New Technologies and Trends in Pharmacy, Pharmaceutical Industry and Education" http://www.pharmacon2007.com
Abstract is available at http://www.pharmaconnectme.com

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  • 1. Pharmacy Education: Do we have a choice? Professor Ian Bates The School of Pharmacy University of London
  • 2. European Directive
    • 3000 hours of directed study within a full-time degree of four years’ duration
    • Greater part of curriculum and not less than 50% of final year must be core
    • At least 35% on actions and uses of drugs
    • At least 35% on experiments and data analysis
    • Research project of 3 – 6 months duration
  • 3. The professional imperative
    • Better care,
    • Better patient experience,
    • Better value for money
  • 4.  
  • 5. Cognitive learning theories: Behaviourist – operant conditioning
  • 6. Stimulus - response
  • 7.
    • Curricular pressures
      • Integration of pharmaceutical and clinical sciences
    • Dislocation of education and practice
    • Not competency-based
    • Not a partnership
      • With national health systems
      • With existing health professionals
    But ….
  • 8. A modern education…
    • … from undergraduate to Consultant
    • A cooperative policy of strategic planning using evidence
  • 9.
    • The learning experience
    • Syllabus – knowledge & content
    • Delivery & quality
    • Outcomes
    • Context – institutional, societal & cultural
    • Access, finance & policy
    Curriculum
  • 10. Pharmacy students N = 5,243 p<0.0001 Standardised mean scores Assessment Goals Independence Good Teaching
  • 11. Motivation: Pharmacy studies % cases (n=1308)           Slovenia Romania Swiss NL Portugal Singapore Nepal Australia Jamaica Malaysia     0 25 50 75 Bates, 2004 Money Job issues Altruism Health interest Science Money : Science rho = − 0.6
  • 12. Standardised mean scores Assessment Goals Independence Good Teaching
  • 13. Standardised mean scores Assessment Goals Independence Good Teaching
  • 14. Bates 2004 University B -0.4 -0.2 0.0 0.2 Mean Z score Clear goals Openess Independence Good teaching workload Assesment High didactic Low didactic Lectures, exams, timetable University A University C
  • 15.
    • It varies
    • Why?
    • Is this acceptable?
    • How can we improve it?
    The learning experience
  • 16. Demographics & workforce
  • 17. Gender by country N=5243 Bates 2005
  • 18. Who’s smarter?
    • OSCEs during
    • pre-registration training
    • Females have a greater success rate both at start and end of pre-registration year.
    • (U= 4252.0, p= 0.004)
    • McRobbie, Bates, et al
    n = 5773 P<0.0001          N = 5773 P<0.0001 Pharmacy graduates Boys Girls gender    + 1st 2:1 2:2 3rd Degree class 10.00 20.00 30.00 40.00 50.00 %
  • 19. Syllabus – the Knowledge problem … pharmacy syllabus is overcrowded chemistry pharmacology biotechnology genetics medicine analysis formulation physical chemistry ethics pharmacognosy phytochemistry drug design immunology pharmacokinetics therapeutics pathology epidemiology health economics chemical analysis physiology proteomics statistics law Licensing&marketing ADRs microbiology medicinal chemistry biochemistry toxicology drug metabolism genomics social & behavioural sciences
  • 20. And so…?
    • Methods
      • PBL
      • Near to patient cases
      • Clinical contact
      • Experiential
      • Subject Integration
    • Designs
      • Scientists as practitioners
      • Adult learning & self-direction
      • Pragmatic & meaningful in situ LLL
  • 21.
    • Competency ->
    • Competence ->
    • Performance
    • Fit to practise?
    And finally…outcomes
  • 22. 10% 20% 30% 40% 50% 60% 70% 1996/97 1997/98 1998/99 2001/02 Pharm Care Competence (OSCE) 60% 30% McRobbie et al Graduation One year later
  • 23. “ Competence” is a complex educational construct… ...with new currency value Skills Behaviours Knowledge Values attitudes Competency Skills Behaviours Knowledge Values attitudes Competency Skills Behaviours Knowledge Values attitudes Competency Skills Behaviours Knowledge Values attitudes Competency
  • 24.
    • Competence -> Performance
    Outcomes
  • 25. Miller’s pyramid Does Shows how Knows how Knows From UG to post-registration development performance assessment in vivo performance assessment in vitro clinical context assessment factual assessment Practice-based, MiniPAT, MiniCEX, etc OSCE style Case studies/ PBL /Portfolio MCQ / Exams
  • 26. Predominantly FDL and e-modes Predominantly face-to-face modes Cohort learners Lone learner On-site (HEI) learning Off-site (work) learning Learning modality with time/career pathway FDL, e-modes off-site, experiential Independent Career driven UG UG/Pre Post-reg Higher
  • 27. Pharmacist Development Strategy Consultant pharmacist Higher level practitioners eg. PhwSI General practitioner Competency progression Development Contributing knowledge & skills Acquiring Knowledge & skills Research & teaching PhD/MPhil New D level MRes PG M level Diploma Registered pharmacist
  • 28.  
  • 29. Logrank P = 0.0048 Intervention = GLF n = 30 hospitals Time - months 14 12 10 8 6 4 2 0 -2 Probability .7 .6 .5 .4 .3 .2 .1 0.0 -.1 Intervention Testing general level competency framework in junior pharmacists Non-intervention
  • 30. -2 -1 0 1 2 -2 0 2 4 6 F E M F E M F E M F E M F E M HOMALS Quantification Higher level practitioners n = 390 Expert PP Leadership Management E & T R & E Practice level Specialist in training Experienced practitioner Leading-edge practitioner
  • 31. General and Higher level practice: Growing the next generation
    • Developmental and competency frameworks are sector independent [Hospital? Community? – it makes no difference!]
    • They work
    • The strategic approach is educational and developmental
    • “ General” can be highly specialist
  • 32.  
  • 33. General and Higher level practice: Growing the next generation
    • The next [urgent] challenge…
    • Competency frameworks for undergraduate education
    • Assessment of performance at UG level
  • 34.  
  • 35. What will high-income countries be suffering from in 2030? (Source: WHO) Depression Heart attack Dementia Alcohol Diabetes Stroke Hearing loss Lung cancer Osteoarthritis Emphysema Percentage of total illness
  • 36. What will low income countries be suffering from in 2030? (Source: WHO) AIDS Birth Depression Road accidents Heart attack Pneumonia Diarrhoea Stroke Cataracts Malaria Percentage of total illness
  • 37. The pharmaceutical imperative
    • Bring our pharmaceutical science into healthcare practice
  • 38. What are the opportunities for pharmacy in healthcare?
    • Chronic disease management
      • Prescribing
      • Medical partnerships
    • Medication review
    • Public health
    • New diagnostics
    • Personalised medicines
  • 39. Where is our professional ‘centre of gravity’?
    • Patient-focussed, medicines-centred
  • 40. Pharmacy Education: Do we have a choice? Professor Ian Bates The School of Pharmacy University of London