Pharmacy Education in Sudan is at a crossroads! Prof. Sami A. Khalid Dean, Faculty of Pharmacy, UST...

Pharmacy Education in Sudan is at a crossroads!

Prof. Sami A. KhalidDean, Faculty of Pharmacy, UST

Outline The current pharmacy education landscape Required curricular changes and future prospects

18th congress of the Scientific Association of the Pharmacy Colleges in the Arab World, Khartoum, 18-20 Nov 2015

Pharmacists - the nation’s experts on medicines

Pharmacy is an interdisciplinary field of science comprising almost every aspect of drug discovery, synthesis, manufacturing, distribution, and patient care.

Patient-focused education is rapidly becoming an essential component of pharmacy education in the developed countries.

Many undergraduate pharmacy programs in Sudan remain influenced by traditional pharmaceutical sciences with limited application of knowledge to patient care.


The Pharmacist Expanding Role!

Pharmacists are healthcare professionals with extensive education and training in the pharmaceutical sciences leading to B. Pharm.

The greatest stride during recent years is expanding the role of pharmacists in the area of pharmacy practice with special focus on patient with an extensive experiential training leading to Pharm D.


Educational challenges and future of practice Reconsideration of the amount of basic sciences

included in curriculum

Science included must be relevant to the need of practicing pharmacist

Skills required for new practice should be underpinned by strong basic sciences

This combination of scientific and clinical training are required to ensure the rigorous, logical and safe approach


The current landscape – Pharmacy Education

Currently there are 16 schools (5 public and 11 private), all but one of which are located in Khartoum.

Their combined annual admission is about 1200 students with fewer male than female students (1:4).

The Faculty of Pharmacy at the university of Khartoum was established in 1964 and remained the only one for 3 decades. Before 1991, the number of students enrolled in the 5 years bachelor program was less than 200.

As of 2009-2013, there were approximately 900 pharmacy students and about 180 graduate each year.


Total number and gender of pharmacy graduates during period 2009 - 2013

2009 2010 2011 2013

Female 523 881 1088 831

Male 270 354 297 345

Total 793 1235 1385 1176

100

300

500

700

900

1100

1300

1500

No

. of

gra

du

ate

s


Average number of pharmacy graduates per year during the last five decades

1960-1970 1971-1981 1982-1992 1993-2003 2004-20140

200

400

600

800

1000

1200

21 59 81164

970

No.

of P

harm

acis

ts

Year


The undergraduate curriculum in U of K follows the traditional full academic year system. The total number of hours for the bachelor of pharmacy degree (B. Pharm) is 3960 hours (4 years, excluding the preliminary year) and consists of 1680 hours of theory (42.4%) and 2280 hours of experiential work (57.6%).

Additionally, students have 200 hours of training at a community or a hospital pharmacy after the second and third years, and 200 hours of pharmaceutical industry training at the end of the fourth year.

Although some clinical aspects are taught sporadically throughout the curriculum, the majority of the teaching and practical training is product focused.

The current landscape – U of K


No.

of S

taff

Status

Professor Associate Professor

Assistance Professor

Lecturer Teaching Assistance

0

20

40

60

80

100

120

140

46 (12%)

49(13%)

71(18%)

101(26%)

122(31%)

Number of teaching staff according to their academic status – nationwide


Percentage of academic staff according to their specializations

29%

15%25

%

31%

Pharmacology

Pharmacognosy

Pharmaceutical Chemistry

Pharmaceutics


Registered medical doctors, dentists and pharmacists in Sudan

Doctors Dental Doctors Pharmacists0

5000

10000

15000

20000

25000

30000

35000

40000

45000

5000043813

5529

11626


2003 2007 2012 2013

Pharmacists 674 1542 1812 1593

Pharmacy assistants 521 759 843 965

Total 1195 2301 2655 2558

250

750

1250

1750

2250

2750

Nu

mb

er o

f p

har

mac

ists

an

d a

ssis

tan

ts

Number of pharmacists and pharmacy assistants in public sector (2003 – 2013)


The U of K program was the first of its kind to introduce MCP in 2004. This program attracts 80-100 applicants annually.

To date, the program has graduated 390 clinical pharmacists and about 100 are due to be graduated this year.

Unfortunately, undergraduate curriculum development in the U of K was confronted by many constraints and lagged behind until very recently. However, some other faculties managed to establish curriculum covering both the pharmaceutical sciences and the clinical subject in an acceptable ratio!

The current landscape (continued)


At present, the facilities, manpower and other resources available do not allow full operation of a patient-focused doctor of pharmacy (PharmD) in Sudan.

Clinically oriented teaching requires the availability of qualified clinical pharmacists for the supervision and follow-up of clinical activities as preceptors.

Accordingly, a 2-year master in clinical pharmacy (MCP) was established by the Faculty of Pharmacy, University of Khartoum, in 2004. This was followed by another similar courses offered by UMST and Omdurman Islamic university.

The current landscape (continued)


Clinical Pharmacy

Pharmaceutical Services Management

Pharmacology

Others

Pharmacoeconomics and Epidemiology

Pharmaceutics

Pharmacognosy

Analysis and Quality Assurance for Cosmetics

Pharmaceutical Chemistry

0 50 100 150 200 250

237

59

22

42

10

9

9

9

8

Spec

ializ

ation

s

Number of specialists

Number of registered specialized pharmacists in Sudan


Change itself (expanding role) Patient expectations Workload Human resources Knowledge and skills Inter-professional collaboration Current legislation Leadership Lack of remuneration

Change is inevitable but at no quantum leaps!


What needs to change?Why is it necessary?How will it happen and when?Who will develop, implement and sustain the process?Who are the key stakeholders?What is their motivation?What knowledge, skills and attitudes will individuals need to carry out the change?What will cost relative to benefit?How does the change relate to existing organizationalarrangements?

Key questions to change existing pharmacy education


Thinking globally and acting locally!

Globalization has revolutionized health educational processes across the globe.

Past few years have witnessed dramatic transformations in pharmacy educational system.

This transformation, however, resulted in compromising some pharmaceutical sciences and ignored an integral components of pharmacy education.


Pharmacy education should de-emphasize some basic pharmaceutical science by incorporating elements of the professional program leading to Pharm.D.

The National Association of Board of Pharmacy Licensure Examination (NABLEX) increased the weighting of pharmaceutical sciences to 40% since May 2005.

The Misconception!

Newton et al. The NAPLEX: Evolution, purpose, scope, and educational

implications. Am J Pharm Educ. (2008)72 (2) 33.

Pharmacists are involved in research to reveal the basic biochemical mechanisms of health and disease and explore molecular targets for new drugs.

They develop and share leading technologies that enable their science. They drive the development of new medicines, investigate methodologies toward the safest, individualized, and most effective use of affordable, accessible medications for all patients.

Regardless of where their work falls along this spectrum, precise therapeutics is their common goal.

A great momentum for pharmaceutical sciences!

What are the pharmaceutical sciences?

Defined as the “science of medicines”

It is the science underpinning the discovery, development, production, and use of medicines — arguably one of the most complex and sophisticated endeavours of mankind.

International Pharmaceutical Federation (FIP). Impact of Pharmaceutical Sciences on Healthcare. The Hague: International Pharmaceutical Federation (FIP); 2012.


One of the ever-pressing need is to make drugs safer and their development more efficient and cost-effective in order to provide society with affordable quality medicines to meet both unmet medical needs and improved drugs to replace existing suboptimal ones

Why the pharmaceutical sciences?

International Pharmaceutical Federation (FIP). Impact of Pharmaceutical Sciences on Healthcare. The Hague: International Pharmaceutical Federation (FIP); 2012.


Fields of pharmaceutical science

International Pharmaceutical Federation (FIP). Changing the world by translating science into practice [pamphlet]. The Hague: International Pharmaceutical Federation; 2014.

Drug Design, Discovery and Drug delivery PK/PD and Systems Pharmacology Phytochemistry/Natural products Formulation Design and Pharmaceutical Technology Translational and Personalized Medicine Biotechnology Analytical Sciences and Quality Control Regulatory Science Pharmacoeconomics Metabolomics etc.


Needs-based professional education model, FIP

NeedsLocal, regional,

national and international

ServicesProvided by the

pharmacy workforce to meet these needs

CompetenciesDemonstrated by the pharmacy workforce

to provide these services

EducationCompleted by the

pharmacy workforce to build these competencies

Quality assured

Locally determined

Globally connected

Socially accountable


Comparing traditional and CBE models

You don’t know what you don’t know


Competency…a complex construct

Competency

Skillsowledge

ValuesattitudesValues

attitudesavioursBehaviours

nowledgeKnowledge

SkillsSkills

BehavioursValues

attitudesCompetency


Competency

BehavioursAttitudes

Knowledge Skills

The awareness and understanding of facts, truths or information gained in the form of experience or learning, or through introspection.

Proficiency, facility, or dexterity that is acquired or developed through training or experience.

A settled way of thinking or feeling about someone or something, typically one that is reflected in a person's behavior.

The way in which one acts or conducts oneself


Demonstrating competenceM

iller

’s T

riang

le, 1

990


Competency based education (CBE): perspectives

.

For:“Education systems and improve the efficiency and effectiveness of their mission through competency based education and a focus on the performance requirements for all health professionals”

Gruppet et al, Human Resources for Health, 2012.

Against:

“Competency based curriculum cannot describe what it is to be a professional”

Brightwell and Grant, BMJ 2013


Pharmaceutical Services Competencies Assessment Participants (2014)

Taskforce and Technical group 1 (framework development)

Technical group 2 (Reviewers)

Detailing 9 % 11%

Supply 11% 11%

Quality assurance of pharmaceuticals

14% 11%

Regulation 9% 11%

Planning 14% 6%

Education 18% 6%

Hospital 14% 22%

Community 5% 11%

Industry 7% 11%

Total 44 participants 18 participants

57%

33%

Public Private


Public Pharmacy

33%

Private Pharmacy34%

Manu-facturer

5%

Supply Body

8%

Wholesaler5%

Pharmacy Direc-torate

8%

Pharmacy Faculty 6%

NMPB1%

Classification of surveyed pharmaceutical facilities

Pharmaceutical Services Competencies Assessment (April – 2014)


How dose education help to prepare pharmacists for the new reality?

Didactic Experiential

Changes needed throughout the

continuum of learning (CPD)!


Contents of the required curriculum

Pharmaceutical Sciences Biomedical Sciences Behavioral, social, and administrative sciences Pharmacy practice Professional experience


Reg

ula

tio

n

Time

Quality Assurance

Recognition

Accreditation

Accreditation: Recognition x QA


The Gold Standard for QA in Professional Education Worldwide is…

Mission, Planning, and Assessment

Organization and Administration

Curriculum

Students

Faculty (Staff)

Library and Learning Resources

Physical and Practice Facilities

Financial Resources

Accreditation

Best Evidence Pharmacy Education


SMC authority comes from an Act of Parliament.

Assurance to the public that schools of pharmacy have adequate educational programmes.

Pre-registration training is preparing trainees to apply their knowledge and skills necessary to practice pharmacy.

Examination of the candidates before their recognition as pharmacists and keeping register

SMC Authority to Ensure the Safety of the Public


The Envisaged Change: It is Not “either/or” Decision!

1st Year (Didactic Experiential) 5th Year

Internship

Science-Based pharmacy

Experiential

CalculusPhysicsBiologyChemistryPharm. Chem.PharmaceuticsMicrobiologyPharmacognosy

Functional anatomyPhysiologyPathophysiologyBiochemistryMolecular biologyImmunologyPharmacology/ToxicologyPharmacogenomicsBiotechnologyPharmacotherapeutics Pharmacy practiceCommunication skill

- Clinical Pharmacy- Problem solving - Integration of

knowledge - Professionalism- Therapeutic monitoring - Disease state management

B. Pharm.


??2nd Year 3rd Year 4th Year 5th Year

Practice Courses

Pre

-reg

istr

ati

on

YearBasic and Applied Sciences

1st Year

Global Dilemmas for Pharmaceutical Education: Science or Practice?


Preregistration Training The aim of the preregistration programme is to

make the transition from student to an effective member of the pharmacy profession.

To develop necessary skills, knowledge and attitudes to undertake the role as pharmacist properly and consistently.

Licensing examination is intended to assess the application of knowledge and cognitive skills necessary for practice as a pharmacist.


Preregistration Period Structured experiential education program to be initiated

from the 4th year and continued as on-site training for not less than 9 months after getting the

B. Pham.

The evaluation of the B.Pharm should be scenario-based utilizing Computer Adaptive Testing (CAT)

The training should be directed to hospital and/or community setting under the supervision of qualified trainers (preceptor).

Objective Structured Clinical Examination (OSCE) should be included in the assessment.


License to practice = Protecting the public The SMC examination insures a minimum standard

of knowledge, skills and abilities necessary to practice pharmacy

It should be based upon two psychometric parameters (i.e. difficulty & discrimination) for the measurement of competence that ultimately secures the protection of the public

Computer adaptive testing (CAT) introduced successfully last seven years by SMC.


Pre-registration Training and assessment

Structured experiential education program to be initiated and continued as on-site training for not less than 9 months after getting the B.Pharm. under the supervision of qualified preceptor.

The evaluation of the B.Pharm should be scenario-based utilizing Computer Adaptive Testing (CAT).

Objective Structured Clinical Examination (OSCE) should be included in the assessment.


Total can-didates

Passed Failed 0

1000

2000

3000

4000

5000

6000

5596

4837 (86.4%)

759 (15.6%)

The Transition – from Graduate to Pharmacists!


45

Suggested Pharmacy Career Path!

Depending on CPD Portfolio (3 yrs.)

Pre-registered Pharmacist

After structured-supervised residency period

After acquiring a relevant postgrad degree

Specialist

Senior Specialist

Consultant

Depending on CPD portfolio

Registered

Pharmacist After passing the licensing SMC exam

Depending on CPD portfolio (2 yrs.)

Senior Consultant


The Continuum of Education for professionals

5 – 6 Years ± 40 Years

Life long Learning

How competencies are acquired for pharmacy practice?

Continues Professional Development (CPD)

Pharm DB.Pharm


The Way Forward!

Pharmacy needs a strategic action plan for the pharmacy profession to strengthen its alignment with the health care needs of Sudanese population and to respond to the stresses on the health care system.

All concerned stakeholders: Ministry of Health, Sudan Medical Council, Ministry of Higher Education, Sudan Pharmacists Union, Academia, pharmacy owners etc.. should articulate a common vision and implement a coordinated plan of action.


CONCLUSION

There is NO “one size fit all” Curriculum. Each Pharmacy School is unique in its mission in Pharmacy Education and therefore each school should determine what their visions and missions before making any curricular changes.

There are many barriers for curricular changes need to be overcome (e.g., faculty shortage, research vs. teaching, etc.)

Curricular changes should be done progressively and NOT by a quantum leap. So, take it slow!


Improving the quality of high schools education.

Admission test of competency.

Update of syllabus to cope with the latest in

pharmaceutical sciences and pharmacy practice.

Introduction of new subjects needed for future

prospects in the profession.

Recommendations


Changes creates opportunities…. as well as challenges ….

Thank You!


Pharmacy Education in Sudan is at a crossroads! Prof. Sami A. Khalid Dean, Faculty of Pharmacy, UST...

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