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Letters to the Editor
Integration, not balance, of science and practice is required
From Dr A. W. Smith, MRPharmS
Both Patrick Wilson and Ivan Stockley (PJ, 3 July, p19) raise questions about the fourth year of the MPharm degree programme and the preparedness of future pharmacists for practice. The fourth year, taught at master’s level, provides the opportunity to take students to the forefront of the discipline and to enable them to reach judgements in complex scenarios where data may be incomplete and where there is uncertainty. So, for example, in my own school of pharmacy, a significant component of the fourth year is clinical pharmacy and ward-based teaching where students consider medicines management for patients with multiple conditions in exactly the same way as colleagues face in practice every day. The additional year has also enabled a clinical placement to be included in the third year, together with opportunities for interprofessional learning alongside medical and nursing students. These, too, offer context to the fourth-year studies.
Two issues are relevant to the current discussion. First, who teaches in our schools of pharmacy? The schools are not ivory towers populated by pharmacist and non-pharmacist academics with little understanding of, or interest in, the practice of the profession. Rather, they comprise an integrated group of academics and practitioners who collaborate closely in planning, delivering and assessing all aspects of the MPharm degree. The second substantive issue is that of the science/clinical practice debate. The profession must move on from talking about the balance between science and practice in the undergraduate curriculum. Balance suggests that the two are different and set against each other. They are not. The talk must be of integration, for without the underpinning molecular and pharmaceutical sciences there is no foundation upon which to build clinical practice.
Others in these columns have commented on frequently questioned topics such as drug synthesis, molecular structure determination, thermodynamics etc. It is true that the challenge for schools of pharmacy is to ensure these topics have a clinical context, however these “hard” sciences should not be abandoned in favour of verbatim cramming of the current issue of the British National Formulary. In delivering a master’s level qualification, the schools of pharmacy have to consider the long term as well as the short-term “oven-readiness” of graduates. In particular, the schools must take account of knowledge half-life and focus on those concepts that will sustain postgraduation learning and development well into the mid-21st century. It is a truism that medicines usage and pharmacy are always changing, but this is never more true for today’s graduates, whose careers will be defined by the era of genomics. If pharmacists are to be relevant to medicines development, utilisation and patient care in the genomics era, then they must continue to understand what makes drugs work at the molecular, cellular, tissue and whole patient level.
With time and continuing professional development, today’s pharmacy graduates more than ever before have the underpinning knowledge and skills to come out from behind the BNF, stop being passive bystanders and really contribute to the advancement of patient care.
Head, Department of Pharmacy and Pharmacology,
University of Bath
There are no shortcuts on the long journey to expertise
From Mrs L. M. O’Loan,MRPharmS
I have been following the science versus practice in pharmacy education debate with great interest over the past few weeks. I am currently undertaking an Open University MA in Education, and would like to offer my view from an educational perspective.
The “theory-practice divide” is well established in the field of education.1 Theoretical knowledge, which is abstract in nature and is often acquired in a classroom setting,2 has historically enjoyed a higher status than practical knowledge,3,4 which develops through participation in “real world” practices.1,2,5 It has been suggested that greater emphasis should be placed on practical knowledge to reduce the problem of “knowing without doing”,1 but that this should not be done at the expense of theoretical knowledge, otherwise the problem could become reversed.1,2
Expert knowledge is both theoretical and practical.5 Indeed, it has been noted recently that experts in clinical pharmacy “need extensive knowledge both of the literature and from experience”.6 So how can we integrate theoretical and practical knowledge? Various solutions to this question have been proposed, including highlighting the relevance of theoretical concepts to the “real world”,1 employing “real world” problems to “problematise” theoretical subjects,7 and using simulated work experiences,8 all of which are useful but do not provide the definitive answer.
It has been suggested that “an understanding of the context is critical to make sense and use of the theoretical and abstract knowledge of science”.1 This would lend support to Larry Goodyer’s view that “the only way to produce graduates more oriented towards the health professions is to ensure a reasonable level of patient throughout the undergraduate period” (PJ, 3 July, p19). While this approach could help students to link theoretical and practical knowledge, the issue of how (and whether) knowledge is transferred from one setting (such as the classroom) to another (such as the workplace) remains contentious.8,9
My view from an educational perspective, therefore, is that, although we should be aiming to integrate theoretical and practical knowledge, there is unlikely to be a shortcut on the long “journey to expertise”.6
Annual Programme Co-ordinator
London Pharmacy Education & Training
1. McCormick R. Practical knowledge: a view from the snooker table. In: McCormick R, Paechter C (editors). Learning and knowledge. London: Paul Chapman Publishing; 1999. pp112–35.
2. Sfard A. On two metaphors for learning and the dangers of choosing just one. Educational Researcher 1998;27:4–13.
3. Lewis T. Valid knowledge and the problem of practical arts curricula. In: Moon B, Murphy P (editors). Curriculum in context. London: Paul Chapman Publishing; 1999. pp130–47.
4. Young M. The curriculum as socially organised knowledge. In: McCormick R, Paechter C (editors). Learning and knowledge. London: Paul Chapman Publishing; 1999. pp56–70.
5. Glaser R. Expert knowledge and processes of thinking. In: McCormick R, Paechter C (editors). Learning and knowledge. London: Paul Chapman Publishing; 1999. pp88–102.
6. Shulman R, Lovejoy A. Assessing clinical pharmacy expertise. The Pharmaceutical Journal 2004;273:26–28 (PDF 90K)
7. Hiebert J, Carpenter TP, Fennema E, Fuson K, Human P, Murray H et al. Problem solving as a basis for reform in curriculum and instruction: the case of mathematics. In: Murphy P (editor). Learners, learning and assessment. London: Paul Chapman Publishing; 1999. pp151–70.
8. Gruber H, Law LC, Mandl H, Renkl A. Situated learning and transfer: implications for teaching. In: Murphy P (editor). Learners, learning and assessment. London: Paul Chapman Publishing; 1999. pp214–30.
9. Wallace M. When is experiential learning not experiential learning? In: Murphy P (editor). Learners, learning and assessment. London: Paul Chapman Publishing; 1999. pp230–44.
If pharmacists have no communication skills, knowledge is wasted
From Mr B. Shooter, MRPharmS
A. T. Florence (PJ, 3 July, p18) makes valid points about the importance of the scientific content of the MPharm course and how it will vary to suit the perceived present and future needs of the profession and its members. Pharmacy itself is surely the dissemination of this knowledge to those who require it whether they be patients or professionals.
Where should the skills needed to manage and communicate this knowledge be acquired? During the course, during the preregistration year or by experience while practising?
I have the great privilege of being able to combine the practice and management of community pharmacy with the teaching of these aspects of the profession. The students with whom I have are given tuition in communication skills, and are encouraged to gain work experience during vacations, to make full use of their preregistration year and to participate fully in continuing professional development once they are qualified. Unless pharmacists have the will and skills to communicate, their scientific knowledge may well be wasted.
The extra year is for integrating science and practice
From Professor M. Heinrich
In response to the important and intensive discussion on the curricula in schools of pharmacy, I am concerned that a four-year degree course is seen as one which is only there to prepare for practice (see letter from Patrick Wilson, PJ, 3 July, p19).
One of the strong aspects of a course like pharmacy is the integration of (basic and applied) science with practice. Getting the balance right is difficult but, while a university will be able to lay the groundwork for “clinical practice”, the everyday and continuous experience (and training) will have to come during the preregistration year and, of course, afterwards (through continuing professional development).
The complexity of modern science requires a profound understanding of a multitude of basic scientific concepts relating pharmacy to other and diverse sciences (eg, biology, chemistry, material sciences). It is this multidisciplinary nature of pharmacy which makes it unique, provided that we are able to focus on the core tasks of pharmacy: the formulation, pharmacological effects, quality, clinical use, discovery and other aspects of medicines. Clinical practice without understanding the scientific basis of these medicines would be a worrying risk to patients, but also implies serious risks to the profession. If graduates have problems in the area of drug monitoring, this is as much a challenge to improving the training in the natural sciences as in clinical pharmacy. It will be essential not to underestimate the complexity and diversity of the scientific knowledge base required.
Lastly, we should remember, that schools of pharmacy today train people who will be dispensing medicines for 40 to 50 years and, for example, in order to profit from continuous professional development, they will need a profound understanding of the relevant areas of science.
Centre for Pharmacognosy and Phytotherapy
School of Pharmacy,
University of London