Innovative PharmD course - Prospects and constraints

In the recent years pharmacy education has grown to generate highly skilled and technical manpower to manage the wide spectrum of pharmaceutical activities associated with the manufacture and sale of medicines. In India, pharma industry is on ascent, with annual growth of 9% to attain estimated 20 billion Euro business by 2015. Currently there are 600 degree and 500 diploma institutions churning out 50,000 graduates, 35,000 diploma holders, 1000 postgraduates and about 300 doctorates every year in India.

In spite of these numbers, pharmacy profession is relatively young in India and has chequered path. Today there is a paradigm shift from the existing industry oriented approach to service and patient-centered curriculum in pharmaceutical academic parlance. There is a drastic change in the approach of Pharmacy Council of India (PCI) to the problems plaguing the profession. There is also a glaring attitudinal change in the student and teacher perception of pharmacy profession. These indications auger well for the profession in realizing the ultimate objective of producing a seven star pharmacist.

In India, although pharmaceutical industry has advanced in last 25 years, the pharmacist continues to remain in backstage of pharmaceutical industry and a salesperson in retail pharmacy. This image has to change, which can be attained by raising the educational standard of pharmacists. No serious attempt has been there to modify the curricula of pharmacy education in India since many years in contrast to manufacturing standards, QC practices, research activities and clinical practices which have undergone tremendous changes.

To fulfil these objectives and to improve the standards of pharmacy education in India, particularly with respect to the emerging discipline of clinical pharmacy, Pharmacy Council of India (PCI) in 2008 started a six year integrated Pharm D course.

The PCI initially approved 28 colleges to start Pharm D course from current academic year. Initially, the permission to start the Pharm D will be issued for a period of one year and will be renewed on yearly basis subject to verification of facilities and achievements of annual targets. PCI has designated a regular panel of inspectors for periodic inspection of pharmacy colleges having Pharm D course throughout the country. This will be a critical responsibility on PCI considering the fact that several pharmacy colleges offering B Pharm degree do not have basic lab facilities and qualified faculty. Any lapse in monitoring and periodic inspection of these Pharm D institutions can tempt their managements to compromise on facilities and thereby devalue this advanced course.

Pharm D programme (Doctor of Pharmacy - six years programme). It is a six years program during which five years comprise of the academic session and final year is for internship in the hospital.

Eligibility
10+2 (M.P.C./Bi.P.C.) or D.Pharm

Subjects Offered:
First year: Human Anatomy and Physiology, Pharmaceutics, Medicinal Biochemistry, Pharmaceutical Organic Chemistry, Pharmaceutical Inorganic Chemistry, Remedial Mathematics/ Biology.

Second Year: Pathophysiology, Pharmaceutical Microbiology, Pharmacognosy & Phytopharmaceuticals, Pharmacology-I, Community Pharmacy, Pharmacotherapeutics-I.

Third Year: Pharmacology-II, Pharmaceutical Analysis, Pharmacotherapeutics-II, Pharmaceutical Jurisprudence, Medicinal Chemistry, Pharmaceutical Formulations.

Fourth Year: Pharmacotherapeutics-III, Hospital Pharmacy, Clinical Pharmacy, Biostatistics & Research Methodology, Biopharmaceutics & Pharmacokinetics, Clinical Toxicology

Fifth Year: Clinical Research, Pharmacoepidemiology and Pharmacoeconomics, Clinical Pharmacokinetics & Pharmacotherapeutic Drug Monitoring, Clerkship, Project work (Six Months).
Sixth Year: Internship or residency training including postings in speciality units. Student should independently provide the clinical pharmacy services to the allotted wards.

(i) Six months in General Medicine department, and
(ii) Two months each in three other speciality departments

Hospital details to link with institute to run Pharm D & Pharm D (Post Baccalaureate) courses:

Hospital should have teaching facility (minimum 300 beds), Pharmacy Practice Department, Specialty of Medicine and any three of the following:

• Surgery
• Pediatrics
• Gynecology and Obstetrics
• Psychiatry
• Skin and VD
• Orthopedics

Pharm D Post Baccalaureate programme: It is a three year programme with two years of study and one year internship or residency.

Eligibility: B.Pharm

Number of seats under each programme allowed as per PCI

Pharm D Programme – 30 students.
Pharm D (Post Baccalaureate) Programme – 10 students
(Ref: www.pci.nic.in)

SALIENT FEATURES OF PHARM D COURSE

1. All subjects taught during B Pharm and M Pharm (Pharmacy Practice) are thoroughly covered including key subjects like Pharmaceutics, Pharmacognosy, Pharmaceutical Chemistry, Pharmacology, Microbiology, Biochemistry, Jurisprudence, Medicinal Chemistry, Biopharmaceutics and Pharmaceutical Formulations.

2. Subjects like Clinical Pharmacy, Community Pharmacy and Hospital Pharmacy have been introduced as independent subjects.

3. New subjects like Clinical Research, Pharmaco-epidemiology, Pharmaco-economics, Biostatistics, Pathophysiology, Clinical Toxicology have been introduced.

4. Pharmacotherapeutics is being taught in three parts spread over three years which will train the pharmacists to meet the challenges of clinical set up and equip them well to actively participate and contribute during ward rounds. This area has so far remained grey for Pharmacists depriving them of clinical rounds and decision making.

5. Hospital Posting: Every student shall be posted in constituent hospital for a period of not less than 50 hours to be covered in not less than 200 working days in each of second, third and fourth year of the course.

6. Clerkship (attending ward rounds on daily basis during fifth year of the course) followed by a seminar at its end.

7. Project work (spread over six months during fifth year of the course) to allow the student to develop data collection and reporting skills in the area of community, hospital and clinical pharmacy. This shall be carried out under the supervision of a teacher. Students will prepare a project report under the guidance of an approved teacher.

8. Internship or residency training for one year during sixth year of the course including postings in specialty units which includes six months in General Medicine department, and two months each in any other three specified specialty departments.

WHO has specifically emphasized the contribution of pharmacists in rational use of medicines by ensuring the pharmacist’s participation in ward rounds, advising medicines to in-patients, monitoring prescriptions, running medicine information centres, in Drug and Therapeutics Committee (DTC) etc. WHO wishes that a pharmacist should be a caregiver, decision maker, life-long learner, communicator, teacher, manager and leader. In order to shoulder these responsibilities, pharmacists need to be appropriately equipped through focused and suitable training which has so far been lacking.

It was with these objectives in mind that the six year integrated Pharm D course was conceived, designed, developed and notified by the PCI under the leadership of its dynamic president, Dr. B. Suresh in 2008. The course aims at rigorously training aspiring candidates in clinical pharmacy practice with one full year of internship in medical as well as surgical specialty wards besides six month long project work and six month long clerkship in a 350 bedded hospital.

The Pharm D course has met with a lot of appreciation and some criticism at the same time. Appreciation has been showered for taking concrete steps towards opening up new vistas in the practice of clinical, hospital and community pharmacy in India and criticism for high fee structure and fewer job opportunities in India. However President PCI, Dr. B. Suresh contends that the new course is actually aimed at opening up vast career opportunities for our pharmacy professionals abroad who have so far been finding it difficult to get licenses to practice pharmacy outside India. Besides, Dr. Suresh claims that the pass outs of the new course shall find more job prospects in fast expanding and flourishing Clinical Research Organizations (CRO) in India.

The Pharm D degree provides registered pharmacists the knowledge and skills of current diagnostic methods, treatment modalities, drug delivery system, therapeutic outcome, pharmaco-economics and pharmacotherapy to meet the rapid changes in the healthcare. The new course is intended to bring Indian pharmacy education at par with the western model and will provide opportunities for Indian students to practice in foreign countries too. Hitherto, the four year programme was not recognized in Western countries, thus severely affecting the job opportunities. Hence PCI contemplated this six year Pharm D course for international acceptability. Pharm D course is a step in the right direction and worth pursuing. However it needs to be made affordable and available at Govt. colleges/universities also. PCI needs to clarify whether Pharm D candidates can apply for Government jobs which stipulate B Pharm / M Pharm as mandatory qualification. All stakeholders need to work in tandem to uplift pharmacy profession and foster the practice of clinical pharmacy in India. Pharm D course is therefore a step ahead in the right direction.