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Am J Pharm Educ. Aug 15, 2008; 72(4): 94.
PMCID: PMC2576434

Pharmacy Education in Developing Countries: Need for a Change

To the Editor: I would like to further elaborate on the ongoing debate regarding issues in pharmacy education in developing countries as discussed in 2 previous letters.1,2 More institutions and even whole countries in the developing world are switching their system of pharmacy education, often blindly, to align with the changes taking place in the West. In this current scenario, many of the western countries have transformed their existing straight-forward bachelor of science or bachelor of pharmacy degree programs to doctor of pharmacy (PharmD) programs. This change has not taken place over night but has occurred after years of thinking and endurance. The situation we are seeing in the developing countries is more of a copycat trend. There are more important issues in higher-education in third-world countries than simply increasing the duration of programs just for the sake of putting a title of “Dr” in front of the names of all of the new graduates without determining whether they even deserve it or not.

State of Pharmacy Practice

Pharmacists in the West are considered as one of the pillars of the healthcare sector. They are responsible for imparting comprehensive and enhanced patient care and are an integral part of the bigger collaborative care model. Most of the pharmacy schools in South Asian countries, particularly in Pakistan, are surviving even without an attached hospital where the pharmacy students can get basic clinical knowledge. This is in addition to the already discussed point of a severe lack of experts/academicians in the field of clinical pharmacy2 or even hospital pharmacy or community pharmacy. I say this because, although most of the related people in Pakistan know about the concepts of hospital pharmacy and community pharmacy, they are still quite ignorant about the branch of clinical pharmacy.3 Even when one analyses the ideal pharmacist-controlled hospital pharmacy or community pharmacy practice in Pakistan, then it is sad to say that even in the 21st century, it still remains almost unheard of.4 Apart from a handful of hospitals and pharmacies in Pakistan that have a formal setup where pharmacists are given on-the-job training and all prescriptions go through the pharmacist, one of them being the Aga Khan University Hospital,3 others just operate as private drug stores owned by non-pharmacists where it is no big deal to get even a prescription drug without a prescription.5 This trend in Pakistan is similar to many of the other third-world countries.6-9 Most of the personnel in these so-called pharmacies have minimum pharmacy training or any related training.4 Furthermore, if a store claims to have a working pharmacist, he/she is seldom found in the store.5,7,10 A couple of reasons for this problem are shortage of qualified individuals and preference of most pharmacists in Pakistan to work in other fields, like industry.

Duration of Study and Training

In a dire situation like this, how can the concerned authorities even think of making the introduction of a PharmD degree in place of a bachelor of pharmacy degree a priority when they already have a hundred other basic issues to take care of? With such a shortage of trained personnel, it is obviously wiser to keep the degree at its present 4-year duration rather than increasing it by another year and indirectly inhibiting the already financially deprived students in a below-the-poverty-line country from enrolling in such a program! To correct the problem of educating students in clinical pharmacy skills, it is better to introduce a pharmacy residency program or specialized internships at the postgraduate level in areas like clinical pharmacy. One such internship program exists at the Aga Khan University Hospital in Pakistan where fresh university undergraduates are given a full year of training in hospital pharmacy, community pharmacy, and clinical pharmacy skills. Proof of the success of this program is the fact that graduates of this program are serving in many institutions around the world.11 On the other hand, residency programs in pharmacy are getting very common in the West and allow pharmacists to specialize in an area, just as medical residency program for their physician counter parts.12,13 This is a growing concept in the West, particularly in medicine programs, where University administrations and curriculum experts are looking to shrink the already inflated medicine undergraduate programs by a whole year. This is being done by introducing the problem-based learning (PBL) approach where the mission is to make the students life-long learners so that they are equipped with problem-solving skills on issues they have not even learned in school. It also believes that one does not need to pour everything in the brains of students, since once they are groomed as active learners, then they can merge into any area of study that they want to. I think the authorities in developing countries ought to follow something constructive from the West this time by shedding some burden off the students' shoulders by teaching them selectively and comprehensively, in the shortest possible time, and nurturing them into active learners. What could be a better example than of McMaster University, from where PBL originated and has evolved tremendously over the many years.14 Now the medicine program at McMaster has been reduced to 3 years of study, the shortest in Canada.

The ultimate goal to produce pharmacists anywhere should be to widen their knowledge base and competence. These are basic components of study anywhere in the world and the reason why pharmacists continue to grow in their abilities to perform more challenging responsibilities. To name a few, pharmacists in Scotland,15 Britain12 and many parts of Canada12,13,16 have already been awarded with limited powers either to prescribe or to change existing prescriptions. Although not impossible in developing countries, a lot more has to be done to see this dream come true.

Muhammad Nabeel Ghayur
Department of Medicine McMaster University, St. Joseph's Hospital Hamilton, Ontario, Canada

REFERENCES

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