Slide 1

The Profession of PharmacyBrigitte T. Sicat, Pharm.D, BCPSAssistant Professor of PharmacyVCU School of Pharmacy

When asked about pharmacy, most people will respond by saying pharmacy is a drugstore or a place where you buy your medication. Some people may talk about pharmacists and drugs. But many people may not know about the Profession of Pharmacy1An informal survey of pharmacists at VCUHSWhat do you feel your specific discipline brings to the health care team?

What dont you know that you look to others for?

Learning ObjectivesAfter this learning session, you should be able to:Discuss how pharmacists are trainedExplain what pharmacists doDiscuss career paths of pharmacistsDiscuss governmental and voluntary oversight of pharmacyDiscuss the continuing education requirements for pharmacistsDiscuss current issues in pharmacy

3Pharmacist trainingPre-pharmacy Pharmacy School4 years to earn Pharm.D. degreeSome programs pre-pharmacy & pharmacy work is combinedResidencySupervised practice Specific field of practiceFellowship

In the next few slides, well talk about how pharmacists are educated and trained.

Today, students of pharmacy must study at least 6 years at the college level to earn the doctor of pharmacy degree (Pharm.D.). The first 2 years are, and liberal studies, are considered prepharmacy requirements that can be earned at a college or university before being accepted into a college or school of pharmacy.

While some students complete their pre-pharmacy work at a college or university before entering a school or college of pharmacy, there are some 6 year programs in the US where students complete their prepharmacy and pharmacy work as one continuous program.

While we only require students to have completed the required prerequisites before entering the VCU School of Pharmacy, over 90% of our first year students have their 4 year degree.

4Prerequisites for the VCU School of Pharmacy Doctor of Pharmacy Program8 SH General Biology (6 SH lecture and 2 SH laboratory) 8 SH College Chemistry (6 SH lecture and 2 SH laboratory)8 SH Organic Chemistry (6 SH lecture and 2 SH laboratory)4 SH Physics (3 SH lecture and 1 SH laboratory) 3 SH Human Anatomy (also, 1 SH lab is preferred)3 SH Human Physiology3 SH Microbiology (also, 1 SH lab is preferred)3 SH Biochemistry6 SH English (3 SH of composition and rhetoric is required)3 SH Calculus3 SH Statistics3 SH Public Speaking35 SH Elective Courses1

90 SH Minimum Total

1 Cell biology, genetics and immunology are highly recommended and are the only science courses that can count towards the minimum of 35 semester hours of electives. Other highly recommended electives are computer science, economics, psychology, and sociology. Others include political science, anthropology, history, foreign languages, philosophy and religious studies

These are the required prerequisites students must complete in their prepharmacy work before applying to the VCU School of Pharmacy.

Most of the prepharmacy requirements are in biology, chemistry, and liberal studies, and some schools such as VCU, require physics and calculus.

To be admitted to most pharmacy schools, candidates must have above average grades. They also must have strong interpersonal skills and enjoy working with and helping people. High ethical behavior is a must. Other traits of pharmacy student applicants are understanding, drive, flexibility, perseverance, problem solving skills, being decisive, and having a good knowledge of pharmacy. 5Pharmacist trainingPre-pharmacyPharmacy School4 yearsSome programs pre-pharmacy & pharmacy work is combinedResidencySupervised practice Specific field of practiceFellowship

The curriculum is designed to prepare pharmacists with the knowledge, skills, and abilities for a successful career in pharmacy. Although I wont go into detail about every course offered in the VCU School of Pharmacy, I have listed them for you here and will highlight a few of them as we move through the slides.

6P1 FallCourse Title

Course Credit Basic Pharmaceutical Principles for the Practicing Pharmacist

3.0 Pharmaceutics & Biopharmaceutics I

3.0 Evidence Based Pharmacy I (Drug Info)

1.0 Health Promotion & Disease Prevention

2.5 Contemporary Pharmacy Practice

3.5Communications in Pharmacy Practice

2.0 Scholarship I

Continues Student Pharmacist Professionalism

Continues Foundations I

1.0 IPPE I: Community I

1.0 Semester Total 17.0

7P1 SpringCourse Title

Course CreditPharmacokinetics*2.0Pharmaceutics & Biopharmaceutics II 2.5 Pharmacognosy 2.0 Clinical Chemistry for the Pharmacist

2.0Clinical Therapeutics Module I: Intro to Medicinal Chemistry

1.0 Clinical Therapeutics Module II: Introduction to Pharmacology

1.0 Clinical Therapeutics Module III: Intro to Special Populations

1.0 Self-care, Alternative and Complementary Treatments*

3.0The U.S. Health Care System 2.5 Managing Professional Patient-centered Practice

1.0 Scholarship I

1.0 Student Pharmacist Professionalism

Continues Foundations II

1.0 IPPE II: Community II

1.0 Semester Total 21.0

8P2 FallCourse Title Course Credit Evidence Based Pharmacy II: Research Methods & Statistics

2.5 Evidence Based Pharmacy III: Literature Evaluation

2.0 Biotechnology, Pharmacogenomics & Pharmacogenetics

2.0 Pharmacy Informatics 1.5 Clinical Therapeutics Module IV: Cardiovascular 4.5 Clinical Therapeutics Module V: Endocrinology 2.5 Clinical Therapeutics Module VI: Neurology I3.0 Scholarship IIContinuesStudent Pharmacist ProfessionalismContinuesFoundations III1.0IPPE III: HospitalContinuesSemester Total 19.0

9P2 SpringCourse Title Course Credit Applied Pharmacokinetics2.0Pharmacoeconomics2.0Epidemiology & Pharmacy Practice2.0Patient Medication Safety2.0 Clinical Therapeutics Module VII: Neurology II1.0Clinical Therapeutics Module VIII: Psychiatry3.0 Clinical Therapeutics Module IX: Respiratory/Immunology3.0 Electives2.0 Scholarship II 2.0 Student Pharmacist ProfessionalismContinuesFoundations IV1.0 IPPE III: Hospital1.0 Semester Total 21

10P3 FallCourse Title Course Credit Pharmacy Practice Management I - Community Practice

4.0 Clinical Therapeutics Module X: Infectious Diseases

4.5 Clinical Therapeutics Module XI: Hematology/Oncology

2.5Clinical Therapeutics Module XII: Nephrology/Urology

2.5Clinical Therapeutics Module XIII: Dermatology/EENT

1.5 Electives

2.0 - 3.0 Scholarship III

Continues Student Pharmacist Professionalism

Continues Foundations V

1.0 IPPE IV: Clinical Patient Care

ContinuesSemester Total 18.0 - 19.0

11P3 SpringCourse Title Course Credit Pharmacy Practice Management II - Institutional Practice2.0 Clinical Therapeutics Module XIV: Gastrointestinal/Nutrition2.5 Clinical Therapeutics Module XV: Women's Health/Bone, Joint2.5Clinical Therapeutics Module XVI:Toxicology/Critical Care1.5 Clinical Therapeutics Module XVII: Special Populations1.0 Pharmacy Law3.0Electives2.0 - 3.0Scholarship III2.0Student Pharmacist ProfessionalismContinuesFoundations VI1.0IPPE IV: Clinical Patient Care1.0Semester Total 18.5 - 19.5

12P4 Experiential YearAcute Care APPE10.0 Hospital Pharmacy APPE5.0 Geriatrics APPE5.0 Primary Ambulatory Care APPE5.0 Elective I APPE5.0 Elective II APPE5.0 Advanced Community Practice APPE5.0 Student Pharmacist Professionalism1.0 Annual Total 41.0

13Pharmacist TrainingPre-pharmacyPharmacy School4 yearsSome programs pre-pharmacy & pharmacy work is combinedResidencySupervised practice Specific field of practiceFellowship

Postgraduate graining is available in the form of residencies and fellowships.

Residencies provide in-depth experiences leading to advanced practice skills and knowledge. Most residencies last 1 year and usually begin on July 1st of each year. Examples of pharmacy residencies include a general PGY-1 Pharmacy Practice residency, ID, ambulatory care, critical care, primary care, community pharmacy, drug information, oncology, psychiatry. Many residency programs are accredited by the American Society of Health System Pharmacists. Pharmacists may complete a PGY-1 general pharmacy residency followed by a 2nd year specialty residency.

Fellowships individualized, postgraduate program designed to prepare pharmacists to become independent researchers. They are typically offered through schools of pharmacy, academic health centers, etc. and usually exceed 12 or even 24 months. Examples of pharmacy fellowships include cardiology, drug development, ID, oncology, psychiatry, transplantation, pharmacoeconomics.

14Governmental & Voluntary Oversight of PharmacyGovernmental OversightFederal & State laws

Voluntary OversightAccreditation of training programsE.g. ASHP accreditation of residency programsCertificationBoard of Pharmaceutical Specialties (BPS)Certified Geriatric Pharmacist (CGP)Certified Anticoagulation Care Provider (CACP)

A complex array of federal and state laws and regulations govern the practice of pharmacy

Federal: FDA & DEA, Centers for Medicare & Medicaid Services (CMS)State: State boards of pharmacy promulgate the specific regulations that govern the practice of pharmacy on a day-to-day basis. Boards issue licenses to pharmacists and pharmacies. One requirement for relicensure every year in Virginia, is a requirement to complete continuing education hours each year. The rate of new drug development has accelerated and many continuing education programs are available to assist pharmacists in being lifelong learners.

Voluntary OversightAccreditation ASHP is an accrediting body that sets standards for residency programsCertification Certification is become increasingly common in pharmacy, particularly in two areas: for pharmacists who practice in highly specialized areas and for pharmacy technicians. The purpose of pharmacy certification is to demonstrate personal achievement in a specialized area. Some examples of pharmacy certifications that you may encounter are:BPS has several specialty areas including Pharmacothearpy (BCPS), Cardiology, Psychopharmacy, Oncology, nuclear pharmacy, etc.Other examples of common certifications that you may see that pharmacists obtain are: CACP (Certified Anticoagulation Care Provider), CGP (certified geriatric pharmacist).

15What do Pharmacists do?Drug-Use ProcessManufactureDistributionPrescribingPreparationStoringDispensingAdministeringMonitoring Reviewing of drugs and their usePharmacists help patients make the best use of their medications

Pharmacys role is to oversee the complicated drug-use process, to make it safe, and make it efficient.

The drug use process in the US is a complex, structured process involving the ..Although it is designed with multiple checks and balances to help keep patients from experiencing a preventable drug misadventure, it is not perfect.

Pharmacists are intimately involved in multiple parts of the process to help ensure the drugs are used safely and effectively.

Simply stated, in their multiple roles, pharmacists help patients make the best use of their medications. 16Career Paths of PharmacistsCommunity pharmacyInstitutional pharmacyLong-term care pharmacyManaged care, home care, and mail-service pharmacyPharmacy academiaOther careersIndustryGovernmentAssociationsOthers

Most pharmacists practice in community pharmacy. However, pharmacists work in all areas of health care, health care education, and medical research. They are practice in community pharmacies, hospitals, managed care organizations, pharmaceutical companies, academia, nursing homes, home health care agencies, clinics, and physician offices, government, professional pharmacy organizations, and pharmacy software companies and as private consultants.

Pharmacists hold positions as staff members, supervisors, managers, teachers, researchers, and entrepreneurs. As mentioned earlier, some pharmacists have advanced training in pharmacy and work in specialized areas such as oncology, psychiatry, etc.

17Current Issues in PharmacyThe profession of pharmacy has evolved

Pharmaceutical carethe functions performed by a pharmacist in ensuring the optimal use of medications to achieve specific outcomes that improve a patients quality of life; further, the pharmacist accepts responsibility for outcomes and ensue from his or her actions, which occur in collaboration with patients and other health-care colleagues

Pharmacy practice has changed in the US from making drug preparations from plants to helping physicians decide which drug to prescribe and having a direct role in helping patients make the best use of their medication. Today pharmacists are striving to practice pharmacy using the principles of pharmaceutical care.

Pharmaceutical care is an important term in pharmacy that is defined as the functions performed by a pharmacist in ensuring the optimal use of medications to achieve specific outcomes that improve a patients quality of life; further, the pharmacist accepts responsibility for outcomes and ensue from his or her actions, which occur in collaboration with patients and other health-care colleagues18Current Issues in PharmacyThere is a need to move even more rapidly to re-deploy pharmacists from medication order fulfillment to patient care. This will require:Supporting payment mechanismProvider status for pharmacists under MedicareCommitment to obtaining and maintaining the knowledge, skills, and abilities required by increased patient care demandsFully embracing the tenets of pharmaceutical carePrograms in order to grow the total size of the profession

Knapp DA. AJPE 2002

IOM Preventing Medication Errors.Given these alarming estimates, there is a ned to move even more rapidly to redeploy pharmacists from medication order fulfillment to patient care.Many pharmacists today are balancing the responsibilities of medication order fulfillment (e.g. dispensing) with performing pharmaceutical care. Many in the profession believe that in the future, the responsbility of medication order fulfillment will be done by technology and that pharmacists will then be freed to spend more of their time on fully using their knowledge, skills, and abilities to provide pharmaceutical care.

To successfully accomplish this will require several things including:

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SummaryPharmacists:Help patients make the best use of their medicationsReceive rigorous education & trainingPractice in a variety of settingsAre licensed to protect the public from harmAre caregivers, clinicians, advisors, teachers, and life-long learners

William N Kelly 2004

We look forward to working with you in the Primary Care Teaching Clinic this month and in the future.20