Pharmacist Education and Training Conundrum

Last month, my commentary onpostgraduate training reflectedmy strong support of new graduates' pursuit of residency training ineither acute care or ambulatory environments.In most years, about 30% ormore of our graduates of the Universityof North Carolina School of Pharmacypursue a residency or graduate schooldegree. I suspect that this may be higherthan the national average; yet, itremains challenging to preferentiallyhire practitioners who have advancedskills and experience we need in manyof our positions. For years, hospitalshave needed individual practitioners topursue continued lifelong learningthrough mentoring by senior membersof the existing staff, and who have astrong personal commitment to growprofessionally while practicing.

As I interact with my colleagues incommunity practice, I hear them suggestthat schools do not give new graduatesenough training and experience to preparethem for the responsibilities theyassume in that particular practice setting.In fact, I sometimes hear that educatorsand the school give them too much"clinical"training and not enough experiencein the day-to-day responsibilities ofthe "real world"community setting.These polar observations define our academicversus practice conundrum.

As an educator, I accept the observationsof both constituencies and recognizeour collective dilemma, but I holdfast to the notion that our mission is toprepare practitionersfor the future ratherthan prepare them forthe job responsibilitiesimmediately followinggraduation. It is furthercomplicated in that ourcustomers (the students)expect us toprepare them for asmany practice alternatives,such as community,hospital, long-termcare, home care, etc,as possible so theyhave freedom to moveabout within the professionas they pursuethe practice that is personallythe best fit.

I do not have theanswers to these phenomena.The practiceof pharmacy has becomeso much morecomplicated, sophisticated,and diverse thanwhen I matriculated.Are we approaching atime when we shouldexpect students todeclare their primarypractice interest, likeacute care practice,and then "track"them into a morepractice-specific curriculum? If thissolution is pursued, what are graduatesto do when their preferenceschange and they wish to migrate to adifferent practice setting? Are employersobliged to retool practitioners todevelop the skills to accomplish thischange, or would practitioners need toreturn to school for additional training?How would the particular expertise ofnew graduates be recognized reliablyby prospective employers? Wouldpractice credentials be different asconferred by Boards of Pharmacy?

It seems apparent that schools ofpharmacy need to embrace all theirconstituents, including their academicinstitutions, employers, students, accreditingbodies, and professionalassociations, to begin discussionsregarding the need to rethink classiceducational approaches for pharmacisteducation. Solutions will require entrepreneurialthinking that is selfless andfocused on the patients we serveregardless of the practice setting.

Mr. McAllister is director of pharmacyat University of North Carolina (UNC)Hospitals and Clinics and associatedean for clinical affairs at UNCSchool of Pharmacy, Chapel Hill.