A World of Care

AACP Article

Embarking on a journey to shape the future of pharmacy practice globally, leaders look to education to begin the transformation.

By Athena Ponushis and Jane Rooney

More than 600 professionals from 46 countries attended the International Pharmaceutical Federation (FIP) Global Conference on Pharmacy & Pharmaceutical Sciences Education last November, sharing their experiences to shape the future of their profession. It was the first global conference dedicated to international pharmaceutical education and it concluded with a sweeping consensus.

“The whole concept behind the conference was to see if we could get a global consensus on what pharmaceutical education should include going forward,” said Dr. Ralph Altiere, FIP Academic Pharmacy Section president. “This sort of sets the expectations, if you will, of what pharmaceutical education should look like around the world and what we should all be striving for, which has never occurred before.”

The world agreed that yes, pharmaceutical sciences education is critical, in each country, in each region, for its specific purpose, and that on the practice side, schools should move toward more direct patient care education of pharmacy students.

The conference, held in Nanjing, China, also set workforce development goals to cultivate a competent, capable workforce around the world to meet expected pharmacy needs. Pharmacy leaders looked at the present state of pharmacy and set it next to a projected, future state, striving to see how education could carry the profession to that envisioned future.

An FIP vision was articulated, “to support and develop high standards of education and training, and to promote and protect the health and wellbeing of civil society through leadership and development of our professional workforce, and to ensure our contribution to the health and wellbeing of patients.”

Professor Bill Charman, chairman of the FIP Education Executive Committee, says now it’s time for action: “There is no healthcare workforce without education, and this, of course, is especially the case in pharmacy and the pharmaceutical sciences. It is key to work forward collaboratively through major partnerships to make sure the agenda encompassed through the workforce development goals is addressed and further developed. This is the beginning of the next steps in this important journey.”

Reaching Consensus

Recognizing education as a key driver and enabler of change in practice and science, FIP had groups working on educational endeavors, but with the formalization of FIP Education, these groups were brought together to work in concert.

Questioning what the strategic plan would be and what the group wanted to accomplish, FIP led development of the global conference. FIP developed working drafts of a vision statement, statements on pharmaceutical education and workforce development goals. These drafts were sent out to FIP members for consultation and feedback—which poured in from around the world—that led to refinement of the statements leading up to the global conference.

A presentation by the World Health Organization on the severe shortage of healthcare workers, including pharmacists, that’s anticipated over the next 10 to 20 years, set the stage for what the delegates would do next—vote on international expectations for an effective pharmaceutical education. Delegates approved 64 of 70 statements. (Currently, FIP is engaging delegates to find out why the other statements were not approved and see how they might be modified to fit in the global context).

Groups spent the entire second day of the conference in workshops generating strategies for implementing workforce development goals that were gathered into three groups: Academy, focusing on schools of pharmacy; professional development, focusing on professional associations; and systems, targeting policy development and governmental strategy, addressing, ‘What do we need to do to increase the capacity of pharmacy education and the pharmacy workforce?’

“It was the first global conference in pharmaceutical education and we achieved an incredibly high level of consensus on what pharmaceutical education should look like, and then focused on how we are going to go about developing a competent, capable and adequate level workforce for pharmacy to meet the needs around the world,” Altiere said. “That was a lot to accomplish and I think we made a superb first step.”

After such a successful conference, FIP is now faced with the task: How do we get the word out? How do we tell the world what took place?

Altiere noted that while the pharmaceutical sciences play a major role in practice and education, especially in areas where there’s a large pharmaceutical manufacturing base, on the practice side, there’s been a shift. “The consensus is we have to move toward more direct patient care education of pharmacy students.”

An Agenda to Learn From One Another

With a mission of transforming pharmaceutical education, FIP does not just identify what needs to be done but develops actions plans to achieve it. Key questions asked included, ‘What are the best practices out there? What are the models for making it happen? What are the innovations people are introducing?’

“Since we are talking about a global organization, it’s important to ask, ‘how can we all learn from each other?’” Altiere said. “What works and what doesn’t work?”

What works in one country may not work in another country, but sometimes, even in countries with inadequate resources, the innovations they create may not be something others have thought of. “So you can learn from each other very quickly,” Altiere said.

The FIP agenda, to transform pharmaceutical education globally, will look different in various regions of the world, “but FIPEd serves as that centerpiece, where people from around the world can network, learn from and work with each other to bring about this transformation that meets the needs of your country and the citizens of your country,” he continued.

The impending shortage of pharmacists added momentum to the return to education. Looking at what shortages exist and projections for how those shortages will grow as population grows and needs grow, FIP recognized a responsibility to prepare pharmacists and transform education to meet societal needs, and cultivate the workforce to provide the healthcare the world needs.

“The relevance and tangible nature of FIP’s work will occur through what happens next—the education statements and workforce development goals from the conference are a framework—and we need to engage partners and like-minded groups to further develop this framework, chart and measure progress, and reassess and amend as necessary,” Charman said.

Where FIP and AACP Align

The AACP Global Pharmacy Education SIG’s strategic plan grants broad support for global pharmacy educators to network, collaborate, provide and evaluate global/international education and training for students and pharmacy professionals. The plan aligns with FIP’s plan to advance and unify the profession, attaining workforce development goals via education initiatives.

“The SIG recently approved a new strategic initiative to engage in impactful global health, education and practice initiatives worldwide. The intent of this new initiative is to encourage and support our members to take part in the work of other global organizations, such as FIP,” said Dr. Shaun Gleason, chair of AACP’s Global Pharmacy Education SIG.

AACP members recently provided feedback to FIP workforce development initiatives. The SIG plans to continue to provide platforms for additional education and engagement with FIP and other international organizations.

“We are at an important point where our voices can have a role in shaping the future of our profession,” Gleason added. “This can be achieved through involvement in AACP and global organizations, by partnering with colleagues around the world, and/or by providing global/international education to our students, including at the local level.”

What AACP Can Do For FIP

Member schools looking to initiate or enhance this area of curriculum can turn to a recent Global Pharmacy Education SIG paper on how to implement global/international education through alignment with the CAPE 2013 outcomes. The paper expands on the steps to implement G/I education in pharmacy curricula, from gaining colleagues’ support to giving examples of lesson content and application techniques. The paper also lends means of assessment. The authors recognize that not all schools can provide G/I education in an international arena, so they give examples of how G/I education can be provided locally, such as through participation in health fairs for immigrant populations or education on global diseases.

“Many members may think that being involved in global/international education is solely about sending students to other parts of the world or accepting international students into their programs,” Gleason said, “but I would like to stress that we can all have a voice in the global future of our profession through local activities, like education and organizational involvement.”

AACP members, individuals and institutions, also have connections around the world that are already moving this transformation of education forward, and Altiere believes that bringing these connections and ideas to FIP would be an invaluable asset.

“The ultimate goal of this education transformation is to improve patient care and improve health outcomes, and part of that is integrating pharmacy more and more into healthcare delivery systems,” Altiere added. “We have data to show that when pharmacists are involved in direct patient care, health outcomes improve and quality of life improves. We know it works, now it’s just a matter of expanding it around the world.”


Schools’ International Partnerships Enhance Patient Care Abroad, Bring Tremendous Value to Faculty and Students

Colleges of pharmacy are increasingly reaching out to institutions and organizations around the world to form international partnerships. The pharmacy schools at Purdue University, The Ohio State University and Creighton University have global programs that allow students to directly interact with pharmacy faculty and students and/or provide care for patients in other countries. All three are finalists for AACP’s Lawrence C. Weaver Transformative Community Service Award, which is presented annually to one college or school of pharmacy demonstrating a major institutional commitment to addressing unmet community needs through education, practice and research

In Kenya, Patient Care Often Includes More Similarities than Differences

In 2003, the Purdue University College of Pharmacy joined the Academic Model Providing Access to Healthcare (AMPATH) Consortium and established the Purdue Kenya Partnership. PKP partners with Kenyan counterparts to create sustainable clinical pharmacy infrastructure and provide patient care programs in combination with research programs that investigate understudied characteristics of patients in sub-Saharan Africa. Students can complete an eight-week elective APPE in Eldoret, Kenya, where they assist with pharmaceutical care during rounds at Moi Teaching and Referral Hospital. Additional programs and services include diabetes care, HIV education and youth outreach, focusing on health education. The program averages 24 student participants per year. In 2008, PKP began hosting eight University of Nairobi student interns each year for six-month internships. The Global Health Residency was developed in 2011, which has 4–5 participants annually from North America and Kenya.

Dr. Ellen Schellhase, associate professor of pharmacy practice and Purdue Kenya Partnership coordinator, explained that it started as a training program but is highly focused on patient care. “From a training standpoint, it’s an opportunity to work on healthcare issues that we might not see here in the United States,” Schellhase said. “But the focus is truly on providing patient care, in an environment that lacks resources and healthcare personnel.”

Student pharmacists who participate in the eight-week program go through an interview and selection process. They also take a two-credit elective course before they go that prepares them for the on-the-ground work they’ll be doing and the cultural differences they will encounter. Once there, participants are partnered with students in Kenya. “Initially, students may think they have different training than their Kenyan counterparts,” Schellhase noted. “And while they do have some different focuses in their schooling, they complement each other well. Students are often surprised at the collaboration they put together.”

Students have significant patient care responsibilities throughout the program, she continued. “It’s a cultural opportunity that challenges their clinical skills tremendously. One of the most transferable things is the soft skillset—communications, teamwork—that transfer to any practice in pharmacy. Students don’t have to go into global health after this; they still gain critical skills for the workforce regardless of the area of practice.”

Schellhase emphasized that the program benefits the entire Purdue community. “We’re seeing more collaboration in patient care initiatives and research with other colleges throughout the university,” she said, noting that the engineering and agricultural schools are getting involved with the partnership. “It’s strengthened our ability to work with other disciplines within the university that we hadn’t had before.”

A significant number of students who participate in the PKP go on to complete residencies in global programs or work with underserved populations in the United States. “The world is becoming smaller and smaller,” Schellhase said. “The patient care issues that we tackle on the ground in Kenya are many of the same issues that we’d see in any setting. The bottom line is that the skills we’re utilizing really translate globally to a variety of different practice settings. There might be some unique challenges or different clinical scenarios, but the important clinical skills relate to any setting.”

Opening the Doors, and Airwaves, to an Exchange of Ideas and Experiences

At The Ohio State University College of Pharmacy, global outreach occurs through several platforms. One of the primary ways the college helps students develop cultural awareness and improve patient health overseas is through its Global Pharmacy Practice Advancement. While the program offers opportunities for students and residents around the globe in countries such as England, South Africa, and Honduras, the most sustained work has been with colleges of pharmacy in Taiwan.

Dr. Chelsea Pekny, global pharmacy initiatives coordinator, explained that students from Taiwan come to Ohio State for a six-week rotation, similar to an APPE. Practicing pharmacists come for rotations that can last from eight weeks up to many months to learn more about a specific practice area. A videoconferencing elective allows students to interact with their counterparts in Taiwan in real time. “Each year focuses on a new topic and how it’s addressed in the United States,” Pekny said. “This year the focus was on the geriatric medication process. After learning about the topic, our students create a presentation and deliver it during a video conference with our partners in Taiwan, and then we hear the same from the students there. It’s a discussion and an exchange of ideas between both universities.” Additionally, about three Ohio State students per year go to Taiwan on APPE elective rotations to work with the school’s partners.

Pekny noted that the college’s curriculum is undergoing changes and that global and cultural exchanges are becoming a higher priority. “Throughout the curriculum we have opportunities where students have the ability to engage with different populations. That brings the global aspect to a local level,” she said. Pekny added that she thinks this heightened focus on cultural awareness helps prepare students for today’s workforce. “With global exchanges, you are taking the best practices from both countries and asking, ‘What do we do really well? What do our partners do well?’ That gives students a much broader perspective of pharmacy,” she said. “They learn more about pharmacy practice. A big part of the exchange is opening their eyes to the cultural differences, which really helps them in their practice, and allows them to tailor the pharmacy experience for each patient.”

The Global Pharmacy Practice Advancement, in addition to other programs and partnerships the school fosters, “helps faculty think about and develop practice areas that provide specialized opportunities for our students,” Pekny explained. “It creates a different type of cohesive celebration as a college.” The college’s Pharmacy Ambassadors program allows students to help immigrant and refugee populations acclimate to the U.S. healthcare and pharmacy systems. Student pharmacists lead educational sessions and interact with individuals who are new to the community. This makes students more thoughtful and aware of different backgrounds when they go on to work in a pharmacy practice and equips our new community members with the skills needed to engage in the healthcare system and improve their health.

Pekny said that any international experience “pushes the boundaries of students’ comfort level. It helps shape what you want to be as a pharmacist and opens students’ minds about what’s out there. A lot of those principles they learn in a global setting can be applied no matter where they are.” And that strengthens the pharmacy community as a whole, she continued. “Any kind of exchange of thoughts and ideas when you’re talking about working with international partners can help grow the pharmacy practice in both areas.”

Students Must Think on Their Feet, and Utilize Uncommon Resources

The Creighton University School of Pharmacy and Health Professions has been operating its Institute for Latin American Concern (ILAC) for 40 years. This international, collaborative healthcare and educational organization provides an immersion experience in the Dominican Republic for students and professionals. ILAC incorporates pharmacy, dental, nursing and medical students, as well as professionals in those areas. The program’s goal, according to Dr. Kalin Johnson, assistant professor of pharmacy practice, is to give them an opportunity to become part of a family and community in campos [villages] in rural areas.

“Our focus is to build relationships and provide care in a clinic during a four-week period in the summer,” Johnson explained. “The clinic is equipped with standard medications, and our student pharmacists dispense and counsel on those medications, as well as help acquire medication history and answer questions from patients, students or professionals.” Among other responsibilities, participating students identify, assess and solve medication-related problems; develop individualized therapeutic plans; collaborate with other professionals to optimize therapeutic drug regimens; and recommend ways to improve quality of life through preventive care.

Johnson travels to the Dominican Republic for the first week of the program to organize all of the medications, help the students get adjusted and help the professionals (who sometimes are faculty members and other times are outside the university community). The goal is to have one professional and two pharmacy students per campo, of which there are five. “The pharmacy professional is with them the first week to two weeks,” Johnson noted. “We always have a physician there during the entire program so students can ask questions.” She said that this interprofessional interaction is one of the biggest benefits for ILAC program participants.

“One of the books we have the students take with them discusses working in areas where there isn’t medicine. One student gave an inhaler to a child but there was no spacer. The child was having a hard time figuring it out so the student made one out of a plastic bottle. It’s an exercise in learning to think on their feet and use their resources.”

Johnson said another benefit is that the immersion experience strengthens students’ communication skills. “Even if they don’t speak perfect Spanish, they are still learning new ways to communicate,” she pointed out. “A lot of students come away with those personal relationships and the ability to see the world through a different lens. The students see how important the relationships are to the Dominicans. They appreciate your time; it’s a people to people experience.”

Broadening students’ horizons highlights one of the key reasons why sustaining global partnerships is so valuable, according to Johnson. It’s also one of the most hands-on experiences you can get in pharmacy education. “Not all students have the chance to manage their own mini pharmacy,” she said. “It’s still very much a controlled environment, but it gives them this freedom and the opportunity to develop confidence.”
That value extends to the broader pharmacy community because the interprofessional interaction often results in a newfound respect for the pharmacy profession from other disciplines. “It forces others to utilize us and learn what we can do,” Johnson noted. “Some medical students who complete the program haven’t had a chance to work with student pharmacists yet. This is their chance to really understand what pharmacy professionals bring to patient care. It helps the medical students develop and nurture those relationships when they return to the United States.”

Many students who participate in the ILAC program continue to do international work. Even those who work in a traditional pharmacy setting, however, find the skills they learn to be extremely applicable. “A lot of the issues they’re working with abroad are the same chronic disease states that they’ll work with in this country,” Johnson said. “They all say that after ILAC, they feel ready for anything.”

Athena Ponushis is a freelance writer
based in Ft. Lauderdale, Fla., and
Jane Rooney is a freelance writer based in Oakton, Va.