The Profession of Pharmacy Brigitte T. Sicat, Pharm.D, BCPS Assistant Professor of Pharmacy VCU 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 Pharmacy

An informal survey of pharmacists at VCUHS What do you feel your specific discipline brings to the health care team? What don’t you know that you look to others for?

Learning Objectives After this learning session, you should be able to: Discuss how pharmacists are trained Explain what pharmacists do Discuss career paths of pharmacists Discuss governmental and voluntary oversight of pharmacy Discuss the continuing education requirements for pharmacists Discuss current issues in pharmacy

Pharmacist training Pre-pharmacy Pharmacy School Residency Fellowship 4 years to earn Pharm.D. degree Some programs pre-pharmacy & pharmacy work is combined Residency Supervised practice Specific field of practice Fellowship In the next few slides, we’ll 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.

Prerequisites for the VCU School of Pharmacy Doctor of Pharmacy Program 8 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 Physiology 3 SH Microbiology (also, 1 SH lab is preferred) 3 SH Biochemistry 6 SH English (3 SH of composition and rhetoric is required) 3 SH Calculus 3 SH Statistics 3 SH Public Speaking 35 SH Elective Courses1 90 SH Minimum Total 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. 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

Pharmacist training Pre-pharmacy Pharmacy School Residency Fellowship 4 years Some programs pre-pharmacy & pharmacy work is combined Residency Supervised practice Specific field of practice Fellowship The curriculum is designed to prepare pharmacists with the knowledge, skills, and abilities for a successful career in pharmacy. Although I won’t 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.

P1 Fall Course Title Course Credit Basic Pharmaceutical Principles for the Practicing Pharmacist 3.0 Pharmaceutics & Biopharmaceutics I Evidence Based Pharmacy I (Drug Info) 1.0 Health Promotion & Disease Prevention 2.5 Contemporary Pharmacy Practice 3.5 Communications in Pharmacy Practice 2.0 Scholarship I Continues Student Pharmacist Professionalism Foundations I IPPE I: Community I Semester Total 17.0

P1 Spring Course Title Course Credit Pharmacokinetics* 2.0 Pharmaceutics & Biopharmaceutics II 2.5 Pharmacognosy Clinical Chemistry for the Pharmacist Clinical Therapeutics Module I: Intro to Medicinal Chemistry 1.0 Clinical Therapeutics Module II: Introduction to Pharmacology Clinical Therapeutics Module III: Intro to Special Populations Self-care, Alternative and Complementary Treatments* 3.0 The U.S. Health Care System Managing Professional Patient-centered Practice Scholarship I Student Pharmacist Professionalism Continues Foundations II IPPE II: Community II Semester Total 21.0

P2 Fall Course Title Course Credit Evidence Based Pharmacy II: Research Methods & Statistics 2.5 Evidence Based Pharmacy III: Literature Evaluation 2.0 Biotechnology, Pharmacogenomics & Pharmacogenetics Pharmacy Informatics 1.5 Clinical Therapeutics Module IV: Cardiovascular 4.5 Clinical Therapeutics Module V: Endocrinology Clinical Therapeutics Module VI: Neurology I 3.0 Scholarship II Continues Student Pharmacist Professionalism Foundations III 1.0 IPPE III: Hospital Semester Total 19.0

P2 Spring Course Title Course Credit Applied Pharmacokinetics 2.0 Pharmacoeconomics Epidemiology & Pharmacy Practice Patient Medication Safety Clinical Therapeutics Module VII: Neurology II 1.0 Clinical Therapeutics Module VIII: Psychiatry 3.0 Clinical Therapeutics Module IX: Respiratory/Immunology Electives Scholarship II Student Pharmacist Professionalism Continues Foundations IV IPPE III: Hospital Semester Total 21

P3 Fall Course 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 2.5 Clinical Therapeutics Module XII: Nephrology/Urology Clinical Therapeutics Module XIII: Dermatology/EENT 1.5 Electives 2.0 - 3.0 Scholarship III Continues Student Pharmacist Professionalism Foundations V 1.0 IPPE IV: Clinical Patient Care Semester Total 18.0 - 19.0

P3 Spring Course Title Course Credit Pharmacy Practice Management II - Institutional Practice 2.0 Clinical Therapeutics Module XIV: Gastrointestinal/Nutrition 2.5 Clinical Therapeutics Module XV: Women's Health/Bone, Joint Clinical Therapeutics Module XVI:Toxicology/Critical Care 1.5 Clinical Therapeutics Module XVII: Special Populations 1.0 Pharmacy Law 3.0 Electives 2.0 - 3.0 Scholarship III Student Pharmacist Professionalism Continues Foundations VI IPPE IV: Clinical Patient Care Semester Total 18.5 - 19.5

P4 – Experiential Year Acute Care APPE 10.0 Hospital Pharmacy APPE 5.0   P4 – Experiential Year Acute Care APPE 10.0 Hospital Pharmacy APPE 5.0 Geriatrics APPE Primary Ambulatory Care APPE Elective I APPE Elective II APPE Advanced Community Practice APPE Student Pharmacist Professionalism 1.0 Annual Total 41.0

Pharmacist Training Pre-pharmacy Pharmacy School Residency Fellowship 4 years Some programs pre-pharmacy & pharmacy work is combined Residency Supervised practice Specific field of practice Fellowship 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.

Governmental & Voluntary Oversight of Pharmacy Governmental Oversight Federal & State laws Voluntary Oversight Accreditation of training programs E.g. ASHP accreditation of residency programs Certification Board 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 Oversight Accreditation – ASHP is an accrediting body that sets standards for residency programs Certification – 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).

What do Pharmacists do? Drug-Use Process Manufacture Distribution Prescribing Preparation Storing Dispensing Administering Monitoring Reviewing of drugs and their use Pharmacists help patients make the best use of their medications Pharmacy’s 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.

Career Paths of Pharmacists Community pharmacy Institutional pharmacy Long-term care pharmacy Managed care, home care, and mail-service pharmacy Pharmacy academia Other careers Industry Government Associations Others 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.

Current Issues in Pharmacy The profession of pharmacy has evolved Pharmaceutical care “the functions performed by a pharmacist in ensuring the optimal use of medications to achieve specific outcomes that improve a patient’s 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 patient’s 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

Current Issues in Pharmacy There is a need to move even more rapidly to re-deploy pharmacists from medication order fulfillment to patient care. This will require: Supporting payment mechanism Provider status for pharmacists under Medicare Commitment to obtaining and maintaining the knowledge, skills, and abilities required by increased patient care demands Fully embracing the tenets of pharmaceutical care Programs in order to grow the total size of the profession 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: Knapp DA. AJPE 2002

Summary Pharmacists: Help patients make the best use of their medications Receive rigorous education & training Practice in a variety of settings Are licensed to protect the public from harm Are caregivers, clinicians, advisors, teachers, and life-long learners We look forward to working with you in the Primary Care Teaching Clinic this month and in the future. William N Kelly 2004