By David P Zgarrick, PhD, FAPhA
As another summer draws to a close and a new semester begins, I’m reflecting upon my Pharmacy Care Management course. While I am confident that I have fairly assessed what I expected students to learn, I am less confident in their abilities to apply fundamental management and leadership principles to pharmacy practice. I’ve come to this conclusion based on reading my student’s assignments, listening to what they say in class, and seeing their general lack of engagement with regard to applying management and leadership skills to pharmacy practice as they enter APPEs and the workforce. This is nothing new, nor is it specific to students at my university. Perhaps it is more at the forefront because ACPE,1 CAPE,2 professional organizations, and employers3 have placed greater emphasis on the development of management and leadership skills and the need for pharmacy graduates to be “practice ready”.
Please do not take these concerns as being critical of my students. Today’s students have the knowledge, skills and abilities to be successful in a challenging PharmD curriculum. While I am certainly willing to be critiqued on my ability to design or teach a course, I do not feel that my abilities (or lack thereof) have resulted in what we are seeing among our students. Rather, I am concerned that most schools and colleges of pharmacy have not created curricula which provide students with foundational knowledge and skills in management and leadership. Nor have we created experiences (simulated and practice-based) which allow students to apply these skills and gain confidence in their abilities.
If You Build It They Will…
I ask you to think about our general “building approach” to teaching pharmacotherapy. We start with foundational knowledge in fields like chemistry, biology and physics, which build into the basic pharmaceutical and clinical sciences. This ultimately leads to course sequences (ie, pharmacotherapeutics) where students are expected to build upon their foundational knowledge to understand and apply drug therapy to patient care. We supplement these courses with practice labs, small group case discussions, and ultimately practice experiences designed for students to understand the relevance and apply these skills in patient care settings.
Imagine if pharmacy schools taught pharmacotherapeutics in a single course in a single semester, without expecting students to be prepared in foundational, clinical or basic pharmaceutical sciences, or even without its related labs and practice experiences. How confident would we feel that our students would be prepared to effectively apply drug therapy knowledge to the care of patients or the service of populations?
As ridiculous as this scenario sounds, it is essentially the approach that many schools of pharmacy use to teach pharmacy management and leadership. We design courses which provide a high-level survey of a large number of management and leadership topics, without having expectations of the relative foundational knowledge. While many pharmacy management instructors develop assignments and case studies that ask students to apply management and leadership skills in the manner pharmacists apply them in practice, the lack of foundational knowledge, combined with a lack of context of how management and leadership are applied to pharmacy practice, result in students who generally cannot see how these skills will help them as a pharmacist. While management and leadership skills are essential to effective pharmacy practice, students often do not understand the need for them until after they enter practice. Could you imagine if pharmacy students did not understand the need for pharmacotherapy skills until after they entered practice?
Sooner than Later
I urge us to consider a new curricular approach to pharmacy management as suggested by Cortney Mospan.4 While no one relishes the thought of adding more courses and topics to what already is a challenging curricula, I invite us to consider the need to expect students to have (and provide opportunities for students to learn) foundational topics to management and leadership (eg, economics, accounting, finance, human resources management), prior to expecting students to learn how management and leadership are applied to pharmacy practice. I also invite us to consider how we can better link simulations, labs, and practice experiences to help students see the relevance of management and leadership to pharmacy practice. Don’t you agree that just as with other curricular elements this is the best approach to help students gain the skills and confidence needed to not only meet our new accreditation and curricular standards, but also to help our graduates truly be “practice ready”?
Acknowledgements:
To my many colleagues, particularly fellow educators and editors, who constantly challenge ourselves to improve the education of our students, and ultimately the care of our patients and the health of our communities. And especially to the late Joseph Wiederholt, PhD, a pharmacy management educator and researcher whose memory reminds me that our work is not only important, but it’s also a lot of fun!
References:
1. Accreditation Council for Pharmacy Education. Accreditation Standards and Key Elements for the Professional Program Leading to the Doctor of Pharmacy Degree (“Standards 2016”). Published February 2015. Available at: https://www.acpe-accredit.org/pdf/Standards2016FINAL.pdf). [Accessed August 4, 2017].
2. Medina MS, Plaza CM, Stowe CD, et al. Center for the advancement of pharmacy education 2013 educational outcomes. Am J Pharm Educ., 2013;77(8): Article 162.
3. National Association of Chain Drug Stores (NACDS). National Community Pharmacists Association (NCPA), Accreditation Council for Pharmacy Education (ACPE) Task Force. Entry-level Competencies Needed for Community Pharmacy Practice. Available at: https://www.acpe-accredit.org/pdf/NACDSFoundation-NCPA-ACPETaskForce2012.pdf. Published 2012. [Accessed August 4, 2017].
4. Mospan CM. Management education within pharmacy curricula: A need for innovation. Curr Pharm Teach Learn 9 (2017) 171-174.
Dr. Zgarrick is the Associate Dean of Faculty for the Bouvé College of Health Sciences and a Professor in the Department of Pharmacy and Health Systems Sciences in the School of Pharmacy at Northeastern University. Educational scholarship interests include pharmacy management education and faculty development. He is an editor of the textbook Pharmacy Management: Essentials for All Practice Settings and author of Getting Started as a Pharmacy Faculty Member. In his/her free time, Dave enjoys skiing, golf and following the Wisconsin Badgers and Green Bay Packers.
Pulses is a scholarly blog supported by Currents in Pharmacy Teaching and Learning
Pulses 
I agree with Dr. Zgarrick’s assessment that PharmD students are expected to be ready to effectively apply management and leadership skills without appropriate foundational knowledge. However, I’m not willing to concede that all PharmD graduates be required to have “foundational topics to management and leadership (eg, economics, accounting, finance, human resource management)” prior to my 3rd year pharmacy management course, which seems to be the suggestion in the article – whether it be a pre-pharmacy requirement or a PY1/PY2 addition.
I completed a Masters in Business Administration (MBA) in addition to my PharmD with the intent of being a more effective manager upon graduation. I undoubtedly had a stronger grasp of the foundational management and leadership topics listed than the average PharmD graduate. Unfortunately, the MBA with all of its course-work requirements and scenario simulation did not prepare me to be “practice ready” per se when faced with a patient threatening to jump a counter if I didn’t give him back his forged Vicodin prescription (Yes – I gave him back that Rx). It did not prepare me for handling my best pharmacy technician secretly lifting 1500 pain pills in a single weekend. It did not prepare me for the countless challenges that I faced while managing 17 different pharmacy operations prior to going to academia – and it hasn’t prepared me for the management and leadership challenges that I now face in a university environment.
That is what experience is for.
That doesn’t mean my advanced training in the foundational knowledge of management and leadership prior to graduating wasn’t useful, but I think it may be too much to suggest we need our PharmD’s to also have an abundance of training economics, accounting, finance, or human resource management. More advance electives or management experience (internships, post-graduate training in management) opportunities should definitely be offered for those students wishing to pursue a management and leadership path.
Joey Mattingly
Assistant Professor
University of Maryland School of Pharmacy
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Joey,
Thanks so much for your comments. I couldn’t agree more that anything that we teach in the classroom or simulate isn’t a substitute for what pharmacists, and everyone else, learns in the workplace. Pharmacy education, given our requirement for incorporating experiential education into our curricula, prepares our students better than many fields, but experience is something we continue to learn from throughout our lives.
In terms of the need for foundational knowledge, I’m not suggesting that students have the same amount or degree of coursework in economics, accounting, marketing, HRM, etc. as they receive in their foundation for pharmacotherapy. All I’m asking is that they have SOMETHING in these areas! Those of us who teach basic principles of economics and other management and leadership in our pharmacy management courses have to do so just so our students can begin to understand their application to pharmacy. Imagine what we could do if students came to our courses with SOME level of preparation?!? Yes…they would be better able to continue their learning, not only in higher level management and leadership electives, but to learn on the job and in life!
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