The Time is Now: Addressing Access and Affordability of a PharmD Education through Revised Program Requirements

By: Victoria L. Williams, PharmD and Katherine A. Kelley, PhD

An article published this summer in the Chronicle of Higher Education, “Is Your Degree Program Too Complicated? Poor design and needless bloat are derailing students,” ignited our passions around the issues of access and affordability just as our own pharmacy academy was gearing up for the processes of revising both the Center for the Advancement of Pharmacy Education (CAPE) Outcomes and subsequent Accreditation Council for Pharmacy Education (ACPE) Standards. As pharmacy educators and leaders, we have the opportunity before us to address both the complexity (e.g., long lists of prerequisites to qualify for application) and volume (e.g., co-curricular hours) of requirements for entry into practice as a pharmacist. We also have the opportunity, and we argue the responsibility, to examine how this combination of volume and complexity are impacting access and affordability of a professional degree and subsequent licensure in pharmacy. 

As we look at the historical progression of the requirements for the Doctor of Pharmacy degree since its inception with CAPE 1998 and Standards 2000, there is a pattern or precedent of adding onto the previous requirements.^1-4 Following Standards 2000, major curricular requirements included: introductory pharmacy practice experiences (IPPE) defined as 300 hours, interprofessional education (IPE), pharmacy curricular outcomes assessment (PCOA) and co-curricular requirements. We recognize the importance of these curricular components and their relationship to the training of the generalist entry-level pharmacists. We also recognize that these changes have complicated the path towards pharmacist licensure for students to navigate. These additional professional requirements have led many programs to push courses/content that used to be part of professional curricula into prerequisites (e.g., biochemistry, physiology), thus further increasing the complexity of the pre-professional curricula and potentially decreasing accessibility. Consider the following. Tuition at US schools and colleges pharmacy has been steadily increasing. Part of the cause for the rise in tuition has been the funding of increased personnel to address accreditation requirements. We also know that black students owe more in student loan debt than their white peers. These factors combined with the potential for disadvantaged students to require more remedial classes provides a glimpse into how action, such as increasing requirements in professional school that push required courses into the prerequisites, can combine to create more expenses and unequal access for some students.

The current process of revising educational program level outcomes and accreditation standards gives us the opportunity and the responsibility to review the changing landscape of the profession. We need to reassess what our programs need to provide to assure that our students will be prepared to be successful entry-level practitioners now and into the future. It is no longer feasible to add on to the existing framework of requirements. We must ethically consider where we can simplify, streamline, and cut volume from the PharmD degree to bolster access and affordability. We must challenge the notion that complexity equals rigor.

Calls to action:

1. CAPE and ACPE revisions must seriously consider where we can reduce barriers to entry to pharmacy education and  practice due to overly complex requirements.
2. Consider tapping into expertise of colleagues from other accredited disciplines during our process of revision.
   1. A “fresh perspective” from health science colleagues can help determine what is essential in our programs. A collaborative attempt at answering “why” (why do we require this prerequisite, this course, these many hours, etc.) between pharmacy faculty and faculty from other disciplines will provide a strategy for determining necessary revisions..
3. Apply the same processes of evaluating complexity and volume of content to our own individual programs. Much of the work of simplifying our prerequisites and program requirements will need to be implemented at the individual program level and are NOT exclusively the responsibility of CAPE and ACPE.
   1. Evaluating curricular overload should be part of every institution’s plan of implementation of Standards 2025. 
   2. Ohio State has recently re-evaluated both prerequisites and pre-program requirements.  We have eliminated unnecessary prerequisite courses and dropped the Pharmacy College Admissions Test (PCAT) due to the high cost of the test and optional test prep courses which creates a financial barrier for some students.⁵ We have added a combined degree program and early assurance programs where students can earn a bachelors and PharmD in 7 years.

The time is now. Will we be courageous and take this opportunity to update our standards and our programs without increasing barriers for future practitioners from all backgrounds?

References

1. Center for the Advancement of Pharmaceutical Education Educational Outcomes.  Association of Colleges of Pharmacy. Alexandria, VA. 1998. 
2. Center for the Advancement of Pharmaceutical Education Educational Outcomes. American Association of Colleges of Pharmacy.  Alexandria, VA. 2004.
3. Accreditation Standards and Guidelines for the Professional Program in Pharmacy Leading to the Doctor of Pharmacy degree (Standards 2000). American Council on Pharmaceutical Education. Chicago, IL. June 14, 1997.
4. Accreditation standards and guidelines for the professional program in pharmacy leading to the Doctor of Pharmacy degree (Standards 2007). Accreditation Council for Pharmacy Education. Chicago, IL. February 17, 2006. 
5. Buchmann C, Condron DJ, Rosigno VJ. Shadow education, American style: Test preparation, the SAT and College Enrollment.Social Forces. 2010:89(2) 435-462.

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Author Bios

Victoria L. Williams is a Pharmacy Education & Innovation Fellow at The Ohio State University, College of Pharmacy and Critical Care Pharmacist at Riverside Methodist Hospital in Columbus, Ohio. Her educational interests include curriculum design/assessment, innovative teaching techniques, and student affairs.  In her free time, Victoria enjoys taking her pug puppy to the dog park, attending Orange Theory Fitness classes, and exploring new restaurants in Columbus.

Katherine A. Kelley is Associate Dean for Assessment and Strategic Initiatives and Professor of Clinical Pharmacy at The Ohio State University, College of Pharmacy in Columbus, Ohio. Her areas of research interest include educational assessment, program evaluation, student learning, and pharmacy education. In her free time, she enjoys, travelling, cooking, and hiking.

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