Pharmacy Education: Bridging the SciencePractice Divide

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Pharmacy Education Bridging the Science-Practice
Divide
EAFP Conference, Tartu, Estonia 2006
Enhancing the Quality of Pharmaceutical Education

• Alexander T. Florence
• The School of Pharmacy, London
• Proceutics, Edzell and Nice

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Future
Science Practice
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Main thesis quality is to do with being fit for
purpose

• Principally ensuring
• The seamless transition between science and
  practice
• Basing practice on science and science for
  practice
• Ensuring appropriate science
• Allowing different emphases

Is pharmacy fit for purpose?
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Challenging false dichotomies
The false dichotomy between the clinic (practice)
and laboratory (science) important not to fall
into the trap of believing that modern practice
is about something else than knowledge.
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A timely topic
Medicine, if anything, is becoming more complex
as we unravel more about the science of the body
and the way drugs interact with it and are
delivered to their targets and used by patients
surely the heart of the pharmaceutical
sciences and practice
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Course Content Judgements

• Intrinsic value of knowledge
• Utility
• Philosophical value
• Responsibility
• Enrichment
• Questions posed on High School Science by the
  American Association for the Advancement of
  Science (AAAS) Science for All Project

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(1) Intrinsic value of knowledge

• Is the material we are presenting so important in
  pharmacy now?
• Will it be important in the future so that it
  must be taught?
• If we argue that it is important, how have we
  come to that conclusion?

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(2) Utility

• Is the proposed material knowledge or skills -
• vital for application in the work environment in
  any of the branches of pharmacy?
• Is it part of the unique pharmaceutical knowledge
  base?
• How have we arrived at the decision as to
  utility?

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(3) Philosophical value

• Does the proposed content encourage students to
  think of the wider issues affecting their future
  profession, their unique role and place in health
  care systems?
• How does it advance their role in reducing risk
  to patients and enhancing care?
• Does it give them pride in the achievements of
  pharmacy and an understanding of the historical
  context of pharmacy?

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(4) Responsibility

• Does the content allow our students to
  participate intelligently in discourse about
  their role and responsibilities?

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Purpose of Courses

• Preparation for practice now or the future? What
  practice?

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Designing and providing courses for the future
avoiding errors of judgement

• Prediction of the future cannot be based on fact
  it is based on intelligent (i.e. informed)
  guesswork founded on research which makes the
  future
• Mistakes can be costly

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Extemporaneous preparation
Extemporaneous preparations

• Labile medicaments (gene products, proteins,
  antibodies)
• Cytotoxic products
• Paediatric medication
• Domiciliary care products
• Individualised dosage forms

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Not only new therapies but the pharmacy of new
therapies
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New approaches eg in utero
Personalised medicines
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Defining the discipline
PHARMACEUTICAL SCIENCES PRACTICE (Not
everything about drugs the body and life)
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The need for new approaches
Because of the

• Variability of human responses to medicines
• Unpredictability of adverse drug reactions
• Slow progress with gene therapy and the therapy
  of many disease states eg cancer
• Potential of the application of knowledge
• of the human genome to individualise therapy
  and minimise risk
• Complexity of new therapeutic entities

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Does the science in our courses underpin the aims
of practice?

• Maximising patient health
• Minimising illness
• Optimising treatment with medicines and devices
• Monitoring outcomes

Pharmaceutical Science
Application of Science
Practice
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Connections

• Must ensure that the science we teach has the
  appropriate connections, that its ramifications
  in practice are explained
• More overt efforts made in teaching to identify
  the problems in practice and to connect these to
  the relevant science

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Spreading
Bacterial adhesion
Adsorption
Wetting
Dissolution
Crystallisation
Polymer surfaces
Crystal surfaces
Micro- nano- particles
Precipitation
Solid surfaces
Cell uptake
Crystalluria Toxicity
SURFACE CHEMISTRY
Liquid Surfaces
Adsorption
Surface tension
Interfacial tension
Surfactants
Antibacterials antivirals
Emulsification
Formulations
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Mapping problems in practice now and the
predicted future to science..
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Mapping knowledge to problems in practice
Practice
Drug Delivery Science
Problem
In vivo destination
Adhesivity
Adverse Reaction to Medication
Nature of formulation
Tonicity, etc
Pathology
Physical action
Instability/ malfunction
Drug
Excipient
Dose form
Drug Specific
Class effect
Other
Preservative
Colour
Surfactant
Pharmacology
Formulation Science
Chemical
Physical
Complexation
log P
Precipitation
Hapten formation
Physical Pharmacy
Cross-reactivity
Medicinal Chemistry
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Mapping knowledge to problems in practice
Drug Delivery Science
Paradoxical bronchoconstriction
In vivo destination
Adhesivity
Adverse Reaction to Medication
Nature of formulation
Tonicity, etc
Pathology
Physical action
Instability/ malfunction
Drug
Excipient
Dose form
Drug Specific
Class effect
Other
Preservative
Colour
Surfactant
Pharmacology
Formulation Science
Chemical
Physical
Complexation
log P
Precipitation
Hapten formation
Physical Pharmacy
Cross-reactivity
Medicinal Chemistry
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Adverse reactions to paclitaxel
Drug Delivery Science
Taxol Reaction
In vivo destination
Adhesivity
Adverse Reaction to Medication
Nature of formulation
Tonicity, etc
Pathology
Physical action
Instability/ malfunction
Drug
Excipient
Dose form
Drug Specific
Class effect
Other
Preservative
Colour
Surfactant
Pharmacology
Formulation Science
Chemical
Physical
Complexation
log P
Precipitation
Hapten formation
Physical Pharmacy
Cross-reactivity
Medicinal Chemistry
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The synthesis of knowledge
A tree of knowledge
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Where from here?

• Ensure continuity of themes and subjects
  throughout the course and ensure that gained
  knowledge does not atrophy
• We need the confidence to instil in students that
  courses have been designed for good reason and
  that they are the best that we can design
  deliver

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We need research to point to the future
nanotechnologies..stem cell therapy gene
therapy remote electronic delivery of drugs
individualised medicine
We need to think not only of the horizon but
beyond