Kevin Taylor is reader in pharmacy and Ian Bates is head of educational development at the School of Pharmacy, University of London
Over the past 20 years, student intakes into schools of pharmacy in the United Kingdom have more than doubled. Nevertheless, the demand for pharmacists remains high, with shortages in both community and hospital sectors.
The existing schools of pharmacy will continue to increase their enrolments to maximise income and address workforce shortages. Moreover, seven universities are at various stages of establishing new schools of pharmacy, with the first having recruited students this year, and many others have also contacted the Royal Pharmaceutical Society expressing a desire to establish pharmacy schools.
In 2002 the number of applicants to study pharmacy decreased. New schools, in new locations, may attract additional applicants. However, if more students are sought from a stationary or shrinking pool there are inevitably implications for the quality of the applicants, with students having poorer academic ability than was previously the case being recruited to fill available university places. Pharmacy lecturers already complain that many students lack basic competencies in mathematics, in chemistry and in their use of English. If less able students, or those from non-traditional, less academic backgrounds, are recruited, a fundamental reassessment of course content and teaching methods will be essential.
The breadth and complexity of pharmaceutical and clinical science has increased exponentially in the past decade or so. This together with the demands of modern professional practice has led to the pharmacy degree programme being extended from a three-year bachelor to a four-year master level degree, as defined by the Quality Assurance Agency (QAA) for Higher Education. The degree then, must now be taught at master’s level necessitating the requisite high academic standards of course content and student achievement. The paradox is that as academics strive to ensure MPharm programmes meet the necessary indicators, the widening access to pharmacy university education produces a significant risk of lowering overall outcomes. As pharmacy places proliferate, will there be sufficient applicants capable of undertaking first degree master’s higher education? Will there be an inexorable decline in expectations as universities cope with a gradual lowering of student entry quality?
Some will claim that widening access will have the opposite effect: stimulating competition for the best candidates, hence forcing up standards of teaching and curriculum design. However, as all current schools of pharmacy scored highly in the QAA’s subject review (a review of university teaching quality), this argument is largely spurious. Although the experience of learning may vary between schools, the quality, overall, is already high (certainly in comparison with many subject areas in higher education). The only way is down.
While student entrants have more than doubled, in the past 20 years the number of academic pharmacists has declined by approximately one-third. Increasing enrolments into existing schools, and opening of new schools, will stretch this resource even further. Moreover, clinical teaching by National Health Service staff may become over-stretched, especially as there is no clear funding stream for such teaching.
There are advocates of the new learning technologies who claim that IT and e-learning will revolutionise the way higher education can be provided, bringing the classroom to the learner, as an alternative to traditional modes of educational delivery. However, our experience is that, with some exceptions, e-learning will inevitably divorce the student from the teacher. “How will this reduce my teaching time?” is usually the first question when academics are told to prepare for the e-revolution. Perhaps the one lesson we should learn from medicine and nursing education is that learning and teaching in pharmacy needs a human focus, one that cannot be substituted by virtual learning environments and virtual tutors. Even hardcore medicines technology needs a human face, and student professionals need adequate exposure to professional practice.
One attraction of a pharmacy degree course is that on graduation students are practically ensured employment, particularly important in an era of tuition fees and student loans. However, in the future, 100 per cent employment on graduation may not be guaranteed, as the number of available pre-registration places is not increasing in line with the rising intakes into schools of pharmacy. This then may prove the bottleneck between the many more pharmacy graduates and increasing numbers of vacant pharmacist positions, as multiple pharmacies, with long opening hours, continue to proliferate.
It can be argued that having more pharmacy graduates than available preregistration places, and ultimately pharmacist positions, will improve standards, with positions being secured by the most able individuals, or those from universities whose courses best equip them for contemporary practice. However, surplus graduates will ultimately drive down salaries, reduce opportunities for pharmacists who are already practising and, in the long term, depress student numbers.
Currently, it is rare for MPharm graduates not to proceed to a preregistration position. Consequently, the degree programme, while combining scientific and professional subjects, is oriented towards equipping students for their preregistration training. However, if in the future a significant proportion of students will not secure a preregistration position, and are instead destined for unemployment, or employment as a pharmacy technician or a position requiring a general “scientific” training, then the content of the degree will need to be addressed, in a direction contrary to that of the past 10 years. Perhaps we will see the start of two-tier pharmacy education: a bachelor’s or foundation level technical pharmacy course (for the masses), and a master’s level practitioner pharmacy course (for the few).
There are shortages in the pharmacy workforce. However, the future is uncertain: will the market for pharmacists ultimately become saturated as new graduates are pumped on to the market and pharmacy technicians take over activities that were traditionally pharmacists’ remit? Will constraints on preregistration place numbers jeopardise the desired expansion in pharmacist numbers and the career aspirations of pharmacy graduates?
Pharmacy student numbers will increase substantially in the near future. The implications for educational standards, course content and the long-term viability of all schools of pharmacy (both new and long-established) may be enormous.
There remain many unanswered questions