By: David M. Kaylor, PharmD and Sarah Raake, PharmD, MSEd, BCACP, LDE
(Un)equal representation
As a student, I remember noticing a theme amongst the faculty members I encountered. All were seemingly residency trained and worked in a health system. The practice of inpatient and ambulatory care pharmacy was everywhere. I was naturally drawn to this area of pharmacy, but I did wonder… Did the community pharmacy arena have this same representation to tout the unique aspects of their careers? Was I drawn to inpatient care because of repeated exposure?
Most students work during their PharmD training. A survey of third-year pharmacy students by Siracuse et al. found that 78.4% of students had community experience. However, the types of experiences varied, and there was still a proportion of students with no community or work experience.1 Experiential rotations are great exposure opportunities, but how are the students who lack work experiences inspired by community practice before their IPPEs and APPEs? Are pharmacy schools relying too heavily on experiential education and work experiences to prepare and inspire students for community practice, knowing that’s where the majority practice?
Representation vs. workforce reality
Forty percent of pharmacists work in a community or retail setting, and a plurality of students in 2021 planned to work in a community pharmacy after graduation. Any community-focused coursework is typically limited to the first year of training before introductory experiential rotations. While some community-focused faculty might lead these educational efforts, those numbers are limited. Though the American Association of Colleges of Pharmacy collects data regarding faculty, the organization does not report the background of faculty members. A literature search regarding this found no studies directly evaluating this question. Perusing online faculty rosters of a sampling of PharmD programs supports this lack of data (and public visibility) on community pharmacy faculty. Quite simply, if community-pharmacy faculty are there, knowing that is challenging.
Reimagining community pharmacy
According to Dr. Misty Stutz, Dean of Sullivan University College of Pharmacy & Health Sciences, “In the early 2000s… pharmacy faculty (including administration) did not see or understand the need for additional training in community practice, and very few faculty were champions for the advancement of clinical skills within the community pharmacy role. This tide is beginning to shift. But even today, implementing clinical services within the community pharmacy is difficult.” Without community pharmacy faculty in the classrooms teaching about community pharmacy, how will the implementation of novel community-based patient care services be achieved? The Accreditation Council for Pharmacy Education Standards 2016, Standard 24, states that schools and colleges must train “practice-ready” graduates.2 With a lack of data surrounding how many community pharmacies focused faculty exist, alongside the limited community-focused activities and the overwhelming proportion of graduates entering into community practice, one has to wonder if Standard 24 is indeed being met at the community pharmacy level?2
Recognizing and reacting to the issue
There is no easy solution, but the first step to addressing this issue is acknowledging the disparity. In the setting of a pharmacist shortage and a decline in pharmacy school enrollment, the lack of community pharmacist representation could impede the industry’s ability to fix the shortage of pharmacists.3-4 One unique way to bring more community experience into the classroom is by leveraging what advanced community pharmacy training exists.
There are 162 accredited community-based PGY1 pharmacy residency programs as of April 2022. Competency area R4 and goal R4.1 of these programs are dedicated to teaching. The successful completion of these programs will help increase the number of community pharmacists with baseline teaching experience and increase the number of eligible candidates for co-funded or adjunct teaching positions. Additionally, colleges should intentionally focus these community pharmacists’ teaching efforts in their areas of expertise.
Colleges of pharmacy should actively evaluate how the community pharmacist’s role is promoted and provide role models for students within their curriculum. If nothing else, the dearth of data on the presence of community pharmacy within the didactic classroom should be of concern to an overly data-driven profession. The Academy must evaluate for disproportionate representation throughout curricula, realizing we are at a crossroads in the profession. Reiterating community exposure in different situations and settings, especially in longitudinal experiences, is one step in the right direction. In times like this, we need to inspire our students to improve the outlook of the pharmacy profession and prevent the continued downtrend in applicants to pharmacy programs.
How else might we turn the tide of student and public opinion in favor of community pharmacy? Continue to advance our thoughts in creating a more favorable public opinion by replying to this post.
Acknowledgments:
We want to thank Dr. Misty Stutz for her time providing feedback on this topic and her championing of and pursuit of advancement for community pharmacy.
References:
1. Siracuse MV, Schondelmeyer SW, Hadsall RS, Schommer JC. Third-year pharmacy students’ work experiences an attitudes and perceptions of the pharmacy profession. Am J Pharm Educ. 2008;72(30):50.
2. Accreditation Council for Pharmacy Education. Accreditation standards and key elements for the professional program in pharmacy leading to the doctor of pharmacy degree. Standards 2016.
3. Blank C. Retail pharmacy has reached the breaking point. Drug Topics. 2022;166(2):23-34.
4. Ngo M. Angry customers, more work and longer hours strain pharmacists. The New York Times. Available at: https://www.nytimes.com/2022/02/10/us/politics/pharmacists-strain-covid.html. Accessed April 25, 2022.
David Kaylor is a recently-graduated PGY2 internal medicine pharmacy resident at UofL Health – UofL Hospital. Educational scholarship interests include promoting the profession of pharmacy, academic advising, and experiential education. In his free time, David enjoys playing guitar and exploring restaurants in the Louisville area.
Sarah Raake is an associate professor and Director of Instructional Effectiveness at the Sullivan University College of Pharmacy & Health Sciences. Educational scholarship interests include assessment, instructional evaluation and improvement, and authentic assessments (OSCEs). In her free time, Sarah enjoys traveling and spending time with her twins on their farm.
Pulses is a scholarly blog supported by Currents in Pharmacy Teaching and Learning
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