Last month, my commentary on postgraduate training reflected my strong support of new graduates' pursuit of residency training in either acute care or ambulatory environments. In most years, about 30% or more of our graduates of the University of North Carolina School of Pharmacy pursue a residency or graduate school degree. I suspect that this may be higher than the national average; yet, it remains challenging to preferentially hire practitioners who have advanced skills and experience we need in many of our positions. For years, hospitals have needed individual practitioners to pursue continued lifelong learning through mentoring by senior members of the existing staff, and who have a strong personal commitment to grow professionally while practicing.
As I interact with my colleagues in community practice, I hear them suggest that schools do not give new graduates enough training and experience to prepare them for the responsibilities they assume in that particular practice setting. In fact, I sometimes hear that educators and the school give them too much "clinical"training and not enough experience in the day-to-day responsibilities of the "real world"community setting. These polar observations define our academic versus practice conundrum.
As an educator, I accept the observations of both constituencies and recognize our collective dilemma, but I hold fast to the notion that our mission is to prepare practitioners for the future rather than prepare them for the job responsibilities immediately following graduation. It is further complicated in that our customers (the students) expect us to prepare them for as many practice alternatives, such as community, hospital, long-term care, home care, etc, as possible so they have freedom to move about within the profession as they pursue the practice that is personally the best fit.
I do not have the answers to these phenomena. The practice of pharmacy has become so much more complicated, sophisticated, and diverse than when I matriculated. Are we approaching a time when we should expect students to declare their primary practice interest, like acute care practice, and then "track"them into a more practice-specific curriculum? If this solution is pursued, what are graduates to do when their preferences change and they wish to migrate to a different practice setting? Are employers obliged to retool practitioners to develop the skills to accomplish this change, or would practitioners need to return to school for additional training? How would the particular expertise of new graduates be recognized reliably by prospective employers? Would practice credentials be different as conferred by Boards of Pharmacy?
It seems apparent that schools of pharmacy need to embrace all their constituents, including their academic institutions, employers, students, accrediting bodies, and professional associations, to begin discussions regarding the need to rethink classic educational approaches for pharmacist education. Solutions will require entrepreneurial thinking that is selfless and focused on the patients we serve regardless of the practice setting.
Mr. McAllister is director of pharmacy at University of North Carolina (UNC) Hospitals and Clinics and associate dean for clinical affairs at UNC School of Pharmacy, Chapel Hill.
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