A New Curriculum at the College of Pharmacy

Among the many accomplishments during her first year as dean of the UF College of Pharmacy, Julie Johnson, Pharm.D., is most proud of the complete restructuring of the Doctor of Pharmacy curriculum. Historically, like many educational programs in the health professions, the Pharm.D. program at UF for decades has been essentially a “2+2” curriculum: the first two years are devoted to basic sciences, taught primarily in large classrooms using a lecture format, and the last two years are focused on clinical pharmacy and the transition to practice.

Pharmacy is not alone in this approach at UF. For example, the College of Medicine had a very similar curricular structure until it underwent a fundamental revision two years ago (COM Curriculum Overview) under the leadership of Dean Mike Good, M.D., and Senior Associate Dean Joseph Fantone, M.D. In pharmacy, as in medicine, it has become recognized that the scientific underpinnings of clinical practice are more difficult to grasp and put to use as a practitioner if they not presented in a clinical context. (And the same is true for dentistry, nursing and veterinary medicine.) Basic sciences learned in discipline-specific silos have limited meaning unless these principles are integrated with clinical coursework and experience. Furthermore, contemporary students who have grown up in a high-tech world are primed to take advantage of simulation and online technologies, and can also benefit from multidisciplinary, small-group learning environments. Lastly, highly competent health professionals are characterized not only by deep scientific knowledge and clinical techniques but also by excellent communication skills, professionalism, evidence-based practice and teamwork.

Pharm.D. Curriculum Task Force

Given her desire to transform the Pharm.D. curriculum, Dean Johnson created a Task Force to make a serious, evidence-based evaluation of the Pharm.D. curriculum, and make recommendations for a new approach. Fifteen Task Force members were appointed, including 10 faculty members, two students and three clinical preceptors and alumni. The Task Force also sought feedback from a variety of interest groups that included students, clinical preceptors and recent alumni, and from faculty through Faculty Forums. Her charge to the Task Force was "to recognize that students now entering the pharmacy curriculum will be practicing into the 2060s and need to be equipped with the knowledge and skills that will be required to navigate the changes in health care over that time frame.” Task Force members were charged with evaluating the literature on contemporary approaches to the education of health professionals, learning what peers are doing (on campus in the health science center and at college of pharmacy peer institutions across the U.S.), and taking into account the importance of lifelong learning skills that graduate pharmacists will need. The only specific directive was that “we’ve always done it that way” was not sufficient justification to continue without any changes.

Desired Attributes of Pharm.D. Graduates

With these instructions, and under Dr. Johnson’s oversight, Task Force members first defined the primary attributes that would be desired for graduates of the UF Pharm.D. program:

• Evidence-based problem solver
• Collaborative interprofessional team member
• Facilitator of change
• Self-directed learner
• High personal standards of professional behavior
• Exemplary soft skills, which include interpersonal communication, teamwork, problem-solving, self-directed learning and self-awareness.

Limitations of Current Curriculum

In addition to defining the desired attributes of Pharm.D. graduates, the Task Force identified key limitations of the current curriculum, to avoid their repetition in the new curriculum and as a springboard for new ideas. While a large number of limitations were listed, the most important were as follows:

• Students are eager to learn pharmacy in Year 1, so increasing the exposure to pharmacy early in the curriculum was important
• Many courses are taught in isolation from the clinical context and this needed to be addressed. Examples included medicinal chemistry, pharmacology and pharmacotherapy taught in silos, and pathophysiology taught separately from the drug treatment associated with that pathophysiology.
• Time spent early in the curriculum on courses covered by students in their undergraduate studies.
• Skills laboratories and evidence-based courses occur too late in the curriculum and these skills need to be developed throughout.
• Increasing focus on professionalism, communication and lifelong learning skills is needed.

The 2015 Pharm.D. Curriculum

College of Pharmacy faculty and students then proceeded to construct a new curriculum for the Pharm.D. degree. This process brought members of the COP community together like nothing before, and galvanized them toward a common goal of creating a 21st-century curriculum that will serve its graduates for decades to come.

What emerged was a curriculum in which basic and clinical sciences are woven through the first three years, with the final year focused on pharmacy practice; clinical practice is learned in the context of systems (cardiovascular, pulmonary, etc.) that tie together basic and clinical science; professional competencies beyond pharmacy knowledge and clinical skills are assured; and appropriate assessments and feedback are integrated longitudinally throughout the four years.

Reggie Frye, Pharm.D.,Ph.D., a professor and chair of pharmacotherapy and translational research, led the Task Force. He focused this group on designing a curriculum to produce the next-generation pharmacist. “We gathered input from a variety of sources and worked to develop a curriculum that fully integrates foundational and applied knowledge,” he said. “An important aspect is that students will directly learn the importance of basic science principles and how that knowledge informs clinical decision-making. It was also important to us that the future graduates of our college have the skills needed to function effectively in interdisciplinary teams and lead team-based approaches to improve patient care delivery and outcomes.”

According to Diane Beck, Pharm.D., associate dean for curricular affairs and accreditation, “This innovative curriculum evolved because we had a visionary Task Force that continuously gathered input and feedback from faculty members, students, recent alumni and practitioners. These multiple perspectives were instrumental in designing a curriculum that will prepare graduates for practice through 2060.”

Amy Kiskaddon, a class of 2015 Pharm.D. student, thought it was critical that, in forging the new curriculum, the Task Force always tried to envision the future of the pharmacy profession, and actively sought feedback from recent graduates and current students. She is confident that “the integrative and clinical approach of the newly designed curriculum will enable students to actively assimilate and apply knowledge throughout the Pharm.D. program, and equip UF Pharm.D. graduates to be superb practitioners and leaders at the forefront of a changing profession.”

Mark Wilson, also a class of 2015 Pharm.D. student, summarizes his experience this way: “When I was first invited to be a part of the Curricular Revision Task Force, I did not grasp the full magnitude of the changes that I would be part of. I believed I would be assisting with shuffling a few courses and tweaking minor content in order to comply with the ever-changing ACPE accreditation standards. However, I quickly realized that this Task Force was committed to creating a curriculum that would truly enable our graduates to become lifelong learners who continue to be on the cutting-edge of pharmacy practice and who are invaluable members of an interprofessional health care team…The new integrated curriculum will enable future students to begin with a solid foundation of pharmaceutical principles that they can continue to build upon as they learn to apply it to patient care in the setting of disease-based modules. In addition to acquiring the knowledge and skills necessary to become a strong evidence-based practitioner, the new curriculum will also help students to develop the attitudes, values and professional behaviors that exemplify a strong patient-centered care practitioner. I am honored to have been part of the curricular revision process and I look forward to the development of Pharm.D. graduates who are ready to adapt to changes in health care for decades to come.”

A graphic display of each year of the new Pharm.D. curriculum contains too much detail to be included in this newsletter, but it can be found in this link for those who are interested. The key elements of the curriculum can be summarized as follows:

Context-based Curricular Integration

• Integration of basic and clinical science
• Material is learned in the context in which it will be used in practice
• Skills labs will simulate practice — provide simultaneous development of knowledge, skills, attitudes and professional values.

Personal & Professional Development of Students

• Development of soft-skills (interpersonal communication skills and personal attributes such as self-awareness, leadership, teamwork, flexibility and an innovative mindset).
• Development of self-directed learning skills so that graduates are prepared for lifelong learning.

Capstone/Milestone Assessments

• Document that students are progressively achieving the learning outcomes.
• Milestone at Year 3 will document student readiness for clinical rotations in final year.
• Milestone at Year 4 will document students are “Team Ready” and “Practice Ready”

Having created the backbone for this new curriculum, which will begin with the class entering in August 2015, the upcoming year will be devoted to forming “teaching partnerships” that will craft the details of each course. A teaching partnership will consist of faculty members from different disciplines who have expertise related to a given body system or other curricular topic. Each team of faculty members will collaboratively plan and design a course so that it accomplishes the learning outcomes and content that have been established. An instructional designer and other members of the educational technology group will assist the teaching partnership in developing innovative learning activities and assessment methods and also in developing a course website that exemplifies excellence.

The restructuring of the Pharm.D. curriculum ties in nicely with the strategic planning process currently underway for UF Health. The first Strategic Plan, “Forward Together,” was published on May 20, 2010; the deans, center directors and hospital administration are now meeting on a regular basis to forge the 2.0 version across all missions for our next five years. In the education realm, this will entail revisions to the professional and graduate studies curricula of each college, as needed, to meet the needs of clinicians and scientists for the 21st century. It will also entail increased interdisciplinary experience across our health science colleges, beyond the excellent experiences already in place, as developed by the Office of Interprofessional Education.

For example, in the new Pharm.D. curriculum, pharmacy students will increasingly collaborate with other health professional students to identify and propose solutions to patient safety or quality issues. A team at UF Health Shands is already piloting this approach with pharmacy and medical students. Students will be required to complete a larger number of rotations that involve them as members of an interprofessional team. There will also be more rigorous assessments of a student’s ability to collaborate as a team member, including a 360-assessment that is completed by team members and Objective Structured Clinical Examinations (OSCEs) that assess communication with other health professionals.

Another consideration being studied in the UF Health strategic planning process is reduction in the delivery of didactic information via large lectures. The COP has been a long-term innovator in this realm, having converted most of the lecture material to a video, online format long ago, and with several faculty already using a “flipped classroom” educational format. In the course of educational planning over the next year, no doubt other health science colleges will learn from the COP experience.

Forward Together,

David S. Guzick, M.D., Ph.D. Senior Vice President for Health Affairs, UF President, UF Health