Competency-Based Curriculum for Pharmacy Practice

Abstract

By LEGISLATIVE ACTION, pharmacists in California health care facilities have been permitted to manage drug therapy since 1981. A recent survey of hospital pharmacists in California reports a significant increase of activities related to the regulation of drug therapy during a 4-year period.' Not only did the percentage of hospitals having pharmacists manage drug therapy increase, but the nature of drug therapy regulation shifted to include more frequent determination of initial dosing and adjustment of maintenance doses. Although specific dosing methods for several drugs have been established, a multiple step process must take place as the pharmacist individualizes a dosing plan for each patient in order to maximize the therapeutic effect and minimize the potential for adverse effects,. This process integrates knowledge and judgment. As the clinical reasoning process becomes a more critical component of the pharmacist's responsibilities, alternative educational approaches must be explored to develop requisite skills.The clinical clerkship experience was introduced into the pharmacy curriculum two decades ago as a method to teach students what we called &dquo;clinical pharmacy skills.&dquo; These skills included obtaining a drug history, instructing a patient about his or her drug regimen, monitoring the patient and laboratory indices for therapeutic and adverse effects, and providing drug-related information to other health care professionals. The clerkship placed the pharmacy student in the patient care setting with other health care professionals in order to observe the actual effects of drugs on patients and to allow students practical experience in developing these newly described clinical pharmacy skills. This approach paralleled the teaching of clinical skills in medicine where observation and application of practice skills enhanced proficiency.About the same time, medical education began to explore competency-based education (CBE), a concept that was conceived 35 years earlier.2 In addition to the traditional transmittal of knowledge to the student, it was believed by clinicians that students would most effectively learn performance-based skills by being directly involved with each clinical activity. The idea that learning should encompass a hierarchy of knowledge, attitudes, and performance forms the basis for CBE.3 Grussing and Rinke provide a critical examination of the methodological and theoretical foundation of CBE.3°4 This article will discuss issues concerning the implementation of CBE for pharmacy practitioners. DEFINITION, OF CBESpady defines CBE as a &dquo;... data-based, adaptive, performance-oriented set of integrated processes that facilitate, measure, record, and certify within the context of flexible time parameters the demonstration of known, explicity stated, and agreed upon learning outcomes that reflect successful functioning in life roles.s&dquo;The graduate of such an educational program in pharmacy practice should be prepared to perform a series of professional tasks that requires tr...