So the Government wants universities to boost "meaningful clinical context and experience" in the MPharm and suggests the best way for us to do this would be to integrate the degree and the pre-registration year. Pilots of this new approach are expected to start in just two years time (PJ ,April 19 2008, 467).
The long-awaited White Paper uses the word "clinical" a great deal (176 times; nearly twice as often as the word "dispensing) and the preface talks about pharmacists' clinical skills. But which skills are these exactly? If universities are to "get more clinical" into their MPharm courses, then I for one would welcome some clear definitions before we plan radical surgery on our timetables.
Is clinical just another term for therapeutics, which some would argue can be taught and learnt perfectly well without seeing real patients? Or does "being clinical" also involve some of the hands-on patient skills which are taught in nursing and medicine?
If clinical means having direct contact with patients then the illustrations chosen for the Paper are interesting for the message they give. There is certainly a lot of (presumably) skilful communication about medicines and health going on, starting with the nicely posed cover shot (two women happily sharing information on what look like antihypertensives). But the physiological measurement shots are much less human. We see the equipment but never a pharmacist's hand actually touching the patient.
Instead, the first (Exec summary) and last (Conclusion) chapters both use the same very traditional image - elegant female hands counting out what could be senna tablets from a bulk dispensing pack.
Deconstructing these pictures reveals subtle differences. At the start of the paper the tablets are scattered in disorder over the triangle counter, hiding parts of the NPA logo. A rather-too-large (glass?) bottle is ready on the bench to receive them.
By the concluding section, all the tablets are neatly stacked up at the base, leaving the inverted NPA logo in clear view. The old glass bottle has gone; instead there is a safety cap on the bench. The positioning is strong, with the tablet triangle pointing the way forward.
If another picture was added, what would it show? If only we could see, then we might have a clearer idea of what we need to be planning for.
Will undergrad pharmacy practice training need to include the practical hands-on clinical skill of taking blood (for screening tests) and giving injections (for immunisations) as well as prescription management screening and dispensing? If so, our undergrads could use the clinical skills labs which already exist for training future doctors and nurses. Or will pharmacists main "clinical skill" be in essence the ability to interpret clinical evidence and prescribe health care interventions without touching the patient? In that case, we could probably manage without access to expensive new facilities.
But perhaps there isn't another "new role" picture to come. Perhaps the White Paper is really putting a well-crafted spin on the same good old skills that pharmacy has been practising for years now - safe medicine supply and good information and advice about medicines and health. In which case, the clinical skill that our future pharmacists need most is to learn to listen to people, and gather evidence on their individual problems and needs.
The case-based learning approach that this Paper endorses should help pharmacy undergraduates to integrate their science knowledge into patient-focused practice- but only if regular contact with real patients is built in from year 1, as it is for most medical students.
Otherwise there is a risk that we could produce a new generation of medicine experts, skilled in clinical data interpretation and prescribing but as remote from the caring process as most pharmacists were in the 1970s, when clinical pharmacy was only "shimmering on a distant horizon" (PJ , Nov 6 1976, 418).
