I applaud the efforts of the Journal’s Editorial Board in initiating the Research Primer series. The articles by Bond1 and Tully2 have set a good stage for anyone interested in conducting research. In my experience, however, conducting research is viewed in most pharmacy departments as ideal but not essential. This is partly due to the
misconception of equating all research with investigations undertaken primarily to acquire new knowledge, without a particular application in mind. This misconception has 2 main consequences. First, many front-line staff see little relevance of research to their daily practice. Second, they find it difficult to formulate everyday problems into researchable questions. I would like to share some of my own observations that may help in overcoming these barriers. First, choose an issue for which you will be able to answer the question, “Who cares?” at the end of the project. It does not have to be a high-profile type of question. For example, choose a problem that frequently frustrates you in daily practice. In my experience, the urge to resolve a common practice problem is, for most practitioners, more powerful than the need to fulfill a scientific curiosity. Who has not encountered a patient with dysphagia and wondered how to make the oral liquid medications safe to swallow?3 Equally important, other people, including your supervisors, are likely to share such frustrations. Instantly, your research project has the potential to solve a departmental problem, with the prospect of support from your colleagues and managers. Second, design your study according to the minimal effort that will be needed to complete the project. Do not expect too much help from grant funding, residents, or students. Most grant applications are seasonal. If your question is of any importance, the urgency to resolve it will not always coincide with the timelines of grant reviews, the start of new residencies, or the availability of summer students. Following this advice does not mean that you can do the project sloppily. Rather, focus on the minimal amount of evidence sufficient to make a practice decision. Use data that are readily available and make reasonable assumptions to define an end point and the a priori magnitude of change that will be acceptable for the key decision-makers.4 Third, set a deadline. Most undergraduate, graduate, and resident researchers complete their projects because they have set deadlines. For non–career researchers, it helps to create our own deadlines. Choosing an important departmental problem usually helps to you move along. Better still, commit to submit an abstract to a conference, since that deadline will be non-negotiable. Fourth, you must disseminate your findings. Doing so is not just good for your resumé or the reputation of your department. All researchers have an ethical obligation to share their findings so that others will learn from them to improve patient care. This is equally true for studies conducted by pharmaceutical manufacturers and by publicly funded health care professionals. Finally, all practitioners have an obligation to use the best evidence available for patient care. This means that we must systematically seek out the tertiary, secondary, or primary literature whenever it is readily available. With widely available guidance on how to conduct research, such as that being presented in the Research Primer series,1,2 I would argue that we are equally obliged to generate primary data ourselves as part of the systematic search for the best evidence available for patient care.
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(particularly among elderly patients), they will also likely prevent some patients from receiving an effective dose of domperidone. Although the Health Canada warning represents an important aspect of postmarketing surveillance and ongoing patient safety, it is important that clinicians be aware of the evidence supporting such warnings if they are to make responsible decisions. References 1. Domperidone maleate—association with serious abnormal heart rhythms and sudden cardiac death (cardiac arrest)—for health care professionals. Ottawa (ON): Health Canada; 2012 [cited 2014 Apr 25]. Available from: www. healthycanadians.gc.ca/recall-alert-rappel-avis/hc-sc/2012/15857a-eng.php 2. Van Noord C, Dieleman JP, van Herpen G, Verhamme K, Sturkenboom MC. Domperidone and ventricular arrhythmia or sudden cardiac death: a population-based case–control study in the Netherlands. Drug Saf. 2010; 33(11):2003-14. 3. Domperidone [product monograph]. Toronto (ON): Teva Canada Ltd; 2012 May 15. 4. Johannes CB, Varas-Lorenzo C, McQuay LJ, Midkiff KD, Fife D. Risk of serious ventricular arrhythmia and sudden cardiac death in a cohort of users of domperidone: a nested case–control study. Pharmacoepidemiol Drug Saf. 2010;19(9):881-8. 5. Sugumar A, Singh A, Pasricha PJ. A systematic review of the efficacy of domperidone for the treatment of diabetic gastroparesis. Clin Gastroenterol Hepatol. 2008;6(7):726-33. 6. Camilleri M. Clinical practice. Diabetic gastroparesis. N Engl J Med. 2007;356(8):820-9.
Salmaan Kanji, PharmD The Ottawa Hospital and Ottawa Hospital Research Institute Ottawa, Ontario Alyssa Stevenson, BScPharm The Ottawa Hospital Ottawa, Ontario Brian Hutton, PhD The Ottawa Hospital Research Institute Ottawa, Ontario Competing interests: Brian Hutton has received personal fees from Amgen Canada for teaching services and methodologic advice related to network meta-analysis (outside the scope of this submission). No other competing interests declared.
Pharmacy Research by “Nonresearch Pharmacists”
References 1. Bond CM. The research jigsaw: how to get started. Can J Hosp Pharm. 2014;67(1):28-30. 2. Tully MP. Research: articulating questions, generating hypotheses, and choosing study designs. Can J Hosp Pharm. 2014;67(1):31-4. 3. Iyer A, Heathcote D. Safe swallowing of oral liquid medications in patients with dysphagia: a patient quality and safety initiative [abstract]. Can J Hosp Pharm. 2014;67(1):61. 4. Øvretveit J. Action evaluation of health programmes and changes: a handbook for a user-focused approach. Abingdon, Oxford (UK): Radcliffe Medical Press; 2002.
will develop the knowledge and skills of baccalaureate-trained pharmacists comparable to ELPD graduates. Available programs continue to evolve. Considerations for Continuing beyond a Baccalaureate Degree in Pharmacy
Several programs are available to Canadian pharmacists seeking a postbaccalaureate PharmD; however, the specifics of the programs differ widely (Table 1).2-6 Until recently in Canada, traditional postbaccalaureate PharmD programs were available from the University of British Columbia2 and the University of Toronto.6 However, with the University of Toronto suspending its full-time program, the University of British Columbia is the only Canadian institution enrolling full-time postbaccalaureate PharmD students in 2014. For those interested in part-time studies, nontraditional postbaccalaureate PharmD distance programs remain an option.3,4 Additionally, the University of British Columbia,2 University of Toronto,6 and University of Waterloo5 anticipate enrolment in a postbaccalaureate PharmD “bridging” program in the coming months. These bridging programs
Within the profession, opinions differ regarding the transition to the ELPD. Some pharmacists express concern over employment stability, while others are confident in their education and work experience. Certainly the ELPD program does not lessen the value of a baccalaureate degree or years of experiential learning. Nevertheless, some practitioners continue to seek further education. As a pharmacist, why return to life as a student? According to recent graduates, the most common reason for completing a postbaccalaureate PharmD program is to remain competitive within the profession.7 There are numerous programs, in addition to the PharmD, available to pharmacists, including pharmacy residencies, doctoral and master’s programs, and MBA (master of business administration) programs, that potentially offer a competitive edge. A specific program should be selected based on alignment of the program’s objectives with the individual’s career goals. Although job satisfaction is multifactorial, improvement in this area is a common reason for seeking a postbaccalaureate PharmD.7 These educational programs increase satisfaction by allowing knowledge development that will improve patient care and advance clinical practice, as well as leadership and research skills. Pharmacists interested in management, research, or education may also wish to pursue a postbaccalaureate PharmD, as graduates from these programs have been found to spend more time working within these areas relative to pharmacists with a baccalaureate degree or an ELPD.8 Postbaccalaureate PharmD graduates obtain the skills and knowledge required to achieve and succeed in various desirable job opportunities. Even the most motivated student should consider the difficult balance of pursuing career advancement with achieving personal goals. Pharmacists completing a postbaccalaureate PharmD program will experience a range of delays in achieving their personal goals. Postbaccalaureate PharmD programs may require relocating or being away from home for extended periods of time. Additionally, staggering tuition fees are common among the programs available to Canadians (Table 1). Personal sacrifices should not be overlooked. Although several options currently exist for Canadian pharmacists seeking a postbaccalaureate program, the programs vary greatly in content, duration, and cost. Therefore, each individual should select the program that will best support his or her career goals. Potential postbaccalaureate PharmD students would be wise to explore each program’s benefits and drawbacks in relation to both career and personal endeavours.
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Mário L de Lemos, PharmD, MSc(Oncol) Provincial Pharmacy Systemic Therapy Program Vancouver, British Columbia Competing interests: None declared.
Postbaccalaureate PharmD Programs for Canadian Pharmacists: Options and Considerations Substantial changes are occurring in the education of Canadian pharmacists. Over the past decade, there has been a transition from the Bachelor of Science in Pharmacy (BScPharm) to the entry-level Doctor of Pharmacy (ELPD).1 With some universities already graduating ELPD students, practising pharmacists may be reflecting on program options to obtain a postbaccalaureate PharmD or ELPD equivalent. Program Options for Postbaccalaureate PharmD