Therapeutics in the Education of Clinical Pharmacists G.
I
the
REQUESTED
lege
indulgence
in changing
tation Clinical
the
from “Teaching Pharmacy” to
the
Education
for
two
basis
of
for
(i)
teaching it
seems
interdisciplinary whom interact
and
have
not
Col-
presen-
Therapeutics “Therapeutics
in in
understand
the
therapeutics
to
appropriate
for
of
this
care
many
with
to to
briefly summarize the nondispensing demonstrated and services provided pharmacists
of
had the opportunity clinical pharmacists,
practicing
in the
roles by
tential
adverse
patient
care
test
and other
the
teaching
portion
of therapeutics
of
the
entire
of the pharmacist’s lated to meet the clinical In more cists
roles
tedly
are
as an integral clinical
component
education challenge
as formuof these new
services.
a rather short time, perhaps little than five years, clinical pharmahave
in improving and health and
and
describe
demonstrated
their
the quality care. The most
of drug prominent
services in
shown
developed, varying
in
although
stages
Table
usefulness
of
I and
therapy roles
evaluation,
serve
to:
(i)
Third Annual of Clinical 3, 1974.
DR. SCHUMACHER is Director tion and Research Programs, macy, Wayne State University,
the
the
Clinical EducaCollege of PharDetroit, Michigan
1975
to physicians, practitioners
stability
conducting
physicians
regimen;
the
other
pri-
providing
to patients on the and nonprescrip-
ill
extend
the
in
appropriate
of
mainteassessment
patients
using
by
the
suggests preparation
prepare
pharmacists
to
Table exposure for responses
service objectives recommendations II
and
pre-
developed with phar-
clinical
institutions academic
the role and above. These
capa-
by providing and patient
treatment protocols in conjunction
appraisal
of various following
as a basis
of
(iii) inregimens
by
(iv)
centers therapy
chronically
in
and
physicians
established by physicians macists.
tensive
audits
therapy; of drug
their side effects, contraindicastorage conditions while emthe need for compliance with
treatment nance drug for
nurses, and as well as
practitioners
of
lined of
care
and education of prescribed
drug
bilities
patient
48202. April,
Meeting of Pharmacology,
the
by
mended Paper presented at American College Atlantic City, May
and
prescribed
My
admit-
pofrom
interactions,
in
tion drugs, tions, and phasizing
(ii) To
the
resulting drug-labora-
of drug effectiveness
meetings
of the College.
therapy
effectiveness crease the
use
presented
Mich.
potential
and
participation
guidance proper
is
reactions,
drug-food,
evaluation health
despite the fine orientation provided by Dr. Francke1 and Dr. Walton2 at previous
review
Detroit,
and availability of the dosage forms selected; (ii) provide drug information
care
This
drug of
drug-drug,
mary
environment.
Ph.D.
the physician in monitoring therapy of patients for appropriateand effectiveness of treatment,
tory
phar-
health
researchers,
assist drug ness
Pharm.D.
compromise
Pharmacists”
To
group
practitioners
the
of my
Clinical
reasons:
macists,
of
title
E. SCHUMACHER.
include:
programs that the is recomto
meet
discussed are out(i)
an
in-
to pharmacotherapeutics interpreting to drug
and therapy;
evaluating (ii)
a 241
SCHUMACHER
Prominent
I
and
Services
Monitoring
ness
Drug
and
Therapy
Effectiveness
2.
Providing to Health
Drug Care
3.
Providing tients on
4.
Providing Patient tients
for of
Treatment
Guidance the Proper
and
Evaluation
Drug Therapy Chronically
for
of
Pa-
thorough knowledge and pharmacology
Ill
and Pa-
the the and
drug
selection
states
and
of
and
the
understanding
principles
utilization
in
(iii)
processes; of
a
providing
tion,
regimens
and
dosage
ceutics
of
appreciation
of drugs
knowledge
and
of
dosage
the
significance
tests the
used to response
understanding procedures terpretation
of
(v)
a
of disease states and an understanding of the
monitor to drug
clinical
laboratory
disease therapy;
states (vi)
(viii)
of disease
a knowledge
of the
in the interpretation the clinical literature mental
studies
in
awareness of tional structure
the
(x)
lastly,
in
force,
and
enhance
application niques cited
242
health
drug
therapy;
order
to
the
and
experience health care
Yet,
in-
appro-
of the drug patient as well to the regimen. stages and
of
practice,
achieved
on
practice
what
experiences
to the
clinical
component
Nor emphasis
is there placed
agreement on these
in
appraising
the
professional
TABLE Academic
reinand
and techinterpro-
as provided facilities.
and
post-
graduate
pro-
II Preparation Pharmacists
Professional
Recommended
for Clinical
1.
Intensive
Exposure
2.
Rigorous
Exposition of and Utilization
Principles
Understanding
of
Selection 3.
Thorough
tics
and
to Pharmacotherapeutics of
Drug
Biopharmaceu-
Pharmacokjnetics
4.
Thorough Appreciation of Pharmaceutics Drugs and Dosage Forms
5.
Knowledge
an
organizahealth care;
comprehension
principles a rigorous
appropriate
used
(ix)
integrate,
of the
and an
care;
techniques
been
the
his
embryonic
and
baccalaureate,
and evaluation of as well as experi-
methods of delivering
of the above,
fessional clinical in appropriate
and
has
in
with
maximize
education
courses
courses.
courses, therapeutics, experiences
evaluation
in these
of the curriculum. on the relative
of the clinical assessment used in the evaluation and inof disease states and processes
aspects
to
a
therapeutics Therefore,
pharmacist
effectiveness for the response
consensus
are
include
the drugs.
of
pharmacy
specific
and
as a basis for interpreting the selection of and response to drug therapy; (vii) an awareness of the sociological and psychological
no
(iv)
forms;
in
therapy.” is to prove
to
of
skills
and
clinical
pharma-
pathophysiology
clinical biochemistry processes as well as the
drugs;
of the
terpretation
Naturally,
interpretapplica-
drugs
the
and
priateness and therapy selected as the patient’s
disease
thorough and
as a basis for the selection,
a thorough
of
biopharmaceutics
pharmacokinetics ing and evaluating
repeated
focus in the therapeutics subject areas supporting in the clinical practice
knowledge exposition
and
is “drug pharmacist
to
Education of Drugs
is on rigorous
cited
pharmaceutics
and Use
Maintenance Assessment
phrase
the value of his unique contribution to health care, it is mandatory that he broaden his acknowledged expertise in the
Appropriate-
Information Practitioners
key
these recommendations For if the clinical
Clinical
in
Practice
Pharmacy 1.
The
TABLE Roles
of
Pathophysiology
of
of
Disease
States 6.
Understanding
of
Clinical
Assessment
Pro-
cedures 7.
Awareness Disease
8.
Knowledge
9.
Awareness
of
of of
Sociology
and
Biostatistical Methods
Psychology
of
Techniques of
Delivering
Health
Care 10.
Rigorous
tice
Interprofessional Experiences The
Journal
of Clinical
Clinical
Prac-
Pharmacology
EDUCATION
grams
a strong
with
the
program
parent present, practice
clinical
similarities
than
are
OF
curriculum facilities
orientation,
are
program
far
more
critical in differentiating program than are teaching, systems, and effectiveness.
Since
teristics
are
often
these
difficult
evaluated
too
by
program
techniques. to present
one
have
at my not
as
tion.
academic and to curriculum
chosen
the (Table
Rather,
III).
nor
I
have
of my familiarity jectives, strengths
quality of
professional content,
It is offered
selected
it
oband
employed. Naturally, the philosophy of our
postgraduate
Pharm.D.
pro-
component of the proin the courses of theraof
disease,
advanced
courses
the first program.
course,
are
three
which
course, which requirements treats common April,
a
the
1975
gram more
appears in other
pathophysiology disease states
College.
in
Slide-sound
these at other
adjuncts institutions.
course is examinations
written
exercises. aspects of
practice
ma-
techniques in our pro-
this oral
by
dis-
Annual
learning
to date, although fully developed
is a primary
TABLE
are
assessed and clinical course
in
prerequisite in the
Course
Weeks
Therapeutic
Aspects
similar clinical with
of
in content programs,
Aspects
of the emphasis
Clinical 10
of
Disease
10
Pathology
10 10
Drug
Literature
Social
Policies
Evaluation and
Seminar
10
Health
Care
Services
in
10
Health 20 10
Professional search
Doctoral Project
Electives
I (Intravenous
Clinical
Re20-30
Therapy,
Therapy,
more on
of
Biostatisties
of
to
30 Clerk30
Aspects Practice
Pharmaceutical Came Facilities
disease
Disease
Pharmacy
ship” Pharmneokinetic
matological
aspects
of
Clinical
of
pharmafirst aca-
III
Pharm.D. Program at College of Pharmacy and Allied Health Professions, Wayne State University
Clinical
and and
concurrently
course during
quarter. therapeutic
the
as
Second
terials, and other audiovisual have been infrequently used
Biochemical
academic quarters The pharmacokinetics
an undergraduate cokinetics, is taken demic The
taken
carries
the
drugs
parameters
Fletcher,3
at
programmed
Pharmacy
clini-
cal pharmacy clerkship, pharmacokinetic aspects of clinical pharmacy practice, elective courses. The therapeutics for the
of
Advanced
aspects
for the
of
year
sequences,
faculty and stu-
because
majority
clerkship
last
mem-
as a recommenda-
Yet it appears content to the
peutic
Pharmacy, Medicine,
parameters
method
cussed
clinical
by applying
pharmacy
our resources. in thrust and
of
of of
Monitoring presented
of the drugs these diseases.
by the
the faculty the School
secondarily by Pharmacoknetic
faculty and to be similar
grams. The therapeutics gram is apparent
of
Competence primarily
program
with the curriculum, and weaknesses,
teaching methods the program reflects
is presented
i\Ieeting
exbeen
example
application treatment of
following
are
quality
Pharm.D.
a prototype
are
postbaccalaureate,
professional institution
dents.
the
to correlate
I
quality methods
our collective programs has
brief
graduate
Material bers from
and
with program In order
translating the recommendations
At
charac-
assess,
indirectly
of program graduates, perience with clinical far
ap-
clinical far less
latter
to
PHARMACISTS
the therapeutic used in the
differences.
content and probably
are
CLiNICAL
Clinical
Pharmacology,
Adverse Drug Reactions, maeeutics, Computers and others) Includes
Principles
Minimum
of
three
Therapy, DerPediatric
and
RadiopharResearch,
of
electives,
Patient
Assessment.
10 weeks
each. 243
SCHUMACHER
our curriculum not only because of its critical relationship to therapeutics but also because it provides the pharmacist with the concepts, insight, and data necessary to make a special contribution ing his consultations on drug therapy. we
know,
pharmaeokinetics
phasized
in
do most cokinetic
physicians develop “sense” about drug
ing
the
is
their
practice
covers the development well
medical
as specific
ations
in
peutic portion dent
discussions
of
evaluation
clinical
their
of
literature
from
their
which
provided
clinical
the
the
case
quality discussion
of
this
input sections.
tion,
and
the
probably
during In
the
focus of
reflects
both
and and
the
cists.
it
best
taught
the
varying
is
my
opinion
by two
therapy
to of
and
that
course
these
a clinical
with and
principles pharmacist
variety as the our
to
for
for for to
building
clini-
dents related
to
the most
of varyin a
the
and of a
by
of
Medi-
therapy for stu-
case studies corwith the disease
of patient our program to
some
number
of than
of the
in
IIMO one
is
experiences limited
contact the
al-
hours
average.
experiences
hours
are
inpatient on an in-
detoxication outpatient
servclinics,
elective experience. of the student in these
Journal
of
Clinical
is
Overis similar
900
and pediatric services, (ii) and
in
programs,
Our
on adult medicine
and (iv) in responsibilities
care
other
programs.
The
School the drug necessary
polydrug-drug (iii)
lectures
discussed in the concurrent aspects of disease course.
thrust (i)
of
weekly possible
greater
to
ice,
se-
It prointerpro-
on “Principles as conducted
of
present whenever
the
all,
patient
(i)
experiences responsibility
It provides experiences
states being therapeutic
a ob-
practice
a series
member
cine. (iii) monitoring
spent internal
in
it does
of treatment centers. (ii) It serves formal mechanism for introducing
students
is
a pharma-
scientist the real
sure
clinical
fessional patient care ing degrees of patient
though
orienta-
the
clinical
mechanism principles
and
our
somewhat
clinical
pharmacokineti-
instructors:
cokinetically oriented strong commitment application
clinical of
care
drugs re-
represents
has three objectives: students with supervised
comparison
phar-
the
which
advanced
as I am
patient
in
sequence
the primary therapeutic
The variety provided in
continuing
varying of
knowledge
it is placed
the curriculum programs. This
knowledge
faculty
the
presenta-
its
throughout among
macokinetic
244
of its
program,
faculty
and
programs, emphasis
the
“laboratory” exercises Patient Assessment,”
the literature appraising the
nature
reinforcement varies markedly
in-
primarily secondarily
project
other clinical that the
course,
in
of drug
is assessed and
our
if students in a clinical
concentrations of related to therapeutic
clerkship
the others, translating
pharma-
laboratory tissue are
expected,
quence vides a
experience
or effectiveness
studies
curricula of my impression
in
considerations
choice
for
practical
enhanced experience
pharmacokinetics
observations,
them
of
the concepts and techin a course such as this
cal skills, poise, and confidence in our students. Discussing our specific clerkship course briefly before making some general
to reinforce case studies
practice
grasp
substantially access to and
actual
therapy from the
to
a project submit
therapy. Competence by written examinations
drug
drug papers
pharmacokinctic
fluence
served
thera-
pharmacokinetic
influencing the 30-50
course syllabus. As principles, students
tion
and as
interpretation
the
firm
pharmacy
consider-
of various
are have
sponse. As
course
modification, dosage regimens
utilization
considerations in each of
on
nor
This
a
cokineties. Lastly, niques imparted
blood and in patients
a pharmatherapy dur-
pharmacokinetie
the
em-
categories of drugs. This didactic is supplemented by weekly stu-
and
by
not
curriculum
years.
monitoring, of drug
durAs
with
Pharmacology
The cx-
EDUCATION
OF
CLINICAL
periences are structured to meet the service needs shown previously in Table I and are supervised by a clinical member of the faculty There
of pharmacy. is undoubtedly
a marked
tion between programs, individual programs, sophistication component wards with
of the
of
of
the
the
and in the
practice The re-
component
of contact
vary
hours,
and and
the interaction physician, nurse,
ing ing
the the
ship
even within quality and
the clinical curriculum.
practice
number
varia-
PHARMACISTS
nature
therapy advanced
course.
ment
We
although we
difficult practice
to measure. experiences
plement,
perfect,
bulatory
experiences.
student termined
is
and
supervise
Yet,
educating that little
our
effectiveness
assessment
and in
input inpatient
of
program,
the
teaching which
experiences an example: therapeutic cardiovascular
desetin
pharmacy and
to digoxin
and
parameters
toxicology,
for
response
to
therapeutic pharmacokinetics
and
monitoring
its aspects
the
administration
develop patient in
the
of disease course; the of digoxin and pharma-
interpretations on digoxin
will
of be
the clinical discussed in
the pharmacokinetic aspects of clinical pharmacy practice course; the therapeutic response of a variety of inpatients and outpatients digoxin total
drug
April,
1975
to therapy
digoxin, in
therapy
the monitoring relationship to regimen
of
rudimentary
patients,
of the
important
macists”
or
appropriate with
years
to
their
semantic
proundernotably
incorporate pharmain emphasis
are
services,
If
we
consensus
of
from the graduate as “clinical pharclinicians,”
it
to describe current first professional deoriented”
whom
close
allowed
and
“pharmacist
“clinically
of
has
to sophisticated.
seems graduates
on
to
time
graduates programs
as
pub-
data
all varying the
designating professional
the
to
yet
programs, have been
courses,
achieved
Table
is
clerkship,
from
clinical
as
have
but
from
postbaccalaureate,
recent
have
the
is used
only
in
cokinetics
some
it
pre-
criteria,
solace and
graduate curricula
modified
our
parallel
the
although
therapeutics,
gree
in
that
fessional graduate
con-
The student will learn the applications of digoxin in disease, review its phar-
macology
cokinetic literature
is
therapeutics
others,
of
is so scanty available on
approach
appears
of
am-
experience
in clinical
education. To summarize tinuity
than
clinical pharmacists or no data are
methods
clinical to im-
The
collective
adand
Inpatient appear easier
performance more readily
tings.
in
variable
need others
that
noting
evaluating
this system of and reinforcement,
lish their observations methods effectiveness. I believe
durclerkno assess-
for
of brief
that
me to discuss
effectiveness
date
sorely
a period
observation
encountered pharmacy
developed
to
we
gain
previously,
clerkships
have
the effectiveness of sentation, application,
by
methods
will be clinical
parameters
of the patient responsibility experiences, quality of the direct supervision of students, and extent of interprofessional interaction. Furthermore, as discussed ministering
between pharmacist and patient regard-
pharmacists,
qualified as
to
provide
characterized
in
I.
Acknowledgments I acknowledge the cooperation of Drs. Candace Brettschneider, Joel Covinsky, Richard Closson, Gary Cripps, Tom Foster, and John Gans in providing me with information on methods employed in teaching therapeutics at their institutions.
References 1.
2.
3.
Francke, D.: Relationship between clinical pharmacology and clinical pharmacy. J. Clia. Pha,r,nacol. 12:384 (1972). Walton, C.: Clinical pharmacology and clinical pharmacy: a necessary alliance for
practical
advances
J. Clin. Fletcher,
Pliarmacol. P., and
in rational 14:1 Bennett,
parameters-following course.
J.
CjOs.
in Pharmacol.
drug (1974). R.: The a 14:9
therapy. use
of
therapeutic (1974). 245
I
the
REQUESTED
lege
indulgence
in changing
tation Clinical
the
from “Teaching Pharmacy” to
the
Education
for
two
basis
of
for
(i)
teaching it
seems
interdisciplinary whom interact
and
have
not
Col-
presen-
Therapeutics “Therapeutics
in in
understand
the
therapeutics
to
appropriate
for
of
this
care
many
with
to to
briefly summarize the nondispensing demonstrated and services provided pharmacists
of
had the opportunity clinical pharmacists,
practicing
in the
roles by
tential
adverse
patient
care
test
and other
the
teaching
portion
of therapeutics
of
the
entire
of the pharmacist’s lated to meet the clinical In more cists
roles
tedly
are
as an integral clinical
component
education challenge
as formuof these new
services.
a rather short time, perhaps little than five years, clinical pharmahave
in improving and health and
and
describe
demonstrated
their
the quality care. The most
of drug prominent
services in
shown
developed, varying
in
although
stages
Table
usefulness
of
I and
therapy roles
evaluation,
serve
to:
(i)
Third Annual of Clinical 3, 1974.
DR. SCHUMACHER is Director tion and Research Programs, macy, Wayne State University,
the
the
Clinical EducaCollege of PharDetroit, Michigan
1975
to physicians, practitioners
stability
conducting
physicians
regimen;
the
other
pri-
providing
to patients on the and nonprescrip-
ill
extend
the
in
appropriate
of
mainteassessment
patients
using
by
the
suggests preparation
prepare
pharmacists
to
Table exposure for responses
service objectives recommendations II
and
pre-
developed with phar-
clinical
institutions academic
the role and above. These
capa-
by providing and patient
treatment protocols in conjunction
appraisal
of various following
as a basis
of
(iii) inregimens
by
(iv)
centers therapy
chronically
in
and
physicians
established by physicians macists.
tensive
audits
therapy; of drug
their side effects, contraindicastorage conditions while emthe need for compliance with
treatment nance drug for
nurses, and as well as
practitioners
of
lined of
care
and education of prescribed
drug
bilities
patient
48202. April,
Meeting of Pharmacology,
the
by
mended Paper presented at American College Atlantic City, May
and
prescribed
My
admit-
pofrom
interactions,
in
tion drugs, tions, and phasizing
(ii) To
the
resulting drug-labora-
of drug effectiveness
meetings
of the College.
therapy
effectiveness crease the
use
presented
Mich.
potential
and
participation
guidance proper
is
reactions,
drug-food,
evaluation health
despite the fine orientation provided by Dr. Francke1 and Dr. Walton2 at previous
review
Detroit,
and availability of the dosage forms selected; (ii) provide drug information
care
This
drug of
drug-drug,
mary
environment.
Ph.D.
the physician in monitoring therapy of patients for appropriateand effectiveness of treatment,
tory
phar-
health
researchers,
assist drug ness
Pharm.D.
compromise
Pharmacists”
To
group
practitioners
the
of my
Clinical
reasons:
macists,
of
title
E. SCHUMACHER.
include:
programs that the is recomto
meet
discussed are out(i)
an
in-
to pharmacotherapeutics interpreting to drug
and therapy;
evaluating (ii)
a 241
SCHUMACHER
Prominent
I
and
Services
Monitoring
ness
Drug
and
Therapy
Effectiveness
2.
Providing to Health
Drug Care
3.
Providing tients on
4.
Providing Patient tients
for of
Treatment
Guidance the Proper
and
Evaluation
Drug Therapy Chronically
for
of
Pa-
thorough knowledge and pharmacology
Ill
and Pa-
the the and
drug
selection
states
and
of
and
the
understanding
principles
utilization
in
(iii)
processes; of
a
providing
tion,
regimens
and
dosage
ceutics
of
appreciation
of drugs
knowledge
and
of
dosage
the
significance
tests the
used to response
understanding procedures terpretation
of
(v)
a
of disease states and an understanding of the
monitor to drug
clinical
laboratory
disease therapy;
states (vi)
(viii)
of disease
a knowledge
of the
in the interpretation the clinical literature mental
studies
in
awareness of tional structure
the
(x)
lastly,
in
force,
and
enhance
application niques cited
242
health
drug
therapy;
order
to
the
and
experience health care
Yet,
in-
appro-
of the drug patient as well to the regimen. stages and
of
practice,
achieved
on
practice
what
experiences
to the
clinical
component
Nor emphasis
is there placed
agreement on these
in
appraising
the
professional
TABLE Academic
reinand
and techinterpro-
as provided facilities.
and
post-
graduate
pro-
II Preparation Pharmacists
Professional
Recommended
for Clinical
1.
Intensive
Exposure
2.
Rigorous
Exposition of and Utilization
Principles
Understanding
of
Selection 3.
Thorough
tics
and
to Pharmacotherapeutics of
Drug
Biopharmaceu-
Pharmacokjnetics
4.
Thorough Appreciation of Pharmaceutics Drugs and Dosage Forms
5.
Knowledge
an
organizahealth care;
comprehension
principles a rigorous
appropriate
used
(ix)
integrate,
of the
and an
care;
techniques
been
the
his
embryonic
and
baccalaureate,
and evaluation of as well as experi-
methods of delivering
of the above,
fessional clinical in appropriate
and
has
in
with
maximize
education
courses
courses.
courses, therapeutics, experiences
evaluation
in these
of the curriculum. on the relative
of the clinical assessment used in the evaluation and inof disease states and processes
aspects
to
a
therapeutics Therefore,
pharmacist
effectiveness for the response
consensus
are
include
the drugs.
of
pharmacy
specific
and
as a basis for interpreting the selection of and response to drug therapy; (vii) an awareness of the sociological and psychological
no
(iv)
forms;
in
therapy.” is to prove
to
of
skills
and
clinical
pharma-
pathophysiology
clinical biochemistry processes as well as the
drugs;
of the
terpretation
Naturally,
interpretapplica-
drugs
the
and
priateness and therapy selected as the patient’s
disease
thorough and
as a basis for the selection,
a thorough
of
biopharmaceutics
pharmacokinetics ing and evaluating
repeated
focus in the therapeutics subject areas supporting in the clinical practice
knowledge exposition
and
is “drug pharmacist
to
Education of Drugs
is on rigorous
cited
pharmaceutics
and Use
Maintenance Assessment
phrase
the value of his unique contribution to health care, it is mandatory that he broaden his acknowledged expertise in the
Appropriate-
Information Practitioners
key
these recommendations For if the clinical
Clinical
in
Practice
Pharmacy 1.
The
TABLE Roles
of
Pathophysiology
of
of
Disease
States 6.
Understanding
of
Clinical
Assessment
Pro-
cedures 7.
Awareness Disease
8.
Knowledge
9.
Awareness
of
of of
Sociology
and
Biostatistical Methods
Psychology
of
Techniques of
Delivering
Health
Care 10.
Rigorous
tice
Interprofessional Experiences The
Journal
of Clinical
Clinical
Prac-
Pharmacology
EDUCATION
grams
a strong
with
the
program
parent present, practice
clinical
similarities
than
are
OF
curriculum facilities
orientation,
are
program
far
more
critical in differentiating program than are teaching, systems, and effectiveness.
Since
teristics
are
often
these
difficult
evaluated
too
by
program
techniques. to present
one
have
at my not
as
tion.
academic and to curriculum
chosen
the (Table
Rather,
III).
nor
I
have
of my familiarity jectives, strengths
quality of
professional content,
It is offered
selected
it
oband
employed. Naturally, the philosophy of our
postgraduate
Pharm.D.
pro-
component of the proin the courses of theraof
disease,
advanced
courses
the first program.
course,
are
three
which
course, which requirements treats common April,
a
the
1975
gram more
appears in other
pathophysiology disease states
College.
in
Slide-sound
these at other
adjuncts institutions.
course is examinations
written
exercises. aspects of
practice
ma-
techniques in our pro-
this oral
by
dis-
Annual
learning
to date, although fully developed
is a primary
TABLE
are
assessed and clinical course
in
prerequisite in the
Course
Weeks
Therapeutic
Aspects
similar clinical with
of
in content programs,
Aspects
of the emphasis
Clinical 10
of
Disease
10
Pathology
10 10
Drug
Literature
Social
Policies
Evaluation and
Seminar
10
Health
Care
Services
in
10
Health 20 10
Professional search
Doctoral Project
Electives
I (Intravenous
Clinical
Re20-30
Therapy,
Therapy,
more on
of
Biostatisties
of
to
30 Clerk30
Aspects Practice
Pharmaceutical Came Facilities
disease
Disease
Pharmacy
ship” Pharmneokinetic
matological
aspects
of
Clinical
of
pharmafirst aca-
III
Pharm.D. Program at College of Pharmacy and Allied Health Professions, Wayne State University
Clinical
and and
concurrently
course during
quarter. therapeutic
the
as
Second
terials, and other audiovisual have been infrequently used
Biochemical
academic quarters The pharmacokinetics
an undergraduate cokinetics, is taken demic The
taken
carries
the
drugs
parameters
Fletcher,3
at
programmed
Pharmacy
clini-
cal pharmacy clerkship, pharmacokinetic aspects of clinical pharmacy practice, elective courses. The therapeutics for the
of
Advanced
aspects
for the
of
year
sequences,
faculty and stu-
because
majority
clerkship
last
mem-
as a recommenda-
Yet it appears content to the
peutic
Pharmacy, Medicine,
parameters
method
cussed
clinical
by applying
pharmacy
our resources. in thrust and
of
of of
Monitoring presented
of the drugs these diseases.
by the
the faculty the School
secondarily by Pharmacoknetic
faculty and to be similar
grams. The therapeutics gram is apparent
of
Competence primarily
program
with the curriculum, and weaknesses,
teaching methods the program reflects
is presented
i\Ieeting
exbeen
example
application treatment of
following
are
quality
Pharm.D.
a prototype
are
postbaccalaureate,
professional institution
dents.
the
to correlate
I
quality methods
our collective programs has
brief
graduate
Material bers from
and
with program In order
translating the recommendations
At
charac-
assess,
indirectly
of program graduates, perience with clinical far
ap-
clinical far less
latter
to
PHARMACISTS
the therapeutic used in the
differences.
content and probably
are
CLiNICAL
Clinical
Pharmacology,
Adverse Drug Reactions, maeeutics, Computers and others) Includes
Principles
Minimum
of
three
Therapy, DerPediatric
and
RadiopharResearch,
of
electives,
Patient
Assessment.
10 weeks
each. 243
SCHUMACHER
our curriculum not only because of its critical relationship to therapeutics but also because it provides the pharmacist with the concepts, insight, and data necessary to make a special contribution ing his consultations on drug therapy. we
know,
pharmaeokinetics
phasized
in
do most cokinetic
physicians develop “sense” about drug
ing
the
is
their
practice
covers the development well
medical
as specific
ations
in
peutic portion dent
discussions
of
evaluation
clinical
their
of
literature
from
their
which
provided
clinical
the
the
case
quality discussion
of
this
input sections.
tion,
and
the
probably
during In
the
focus of
reflects
both
and and
the
cists.
it
best
taught
the
varying
is
my
opinion
by two
therapy
to of
and
that
course
these
a clinical
with and
principles pharmacist
variety as the our
to
for
for for to
building
clini-
dents related
to
the most
of varyin a
the
and of a
by
of
Medi-
therapy for stu-
case studies corwith the disease
of patient our program to
some
number
of than
of the
in
IIMO one
is
experiences limited
contact the
al-
hours
average.
experiences
hours
are
inpatient on an in-
detoxication outpatient
servclinics,
elective experience. of the student in these
Journal
of
Clinical
is
Overis similar
900
and pediatric services, (ii) and
in
programs,
Our
on adult medicine
and (iv) in responsibilities
care
other
programs.
The
School the drug necessary
polydrug-drug (iii)
lectures
discussed in the concurrent aspects of disease course.
thrust (i)
of
weekly possible
greater
to
ice,
se-
It prointerpro-
on “Principles as conducted
of
present whenever
the
all,
patient
(i)
experiences responsibility
It provides experiences
states being therapeutic
a ob-
practice
a series
member
cine. (iii) monitoring
spent internal
in
it does
of treatment centers. (ii) It serves formal mechanism for introducing
students
is
a pharma-
scientist the real
sure
clinical
fessional patient care ing degrees of patient
though
orienta-
the
clinical
mechanism principles
and
our
somewhat
clinical
pharmacokineti-
instructors:
cokinetically oriented strong commitment application
clinical of
care
drugs re-
represents
has three objectives: students with supervised
comparison
phar-
the
which
advanced
as I am
patient
in
sequence
the primary therapeutic
The variety provided in
continuing
varying of
knowledge
it is placed
the curriculum programs. This
knowledge
faculty
the
presenta-
its
throughout among
macokinetic
244
of its
program,
faculty
and
programs, emphasis
the
“laboratory” exercises Patient Assessment,”
the literature appraising the
nature
reinforcement varies markedly
in-
primarily secondarily
project
other clinical that the
course,
in
of drug
is assessed and
our
if students in a clinical
concentrations of related to therapeutic
clerkship
the others, translating
pharma-
laboratory tissue are
expected,
quence vides a
experience
or effectiveness
studies
curricula of my impression
in
considerations
choice
for
practical
enhanced experience
pharmacokinetics
observations,
them
of
the concepts and techin a course such as this
cal skills, poise, and confidence in our students. Discussing our specific clerkship course briefly before making some general
to reinforce case studies
practice
grasp
substantially access to and
actual
therapy from the
to
a project submit
therapy. Competence by written examinations
drug
drug papers
pharmacokinctic
fluence
served
thera-
pharmacokinetic
influencing the 30-50
course syllabus. As principles, students
tion
and as
interpretation
the
firm
pharmacy
consider-
of various
are have
sponse. As
course
modification, dosage regimens
utilization
considerations in each of
on
nor
This
a
cokineties. Lastly, niques imparted
blood and in patients
a pharmatherapy dur-
pharmacokinetie
the
em-
categories of drugs. This didactic is supplemented by weekly stu-
and
by
not
curriculum
years.
monitoring, of drug
durAs
with
Pharmacology
The cx-
EDUCATION
OF
CLINICAL
periences are structured to meet the service needs shown previously in Table I and are supervised by a clinical member of the faculty There
of pharmacy. is undoubtedly
a marked
tion between programs, individual programs, sophistication component wards with
of the
of
of
the
the
and in the
practice The re-
component
of contact
vary
hours,
and and
the interaction physician, nurse,
ing ing
the the
ship
even within quality and
the clinical curriculum.
practice
number
varia-
PHARMACISTS
nature
therapy advanced
course.
ment
We
although we
difficult practice
to measure. experiences
plement,
perfect,
bulatory
experiences.
student termined
is
and
supervise
Yet,
educating that little
our
effectiveness
assessment
and in
input inpatient
of
program,
the
teaching which
experiences an example: therapeutic cardiovascular
desetin
pharmacy and
to digoxin
and
parameters
toxicology,
for
response
to
therapeutic pharmacokinetics
and
monitoring
its aspects
the
administration
develop patient in
the
of disease course; the of digoxin and pharma-
interpretations on digoxin
will
of be
the clinical discussed in
the pharmacokinetic aspects of clinical pharmacy practice course; the therapeutic response of a variety of inpatients and outpatients digoxin total
drug
April,
1975
to therapy
digoxin, in
therapy
the monitoring relationship to regimen
of
rudimentary
patients,
of the
important
macists”
or
appropriate with
years
to
their
semantic
proundernotably
incorporate pharmain emphasis
are
services,
If
we
consensus
of
from the graduate as “clinical pharclinicians,”
it
to describe current first professional deoriented”
whom
close
allowed
and
“pharmacist
“clinically
of
has
to sophisticated.
seems graduates
on
to
time
graduates programs
as
pub-
data
all varying the
designating professional
the
to
yet
programs, have been
courses,
achieved
Table
is
clerkship,
from
clinical
as
have
but
from
postbaccalaureate,
recent
have
the
is used
only
in
cokinetics
some
it
pre-
criteria,
solace and
graduate curricula
modified
our
parallel
the
although
therapeutics,
gree
in
that
fessional graduate
con-
The student will learn the applications of digoxin in disease, review its phar-
macology
cokinetic literature
is
therapeutics
others,
of
is so scanty available on
approach
appears
of
am-
experience
in clinical
education. To summarize tinuity
than
clinical pharmacists or no data are
methods
clinical to im-
The
collective
adand
Inpatient appear easier
performance more readily
tings.
in
variable
need others
that
noting
evaluating
this system of and reinforcement,
lish their observations methods effectiveness. I believe
durclerkno assess-
for
of brief
that
me to discuss
effectiveness
date
sorely
a period
observation
encountered pharmacy
developed
to
we
gain
previously,
clerkships
have
the effectiveness of sentation, application,
by
methods
will be clinical
parameters
of the patient responsibility experiences, quality of the direct supervision of students, and extent of interprofessional interaction. Furthermore, as discussed ministering
between pharmacist and patient regard-
pharmacists,
qualified as
to
provide
characterized
in
I.
Acknowledgments I acknowledge the cooperation of Drs. Candace Brettschneider, Joel Covinsky, Richard Closson, Gary Cripps, Tom Foster, and John Gans in providing me with information on methods employed in teaching therapeutics at their institutions.
References 1.
2.
3.
Francke, D.: Relationship between clinical pharmacology and clinical pharmacy. J. Clia. Pha,r,nacol. 12:384 (1972). Walton, C.: Clinical pharmacology and clinical pharmacy: a necessary alliance for
practical
advances
J. Clin. Fletcher,
Pliarmacol. P., and
in rational 14:1 Bennett,
parameters-following course.
J.
CjOs.
in Pharmacol.
drug (1974). R.: The a 14:9
therapy. use
of
therapeutic (1974). 245
