Pharmacy education, Post Graduate Programs and Specialization at University of Southern California (United States)

Pharmacy education, Post Graduate Programs and Specialization at University of Southern California (United States)

by Dr Dilip.C

(Written based on author’s one month Pharma bridge experience at USC school of pharmacy, California)

ABOUS USC,

Pharmacy education and practice is almost similar in all cities across Unites States though not identical. Founded in 1905, USC School of Pharmacy is the oldest and foremost pharmacy school in Southern California and is a national leader for its progressive curriculum and research excellence. The very first Doctor of Pharmacy program- Pharm D was started in 1950. In 1968, the School of Pharmacy launched the nations First Clinical Pharmacy training program and some of the facilities for training included: Los Angels country USC medical centre; USC keck medical center; USC Norris Cancer Center and in addition to that, USC have four campus Pharmacies owned and operated by the School of Pharmacy.

Being the pioneers to start the nations first Pharm D program, USC School of Pharmacy has around 740 Pharm.D students (180 per year), 220 graduate students and 75 full time faculties. In addition, 440 part time and volunteer faculty work for USC, since everyone is dedicated to build the profession. These graduates account for 50 percent of practicing pharmacists in southern California and are graduated from USC. 220 graduates comprise of Ph.D./regulatory/ Masters/drug development/post marketing surveillance etc that mainly focuses on research work as USC ranks among one of the top 10 institutions for research.

In India, Pharm D (short form for Doctor of Pharmacy) was first started in 2008, introduced as a 6-year program, which includes 5-year academic study and 1 year of internship. Anyone interested can take the exam after high school and join the Pharm D and start their journey towards becoming a Pharmacist. In USA, it is slightly different. A student who wishes to join Pharm.D has to meet certain prerequisites. They have to undergo 3-4 years of undergraduate studies. It can be mathematics, physical science, biological sciences (biology, physiology, microbiology etc) English, communications, psychology, Sociology, economics, social and behavioral sciences, humanities etc. Once all prerequisites are met, the student is eligible to enroll in Pharm D program. In USA, Pharm.D is a 4 year Program that is broadly divided into non clinical and clinical, also known as IPPE and APPE. IPPE stands for Introductory Pharmacy Practice and APPE stands for Advance Pharmacy Practice (externship).  During initial years of study, students focus on learning basic skills required for pharmacy practice, like taking B.P, doing Pulse check, giving injections and exposure to the community setting. As the course progresses, there will be less and less of basic sciences and more of clinical pharmacy practice.

Pharmacy Education (Clerkship -APPE)

As the program advances, the student has to undergo clerkship (APPE) where they will be put on six rotations, 6 weeks each.

Mandatory requirements are:

·       Acute care/Medicine; where the students get an opportunity to work with sick patients in hospital

·       Ambulatory care (outpatient clinics)

·       Community Pharmacy

·       Health systems (broader issues)

·       PTC Medication, Therapy, Antimicrobial Stewardship etc.

·       Elective- HIV, DIC, international, AIDs clinic etc

Before completion of the program, student has to accumulate 900 hours of experience in clerkship (APPE) and 600 hours in voluntary work/internship in any pharmacy related area.  Clerkship is more like patient care/clinical activity, but internship is a paid position where the higher proportion of distribution of drugs and preparation of prescription. By the time of completion of the graduation, a student has to accumulate 1500 hours total.

CASE CONFERENCES

Case conference is another interesting part of the Pharm D academic curriculum, where the students get an opportunity to present their clinical findings. Case conferences provide a good platform for aspiring pharmacy students as they get an opportunity to discuss their clinical findings, share any new medical procedures which they come across, conduct drug reviews and participate in journal clubs. I have been part of many brainstorming discussion about various diseases and drugs in these conferences, which keeps everybody abreast with the latest information's and helps to hone the clinical skills of the emerging clinical Pharmacist. We had attended four such clinical conferences, which falls on Tuesdays. First day, the discussion was on anticoagulants followed by two journal clubs on the same topic. Two students presented latest medical procedures like watchman procedure and lariat procedure with video demonstrations, which turned out to be an awesome experience. All sessions were from 8am to 1pm.

 A study on anticoagulants was presented in one of the journal club. Students take up a recent, relevant literature and present the background with objectives, study design, inclusion/exclusion criteria, discussion, statistical analysis, outcomes and conclusion to the detail. Every body understands the strength and weakness of the study and gets to know more about anticoagulants.

Case conference on diabetes was really interesting. Minute details about the disease have been put up for discussion, including the drugs used, dosing, patient counseling, life style modifications etc. Less importance is given to theory and is more focused on improving the practice skills and team building exercises, which are truly constructive that makes a student pharmacist confident enough to work in any clinical setting. It was more or less like a comprehensive review on diabetes where the preceptor discusses about diabetes, different type of medications, included dosage and side effect and patient counselling. Two to three cases were also discussed with students.

Pharm D education- Post Pharm D

Every student has to pass the licensing exam, if they want to get into pharmacy profession, provided they must have graduation and internship. The licensing exam and the rules associated to it vary by each state and the state law. So depending upon the state the exam may differ. The student must also clear national licensing exam in order to cross the final hurdle.  If anybody wants to go for higher studies after pharm. D, can opt for residency, which is a one year program of two category, General (PG Y1) and Specialty (PG Y1). It s an extension of internship which is more or like an advanced training. Student has the option to do continuing Pharmacy education certificate programs as well as board certification (BCCP etc in oncology, psychiatry etc.)

Pharmacy practice history in USA

 In pre 1950, it was caring (patient caring) in USA, after 1950, pharmacist started dispensing the medicine, later in 1970, hospital clinical pharmacist, consultant pharmacist etc came into picture including pharmaco-kinetics, DI, monitoring etc. In 1980, pharmacist started focusing on patient education, cost control, pharmaco-economics etc and in 1990 again pharmacist returned to care (pharmaceutical care, manage, ambulatory care). Currently there are plenty of career opportunities in USA in the areas like community, ambulatory care hospital, specialist, Govt, industry consultant, academia and Pharmacy benefits management.

RECOGNISED PHARMACY SPECIALITES

 Nuclear pharmacy in 1978 was the first specialty recognized in USA, This stream does not exist in many countries followed by nutrition support pharmacy in 1988, pharmacotherapy in 1988, psychiatry pharmacy in 1992(BCCPP) Oncology pharmacy in 1996, ambulatory care pharmacy 2010, Critical care pharmacy in 2013, pediatric pharmacy in 2013.

Recertification

Every seven years, recertification has to be done. Recertification is a procedure that documents the specialist’s current knowledge and skills. There are 100 questions in recertification examination and the specialist has to pass the recertification programme. Continuing education option is also available in some specialties.