An international capstone experience for pharmacy students.

This report describes the experiences of the University of Tennessee College of Pharmacy over 20 years with an international capstone educational experience for students. Although the university provides reciprocal opportunities to international students, this report focuses on the experiences of the college's pharmacy students who have participated in the program. This capstone course is offered as an elective course in the advanced pharmacy practice experience (APPE) component of the college's experiential program. Goals of the program and a brief description of its organizational structure are provided. Results of a structured student satisfaction survey and a survey covering the most recent 3 years of the program are presented. This program has greatly broadened participants' cultural horizons and expanded their global view and understanding of the contributions of pharmacy to health care.

Education and training of pharmacists: comments on sustaining continuous improvement.

OBJECTIVE: To examine three approaches to improving the education and training of pharmacists and their interrelationships. DATA SOURCES: American Association of Colleges of Pharmacy, American Society of Health-System Pharmacists, National Center for Education Statistics, and peer-reviewed pharmacy literature. SUMMARY: The education of pharmacists continues to change based on a paradigm of continuous quality improvement and broad agreement that many newly graduated pharmacists are not ready to practice in all practice settings. This commentary looks at three avenues for change: increased prepharmacy coursework up to a baccalaureate degree, more clinical experience during the professional Doctor of Pharmacy program, and postgraduate professional residencies. The three avenues are examined in terms of feasibility, unanswered questions, and interrelationships among the variables. CONCLUSION: The interrelationships among the three approaches for change suggest a coordinated approach in which progress in each area informs the others. Requiring additional prepharmacy coursework up to a baccalaureate degree is feasible and likely sustainable relative to total number of awarded and projected baccalaureate degrees. Higher undergraduate academic expectations can provide "space" in the pharmacy curriculum for more clinical education. The space makes more clinical education possible, with the caveat that more clinical education will require many more residency-trained pharmacists to serve in faculty positions. Residency growth could generate needed additional qualified faculty members and preceptors. Further evolution in pharmacist education and training should be driven by the goal of advancing the profession's leadership in improving the safety and quality of the medication-use process.

Unmet needs in the medication use process: perceptions of physicians, pharmacists, and patients.

OBJECTIVES: To explore the perception of unmet needs in the medication use process from the perspectives of three of the principal participants in the process--physicians, pharmacists, and patients--and to identify the individual(s) or strategy(ies) perceived to be the best or most likely candidate(s) to resolve the problems identified. PARTICIPANTS: Physicians (primary care, cardiology, oncology, and obstetrics/gynecology specialties), pharmacists (community and health-system settings), and patients from four medium-sized U.S. cities. The survey instrument was modified for each group. MAIN OUTCOME MEASURES: The medication use process was divided into nine steps, based on a previous study. A two-part question was framed for each step. In part A, respondents were asked to indicate their level of agreement (on a 5-point scale) about whether the step was being conducted appropriately. In part B, those who disagreed with a statement in part A were asked their opinions on the best possible candidate or strategy for improving that step. RESULTS: Both physicians and pharmacists identified four areas of unmet needs: timing of physician visit, patient counseling, patient use of medications, and patient monitoring. Each group held itself primarily responsible for the resolution of most of these problems. Patients did not identify any unmet needs from the survey. In responses to open-ended questions, however, they cited medication cost, appropriateness, access, and convenience as problems. CONCLUSION: Providers and patients reported substantially different perspectives on medication use problems and on improving the process. Addressing the unmet needs identified in this study will require better understanding, communication, and collaboration among physicians, pharmacists, and patients.

Physicians' expectations of pharmacists.

Physicians' current and future expectations of and current experiences with pharmacists were studied. A three-part questionnaire was mailed to 2600 practicing physicians in California, including office-based practitioners, hospital-employed (nonhouse staff) physicians, and medical residents. A 5-point Likert scale was used to measure respondents' level of agreement with statements in each part; part 1 dealt with current expectations, part 2 with current experiences, and part 3 with future expectations. Respondents were asked to confirm their practice setting (office-based, hospital-based, medical resident, or other) and to indicate the number of years since graduation from medical school. The mean values of physician agreement with each statement were reported. There was neither strong agreement nor strong disagreement with any statement regarding physicians' current and future expectations of and current experiences with pharmacists. There was no correlation between practice setting and level of agreement with statements in any part of the questionnaire. There was a correlation between the number of years since graduation from medical school and the level of agreement with statements about current and future expectations; in both cases, those physicians who graduated from medical school less than 10 years ago had higher expectations of pharmacists than those who graduated 10 or more years ago. Overall, physicians do not know what to expect of pharmacists. Physicians' expectations of pharmacists were most strongly correlated with the number of years since graduation from medical school and least strongly correlated with physicians' practice setting.