Historical study of clinical pharmacy education in Japan (part 1). The founding and history of the one-year graduate course of clinical pharmacy practice (yakugaku senkouka) at the Meijo University

Since there was an increasing demand for highly educated pharmacists with clinical experience, a one-year graduate course in clinical pharmacy practice (Yakugaku Senkouka) was established at Meijo University in 1975. This was aimed to provide pharmacists a training program for clinical skills and hospital settings. The course became a leading school in clinical pharmacy education in Japan. The present study describes what it was like and how it contributed to the development of clinical pharmacy in the country. In this article, the history is divided into five terms ranging from 1975 to 2002. The first term (1975-1979): To introduce the educational system, a system that was modeled on those in USA was introduced. The curriculum of clinical clerkship and the methods for evaluating training process were devised. The second term (1980-1984): Clinical clerkships were systematized and modified to fit to society. A manual textbook for training in clinical pharmacy was edited. The third term (1985-1989): The activities in the course were recognized as a new professional practice of pharmacists in Japan under The New Medical Law and The Law of Healthcare Insurance. The fourth term (1990-1995): Clinical pharmacy became popular nationwide. In Meijo University, a new challenge was made to merge clinical pharmacy skills with scientific backgrounds. The fifth term (1996-2002): To cope with the trends of extending undergraduate pharmacy education to six years, it has been decided that the course will be reorganized into a 2-year master's course in clinical pharmacy and accepted as a graduate course in 2003. The history of the course, a forerunner of clinical pharmacy education in Japan, ended in 2002.     

Project of continuing professional development for pharmacists supported by three public universities

The Tokai Regional Alliance Center for Recurrent Education supported by three public universities in Tokai area executes a continuing education program for pharmacists. One of the major features of this program is that it can deliver lectures easily to pharmacists using a web conferencing system. This system enables pharmacists to attend lectures at several remote places. The program consists of two learning courses. One is a lecture series given by teachers belonging to the university or university facilities. Another course is a training series using the university equipment. This training course incorporates the contents of a new 6-year pharmacy education program. Moreover, this training course is intended to facilitate participation of pharmacists to the health care team. This continuing professional development for pharmacists will not only improve their pharmaceutical expertise, but also will provide the education necessary for pharmacists to perform well in actual medical practice. Through these efforts the continuing education of future pharmacists will be strengthened by new educational contents provided by pharmaceutical universities.     

Education in graduate school of pharmaceutical sciences

The report of the Council for the improvement in the education of pharmaceutical sciences and the recommendation of the Central Council for Education indicate that the 6-year education is required to develop pharmacists with high qualities as medical staff. Each college of pharmacy started the education and practical training based on the model core-curriculum with the original program. On the other hand, to develop a scientist for the development of novel medicines, 4-year education program is also required. Under these new education systems, what we should do in the education in the graduate school of pharmacy and pharmaceutical sciences has been discussed. Recently, the first report about the purpose and the strategy in the graduate school in the new generation was submitted. Here, I will comment on the details of this report.     

Recurrent education for pharmacists to support regional medicine

New-generation pharmacists who graduate from the 6-year pharmacy education program will come into being in Japan in 2 years' time. The new program regards technical skills and caring attitudes suitable for healthcare professionals as important, as well as expert knowledge. Pharmacists are expected to become more involved in pharmacotherapy and patient care to overcome rural physician shortage and achieve better outcomes in pharmacotherapy. Pharmacists themselves also want to contribute to improve pharmacotherapy and patient care. Pharmacists educated with the former 4-year education program, however, hardly had a chance to learn clinical pharmacy or pharmaceutical care when they were pharmacy students. They have so far studied clinical knowledge, skills, and attitudes by themselves mostly after graduation. Therefore most pharmacists have not received systematic education or training about clinical pharmacy. Pharmacy schools employ pharmacists and physicians as professors, and built practical rooms for pre-clinical training to study pharmacy practice in recent years. We should use those human resources and laboratory equipment in pharmacy schools to facilitate recurrent education for pharmacists. Internet-based real time remote lecture is also useful for pharmacists working far from pharmacy schools to attend a recurrent class. I propose an education system in which pharmacists who completed the recurrent education program teach students pharmacy practice in their worksites, and both pharmacists and students are developing their practical skills to a high degree together.     

Implementation of a modified decentralized drug distribution system with the use of master medication carts

A decentralized drug distribution system with the use of master medication carts was implemented. This system was designed so that roving pharmacists could dispense new medication orders quickly and develop a more personal means of nurse-pharmacist interaction for the benefit of better patient care. The key to the system using roving pharmacists is a master medication cart, a pharmacy dispensing unit on wheels, which travels to each nursing unit. The pharmacy medication profiles are kept with the cart, and at each nursing unit patient medication profiles are reviewed, new drug orders are filled, missing medications and discrepancies are resolved, and nurse-pharmacist consultations can take place. There are two roving pharmacists who make simultaneous rounds of all nursing units in the hospital with two similarly stocked master medication carts from 9 A.M. to 9 P.M., seven days a week. All unit dose drawers are filled in the central pharmacy and are exchanged once daily at 2 A.M. by the night pharmacy technician. Each master medication cart carries about 300 different medications, which comprise nearly 95% of the drug needs of the 340 patients served by the two medication carts. The pharmacy department has added 1.4 Full-Time Equivalent (FTE) registered pharmacists and eliminated 2.8 FTE pharmacy messengers in implementing the decentralized drug distribution system. Currently, three registered pharmacists per day are assigned to the inpatient unit dose drug distribution system (two roving pharmacists and one unit dose filling pharmacist). Our roving pharmacists play a vital role in improving patient care. The overwhelming support by the nursing and medical staff represents an attempt by the hospital to continue to provide an optimal health care delivery system.     

Changes in pharmacy, nursing, and total personnel staffing in U.S. hospitals, 1989-1998.

Pharmacy, nursing, and total hospital personnel inpatient staffing in U.S. medical-surgical hospitals for 1989, 1992, 1995, and 1998 was studied. Nursing and total personnel staffing data were obtained from the American Hospital Association, and pharmacy personnel data were obtained from the National Clinical Pharmacy Services database. Between 1989 and 1998, mean +/- S.D. registered-nurse staffing per 100 occupied beds increased from 124.46 +/- 92.24 to 196.57 +/- 131.92, or 57.94%. Pharmacist staffing per 100 occupied beds increased from 6.47 +/- 3.01 to 7.95 +/- 4.88, or 22.87%. The total number of registered nurses increased by 126,960 (15.78%), and the total number of pharmacists declined by 320 (0.72%). The increase in pharmacist staffing per 100 occupied beds was due almost entirely to decreases in hospital census between 1989 and 1998. Total hospital personnel staffing per 100 occupied beds and the absolute number of hospital employees increased at much higher rates (55.2% and 12.95%, respectively) than pharmacist staffing. Pharmacy technician staffing per 100 occupied beds increased by 42.96%, and pharmacy clerk staffing increased by 25.37%. Between 1989 and 1998, pharmacist staffing in U.S. medical-surgical hospitals increased at less than half the rates for registered nurses and total hospital personnel.     

“互联网+三位一体多元驱动”医院青年药师岗位胜任力持续提升项目实践

目的：为全面提升药师药学服务能力,积极探索以岗位胜任力为导向的能力培育模式,建立药师新型工作途径,为科室发展提供人才梯队储备。方法：基于药师药学服务胜任力评价标准,结合外部环境要求,打破岗位限制,借助"互联网+"多平台工具,将调剂药师、信息药师及临床药师有机融合,建立"三位一体多元驱动"的医院药师协同学习、考核、实践、输出的工作提升项目,并在实施过程中运用PDCA循环持续改进完善。结果：通过学习实践共同体,打破固有岗位的限制,将各岗位药师充分融合、交叉互补、资源共享,有效实现了药学专业技术人才药学服务核心竞争力的快速提升和同质化发展。结论：能够有效地提高医院药师专业知识技能和核心竞争力,对科室发展和人才梯队储备具有重要的参考意义。     

美国医院药房药学技术员的培训准则

为了使医院药师从繁杂的一般技术性工作中解放出来,投身于面向病亿的药学保健工作,美国医院药房对药师与非药师人员的职责进行了明确的划分。其中作为非药师人员重要组成部分的药学技术员,担负着配制制剂并进行包装,贴签和分发,病人用药记录的维护、药品供应清单的管理等重要工作。     

Cooperation of medical and pharmaceutical sciences between private and national universities to educate professionals in the fields of drug development and rational pharmacotherapy

Cooperation in education and research in medical and pharmaceutical sciences between Kobe Pharmaceutical University and Kobe University was started in 2008 for training professionals in drug development and rational pharmacotherapy. Initially, we started a two-year pharmacy residency program. Our pharmacy residents can attend lectures at our universities, and they also help pharmacist preceptors educate undergraduate pharmacy students in practical training. As curricula for cooperative education of pharmacy, nursing and medical students, we developed two new elective subjects (early exposure to clinical training for first year students and IPW (inter-professional work) seminar for fifth year pharmacy students) to learn about the roles of health care professionals in a medical team. Cooperative research between faculty members and graduate students is also in progress. For faculty and staff developments, invited lectures by clinical pharmacy and medical professors from the United States on the clinical education system in pharmacy and medicine in the United States have been held. This systematic cooperation will contribute to the promotion of a new curriculum for inter-professional education in the health-science fields.     

Historical study of clinical pharmacy education in Japan (part 2) retrospective evaluation of the roles of the one-year graduate course of clinical pharmacy practice (Yakugaku Senkouka) at Meijo University

Clinical pharmacy practice education started 30 years ago in Japan. Since 1975, a one-year graduate course, clinical pharmacy practice (Yakugaku Senkouka), has been offered at Meijo University, making it a leading school to raise pharmacists with sufficient experience in hospital settings. This article describes the scope of the course, the development of educational systems to meet public demand for new pharmaceutical skills, and the influences on reforming the Japanese health-care system. The content consists of the following: (1) The process of building up the first curricula of clerkship, (2) requirements for admission, namely including an essay, an interview, school records and an aptitude test, (3) establishing the teaching discipline, (4) achievement goals, (5) learning process modeled on methods used in the United States, (6) establishing the concept of medical ethics, (7) professional status of course graduates, and (8) nationwide influence on the social health-care of the country. The one-year graduate course of clinical pharmacy practice was terminated in 2002 and is to be reintroduced as a two-year graduate school course to cope with the present and future trends in health-care systems.     

Establishing a rehabilitation program for impaired pharmacists

The Texas Pharmaceutical Association (TPA) rehabilitation program for impaired pharmacists and pharmacy students is described. Since its inception in 1983, the TPA Pharmacists Rehabilitation Program has provided assistance to impaired pharmacists and pharmacy students, as well as their families, friends, customers, and coworkers. The program uses a carefully developed intervention process designed to assist impaired pharmacists and pharmacy students in obtaining evaluation and treatment of their condition. After a referral, an appointment is made for the impaired person at 1 of 15 regional evaluation and referral centers across the state, where arrangements for appropriate treatment are made. After treatment, the Committee on Pharmacists Rehabilitation aids the pharmacist or student in reentering the profession or returning to school. Intervenors are pharmacists registered in the state of Texas who have participated in TPA's training sessions; TPA also provides an intervenor's workbook. Amendments to the Texas Pharmacy Act passed in 1983 and 1985 provide protection for intervenors who are working with pharmacists and pharmacy students with impairment problems. Referrals are made by means of a 24-hour, toll-free hotline funded by a pharmaceutical manufacturing company. Other funding comes from individual donors, member associations affiliated with TPA, chain drugstores, wholesalers, and the Texas State Board of Pharmacy. A successful rehabilitation program for impaired pharmacists and students must be carefully designed and implemented, with attention paid to legal, financial, and intervention-related issues associated with substance abuse.     

Personnel management for hospital pharmacists

This paper launches a seven-part series of articles on personnel management for hospital pharmacists. The series is designed to help hospital pharmacists who supervise other workers improve their skills in handling personnel matters. Methods of managing the pharmacy manager will be reviewed, including the establishment of goals and priorities, time management, and mechanisms for coping with stress. Techniques for recruiting, interviewing, and hiring and for training new employees will be presented. Several motivation theories will be examined and applied to professional and supportive personnel in the pharmacy department. Methods of evaluating performance and disciplining employees will be reviewed. Each article will include typical examples from hospital pharmacy practice to illustrate the concepts.     

我国医院药师在医疗机构中的定位与作用

目的:明确新医改形势下我国医院药师在医疗机构中的定位与作用。方法:介绍我国现有药师的分类并分析探讨其职责和定位。结果与结论:我国现有药师按专业不同可分为药师、中药师和临床药师;按职称职务可分为药士、药师、主管药师、副主任药师和主任药师;按是否注册可分为药师和执业药师。他们主要在医院药剂科、研究所、制药企业的研究部门、药检所以及药品的生产和流通等部门从事相关工作。医院药师在医疗机构中具有独立性、辅助性、经济性和结构上的立体性。在新医改政策下,医院药师并不是要放弃传统的医院药学工作,而是要增加临床药学的工作内容,使医院药师的队伍不断壮大,功能更加完善。传统的医院药学工作和现代的临床药学工作是相互促进、相互支撑的,都是医疗工作中不可或缺的组成部分,只有在做好传统医院药师本职工作的基础上来开展临床药学活动,才是医院药师正确的发展之道。     

住院药师规范化培训质量管理体系的构建

目的:构建住院药师规范化培训质量管理体系,全面提高培训质量,加强药学人才队伍建设。方法:总结9年来住院药师培训的经验,利用质量管理理论分析培训质量影响因素,针对培训各阶段、各环节开展质量控制,探索全程化质量控制内容和方法。结果:基于我院医院药学工作基础、教学优势和软硬件支撑,从目标管理、过程管理、考核管理、方法管理和对象管理五个方面初步构建形成住院药师规范化培训质量管理体系。结论:通过住院药师规范化培训质量管理体系的构建,有助于加强住院药师培训全程化管理,显著提高住院药师培训质量,促进医院药学人才队伍建设和学科发展。     

中药临床药师培训基地建设与人才培养的探索与实践

目的：探讨中药临床药师培训目标、培训模式以及培训方案,分析人才培养的局限性及不足,为各医院中药临床药师的培养提供参考。方法：梳理首都医科大学附属北京友谊医院中药临床药师培训具体内容,细化综合能力、药学及临床基本知识、临床药学技能培训和中药科研技能培训的方案及内容,强化中医基础知识在中药临床药学中的重要地位,不断完善中药临床药师基地建设和人才培养模式。结果：明确了学员的报名条件和培训目标,突出了药学、中药学和中医基础知识与临床的重要相互作用关系,并分析讨论基地建设与人才培养的局限性和不足。结论：中药临床药师是执行中药临床药学工作的主体,优化基地的培训体系和内容,丰富人才培养方案,解决问题与不足,本基地的工作内容可为中药临床药师的基地建设和人才培养提供参考。     

Economic Analysis of Obtaining a PharmD Degree and Career as a Pharmacist

Objective. To evaluate the economic value of pharmacy education/career and the effects of the cost of private or public pharmacy school, the length of degree program, residency training, and pharmacy career path on net career earnings.Methods. This study involved an economic analysis using Markov modeling. Estimated costs of education including student loans were considered in calculating net career earnings of 4 career paths following high school graduation: (1) immediate employment; (2) employment with bachelor’s degree in chemistry or biology; (3) employment as a pharmacist with no residency training; and (4) employment as a pharmacist after completing one or two years of residency training.Results. Models indicated that throughout their careers (up to age 67), PharmD graduates may accumulate net career earnings of $5.66 million to $6.29 million, roughly 3.15 times more than high school graduates and 1.57 to 1.73 times more than those with bachelor’s degrees in biology or chemistry. Attending a public pharmacy school after completing 3 years of prepharmacy education generally leads to higher net career earnings. Community pharmacists have the highest net career earnings, and PGY-1 residency-trained hospital pharmacists have greater net career earnings than those who immediately started their careers in a hospital setting.Conclusion. The economic models presented are based on assumptions described herein; as conditions are subject to variability, these models should not be used to predict future earnings. Nevertheless, the findings demonstrate investment in a pharmacy education yields favorable financial return. Application of results to schools of pharmacy, students, and graduates is discussed.     

Shadowing program to increase student awareness of hospital pharmacy practice

A shadowing program designed to acquaint second-year pharmacy students with the professional responsibilities of a hospital pharmacist is described. The program developed by the Toledo Area Society of Hospital Pharmacists allowed second-year pharmacy students to "shadow" a staff pharmacist for three to four hours. The program required the cooperation of area hospital pharmacists to develop rotations at each site. Eight hospitals provided shadow rotations for 87 students during the program's first offering. Reactions were positive from both students and pharmacists. Direct pharmacist-student interaction, low cost, and flexibility were important factors in the program's success. The shadowing program has proven to be an effective method of introducing hospital pharmacy career options to prepharmacy students.     

Hospital pharmacy supportive personnel utilization: a regional survey

The results of a regional survey of hospital pharmacy supportive personnel (technicians) are presented. The data represents the responses from 118 directors of pharmacy in hospitals within a 150-mile radius of Pittsburgh, Pennsylvania. A high percentage of the hospitals (92.4%) utilize pharmacy technicians in some capacity. In hospitals employing pharmacy technicians, on the average, there is approximately one technician for each pharmacist. The demand for technicians is relative strong with 120 job openings each year because of turnover and new positions. The requirements for employment vary, but most institutions minimally required a high school diploma or equivalent. The vast majority of hospital pharmacy technicians possess a high school diploma with only a small percentage having any additional training. Only about 15% of the hospitals have any type of formal pharmacy technician program and almost 80% of the directors are in favor of external continuing education programs. Regarding how best to train and educate hospital pharmacy technicians, 66% of hospital pharmacy directors feel that a formal college or university based program should be required. Approximately one-third of the hospitals have various levels of pharmacy technicians, and the most important criteria for determining levels are experience, technical responsibility, and seniority. Although only eight percent of the hospital pharmacy technicians have any formal training, 36% of the hospitals would start graduates of formal educational programs at higher entry level positions.     

基层医疗机构药学人才培养现状调查分析

目的 了解当前基层医院药学人才特点及培养现状,为促进基层医院药学人才培养发展提供实证参考.方法 通过医院药学技术人员资料统计表及问卷调查方式了解药学人才培养现状,并通过广东省卫生科教网上历年继续教育项目信息,统计近3年申报通过的继续教育项目情况.结果 接受调查的11家医院中一线药学技术人员师级最多,占59.51％,第2位为士级,占26.43％;管理层人员中级以上占80.00％.顺德地区医院药学技术人员主要学历为学士或函授本科毕业,但仍有73人(13.13％)为高中或初中学历;68.93％技术人员每年得不到外出培训机会;历年继续教育项目以临床药学方向最多.结论 技术人才的继续教育缺失使基层医院药学存在发展障碍,需要探索出适合基层医疗机构药学人才梯度建设的培训模式.