A Decade of Pharmacy Practice Education in India

With a decade of introduction of pharmacy practice education in India, there has been a paradigm shift in the practice of pharmacy in the country. In spite of this, pharmacy practice education faces many challenges before it can transform the pharmaceutical care practice in India from a product-oriented approach to patient-oriented care. Pharmacy education in India is mainly industry oriented. The curriculum at the undergraduate level is more or less designed for preparing students towards industry rather than for patient-oriented services like hospital, clinical, and community pharmacy. To train the graduate pharmacists to provide patient-oriented services, a pharmacy practice course was started at a postgraduate level. Pharmacy practice curriculum enters its tenth year in India since its beginning in 1997.¹ The curriculum trains the postgraduates in rational therapeutics, patient counseling, pharmacovigilance, therapeutic drug monitoring, clinical research,and toxicology to name a few. With the efforts being on introducing the advanced clinical-based courses of the doctor of pharmacy (PharmD) degree in India, there is a need to contemplate where the profession stands at this juncture.² As of today pharmacy practice is at a crossroads in India, facing numerous challenges that need to be addressed before marching further. This letter is an effort to identify deficiencies, vis-à-vis regulatory requirements, and evaluate the current status of pharmacy practice education in India.

The decade long journey of pharmacy practice curriculum in India provides some key insights:

• (1) The profession is restricted only to the hospitals linked to a pharmacy practice school. With the completion of a decade there are few pharmacy schools providing specialization in pharmacy practice. Due to lack of job avenues, prospective postgraduates cannot opt to work as a clinical pharmacist in Indian hospitals as the value of clinical pharmacy services is not recognized.

• (2) Regulatory framework does not recognize the need for clinical pharmacist at the national level. There are no regulatory guidelines for having qualified clinical pharmacists in an Indian hospital. Even if the regulations are framed in due course, a point to ponder is whether there will be any experienced pharmacists left to practice in the clinical set up as there is a mass migration of trained clinical pharmacist to pharmaceutical industry. Though clinical pharmacists have gained the confidence and acceptance of the medical fraternity, that acceptance alone will not help to overcome the shortcomings, like lack of a regulatory framework or scarce job opportunities as a clinical pharmacist. Pharmacy councils and professional leaders need to take initiative by lobbying with relevant government authorities to create a position in the hospital set-up where a trained clinical pharmacist can fit in.

• (3) Exodus of trained clinical pharmacists toward industry as there is almost no opportunity in the hospital setting. As there is no recognition of the job done by the clinical pharmacist at the regulatory level, the profession failed in to create job opportunities in hospitals for qualified clinical pharmacy postgraduates. Students are forced to either seek jobs in industries (clinical research) or continue in academics, at times teaching subjects which are out of scope of clinical pharmacy (as not many university hospitals have pharmacy practice school). The last option being to move to countries where the pharmacy profession is well recognized. (A chart depicting the career model for a pharmacy practice postgraduate in India is available from the author.)

• (4) The need for adding industry relevant topics in course curriculum – Dilemma of Dilution vs Evolution. There is a widening gap between the number of students graduating from pharmacy practice institutions and the number actually employed as pharmacy practitioners. There is a need to take key steps to either create a niche for clinical pharmacy professionals in the hospital or make them competent to take up other challenging jobs in the industry. There is a need for introducing specific roles that include training in pharmacogenomics, pharmacokinetic-pharmacodynamics, and medical informatics, which are job-oriented skills. Before the academic move to the next step of bringing PharmD courses, there is a need to augment the acceptability for existing courses. In an evidence-based health service, it is not just sufficient to propose new roles for clinical pharmacist without adequate evidence of benefits. Services should not only be clinically cost effective but also acceptable to patients and other health care colleagues.

This situation helps the profession to learn the difficulties in implementing patient-oriented services when the health care system does not recognize the need for clinically trained pharmacists. The experience in the past decade helped to understand the lacunae within the profession, especially on the regulatory side. This situation calls for the sustained effort by academic leaders to work with government authorities to bring suitable changes in regulation that will help the profession grow towards patient care. Working on regulatory issues with the respective government authorities is an important task for profession leaders as the regulatory environment is one of the important factors that determine the growth of health professions like pharmacy.

To summarize, clinical pharmacy education in India after a decade is at a crossroads. The pharmacy educators are in a dilemma as to whether the course will evolve by incorporating industry relevant components or progress into a clinically relevant course with the help of regulatory changes. This dilemma may resolve with time.

Seema Mangasuli, M Pharm
Surulivel Rajan, M Pharm
Sohil Ahmed Khan, M Pharm
Department of Pharmacy Practice S S Cancer Hospital and Research Centre Karnataka, India