Critical Considerations in Pharmacy Curriculum Development in South Asian and Southeast Asian Developing Nations

To the Editor. In the context of pharmacy education, curriculum development has always been a core issue for discussion.¹ The progressive role of pharmacists in patient care has made it necessary for pharmacy institutions to modify and upgrade their curriculum periodically. If we examine pharmacy curriculum development in the Asian scenario, we discover many limitations or weaknesses that act as hurdles to effective curriculum development.

Among these hurdles, the most important is the lack of skilled or qualified clinical pharmacists to develop an effective pharmacy curriculum and poor pharmacy practice setups that do not provide sufficient opportunities to practice the clinical aspects of pharmacy. In spite of these weaknesses, many Asian developing nations are offering programs like the doctor of pharmacy (PharmD) degree. This weakness may be compensated by following the curriculum made available online by universities in the United States (US) and Canada. In addition, periodic updates of the American College of Clinical Pharmacy (ACCP) regarding pharmacy practice provide additional resources for these nations to modify or review their curriculum. A drawback to this approach is the fact that the curriculum is updated or revised or sometimes copied directly from these resources without considering whether the course fulfils their own national needs. Similarly, not much attention is paid to whether the country has enough facilities in its local institutions and health care settings for the students to practice properly what they have learned theoretically. Common examples in this regard are the PharmD programs developed in Asian nations (Pakistan, India, Bangladesh, Philippines, and Thailand). Despite these weaknesses, the Pakistani PharmD program mandates that all Pakistani pharmacy institutions (universities or colleges) follow the Higher Education Commission (HEC) approved PharmD syllabus, which is the essential requirement for accreditation and affiliation.

However, there are a number of South East Asian and South Asian countries that are still running bachelor of pharmacy (BPharm) programs that do not adhere to a standard syllabus. Malaysia is one such country with its own peculiar set of challenges. Although public universities offer BPharm programs that fulfil the needs of industry and hospitals, each has its own BPharm program. Further compounding the situation is the existence of a dual pharmacy education standard whereby private institutions that have a memorandum of understanding or a franchise with British or Australian universities teach the curriculum of the latter countries in 2-year split programs in which students spend the first 2 years in the home country and the other 2 years in the respective foreign country. Furthermore, the majority of such institutions offer master of pharmacy (MPharm) degrees that are not considered equivalent to the Malaysian MPharm; so graduated MPharm students have to study an additional year if they wish to enroll in a doctorate (PhD) degree program at a Malaysian public university. Additionally, the lack of synchronization between course contents and learning objectives is another limitation of the pharmacy professional programs offered by South Asian and South East Asian countries. In one pharmacy program in Malaysia, colleagues reported that the course contents are not in compliance with the learning objectives. This noncompliance not only hinders the students' effective learning process, but also the demonstrator's/lecturer's ability to discuss the course-oriented issues in detail.

Apart from the curriculum development and selection of course contents, the strategies adopted or recommended for student evaluation are also questionable. In general, the course evaluation is conducted on the basis of coursework, ie, midterm quizzes, assignments, projects and a final examination. Normally, the coursework evaluation countes 30%-40% of the course grade and the final examination counts 60%-70% of the course grade. The midterm quizzes, final examination, and in some cases projects and assignments are the only means of evaluating students' knowledge, and to some extent, their skills. Evaluation through midterm quizzes and final examinations are ideal for individual assessment. However, assignments and group projects may result in biased evaluation of the students. From my experience, students often plagiarize from electronic resources by resorting to the cut-and-paste technique. This problem can be countered if a handwritten assignment is requested, but in the case of group assignments like research reports or projects, evaluation would be more accurate if a viva is conducted for every student who participated in that project so that those who did not contribute substantively to the project do not benefit unfairly. Some institutions have adopted oral and poster presentations as an additional tool to evaluate student knowledge about the research design. However, these presentations again are insufficient because it is often the most proficient student who makes the presentation, with the others profiting from his/her contribution.

In addition, other strategies such as clerkships and hospital internships are assigned a mere 10% to 15% of the total grade. Even if we see clerkships in clinical-oriented pharmacy programs as an important training and evaluation technique, if we allocate a low percentage of the grade to students' performance of patient care activities, we limit the preceptor's ability to evaluate the student's knowledge properly. If clerkships are assessed separately from coursework, it would result in a more effective evaluation of the student's clinical skills and students would get maximum benefit from their practical skills training. Similarly, these programs give little or no consideration to public speaking and seminars, which are also important aspects of skills training for pharmacists.

The main aim of this perspective is to highlight the limitations in the pharmacy curriculum of the developing Asian nations so that they can be taken into consideration when revising or updating their curriculum. Adoption of the suggested strategies for rectifying such flaws in the pharmacy curriculum will go a long way towards producing skilled and knowledgeable pharmacists who can establish ideal pharmacy practice setups in their own countries.

Tahir Mehmood Khan
King Faisal University Al-Hassa, Saudi Arabia