Daniel L. Brown

A looming joblessness crisis for new pharmacy graduates and the implications it holds for the academy.

The new millennium ushered in a period of hope and change for the profession of pharmacy. The doctor of pharmacy (PharmD) degree became the exclusive first professional degree as of 2000, bringing with it expectations for a dramatic expansion of direct patient care roles for pharmacists. Just 1 year later the pharmacy academy began a period of unprecedented growth, fueled by a long-standing shortage of pharmacists and an outstanding job market for new pharmacy graduates, making jobs for PharmD graduates easy to find and causing salaries to spiral upward. As a result, the PharmD degree became a hot commodity, generating a seemingly inexhaustible supply of applicants to colleges and schools of pharmacy. Inevitably, higher education came to see pharmacy as a “golden goose.” n nBut no goose harbors an infinite supply of golden eggs, and the inordinate rate of academic growth that ensued has put the academy at risk, along with its students. Calls for measured academic growth, brought forth in published commentaries in 2005 and 2010, went largely unnoticed.1,2 The house of student delegates of the American Pharmacists Association-Academy of Student Pharmacists even weighed in on the subject in 2012 by approving resolution 2012:2 — Creation, Expansion, or Reductions of Schools and Colleges of Pharmacy Relative to Pharmacist Demand, which called upon current and future schools to evaluate the demand for pharmacists before taking action.3 Remarkably, most leaders of pharmacy organizations and academic institutions remained relatively silent on the matter. n nThis commentary examines the massive increase in the number of pharmacy graduates since 2001 and the vast overestimations, in the author’s opinion, made back in 2001 about the number of pharmacists that would be needed by 2020. It also identifies potential implications of the changing pharmacist job market for the pharmacy academy.

Enhancement of phenytoin elimination by multiple-dose activated charcoal.

The effect of multiple-dose activated charcoal on the elimination of intravenously administered phenytoin was studied. Seven normal volunteers received phenytoin sodium 15 mg/kg IV with and without activated charcoal. During the charcoal phase, a total dose of 300 g was administered in repeated doses over 48 hours with sufficient sorbitol to produce one to two bowel movements per day. Serum phenytoin concentrations were determined from one to 72 hours after the infusions and were fitted to a one-compartment linear elimination model. The administration of multiple-dose activated charcoal reduced the phenytoin half-life from 44.5 to 22.3 hours. In addition, phenytoin area under the curve was decreased and the elimination rate was increased. Multiple-dose activated charcoal is effective in enhancing the elimination of phenytoin in normal volunteers. Although future studies are needed to determine its role in treating patients with phenytoin toxicity, multiple-dose activated charcoal may provide a readily available, inexpensive therapeutic intervention.

Vancomycin Dosing Chart for Use in Patients With Renal Impairment

A new vancomycin dosing chart for use in patients with impaired renal function is described. The chart has been adapted from a previously published nomogram, based on a linear relationship between vancomycin clearance and creatinine clearance. Doses are designed to achieve an average steady-state serum concentration of approximately 15 mg/L. Use of the chart necessitates first measuring or estimating the patients body weight and creatinine clearance. The chart provides the advantages of generating an exact dose and dosing interval, as well as being somewhat easier to use than the original nomogram. Predicted average steady-state serum concentrations resulting from the dosing chart range from 12.1 to 18.2 mg/L, with a mean of 15.0 mg/L.

Pharmacy curriculum outcomes assessment for individual student assessment and curricular evaluation.

The Pharmacy Curriculum Outcomes Assessment (PCOA) is a standardized examination for assessing academic progress of pharmacy students. Although no other national benchmarking tool is available on a national level, the PCOA has not been adopted by all colleges and schools of pharmacy. Palm Beach Atlantic University (PBAU) compared 2008–2010 PCOA results of its P1, P2, and P3 students to their current grade point average (GPA) and to results of a national cohort. The reliability coefficient of PCOA was 0.91, 0.90, and 0.93 for the 3 years, respectively. PBAU results showed a positive correlation between GPA and PCOA scale score. A comparison of subtopic results helped to identify areas of strengths and weaknesses of the curriculum. PCOA provides useful comparative data that can facilitate individual student assessment as well as programmatic evaluation. There are no other standardized assessment tools available. Despite limitations, PCOA warrants consideration by colleges and schools of pharmacy. Expanded participation could enhance its utility as a meaningful benchmark.

White coat ceremonies in US schools of pharmacy.

Background Pharmacy and medical schools share similar concerns regarding the need to place greater emphasis on professional socialization. Many academic institutions of both professions have elected to establish a white coat ceremony to initiate the process of inculcating professional values. However, a recent literature search revealed little published information on pharmacy white coat ceremonies. Objective To determine the prevalence of white coat ceremonies in US schools of pharmacy and identify commonalities between ceremonies conducted at different schools. Methods In April 2002, a 25-question survey was sent via E-mail to the deans of the 83 accredited schools of pharmacy in the US. The survey solicited details about the nature of each schools white coat ceremony or reasons why the school does not conduct a ceremony. Results The first ceremony in pharmacy was held at the University of Kentucky in 1995. As of May 2002, 51 of the 83 schools had already conducted a white coat ceremony and another 10 indicated plans to initiate a ceremony by the end of the year. Telephone follow-up confirmed that, as of May 2003, the number had risen to 61 schools. Most schools conduct the ceremony during the first professional year. Common features include presentation of the coat, recitation of an oath, a speech by an honored guest, a class photograph, and a reception. Conclusions The white coat ceremony is a growing phenomenon in pharmacy education that could play a pivotal role in the quest to better achieve professional socialization among students.

Rethinking the Role of Clinical Practice Guidelines in Pharmacy Education

Clinical practice guidelines (CPGs) play a major role in pharmacy education. Students learn to locate, retrieve, and apply CPGs in didactic coursework and practice experiences. However, they often memorize and quote recommendations without critical analysis, which tends to undermine their clinical growth. Students should become genuine drug experts, based on strong critical-thinking skills and the ability to assimilate extensive clinical and scientific knowledge. Clinical practice guidelines improve health care, and students should be familiar with them, but there are legitimate criticisms of CPGs, stemming largely from potential conflicts of interest and limitations in the quality and scope of available evidence. Despite such flaws, CPGs can be used to facilitate the clinical growth of students if the emphasis is placed on critically analyzing and evaluating CPG recommendations, as opposed to blindly accepting them. From that perspective, the role that CPGs have come to play in education may need to be reconsidered.