Maryland's nontraditional pathway to the doctor of pharmacy degree: Development and improvement

The University of Maryland School of Pharmacy faculty decided in 1989 to move to the Doctor of Pharmacy as the entry-level degree, admitting the first class of PharmD-only students in the Fall of 1993. Concomitantly, a non-traditional (NTPD) pathway was established to permit practitioners the opportunity to earn the PharmD degree. This article summarizes the NTPD Pathway as it was originally designed, including the underlying premises.

The Curriculum Committee has recently completed a formal evaluation of the NTPD Pathway, and made recommendations for improvement to more closely meet the terminal performance objectives of the PharmD degree, and to better meet the needs of the students enrolled, including: eliminate practice-specific versions of courses, institute a readiness assessment course designed to optimize students' success in the pathway, more fully develop the therapeutics sequence of courses, institute a Principles of Pharmaceutical Sciences course, and create elective opportunities within the pathway.

INTRODUCTION

As the concept of pharmaceutical care was introduced and developed and it was evident that pharmacy education must change, the University of Maryland School of Pharmacy faculty voted in 1989 to consolidate the School's BS in pharmacy program with its post-baccalaureate Doctor of Pharmacy program. The new program was developed in the early '90's, and the first class of PharmD-only students was admitted in the Fall of 1993. The new program was not without controversy for many reasons such as increased length of the entry-level program (from three years to four), increased tuition (although previous levels were very low at this state institution), and continued ability to meet the demand for newly educated pharmacists. Pharmacists in Maryland were naturally concerned that new graduates would emerge with a different set of knowledge, skills and abilities than those from the baccalaureate program, and would also have a new degree.

Responding to these concerns, a joint committee of faculty and practitioners was formed to study the issues. Since requirements for the two degrees were different, grandfathering alumni with baccalaureate degrees or exchanging baccalaureate degrees for Doctor of Pharmacy degrees were not options. This committee felt that pharmacists wanted to learn more about pharmaceutical care, and to obtain the academic credentials that they perceived would be beneficial. The problem was that very few were in a position to stop working for a year or two to go back to school to earn the degree, nor would the School be able to accommodate a large influx of full-time day students wishing to study for a year to obtain a doctorate as an add-on degree.

The joint committee proposed the development of a nontraditional pathway to the Doctor of Pharmacy degree that would require that students meet the same terminal performance objectives as those established for the four year PharmD degree (see Appendix). The goal of the program was to enhance the ability of pharmacists to provide pharmaceutical care within their current practice setting. The nontraditional pathway proposal was based on a set of guiding principles: 1. Pharmacists who are students in the NTPD Pathway would be able to complete degree requirements without taking extended leave from their employment.

2. Students would be allowed, and in fact required, to complete the majority of experiential learning requirements in their own practice setting to better enhance their ability to provide pharmaceutical care in that current practice setting.

3. Admission to the program was contingent upon having completed an accredited baccalaureate program and be actively practicing with access to patients. Applicants were required to obtain documented validation of their ability to interact with patients in their practice setting or an alternate practice setting, as evidenced by their supervisor's signature.

4. An important part of the program would be the assessment of prior learning for which academic credits could be granted.

5. Due to the nontraditional aspects of this pathway, and a dynamically changing practice environment, it was recognized that continuous course and pathway assessment would be essential.

The first course offered in the nontraditional pathway, Principles of Pharmaceutical Care, was taught in the Spring of 1992, a year before the new PharmD program was implemented. The course was available for continuing education credits, but students could also choose to enroll as "special students" earning credits that could eventually be petitioned to transfer into the nontraditional pathway once the Doctor of Pharmacy program began. Fifteen students took the initial offering of the course, anticipating that the Doctor of Pharmacy degree program would eventually be in place, and that their academic credit could be transferred.

ORIGINAL PATHWAY

The nontraditional Doctor of Pharmacy (NTPD) Pathway was officially approved by the faculty in January 1994. The program of study consisted of a minimum of 30 academic credits, as required by the University of Maryland, of which up to 10 could be achieved through Prior Learning Assessment (PLA). A requirement of 30 credits was also consistent with completion of a two year Master's degree, and the additional year of study in the PharmD program. Of the 30 credits, 20 were required didactic course work, and the remaining 10 were required experiential learning. If a student chose to take an elective course or rotation, it was in addition to the required 30 credits. Admission was limited to graduates of BS Pharmacy programs, accredited by ACPE. Candidates were required to be licensed and practicing in Maryland, the District of Columbia or an adjacent state to be able to access both courses and the program's mentoring system. Candidates were also required to document access to patients, to assure they could complete programmatic requirements. Through the Fall of 1994, pharmacists who met these criteria and expressed interest were admitted to the program. As knowledge of this program became widespread, the number of applicants continued to grow. Faculty established a maximum entering class size of 60 students; 30 community candidates, and 30 hospital/organized health care practitioner candidates (the maximum number of students we could accommodate given our resources and concomitant launching of the entry-level PharmD program). Up to 30 applicants were selected for admission based on their affiliation with the School as a preceptor, as part of the School's ongoing commitment to preceptor development. However, due to the large number of applicants, and the diversity of the applicant pool, a lottery was tried in order to ration admission for the remaining 30 positions, with the expectation that all qualifed applicants would eventually be accepted. The lottery approach met with unanimous disfavor, was quickly discontinued and was replaced by a more traditional criteria-based admissions process (evaluation of previous academic performance, interview, and evaluation of communication skills).

The original nontraditional pathway is shown in Figure 1, and major learning outcomes for each course are available from the corresponding author. Consistent with the goal of enhancing the ability of pharmacists to provide pharmaceutical care within their current practice setting, the Principles of Pharmaceutical Care course was offered in two versions, one for community practitioners, and one for practitioners in hospitals and other organized health care settings. Students also registered for either Ambulatory Care Therapeutics, or Acute Care Therapeutics, depending upon their area of practice. The only other required didactic course that was tailored to the student's practice was Pharmacotherapy, in which students were asked to select six therapeutic modules from a menu of 10 for in-depth study. Students were given two choices for fulfilling the pharmaceutical science requirement in the program, taking either Integrated Science Seminar, or Novel Drug Delivery Systems. The goal of these courses was to enable students to apply new scientific knowledge to help solve therapeutic problems and to comprehend new developments in science related to pharmaceutical care.

Students completed all but one experiential rotation in their practice setting. This provided the opportunity for students to enhance their own practice setting by developing their pharmaceutical care skills on their own patient population. In addition, pharmacists were not forced to take time off from their practice to complete experiential rotations.

Each student was assigned a faculty mentor for the experience portion of the pathway who met with the student at least once a month for patient presentations and feedback. Mentors frequently met more often with the students, or remained in contact by phone or electronic mail between meetings.