Bachelor of Pharmacy Degree in Cuba: New Educational Challenges

To the Editor. The principal pharmacy degree offered by Cuban universities is a 5-year bachelor of pharmacy degree. In Cuba, all colleges and schools of pharmacy are public. The Ministry of Higher Education is responsible for policy in matters of undergraduate and postgraduate education. Additionally, the National Council on Pharmaceutical Education (NCPE) releases its revised competency standards and guidelines, which require colleges and schools of pharmacy in Cuba to evaluate their educational outcomes for accreditation. All pharmacy programs are accredited by the Cuban Council for Accreditation of Higher Education (CCAHE), the body responsible for developing and evaluating educational standards.^1,2

In Cuba, as in other countries around the world, the pharmacy profession has moved from a product orientation (dispensing medications) to a patient focus. The main change currently affecting practice is the introduction of pharmaceutical care as a professional model. Pharmaceutical care is a patient-centered, outcome-oriented, contemporary pharmacy practice that requires the pharmacist to work in concert with the patient and the patient's health care providers to promote health, prevent disease, and assess, monitor, initiate, and modify medication use so that pharmacotherapy is safe and effective.³ Given the public nature of the health care system in Cuba, the government has adopted initiatives to encourage pharmacists to apply this new professional practice; thus, pharmaceutical care was considered in Cuban pharmacy legislation in 2005.⁴ Some pharmacists have adopted pharmaceutical care as the guiding principle for the profession, and assume responsibility for the detection, prevention, and resolution of actual or potential drug-related problems.^5,6

Cuba is grappling with the need to expand, enhance, and improve existing education programs for pharmacy students, in light of expanding roles and responsibilities for pharmacists. Accordingly, the curriculum has been revised significantly to provide the education and experiential training that will provide the student with the knowledge, skills, and ability required of the pharmacy practitioner in the 21st century. Many factors, such as Cubans' increasing need for pharmaceutical products and services, have influenced changes in the pharmacy curricula. These considerations led to the incorporation of social pharmacy in the curriculum. Understanding that social pharmacy is an interdisciplinary discipline that enables pharmacists to act, take part in, and take responsibility for drug matters at a societal level,⁷ this initiative was introduced to provide students with more opportunities and exercises to improve communication competence, critical thinking, problem solving, and analytical and ethical reasoning. The new discipline includes 3 subjects: pharmacy services (includes community and hospital pharmacy and experiences in ambulatory, inpatient, and managed-care environment), management and special pharmacy services (includes pharmaceutical care practice), and ethics in pharmacy (includes marketing, knowledge of drug distribution, health care delivery systems, ethical principles pertaining to professional practice). At the beginning of the first course in the second year, the concept of social pharmacy is discussed and its importance in the curricula is explained, and students are given the opportunity to express their opinions and perceptions about the social impact of the pharmacy profession. Questions about drug information, patient counselling, drug use, drug-related problems, and compliance are analyzed, using examples from actual practice to illustrate the impact of pharmaceutical care.^8,9 The goals of the courses are to provide students with a foundation for understanding health and drug laws and regulations, and medicines in a societal context, and to prepare students to counsel patients. Specifically, a management and special pharmacy services course provides the basic concepts to be applied by the student in the 120-hour internship at the end of the fourth year. Pharmaceutical care is considered to be a main component of the internship, and the educational topics include: the philosophy of pharmaceutical care, the process of pharmaceutical care, the strategic planning process, and training in interpersonal communication, marketing, documentation, and team building skills. The social pharmacy discipline represents only 2% of total curriculum hours. An important component of this discipline is the introduction to a variety of teaching and learning methods, with particular emphasis on problem-based learning. The most frequent teaching methods used are lectures presented in classrooms, case studies, discussion groups, class assignments, demonstrations, and pharmacy practice experiences.

Cuban pharmacy students are able to speak about pharmaceutical care, and to recognize the differences with other practice models; they retrieve information about patients' most used drugs and common drug-related problems, and obtain information that could support the proposal of a pharmaceutical care plan. Students interact with patients by giving educative lectures, handing out brochures and manuals, and assess the impact of the education given on the patients' knowledge about diseases and treatments during the pharmaceutical care practice course.

The introduction of social pharmacy is the first academic approach to teaching pharmaceutical care in Cuba. The purpose is to continue improving course activities to offer students better opportunities to develop pharmaceutical care during their stay at the university. At the same time, this presents a challenge for pharmacy educators who must implement these new initiatives into pharmacy education, instilling in their students a high level of motivation and commitment, and the self-confidence to assume responsibility for improving drug therapy results in their patients.

• © 2011 American Association of Colleges of Pharmacy