Variety and Quantity of Professional Electives

INTRODUCTION

Many pharmacy programs are new and likely seeking input on how to develop their curriculum.¹ Even fully accredited programs may be seeking guidance on how to maintain accreditation.²

As part of a program’s self-study process, data from the American Association of Colleges of Pharmacy (AACP) Graduating Student Surveys are reviewed to identify areas of strengths and weaknesses within the program. To underscore the importance of elective course options in the curriculum, the survey explicitly asks students to what extent they believed elective courses met their needs.³

The Accreditation Council for Pharmacy Education (ACPE) requires that colleges and schools of pharmacy provide a broad range of elective courses that ensure students have the opportunity to learn about career options, cultivate personal interests, and achieve curricular outcomes.⁴ However, ACPE does not define the number and types of elective courses required within a degree program, leaving those decisions to individual colleges and schools of pharmacy. The decision about the extent of elective course offerings is complicated by the limited time and resources available to develop and maintain elective courses. For example, state funding for higher education decreased significantly in the 2009 and 2010 fiscal years.⁵ Moreover, during the 2009-2010 academic year, 101 colleges and schools of pharmacy had 374 vacant and/or lost faculty positions.⁶

To ensure that the elective courses offered inform students about career opportunities, course content should be reflective of the roles and responsibilities of licensed pharmacists in various practice settings. Required coursework should cover the most common practice settings, while elective courses should cover some of the remaining practice settings. The top 3 pharmacy practice settings employing pharmacists according to The National Pharmacists Workforce Survey in 2009 were hospital, chain, and independent. Other less common pharmacy practice settings included long-term care, home health, nuclear, industry, managed care organization, academia, and government.¹¹ The 2011 AACP Graduating Student Survey, which assessed pharmacy students’ employment plans after graduation, found that the top 3 career settings in which 2011 pharmacy graduates anticipated working were chain community pharmacy, hospital pharmacy, and independent community pharmacy. The remaining career settings in which students planned to work (listed in no particular order of priority) included long-term care, managed care, pharmaceutical industry, armed services, or regulator agency, other governmental positions, professional association, other pharmacy-related field, and non-pharmacy-related field. Also, some indicated they planned to pursue further education.³ Faculty members should consider the possible future roles of pharmacists in addition to more traditional roles when assessing or establishing elective course offerings. In addition to traditional opportunities, emerging opportunities for pharmacists exist in medication therapy management, pharmacogenomics, medication reconciliation, patient advocacy, research, antibiotic stewardship, care coordination, medication safety, armed services, drug regulation, managed care, government, technology, and academia.¹²

Articles have been published that provide recommendations concerning general competencies to be achieved throughout the PharmD curriculum, as well as the extent of coverage of specific aspects of pharmacy (eg, nuclear pharmacy, pharmacogenomics, and drug information) in required and elective courses.^7-10 A search of the American Journal of Pharmaceutical Education, the Pharmacy Education Journal, and the International Journal of Pharmacy Education, however, found no articles that summarized the scope of electives provided by US colleges and schools of pharmacy.

Knowing what other colleges and schools of pharmacy offer would provide a point of comparison for colleges and schools to use in deciding whether they offer a sufficient amount and variety of elective courses. The purpose of this study was to identify currently offered elective courses in accredited US pharmacy programs.

METHODS

An Internet search was conducted from January 2011 through August 2011 to compile a list of classroom-based elective courses and elective advanced pharmacy practice experiences offered by pharmacy programs granted pre-candidate, candidate, or full accreditation status by ACPE as of January 2011. The number of classroom-based elective course credit hours and elective APPEs required also were identified. Credit hours for programs with 3 quarters rather than 2 semesters were multiplied by two-thirds to determine an equivalent number of semester credit hours. Credit hours for programs with 4 quarters rather than 2 semesters were multiplied by one-half to determine an equivalent number of semester hours.

Enrollment for each college or school was identified through the AACP Fall 2010 Profile of Pharmacy Students.¹³ The college’s or school’s Web site was consulted when enrollment was not included in the AACP Pharmacy Profile. Whether the pharmacy college or school was private or public, whether it had at least 1 branch or satellite program, and the length of the curriculum were determined by reviewing the AACP 2011- 2012 Pharmacy School Admission Requirements.¹⁴ The accreditation status of each college or school was identified through the ACPE Web site.¹⁵

Elective courses were grouped into categories. A category was created when a course from more than 1 college or school covered similar content. Elective courses were counted in more than 1 category if the course title indicated representation of more than 1 content area (for example an elective course on pediatric oncology would be placed in both the “pediatrics” and the “hematology/oncology” categories). Course descriptions were consulted when it was unclear from the course title how to categorize an elective course. Elective courses were categorized as “other” if the title of the elective was unclear and course descriptions were unavailable, if both the course title and description were unclear, or if no other college or school covered the same content. Separate categories were created for classroom-based courses and elective APPEs. The University of Missouri - Kansas City Institutional Review Board determined that this study was exempt from full review.

RESULTS

The Web sites of 123 colleges and schools of pharmacy were reviewed. Four colleges and schools were not included in the results as these PharmD programs obtained their precandidate status from ACPE after data had been collected. The characteristics of the colleges and schools of pharmacy included in the study are summarized in Table 1.

The average number of credit hours required for elective lecture-based courses was 7 (range 2 to 18). The average number of elective courses offered by each college or school was 32 (range 5 to 83). One hundred twenty-five categories were developed. The average number of elective course categories a college or school of pharmacy offered was 24 (range 5 to 51). The 20 most common categories of elective courses offered are described in Table 2. Table 3 provides the frequency and percentage of colleges and schools offering elective courses covering less common practice areas that were not in the 20 most common categories. These practice areas are ones identified in the 2009 National Pharmacists Workforce Survey the 2011 AACP Graduating Student Survey, and an article that identified emerging areas for pharmacy involvement.^3,11,12

The average number of elective APPEs required was 3 (range 1 to 5). Sixty-four categories of APPE electives were developed. The average number of categories a college or school of pharmacy offered was 24 (range 4 to 42). The 10 most common categories of APPE electives offered by colleges and schools are described in Table 4. Table 5 provides the frequency and percentage of programs offering elective APPEs covering less common practice areas that were not in the 10 most common categories. ^3,11,12

DISCUSSION

This review provides a foundation for colleges and schools to use in determining the number of elective courses to offer. If the number of elective options offered by a PharmD program appears to be on the low end compared with other colleges and schools, these data can inform the program’s decisions regarding use of resources for additional elective courses and provide administrators with examples of what types of elective courses could be added. The optimal number of elective courses for a PharmD program, however, is still uncertain.

Elective courses can cover emerging or less commonly encountered content (for example long-term care, technology, and academia) that is not incorporated into required courses in order to complement a college’s or school’s core curriculum. Most elective courses found by this review did not cover areas identified by others as being less common or emerging.

One limitation to this study was the reliance upon information provided on a Web site which in some cases required interpretation of the content of each course and/or may not have been up to date. This may not be a significant limitation in light of results published by other investigators who used survey instruments to assess the coverage of select topics within US colleges and schools of pharmacy. Murphy and colleagues found that 34.8% of their sample taught pharmacogenomics within elective coursework, as compared to 39% of colleges and schools identified in this study.⁸ Bednarczyk and colleagues found that 29% of colleges and schools of pharmacy surveyed had a standalone elective course covering nuclear pharmacy. Thirty-three percent of the colleges and schools with information regarding lecture-based elective courses in this study provided a lecture-based nuclear pharmacy elective course.¹⁰ Seventy percent of programs sampled in a study by Cole and Beresnen offered an elective drug information pharmacy practice experience compared to 74% of programs sampled in this study.⁹ The differences in overall findings from these studies that used survey instruments and in this study are small, suggesting that similar information can be gleaned from Internet searches.

Another limitation of this study is that students could be learning about specific aspects of pharmacy in required coursework and may not need additional elective coursework to learn more about these aspects of pharmacy. Murphy and colleagues, for example, identified 50 colleges and schools of pharmacy that covered pharmacogenomics as part of required coursework and 15 that required a course focusing specifically on pharmacogenomics.⁸ Cole and Berensen identified 70 pharmacy programs requiring at least 1 drug information course.⁹ Bednarczyk and colleagues identified 20 colleges and schools that included nuclear pharmacy concepts in required coursework.¹⁰

A third limitation is that information was not available for all of the 123 colleges and schools of pharmacy recognized by ACPE as of January 2011. The characteristics of colleges and schools of pharmacy providing more detailed information on electives (eg, the 91 colleges and schools providing the number of required, elective APPEs), however, appear to be similar among the 123 colleges and schools granted pre-candidate, candidate, or full accreditation status by ACPE as of January 2011.

A fourth limitation is that data on the total number of weeks of elective APPEs required was not collected. This may not be a significant limitation as the specific amount of time (for example, 4 weeks vs. 5 weeks) needed/required to develop awareness and cultivate personal interest is uncertain.

Further research is required to more fully identify whether the elective courses offered by colleges and schools allow students to gain awareness of potential career choices and cultivate personal interests. Investigators will want to survey students to determine how aware they are of opportunities in pharmacy, how well their interests match with these opportunities, and whether the elective courses offered allowed them to obtain a better understanding of available career choices. These studies should be done in light of the elective courses already provided to students and the extent to which the concepts covered in these elective courses are included in the required curriculum.

Another interesting angle to investigate would be whether colleges and schools should strive harder to incorporate less common roles for pharmacists in elective courses or should continue to focus on common career choices. The answer to this question lies in whether the required curriculum is sufficient for students to gain awareness and develop interest in areas where pharmacists frequently practice.

CONCLUSION

A wide range of elective courses is offered by colleges and schools of pharmacy. Most elective courses cover common practice areas, while fewer cover emerging or more unique content. Further research is needed to determine if these elective options allow pharmacy programs to achieve ACPE standards.