Ensuring Doctor of Pharmacy Graduates Have the Essential Competencies for Innovative Practice

INTRODUCTION

As the pharmacy profession continues to evolve from product oriented to more patient centered, pharmacy programs have been undergoing a transition from a traditional pharmacy curriculum to competency-based education.¹ Competency-based education has been developed to instill the required clinical competencies in graduates to better meet the contemporary role of pharmacists in accordance with the latest scientific knowledge and evidence-based practices in an ever-evolving health care landscape.¹

Since 1992, the American Association of Colleges of Pharmacy (AACP) Center for the Advancement of Pharmacy Education (CAPE) has pioneered the development of key Educational Outcomes. These Educational Outcomes have been periodically revised to guide curriculum planning, delivery, and assessment within colleges and schools of pharmacy.² Of important note is that the CAPE Educational Outcomes are included as Standards 1 through 4 in the Accreditation Council for Pharmacy Education (ACPE) 2016 Standards for accrediting Doctor of Pharmacy (PharmD) programs.³ However, to remain abreast with the evolving role of pharmacists in public health, especially during the COVID-19 pandemic, the incorporation of new domains is essential.

This commentary highlights the strategic use of workforce development of population health based on two perspectives: emergency preparedness and response as well as digital health. The public health focus can help address services needed by patients. The evolving digital health landscape of disruption highlights the need to adapt pharmacy education to render digital literacy for all learners. It is also important to foster competency and build innovators at the forefront who can be proactive in emergency response planning and also embrace change through digital health innovations.

Domains related to emergency preparedness and response are critical, as many public health emergencies have emerged throughout the years. For example, in 2002-2003 there was a global outbreak of severe acute respiratory syndrome (SARS). In 2009-2010, the H1N1 influenza pandemic occurred. In 2013 to 2016, the Ebola virus outbreak happened in West Africa. Recently, the COVID-19 global pandemic occurred.^4,5 All these public health emergencies highlight the critical and integral role that pharmacists can play in emergency preparedness and response to pandemics as well as other public health emergencies. Since pharmacists are the most accessible health care professionals, they can serve as frontline health care workers who provide primary, secondary, and tertiary public health services.

During public health emergencies, pharmacists in all sectors, including community, hospitals, long-term care facilities, and outpatient clinics, are involved in emergency response planning and execution where they play a vital role on interprofessional health care teams. In fact, pharmacists can improve public health through various services including developing strategies to continue access to medications and supplies, supporting health care needs and services, providing clinical care to affected patients, educating the community, and serving as reliable information sources.⁵

Pharmacists, through operation management, can optimize delivered services and ensure continuity of care for patients, health care teams, and communities during pandemics and emergencies. This can be accomplished by managing inventories, ensuring adequate medications, providing health care products and supplies, addressing medication shortages, and making therapeutic substitutions. In addition, pharmacists are involved in packaging, storing, dispensing, and administering medical countermeasures such as antivirals, antibiotics, and antitoxins.^5,6 These services result in optimizing pharmaceutical care to improve patients’ quality of life and health outcomes.⁷

Pharmacists are also involved in point-of-care services, including screening, testing, and providing immunizations.^4-7 Moreover, pharmacists provide innovative digital health services, including applying digital communications, telemedicine, clinical services, and education on evidence-based information that counters misinformation during public health emergencies and pandemics.^5,7

An effective and strategic response to emergencies and pandemics depends on adequate education, training, and planning. Therefore, pharmacy curricula should incorporate aspects of global public health and emergency preparedness and response to yield pharmacists with the expertise, knowledge, and skills needed to enable them to combat pandemics.^5,7 In addition, training is specifically important for pharmacists to prepare them for their new roles to effectively respond to emergencies. Specifically, pharmacists need to be trained in planning, supporting, and disseminating evidence-based information. Pharmacists must be equipped with interdisciplinary skills, mental health education, and knowledge on resources management as well as implementation of best practices.^4,5

Hannings and colleagues’ research has shown that there is a gap in emergency response training of pharmacy students.⁸ Specifically, a call to action for emergency preparedness training was published by the Washington State University’s College of Pharmacy based on their experience working with the Metropolitan Medical Response System.⁹ Similarly, the University of Georgia’s College of Pharmacy described two emergency preparedness simulations that they conducted as part of their introductory pharmacy practice experiences.⁸ In addition, there are several guides for pharmacists on pandemic response issued by pharmacy organizations, including the Pharmacist's Guide to Pandemic Preparedness and the COVID-19 Vaccine Confident playbook.^10,11

On the global level, in 2020 the International Pharmaceutical Federation (FIP) published a revised Global Competency Framework. This framework included emergency response as one of its competencies, which promotes the participation of pharmacists in multidisciplinary health care teams in response to public health emergencies.¹² Additionally, a framework by Aruru and colleagues has been recently published to help expand pharmacists’ roles in emergency preparedness during the pandemic and beyond.⁵ The proposed framework includes five areas of competency: emergency preparedness and response; operations management; patient care and population health interventions; public health pharmacy education and continuing professional education; and evaluation, research, and dissemination for impact and outcomes.⁵

Given these recent publications, it is integral for emergency preparedness and response to be part of the new ACPE Standards and CAPE Educational Outcomes domains. Updated Standards and Educational Outcomes should be integrated in pharmacy curricula to ensure that the graduates will be equipped with the essential skills needed for frontline responders to effectively execute the response plans during public health disasters and emergencies.

The second area in which new Standards and Educational Outcomes should be considered is digital health. During the COVID-19 pandemic, digital health has influenced the ability to scale, test, coordinate, manage data, contact trace, and quarantine. The countries that melded these strategies with appropriate policy and health care services had lower per capita mortality rates and flattened incidence curves.¹³ In addition, wearable devices have been studied to help track recovery from and predict COVID-19 with self-reported symptoms, as demonstrated by the DETECT (Digital Engagement & Tracking for Early Control & Treatment) study.¹⁴

Antwerp and colleagues’ report on the future of health that was published by Deloitte included interviews with industry experts, representing independent pharmacies, payers, providers, large retail chains, technology developers, pharmacy associations, and academia.¹⁵ This report emphasized pharmacists’ ability to identify and facilitate digital health tools and diagnostics, interpret data for patients, and “prescribe digital therapeutics.”¹⁵ Approximately 40% of Americans wear a form of digital tracking, and 30% of patients wear a digital device daily.¹⁶ The role of pharmacists could potentially expand into engaging with digital health, such as enhancing medication adherence through “smart” medication packaging with real-time alerts to help aging patients be able to stay at home.¹⁵ Pharmacists could assist in population health analytics through developing tools and programs that improve population health as well as interpretation.¹⁵ Thus, pharmacists have the potential to play an instrumental role in remote health monitoring to ensure patients’ safety.¹⁶

There has been a strategic movement to provide students, faculty, and practitioners with opportunities to enhance their skills in digital health. In 2021, AACP held its inaugural Digital Health Institute for pharmacy educators. Recently, the FIP has issued an online “Train-the-Trainer” digital health curriculum series for its members. Notably, the FIP report highlights several innovative digital health didactic activities that incorporate patient experts to help inform digital health curricula and purposeful integration of digital health content throughout the whole program.¹⁷

Similarly, there are innovative global digital health implementations from various countries. In the FIP report, the University of Geneva/University of Lausanne’s Institute of Pharmaceutical Sciences of Western Switzerland developed a course that incorporates patient experts as teachers to share their health care experience and use digital health resources with students. At La Trobe University in Australia, digital health is integrated vertically and longitudinally into the curriculum. Basic concepts of digital health and electronic medical records are introduced to first-year students. Students learn how to evaluate digital health apps and concepts, such as big data and artificial intelligence, and partake in case studies related to digital health through role play and objective structured clinical examination.¹⁷

Lastly, the FIP conducted a global survey on digital health in pharmacy education (N=1060 respondents, 91 countries, pharmacy schools, pharmacists, pharmacy students), which revealed that 57% of pharmacy programs do not offer digital health education. Competencies of digital health, such as patient-centered digital health (58%) and digital health tools (55%), were the most desired subjects in the curriculum. Most practitioners expressed an interest in learning more about mobile applications, electronic health records, telehealth, online pharmacy, and remote patient monitoring. Only 10% of pharmacy student respondents indicated they had learned digital health in the curriculum. The two most common challenges outlined by respondents were the lack of experts (50%) and resources (40%).¹⁷ As a result, FIP shared strategies such as supporting educators in training, sharing best practices from digital health initiatives at pharmacy schools, creating a Global Curriculum and Training Resources Toolkit, and promoting digital health literacy for students through the International Pharmaceutical Students Federation.¹⁸

The evolution of digital health necessitates that countries and stakeholders consider including digital health in the health professions curriculum. Some believe that the including content related to reviewing electronic medical records is sufficient to cover the digital health concepts in a curriculum. In addition, major large pharmacy chains and payers have not pushed for growing digital health applications at this time.¹⁵ Colleges of pharmacy can lay a foundation of digital health concepts and foster creativity by highlighting ongoing and new digital health applications. This would result in practitioners who have the ability to not only navigate but also innovate to improve population health and positively influence the perception and future of the profession. Rather than being reactive in updating the curriculum, pharmacy education can proactively welcome disruption and innovation that includes pharmacists as key players in digital health applications.