ELPD CPhA position paper & Briefing note Feb 09

So the Briefing note is just a summary of the position statement.  Here are the highlights of the position statement:
•    Vision of “Optimal drug therapy outcomes for Canadians through patient-centred care”
•    CPhA believes that pharmacy learning modules should be continually advanced
•    They also know that some faculties have already implemented the PharmD

So they SUPPORT the transition from BSc Pharm to ELPD but they think this transition should address:
•    Business and economic considerations
•    The impact on supply of graduates
•    Demand/Funding for clinical training
•    And the impact it will have on the profession where there will be two forms of academic qualification!
**They also think that there should be programs for current pharmacists to upgrade to their knowledge and skills

They talk a bit about background:
•    currently BSc Pharm = 4 years + 1 year of prereqs
•    must meet CCAPP standards to be accredited
•    Since early 1990’s U of T and UBC offered post-grad PharmD degrees

PharmD generally = 2 years of pre-pharm education and 4 years of pharm education.  This gives the PharmD a greater focus on clinical “experiential learning” than the current BSc Pharm programs.  CCAPP made draft standards for the 1st prof degree in pharm program (FPDPD) in 2007.

The Canadian health system needs pharmacists to have an enhanced role with more focus on patient outcomes.  Changes in legislation in several provinces indicate this and include more authority in prescribing and monitoring drug therapy.  Also pharmacists are being reimbursed in some provinces for medication management services.

These changes requires changes in skills and knowledge, and so to ensure safety in these expanded roles the pharmacy curricula will need to evolve.

But while these changes would be great, there are limits to how much can fit into the traditional 4 year program.  Strategic plans are being developed in most schools to help with these changes, and some of these will lead to ELPD programs. 

ELPD programs already exist in Canada at the following schools: U of Montreal (1st class enrolled in 2007), U Laval (will start in 2010), U of T is waiting for confirmation.

CPhA has strategic goal to “Advance the role of the pharmacist” and they have led two major initiatives in support of this.  The Blueprint for pharmacy and Moving Forward: Pharmacy HR for the Future.  These both identify a need for curricular change to advance pharmacy practice.

Blueprint: Continuing professional development – CPD – future education needs to focus on foundational skills like “communications, clinical decision making, physical assessment, informatics, confidence building, and research”.  Management, leadership, advocacy and change management skills all need to be incorporated. 

There are two specific key actions in the Blueprint Implementation plan:
•    To make sure core pharmacy curricula adequately prepares new grads for an increased scope of practice
•    Increase accessibility, quality/quantity, and variety of the experiential learning opportunities to prepare students for expanded practice roles

Moving forward has two specific points on curricula revisions to include more experiential training:
•    #14: Review knowledge base, abilities, values, and IP skills and clinical experience that will be required of practicing pharmacists in expanded roles and develop pharmacy curricula to ensure new grads are competent to practice in these emerging roles
•    #15: Ensure Canadian Pharm Grads get credentials that reflect the expected increase in academic rigor of their restructured curricula for ELPD

At the end they sum it up by stating that CPhA supports the reviewing and ongoing modifications to pharmacy curricula since it will be necessary to ensure pharmacy students are prepared with the skills and knowledge they will need to practise at the current level that will be required by the health system.

I think it would be in our best interest to echo these statements for our policy!

Thanks!
Hayley

Raj's Summary:

Entry-level PharmD degree programs in Canada: Some facts and stakeholder opinions
Tamar Koleba, PharmD; Judith G.Marin, PharmD; Peter J. Jewesson, PhD, ACPR, FCSHP

ADPC (Association of Deans of Pharmacy in Canada) and AFPC (Association of Faculties of Pharmacy in Canada) support the conversion to ELPD (2004).

Against: CAPSI (2004), CACDS (2004), CSHP (2002), CPhA (2005), CCCP (Canadian College of Clinical Pharmacy) 2002

CPhA believes that there is a need for practice change but is unsure if ELPD is the answer.

Fear: May give the government an impression that pharmacists with BSc. Degree have inadequate education and training, will lead to two-class professional structure

CPhA doesn’t support it – 2005 communication with Nancy Shurtleff
CSHP concerned that ELPD might lead to polarization of the profession
Members felt that the curriculum does need to be changed but ELPD may not be the solution
Conclusion: appears inevitable that Canada will follow the foot steps of States in the implementation of the program
Students feel that shortage of the pharmacists is the reason behind inadequate care provision rather than the curriculum
CAPSI doesn’t support the ELPD
At the 2004 Annual Conference of the Federal/Provincial/Territorial Ministers of Health, a 10-year plan to strengthen health care was developed and the ministers approved a new approach for assessing proposals for changes in entry-to-practice credentials for medical and health professions to ensure a sufficient supply of personnel to provide timely and high-quality health care in Canada. Pharmacy faculties outside Quebec will need approval from their provincial or territorial ministries of health before changing entry-to-practice credentials.

Result of change to ELPD in US:
BSc and ELPD shared similar responsibilities
Post-BSc Pharm D graduates mainly involved in teaching and research
Professional satisfaction appeared to
Job satisfaction associated with the practice environment (hospital vs. community), job title and perceived utilization of the skills rather than the degree earned
More recently, Cox and Fitzpatrick11 reported that pharmacists who had received additional training (i.e., beyond the baccalaureate degree) were more professionally satisfied than those without additional training.
Hard to find studies that compared ELPD and BSc. after 1999
Methodological problems with the reviewed studies((e.g., low response rates, imbalanced representation by degree, non-validated survey instruments); makes interpretation of results hard
Dated results ( at least 10 years old), extrapolate with caution due to different training conditions, practice environment and time frames
Graduates with a Canadian baccalaureate degree have various options for further training in Canada, including a

12-month, post-baccalaureate residency certificate program, an MSc degree in pharmacy practice

(Available to French-speaking graduates from any province), and a post-baccalaureate training program leading to a Doctor of Pharmacy degree.

Excerpt from the article: “In summary, there does not appear to be any concrete published evidence that ELPD-prepared pharmacists are involved in higher-level activities, are more professionally satisfied, or improve patient outcomes any more than those pharmacists possessing a baccalaureate degree. Of course, absence of proof is not proof of absence.”

What do I conclude from this article: The article provided information about how different faculties operate and which faculties support the idea of ELPD. There is need of more research in order to compare the impact of ELPD on patient care and outcomes vs. BSc.

Polly, what year is that last article from? I seem to have misplaced the original email.

Here is the summary of our discussion:

- Don't focus on the evidence for the change to ELPD because frankly it is weak.  In the US they did not focus on evaluating the impact of this change because there was no need to.  All the schools changed to an ELPD program and it would not switch back even if the evidence did not support the change. 

- Take a look at the results of the student and the new practitioners section of the Moving Forward study and compare their feedback to both the Blueprint and our current educational programs.  Ask if our current education (based on the results of the Moving Forward study) will prepare us for "the future of pharmacy practice".  If it does not suggest and support educational program changes (eg. to have more a more clinical influence and experience).

- The degree change requires the support of each individual provincial government body before individual universities can do anything.

- Dean Hill suggested that the President(s) of CAPSI contact the President of AFPC (Association of Faculties of Pharmacy of Canada) as they are responsible for accreditation for the schools of pharmacy and they are currently DRAFTING the curriculum differences that will differentiate the ELPD program.  If we can see how the education differs we can then decided if this change in the program will be beneficial to students in terms of preparing them for our expanding scope of practice.  The Deans association (I forget what it is called) is currently working with the AFPC to produce a joint statement that is in favour of the ELPD program.  Though the statement is still in draft stages, if the President(s) explains that we are currently reviewing our position statement and the differences in the programs could possibly play a key role, the AFPC may be willing to share information if we keep it confidential until the official position comes out.

- We want to ensure that we take a responsible leadership position on this matter since it directly affects ALL our members but whatever position we decide to take we should try to ensure that we do not isolate a part of our membership.  For example, we need to be cautious because we should be supporting the degrees (PharmD, B.Sc, etc) of all our members as an association despite our personal opinions. 

- Since our position statement will be available to the media and government we should look into using a Media Consultant so that our position is clear and understandable to the lay media and pharmacists.  Since cost is involved with this, it was suggested that we contact CPhA and ask them if we can use their consultant for free or a discounted rate

This is all I can think of right now.  Amy, Amy and Jessica anything to add/correct?