The PharmD graduate of the future

We are rapidly moving forward to develop a doctor of pharmacy (PharmD) curriculum that will prepare pharmacists to excel in a changing health care marketplace. A recent interview with Sharon L. Youmans, PharmD, MPH, our vice dean, lays out our plans. What will be the impact of the new curriculum? Most importantly, how will it affect patients? As we consider the future of pharmacy education and practice, here is a scenario we are working to realize.

B. Joseph Guglielmo, PharmD
Dean
Troy C. Daniels Distinguished Professorship in Pharmaceutical Sciences
UCSF School of Pharmacy

Imagine … you are a patient in the not-too-distant future.

You are taking several medications to prevent or treat a medical problem.

Your medications have been chosen precisely to fit your needs: they are safe, effective, and work well with your unique biology and genetic makeup. They are delivered into your body in new ways, such as through nanoscale devices; they go only where they are needed; drug levels are monitored via a digital implant that transmits a secure signal. Your drugs have been tailored to your lifestyle and any factors—including other medical or physical conditions and affordability—that affect which drugs are best for you.

You get your health care not from a single provider, but from a team of physicians, nurses, dentists, pharmacists, and physical therapists. The entire team has access to your complete and up-to-the-minute-accurate medical record, including your list of current medications with their doses and directions for use. Your care team has access to your digital health feed, and you have access to the same information. You connect with the team as needed in person, and virtually on the web.

Elisabeth Fall

The pharmacist—who works in your clinic and/or virtually—ensures you are on the right medications, that you are taking them correctly, and all side effects or problems are addressed immediately.

Your pharmacist ensures that your medications work well together—not against each other—and that you are taking only the medications you absolutely need. She alters your prescriptions as needed, while monitoring any over-the-counter medications, herbals, or dietary supplements you are taking, along with any foods that might affect how your drugs are absorbed into your body.

She addresses many of your primary care needs—managing your diabetes or heart disease, monitoring your blood pressure, ordering lab tests, ordering and adjusting your prescriptions, and triaging results with the rest of your health care team.

Elisabeth Fall

She thinks critically as changing situations demand, calls upon the latest science in evaluating your health and treatment directions, and works as an essential member of your team as your advocate, communicating effectively and in a timely manner with you and the team.

She not only cares for your needs, she also is responsible for evaluating and improving the effectiveness of pharmacist services related to overall costs within the larger health system of which your clinic is a part.

How did your pharmacist prepare for this role while in pharmacy school?

• She gained a strong base of science knowledge in many fields by learning how to evaluate and apply scientific principles, rather than simply memorizing facts. She was also continually exposed to advances in basic science research that would ultimately be related to pharmacy practice. She sought the latest therapeutics research as a matter of course.
• She dove deep into her particular passion in more detail, first gaining essential core knowledge in biomedical science, social and behavioral science, clinical science, systems science, educational science, and epidemiology and population science—then more detailed knowledge in one of these areas through her own project.
• From her first days in pharmacy school, she worked in patient care situations where her work affected real outcomes for patients and health care systems. She assumed more of this kind of hands-on clinical responsibility as her education progressed.
• The health of the patient was the single driving force in her education.
• She learned in a team-based environment with dental, medical, nursing, and physical therapy students—and with seasoned practitioners in all these fields—as well as with PhD science students and renowned scientists. Working as an equal across traditional academic boundaries was her norm. In fact, she could not imagine a time when then this was not the case.
• She became adept at communicating with patients, taking patient medication histories, and physically assessing patients. She learned not only to listen, but also to truly hear what her patients were saying.
• She spent more time actively learning than sitting in a classroom. She finished her background studies and reading before class. The expectation was to come to class fully prepared to engage in group projects and to think critically about questions and solutions to problems.
• She learned as part of a health care team that addressed gaps in care. She studied among teachers and students who were diverse in race, culture, and beliefs. She worked with patients from all backgrounds and parts of society.
• She studied with fellow students who stepped up to the plate, effectively advocating for the profession and for patients.
• She assumed that she would enter an advanced training program after earning her PharmD degree. This meant licensure as an advanced practice pharmacist, which would allow her to apply the full extent of her expertise, provide many primary care services to patients, and work as an equal with fellow providers in health care delivery models that would constantly evolve. For her, it also meant additional training in business, which would give her the skillset needed to lead health system changes.

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Your pharmacist graduated from pharmacy school at UCSF under a PharmD curriculum transformation begun in 2014, fully implemented in 2017, and known as the UCSF Bridges Pharmacy Curriculum. She completed additional training to become a licensed advanced practice pharmacist, and she went on to earn an MBA.

Many of her classmates chose to focus on direct patient care, as she did. Because of the flexibility of the curriculum, many others finished advanced training and then stepped into careers in clinical research, the pharmaceutical industry, regulatory affairs, business, academia, law, and global health, after earning PhD, MEd, MS, and other degrees in specialized fields. Other classmates came to pharmacy school already holding advanced degrees.

Regardless of their ultimate career decisions, they all entered the workplace with enduring traits: a strong background in science, a curiosity for what is new on the frontiers of research, critical thinking as a habit of mind, an expectation of working equally in teams, an expectation of and comfort with continuing change, and the assumption that the health of the patient is at the center of it all.