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Update on PharmD curriculum transformation
An interview with Vice Dean Sharon L. Youmans
We last interviewed UCSF School of Pharmacy Vice Dean Sharon L. Youmans, PharmD, MPH, in the summer of 2015, as the School’s faculty was endorsing the blueprint for a new UCSF doctor of pharmacy (PharmD) curriculum.
What’s happened in the interim?
Youmans updates us in this conversation with the School’s editorial director, Grant Burningham.
Our goal is to prepare fearless and compassionate leaders in pharmacy, with a scientific mindset and a limitless future.
Burningham: Sharon, what’s changed in the months since we last interviewed you about curriculum transformation?
Youmans: That’s a big question. First, we delayed the launch of the new curriculum from 2017 to July 2018. We have a tremendous responsibility to our future students to get this right—and to our current students to continue giving them 100 percent. That extra year is giving us time to do both. Next, the faculty committee that created the original blueprint finished its work, and a new group of faculty began putting substance to the plan.
During this second phase, it became clear right away that we needed staff leaders even closer at our sides. Operationally, the scope of this work is tremendous—from the need for new instructional support models to new student recruitment models, from budget to space.
The phase-two team has 15 people—faculty and staff. As we move forward, more faculty members are joining the building crew. And we’re adding new staff to meet the demands of what we’re building, and of delivering two curricula at the same time until 2021.
As plans unfold, we’re also relying on feedback from a terrific group of student and volunteer faculty stakeholder advisors.
We have a tremendous responsibility to our future students to get this right—and to our current students to continue giving them 100 percent.
Burningham: If the new curriculum begins in 2018 and both curricula are delivered together until 2021, that means the new curriculum is three years long?
Youmans: Yes, three years, but year-round with intermittent breaks.
Burningham: That’s a major change. Why the switch from a four-year to a three-year PharmD program?
Youmans: The number of quarters of instruction required by our accreditation agency is the same, and the total cost of instruction is about the same. But we’ve abandoned the long summer breaks. This puts our students at commencement in three calendar years. They’ll save a year of San Francisco living expenses, and they’ll be ready to begin practice immediately, or—as we hope—to continue on with advanced training after the PharmD.
Burningham: What’s been the reaction to the idea of a shorter program?
Youmans: We heard some early concerns about summer vacations. But health care professionals don't get summers off, so the timeline reflects the professional work world. The effect on summer internships is also something we’re exploring in depth with employers.
We’re also hearing from applicants that the three-year program is appealing. They see the advantage of beginning advanced training earlier and moving more quickly into their careers.
Burningham: And I understand the new, three-year program is competency-based and pass/no pass?
Youmans: Exactly. This means that student learning and assessment will focus on the use and application of learning. Assessment will be pass/no pass, instead of grades. A note here—almost half of our curriculum is pass/no pass now. Our experiential education courses are all pass/no pass, and have been for many years.
And “pass” is a high bar—just to be clear—with the focus being on demonstrating command and application of achieved competencies. We’ve purposely added time to the calendar to help students build on and apply their learning as they progress.
Burningham: When we spoke with you last, you described why the PharmD curriculum needed to change. Is the need the same?
Youmans: If anything, it’s more pressing now than ever.
Consider all the moving parts in health care. Look at the legislative situation nationally, in terms of health insurance coverage, the disparities in who has or will have access to care or not, the skyrocketing incidence of chronic diseases and the complexity of managing them with medications, and the absolute need to coordinate care in partnership with physicians, nurses, pharmacists, and dentists.
Add to this the daily avalanche of new research information about diseases and disease treatment and prevention; it’s growing exponentially, but the amount of time to teach and learn in the PharmD program has not.
And of course, our students are social and used to multitasking and seeking their own information. They don’t want to be lectured at or work in isolation, doing one thing at a time.
One word you hear a lot from today’s students is relevance. So teaching content without context, especially in the health care setting, does not work as well. Students say, “Why am I learning this?” “Why do I need to know this?” “What’s the connection to something I’m actually going to do?”
Today’s education programs also need to be delivered in ways that match the technology expectations of students.
All of these considerations have intensified, which is why we’re taking the lessons we’re learning while building the new curriculum and applying them to the current curriculum as much as possible. We’re focusing on both.
Burningham: How would you sum it up for our readers?
Youmans: Health care is increasingly multifaceted and complex. New data is coming at us at warp speed. Now more than ever we need practitioners, we need pharmacists, who are nimble, unfazed by complexity and uncertainty and rapid change—pharmacists who are unwilling to accept the status quo, who automatically look for potential solutions when they see problems, who know how to ask the right questions and find the best answers in the face of change.
Our goal is to prepare fearless and compassionate leaders in pharmacy, with a scientific mindset and a limitless future. To do this, we need to transform what we teach and how we teach. To be clear, this need is not new. We’ve been transforming the curriculum since we first accepted students in 1872, and we’re continuing today with our current curriculum.
Burningham: How would you describe the underlying framework of the 2018 curriculum—the gestalt?
Youmans: First, it’s designed so that student learning is active, integrated, grounded in scientific thinking. Scientific thinking will underlie all coursework.
There’s too much information today for students to memorize everything as we did in years past. Memorizing and learning aren’t synonymous. Instead, students will learn how to question, how to identify problems, how to gather information, pose and test solutions. They’ll be asking why, why not, what if.
They’ll be able to navigate whatever the future holds for the profession as long as they can think in a scientific way.
If you get information you've never seen before, how do you analyze it? If you need information, where do you find it? How do you know you can trust the source? It's these skillsets that are truly transferable to the workforce.
Our students will learn to do this automatically, no matter their career paths—in the research lab, in the clinic, in a policy career. Our goal is to prepare self-directed professionals by mirroring this in the curriculum. Students will prepare before class, then actively engage, share, and learn together in class.
Scientific thinking will underlie all coursework.
It will come as no surprise that with this kind of approach, lectures will be limited. The education literature indicates that passive education doesn’t help students to learn. The information just doesn't stick as well.
So imagine students who begin to think scientifically and collaborate in their learning and actively engage in their learning, beginning on day one of the program. Then, think of coursework that builds on top of this philosophy, and assessment based on competency—on the use and application of knowledge.
And we want students to challenge us as well as challenge themselves.
Burningham: OK, so I understand the approach. Tell me about the actual coursework.
Youmans: Let me answer from a slightly different angle—from how students will experience the coursework.
They’ll build their core knowledge, explore the latest in science and practice, and they’ll immediately dive into real-life pharmacy practice experiences.
Burningham: What do you mean by “core knowledge?”
Youmans: To begin with, it’s the science and therapeutics knowledge pharmacists need to be able to evaluate options, make decisions, and act expertly.
Historically, this meant faculty would teach separate courses on topics such as pharmacokinetics and physiology.
Now, it means students learning these subjects through organ systems and disease themes. Learning pharmacokinetics or health policy, for example, through comprehensive study of the cardiovascular system. Then learning more about pharmacokinetics or health policy through in-depth exploration of the respiratory system, the renal system, cancers, neurological diseases, and so on.
Remember what I said about relevance? That’s the aim. And to maximize the relevance, the faculty will use patient cases that build in complexity. Learning will build from one theme to the next. Cases will become more complex over time. Learning will be cumulative.
Building core knowledge also means making sure our students all share a portfolio of knowledge and understanding from the get-go. We call this the Foundations course. And it also means students develop the core patient care skills over time that they need to apply and succeed in their pharmacy practice experiences.
Burningham: So what about pharmacy practice experiences? Will they be the same as they are now?
Youmans: Like now, pharmacy practice experiences begin immediately in the new curriculum. Like now, students progress from introductory experiences in community and institutional settings to more advanced experiences in hospitals and clinics.
What’s different is that we’re aligning, as much as possible, what students are learning in clinical practice settings with what they are learning though the lens of organ systems and diseases.
So, in the new curriculum, students will learn about the science and therapeutics of the cardiovascular system while they’re applying that knowledge in a pharmacy practice setting. Again, it’s about relevance.
And remember, too, that here in the Bay Area our students will learn from a lot of different types of patients.
Burningham: I’m especially interested in the third way you say students will experience the curriculum—by exploring. What exactly do you mean?
Youmans: That’s what we call the “inquiry” part of the curriculum. While students learn about the science and therapeutics of organ systems and diseases, and apply what they learn to practice, they’ll also learn about the latest developments in research and pharmacy practice.
This is very cool. Think about it for a minute. The UCSF School of Pharmacy is known for its breakthroughs across many fields of science and pharmacy practice. In fact, science is at the heart of everything the School does. What I mean here is not just lab science—it’s the School’s scientific approach to seeking and applying new knowledge across the board. Add to this the fact that UCSF is devoted exclusively to health and what do you get? An opportunity for students to explore what’s on the frontier of science and practice, which is possible here like nowhere else.
Youmans: Imagine you’re a pharmacy student here. While you’re learning the science and therapeutics of the renal system, you’ll explore the implantable bioartificial kidney being developed by Shuvo Roy, a bioengineer in the School. Shuvo shares a challenge he’s facing with his research, and you and your classmates think through the problem and pose your solutions.
Or you might explore with chemist Bill DeGrado his pioneering research in preventing fibrosis—scar tissue—when you’re learning about heart attacks.
Maybe you work with managed care pharmacist Marilyn Stebbins, who’s creating ways to solve the medication-related problems of transitioning patients, including oncology patients, from the hospital to their homes.
You’ll begin by developing your inquiry skills, with medical students, through an Inquiry Immersion course. Eventually, as you sharpen your skills, you’ll explore your own interests through what we call a Discovery Project.
Burningham: Beyond the Discovery Projects, will students be able to customize their learning?
Youmans: Certainly, yes, through electives.
Also, I want to mention what’s called the Co-Curricular Program, which offers activities based on individual student interests, experiences, and goals. There’s community outreach and service activities, programs to increase cultural understanding, career development programs, self-care activities, as examples. These are all very important to preparing students as well-rounded new practitioners.
Burningham: I understand that you’re recommending graduates get additional training beyond the PharmD. Why?
Youmans: Advanced specialized training plus the UCSF PharmD is a powerful combination and one that will open a host of career possibilities—in health systems, business, academia, government, industry, and health policy, as well as in community pharmacy, where pharmacy models are changing.
Burningham: How do you define advanced training?
Youmans: I mean pharmacy residencies, fellowships, and MBA or MPH programs, as examples. Some 70 percent of our graduates go on to complete advanced training. And remember that, with specific advanced training, graduates are eligible for licensure as an advanced practice pharmacist (APh). We strongly encourage this licensure step.
Burningham: Closing thoughts?
Youmans: Yes, I wish I was applying to this program!
In all seriousness though, curriculum change is a process. When done right, it’s always under way.
What we’re doing now is amplifying the degree of change to an already strong PharmD program here at UCSF. Our current students and grads are proof of the strength of our current program. They’re terrific. They’re leading the profession.
But as I said before, the health care landscape, research … they’re all changing so quickly that we need to be ahead of the curve in our approach to education—to be proactive and not reactive to the education needs of future students.
A last point I want to make is that scientific thinking is not only the foundation of all coursework and learning in our program, it’s the foundation the faculty uses to continually improve the curriculum itself.
While our students are posing questions about biology, policy, and practice in their learning, our faculty is continually asking: Why are we teaching this in this way? What does the data show? How can we improve how we teach and how students learn?
About the School: The UCSF School of Pharmacy aims to solve the most pressing health care problems and strives to ensure that each patient receives the safest, most effective treatments. Our discoveries seed the development of novel therapies, and our researchers consistently lead the nation in NIH funding. The School’s doctor of pharmacy (PharmD) degree program, with its unique emphasis on scientific thinking, prepares students to be critical thinkers and leaders in their field.