Competency based pharmacy curriculum!

The Medical Council of India (MCI), the then medical education regulator, had developed the competency based under graduate (MBBS) curriculum for the Indian medical graduates and the same was notified in 2018. The MCI visualised that Indian medical graduates should be able to recognise “Health for All” as a National Goal. The medical graduates should be able to fulfil their societal obligations towards realization of this goal. The MCI had obtained the copyright from the registrar of copyrights, Government of India, for its competency based programme. The programme is designed to create the graduate possessing the requisite knowledge, skill, attitudes, values and responsiveness. The purpose is to ensure that the graduate would function appropriately and effectively as a physician of the first contact of the community while globally being relevant.  The programme is also designed to give emphasis on learning than on teaching. This should be the model for all other programmes including the various pharmacy programmes.

The World Health Organization (WHO) states “the competency based education is the most effective approach to ensuring preparedness for practice”. It urges the member states to invest in strengthening competency based health worker education that will bring dividends in health, jobs, global health security, economic opportunity and gender equity. In its recent document “Global Competency and Outcome Framework for Universal Health Coverage” outlined the competencies required for different types of health workforce. It defines the competency based curriculum. “A curriculum that emphasizes the complex outcomes of learning rather than mainly focusing on what learners are expected to learn about in terms of traditionally defined subject content. In principle, such a curriculum is learner centred and adaptive to the changing needs of students, teachers and society. It implies that learning activities and environments are chosen so that learners can acquire and apply the knowledge, skills and attitudes to situations they encounter in work environments”. Competence is the state of proficiency of a person to perform the required practice activities to the defined standard. This incorporates having the requisite competencies to do this in a given context. This approach to identifying, and assessing, outcomes can be used to design or redesign curricula to incorporate the content presented in this framework as well as from other frameworks and sources. The framework has been developed through the lens of education but can also be used to define the practice activities and performance standards for the purpose of regulation and employment. This is also a guiding document for developing competency based curriculum.

Though it is late in the revision of Diploma in Pharmacy curriculum, but is an innovative attempt. For the first time, the Pharmacy Council of India (PCI) has introduced the competency based curriculum. The previous revision of the Diploma in Pharmacy programme was done 1991 and the Education Regulation 2020 introduced the new competency based curriculum. While framing the new curriculum, it defines the competency as “A distinct composite of knowledge, skill, attitude and value that is essential to the practice of the profession in real life contexts”. It has identified the following professional competencies: capable of reviewing the prescriptions; dispensing prescription and non-prescription medicines; providing patient counselling and education; managing hospital/community pharmacies; expertise on medications; proficiency on drugs and pharmaceuticals; entrepreneurship and leadership; delivering primary and preventive health care; professional, ethical and legal practice; and continuing professional development. Reviewing the prescription in a professional manner to ensure the prescription is correct and complete. While dispensing medicines the pharmacist should comply with regulatory requirements. While dispensing non prescription medicines, the pharmacist must use his/her knowledge in the interest of the patient. Effective patient counselling or providing education is for promoting safe and effective of medicines. It also promotes adherence of medication and is especially important for medications for long term use and antimicrobial agents. Inappropriate use of antimicrobial agents especially not taking the full course as advised is a bigger threat because of development of antimicrobial resistance. Managing hospital and community pharmacy involves procurement, inventory management, and distribution of medicines and other medical products. Distribution should follow good distribution practice as per the hospital rules. The pharmacist should be able to provide expert opinion on medications to other healthcare professionals for safe and effective use based on the currently available evidence. The pharmacist should be able formulate the various pharmaceutical dosage forms based on his/her knowledge of various subjects (courses). The pharmacist should be able to provide both individual health care and public health. The pharmacist should not only be knowledgeable on legal and professional guidelines but also sensitised to adhere ethical principles in practice. The pharmacist should be able to recognise the knowledge and skills in effective delivery of professional services from time to time. They need to be self motivated to bridge such gaps through attending continuing professional development programmes.

The competency based curriculum for Diploma in Pharmacy is prepared and implemented. The students learning outcome is given priority. The teachers need to be sensitised and trained to be familiar with the objectives of course outcomes. Teacher training should be made as part of implementing the competency based curriculum. We should learn from the Medical Council of India based initiative of educating the educators. Many of the medical colleges have a department for medical education. The pharmacy colleges at present do not give much priority for teachers’ education. Without teachers’ training/education the best curriculum is likely to be ineffective in achieving the intended outcomes. The pharmacy council of India being the sole regulator for various pharmacy programmes, it is the responsibilities of the council to make provision for teachers’ training. The teachers’ training should be made mandatory for the teachers to undergo. Earlier, there were provisions for orientation programme for new teachers and  refresher courses for updating on subject knowledge. The UGC was supporting such programmes. The All India Council for Technical Education (AICTE) and Indian Society for Technical Education (ISTE) have been supporting similar programmes. These programmes were mandatory for career advancement of teachers.

The profession of pharmacy has undergone paradigm shift. The initial focus of pharmacist’s job has changed from mere dispenser of medicines and medical products to medicine expert. The competencies to be defined based on the opportunities available. The opportunities available not only in our country but should focus on global acceptance. While it is important to have well defined competency based curriculum, it is equally important to have methodology to assess attainment of competency. The teachers required to be trained in question paper setting too. Though the curriculum designs to nurture the students in all three domains of Bloom’s Taxonomy: cognitive (knowledge), affective (attitude), and psychomotor (skills). The evaluation techniques must follow appropriate methodology to evaluate all three domains: knowledge, skills and attitude. Knowledge is usually looked at the lowest level. Generally, knowledge means facts and figures. Who is more knowledgeable than Google or Alexa at this time. All these days, the evaluation questions are knowledge based. Now, if Bloom Taxonomy is to be followed proper assessment of attainment of competencies, the teachers should also be trained. In accreditation of National Assessment and Accreditation Council (NAAC) the competencies of the graduates and their attainment is given due weightage. It requires that the competencies of the graduates are defined and made known about to the teachers and students. It also emphasises the method for assessment of attainment of competencies.  

The Pharmacy Council of India has initiated the competency based Diploma in Pharmacy Programme with Education Regulation 2020. This is a good beginning. There are three other programmes: Bachelor of Pharmacy, Master of Pharmacy and Doctor of Pharmacy still remaining which need updating. There are many challenges too: Bachelor of Pharmacy should be considered as a health science programme or technological programme. The curriculum is to be framed based on the defined competency required. Hopefully, the Pharmacy Council of India and the educationists would find a solution of the different challenges and frame a competency based curriculum for all programmes. At present, the Pharmacy Council of India is the only education regulator for pharmacy programmes.