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Canadian University Faculties of Pharmacy: Undergraduate curriculum survey of geriatric content

The present geriatric content of undergraduate education in Canadian pharmacy schools was examined. A 35-item survey covering a range of educational topics was sent to relevant faculty members at each of the Canadian schools of pharmacy. All nine Canadian faculties of pharmacy responded. Only three schools had a separate geriatric course, the rest had integrated geriatric content. Both clinical and didactic courses were taught primarily by pharmacy faculty, and rarely by medicine faculty. Established guidelines surrounding inappropriate prescribing practices in the elderly were specifically taught in most schools. Innovative strategies included role playing, geriatric therapeutics "hot-lines" manned by pharmacy students, geriatric education modules, and geriatric pharmacology textbooks written by faculty members. The variability in the geriatric curriculum could be addressed with a mandatory geriatric issues pharmacy course. Partnerships with academic divisions of geriatric medicine and clinical pharmacology could further enrich the educational experience for pharmacy and medical students.

INTRODUCTION

Medications are powerful, but potentially dangerous in the treatment of multiple diseases in elderly individuals. Adverse drug reactions have been reported as being the fourth leading cause of death behind heart disease, cancer and stroke(l). Most serious adverse drug reactions are dose related, and over 85 percent of these occur in the elderly. Medications that were appropriately prescribed at a younger age may now have risks that outweigh their benefits(2-6). Elderly patients may have issues of non-compliance with complicated medication regimens, medication side-effects, drug-drug interactions, and drug-disease interaction. These risks are increased in elderly patients who may have cognitive, physical and sensory impairments(7). For these reasons, a well-informed pharmacist is an important "care of the elderly" team member and educational resource for physicians, health professionals, caregivers and the elderly themselves.

Geriatricians, internists and family practitioners often rely on a pharmacist's expertise when prescribing for their elderly patients. A pharmacist's recommendations and assistance for appropriate drug therapy, patient education, drug histories, and surveillance for adverse drug events are highly regarded. Pharmacists have been shown to have an important contribution to medical students(8). However, in a U.S. survey conducted by Simonson and Pratt(9) it was reported that 80 percent of pharmacy graduates felt that their formal education in pharmacy did not adequately prepare them for geriatric pharmacy practice. More recently, certificate courses have been developed and offered in the U.S. for the accreditation of those pharmacists who provide care for the elderly(10). Interestingly, some Canadian pharmacists also take this U.S. accreditation exam, if only to gain recognition for geriatric skills they have acquired whether in clinical practice, or in pharmacy school. Internationally, pharmacists who specialize in geriatric care can be certified by the Council for Certification in Geriatric Pharmacy and carry the designation of Certified Geriatric Pharmacist (CGP). In Canada, corporate accreditation programs have been set up to train and develop consultant pharmacists in the delivery of pharmaceutical care to the growing geriatric population.

In contrast to these certification programs, the geriatric content of the curriculum taught to undergraduate pharmacy students across Canada is largely unknown to those who care and prescribe for the elderly. The purpose of this project was to better define the present geriatric content of undergraduate education in Canadian pharmacy schools. Our primary goal was to understand what is taught to pharmacists on geriatric topics at the undergraduate level, and identify innovative teaching and learning initiatives implemented in individual schools that could be used by other schools of pharmacy, as well as undergraduate medical students across Canada.

METHOD

This project was conducted during March and April, 1999. A 35-item survey, divided into five sections, was developed using an iterative process with input from practicing and academic pharmacists and geriatricians. The topics covered in the five sections included: (i) teaching geriatric pharmacology and therapeutics; (ii) geriatric curriculum content; (iii) clinical and placement experience; (iv) innovative teaching strategies; and (v) feedback. The five pages of the survey instrument along with a one page cover letter were sent by facsimile (FAX) and electronic mail to a faculty member of each of the Canadian faculties of pharmacy identified by the Dean as having both interest in, and knowledge of, geriatric issues and the geriatric curriculum content at their school. The responses were collated and analysed using simple quantitative (frequency) and qualitative (content analysis) statistics. Unanswered questions or unclear responses were clarified in a follow-up electronic letter.

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