Communities: Academic Pharmacy
Unmet Public Health Needs"
Report of the 2004-05 Argus Commission
Robert E. Smith (Chair),a Robert A. Kerr,b Milap C. Nahata,c Victoria F. Roche,d Barbara G. Wells,e and Lucinda L. Mainef
217 Walker Building, Auburn University,
bThe University of Maryland, 20 N. Pine Street, Baltimore, MD 21201
cThe Ohio State University, 500 West 12th Avenue, Columbus, OH 43210-1291
dCreighton University, 2500 California Plaza, Omaha, NE 68178-0104
eThe University of Mississippi, PO Box 1848, University, MS 38655-1848
fAmerican Association of Colleges of Pharmacy, 1426 Prince Street, Alexandria, VA 22314-2841
The AACP Argus Commission is comprised of the past five presidents of the American Association of Colleges of Pharmacy (AACP). Its purpose is to scan the environment for the Association and offer its views for AACP action and policy. The Commission also responds to specific AACP Presidential requests for discussion and analysis.
The 2004-2005 Argus Commission was specifically charged to examine how colleges and schools of pharmacy, through efforts of students, faculty, and administrators, are or might be engaged in efforts to form partnerships with communities, broadly defined. Those partnerships with local, state, regional, national and international entities may have many purposes and can be foundational to the common education, research, and service missions of AACP member institutions. As pharmacy is a health care discipline, it is not surprising that the goals of many of these partnerships relate to improving the health of individuals and communities and meeting unmet public health care needs in society. One additional purpose for engaging communities to meet their unique needs is to enhance the cultural competence of pharmacy students, faculty, and practitioners.
AACP has asserted through publication of the 2004 CAPE Outcome statements that specific competencies in public health are core to the contemporary Doctor of Pharmacy degree program. Through collaboration with the Association of Teachers of Preventive Medicine (ATPM) and the Association of Academic Health Centers (AAHC), AACP has developed a curricular framework to guide the evaluation and evolution of curricula in pharmacy and other health education disciplines in areas of prevention and public health. While it may seem to some that these are new constructs that must be forced into an already over-burdened curriculum, in fact many of the components of the framework are already central to our educational programs and core competencies (e.g., immunization efforts, chronic disease screening). At the 2005 AACP Interim Meeting, several schools shared examples of programs related to teaching, service, and research in the public health arena, documenting the significant contributions many schools are already making in tackling unmet needs in our communities.
"Civic engagement" is a term not commonly heard at AACP meetings or read in articles in AACP publications. Yet teaching, learning, and discovering new knowledge are in fact acts of civic, or academic, engagement because of their potential for shaping society and changing the course of history. "Service learning" is a term more common in pharmacy education, especially as schools have worked to implement early practice experiences and active learning in the professional degree program. Even so, civic engagement in its most robust application relates to every aspect of higher education, not just student learning. It relates to our programs of research and service and their relevance to society. Further, civic engagement relates to our goals for leadership on campus, in our communities, in public policy, and globally.
Perhaps most fundamentally, as educators our first responsibility is to our students and their learning needs. As noted above, civic engagement provides a rich educational background for the learning of cultural diversity, values, and ethics. In "Integrity in the College Curriculum", a booklet published by the Association of American Colleges and Universities in 1985, eight essential areas in a baccalaureate degree core curriculum are discussed. While AACP represents professional schools, these core areas seem to have continuing relevance to students of pharmacy. Two of these core values, ethics and international and multicultural experiences, are specifically relevant to civic engagement. Such engagement becomes the context in which the areas of values, ethics, and cultural diversity can be learned or enhanced. Civic engagement opens students to a study of values and ethics, provides them with opportunities to experience and understand diversity, and strengthens their understanding of the American experience and contemporary society.
This report offers definitions, examples, rationale, and recommendations related to the agenda of civic engagement in pharmacy education. It communicates the fact that pharmacy educators are engaging communities at all levels yet suggests that we have far to go to make our most significant contributions. It touches upon the stresses felt today in both higher education and health care and the unique position pharmacy educators, students, and practitioners find themselves in given the centrality of safe medication use as an issue in health care and public policy.
SUGGESTION 2: Colleges and schools of pharmacy should work to create additional opportunities for faculty placement and student experiential learning in community health centers, public health clinics, and other safety net practice environments.
Discovery and Application of New Knowledge
There are also important questions to raise regarding the intersection of academic engagement and our research activities. Without question the pursuit of new knowledge through research is highly valued and rewarded within higher education. Original peer-reviewed publications and a sustained track record of competitively funded research efforts are requisites for promotion and tenure in most of our institutions and especially those that are research intensive or comprehensive educational institutions. AACP is on record at numerous points across time with the belief that all faculty should be scholars.
Faculty at schools and colleges of pharmacy have fared quite well during the era of increased funding for the National Institutes of Health. NIH funding of pharmacy faculty increased 123 percent over the eight year period AACP has obtained and analyzed NIH funding for research at member schools. Pharmacy faculty in recent years have been awarded more NIH support than counterparts in dentistry, nursing, and veterinary medicine. These efforts are laudable and important to sustain yet there is evidence that the public does not always appreciate the significance of such work. This lack of understanding could, if not addressed, make sustained support vulnerable at the state and federal levels.
In the context of a discussion related to research and civic engagement, it is also important to ask whether an appropriate balance is able to be struck between the types of research historically funded by NIH and other federal funding agencies and research captured by the term "Community-based participatory research". Such research is particularly germane to analyses of the actual use of medications in community-living populations which does not lend itself perfectly to the classic randomized controlled design. Explorations of differences in health-seeking behaviors in various populations and of the intersection between health literacy and medication use are additional examples of timely and important research areas that might fall under the community-based participatory research umbrella. So too might specific health policy analyses related to how health benefit design and health services access vary across multicultural populations and groups. Given the centrality of medication use, and increasing concerns about affordability and safety of medications, pharmacy faculty have an important role to play in advancing such translational and applied research.
Richard A. Cherwitz recently prepared an essay found among the resources from the University of Texas -- Austin project on academic engagement. He notes the challenges facing educational institutions and particularly public research universities whose scholars have found success in pursuing increasingly narrow, highly theoretical, often independent research questions. Funding, especially in the biomedical arena, has been most plentiful for basic rather than applied research. The public commitment in this regard has been expressed in the doubling of the National Institutes of Health budget over a five-year period. Related issues and an in-depth discussion of the implications of NIH priorities can be found in the 2004-2005 report of the AACP Research and Graduate Affairs Committee.
The new world order, Cherwitz posits, requires an increased commitment to and removal of barriers preventing collaborative, interdisciplinary, socially relevant research and learning. This will in turn promote public confidence, generate revenue, and open doors of universities to a more diverse population. He cites examples from his own campus of a critical mass of faculty who embrace these concepts and function as "intellectual entrepreneurs". They are individuals who exemplify academic engagement as they seek both to discover and put to work knowledge that makes a difference. Examples include a neurobiologist and pharmacologist struggling to bring personal and public policies in line with scientific knowledge about alcohol addiction and a philosopher helping to increase the role of ethics in corporate decision making.
To be both sensitive to and effective in addressing community needs, investigators must access data and information that helps characterize the issues and problems confronting a given group or population. Sources of data are available from public health departments, state extension services, governmental and nongovernmental organizations, and certain advocacy organizations. The websites of the American Public Health Association (www.apha.org) provides links to every state and major county departments of public health. The Campus Community Partnerships for Health site [www.depts.washington.edu/ccph] is also a rich repository of information and links to programs which aim to strengthen the relations between academicians and the communities that they might engage.
In his essay Cherwitz asks significant questions about the daunting challenges confronting universities working to ignite intellectual entrepreneurship as a component of academic engagement. In essence he asks the "how" questions: how can faculty integrate, synthesize, and unify knowledge to address complex problems rather than pursue increasingly narrow research questions? How can incentive systems (e.g., promotion and tenure and funding models) be aligned with the needs for different types of scholarship without interfering with important aspects of traditional academic excellence and productivity? How can faculty maintain standards of academic integrity and objectivity, while participating in community projects in which they may become ideologically vested, serve as change agents or directly profit?
Without question there are issues regarding the structure and delivery of health care, development of and access to life-saving medications and other therapies, information transfer, and patient empowerment that beg for investigation by scholars in our nation's pharmacy schools. In addition there are emerging ethical issues and other issues related to public policy that require analysis and the scholarly contributions of our knowledgeable faculty, graduate students, and fellows. A serious examination of our relative strengths and models of collaboration in key areas related to drug development, appropriate use, and policy is warranted.