The PHARMINE study on the impact of the European Union directive on sectoral professions and of the Bologna declaration on pharmacy education in Europe.

The Bologna declaration and the European Union (EU) directive 2005/36/EC on the recognition of professional qualifications influence the mobility of pharmacy students and pharmacy professionals, respectively. In addition the Bologna declaration aims at tuning higher education degrees including pharmacy throughout the EU in order to prepare for a harmonised European Higher Education Area. The directive outlines the knowledge, skills and qualifications required for the pursuit of the professional activity of a pharmacy in the EU. The PHARMINE project (Pharmacy Education in Europe, www.pharmine.org) looked at how the Bologna declaration and the directive influence modern-day pharmacy education and training in Europe.

Introduction

Within the European Union (EU), the sectoral profession of pharmacy (like medicine and dentistry) is governed by EU directive 2005/36/EC of the European parliament and of the council on the recognition of professional qualifications. The purpose of this directive is to streamline legislation on cross-border provision of services and automatic recognition of qualifications. The latter aims at ensuring free movement of professionals (pharmacists and others) within the 27 member states of the EU. The directive assigns the principal conditions for access to the activities in the field of pharmacy; articles 44 and 45 and annex 5.6.1 fix many aspects of pharmacy education and training (annex 1).

Pharmacy education is also influenced by the Bologna declaration. Here the aims are different. Whilst the directive 2005/36/EC defines the legal conditions for the recognition of professional qualifications within the 27 member states of the EU, the Bologna declaration – taken up by the ministers of education and /or research from the 27 member states and the EU's 28 neighbouring countries - proposes actions for tuning courses in higher education institutions (HEIs). The aim is to converge to an EU model of education, the European Higher Education Area (EHEA) (see annex 2).

The PHARMINE consortium consists of universities from EU member states and neighbouring countries that are members of the European Association of Faculties of Pharmacy (EAFP). The consortium surveyed pharmacies and pharmacists and looked at how EU higher education institutions and courses are organised. Furthermore PHARMINE evaluated how the EU directive and the Bologna declaration influence pharmacy education.

The PHARMINE consortium (see list at the end) produced country profiles with extensive information for each country, available at: http://www.pharmine.org/losse_paginas/Country_Profiles/

Comparable degrees and diploma supplement

The first action of the Bologna declaration proposes the adoption of comparable degrees with implementation of a diploma supplement. As many aspects of the pharmacy course are fixed by articles 44 and 45 and annex 5.6.1 of the directive, courses in different countries are comparable.

The PHARMINE study showed that in most countries the sectoral profession model of pharmacy education based on directive 2005/36/EC consists of an integrated 5-year, seamless course (figure 1, left). The course has three main elements. The first element is that of generic knowledge (anatomy, physiology, general chemistry, physics, mathematics, etc.) and skills (communication, management, accounting, ethics, languages, etc.). Courses concentrate on such subjects during the early years - the time and effort spent on them dwindle towards the end of the five years’ formation. The second element concerns pharmacy-specific knowledge and skills (pharmaceutical chemistry, drug formulation, pharmacology, toxicology, therapeutics, pharmaceutical care, legislation on dispensation of medicines, drug development and licensing, etc.). These pharmacy-specific competences are introduced early in the course in order to inculcate future professionals with the importance of pharmacy in the healthcare system; the time and effort spent on them progressively increase through the course. The third element is traineeship - an essential part of education and training in any sectoral profession – that is introduced early in the course and again gathers importance towards the end.

Figure 1

Models for pharmacy education and training in the EU based on the professional recognition directive (left) and the Bologna declaration (right).

All HEIs questioned (see list at the end) followed the above scheme and taught a curriculum based on the subjects listed in annex 5.6.1 of the directive. Several suggested that subjects such as biotechnology, immunology, pharmaceutical care, and marketing and management be included in the list.

The diploma supplement has eight sections of information identifying the holder of the qualification; the qualification, its level and function; the contents and results gained; certification of the supplement; details of the national higher education system plus any additional information. The supplement is designed as an aid to help recognition – it is not a CV or a substitute for the original qualification. Most pharmacy HEIs questioned do not issue diploma supplements as yet.

Course length and structure

The second action of the Bologna declaration concerns the global adoption in courses of a system based on two main cycles: an undergraduate/first cycle (bachelor, three years), followed by the postgraduate/second cycle (master, two years). The bachelor degree should “…be relevant to the European labour market as an appropriate level of qualification”. Thus the Bologna model (figure 1, right) has two independent cycles or tiers with the same total duration of 5 years.

The emphasis is on improved mobility: mobility concerning entry into the job market with a bachelor degree, mobility amongst different disciplines with entry into a master program of students with a variety of different bachelor degrees, and finally mobility within the European Higher Education Area (EHEA, see annex) following harmonisation of courses into a bachelor-master system.

The Bologna model for pharmacy education if applied in strict concordance with the Bologna declaration would presumably differ from the model based on the directive in several ways. The bachelor course would have to be constructed such that it prepares graduates for continuation in the master program and also for entry into the job market. The master course would have to be constructed - for example with traineeship concentrated into the 4th or 5th year – to accommodate bachelor graduates from disciplines other than pharmacy.

Most (25/29) European countries do not apply the second action of Bologna and have a five-year integrated, seamless course in accordance with the directive. This is also true for candidate countries such as Iceland, Macedonia and Turkey.

Some countries such as Belgium, Sweden and Latvia award “academic” bachelor degrees that are a requirement for entrance into the master degree in pharmacy but not a qualification for the job market.

Finland produces bachelor graduates in pharmacy (B. Pharm.) that enter the job market with tasks similar to pharmacists in the areas of customer service and patient counselling. Such bachelors are however, excluded from pharmacy ownership, management and / or in-depth scientific issues. The position of responsible pharmacist is restricted to Master in Pharmacy graduates.

Germany has a 2+2+1 years structure with a “Staatsexamen” at the end of the second, fourth and fifth years.

Austria has a 4.5 year course and the UK a 4 year course.

European Credit Transfer System credits ECTS and links to continuing professional development (CPD)

The third Bologna action concerns ECTS, a system whereby students validate a period of instruction or training at a given HEI (annex 2). If the student then moves to another HEI in another discipline or another country, then this HEI has to accept the ECTS already accumulated. ECTS are designed to allow accumulation of learning experiences from different sources and transfer of learning experiences from different HEIs and from different courses. For this HEI courses are organized into teaching units within semesters. Each teaching unit is validated by acquirement of a number of ECTS units.

The use of ECTS is based on the convention that 60 credits represent the workload of a full-time student during one academic year. Workload refers to the notional time an average learner might take to complete the required learning outcomes.

Almost all countries have introduced ECTS. Latvia has a separate system that is linked to ECTS as is the “English Credit Framework” used in the UK.

A second aspect of ECTS concerns their use at both pre- and postgraduate levels thus linking initial education to CPD. This was not observed in pharmacy HEIs as most countries – excepting Hungary, Portugal and Romania – do not subject licence renewal to obligatory CPD.

Obstacles to mobility

The fourth action of the Bologna declaration focuses on removal of obstacles to student and staff mobility.

Budget and lodgings were identified as obstacles and many countries have provided means to overcome them. Language was also cited as an obstacle by most; some countries overcome this by teaching courses in English, such as Malta where the entire degree course is given in English.

Another obstacle was the integrated and rigid nature of the course structure that hindered student exchange programs of less than one year. Countries such as Denmark overcome this by focusing student exchange in the last years of the program (master level) during which the course organisation is much less rigid.

European quality assurance system

The fifth Bologna action concerns promotion of European cooperation in quality assurance. Most countries questioned had national quality assurance agencies that were however often members of the European Association for Quality Assurance in Higher Education (ENQA). ENQA disseminates information on good practices in the field of quality assurance in higher education to European quality assurance agencies and higher education institutions (http://www.enqa.eu/). National quality assurance agencies also called on international experts.

European dimension in education

The sixth Bologna action concerns the promotion of a European dimension in education. Most countries have inter-institutional cooperation with regard to curricular development and integrated programmes but these are introduced late in the course or even at the postgraduate level and are focused on science and research. Many are not limited to pharmacy but include other disciplines for example course in preclinical and clinical drug evaluation.

Mobility of pharmacy students

In the PHARMINE study, data were obtained on student mobility. Mobility (%) was calculated as follows: (((number of incoming + outgoing students per year) x months) / (total student number x 9 months)) x 100. Average mobility for students was 3.5±3.3 and for staff 0.4±0.4. Thus mobility was low in both cases and there was wide variability amongst HEIs.

Summary

The PHARMINE study revealed that the main factor acting on the structure and contest of the curriculum for pharmacy was the directive. Pharmacy HEIs do incorporate some Bologna actions such as the use of ECTS but other actions such as the bachelor-master structure are more difficult to implement.