Download Clinical Pharmacy: An Example of Interprofessional Education in the

Clinical Pharmacy: An Example of
Interprofessional Education in the Late
1960s and 1970s
Dominique A. Tobbell
University of Minnesota
In 1968, the associate editor of Modern Hospital announced that clinical
pharmacy was the “hot new trend” in pharmacy circles.1 Pharmacy educators
developed the concept of clinical pharmacy—and launched the first clinical
pharmacy programs—in the mid-1960s as a new type of pharmacy practice
that was patient oriented, rather than drug product oriented. The new clinical pharmacist was to “function as an integral member of the patient’s health
care team and will be personally involved with all aspects of the patient’s
­medication problems from the time of admission to the time of discharge,
and he may well be involved in follow-up supervision of the medical regimen
for the discharged patient.”2
This new type of pharmacist required a new type of training, one that
introduced pharmacy students to working within the health-care team,
provided them with experience in the “clinical practice of pharmacy at the
patient’s bedside,” and exposed them to medical terminology and clinical
knowledge of diseases.3 As pharmacy educators at Purdue University School
of Pharmacy and Pharmaceutical Sciences recommended in 1968, the new
clinical pharmacist “should be familiar with the principles of disease so he
can converse easily on common ground with the physician. The physician
should be able to present a disease or problem to the pharmacist and, if drug
therapy is indicated, the pharmacist should be able to recommend the best
drug ­regimen available.”4
The early clinical pharmacy programs in schools of pharmacy are a
study of interprofessional education. They used a combination of clinical
pharmacy clerkships (modeled on the medical student clerkship), student
Nursing History Review 24 (2016): 98–102. A Publication of the American Association for the History
of Nursing. Copyright © 2016 Springer Publishing Company.
http://dx.doi.org/10.1891/1062-8061.24.98
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participation in patient rounds, and, in many cases, student participation in
medical school classes. By exposing clinical pharmacy students to their future
colleagues in medicine and nursing, pharmacy educators hoped to “foster
concepts of team spirit” among all members of the health-care team.5 In
September 1967, for example, Wayne State University College of Pharmacy
in Detroit introduced an elective course in clinical pharmacy to final professional year students, making it a core course in the pharmacy curriculum
the following year. The clinical components of the course were conducted
at Providence Hospital in Southfield, Michigan. In addition to fifteen hours
of lectures, the course involved students’ participation in patient rounds
in various clinical specialties. These rounds exposed pharmacy students to
patients’ lived experience of disease, surgical intervention, and trauma and
allowed them to see firsthand the ways in which drugs were administered
and managed on the wards.6
The students also spent two hours on a nursing unit in which each student would be assigned to a nurse. During those two hours, the pharmacy
student would observe the nurse’s medication procedure: the ordering, administering, and charting of medications. For one pharmacy student, the experience on the nursing unit made him “realize the importance of the clinical
pharmacist’s role in educating, as well as learning from, the nurses.”7 Pharmacy students also participated in a teaching exercise so as to prepare them
for their “role of educator in both community and institutional practice.”
Here, pharmacy students presented pharmacology lectures to student nurses.
Through this teaching experience, one pharmacy student reflected, “I really
felt that I ­contributed to and also played the role of a member of the health
care team.”8 The ­nursing students also found the pharmacy students a worthwhile addition to the health-care team. As one nursing student noted, “Who
knows drug information better than one who has devoted his entire education
to it?” For another nursing student, while it was not “necessary to have the
clinical pharmacist on the nursing unit . . . I do think it would be beneficial to
be able to call on his knowledge when necessary.”9
While at Wayne State University, clinical pharmacy training was incorporated as part of the undergraduate curriculum, in September 1967, ­Purdue
University School of Pharmacy and Pharmaceutical Sciences established a
cooperative graduate program in clinical pharmacy with Indiana University
School of Medicine. Following a year of coursework on the Purdue campus,
students moved to the School of Medicine to complete junior- and seniorlevel medical school courses and medicine clerkships. During the clerkships,
the pharmacy students—like their medical student colleagues—were assigned
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Dominique A. Tobbell
to a number of patients who they followed throughout the patients’ hospital
stay. The students completed histories, physicals, and routine laboratory work
on patients and formulated differential diagnoses. Pharmacy students initially “felt somewhat insecure” on the wards. However, when questions were
raised about the pharmacology of a drug or about differences and interactions
between drugs, the medical students “seemed grateful for any assistance I provided.” In some cases, the pharmacy students found patients more willing to
talk to them than to the medical students. As one student recalled, the patients
were more “relaxed and free in their conversation with me . . . and often they
gave me information pertinent to their case that one of the medical students
had not been able to obtain in the history and work-up.” Perhaps, the student
reflected, this was “because they knew I was a pharmacist and not a physician,
or perhaps because I was a girl.”10
Through the 1970s, clinical pharmacy students took classes with
­medical students, rounded and attended ward conferences with nursing
and medical students, and participated in the hospital environment as new
members of the health-care team. By all published accounts, this experiment
in interprofessional education was a success. As Robert Cipolle, PharmD, a
student in the University of Minnesota’s clinical pharmacy program in the
mid-1970s, recalled:
[The medical students would] turn to us, and turn to me and say, “You’re the
pharmacist. What should we use to treat this patient?” They just treated us like we
were supposed to be there and supposed to know. It was a wonderful experience. It
was just a wonderful experience. I, basically, went to school with Medical School
[students], who later became interns and residents as I was a young pharmacist. So we
sort of grew up together.11
Eventually, the clinical pharmacy programs outgrew the capacity of the
medical school classes, and pharmacy schools established their own courses
in relevant medical content.12 However, the practice of having pharmacy students complete clinical clerkships and participate in patient rounds remained
a core component of clinical pharmacy education and thus a defining element
of interprofessional education. This interprofessional education prepared
pharmacy, nursing, and medical students to work together as part of a newly
expanded health-care team. Indeed, more than fifteen years after the first
­clinical pharmacy programs were established, William E. Smith, PharmD,
MPH, PhD, a leader in the clinical pharmacy movement and clinical professor at the University of Southern California School of Pharmacy ­concluded
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that the “pioneers” in the clinical pharmacy movement had accomplished
what they had set out to achieve: “to contribute to quality of patient care
by using their drug knowledge, to be a respected colleague of physicians and
nurses, [and] to be a respected health-care professional.”13
Acknowledgments
This paper was presented at the American Association for the History of
­Medicine meeting, Chicago, April 2014.
Notes
1. Lorry S. Plagenz, “Clinical pharmacy is ‘hot new trend,’” Modern Hospital 111,
no. 5 (1968): 101–103.
2. Glen J. Sperandio and P.F. Belcastro, “The clinical pharmacist: adviser, teacher, consultant,” Modern Hospital 111, no. 5 (1968): 100. For more details on the history of clinical
pharmacy, see Don C. McLeod, “Clinical pharmacy: the past, present and future,” American
Journal of Hospital Pharmacy 33 (1976): 29–38; and Elizabeth Siegel Watkins, “Deciphering
the Prescription: Pharmacists and the Patient Package Insert,” in Jeremy A. Greene and Elizabeth Siegel Watkins (ed.) Prescribed: Writing, Filling, Using, and Abusing the Prescription in
Modern America (Baltimore: Johns Hopkins University Press, 2012), pp. 91–116.
3. Sister Emmanuel, “Experience with a course in clinical pharmacy. Part one: the
preliminary planning phase,” American Journal of Hospital Pharmacy 25, no. 10 (1968):
551–8, quotation from p. 552.
4. Suzanne Pratt, Allen V.R. Beck, and Glen J. Sperandio, “Experience in a new
Clinical Pharmacy Training Program,” American Journal of Hospital Pharmacy 25, no. 10
(1968): 559–63, quotation from p. 562.
5. Emmanuel, “Experience with a course in clinical pharmacy,” 552.
6. Sister Emmanuel, “Experience with a course in clinical pharmacy. Part two:
­Lectures, patient rounds, and other laboratory experiences,” American Journal of Hospital
Pharmacy 25, no. 12 (1968): 682–90, quotations from pp. 688, 689.
7. Ibid., 688.
8. Ibid.
9. Sister Emmanuel, “Experience with a course in clinical pharmacy. Part three:
Evaluating the course from several aspects,” American Journal of Hospital Pharmacy 26, no.
2 (1969): 100–113, quotation from p. 108.
10. Pratt, Beck, Sperandio, “Experience in a new Clinical Pharmacy Training
­Program,” 561.
11. Oral History Interview with Robert Cipolle by Dominique Tobbell on June 12,
2012. University of Minnesota Academic Health Center Oral History Project, http://blog.
lib.umn.edu/ahc-ohp/ahc-oral-history-project/RCipolle.pdf, 3.
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12. At the University of Minnesota, the medical school was struggling to absorb the
clinical pharmacy students into its courses by 1979. Peter C. Magrath, “Reflection, College
of Pharmacy, October 17, 1979,” University of Minnesota Archives, President’s Office,
Collection 841, Box 262, Folder: Pharmacy (Planning).
13. William E. Smith, “Clinical Pharmacy in the 1980s,” American Journal of
­Hospital Pharmacy 40, no. 2 (1983): 223–9, quotation from p. 223.
Dominique A. Tobbell
Associate Professor
Program in the History of Medicine
University of Minnesota
MMC 506
420 Delaware St. SE
Minneapolis, MN 55455