Experience and Future of Introductory Pharmacy Practice Training in Developing Countries: Example of Saudi Arabia
With the increased focus on skills and attitudes, pharmacy practice training has become an essential component of pharmacy education during which students improve their skills and develop important work habits. Therefore, accreditation agencies require pharmacy colleges and schools to provide pharmacy practice experiences throughout the curriculum.1 
 
Developing countries may differ from developed countries in the challenges facing the implementation of introductory pharmacy training. These challenges include a limited number of sites, low-quality sites, absence of training assessment, and variations in pharmacy practice models within the same country. These challenges will certainly affect the outcome of the training and may result in students graduating from the same school with big variations in skills and experience. In Saudi Arabia, the college of pharmacy at King Saud University was the first and has been the only pharmacy school in the country for more than 40 years.2-4 In addition to the above mentioned challenges, significant changes were made to pharmacy training as part of the new curriculum. 
 
In the old curriculum, after students finished all courses, they were required to spend 1 semester training in a hospital pharmacy. Students are trained in inpatient and outpatient pharmacy, intravenous preparations, and other elective practice experiences. In preparation for academic accreditation and based on feedback from students and preceptors, training in the new curriculum was divided into 2 parts, the first in the summer after the third year and the second in the summer after the fourth year. In the first exposure, students spend 250 contact hours in community pharmacy or primary care clinics. In this experience, the goal is that students will be exposed to medications and build important patient counseling skills. The second experience involves another 250 hours in hospital pharmacy. The experience includes inpatient pharmacy, intravenous preparations, drug information, and other elective practice experiences, depending on site availability. 
 
Because many preceptors take their vacation in the summer, moving training to the summer limited the number of available training sites. Also, faculties are not usually available in the summer for site visits. To handle these challenges and to increase the number and quality of training sites, we established a preceptor development program. This program involves a basic preceptor training workshop, a retreat for training coordinators twice a year, and continuing education activities in pharmacy training topics led by well-known international speakers recommended by the American Association of Colleges of Pharmacy. Also, we focused more on accrediting training sites, developing training manuals, and establishing an assessment system. To double the number of available sites, summer training was divided into 2 periods of 6 weeks each (ie, 250 hours). All these different solutions resulted in an increase in the number and quality of training sites (trained students increased from 194 in 2009 to 612 in 2010). These extra activities were accomplished by establishing an experiential training unit that reports to the vice dean for academic affairs. The unit is staffed by 3 full-time pharmacists, 2 pharmacy technicians and 2 administrative assistants, and is supervised by a part-time faculty member who holds a doctor of pharmacy degree. 
 
While we have had some success in handling some of the current challenges, we need to look at the future of introductory pharmacy training and continuously review the training objectives and adapt them to the needs of the country’s health-care system. The use of simulation and model pharmacy as adjuvant to practical training may help with the limited number of sites and the unavailability of some experiences. However, using technologies is expensive and many schools in developing countries will not be able to afford them. The cost can be reduced by sharing these technologies between several schools in the region and with medical and nursing schools on the same campus. 
 
Students must be involved in educating the public about the use of medications as part of their training. Starting training earlier in the pharmacy program will help students to develop their professional skills and to relate the information learned in courses with skills practiced at pharmacy training sites. Moreover, educators may elect to integrate training with courses. However, integration needs to be carefully planned and implemented. Students’ reflection on training activities is an important learning tool that needs to be used more in the future. Implementing a training exchange program will help in improving the quality of training and expose students to other healthcare systems. 
 
In conclusion, introductory pharmacy training in developing countries is facing many challenges including limited sites, variations in pharmacy training experiences between sites, little use of good assessment tools, and not enough resources to use technology in training. The future may involve thinking about a new model for introductory pharmacy training to facilitate finding alternative solutions that fit the needs of developing countries.