Thirty key informants were contacted and given the opportunity to participate in this study. All who could be contacted agreed to participate, yielding a response rate of 100%. Of those interviewed, 25 (83%) were from 10 different colleges and schools of pharmacy across the nation. Of these, 13 (52%) were from institutions classified as having a research focus and 12 (48%) were from institutions considered to be teaching oriented. A college or school was considered to have a research focus if it was ranked in the top 40 among colleges and schools of pharmacy with National Institutes of Health funding. Other key informants were from the Food and Drug Administration, the American Association of Colleges of Pharmacy, the Critical Path Institute, and the Institute for Safe Medication Practices. Of those interviewed, 22 (73%) were men. The interviewees had diverse backgrounds, although all were leaders in the teaching or implementation of at least one facet of SoS. For example, interviewees represented tenure-track and nontenure-track faculty members; assistant professors, associate professors, full professors, experiential education directors, and deans; clinical faculty members with expertise in ambulatory care, community, and hospital settings; faculty members who specialized in pharmacy administration/outcomes research, medicinal chemistry, toxicology, pharmacology, and law; and members of professional, not-for-profit, and governmental organizations. Additional demographic data are included in . Common opinion themes that emerged among key informants are detailed below.
Demographics of Key Informants in a Study on Educating Pharmacy Students About the Science of Safety (n = 30)
Newly graduated pharmacists should meet minimum SoS requirements. Respondents agreed that newly graduated pharmacists should possess a minimum set of knowledge, skills, and abilities such as: (1) the ability to identify errors and the causes of those errors; (2) knowledge of how to report concerns regarding medication safety; (3) the skills to measure, build, or change a system to reduce errors and to improve quality; and (4) the ability to effectively communicate verbally with patients and other healthcare providers about medication safety. A representative quote from a key informant was, “…quality includes, not just ensuring the right tablet gets into the bottle, but making sure that the patient takes it correctly, making sure the patient understands the medication, making sure the patient gets well, ultimately.” Key informants agreed that pharmacists are distinctively positioned for a leading SoS role in the US health care team: “[Pharmacists need to] recognize that they have, as a result of where they are…a unique perspective, a unique opportunity, and as a result of these, a unique responsibility.” Key informants advocated that students should be taught to appreciate the history behind the evolution of safety systems in order to prevent history from repeating itself. For example, 1 interviewee mentioned that students should understand the genesis and evolution of unit-dose packaging and systems to fully appreciate what types of errors were occurring at that time and to provide context for future decisions regarding medication risks in practice.
Pharmacy colleges and schools are preparing students well in some areas of medication safety and not well in others. When asked to describe how well pharmacy schools were preparing students in the area of medication safety, only 2 key informants indicated that they felt colleges and schools were doing a “good” or “great” job. A general consensus among key informants was that the teaching of SoS was not systematic (“if they get [certain aspects of SoS], they get it serendipitously”) and that there is not a designated place for it in the curriculum. However, a prevalent theme was the idea that despite certain gaps that need to be addressed, much of the pharmacy curriculum already was devoted to safety. One informant stated “…given that [the FDA's] definition, the entire curriculum of the College of Pharmacy is probably devoted to [SoS]….Probably every discussion we have and every lecture we give has something to do with ensuring or trying to accomplish the safety/effectiveness agenda.” Educators especially believed that students were well prepared as far as basic science and clinical courses such as pharmacology, pharmacotherapeutics, and pharmacokinetics.
When asked to indicate what gaps exist in medication safety education, the following 4 areas were identified: lack of (1) student acceptance of a “culture of safety”; (2) ability to verbally communicate effectively with patients and other healthcare providers about medication safety; (3) knowledge of the research and development process; and (4) skills to measure, build, or change a system to reduce errors and to improve quality. Key informants expressed the concern that students were being taught about the problems that exist (eg, medication errors, insufficient attention to using evidence-based medicine for prescribing, poor post-marketing surveillance), but not how to effectively ameliorate these problems. As one educator phrased it, “I don't think we [as educators] do a good job of teaching students how to implement solutions to those problems.” This theme was the undercurrent of why key informants believed that pharmacy curricula did not adequately teach students to develop problem-solving and decision-making skills. There was no consensus among key informants concerning which schools are doing a particularly good job in preparing their graduates in SoS (ie, no school was mentioned by more than 1 informant).
SoS education should be “hands on” or interactive. Key informants disagreed on the best way to add SoS to pharmacy curricula. Suggestions included: make the SoS a separate required course; use an integrated curricular model that threaded SoS material throughout the curriculum; and expose students to SoS topics during experiential training. Regardless of the method of curricular addition preferred, informants agreed that SoS training should be hands on, interactive, and as “real world” as possible.
When asked about offering tracks that specialize in medication safety, key informant answers varied. Some stated that there should be a core set of standards for all students, supplemented with opportunities to specialize in SoS. Others expressed concern that students have insufficient knowledge about what they want to do professionally and might not be able to make informed decisions regarding specialization.
There Are Barriers to Improving SoS Curricula at Colleges and Schools of Pharmacy. Key informants agreed that one of the greatest barriers to improving SoS education at colleges and schools of pharmacy was finding time in an already packed curriculum. Several also brought up the lack of communication between faculty members as represented by the following quote: “I think the biggest challenge in that [integrating the curriculum] is having faculty work with each other. I think faculty very much work in silence and it's difficult to convince faculty to work together.”
Another barrier noted was lack of faculty expertise in SoS. Interviewees thought it was important for faculty members with expertise in this area to share their expertise by developing curricular materials such as readings, slides, syllabi, as well as a train-the-trainer program.
Some key informants thought that pharmacy employers were part of the problem with some of the issues of medication safety in the United States. Although employers have made steps to improve their dispensing systems, some key informants felt that employers did not emphasize a culture of safety in pharmacy practice. Nevertheless, there also was a belief that pharmacy employers could be part of the solution if they were given the right incentives to focus more on medication safety within their practice.