Shauna Buring, PharmD and Elena Umland, PharmD
ACCOUNTABILITY
Introduction
Role of Accreditation
Self-regulation through the process and outcomes involved in accreditation are important in demonstrating
accountability to stakeholders. (CHEA) Accreditation supports accountability to students, families,
government agencies, and the public. The process of self-study and accreditation in pharmacy education is
one measure of accountability. The standards for pharmacy education are continually revised through a
lengthy process of thought leader and stakeholder input. Individual colleges/schools expend great effort in
a 12-18 month time period of self-study, evaluating how their program measures up against the 30
standards for the professional degree program. Peer review teams review and validate the self-study,
determining to what degree the program is compliant with the standards and extensive monitoring and
follow-up is typically required. So, is this enough for accountability? How much is enough? When do we
stop and say “it’s good enough”? Extensive resources are expended in the process of self-study, onsite
accreditation visit, and monitoring. As an additional measure of accountability, the Accreditation Council
for Pharmacy Education (ACPE) recently established a policy requiring colleges/school make specific
outcomes of their program (e.g. on-time graduation rate, NAPLEX results) publicly available. (ACPE)
Historically, the accreditation cycle for pharmacy education was 6 years and institutions could approach it
as “one and done” endeavor. Although full accreditation has been extended to 8 years, the standards now
require an ongoing, systematic approach to self-assessment with continuous program improvement at the
forefront; this has yielded a marathon versus sprint approach to self-evaluation and enhancement. If
colleges/schools of pharmacy are not being held accountable through a broad, all-encompassing,
continuous accreditation process, then the question should be asked, why are we doing it? Are we not
measuring the quality of education Vis a Vis our accreditation process?
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Shauna Buring, PharmD and Elena Umland, PharmD
Accountability Beyond Accreditation
Alternatively, or perhaps in addition to the above, one could propose that the ultimate measure of quality
pharmacy education would occur via evaluating the impact of future pharmacists on healthcare inclusive of
the savings in healthcare dollars and impact on improving the healthcare quality. Is it the Academy that
should be held accountable for such outcomes? Or are there organizations beyond ACPE that should also
be employed in this measurement of accountability? Per the letter written to the people of Purdue
University by its President, Mitchell E. Daniels Jr., in January of 2014, it is suggested that “higher education
has been immune from close examination of its results, as reflected in value compared with price”. In other
words, does the price of a pharmacy education “pay off” in its subsequent impact on society?
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Proving Accountability
In addressing the questions raised regarding accountability, three major recommendations emerged. These
recommendations surround the role of a consortium, measurement of accountability to the healthcare
environment and the further development of tool(s) to evaluate pharmacy students and graduates relative
to their achievement of the skills deemed imperative to full personal and professional development.
Consortium
The role of consortia in higher education has been studied and found to aid in the operational advancement
of the member institutions. (Burley, 2012) Further, the role of consortia in expanding and extending
learning has been described as a “vast, untapped resource” with “…tremendous potential…to become more
effective learning organizations”. (Burley, 2012) Examples of existing, successful consortia in the United
States that are meeting this definition include the MedEd Portal, a collaborative partnership between the
American Association of Medical Colleges and the American Dental Association (MedEd website); the Nexus
of the National Center for Interprofessional Practice and Education (Nexus website); and the
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Shauna Buring, PharmD and Elena Umland, PharmD
Interprofessional Education Collaborative (IPEC website). The broad goals of these endeavors, respectively,
are to promote educational scholarship and collaboration; to develop the relationship between health
professions education and practice as a means of providing better quality, cost-effective care for
communities of patients; and to promote efforts that would advance interprofessional learning experiences
to help prepare future health professionals for enhanced team-based care of patients and improved
population health outcomes. Comparatively, the Pharmine consortia were established to create a
European model for pharmacy education and training across the European Union. (Pharmine website) In its
development, stakeholders from government and regulatory institutions that address policy and the use of
healthcare resources as well as drug and therapy-related regulatory issues were included.
In observing the goals of collaboratives, consortia and nexus, could the development of similar
organization(s) assist in moving pharmacy education forward? These could exist on a granular level (e.g., a
consortia of pharmacy schools to deliver specific educational content such as pharmacokinetics) or as a
broader endeavor such as a Nexus surrounding the Center for the Advancement of Pharmacy Education
(CAPE).(CAPE 2013) In the example of the pharmacokinetics consortia, faculty time could be preserved to
ideally assist in contributing to their overall creativity via ‘sabbatical-like’ experiences while any negative
impact to the students should be non-existent. In the example of CAPE, could a CAPE-Nexus be formed to
develop the long-term accountability outcomes of pharmacy education, recognizing accreditation as an
interim step? Could it be the body that defines how pharmacy education is to be held accountable to not
only students and faculty, but ultimately to the healthcare community and patients? And could it be the
body to serve as a resource to all its constituents as accountability is continuously evaluated for the
improvement of healthcare outcomes?
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Shauna Buring, PharmD and Elena Umland, PharmD
Recommendation(s): AACP should collect data via member profiles and use this information to develop a
consortium focused on leveraging the accountability of pharmacy education to the healthcare
environment.
Accountability to the Healthcare Environment
Pharmacy education in the United States is regulated by the Accreditation Council for Pharmacy Education
and ultimately, the U.S. Department of Education. In most countries, governments are responsible for the
quality of health professions education either through a department or ministry of education or health.
Infrequently, responsibility for the quality of education for health professionals lies with a national
pharmacy organization. (FIP Framework)
The Institute of Medicine report, Health Professions Education: A Bridge to Quality, highlighted that the
education of health professionals including pharmacists was not adequately preparing clinicians to provide
high quality care.(IOM 20003) The IOM challenged colleges and accreditors to develop healthcare
professionals who were able to: provide patient-centered care, work as part of an interprofessional team,
practice evidence-based medicine, focus on quality improvement, and use information technology. While
advances in some of these areas may have been made, it’s been a decade since this report and, one could
argue, substantial progress in linking education with practice and developing all graduates who are
competent in these areas has not been realized.
In a commissioned report regarding educating health professionals for the 21st century, it was identified
that education is crucial to transforming the healthcare system. Certainly, the healthcare system has
become increasingly costly and complex. Accordingly, the professional education system must keep pace
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Shauna Buring, PharmD and Elena Umland, PharmD
by offering instructional approaches that adequately prepare each of our graduates to not only function in
this environment but to transform it through continuous quality improvement.
Although pharmacy education has been attempting to address the five core areas outlined in the IOM
report from a decade ago, and the standards for pharmacy accreditation have become increasingly complex
and rigid, the question becomes, Are we where we want to be in terms of preparing our graduates to work
in and transform the current health care system? Do our students see the connection between their
education and practice? Do they feel accountable to their patients and understand the responsibility of
being a pharmacist? A strong connection between pharmacy education and patient care is critical so
students see the connection and feel the accountability to their patients, their families, and their healthcare
colleagues. We want to educate and train individuals who are able to maximize the healthcare of their
patients as pharmacists. In order to practice at the top of their license and transform practice, we need to
leverage pharmacy education to do so. Would a better connection between education and practice
facilitate this? Currently, the Department of Health and Human Services has no responsibility or impact on
health professions education. Similar to the relationship between the Ministry of Health and the
Department of Education, Training and Employment in some countries, conceivably collaboration between
the DHHS and the Department of Education would better support the vision of connecting students with
practice in an education system that is focused on clinical practice and the service of patients. It is
recognized that a strong relationship between the health and science sectors of society and the
government and pharmacy education is of extreme importance in maximizing pharmacy’s contributions to
the delivery of quality, cost-effective healthcare. (FIP Framework) And it has been determined that
improved healthcare (quality and cost) must include a focus on individuals and families; a redesign of
primary care services and structures; population health management; a cost control platform; and system
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Shauna Buring, PharmD and Elena Umland, PharmD
integration and execution (Triple Aim). Assessment of this within pharmacy education cannot be
understated.
Recommendation: AACP should work with ACPE, the Department of Education, and the Department of
Health and Human Services to explore a collaborative approach to measures of accountability for pharmacy
education to the healthcare environment and improvement of patient care.
AACP Curricular Quality Surveys
In the revision of the CAPE outcomes, one of the most significant changes is the addition of affective skills.
Although faculty, preceptors, and employers have valued professionalism, leadership, innovation, and selfawareness, these “soft skills” have traditionally not been purposefully taught, facilitated, and nurtured in
the PharmD curriculum in the same way as pharmaceutical knowledge and pharmacy practice skills.
Society, however, is increasingly demanding said skills and attributing personal and professional success to
them. The increasing attention to these skills is clear as CAPE 2013 now includes Domain 4 which focuses
on the student’s personal and professional development. This speaks to the graduate being able to use the
knowledge and skills from the professional program upon graduation to “practice at the highest level of the
profession”. These skills were also included in CAPE 2013 because they affect a graduate’s ability to
“transform their knowledge and skills into positive outcomes” regardless of practice setting. As
colleges/schools adopt CAPE 2013 and work to develop curricular and extracurricular activities to develop
these abilities, the Academy must think about how these skills can be measured. (CAPE 2013)
One valuable tool in measuring stakeholders’ perceptions of various aspects of the professional program
has been the AACP Curricular Quality Surveys. Although this is an indirect measure, it allows the
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Shauna Buring, PharmD and Elena Umland, PharmD
college/school to gather feedback from multiple sources and triangulate an issue. Importantly, it will hold
colleges/schools accountable for developing these important and under-valued skills.
Purdue University and the Gallup organization collaborated to develop the Great Jobs and Great Lives
Gallup-Purdue Index. (Gallup-Purdue) The purpose of the index is to measure factors that affect individuals’
well-being including a feeling of purpose, social support, financial stability, sense of community, and
physical health. One could argue that development of skills in the affective domain contributes to
workplace engagement and factors assessed in the Gallup-Purdue Index. Possessing the skill of being selfaware, knowing what abilities, emotions, and motivations one has that could affect professional growth
could certainly impact well-being. Similarly, exhibiting the behaviors of a professional by committing to
continuous improvement and demonstrating respect, integrity and accountability contribute to a feeling of
purpose and being motivated to achieve professional goals. Questions targeting alumni and addressing
workplace engagement and well-being could be included to gain a sense of how our graduates are
performing in the “real world”.
Recommendation: AACP should develop survey questions that measure the affective domain. Questions
should be added to the AACP Curricular Quality Surveys for faculty, students, preceptors, and alumni. After
years of collected data, AACP should perform an analysis to identify trends contributing to positive wellbeing and workplace engagement after graduation.
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Shauna Buring, PharmD and Elena Umland, PharmD
References
Accreditation and accountability: looking back and looking ahead. Council for Higher Education
Accreditation. http://www.chea.org/pdf/accred_account.pdf Accessed January 5, 2015.
Policies and procedures for ACPE accreditation of professional degree programs. Accreditation Council for
Pharmacy Education. https://acpe-accredit.org/pdf/PoliciesProceduresJuly2014.pdf Accessed December
12, 2014.
An Open Letter to the People of Purdue. President Mitchell Daniels Letter: January 2014.
http://www.purdue.edu/president/email/2014/1401-med-openletter.html Accessed February 3, 2015.
Burley D, Gnam C, Newman R, Straker H, Babies T. Leveraging higher education consortia for institutional
advancement. International Journal of Educational Management 2012;26(3):274-283.
Mission and Vision. MedEd Portal. American Associate of Medical Colleges.
https://www.mededportal.org/about/missionandvision/ Accessed February 3, 2015.
Learn about the Nexus. National Center for Interprofessional Education and Practice.
https://nexusipe.org/about-nexus Accessed February 3, 2015.
About the Interprofessional Education Collaborative (IPEC). IPEC: Connecting Health Professions for Better
care. https://ipecollaborative.org/About_IPEC.html Accessed February 3, 2015.
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Pharmacy education in Europe (PHARMINE): Final report.
http://www.pharmine.org/wp-content/uploads/2014/05/PHARMINE-Final-Report-Public-Part.pdf
Accessed February 2, 2015.
Medina MS, Plaza CM, Stowe CD, et al. Center for the Advancement of Pharmacy Education 2013
Educational Outcomes. Am J Pharm Ed. 2013; 77 (8) Article 162.
A global framework for quality assurance of pharmacy education. FIP Pharmacy Education Task Force.
http://www.fip.org/files/fip/PharmacyEducation/QA%20Booklet.pdf Accessed Jan 5, 2015.
Institute of Medicine Committee on the Health Professions Education Summit; Greiner AC, Knebel E,
editors. Health Professions Education: A Bridge to Quality. Washington (DC): National Academies Press
(US); 2003. Available from: http://www.ncbi.nlm.nih.gov/books/NBK221528 Accessed January 19, 2015.
The Institute for Healthcare Improvement Triple Aim.
http://www.ihi.org/engage/initiatives/TripleAim/Pages/default.aspx Accessed February 2, 2015.
Great Jobs Great Loves: The 2014 Gallup-Purdue Index Report.
http://www.luminafoundation.org/files/resources/galluppurdueindex-report-2014.pdf Accessed January
7, 2015.
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Frenk, J et al. Health professional for a new century: transforming education to strengthen health systems
in an interdependent world. Lancet 2010;376(9756):1923-58.
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