Research skills training for the Doctor of Pharmacy in US Schools of Pharmacy: A descriptive study

Authors


Creighton Health Services Research Program, Creighton University School of Pharmacy and Health Professions, 2500 California Plaza, Omaha, NE 68178, USA. E-mail: kfuji@creighton.edu

Abstract

Objectives As the practice of pharmacy grows increasingly complex, graduates are expected to possess a comprehensive set of skills enabling them to provide optimal patient care. Thus, research skills are becoming increasingly valuable and a necessary part of pharmacist training globally. However, training opportunities for improving research skills have not been well explored in the literature. This study examines how research skills are currently being offered in various Doctor of Pharmacy curricula in US Schools of Pharmacy.

Methods A five-question survey was e-mailed to key individuals at 95 Colleges of Pharmacy in the USA and Puerto Rico. Responses were aggregated and then stratified by research project requirements, as well as by school type (public or private; Carnegie Foundation classification).

Key findings Seventy-nine respondents provided usable surveys for an 83% response rate. Respondents encompassed a representative population of school types. Although most schools do not require completion of a research project (75%), the majority of research skills listed were taught in various forms in over half of the responding institutions. There did not appear to be a significant distinction in research skills training provided based upon school type. However, schools requiring students to complete a research project in order to graduate provided the most comprehensive research skills training.

Conclusions Research skills training has greatly increased over the past 10 years. However, more study needs to be done in a number of areas, including determining the most effective way to offer research skills training, determining its post-graduate impact and determining its overall effect on the profession of pharmacy.

Introduction

The value of research skills training in developing Doctor of Pharmacy (Pharm.D.) graduates has been well recognized by key stakeholders in the pharmacy profession. The Canadian Council for Accreditation of Pharmacy Programs, the Royal Pharmaceutical Society of Great Britain and other international educational institutions have emphasized the need for pharmacy graduates and pharmacists to be able to use research, critical thinking and problem-solving skills to provide optimal patient care.1–5 The major academic and professional practice associations for pharmacy in the USA have identified training objectives and vision statements indicating the need for research skills to enhance the skills of academic pharmacist faculty and practising pharmacists.6,7 The accreditation standards for US Colleges of Pharmacy have also evolved to reflect the increased complexity and research needs of the profession and society.8 The latest revision to these guidelines holds academic programmes responsible to prepare students that will be able to ‘manage medication use systems, through the ability to apply patient- and population-specific data, quality improvement strategies, medication safety and error reduction programs, and research processes to minimize drug misadventures and optimize patient outcomes; to participate in the development of drug use and health policy; and to help design pharmacy benefits.’8 Graduates from pharmacy programmes who developed research skills while in their programmes indicated that this training improved their decision-making, and enhanced their marketability and effective functioning in their work.9

As the first nation to award a clinical doctorate as the standard pharmacy graduate degree, the ways in which US Schools of Pharmacy implement curricular and extracurricular training is potentially instructive to other countries considering major changes. For example, Japan is currently in the process of moving all pharmacy schools to the clinical doctorate degree.10 In the UK all pharmacy students must complete a fourth-year research project, yet studies have indicated that the teaching of research methods to complete these projects is quite varied and could benefit from further refinement.11–13 The need for increased research training in the preparation of pharmacists is global.

Prior studies of US pharmacy schools indicate that almost all entry-level Pharm.D. programmes require students to complete a statistics course, and a drug-information/literature-evaluation course.14,15 Applicable research skills training for pharmacy students in the area of drug information entails literature searching, evaluation and critical interpretation. These skills, although undoubtedly important, do not sufficiently address other research skill areas needed to solve problems that emerge in practice and translate these findings into practice. Such skills include performing systematic data collection, demonstrating the ability to manage data, selecting appropriate data-analysis procedures, analysing data, interpreting research findings, preparing a written report or preparing and delivering presentations about these findings. Past research by Murphy et al. found that only half of US pharmacy schools require students to complete formal coursework in research methods and few schools require a research project for students.14 Comparison of more recent work by Murphy and colleagues15 with their 1999 survey results14 indicate that these estimates have not changed in the past 10 years. A critical unexplored area in the literature is the breadth and scope of pre-doctoral, post-doctoral and extracurricular opportunities that fully portray research skills training offered by schools beyond the required Doctor of Pharmacy curriculum. This paper seeks to address this knowledge gap.

The purpose of this study was to examine how research skills training opportunities are currently offered in US Schools of Pharmacy. Pre-programme, within-programme and post-programme offerings were studied. The frequency and types of research skills included in Doctor of Pharmacy curricula, and relationships between type of school (private or public; Carnegie classification), research project requirements and ways research skills training are offered within US Schools of Pharmacy are described.

Methods

Research design

A cross-sectional study of pharmacy research skills training opportunities for Doctor of Pharmacy candidates in US colleges was conducted over 8 weeks by e-mail and completed by January 2008. A telephone reminder was initiated for those who did not respond to the e-mail invitation. The final survey response was completed by October 2008. The study was approved by the Creighton University Institutional Review Board.

Study subjects

A faculty member who was most likely to have detailed knowledge about research training opportunities in their School of Pharmacy was contacted and invited to participate. This individual was selected purposefully based upon their academic titles (e.g. assistant or associate dean or department chair) from the American Association of Colleges of Pharmacy (AACP) 2006–2007 roster.16 An individual was identified from each of the 95 Colleges of Pharmacy in the USA and Puerto Rico. The University of Puerto Rico School of Pharmacy was included as it falls under the purview of the Accreditation Council for Pharmacy Education (ACPE), the accrediting body for US Schools of Pharmacy.

Survey instrument and data-collection procedures

Survey items were developed based upon two widely accepted definitions for research. One definition is commonly used in the social and behavioural sciences.17 This definition explicitly represents research as a process that is directed with a specific intention. Six steps are described: (1) identifying a research problem, (2) reviewing the literature, (3) specifying a purpose for research, (4) collecting data, (5) analysing and interpreting the data and (6) reporting and evaluating. A similar definition is offered in the US Code of Federal Regulations18 governing research with human subjects. This document defines research as ‘any systematic investigation, including research development, testing, and evaluation, and is intended to develop or contribute to generalized knowledge.’18 The survey questions were designed using the refined steps described above, as well as evaluating past literature on the subject, reviewing the current ACPE standards for Doctor of Pharmacy programmes, and creating items necessary to fill in our knowledge gap about research training opportunities in schools.8,14,15 To determine what specific research skills training were offered in pharmacy curricula, research skills comprising the entire research process were listed separately for respondents. This list was finalized by peer review using three faculty members who have substantive experience in both teaching and conducting the research process.

A survey instrument was created and distributed via e-mail. The survey consisted of both closed and open-ended questions. Respondents completed the survey by replying to the e-mail with embedded responses on the e-mail directly. They could also choose to print the e-mail and received instructions on how to fax the response back. Reminders to those who did not respond to the e-mail invitation were done by telephone. A single telephone reminder was made, asking them to either spend 5–10 min to verbally complete the survey, or to complete the survey re-sent to them via e-mail at the time of the reminder phone call.

Data analysis

Survey responses were recorded and an aggregate summary of the results was compiled into a matrix of descriptive findings. The aggregated data were examined and possible associations explored. As a result of this process, survey responses to the items about the curricular training skills and the extracurricular research training opportunities were further analysed using inferential analysis. One stratification compared schools requiring a research project and schools not requiring a research project. A second stratification compared schools that were private to those considered public (58 public and 37 private). The third stratification compared doctoral institutions to non-doctoral institutions as determined by Carnegie classification.19 The nine Carnegie categories that describe higher education institutions are: (1) very high research university, (2) high research university, (3) doctoral/research university, (4) large Master's university, (5) medium Master's university, (6) small Master's university, (7) special focus – medical institutions, (8) special focus – health institutions and (9) Baccalaureate-only institutions. In order to facilitate data analysis, we created two categories from these nine. One category combined the first three categories into a ‘doctoral institution’ category (n = 53 schools), and those schools falling into one of the remaining six categories were combined into the second category ‘non-doctoral institution’ (n = 42 schools). Demographic data about the schools were gathered from the AACP directory.

Both descriptive and inferential analysis was conducted using SPSS software. A χ2 test was used with P values of less than 0.05 considered significant. For tables with any number of cells containing fewer than the expected value of 5, a Fisher's exact test was used in place of a χ2 test.20 Actual P values have been provided to the reader so they may better interpret the findings presented.

Results

The overall response rate was 83%, with 79 of the 95 US schools surveyed providing usable responses. The 79 responding schools could be classified as follows: 48 public and 31 private, 45 doctoral institutions and 34 non-doctoral institutions, and 20 requiring a research project and 59 not requiring a research project. Table 1 displays demographic characteristics of respondents.

Table 1. Demographic characteristics of respondents (n = 79)
 n (%)
School type
Public48 (60.8)
Private31 (39.2)
Years in existence
<10 years24 (30.4)
11–50 years1 (1.3)
51–100 years19 (24.1)
>100 years35 (44.3)
Carnegie classification
Very high research25 (31.6)
High research14 (17.7)
Doctoral6 (7.6)
Specialty medicine10 (12.7)
Specialty health3 (3.8)
Large Masters10 (12.7)
Medium Masters5 (6.3)
Small Masters2 (2.5)
Baccalaureate3 (3.8)

Overall, only four of the 79 responding schools required pre-pharmacy coursework, concurrent coursework in the degree programme, and offered post-Pharm.D. experiences, creating one continuous track from pre- to concurrent to post-Pharm.D. training. Two of the schools were private institutions, and all three schools were classified as either a high or very high research institution under the Carnegie classification. All schools offered at least one of the research skills listed in Table 2 in some area of required coursework of the curriculum.

Table 2. Overall responses of schools teaching various research skills in curricular course offerings (n = 79)
Research skill or abilityRequired course, n (%)Elective course, n (%)Not explicit in curriculum, n (%)
 DidacticExperientialBothDidacticExperientialBoth 
  1. Respondents could select all applicable course offerings. A ‘both’ designation was given to respondents who selected both the didactic and experiential course offerings.

  2. aFor the purposes of this survey, ‘research project’ is defined as a project requiring a student to demonstrate all of the above-listed skills.

Develop a research problem statement43 (54.4)12 (15.2)9 (11.4)38 (48.1)36 (45.6)29 (36.7)10 (12.7)
Develop a research hypothesis42 (53.2)11 (13.9)9 (11.4)36 (45.6)35 (44.3)23 (29.1)5 (6.3)
Construct an appropriate research design42 (53.2)13 (16.5)10 (12.7)35 (44.3)34 (43.0)22 (27.8)7 (8.9)
Perform a literature search77 (97.5)46 (58.2)45 (57.0)37 (46.8)39 (49.4)29 (36.7)1 (1.3)
Critically evaluate selected literature78 (98.7)44 (55.7)44 (55.7)35 (44.3)37 (46.8)29 (36.7)1 (1.3)
Perform systematic data collection26 (32.9)23 (29.1)11 (13.9)36 (45.6)40 (50.6)26 (32.9)8 (10.1)
Demonstrate ability to manage data24 (30.4)17 (21.5)7 (8.9)33 (41.8)37 (46.8)23 (29.1)12 (15.2)
Select appropriate data analysis procedures48 (60.8)22 (27.8)19 (24.1)34 (43.0)34 (43.0)23 (29.1)2 (2.5)
Analyse data40 (50.6)24 (30.4)16 (20.3)34 (43.0)34 (43.0)23 (29.1)4 (5.1)
Interpret research findings59 (74.7)37 (46.8)32 (40.5)33 (41.8)35 (44.3)25 (31.6)1 (1.3)
Prepare a written report about a research project229 (36.7)19 (24.1)13 (16.5)35 (44.3)36 (45.6)25 (31.6)7 (8.9)
Design a research project25 (31.6)11 (13.9)7 (8.9)31 (39.2)30 (38.0)18 (22.8)15 (19.0)
Complete a research project10 (12.7)11 (13.9)2 (2.5)24 (30.4)28 (35.4)15 (19.0)20 (25.3)

Pre-pharmacy coursework requirements

A little over two-thirds (69%) of respondents required students to complete pre-pharmacy coursework in statistics. This is consistent with previous findings.14 Of these respondents, 14% also required a research design/methods course.

Professional programme curricular requirements

The distribution of research skills taught in required or elective coursework and how these skills were taught (didactic, experiential or both) is displayed in Table 2. Nine schools provided required didactic education that comprehensively addressed all of the 13 skills listed in the survey, including completion of a research project. Most of the research skills comprising the entire research process were offered by at least half of the respondents. Nearly all respondents (98%) taught literature searching and critical literature evaluation in required didactic courses. Other frequently taught skills in required didactic courses were interpreting research findings (75%) and selecting appropriate data-analysis procedures (61%). Significantly fewer schools required actual design of a research project (32%) or completion of a research project (13%). Twenty schools (25%) required completion of a research project in order to graduate from the Doctor of Pharmacy programme. Overall, the cognitive skills of research were emphasized to a greater extent than application skills within the Doctor of Pharmacy curriculum.

Three-quarters (74%) of respondents did not have a required research project. These findings remain unchanged from those found in previous studies suggesting no change in academic programme movement for at least 10 years or more.14,15

Extracurricular research skills training opportunities

Pharmacy training experiences offered outside the curriculum were quite varied and well represented among pharmacy schools (see Table 3). Summer research programmes were most prevalent (76%), followed by post-Pharm.D. general residencies (73%), academic year research programmes (62%), post-Pharm.D. specialty residencies (62%), and post-Pharm.D. research fellowships (49%). The majority of these extracurricular research skills training opportunities required a research project to be completed (ranging from 55 to 92%). Additional research skills training was available at a large number of institutions.

Table 3. The frequency of schools offering extracurricular research skills training experiences (ECTEs) and whether a research project is required for those experiences (n = 79)
ECTEsSchools offering ECTEs, n (% of respondents)ECTE that includes a required research project, n (% of schools offering ECTEs)
Summer research programme60 (76)33 (55)
Academic year research programme49 (62)30 (61)
Post-Pharm.D. general residency58 (73)50 (86)
Post-Pharm.D. specialty residency49 (62)43 (88)
Post-Pharm.D. research fellowship39 (49)36 (92)

Research project requirement status

Schools with a research project reported more rigorous pre-pharmacy coursework compared to schools without a research project requirement. The requirement for a research design/methods course (P = 0.066) approached statistical significance, whereas the combination of research design/methods and statistics (P = 0.028) was associated with schools that required a research project.

Schools requiring a research project offered research skills training primarily through required didactic or required elective courses. The skills that were found in both types of required course curricula for schools requiring a research project compared to those that did not included: developing a research problem statement (P = 0.001), developing a research hypothesis (P = 0.001), constructing an appropriate research design (P = 0.000), selecting appropriate data-analysis procedures (P = 0.069), preparing a written report (P = 0.014), designing a research project (P = 0.000) and completing the research project (P = 0.062). These results all demonstrate or suggest a statistically significant association. The skills that were found in required didactic course curricula for schools requiring a research project compared to those that did not included: performing systematic data collection (P = 0.004), demonstrating the ability to manage data (P = 0.023) and analysing data (P = 0.016). These same skills were found in required experiential course curricula for schools requiring a research project compared to those that did not: performing systematic data collection (P = 0.022), demonstrating the ability to manage data (P = 0.026) and analysing data (P = 0.007). In contrast, schools not requiring a research project (n = 75%) offered research skills primarily in elective experiential courses. P values for these research skills were: developing a research problem (P = 0.005), developing a research hypothesis (P = 0.008), constructing an appropriate research design (P = 0.002), performing a literature search (P = 0.014), critically evaluating selected literature (P = 0.028), performing systematic data collection (P = 0.001), demonstrating the ability to manage data (P = 0.008), selecting appropriate data-analysis procedures (P = 0.020), analysing data (P = 0.016), interpreting research findings (P = 0.002), completing a written report (P = 0.000), designing a research project (P = 0.018) and completing a research project (P = 0.006).

Performing a literature search, critically evaluating selected literature and interpreting research findings were the only research skills that did not demonstrate statistical significance for being taught more as required courses in schools requiring a research project compared to schools that did not, with an almost equal distribution of research project and non-research project respondents for required courses. Only one respondent (non-research project) said that both performing a literature search and critically evaluating selected literature was not offered in a required didactic course. There were no significant differences in extracurricular research training experiences offered between research project and non-research project schools.

Carnegie classification of school and research training

Carnegie classifications describe institutional diversity in US higher education. For the purposes of this study, we focused on what was being taught at each university using the Undergraduate and Graduate Institutional Program classifications.19 These were further stratified as described earlier.

Pre-pharmacy requirements did not differ significantly between doctoral and non-doctoral institutions. Offerings that differentiated doctoral and non-doctoral institutions were elective experiential in nature. All research skills listed in Table 2 were more frequently offered through elective experiential courses in the curricula of programmes in doctoral institutions. These results were: developing a research problem (P = 0.010), developing a research hypothesis (P = 0.017), constructing an appropriate research design (P = 0.017), performing a literature search (P = 0.020), critically evaluating selected literature (P = 0.016), performing systematic data collection (P = 0.009), demonstrating the ability to manage data (P = 0.056), selecting appropriate data-analysis procedures (P = 0.060), analysing data (P = 0.054), interpreting research findings (P = 0.010), completing a written report (0.045), designing a research project (P = 0.068) and completing a research project (P = 0.045). All results either demonstrated a statistical association or suggested a relationship. No difference in the distribution of the research skills offered in required didactic, required elective and elective didactic courses between doctoral and non-doctoral institutions was found. Similarly, there was no difference in research project requirements between doctoral and non-doctoral institutions.

Regarding extracurricular research skills training offerings, a summer research programme (P = 0.001), specialty residency (P = 0.001) and research fellowship (P = 0.001) were more likely to be offered in doctoral institutions.

Public and private school comparison of research training

No notable difference was found in the pre-pharmacy requirements between public and private schools, or the way that the different research skills were offered. Public schools were more likely to offer a variety of extracurricular research skills training. Summer research programmes (P = 0.000), general residencies (P = 0.051), specialty residencies (P = 0.013) and research fellowships (P = 0.008) were more likely to be offered in a public school compared to a private school.

Discussion

Comprehensive research skills training in a continuous track from pre- to concurrent to post-Pharm.D. education is sparse, present in only four of the 79 schools that responded. Most of the research skills comprising the entire research process were offered by at least half of the respondents. All schools taught at least one of the research skills in required coursework. Overall, the cognitive skills of research were emphasized to a greater extent than application skills within the Doctor of Pharmacy curriculum. Three-quarters (74%) of respondents did not have a required research project. However, the majority of pharmacy training experiences outside the curriculum required a research project to be completed. Pre-pharmacy coursework for research design and methods characterizes schools that require a research project. These schools also offered research skills training primarily through required courses, whereas schools not requiring a research project offered training primarily through elective experiential courses.

Summer research programmes were most prevalent, although training experiences were varied and well represented among schools of pharmacy.

This study was not designed to explore the continuity and sustainability of pharmacy training opportunities offered. It is still not known whether schools offer these various extracurricular programmes in an uninterrupted and continuous manner or, alternatively, offer them based upon available candidates, or available sites. We also do not know if there has been a shift in which schools have required research projects over the last 10 years, nor did we explore the number or proportion of Doctor of Pharmacy students who engaged in these programmes in each school. Developing this understanding would help us to better understand the depth of the research programme development that is taking place in our schools and should be considered in future research. A 10-month time period for data collection may have introduced some concern about temporal bias in the data. However, curricular change is a slow process. This time period is likely to reflect an accurate cross-sectional description of Schools of Pharmacy curricula.

Pharmacy schools have a responsibility to prepare graduates with the necessary tools to succeed in an increasingly complex health care-delivery environment. This study provides insight into the growing disparity that pharmacy schools are facing: the increasing demands on Doctor of Pharmacy graduates in practice to respond to increasingly complex responsibilities that require integrating methods of inquiry, and the lack of growth and integration of research skills training within US school curricula. The US case offers a picture to be examined by schools in other nations. Issuing a clinical doctorate degree should indicate that graduates are being adequately trained to effectively participate in patient care, improve the quality of care and examine problems and develop solutions that emerge in complex care.

The results of this study inform us about research skills that pharmacy graduates are likely deficient in, and help to further the discussion about what research skills need to be a minimum competency within the contemporary Doctor of Pharmacy curriculum. This is a global need. Pre-pharmacy requirements of either a research design/methods class or both a research design/methods class and a statistics class were more common in research project schools than in non-research project schools. As these institutions place a higher emphasis on research, it is logical that their pre-pharmacy requirements would require students that enter have an introductory background and fundamental understanding of research. For those schools requiring a research project, it may be necessary for students to enter pharmacy school better equipped to handle such a requirement. Inclusion of core research skills training coursework in the pre-pharmacy requirements is one strategy that may be helpful as curricular revision is considered nationally. This is supported by prior studies that have shown faculty believe statistics, research design, senior projects and research electives (research clerkships, independent study courses) are most important after drug information and literature evaluation skills.21

The value of having a research project has been examined in past studies. For those schools requiring students to complete a research project, it was generally well regarded among both faculty and students. A study of faculty attitudes regarding student research projects found that faculty members generally felt positive regarding the overall value of research projects. This included feelings about time and resource needs, and benefits for both students and faculty.21 A study of student attitudes found that most students felt that Pharm.D. programmes should have students complete a required research project, and that doing the project was a valuable experience.22

Past literature has described reasons why schools may be reluctant to require a research project. Some faculty expressed concerns about not having enough faculty members who were qualified to oversee a research project, and not enough time overall for faculty. Others felt that it may not be necessary for all students to engage in such a project, but that some specific students would find it beneficial. There were also undisclosed comments concerning the value of research in the overall development of students.21,22

Performing a literature search and critically evaluating selected literature are well established as part of a standard Pharm.D. curriculum. There are multiple reasons why these skills are needed in practice, and there may be less controversy about their inclusion in the curriculum. This is evident in a prior study, as faculty felt that out of required courses, drug information and literature evaluation are very important for students, and are most ‘designed to impart research related skills (including critique and evaluation).’21 Students felt that drug information/drug literature evaluation courses most ‘adequately prepared me to conduct the project’ (if one was present) compared to other research skills such as research design and statistics.22

The overall descriptive characteristics of research skills training in Doctor of Pharmacy curricula have not changed for the last 10 years. Drug information is still the primary course in which research skills are taught. The numbers of schools that have a required research project have also remained constant over time. However, there has been a reported increase in the teaching of various research skills overall. It may be that schools, although hesitant to impose a research project in their curriculum, have observed data from past studies indicating that there is much value in teaching research skills in some form. It may be that faculty and student attitudes regarding the added value that the teaching of research skills has had on their careers as pharmacists has been a major driver in the increased teaching of research skills overall. On the other hand, schools may be looking at some of the faculty concerns that have been reflected in past studies and determined that many of those concerns were valid and were major impediments in instituting a research project. Although the majority of research skills correlate strongly with research project schools, it is possible that a research project may not be the only way (or the best way) to teach students research skills. This is reflected in our survey results, as many skills are being offered overall, even though schools requiring a research project are in the minority.

Curricular requirements of Doctor of Pharmacy programmes need to be examined further to develop more comprehensive research skills training. We need to further explore and describe the breadth, scope and depth of elective didactic and elective experiential courses in which research skills are taught. It will also be important to address the impact research skills training has on students in terms of post-doctoral success, meeting career needs and making visible contributions to the research-dependent progress of the profession. In addition, studies are also needed to determine the various ways that research skills training are effective within the curriculum.

Conclusions

Research skills training has not changed substantively in the past 10 years. Whereas research skills training has a presence in the required curriculum of many schools, it still appears to be offered primarily as an extracurricular pursuit for students. This study provides us with a deeper understanding of how research skills are offered across the continuum of training, and forms a foundation for a more in-depth look at research skills training in our Doctor of Pharmacy curricula.

Acknowledgements

The authors wish to thank Mr Trenton Keim, who provided assistance with administration of the survey and data entry support.

Ancillary