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Role and status of the basic pharmaceutical sciences in pharmacy education : a case study of the UBC… Albon, Simon Piers 2014

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  ROLE AND STATUS OF THE BASIC PHARMACEUTICAL SCIENCES IN PHARMACY EDUCATION: A CASE STUDY OF THE UBC BSC(PHARM) PROGRAM.   by Simon Piers Albon  B.Sc., The University of British Columbia, 1979 M.Sc., The University of British Columbia, 1983  A THESIS SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF  DOCTOR OF PHILOSOPHY in THE FACULTY OF GRADUATE AND POSTDOCTORAL STUDIES (Curriculum Studies)  THE UNIVERSITY OF BRITISH COLUMBIA (Vancouver)  April 2014  © Simon Piers Albon, 2014 ii  ABSTRACT  The basic pharmaceutical sciences have played an integral role in the scientific foundations of pharmacy education in Canada for 70 years although their role has shifted as programs have become more clinically-focused. Less reliance on the basic pharmaceutical sciences has prompted concerns regarding the scientific foundations of contemporary curricula and to what extent they are adequate for preparing today’s pharmacists. Addressing these concerns, this study inquired into the role and status of the basic pharmaceutical sciences in UBC’s current BSc(Pharm) program. Employing qualitative case study methodology and learning-centered approaches to post-secondary education, a combination of document, interview, and classroom observation analyses were used to establish: 1) the history of the basic pharmaceutical sciences in UBC pharmacy programs; 2) faculty perspectives on their role and status in the current program, and; 3) the curriculum and pedagogical practices of basic pharmaceutical scientists. Results from document analyses examining the history of pharmacy education in British Columbia since Confederation show that the basic pharmaceutical sciences have played a dominant role in UBC pharmacy programs for four decades; emphasis has decreased from 40% in the heavily science-based curricula of the 1980s to 25% of today’s clinically-focused program. Regarding the role and status of the basic pharmaceutical sciences in the current program, interview analyses suggest perspectives of scientists and practitioners are deeply polarized. While there is agreement that the basic pharmaceutical sciences have a role in preparing students for practice, science and practice solitudes confound curriculum decisions regarding optimal levels, importance, and status. Interview and classroom observation analyses suggest the curriculum and pedagogical practices of basic pharmaceutical scientists are predominantly teaching-centered. Although committed educators, discipline-based practices and a legacy of iii  privilege may be exacerbating the science and practice solitudes, the lack of agreement amongst scientists and practitioners about role and status, and existing tensions regarding curriculum optimization. To address confounding factors, scholarly approaches and interdisciplinary curriculum development teams are suggested for on-going curriculum reforms. In addition, faculty development programs connecting basic pharmaceutical scientists with practice and developing learning-centered teaching approaches are proposed. The role of Faculty leadership and policies in curriculum reform efforts is also described.                   iv  PREFACE  This research study obtained the approval of the UBC Research Services Research Ethics Board (Behavioral Research Ethics Board; UBC BREB Number: H11-00025).                    v  TABLE OF CONTENTS  ABSTRACT ................................................................................................................................... ii PREFACE .................................................................................................................................... iv TABLE OF CONTENTS ..............................................................................................................v LIST OF TABLES ..................................................................................................................... viii GLOSSARY ................................................................................................................................. xi ACKNOWLEDGEMENTS ...................................................................................................... xiv DEDICATION .............................................................................................................................xv CHAPTER ONE: INTRODUCTION ..........................................................................................1 1.1 The Curriculum Challenge ..............................................................................................1 1.2 Clarifying Intentions, Study Purpose and the Research Questions .................................2 1.3 About Pharmacy Programs in Canada ............................................................................4 1.4 The Study ........................................................................................................................6 1.5 Significance of the Study ................................................................................................8 1.6 Researcher Background...................................................................................................9 1.7 Organization of Thesis ..................................................................................................11  CHAPTER 2: PHARMACY PRACTICE .................................................................................15 2.1 Society and the Professions ...........................................................................................15 2.2 What is a Profession? ....................................................................................................16 2.3 Sociology and Pharmacy ...............................................................................................19 2.4 A Brief History of the Professionalization of Pharmacy in Canada .............................28 2.5 Canadian Pharmacy Today, the Blueprint for Tomorrow and this Study .....................33  CHAPTER 3: PHARMACY EDUCATION .............................................................................39 3.1 Professionalization, Specialized Knowledge and Pharmacy Education .......................39 3.2 What is Curriculum? .....................................................................................................41 3.3 Conceptualizing Curriculum and Educational History .................................................46 3.4 A Brief History of Pharmacy Education and Curricula in Canada ...............................52 3.5 Pharmacy Education Today, the Blueprint for Tomorrow and this Study ....................60  CHAPTER 4: METHODOLOGY AND METHODS ..............................................................63 4.1  Why Case Study? ..........................................................................................................63 4.2 Pragmatics of the Study.................................................................................................72 Conceptual Structure of the Case Study ...................................................................72 Theoretical Framework ............................................................................................75 Study Setting and Case Context ................................................................................76 Study Participants, Recruitment and Consent ..........................................................77 Data Collection Procedures .....................................................................................80 Data Analysis and Interpretation .............................................................................88 vi  Data Management and Procedural Auditing............................................................91 Trustworthiness and Issues of Generalizability ........................................................92 Ethical Considerations .............................................................................................94 Limitations ................................................................................................................94  CHAPTER 5:  SCOPE AND DEPTH OF THE BASIC PHARMACEUTICAL SCIENCES .....................................................................................................................................................100 5.1 Historical Document Analysis ....................................................................................101 Curriculum Development Timelines .......................................................................101 The Empiricist Apprentice Curriculum...................................................................109 The Pharmacist Basic Scientist Curriculum ...........................................................111 The Pharmacist Pharmaceutical Scientist Curriculum ..........................................117 The Pharmacist Clinician Curriculum ...................................................................123 Program Enrollment and Roster Analysis ..............................................................131  CHAPTER 6: ROLE AND STATUS OF THE BASIC PHARMACEUTICAL SCIENCES .....................................................................................................................................................134 6.1  Introducing the Study Participants and Prefacing Role and Status .............................135 Congruency on What Constitutes the Basic Pharmaceutical Sciences ..................137 Pharmacy Practice Experience and Teaching Practices: Emerging Differences ..138 Congruency on the Blueprint for Pharmacy and the Future of the Profession ......142 6.2  Faculty Perspectives on Role: Growing Solitudes ......................................................143 Exploring Role With the Basic Pharmaceutical Scientists .....................................144 Exploring Role from the Clinical and Practice Faculty Perspective .....................147 6.3  Faculty Perspectives on Status: Recognition and Convergence .................................151 Status and the basic pharmaceutical scientists.......................................................152 Status and the Clinical and Practice Faculty .........................................................157  CHAPTER 7: CURRICULUM AND PEDAGOGICAL PRACTICES OF THE BASIC PHARMACEUTICAL SCIENTISTS ......................................................................................162 7.1  Curriculum and Pedagogical Practices: Exploring Broadly ........................................163 Setting the Stage......................................................................................................163 Approaches to Course Design ................................................................................166 A Closer Look at Content Selection: Exploring Issues of Scope and Depth ..........169 Use of Objectives ....................................................................................................174 Teaching Methods and Active Learning Strategies ................................................175 Assessment Practices ..............................................................................................177 7.2  Curriculum and Pedagogical Practices: Experiencing the Specific ............................179 Three Classes in a Week .........................................................................................179 Monday, 9-10am, IRC 6: Ian’s Class .....................................................................180 Wednesday, 3-4pm, IRC 2: Lindsey’s Class ...........................................................185 Thursday, 10-11am, IRC 6: Brad’s Class ..............................................................189 7.3  Chapter Summary ........................................................................................................191 vii  CHAPTER 8: WHAT HAS BEEN LEARNED, IMPLICATIONS AND CONCLUSIONS .....................................................................................................................................................193 8.1 Learning from Research Question 1............................................................................194 Broad Findings .......................................................................................................195 Findings Regarding Scope and Depth of the Basic Pharmaceutical Sciences .......197 8.2    Learning from Research Question 2............................................................................200 Findings Regarding Role and Status of the Basic Pharmaceutical Sciences .........201 8.3    Learning from Research Question 3............................................................................204   Findings Regarding Curriculum and Pedagogical Practices Pharmaceutical  Scientists ................................................................................................................ 205 8.4    Research Claims ..........................................................................................................208 8.5    Contributions to the Scholarly Literature ....................................................................210 8.6    Implications .................................................................................................................211 8.7    Conclusions .................................................................................................................221  REFERENCES ..........................................................................................................................225 APPENDIX A .............................................................................................................................250 APPENDIX B .............................................................................................................................257                 viii  LIST OF TABLES  Table 1: Some curriculum definitions from educational scholars and practitioners ....................43  Table 2: Comparison of key dimensions of curriculum ...............................................................51  Table 3: Conceptual orientations towards pharmacy education and curricula in Canada since    Confederation ................................................................................................................. 53  Table 4: Common qualitative research approaches and key interpretive questions .....................70  Table 5: Study sample characteristics ...........................................................................................81  Table 6: Faculty and curriculum review documents for UBC pharmacy programs .....................83  Table 7: The empiricist apprentice curriculum ...........................................................................112  Table 8: Curriculum and pedagogical practices of basic pharmaceutical scientists ...................164                             ix  LIST OF FIGURES  Figure 1: A view of curriculum ....................................................................................................44  Figure 2: Conceptual structure for the case study ........................................................................74  Figure 3: Theoretical framework adopted for the study ...............................................................75  Figure 4: UBC pharmacy curriculum development, 1944-1958 ................................................102  Figure 5: UBC pharmacy curriculum development, 1958-1972 ................................................103  Figure 6: UBC pharmacy curriculum development, 1972-1985 ................................................104  Figure 7: UBC pharmacy curriculum development, 1985-1997 ................................................105  Figure 8: UBC pharmacy curriculum development, 1996-2003 ................................................106  Figure 9: UBC pharmacy curriculum development, 2003-2013 ................................................107  Figure 10: The pharmacist basic scientist curriculum (UBC BSP, 1960) ..................................114  Figure 11: The pharmacist pharmaceutical scientist curriculum (UBC BSc(Pharm), 1980) .....118  Figure 12: The pharmacist clinician curriculum (UBC BSc(Pharm), 2010-2011) .....................124  Figure 13: Program enrollment data and roster analysis, 1946-2011 .........................................133                    x  LIST OF ABBREVIATIONS  AFPC – Association of Faculties of Pharmacy of Canada ADPC – Association of Deans of Pharmacy of Canada  BC – British Columbia BCMA – British Columbia Medical Association BCPhA – British Columbia Pharmaceutical Association BSc – Baccalaureate of Science BSc(Pharm) – Baccalaureate of Science in Pharmacy BSP – Bachelor of Science in Pharmacy CAHP – Canadian Academy of the History of Pharmacy CAPS – Cases in Pharmaceutical Sciences CCAPP – Canadian Council for the Accreditation of Pharmacy Programs CCPF – Canadian Conference of Pharmaceutical Faculties CPhA – Canadian Pharmacists Association E2P – Entry to Practice FPS – Faculty of Pharmaceutical Sciences HBC – Hudson’s Bay Company MSc – Master of Science MSP – Master of Science in Pharmacy NAPRA – National Association of Pharmacy Regulatory Authorities OSCE – Objective Structured Clinical Exam PEBC – Pharmacy Examining Board of Canada  PharmD – Doctor of Pharmacy PhD – Doctor of Philosophy SPEP – Structured Practice Education Program US – United States UBC – University of British Columbia WebCT Vista – Web Course Tools Vista version.     xi       GLOSSARY Community pharmacy: refers to the provision of care through neighbourhood drug stores licensed to store, dispense and sell drugs or medical devices to the public. Common community pharmacies include Canadian chain drug stores such as London Drugs®, Shopper’s Drug Mart® and Pharmasave®; sometimes referred to as corporate pharmacy.  Conceptual orientation: refers to a coherent array of overlapping and interacting dimensions, issues, and factors that help frame the complexity of curriculum. Curriculum dimensions for this study: purpose, what is taught (content knowledge), how it is taught (teaching methods), overall design and structure (with attention to coherence), and how learning is demonstrated and judged (through assessment and evaluation). Curriculum: refers to the organized delivery of a selection of content and learning experiences that is appropriate for the learning context, integrated and of increasing difficulty throughout a course or program of study, and designed to create a flexible, respectful and supportive learning environment.  Helping students to meet the objectives/outcomes for their courses and our pharmacy program and recognize their potential as individuals and professionals is central.   Depth: refers to the degree to which the fundamental principles of the basic pharmaceutical sciences should be explored in pharmacy curricula and understood by students to support contemporary shifts in pharmacy practice.  Empirical science: refers to knowledge derived from systematic observation and personal experience of the world rather than on intuition, faith, reasoning, or appeals to authority. Empirical evidence, as it is used here, is often qualitative or descriptive. Faculty: the word “Faculty” is used to denote the UBC Faculty of Pharmaceutical Sciences. The words “faculty members” or “faculty” refers to those contributing to the current BSc(Pharm) program. As appropriate, they are referred to throughout the study by various signifiers including scholars and educators, basic pharmaceutical scientists, clinical and practice faculty, scientists, practitioners, and disciplinary experts.  Galenical pharmacy: refers to methods of preparing and delivering medicines of animal, vegetable and mineral origin; galenical pharmacy has ancient roots in the history of the profession and was a common subject in pharmacy programs of the early 20th century.  xii  Ideal professions: refer to a subset of professional occupations that are recognized for their long histories and dominance in organized societies. Architecture, law, medicine and the clergy are typically cited in the sociology literature as ideal professions. Institutional pharmacy: refers to the provision of care through organized health care settings including hospitals, nursing homes, extended care facilities, and neighborhood health centers. Materia medica: means medical material and refers to the medicines of animal, botanical and mineral origin used for the treatment of disease. Materia medica has ancient roots in the history of the profession and was a common subject in pharmacy programs of the early 20th century. Materia medica monographs, found in early textbooks, typically included information on the origin, composition, appearance, use and dose of the medicine as well as the methods and standards of preparations and storage.  Pharmacognosy: is the scientific study of medicines derived from naturally occurring botanical sources and a subject often found in pharmacy programs in the first half of the 20th century.  In Canadian pharmacy programs pharmacognosy, as a curriculum subject, reached its height of importance in the late 1950s and early 1960s. Practical Pharmacy: refers to the practical laboratory exercises included in pharmacy curricula to develop the technical laboratory skills needed to prepare products made and sold in pharmacies. Practical pharmacy courses were found in pharmacy programs of the early to mid -20th century. Profession: is a subset of occupations that can be characterized by the following framework of distinctive dimensions: offering a socially necessary function, specialized knowledge, securing exclusive legal jurisdiction over their knowledge and services, intensive accredited preparation usually in universities, and norms of professional conduct including a commitment to social responsibly usually in the form of a Code of Ethics. Professionalization: refers to the process by which occupations achieve and maintain professional status articulated as a sequence of events. Professionalism: refers to the conduct, aims or qualities that characterize or mark a profession or a professional person. Professionalism is often related to the quality and standards of education and practice. Profession of Pharmacy: conceived broadly, the signifier “profession of pharmacy” encompasses many constituencies including institutional and community pharmacy practice, xiii  pharmacy education, academic pharmacy, the pharmaceutical industry as well as advocacy, regulatory, corporate and government bodies. The uses of the signifiers “profession,” “pharmacy profession” or the “profession of pharmacy” in this thesis denote a narrower grouping of constituencies that include primarily pharmacy practice, pharmacy education and academia. Broader uses of the signifiers will be indicated in the text when necessary. Role: refers to the characteristic or expected function of a person or thing in a particular setting or environment. The word role, as it is used in this thesis, refers to the expected function of the basic pharmaceutical sciences in the UBC BSc(Pharm) program. Scope: refers to the breadth or range of relevant topics that should be covered in pharmacy curricula for understanding the basic pharmaceutical sciences and understood by students to support contemporary shifts in pharmacy practice.  Status: refers to the condition or position of a thing with regard to its importance. The word status, as it is used in this thesis, refers to the importance of the basic pharmaceutical sciences in the UBC BSc(Pharm) program.                   xiv  ACKNOWLEDGEMENTS  Completing this degree program has been a very, very long haul. There have been many times I wondered whether I would make it or if I had the gas to cross the finish line. But I persevered and I could not be more proud. What an incredible ride and despite the head scratching, sweat, and cursing required, I have enjoyed every minute of it. I have loved the opportunity to engage so intensely in the courses, with the professors, in the readings and writings, and with the incredible cohort of fellow students; many have long-since graduated. Fabulous people, fabulous experiences! I feel very privileged to have had this opportunity and I can honestly say that going back to school has been one of the best decisions I have made in my life.  There are many people to thank for helping me reach this stage. First of all to my supervisors, Harry, Tony and Wayne, I thank you for your direction, encouragement and patience.  I would not have made it to this point without your tremendous help and support. It has been an absolute pleasure working with you. I would like to thank my Faculty and in particular, former Dean, Dr. Robert Sindelar and Associate Dean Academic, Dr. David Fielding for encouraging me to pursue this degree and for their tremendous support throughout. To Marion, thank you for all your time, energy, and brilliance. I look forward to doing great things in the Faculty and our pharmacy program with you in the future. To my kids, Danielle and Georgina, my parents and my sisters I say thank you and “guess what? I’m done!!” Eden, my love, you have lived and breathed every step I have taken and every word I have written. I thank you for never once doubting. To finish, thank you all for helping me become a better teacher, scholar, colleague and person. Your support and encouragement has allowed me to contribute to my Faculty and this profession in ways that would not have been possible without this journey.  xv  DEDICATION  This thesis is dedicated to all those middle-aged individuals that think they are too old to go back to school or to learn something new. I started this degree at age 50 and I am now 56. So if you have been mulling over the idea of going back to school for awhile, perhaps even years, then I say to you, find a way to do it! Buckle up for an incredible journey and as I always say to my students, “Give it everything you’ve got!”  1  CHAPTER ONE: INTRODUCTION  1.1 The Curriculum Challenge  This research study explores the role and status of the basic pharmaceutical sciences in the University of British Columbia’s (UBC) contemporary Baccalaureate of Science in Pharmacy [BSc(Pharm)] degree program.  Recognized nationally as the first entry-to-practice degree in seven of ten professional schools of pharmacy, Canadian BSc(Pharm) programs, including UBC’s, have undergone profound change in response to Canada’s increasingly complex and over-burdened public health care system (Canadian Pharmacists Association [CPhA], 2013; Faculty of Pharmaceutical Sciences [FPS], 2012). Aligning pharmacy curricula with models of professional practice that emphasize clinical education and patient-centered care has been the primary focus of BSc(Pharm) curriculum revisions (Hepler & Strand, 1990; Hubball & Burt, 2004; Jungnickel, Kelly, Hammer, Haines, & Marlowe, 2009; Perrier, Winslade, Pugsley,  Lavack, & Strand, 1995). Through nationally coordinated efforts (Association of Faculties of Pharmacy of Canada [AFPC], 2010), BSc(Pharm) curricula have been revised to reflect nationally accepted educational outcomes, increased emphasis on clinical and experiential learning and less reliance on scientific fundamentals (Cutler et al., 2009; Skau, 2007; Speedie et al., 2012). Although these curricular revisions are anticipated to help strengthen and align the profession with the health care needs of Canadians (CPhA, 2013), recently concerns have been raised regarding:  1) the diminishment of the foundational basic pharmaceutical sciences in revised curricula, and; 2) to what extent these contemporary curricula are adequate for preparing pharmacists to meet Canada’s present and future health care challenges (Campbell, 2006; Cutler et al., 2009; Skau, 2007; Woster, 2003). With little scholarly research literature investigating these issues and their impact on BSc(Pharm) programs in Canada (Austin & Gregory, 2007) and 2  none in British Columbia (BC), this study attempts to address this gap by exploring, analyzing and documenting the role and status of the basic pharmaceutical sciences in UBC’s BSc(Pharm) program. Critical insights from this study are anticipated to help inform current pharmacy curriculum reform efforts at UBC (FPS, 2012). This research is also anticipated to provide perspectives on the balance between the basic pharmaceutical sciences and clinical and experiential learning needed in the education of contemporary pharmacists in BC.  1.2 Clarifying Intentions, Study Purpose and the Research Questions  As it has many times in its long esteemed history, today the profession of pharmacy in Canada is facing critical challenges to its core identity, function and role (CPhA, 2013). Attempting to shake off the legacy of decades of technical product-orientation and dispensing focus in practice, the national “Blueprint for Pharmacy” initiative, sets out a bold vision for strengthening, realigning and reasserting the profession’s role, status and key services within the Canadian healthcare system. Coordinated by the Canadian Pharmacists Association beginning in 2007 and now endorsed by all sectors of pharmacy in Canada, the Blueprint’s long-term plan emphasizing “optimal drug therapy outcomes for Canadians through patient-centred care” (CPhA, 2013, p.6) has challenged academic pharmacy to establish the knowledge, skills and values required of Blueprint practitioners; putting patients, drug therapy and patient-centered care ahead of products and dispensing is the primary focus. Targeting 2020 as the implementation timeline, the next decade promises on-going curriculum reform within Canadian BSc(Pharm) programs to meet the Blueprint’s vision; recent commitments by the Deans of Pharmacy of Canada to implement the six-year Doctor of Pharmacy (PharmD) degree in all Canadian pharmacy schools by 2020 (Association of Deans of Pharmacy of Canada [ADPC], 2010) sets the stage for change. While nationally-accredited educational outcomes are well-3  established for Canadian BSc(Pharm) programs (AFPC, 2010) and learning-centered curriculum and pedagogical practices have significant traction in pharmacy education (Abate, Stamatakis, & Haggett, 2003; Bradberry et al., 2007; Hubball & Burt, 2004; Hymel & Foss, 1990), the content knowledge of the Blueprint pharmacist has emerged as a focus of much curriculum deliberation and reform effort (Speedie et al., 2012). Vying for attention within the knowledge domains of the Blueprint pharmacist and curricula are, among others: professionalism and social responsibility (Duncan-Hewitt, 2005); intra- and interprofessional education and cultural competency (AFPC, 2010; CPhA, 2013; Jungnickel et al., 2009); technology and informatics (Blouin et al., 2009), and; the scientific knowledge base required for contemporary pharmacy practice and education (Albon, 2010; Campbell, 2006; CPhA, 2013; Cutler et al., 2009; Skau, 2007; Woster, 2003). This study focuses on this last issue with particular attention on the basic pharmaceutical sciences, a foundational knowledge domain in BSc(Pharm) programs for 70 years. As mentioned previously, there is very little scholarly research investigating the scientific foundations of Canadian BSc(Pharm) programs to help inform or guide curriculum reform efforts in the Blueprint era (Austin & Gregory, 2007).  This study addresses this issue directly by exploring the state of the basic pharmaceutical sciences in contemporary pharmacy education in BC. Focusing primarily on understanding the present situation, the purpose of this study is to establish the role and status of the basic pharmaceutical sciences in the current UBC BSc(Pharm) program.  To what extent the basic pharmaceutical sciences have a place in the knowledge base of the contemporary pharmacist and Blueprint curricula as well as providing critical insights into what goes on in the classrooms of basic pharmaceutical scientists, represent the two main lines of inquiry. A third situates UBC’s BSc(Pharm) program historically within the broader history of pharmacy practice and education in Canada and BC. Together, these lines of inquiry provide 4  context for bringing understanding to the challenges facing the pharmacy profession, professional education and curriculum reform today. To address the study’s purpose this research is guided by the following questions: 1) What has been and what currently is the scope and depth of the basic pharmaceutical sciences in the current UBC BSc(Pharm) program? 2) What are the current perspectives, as articulated by pharmacy scholars and educators, on the role and status of the basic pharmaceutical sciences in the UBC BSc(Pharm) program? 3) What has been and what currently are the curriculum and pedagogical practices used to teach the basic pharmaceutical sciences in the UBC BSc(Pharm) program?  1.3 About Pharmacy Programs in Canada Currently there are ten university-based professional schools of pharmacy in Canada that have exclusive authority and responsibility for educating pharmacists. Evenly distributed across the country, seven out of the ten schools offer a 1+ 4 program (that is, one prerequisite year of introductory basic sciences followed by the four-year pharmacy program) leading to the BSc(Pharm) degree (Canadian Council for Accreditation of Pharmacy Programs [CCAPP], 2013).  Although pharmacy education and programs have changed profoundly since the passing of the first Canadian Pharmacy Act in 1870 (Austin & Duncan-Hewitt, 2005; Hepler, 1987), the 1+ 4 BSc(Pharm) degree program has provided the standard entry-to-practice qualifications for pharmacists in Canada for more than 50 years (Riedel & Stieb, 2001). As mentioned briefly in Section 1.2 above, there is a move nationally towards the PharmD degree as the first entry-to-practice degree by 2020 which requires an additional year of experiential training beyond the BSc(Pharm) qualifications (ADPC, 2010). Currently, pharmacy schools in Quebec (Universities of Laval and Montreal) and the University of Toronto offer the PharmD degree with 2-3 other 5  Canadian schools, including UBC, moving towards PharmD implementation (CCAPP, 2013; FPS, 2012; Koleba, Marin, & Jewesson, 2006). The entry-level PharmD degree has been mandatory in US pharmacy schools since 2000 (Jungnickel et al., 2009). Following successful completion of national board exams including both written multiple choice and performance-based assessments, pharmacy graduates can practice anywhere in Canada (AFPC, 2010). The vast majority of pharmacy graduates work either as pharmacists in local community pharmacies (e.g., Shopper’s Drug Mart®, Pharmasave®) or in institutional settings such as hospitals, nursing homes, extended care facilities, neighborhood health centers or research environments (Jones, MacKinnon, & Tsuyuki, 2005).  A key strength of the pharmacist as a member of the Canadian health care team is the scope and depth of their knowledge about drugs; that is, their unique understanding of how organic molecules known as drugs, do what they do in the treatment of disease, the management of health outcomes, and quality of life for patients (Pandit, 2007). Historically, Canadian BSc(Pharm) programs, including UBC’s, have been predominantly science-based comprising five disciplines (Skau, 2007). Medicinal chemistry (the chemical, physical and structural basis of drug properties and action), pharmaceutics (the science of drug delivery) and pharmacology (the science of drug action and toxicity) make up the basic pharmaceutical sciences, while clinical pharmacy (drug therapy, disease treatment and patient-care) and pharmacy practice (drug distribution, pharmacy management and patient care) represent the practice-oriented and experiential learning disciplines. While pharmacists today share similar general and scientific knowledge foundations with other health professions such as medicine, nursing and dentistry (AFPC, 2010; DePaola & Slavkin, 2004; Mowforth, Harrison, & Morris, 2005; Weatherall, 2006; Wolf et al., 1993), emphases on understanding how the basic pharmaceutical sciences 6  underpin therapeutic decision-making distinguish pharmacy programs amongst health professions and provide the unique scientific foundations for professional practice and education (Skau, 2007); no other entry-level health care professional has the specialized drug knowledge of the pharmacist or can make this unique claim (Speedie et al., 2012). Completion of prerequisite courses in biology, chemistry, mathematics and physics prior to admission into pharmacy programs also emphasizes the centrality of science in the education and knowledge base of pharmacists (Austin & Gregory, 2007).   In terms of program structure, generally, the early years of BSc(Pharm) curricula build basic pharmaceutical sciences knowledge while the latter years apply this knowledge in the practice-oriented disciplines of clinical pharmacy and pharmacy practice. Experiential learning in off-campus institutional and community practice settings becomes increasingly predominant towards the end of BSc(Pharm) programs. Austin and Gregory (2007) have aptly described this building blocks approach to BSc(Pharm) curriculum design as follows: “as it is necessary to learn to walk before one can run, it is equally necessary to understand science before one can apply it in a clinical context” (p. 615). While there has been significant learning-centered curriculum reform (Hubball & Burt, 2004), the discipline-based, building blocks structure of Canadian BSc(Pharm) programs remains a common characteristic of pharmacy education and curricula today (Duncan-Hewitt & Austin, 2005). The heritage of this structure dates back to the pharmacy programs of the late 19th and early 20th century in Canada and to the mid-1940s in UBC pharmacy programs (Raison, 1967; Reidel & Steib, 2001).  1.4 The Study  The purpose of this study is to investigate the scientific foundations of UBC’s current BSc(Pharm) degree program with particular attention to the basic pharmaceutical sciences. 7  Underpinned by Hubball and Burt’s (2004) theoretical framework for learning-centered curricula and framed by three research questions, this study seeks to open up complicated conversations (Pinar, 2004) about curriculum, curriculum content and the challenging work of establishing the role the basic pharmaceutical sciences did, should, and might continue to play in the knowledge base of UBC’s pharmacy graduates. Equally important is understanding the status of the basic pharmaceutical sciences and how current perspectives on their value and importance might provide insight and guidance regarding curriculum decision-making and reform efforts.  Employing research methodology focused on in-depth exploration of the research questions, the study design converges historical context with contemporary views of pharmacy scholars and educators and first-hand knowledge of the teaching practices of basic pharmaceutical scientists to address its purpose. Not only does this study provide a unique opportunity for critical examination of the basic pharmaceutical sciences in UBC’s BSc(Pharm) program, it offers a window into what actually happens in the classrooms of basic pharmaceutical scientists, something that is currently missing in the research literature.  The knowledge gained is anticipated to help: 1) inform current strategic planning and curriculum deliberations about UBC’s BSc(Pharm) program; 2) provide insights and perspectives on the role and status of the basic pharmaceutical sciences as well as the science-practice balance in the program, and; 3) bring understanding to internal Faculty and curriculum dynamics that affect curriculum change. More generally, this study is an attempt to address the Blueprint for Pharmacy’s challenge to academic pharmacy regarding curriculum revision. At its heart, it is about advocating scholarly, contextualized and evidence-based approaches to curriculum decision-making that align closely with contemporary thinking and research-based approaches to post secondary curriculum reform (Blouin et al., 2009; Hubball & Gold, 2007; Weiman, 2007). 8   Pragmatically, a theoretical empirical inquiry using Stake’s (2010) qualitative intrinsic case study approach was designed and conducted to address the purpose of the study and answer the research questions. The study’s case is the current UBC BSc(Pharm) program. The study took place between March 15, 2011 and March 15, 2012 in the George T. Cunningham Building, home of the UBC Faculty of Pharmaceutical Sciences since 1960, and the lecture halls in UBC’s biomedical library where much of the large-class teaching (for 150 plus students) in the program takes place. Twenty three faculty members participated in the study (approximately 40% of the current faculty roster) including thirteen basic pharmaceutical scientists. Representing all academic ranks, academic disciplines and appointment types (full-time, part-time and emeritus), the study sample drew from over 60 years of experience and Faculty history11.5 Significance of the Study . Data collected about the case included semi-structured interviews, classroom observations of basic pharmaceutical scientists, and document analyses. Constant comparative analysis was used to examine connections between the historical context, perspectives and opinions of study participants and the classroom practices of the basic pharmaceutical scientists. The use of multiple data sources helped establish trustworthiness of the research findings through triangulation. Finally, throughout the study the researcher kept a detailed journal of field notes and reflections on issues raised and opinions expressed.   Demands on the Canadian health care system today are the basis of current national efforts to realign pharmacy’s professional role and review BSc(Pharm) curricula (CPhA, 2013; Dolovich, 2012). Examining the scientific foundations of contemporary pharmacy education and                                                  1 For the purposes of this study “faculty members” or “faculty” are considered all the contributors to the current BSc(Pharm) program. As appropriate, they are referred to throughout the study by various signifiers including scholars and educators, basic pharmaceutical scientists, clinical and practice faculty, scientists, practitioners, and disciplinary experts. The word “Faculty” is used to denote the UBC Faculty of Pharmaceutical Sciences. These definitions have been included in the Glossary. 9  the science-practice balance in BSc(Pharm) curricula is emerging as a key issue that has shaped and will continue to shape pharmacy education and professional practice (FPS, 2012; Skau, 2007; Speedie, 2012).  This study will not only attempt to add to the scant pharmacy education literature exploring, analyzing and documenting the role and status of the basic pharmaceutical sciences in pharmacy education but appears timely in terms of the important issues facing the profession and professional education nationally. Focused on UBC’s BSc(Pharm) program, this case study represents the first of its kind on this program and the teaching practices of the Faculty’s basic pharmaceutical scientists. It is anticipated that critical insights from this study will situate the UBC BSc(Pharm) program in the broader context of pharmacy educational change in Canada, and inform scholarship, curriculum reform efforts and pedagogical practices regarding the basic pharmaceutical sciences in pharmacy education at UBC. This study will also attempt to provide perspectives on the present and future role and status of the basic pharmaceutical sciences in contemporary pharmacy education and professional practice in BC and Canada.   1.6 Researcher Background  As of August 2013, I had been teaching in the UBC BSc(Pharm) program for 26 years; I have recently been inducted into UBC’s Quarter Century Club, the ceremony taking place on November 13, 2012. My academic background, completed at UBC, is in the natural sciences, including a Baccalaureate of Science (BSc) in general and a Master of Science (MSc) in organic and analytical chemistry. I think of myself as a medicinal chemist and science educator. My primary role has been teaching medicinal and analytical chemistry in Years 1 and 3 of the BSc(Pharm) program. I am not a pharmacist and wonder regularly how my understanding and approach to education and teaching would change if I were. I joined the Faculty as a Lecturer in 10  1986 and was tenured as a Senior Instructor in 1994. Since I joined the Faculty I have immersed myself in all things teaching and learning. I have a diverse array of curriculum development, course design, and teaching experiences as well as a keen interest in the scholarship of teaching and learning. I have published my work, presented extensively at local, national and international meetings, and received substantial grant funding to support my scholarly activities. I am also an award winning teacher receiving Faculty, university, and national teaching awards. At the national level, I spent nine years as a member of the Association of Faculties of Pharmacy of Canada, the professional organization representing academic pharmacy in Canada, including its president in 2007-2008. I am currently the Acting Associate Director of our Faculty’s Office of Educational Support and Development. Although my career has had many ups and downs I feel great privilege and satisfaction to be able to do the work I do in the Faculty and feel supported and respected. I have grown up in this Faculty and care deeply about the pharmacy program, our students, and the profession.  I am also a science lover. I have developed an incredibly deep connection with the science I teach and how weird little organic molecules called drugs do what they do in the ways they do it. I find the basic pharmaceutical sciences fascinating and have come to appreciate just how profoundly scientific pharmacy and drug therapy is. While I personally do not advocate for drug therapy preferring non-drug or live-style change options whenever possible, I do believe, today more than ever, there is a need for health professionals that have expert knowledge of the natural sciences, human biology, how drugs work and how to manage drug therapy. Currently only pharmacy programs offer this in-depth knowledge about drugs and the basic pharmaceutical sciences form much of the scientific foundation of this knowledge. As a long time medicinal chemist I have witnessed the changes in our pharmacy curricula and the continued diminishment 11  of the scientific foundations of the program. While this trend is concerning, what and how much of the basic pharmaceutical sciences is needed in contemporary curricula is a matter of intense debate (Rosenthal, Austin, & Tsuyuki, 2010; Skau, 2007). In my view, this Faculty needs to think more collectively and critically than it has about the knowledge base of the Blueprint for Pharmacy’s envisioned practitioner (the medication therapy expert) and what role the basic pharmaceutical sciences might play in that knowledge base, if any (CPhA, 2013). While I am well-placed to engage in this work I am under no delusion that the basic pharmaceutical sciences will or should remain part of the specialized knowledge base of the pharmacist or in pharmacy curricula; the basic pharmaceutical sciences may have to go the way of compounding and the apothecary. What I would like to know however, is that if curriculum changes are needed, they have been made from a scholarly research-based perspective. I feel that opening up this conversation is embodied in this research study and represents the start of the next phase of my pharmacy career. I am excited about the possibilities. As I have engaged in this research project I have been particularly mindful and reflexive of how my experiences, opinions, insights and biases could impact this study. To address this possibility I have used extensive data triangulation in my analyses, engaged study participants in member checking activities, and verified my findings through independent analysis and data auditing.  1.7 Organization of Thesis This thesis is organized into 8 chapters. Chapter 1 has provided an overview of the study in light of the challenges facing contemporary pharmacy practice and education today. Its purpose, research questions, and significance along with the site of the study, the UBC BSc(Pharm) program, the study outline and my background as researcher have been described.  Chapter 2 begins the literature review by exploring professions with a specific focus on 12  pharmacy. Through an examination of what a profession is and how sociological theories have helped characterize them, a brief history of the professionalization2                                                 2 The definition of “professionalization” adopted for this study can be found in the Glossary.  of pharmacy in Canada will be presented. Key to this historical account is the critical internal and external pressures that have shaped the profession historically and continue to generate urgency today. Chapter 2 also situates this study in the complex pharmacy practice landscape and foregrounds the corresponding examination of pharmacy education in Chapter 3. Building on Chapter 2, Chapter 3 examines how the professionalization of pharmacy in Canada has impacted pharmacy education and curricula. More specifically, Chapter 3 introduces the specialized knowledge that distinguishes pharmacists and pharmacy education amongst health professions and then follows with a broader examination of the complexities of curriculum that underpin this study. Perspectives on what curriculum is and the approach to developing the subsequent history of pharmacy education in Canada are explored. Key to this historical account, which focuses on the role that science and the basic pharmaceutical sciences have played, is the notion of a conceptual orientation towards curriculum; a construct that attempts to capture curriculum complexity in a framework of dimensions for analyzing and interpreting how curriculum is conceived and enacted.  Chapter 3 finishes by clarifying the intentions of this research study and bridging both Chapters 2 and 3 with the study methodology and methods developed in Chapter 4. Designed as a theoretical empirical case study of UBC’s current BSc(Pharm) program, Chapter 4 begins with an exploration of the field of educational research in an attempt to locate theoretical empirical inquiry within it and construct an argument as to why Stake’s (2010) qualitative intrinsic case study approach employing multiple data collection methods was an appropriate methodological choice. The chapter then continues by describing the study pragmatics. The conceptual structure of the study and the theoretical framework used to guide data collection will be presented. 13  Descriptions of the study setting, its participants and the methods used to collect, manage and analyze the data collected are included. The chapter concludes with comments on issues of trustworthiness, ethical considerations and limitations of the study. Chapters 5, 6 and 7 present the results of the study. Chapter 5 attempts to answer research question one by examining what has been and what currently is the scope and depth of the basic pharmaceutical sciences in the current UBC BSc(Pharm) program. Curriculum development timelines resulting from the historical document analyses of pharmacy education in BC and at UBC since Confederation, are used to situate the current BSc(Pharm) program historically. Through meta-analysis of the curriculum development timelines, pharmacy curricula representative of distinctive conceptual orientations towards pharmacy education provide the basis for: 1) examining the development of pharmacy education at UBC; 2) whether or not these changes aligned with the broader historical changes in pharmacy education in Canada, and; 3) how the emphases on science and the basic pharmaceutical sciences in pharmacy education at UBC have been impacted. Roster analysis and program enrollment information are included as additional indicators of changing perspectives and emphases. Chapter 6 answers research question two by providing the results of interview analyses with a broad sample of faculty regarding the role and status of the basic pharmaceutical sciences in UBC’s current BSc(Pharm) program. The chapter begins by introducing the study participants including their views on what the basic pharmaceutical sciences are, practice experience and its impact on teaching, and the future of the profession. The chapter finishes with the study participant’s perspectives on the role and status of the basic pharmaceutical sciences in the current program. As key working parts of the case their voices as scientists, practitioners, scholars and educators explore the importance of science and the basic pharmaceutical sciences in the program, the extent to which these sciences have a place in the knowledge base of the 14  contemporary pharmacist and the inherent tensions associated with curriculum deliberation, reform and optimization. Chapter 7 focuses specifically on the basic pharmaceutical scientists. It attempts to answer research question three by exploring the curriculum and pedagogical practices of those responsible for teaching the basic pharmaceutical sciences in the BSc(Pharm) program. Presented in two parts, the chapter begins with a broader examination of the curriculum and pedagogical practices of the basic pharmaceutical scientists developed through interview and course document analyses. Focused on the study’s theoretical framework of curriculum dimensions, approaches to course design and teaching practice are presented and discussed. The chapter finishes by describing “Three Classes in a Week,” a closer look at how the basic pharmaceutical sciences are taught through first-hand accounts of classroom experiences. The intent of Chapter 7 is to provide a sense of the curriculum and pedagogical practices used to design and teach the basic pharmaceutical sciences courses in the program, the scientific content currently taught and the basic pharmaceutical scientists responsible for their designing and teaching. The chapter finishes with a brief summary. Chapter 8 completes this thesis by revisiting results Chapters 5, 6 and 7 to examine what has been learned about the case. The chapter’s focus is discussing the major claims that have emerged from this study, their implications for practice, policy and future research, and the conclusions that have been drawn.          15  CHAPTER 2: PHARMACY PRACTICE  The intent of this chapter is to explore the key issues that have shaped and continue to shape pharmacy practice in Canada, situate this study in the complex landscape of pharmacy practice historically and foreground the corresponding examination of pharmacy education in Chapter 3. Through an examination of what a profession is and how sociological theories have helped characterize and explain the development of professions in society, a brief history of the professionalization of pharmacy in Canada will be presented. Key to this historical account, which presents three broadly overlapping eras of pharmacy practice since Confederation, is the explication of critical internal and external pressures and stresses that have shaped the profession historically as well as those generating a sense of urgency within the profession today. The current pan-Canadian project, “The Blueprint for Pharmacy,” a national initiative to strengthen and realign the profession’s social responsibility and scope of practice with the health care needs of Canadians, other health professions and the health care system, will be introduced as indicative of continuing professionalization efforts. It is hoped that once readers have finished this chapter they will have a sense of the historical development of pharmacy in Canada, the issues that have driven and continue to drive the professionalization process today, the timeliness and significance of this study, and what is to come in Chapter 3.  2.1 Society and the Professions In Canada, as elsewhere, professions and professionals are an integral part of a functioning society responsible for running many of society’s major institutions and completing much of society’s business (Abbott, 1988; Almarsdóttir, Kaae, & Traulsen, 2014; Bissell & Traulsen, 2005; Schön, 1983). In the words of Donald Schön (1983), “we look to professionals for the definition and solution to our problems, and it is through them that we strive for social 16  progress” (p. 3). The prevalence and importance of the professions and the particular kinds of work professionals perform is captured succinctly by Andrew Abbott (1988): “[t]he professions dominate the world. They heal our bodies, measure our profits, save our souls” (p.1). In return, society grants professional occupations and professionals “extraordinary rights and privileges” (Schön, 1983, p. 4). Along with prestige, social status, high remuneration and autonomy, professions and professionals are given authority for social control, deciding who can enter the profession, self-regulation, and establishing programs and standards of education, training and professional practice (Abbott, 1988; Bissell & Traulsen, 2005; Larson, 1997; Macdonald,1995; Schön, 1983; Wilensky, 1964). Few occupations are given the rights and freedoms of professionals and although many occupations have sought professional status few have succeeded (Abbott, 1988; Bissell & Traulsen, 2005; Larson, 1997; Wilensky, 1964). The profession of pharmacy, as one of many well-established and long-standing health professions, plays an important and critical role in the safe and effective distribution and use of the drugs and medications required to meet the health care needs of Canadians. Like most occupations seeking professional status, the process of professionalizing pharmacy is characterized by a long and tumultuous history that continues today (Almarsdóttir, Kaae, & Traulsen, 2014; Beales & Austin, 2006; CPhA, 2013). As developed next, the literature on the sociology of professions provides particularly useful perspectives and frameworks for examining the sustained and almost herculean campaign required by practitioners, activists and political advocates to establish and maintain professional status in society.  2.2 What is a Profession?   Although the notion of a profession has a long esteemed history with medieval and in some cases ancient origins (Abbott, 1988; Kremers & Urdang, 1976), the professions, as the 17  occupations we recognize today, have emerged much more recently. For example, the “learned” occupations of divinity, law, and medicine, referred to in the sociology literature as the ideal professions due to their long histories and dominance in organized societies (Abbott, 1988; Gidney & Millar, 1994; Larson, 1997), have only acquired professional legal status in both Europe and North America since the 1800s. Like medicine, pharmacy is another important although less studied health care occupation. It has a history that parallels the development of western philosophy and roots that extend back over 6500 years to early healing practices and writings of the Babylonians, Assyrians and Egyptians (Ceresia & Brusch, 1955; Dove, 2011; Fullerton & Enves, 1951; Kremmers & Urdang, 1976; Thompson, 1929). Pharmacy received professional legal status in Britain in 18683 and Canada in 1870 4                                                 3 The Pharmaceutical Society of Great Britain was established in 1841. It was granted a Royal Charter in 1843 and became the Royal Pharmaceutical Society of Great Britain later, in 1988. Soon after the original formation of the Society, there were calls to restrict the right to practice pharmacy to those who were specially licensed to promote professional standards of training and to establish controls on the sale of drugs. These calls led to the passing of the Pharmacy Act 1868 which introduced a list of drugs, including opium, which could be sold only by ‘pharmaceutical chemists’. Apart from the restrictions imposed by the 1868 Act, there was no legislative control of opiate drugs in the United Kingdom until 1916 (Dove, 2011).  with the passing of their first Pharmacy Acts. Yet despite longevity and importance of professions in western societies defining what constitutes a profession and what distinguishes them from other occupations has been problematic; many of the definitions remain nuanced and contested (Abbott, 1988; Bissell & Traulsen, 2005; Larson, 1997, Macdonald, 1995; Schön, 1983). Sociologists of the often-studied ideal professions have defined them sparsely as “organized bodies of experts who apply esoteric knowledge to particular cases” (Abbott, 1988, p. 4) or occupations based on “formally rational abstract utilitarian knowledge” (Macdonald, 1995, p. 1). Larson (1997), with her primary focus on medicine and law, provides a broader definition suggesting that “professions are 4 The practice of pharmacy was largely unregulated in Canada until after Confederation in 1867; Ontario, Quebec, New Brunswick and Nova Scotia were the first confederated provinces. Pharmacy Acts were passed in Quebec (1870), Ontario (1871), Nova Scotia (1876) and New Brunswick (1884) establishing legally recognized Associations or Colleges authorized to regulate pharmacists and the practice of pharmacy in each province. Association and College duties typically included registering practitioners, setting standards of practice and education, establishing a Board of Examiners and administering licensure examinations (Raison, 1967). 18  occupations with power and prestige…[and that] society grants these rewards because professions have special competence in esoteric bodies of knowledge linked to central needs and values of  the social system, and…to service of the public, above and beyond material incentives” (p. x). The literature from teacher education on professionalism5                                                 5 The definition of “professionalism” adopted for this study can be found in the Glossary (American College of Clinical Pharmacy, 2009).  and professionalization share many of these definitional characteristics with the ideal professions (Clarke, 2001; Clarke & Ericson, 2003; Hargreaves, 2000). Donald Schön (1983), through his studies of practicing architects, psychotherapists, engineers, planners and managers, broadens these definitions further by recasting the professions not as occupations based on esoteric knowledge but ones based on tacit knowledge and professional action comprising distinctive, reflective and practical judgment. While a unifying definition remains elusive and the debates continue (Bissell & Traulsen, 2005), several key dimensions of these definitions appear common and serve to distinguish the professions from other occupations: offering a socially necessary function, specialized knowledge, securing exclusive legal jurisdiction over their knowledge and services, intensive accredited preparation usually in universities, and norms of professional conduct including a commitment to social responsibly usually in the form of a Code of Ethics. Of these distinctive dimensions, two seem particularly important: specialized knowledge and social responsibility. For the former, the more abstract and intellectually out of reach the profession’s knowledge base is from the public, the more likely the profession will be able to secure long term jurisdictional claim against competing professions, maintain control over professional preparation, and solidify its role and legal status in society (Abbott, 1988). Regarding the latter, adopting norms of professional conduct in which the needs of the citizenry supersede personal gain appear crucial for persuading society (the general public, governments  19  and professional governing and advocacy bodies) of the continuing need for their professional services (Macdonald, 1995). Although the literature on the sociology of pharmacy is scant compared with the ideal professions or teacher education (Bissell & Traulsen, 2005; Hepler, 1987; McCormack, 1956; Savage, 1994; Thorner, 1942; Wilensky, 1964), this framework of distinguishing dimensions has been used to establish pharmacy’s role and status as a profession historically including in Canada (Beales & Austin, 2006). It also forms the basis of the definition of a profession used in this study and the sociological analyses of pharmacy that follow. Before continuing it is important to note that conceived broadly, the “profession of pharmacy” encompasses many consistencies including institutional and community pharmacy practice62.3 Sociology and Pharmacy , pharmacy education, academic pharmacy, the pharmaceutical industry as well as advocacy, regulatory, corporate and government bodies (ADPC, 2010; Wolf et al., 1993). The uses of the signifiers “profession,” “pharmacy profession” or the “profession of pharmacy” in the sociology literature, the contemporary pharmacy education literature, and in the analogies developed below denote a narrower grouping of constituencies that include primarily pharmacy practice, pharmacy education and academia (ADPC, 2010). Broader uses of the signifiers will be indicated in the text where necessary. Sociologists have long been interested in the professions although their systematic study did not begin until the 1930s (Abbott, 1988; Bissell & Traulsen, 2005; Larson, 1997; McDonald, 1995). Reaching prominence in the Industrial Revolution era (particularly post-1830s), antecedents to contemporary professions emerged as loosely, yet hierarchically, organized groups of learned individuals (mostly university educated men conversant in Latin, Greek and                                                  6 The definitions of “institutional” and “community” pharmacy adopted for this study can be found in the Glossary.  20  contemporary literature) and freelance practitioners (educated through apprenticeship) that were well-connected with the social elites (Abbott, 1988; Larson, 1997). Within the new and rapidly growing commercial and industrial market place of the time, these gentlemanly professions7 Many professionalization theories have been developed, each based on a distinct vision of society and the contextual factors influencing occupations that aspire to professional status. Different, competing and hotly contested worldviews and theoretical paradigms of thought about how society assembles, operates and coheres, and how physical and perceived social structures influence and pattern human agency or vise versa underpin these theories (Abbott, 1988; Bissell & Traulsen, 2005; Larson, 1997; Macdonald, 1995). While much sociological theorizing about the professions has been based on the ideal professions, primarily through case study research completed in Europe and the influential Chicago School of Sociology (Becker, 1999; Hamel,  were distinctly out of step with the principles of scientific management that permeated societal transformation and the capitalist industrial workplace (Taylor, 1911). For social theorists interested in developing explanatory theories for the organization and cohesion of industrialized societies and the impact of industrialization on citizens, the professions were an anomaly in need of study (Abbott, 1988).  Much of our understanding of contemporary professions has been derived from sociological theories of professionalization; that is, the many perspectives on how these gentlemanly occupations established and maintained their professional role and status within competitive marketplace economies (Abbott, 1988; Bissell & Traulsen, 2005; Gidney & Millar, 1994; Larson, 1997; Macdonald, 1995). Appreciating the challenges and value of sociological research and theorizing requires a sense of just how complex the landscape is in which professions like pharmacy emerge, exist and continue to operate (Almarsdóttir, Kaae, & Traulsen, 2014).  One version of this complex landscape is provided next.                                                  7 These professions were referred to as “gentlemanly” due, in part, to the exclusion of women (Dove, 2011). 21  Dufour, & Fortin, 1993; Hughes, 1945, 1963), pharmacy, by comparison, has received only limited sociological attention (Denzin & Mettlin, 1968; Hepler, 1987; McCormack, 1956; Savage, 1994; Thorner, 1942; Wilensky, 1964). Bissell and Traulsen (2005) in their recent book Sociology and Pharmacy Practice openly acknowledge this and suggest that “pharmacy has always had an important…social role within the healthcare division of labour, and, as such,…[could benefit greatly from] the sociological imagination” (p.3).  For these authors, health and illness are important social phenomena that influence the nature of social structure, the relationship between individuals and society, and society’s historical development.  In western societies, like Canada, the perceptions and management of health and illness along with health care practices are embedded in a complex web of physical and ethereal structures and relationships that shape and influence the way societies organize, self-identify and citizens live. Canada’s publicly funded healthcare system, warts and all, is woven into the fabric of Canadian society, the individual life experiences of Canadians and distinguishes Canada in the world (CPhA, 2013). In the context of pharmacy practice, taking medication, responding to the pharmacist’s advice and the pharmacist-patient relationship all impact the patient’s and pharmacist’s identity, sense of self and state of health (Kassam, Volume-Smith, & Albon, 2008). In addition, pharmacists work within local intra- and interprofessional healthcare teams requiring maintenance and negotiation of relationships with a range of healthcare professionals and institutional organizations, structures and policies. Broadening this view further, the conflicts between private and public healthcare services, societal trends, and the ideologies and fiscal constraints of local, national and international governments complicate this picture. As Bissell and Traulsen (2005) attest “the practices of pharmacists, the use of medicines by patients, interactions between pharmacists, patients [and other healthcare professionals], and the [local, 22  national and international] organizational and institutional structure of pharmacy services are all areas ripe for sociological analysis” (p. 4). It is in attempting to examine and bring understanding to the nature of this complex landscape that sociological theorizing has value. Sociological theories of professionalization, in particular, have helped shed light on the issues that have shaped and continue to shape the profession of pharmacy (Almarsdóttir, Kaae, & Traulsen, 2014). The literature on the sociology of professions is vast. What follows is an analysis of the sociological literature on pharmacy.  Sociology, a term coined in the 1830s by Auguste Comte (often referred to as the father of positivism), has been referred to as the science of society which studies the contexts in which individuals live and work, the social forces that act upon them within those contexts and how they, as individuals, contribute to and modify those contexts (Bissell & Traulsen, 2005). As exampled above, a cursory application of the sociological imagination to the practice of pharmacy situates the pharmacist in the complex web of interactions, relationships and structures that embody the maintenance of health and management of illness in society. The sociological study of professions like pharmacy owes much of its theoretical roots to the philosophies of Emile Durkheim, Max Weber and Karl Marx (often referred to as the fathers of sociology) and to the broad social theories of functionalism and social action including symbolic interactionism8                                                 8 Sociological theories based on social action focus on the meaning of action and interaction among individuals to attempt to explain how society develops, coheres and functions. Symbolic interactionism, a highly developed example of the social action perspective, sees society as a product of continuous face-to-face interaction among individuals in different settings. The symbol is something that meaningfully represents something else (ie., a written or spoken word, a gesture, or a sign ). The interaction refers to the ways two or more people respond to one another. Developed in the 1930s, symbolic interactionism focuses on the processes by which people interpret and respond to the words and actions of others and studies the way social structures, as patterns of behaviour, arise out of these processes (Bissell & Traulsen, 2005).  . Contemporary professions literature (influenced by the fathers of sociology to different extents) also includes feminist, race and ethnicity, Foucaultian, and risk theory perspectives (Bissell & Traulsen, 2005; Macdonald, 1995). Each of these perspectives brings a different worldview to 23  the study of society that reflects to varying degrees, the importance of structural systems and human agency in their vision of the nature of society. Each theoretical perspective or lens provides different epistemological understandings and knowledge about the society or context under study. For the purposes of the sociological examination of pharmacy, only functionalist theories will be explored. While this approach is potentially deterministic and may limit trustworthiness of the arguments developed (Mathison, 1988), much of the present understanding of issues that have shaped and continue to shape pharmacy can be traced to functionalist research and a systems view of society. Some of the only systematic studies of pharmacy were in this tradition (Bissell & Traulsen, 2005; Hepler, 1987; McCormack, 1956; Savage, 1994; Thorner, 1942; Wilensky, 1964) and much of the theoretical basis of the pharmaceutical care movement in the 1990s, a time of radical change in both pharmacy practice and education in North America, appears to be grounded in functionalist sociology (Hepler, 1987; Hepler & Strand, 1990). Social action theories, with their Weberian focus on human agency, human protagonists and power theories in the shaping of society, has a valuable contribution to make to an understanding of the professionalization of pharmacy but has only been developed for the ideal professions, specifically medicine (Larson, 1997). Based on Raison’s (1967) centennial project celebrating Canada’s 100th anniversary in 1967 which documents both the history of pharmacy across the country and the role and persistent actions required of pharmacy leaders of the time to establish and maintain the profession provincially and nationally, it is hard to argue against the importance of human agency in the history of Canadian pharmacy.  Presented next is an examination of functionalist perspectives on the professionalization of pharmacy.  Functionalism, which dominated sociological thinking about the role of professions in society from the 1930s to the 1960s, can be traced to the positivist orientations and social 24  theories of Comte and Durkheim (in France) but was systematically developed by Harvard sociologist Talcott Parsons through the study of medicine (Abbott, 1988; Bissell & Traulsen, 2005; Gauthier & Boisseau, 2009; Macdonald, 1995). Parsons’ functionalist perspective viewed society as a system of interrelated parts (or structures) with each part contributing to the cohesion and vitality of the system; a metaphor aligned with the natural sciences view of a biological organism. Like Durkheim, Parsons’ felt the professions fulfilled a critical function in society (hence the name functionalism) embodying the eufunctional characteristics and social forces by which a stable and progressive social system is maintained. Up to the end of the 1960s much of the mainstream functionalist research and writings on the professions was concerned with identifying essential traits of an ideal profession. Based on the traits exhibited by medicine in particular, functional traits analysis was used to classify other occupations on a scale of professionalism. The Guttman scale of professionalism was an attempt to operationalize functional traits analysis of occupations (Abbott, 1988; Bissell & Traulsen, 2005; Macdonald, 1995). Some of the early sociological studies on pharmacy were of this nature leading to a classification of pharmacy as a marginal profession (McCormack, 1956; Thorner, 1942), a fate suffered equally by chiropractics (Wardwell, 1952). The marginal status for pharmacy was due primarily to the highly technical nature of pharmacy services as well as the inherent conflict between business practices of the independent pharmacy owner and social responsibility of the pharmacist to the paying public. The key distinguishing dimensions of professions presented earlier in Section 2.2 (i.e., offering a socially necessary function, specialized knowledge, securing exclusive legal jurisdiction over their knowledge and services, intensive accredited preparation usually in universities, and norms of professional conduct including a commitment to social responsibly usually in the form of a Code of Ethics) appear founded in this early 25  sociological work on the professions and specifically for pharmacy. Interestingly, the characterization of pharmacy as a marginal profession has been an ongoing insecurity as well as an important developmental dynamic in the history of the pharmacy profession (Buerki, 1999; Jungnickel et al., 2009). Pharmacy’s ongoing claim to professional status, seriously challenged in 1915 by Abraham Flexner, the individual largely responsible for transforming medicine into the most influential and respected profession in 21st century North America (Campbell, 2006), and then again through the sociological studies of the 1940s (Thorner, 1942), 1950s (McCormack, 1956) and 1960s (Denzin & Mettlin, 1968), continues to be haunted by the stubborn stigma as a marginalized profession amongst the professional work of pharmacy visionaries today (Jungnickel et al., 2009; Svensson et al., 2012). In the British Columbian context, Dove (2011) describes two such challenges to the professional role and status of pharmacy. The first, in 1929, which focused on the technical nature of pharmacy services, saw the BC legislature attempt to “[re]classify pharmacy as a trade and place it under the minimum wages law” (Raisin, 1967, p. 35).  The second, in the 1960’s, emerged from growing concerns from governments and the public that saw “pharmacists as ‘counters and pourers’ …rais[ing] the question: Are pharmacists professionals or merely technicians?” (Dove, 2011, p. 84). While both were resolved in favour of the profession each had, and continues to have, significant impact on the history, future and self-perception of the profession in the province (Austin, 2013; Rosenthal, Austin, & Tsuyuki, 2010).  Fifty years on, the “Blueprint for Pharmacy,” the current pan-Canadian initiative to solidify pharmacy’s core role and services in the provision of health care to Canadians (CPhA, 2013), could be viewed as the latest measure to advance the professional status of pharmacy within the Canadian health care system. This issue will be explored further in Section 2.5 below. 26  Also studied extensively during this time was how various occupations became legally recognized professions, a process called professionalization (Wilensky, 1964). Although there were many theories of professionalization proposed (Abbott, 1988; Gauthier & Boisseau, 2009; Larson, 1997; Macdonald, 1995), most articulated this process as a sequence of events. Wilensky’s (1964) classic study, “the professionalization of everyone” (p. 137), organized the dates of first events in the histories of 18 American professions, including pharmacy, finding that professionalization could be described as a series of five stages through which an occupation had to pass to achieve professional legal status. Although not always followed sequentially, the stages of professionalization (which closely resemble the distinguishing dimensions of a profession) included: engaging in the occupation as full time employment, establishing a training school often within a university setting, forming a professional association, agitating politically for legal status and jurisdictional claim, and establishing a code of professional ethics (Abbott, 1988; Wilensky, 1964). Importantly, Wilensky’s model also acknowledged the constant struggle for jurisdictional claim by professions against closely related professions and occupations following professionalization; a point emphasized across the professions literature and exampled by the external challenges to the pharmacy profession mentioned earlier (by Flexner, the functionalist studies on pharmacy and in BC). What Debra Savage (1994) has called “border skirmishes” (p.141) between the professions, Andrew Abbott (1988) claims is the central phenomena of professionalization and professional life: the competition between professions and occupations for jurisdictional claim to a profession’s specialized knowledge and services. According to Abbott’s (1988) model, which Macdonald (1995) suggests has functionalist roots,  each profession is bound to a set of tasks by ties of jurisdiction, the strengths and weaknesses of these ties being established in the processes of actual professional work. Since none of these links is absolute or permanent, the professions make up an interacting system, an ecology. Professions compete within this system, and a 27  profession’s success reflects as much the situations of its competitors and the system structure as it does the profession’s own efforts. From time to time, tasks are created, abolished, or reshaped by external forces, with consequent jostling and readjustment within the system of professions (p.33).  The issue of jurisdictional claim is particularly relevant to pharmacy profession in Canada today and will be discussed again later in this chapter (Section 2.5).  While functionalist theories were harshly criticized for their systems view of society, the privileged position of professions as well as for neglecting human agency in the shaping of professions and society, functionalist traits and professionalization theories do provide valuable frameworks for distinguishing professions amongst occupations. They also help us understand the internal (i.e., factors influencing the distinguishing dimensions of a profession and the professionalization process) and external (i.e., addressing the needs of society and jurisdictional competition) issues to which occupations must respond to achieve and maintain professional status (Abbott, 1988; Beales & Austin, 2006; Gauthier & Boisseau, 2009; Larson, 1997). Rather surprisingly, although many of the studies and arguments cited above are decades-old many of the issues raised, particularly regarding pharmacy’s self-perception and the persistent stigma as a marginal profession, are still applicable to the profession today (Austin, 2013; Dove, 2011; Jungnickel et al., 2009; Rosenthal, Austin, & Tsuyuki, 2010; Speedie et al., 2012; Svensson et al., 2012). In the next section the professionalization of pharmacy in Canada will be briefly reviewed with particular attention to the functionalist framework just described. The reader should be aware that although additional footnotes have been added to the history for more in-depth exploration, the section can be read with or without them. 28  2.4 A Brief History of the Professionalization of Pharmacy in Canada     The history of pharmacy in Canada9 has been documented back to the 16th and early 17th centuries, particularly in Eastern Canada, to the arrival of colonial explorers from Britain and France (Martin, 1954; Raison, 1967). While the two countries competed vigorously for control of the territory and commodities, particularly the lucrative fur trade, of the central, eastern and maritime regions of the country10, the exploration and settlement of western Canada and the subsequent spread of pharmacy across the country has been attributed largely to the economic expansion of the Hudson’s Bay Company11 (HBC) (Cameron, 1993; Martin, 1954). Based initially out of York Factory (in 1670) and then Fort Churchill (in 1717) on the south west shores of Hudson Bay, by the early 1800s the HBC had established trading posts and supply routes along the country’s major river systems to the foot of the Rocky Mountains in the south and Great Slave Lake and Mackenzie River basin in the north12                                                 9 Pharmacy is recognized as one of the world’s oldest professions as evidenced by, amongst other artifacts, 4000 year old written records on Assyrian clay tablets and Egyptian papyrus of hundreds of drugs of vegetable and mineral origin as well as formulas for the preparation of specific medications. The ancient Greeks are thought to have introduced the modern day terms pharmacy and pharmacist. Associated with purification and the purging of evil, medications were known as pharmakons while those that prepared them pharmakopoeos. Borrowing primarily from British “free enterprise” traditions, early Canadian pharmacy practitioners were physicians, apothecaries, druggists and chemists.  Although it is unclear when the designation of “pharmacist” was adopted nationally for all those practicing pharmacy in Canada, one of the first provincially legislated uses of the signifier was in the first Pharmacy Act in Ontario, passed on February 15, 1871 (Dove, 2011; Raison, 1967).  . By the early 1820s the HBC had also established trading posts on the Pacific Coast on the Columbia and Fraser River systems as 10 Although First Nations peoples had inhabited the region for thousands of year, French explorer Jacques Cartier is often credited with discovering Canada (1535). By the early 1700s France claimed control of territories known as New France that extended from Quebec, the St. Lawrence River region and the Maritime Provinces down to Louisiana and the Gulf of Mexico. By the 1670s, the British had claimed control of Rupert’s Land as part of British North America which included all the land and water ways that drained into Hudson Bay, a region over one-third the area of Canada today. Engaging in many conflicts for control of the land and commodities in New France and British North America the French ceded control of the region to the British with the signing of the Treaty of Paris in 1763 (Canadian Encyclopedia, 2012).  11 The Hudson’s Bay Company (HBC) was founded in 1670 and was given control of Rupert’s Land and the fur trade in the region. The North West Company, one of the HBC’s major competitors, was also involved in opening up western Canada. In 1821 the North West Company merged with the HBC creating a near monopoly of the fur trade in the country (Canadian Encyclopedia, 2012).  12 By 1810 HBC had established trading posts on Lake Athabasca (in northern Alberta) and on Great Slave Lake and the Mackenzie and Liard Rivers systems (in the North West Territories) in the north. In the south HBC trading posts had been established in central Alberta on the Clearwater, Sturgeon and North Saskatchewan River systems (Canadian Encyclopedia, 2012).   29  well as on southern Vancouver Island13. Until the completion of the Canadian Pacific Railway in 1885 connecting the country from the St. Lawrence River to the Pacific Ocean, access to the trading posts on the Pacific coast was predominately by ship around the southern tip of South America (after 1855 use of the Panama Railway shortened the trip). Due to the Rocky Mountains overland trading routes were deemed impractical. While the practice of pharmacy was largely unregulated in Canada until after Confederation in 186714, the pharmacy practices that were available were typically provided by physicians practicing both medicine and pharmacy and appointed by the colonial powers to work in the trading posts of the HBC15                                                 13 The first HBC trading post on the Pacific Coast, which controlled the fur trade west of the Rocky Mountains, was Fort Vancouver built on the Columbia River in 1821(now the city of Vancouver, Washington). With the signing of the Oregon Boundary Treaty in 1846, establishing the border between Canada and the United States, Fort Victoria, initiated in 1843, became the new base of operations for the HBC. Fort Langley, constructed near the mouth of the Fraser River in the late 1820s became a major HBC trading post on the Pacific Coast (Canadian Encyclopedia, 2012). . Following the decline of the fur trade in the 1870s, regulation of the profession by 1911, and the subsequent economic diversification, industrialization and rapid population growth across the country, the early decades of the 20th century saw the increasing demand for pharmaceuticals and pharmacy services addressed by a mix of practitioners. In addition to physicians, druggists and chemists, pharmacists, and pharmacy apprentices and clerks provided the majority of the pharmacy 14 Although Ontario, Quebec, New Brunswick and Nova Scotia had joined Canada in 1867 it was not until 1905 that all western provinces were confederated (Manitoba, 1870; British Columbia, 1871; Alberta and Saskatchewan, 1905). Regulation of pharmacy, through legislated Associations or Colleges in each province, was established by 1884 in the first four confederated provinces and by 1910 in the western regions of the country but remained unregulated in the western regions of the country until 1911. Following confederation pharmacy Associations were established in Manitoba (1878), British Columbia (1891), Alberta (1905) and Saskatchewan (1911). Prince Edward Island joined confederation in 1873 and established an Association to regulate pharmacy in 1905; Newfoundland and Labrador joined in 1949 but had established a pharmacy Association in 1905 (Raison, 1967). 15 Canada’s First Nations were the first dispensers of medications, crude preparations of plants and herbs. Early Metis and HBC fur traders brought British and European medicines. As HBC became established physicians followed bringing formalized treatments and therapies; they dispensed medicines and/or made their own. The clergy were also involved in treating illness, administering and compounding medications and in particular, controlling distribution of poisons. One of the first systematized approaches to pharmacy was introduced by the North West Mounted Police in Saskatchewan who established hospitals and medical supply depots. Hospitals often had responsibility for managing depot supplies and for filling and compounding prescriptions; hospital attendants and nurses compounded medicines under medical supervision. More generally, the lack of regulation/legislation permitted anyone to establish a professional practice regardless of qualifications. Anyone could open a store, sell drugs and medications, and dispense prescriptions (Cameron, 1993; Raison, 1967). 30  services required to meet the growing societal demand. Trained predominantly in British traditions, the professional roots of these early pharmacy practitioners and the professionalization of pharmacy in Canada to the present day can be traced back to the practices of the apothecary (Beales & Austin, 2006; Dove, 2011; Kremers & Urdang, 1976). Originating from 13th century British and European guild economies and employed full time in the preparation and trade of crude medicinal herbs and medicines as well as a range of common commodities, apothecaries emerged as a niche occupation in response to acute demands for specialized disease treatments and health-related services that were difficult to buy or sell through established trade markets (Beales & Austin, 2006; Kremers & Urdang, 1976). Of particular importance and suggestive of key distinguishing dimensions of a profession, these specific products and services addressed acute client vulnerabilities requiring knowledge, skills and tacit understandings deemed beyond the ordinary person, offered a service ideal in which the client’s needs superseded the personal interests and profit of the seller, and could only be acquired through long prescribed apprenticeship training from within the community of apothecaries (Buerki, 1999). Coveted and fiercely protected empirical knowledge of pharmacognosy (naturally occurring botanical medicines), galentical pharmacy (methods of preparing and delivering medicines) and materia medica (specific medicinal recipes for the treatment of disease) along with guarded secrecy and an heir of mystique, reinforced the specialized knowledge and unique position of apothecaries in guild societies (Kremers & Urdang, 1976; Thompson, 1929). The abstract and spiritual nature of the apothecary’s jurisdictional claim is suggested in C.J.S. Thompson’s book (1929), The Art and Mystery of the Apothecary, in which he states,  [t]he art of the apothecary has always been associated with the mysterious, and its practitioners, owing to their peculiar knowledge of drugs of unknown powder, 31  some of which were capable of producing delirium and sleep, were believed to have connection with the world of spirits and so act as intermediaries between the seen and the unseen (p. 3).  The Antidotaria, the books of early apothecaries containing extensive collections of recipes and list of drugs employed in healing (Thompson, 1929), are the ancient precursors to today’s United States Pharmacopeia16 It is important to note that despite having many of the unique characteristics of professions (i.e., offering a socially necessary function, specialized knowledge, securing exclusive jurisdiction, intensive preparation and norms of professional conduct), apothecaries did not maintain professional status due in part, to a failure to achieve Wilensky’s (1964) five stages of professionalization (i.e., engaging in the occupation as full time employment, establishing a training school often within a university setting, forming a professional association, agitating politically for legal status and jurisdictional claim and establishing a code of professional ethics). While apothecaries of 17th century Europe had secured their employment, created the Society of Apothecaries, established intensive training programs including long apprenticeships, fluency in Latin, and a code of ethics, the apothecaries could not establish long term jurisdictional claim to their specialized knowledge and services (procurement of drugs and medicines, compounding and dispensing). Druggist and chemists, who could sell medicines but not compound them and  (United States Pharmacopeial Convention [USP], 2000). Claiming wide-spread social need, theoretical mastery, exclusive jurisdiction and adherence to norms of ethical behavior and practice, apothecaries were able to establish themselves as uniquely qualified drug specialists as well as differentiate their products and services from the competing occupations of spicers, pepperers and grocers in the guild marketplace (Beales & Austin, 2006; Kremers & Urdang, 1976; Thompson, 1929).                                                   16 The United States Pharmacopeia contains 1200 pages of recipes and analytical procedures for close to 4000 drugs and drug products and represents a component of the specialized knowledge of contemporary pharmacists. 32  physicians, who could do both in addition to controlling prescriptions of controlled drugs (opiates), competed fiercely in this market place (Beales & Austin, 2006; Kremers & Urdang, 1976; Thompson, 1929). In a chapter that Thompson (1929) has titled, “The Battle of the Dispensary - The End of the Struggle” (p. 272) he describes 150 years of intense disputes between apothecaries, druggists and chemists and physicians for control of prescribing, procurement, compounding, and dispensing of medicines ending unsuccessfully for apothecaries. Eventually apothecaries were absorbed into the practice of medicine, remained as subordinate freelance practitioners or disappeared (Bissell & Traulsen, 2005; Thompson, 1929). By the close of the eighteenth century, the apothecary was “the physician of the poor at all times, and to the rich whenever the distress or danger [was] not great” (Thompson, 1929, p. 281). With the passing of the British Pharmacy Act in 1868, druggists and chemists, had successfully navigated the five stages of professionalization, replaced apothecaries, and established their practitioners as the legally recognized drug specialists in much of Britain and Europe (Beales & Austin, 2006; Kremers & Urdang, 1976). Heavily influenced by British colonialist and American traditions, and having negotiated the difficult path of professionalization over a 200 year period (Beales & Austin, 2006; Hepler, 1987; Hepler & Strand, 1990), pharmacy in Canada achieved legal professional status in 1870 with the passing of the first Pharmacy Act in the province of Quebec. By securing this legislation, which involved intensive jurisdictional disputes between apothecaries, druggists and chemists, and physicians reminiscent of earlier British and European struggles as well as lobbying of social elites and government representatives, the stage was set for pharmacists to secure the professional authority as the drug specialists responsible for the procurement, preparation and safe use of drugs and medicinal agents across Canada (Beales & Austin, 2006). First dates in the process of professionalization of Canadian pharmacy are 33  summarized here (Raison, 1967; Riedel & Stieb, 2001): 1) the first pharmacist of colonial origin practicing fulltime was Louis Hérbert in Nova Scotia [ca. 1604]; the practice of pharmacy, spread across the country by the Hudson’s Bay Company over a 200 year period, was established in British Columbia in the early 1800s; 2) the first pharmacy school within a university setting in Canada was in Ontario (in 1892); British Columbia’s first university-based pharmacy program opened at the University of British Columbia in 1946; the last university-based program to be established was at the Memorial University of Newfoundland in 1967.  The Canadian BSc(Pharm) program was approved as a minimum requirement in all Canadian pharmacy programs by 1960; 3) the first professional pharmacy association, the Canadian Pharmaceutical Association (later the Canadian Pharmacists Association) was founded in 1867; the first association representing academic pharmacy, the Canadian Conference of Pharmaceutical Faculties (CCPF) established in 1944, was reorganized in 1969 as the Association of Faculties of Pharmacy of Canada (AFPC); 4) first official legal status for pharmacists occurred with the passing of the Quebec Pharmacy Act in 1870; by 1910 all provinces and territories had passed similar legislation. Provincial legislation establishing scopes of practice for pharmacists continue to be revised (CPhA, 2013), and; 5) the first code of ethics for pharmacy in Canada was established by the Alberta Pharmaceutical Association in 1937.  2.5 Canadian Pharmacy Today, the Blueprint for Tomorrow and this Study Since the passage of the first Pharmacy Act of 1870, the professionalization of pharmacy has continued vigorously (Beales & Austin, 2006; Buerki, 1999; CPhA, 2013;  Hepler, 1987). Characteristic of the ongoing challenges professions face (Abbott, 1988; Wilensky, 1964), Canadian pharmacy has undergone profound change in its knowledge base and practice models in order to demonstrate to the public, payers, legislators and other health care providers its value 34  to individuals, the health care system and society as a whole.  In the approximately 140 years since the passing of the first Pharmacy Act, pharmacists have seen their specialized knowledge and practice roles shift from empiricist-apothecary to drug dispensing pharmacist-scientists to  drug use advisors and consultants, pharmaceutical care practitioners and medication therapy experts (Austin, 2013; CPhA, 2013; Hepler, 1987; Hepler & Strand, 1990). Today, while pharmaceutical care continues to provide the philosophical basis for the profession, most recently the pharmaceutical care process (the practice model of the pharmaceutical care practitioner) has been replaced with a refined set of tasks under the title of medication therapy management and an approach to practice focused on patient-centered care (Dolovich, 2012; Van Mil & Fernandez-Llimos, 2013). While these changes may seem subtle and even unimportant they represent the shifting theoretical and practical goalposts of the profession as it seeks to position itself amongst competing health professions and to adjust to the needs of society. At the heart of this shifting ground appears to be, in part, a search for a new specialized knowledge base on which to assert its professional jurisdictional claim as well as a reconnection with its social responsibility (Austin, 2013; Duncan-Hewitt, 2005). Some say that this process is about “searching for the soul of pharmacy” (Zellmer, 1996, p. 1) while others, describing a profession in crisis, see the current challenges facing the profession as the legacy of major external forces in society, in particular, the impacts of industrialization (Buerki, 1999; Hepler, 1987; Hepler & Strand, 1990). One particularly critical example of the impacts of industrialization on the pharmacist’s specialized knowledge and practice role has been documented by Savage (1994). Analyzing the impact of the pharmaceutical industry on compounding practices in pharmacies in North America (a foundational aspect of the pharmacist’s specialized knowledge), she found that in the 1930s 75% of all prescriptions were compounded in pharmacies. By the 1950s this number 35  had dropped to 25% and by the early 1960s to 4%. By the early 1970s pharmacy had effectively lost three of its four mainstays of jurisdiction to the pharmaceutical industry (drug procurement, storage and compounding) leaving dispensing and drug distribution as the focus of practice (Savage, 1994). Pharmacies became the channel of distribution for the pharmaceutical industry and the pharmacist’s role was reduced to that of a technician and drug dispenser with the concomitant loss of social and professional worth (Hepler, 1987). Arguments have been made that since that time the profession has been on a long, slow, painful path of self-reflection and reinvention, searching for opportunities to use existing knowledge more fully or develop a new knowledge base upon which to reassert its jurisdictional claim and professional status within the health care system (CPhA, 2013; Hepler, 1987; Hepler & Strand, 1990; Manasse, 1989).  The introduction of pharmaceutical care in the 1990s, embraced as a “truly …revolutionary concept in the practice of pharmacy” (Buerki, 1999, p. 159), reestablished pharmacy’s purpose and specialized knowledge based on the detrimental health issues and costs associated with drug misuse, underuse and overuse in society referred to in the pharmaceutical care literature as drug morbidity and mortality (Hepler, 1987; Hepler & Strand, 1990; Manasse, 1989). Pharmaceutical care, a term intended to invoke analogies with the ideals of medical care and nursing care, was defined by Hepler and Strand (1990) as,  the responsible provision of drug therapy for the purpose of achieving definite outcomes that improve a patient’s quality of  life…Pharmaceutical care involves the process through which a pharmacist cooperates with a patient and other health professionals in designing, implementing, and monitoring a therapeutic plan that will produce specific therapeutic outcomes for the patient (p. 539).  Unfortunately pharmaceutical care was not widely known outside of the pharmacy profession and did not radically transform practice in the ensuing decades as many had hoped, particularly in community pharmacy settings (Kassam & Kwong, 2009). Today, the legacy of the 36  industrialization of pharmacy, drug dispensing and distribution, remains an almost unmovable focus in contemporary pharmacy practice particularly in the community setting (CPhA, 2013; Strand, 2008). As evidenced by the recent battles between Shoppers Drug Mart®, Canada’s leading chain drugstore, and the government of Ontario over “professional allowances” that generic drug manufacturers pay to pharmacists to stock and sell their products, the role of the pharmacist as drug dispenser continues to be fiercely defended by chain drug store pharmacies (Taylor, 2010).  Looking forward there does seem to be consensus within the profession that the concept of pharmaceutical care will continue to articulate the core responsibility and purpose of the profession (ADPC, 2010; AFPC, 2010; CPhA, 2013; Jungnickel et al., 2009). There also seems to be agreement that pharmacy practice will center around three functional roles that include a significant focus on wellness and disease prevention as opposed to just disease treatment: patient-centered care, population-based care, and systems management. In addition, pharmacists will have the authority and autonomy to manage drug therapy, will be held accountable for the health outcomes achieved and will be paid for their specialized knowledge and services as medication therapy experts (Dolovich, 2012; Marra, Lynd, Grindrod, Joshi, & Isakovic; 2012). Other more contentious internal professionalization issues revolve around the preprofessional curriculum (Boyce & Lawson, 2009), generalist vs. specialists education and the need for residency training following completion of the first professional degree (Murphy et al., 2006; Schwinghammer, 2004), professionalism and social responsibility (Duncan-Hewitt, 2005), interprofessional team work and cultural competency (Jungnickel et al., 2009), faculty recruitment (Kerher, Kradjan, Beardsley, & Zavod, 2009), technology (Blouin et al., 2009) and establishing the scientific knowledge base of contemporary pharmacy practice and education 37  (Kunzli, Riggs, & Reid, 2012; Skau, 2007). Externally, in addition to the myriad of pressures related to Canada’s increasingly complex and over-burdened public health care system, the emergence of nurse practitioners, physician’s assistants and naturopathic doctors that are encroaching on pharmacy’s jurisdictional territory (Campbell, 2006), pharmacy technicians assuming responsibility for the drug dispensing and distribution functions within pharmacies (at a lower wage) (Zebroski,1998), looming joblessness for pharmacists (Brown, 2013) and the need for new remuneration models that accommodate pharmacy’s expanding scopes of practice (Marra et al., 2012), the options for the future of the pharmacy profession are becoming increasingly clear: “[adapt] or risk irrelevance and extinction” (Austin & Duncan-Hewitt, 2005, p. 381).  The “Blueprint for Pharmacy,” a national initiative of the Canadian Pharmacists Association started in 2007 and now endorsed by all sectors of pharmacy in Canada (CPhA, 2013), can be interpreted as the newest chapter in the story of the professionalization of pharmacy in Canada. In direct response to the internal and external pressures experienced by the profession today and as an example of the high stakes nature of maintaining professional status and autonomy amongst professional health care occupations, the Blueprint’s vision sets out a long-term plan intended to strengthen and realign the profession’s jurisdictional claim as medication therapy experts within the Canadian healthcare system and society. Based on the philosophy of pharmaceutical care and goals emphasizing “optimal drug therapy outcomes for Canadians through patient-centred care…[and that the ] status quo is not an option” (CPhA, 2013, p.6),  the Blueprint’s implementation plan has identified five strategic areas for action (i.e., education and continuing professional development, pharmacy human resources, financial liability and sustainability, legislation, regulation and liability, and information and 38  communication technology). As one of the major players in this process, academic pharmacy has been identified as a lead organization for implementing educational change in the Blueprint era. Ensuring that core pharmacy curricula address the knowledge, skills and values required for future pharmacy practice and that new graduates are prepared to develop and practice in emerging roles is the focus of current curriculum reform efforts in Canadian pharmacy programs. As an emerging internal stress within the profession, addressing and establishing the scientific knowledge base for the contemporary medication therapy expert will be challenging considering the competing interests amongst various knowledge constituencies within academic pharmacy (Austin & Duncan-Hewitt, 2005; Holmes & Desselle, 2004). Striking a balance between the knowledge disciplines of the basic pharmaceutical sciences, clinical sciences and pharmacy practice or as has been suggested, developing new paradigms of knowledge through integration of these existing knowledge paradigms, will be an important task for the future of the profession (Austin, 2013; Speedie et al., 2012). To this end, the proposed research project appears timely and is anticipated to explore this issue in detail for UBC’s BSc(Pharm) program.  While the professionalization of Canadian pharmacy promises to be anything but static, there is ample evidence to suggest that the reshaping of the pharmacist’s role over the past 140 years may have had an impact on pharmacy education. This issue will be the focus of Chapter 3.       39  CHAPTER 3: PHARMACY EDUCATION   The aim of this chapter is to build on Chapter 2 with the dual purpose of examining how the professionalization of pharmacy in Canada has impacted pharmacy education and curricula historically and clarifying the intentions of this study. Chapter 3 begins by revisiting the specialized scientific knowledge that distinguishes pharmacists amongst health professionals and then continues with a broader examination of the complexities of curriculum that frame the history presented and underpin this study. Perspectives on what curriculum is, the curriculum definition adopted for this study and the approach developed for examining the history of pharmacy education and curricula in Canada since Confederation will be presented. The role that science and the basic pharmaceutical sciences have played in pharmacy education will be key to this historical account. Chapter 3 finishes by situating and clarifying the intentions of this study and bridging Chapters 2 and 3 with the Methodology and Methods developed in Chapter 4.  On completing this chapter it is hoped readers have a sense of the interplay between societal change, professional practice and pharmacy education, the role of science and the basic pharmaceutical sciences in pharmacy education in Canada historically, how this study is situated within this historical landscape and what is to come in Chapter 4.  3.1 Professionalization, Specialized Knowledge and Pharmacy Education As developed in Chapter 2, the professions represent an important subset of occupations that have become an integral part of a functioning society. Sharing long histories and imbued with elite social status, high remuneration and autonomy, professions and professionals are given legal authority for, among other things, establishing programs and standards of education and practice (Austin, 2013). What distinguishes professions from other occupations and why society grants professional occupations special rights and privileges appears to be due, in part, to their 40  specialized knowledge. The unique knowledge of pharmacists ensures the safe and effective distribution and use of the drugs and medications for Canadians (CPhA, 2013). University-educated, predominantly through nationally accredited 1+4 year, outcomes-based BSc(Pharm) degree programs (AFPC, 2010), Canadian pharmacists today share similar general and scientific knowledge foundations with other health professions that includes the natural (basic and organic chemistry, physics, math), biological (biology and microbiology) and biomedical (anatomy, physiology, pathophysiology, and immunology) sciences (AFPC, 2010; DePaola & Slavkin, 2004; Mowforth, Harrison & Morris, 2005; Weatherall, 2006; Wolf et al., 1993). As discussed previously in Section 1.3, what distinguishes pharmacy as a profession and differentiates it from other health professions is, in part, a specialized knowledge of drugs grounded in the basic pharmaceutical sciences: medicinal chemistry, pharmaceutics and pharmacology (Lemke, Williams, Roche, & Zito, 2008; Pandit, 2007). Therefore, in addition to an understanding of how the body functions in wellness and disease, offering scientifically-based knowledge and skills regarding how drugs work, act and interact as well as how they can be delivered and used safely in the management of drug therapy and patient-centered care provides the basis for pharmacy’s unique contribution to the Canadian health care system and team. While pharmacy today is recognized as a science-based profession (Crabtree, 2012: Skau, 2007), the foundational scientific knowledge and skills of pharmacists have undergone profound change as the profession has adapted to dramatic changes in society, the health care needs of Canadians, and medical advancement (Chew & Sharrock, 2007; Hepler, 1987; Riedel & Stieb, 2001). Mapping the professionalization of pharmacy in Canada over the past 140 years, pharmacists have seen their knowledge base and practice roles shift from empiricist-apothecary to drug dispensing, pharmacist-scientists to drug use advisors and consultants, pharmaceutical care practitioners and 41  medication therapy experts (Beales & Austin, 2006; Hepler & Strand, 1990). Having legal authority and responsibility for establishing programs and standards of education and practice, the tremendous efforts of professionalization have necessitated equally intensive efforts and dramatic shifts in pharmacy education and curricula (Buerki, 1999; Hepler, 1987;  Newton, 1991; Riedel & Stieb, 2001).  Exploring these shifts underscores not only the complex interplay between societal change, pharmacy practice and pharmacy education but the ways pharmacy curricula have adapted historically to reflect changing perspectives on the role and importance of science and the basic pharmaceutical sciences in the knowledge base and education of the practicing pharmacist. The history of pharmacy education in Canada to be presented later in this chapter begins by exploring the complexities of curriculum.  3.2 What is Curriculum? For this author, curriculum can be many things, take many forms and mean different things to different people. A cursory Google search for “curriculum definitions,” for example, provides over ten million hits on the topic. Analysis of the scholarly literature on curriculum studies, like the Google search above, underscores just how broad and diverse the thinking and opinion is regarding what constitutes curriculum as well as the vigour and intensity with which various ideas, approaches and stances have been and continue to be legitimized and defended (Lather, 2006; Moss et al., 2010; Palys & Atchison, 2008). Since curriculum studies emerged as a legitimate field of academic study in the early 20th century (Pagano, 1999), curriculum scholars have fought intellectual and verbal wars over curriculum (Flyvbjerg, 2001). Theory versus practice debates (Dewey, 1977; Hubball & Gold, 2007; Schwab, 1973) as well as how curriculum often unconsciously replicates the social and economic norms and structures in society (Apple, 2004) also figure strongly in this scholarly discourse and continue to impact 42  views of what curriculum is and can be (Egan, 1978; Marsh & Willis, 1999; Robinson, 2002). Ask ten educational scholars and practitioners how they would define curriculum and you will likely receive ten different answers (Table 1). Ask a larger group and although definitional agreement is unlikely, broad themes and patterns begin to emerge that reflect the complex and multifaceted nature of curriculum and why a common definition does, likely will, and probably should, remain elusive. Figure 1 attempts to illustrate some of this complexity.  As society’s dominant means of educating its citizenry, curriculum (and the educational institutions through which they are provided) is embedded in societal and world complexity and constantly buffeted by historic, political, economic, technological, demographic and cultural social forces and change. In addition, curriculum, which often mirrors societal complexity, is a potent form of socialization inculcating citizens, as learners, into accepted norms of behavior, habits of thought and ways of being, acting and contributing to society. Although rarely made explicit, curriculum embodies an underlying theory with deep seated ontological (metaphysical reasons for being; broadly based on deductive versus inductive reasoning) and epistomological beliefs (that is, ways of knowing that often privilege specific types of knowledge) that guide the thinking, acting, doing and language of curriculum work (Cohen, Manion, & Morrison, 2000). With roots in history, philosophy, psychology, theology and sociology, curriculum theorists, for example, have focused their energies on interpreting and understanding world and societal complexity and how it impacts schools, curriculum, teachers and students. This scholarship has resulted in a multitude of curriculum theories that address important societal issues in terms of their positive and negative effects in society and on schools, curriculum, teachers and students. Curriculum theories addressing modernism (Bobbitt, 2004; Tyler, 1949), postmodernism (Slattery, 2006), criticality (Apple, 2004), queerness (Sumara & Davis, 1999), gender (Grumet & 43  Table 1: Some curriculum definitions from educational scholars and practitioners  1.  “[Curriculum is] that series of things which children and youth must do and experience by way of developing abilities to do the things well that make up the affairs of adult life; and to be in all respects what adults should be.” (Bobbitt, 2004, p. 11)  2. “[Curriculum is] an instructional program as a functioning instrument of education.” (Tyler, 1949, p. 1)  3. “Curriculum, it seems to me, is the study of what should constitute a world for learning and how to go about making this world. As such it implies, in microcosm, the very questions that seem to me to be of foremost concern to all of humanity. Such questions as “what is the good society, what is the good life, and what is a good person, ” are implicit in the curriculum question.” (B. J. Macdonald, 1995, p. 137)  4.  “I employ the concept of currere – the Latin infinitive of curriculum – to denote the running (or lived experience) of the course.” (Pinar, 2004, p. xiii)  5. “The curriculum in schools responds to and represents ideological and cultural resources that come from somewhere. Not all groups' visions are represented and not all groups' meanings are responded to. How, then, do schools act to distribute this cultural capital? Whose reality "stalks" in the corridors and classrooms of American schools?” (Apple & King, 1977, p. 343)  6. "we refer to curriculum in higher education as a coherent program of study (e.g., 4-year BSc) which is responsive to the needs and circumstances of the pedagogical context and is carefully designed to develop student's knowledge, abilities and skills through multiple integrated and progressively challenging course learning experiences." (Hubball & Gold, 2007,  p. 7)  7. “we take curriculum to mean that which is imagined, proposed, and enacted by teachers as they engage with learners around topics building on, but not limited by, curriculum guidelines as presented by Ministries of Education or similar governing bodies. In other words, curriculum is that which the teacher teaches. Such a curriculum addresses the public desire for a common or core set of experiences…, student needs and interests, and it relies on the teacher¹s talents, and strengths. This is an integrated view of curriculum and consistent with our argument that classrooms are dynamic systems.” (Dr. Tony Clarke, personal email communication, September 24, 2007)  8.  “Curriculum refers to the organized delivery of education through instructional design, with the goal of achieving specific objectives/outcomes.” (Dr. Zubin Austin, personal email communication, September 27, 2007)  9. "the curriculum is an outline of a program of study (e.g., for a certificate, degree, etc.). That is, it transcends the course level. At its most basic, the curriculum could just be a list of courses, but it could also prescribe some sort of order to the courses and might include some indication of the knowledge, skills and attitudes expected of learners.” (Marion Pearson, personal communication, September 26, 2007)  10. “Curriculum - content of instruction in a particular subject area (pharmacy) that has been so chosen and organized based upon rationale (knowledge, skills, processes and strategies required) related to the discipline being taught. I.e., our curriculum is designed to prepare pharmacy practitioners (essentially) and the units are structured and ordered in such a way so as to best accomplish that outcome. Curriculum is also a formal plan of subjects, goals, objectives agreed upon.” (Dr. David Fielding, personal communication, October 23, 2007)  44  Societal ComplexitySchool & Curriculum ComplexityCurriculum embodies a world view (societal and world complexity) and a sense of purpose; what is taught, how it is taught, an approach to organization, and an anticipated impact also appear important. Through interaction with curriculum,  students and teachers are influenced by societal complexity and the socialization process.Student/teacherComplexityWhat is curriculum?Complexity driven by many contextual factors including historic, political, economic, technological, demographic and cultural factors and world events; factors are temporal and subject to constant change. Curriculum embeds societal/school complexity and a process of socialization . Student/teacher interaction is complex and impacted by curriculum. Curriculum theorists interpret societal complexity (context) in light of its impacts on schools, curricula, teachers and students. Curriculum theories represent the different lenses theorists use to “see and explain” the complexity and its impact on education, the curriculum, teachers and students.Societal o plexitySchool  urriculu  o plexityCurriculu  e bodies a orld vie  (societal and orld co plexity) and a sense of purpose; hat is taught, ho  it is taught, an approach to organization, and an anticipated i pact also appear i portant. hrough interaction ith curriculu ,  students and teachers are influenced by societal co plexity and the socialization process.tudent/teacherCo plexityt i  i lCo plexity driven by any contextual factors including historic, political, econo ic, technological, de ographic and cultural factors and world events; factors are te poral and subject to constant change. Curriculu  e beds societal/school co plexity and a process of socialization . Student/teacher interaction is co plex and i pacted by curriculu . Curriculu  theorists interpret societal co plexity (context) in light of its i pacts on schools, curricula, teachers and students. Curriculu  theories represent the different lenses theorists use to “see and explain” the co plexity and its i pact on education, the curriculu , teachers and students.Figure 1: A view of curriculum17                                                     17 Clipart used in Figure 1 retrieved from the Open Clip Art Library available at http://openclipart.org/. 45  Stone, 2000), sexuality (Britzman, 1996), multiculturalism (Slattery, 2006), ecology (Sumara, Davis & Laidlaw, 2001), complexity science (Davis & Sumara, 2005) and aboriginality (Cole, 2002; Mazzei & Jackson, 2009) are examples of the important ways that views on curriculum have been exposed to scholarly examination and how conceptions of what curriculum is, does and can be have been broadened. Whether explicitly or implicitly understood, this orientation or lens with which curriculum is viewed (a world view) along with its complex contextual nature have important implications for curriculum work, specifically its development, implementation, evaluation and reform (Hubball & Gold, 2007). Influenced by world view and context, establishing the purpose of curriculum, the approach to curriculum planning, its design and structure, what knowledge is privileged, how it should be taught, the roles of teacher and learner, and the perceptions of how people learn, what learning entails and how it is demonstrated and judged are among some of the important challenges of creating a coherent and purposeful education. Amongst the community of curriculum scholars and practitioners, curriculum is recognized as complex, contextual, temporal, and guided by deep seated, although often unconscious, beliefs. In addition, curriculum embodies a sense of purpose and how people learn along with what is taught, how it is taught, an approach to organization, and an anticipated impact on learning (Bransford, Brown, & Cocking, 2000; Egan, 1978; Hubball & Gold, 2007; Sork, 2010). Given these themes, expectations of a common definition for what constitutes curriculum are likely unrealistic. More realistic might be the observed multiplicity of definitions that acknowledge the broad range of human experience and address the educational needs of teachers, learners and society within specific learning contexts. The professional education of the Canadian pharmacist represents one such context.  Below is this author’s definition of curriculum adopted for this study: 46  Curriculum refers to the organized delivery of a selection of content and learning experiences that is appropriate for the learning context, integrated and of increasing difficulty throughout a course or program of study. Designed to create a flexible, respectful and supportive learning environment, help students meet the objectives/outcomes for their courses/program and facilitate their growth as individuals and professionals is central.     How curriculum might be conceptualized historically is developed next. 3.3 Conceptualizing Curriculum and Educational History As mentioned at the outset of this chapter, the dual purpose of Chapter 3 is to build on Chapter 2 by exploring pharmacy education and curriculum change resulting from professionalization and focusing the intentions of the study. Examining the ways Canadian pharmacy curricula have changed historically to reflect curriculum complexity, shifting perspectives on professional practice, and the role and importance of science and the basic pharmaceutical sciences proved challenging. While the enormous energies directed at curriculum reform in Canada was abundantly evident (Louis & Twaites, 1996; MacCara, 2012; Raison, 1967; Riedel & Stieb, 2001), the Canadian historical literature on pharmacy education is largely fragmented and presented chronologically with limited detail on the specifics of curriculum reform or insight as to how curriculum was viewed holistically. While historical perspectives are discussed primarily in terms of structural alternatives (i.e., total number of years), hours of instruction required, and content generalities, a coherent view of curriculum (as conceptualized and enacted) and how these views have changed historically is less evident. This situation stands in contrast to that in the US (Anderson-Harper, Robinson, & Kochan, 1996; Buerki, 1999) and the historical literature from other professions such as teacher education. Showing striking similarities to the historic developments in pharmacy practice and education, the scholarly professionalization literature on teachers and the history of teacher education provided early 47  guidance for conceptualizing curriculum in ways that addressed curriculum complexity as discussed in Section 3.2 and the dual purpose of this chapter (Feiman-Nemser, 1990; Hargreaves, 2000).  Interested in the quality of teacher’s and teacher education programs in the k-12 system, Hargreaves (2000) and Feiman-Nemser (1990) analyzed teacher preparation historically for coherent perspectives on teaching, learning, and learning to teach that have been and continue to be used to situate, inform, and reform the practice of educating teachers. Hargreaves (2000) for example, examined the quality and standards of teaching practice (which he refers to as professionalism) throughout the 19th and 20th centuries. Adopting the concept of “grammar of schooling” (Tyack & Tobin, 1994, p. 453) to denote broad institutionalized perspectives on how to educate (that are highly stable and slow to change), he describes the history of teacher professionalism in terms of four ages, each with a set of practices that define the essence of curriculum and teaching. Although Hargreaves’ approach acknowledges the complexity of curriculum and provides a means for historical analysis, his framework was limited mainly to the impact of social and contextual changes on teaching practice. Of potential importance to the arguments developed in this chapter however, was the suggestion that his four ages overlapped significantly and that each new age exhibited “significant residues and traces from the past” (Hargreaves, 2000, p. 152). In a more comprehensive historical analysis of teacher preparation, Fieman-Nemser (1990) used the term conceptual orientation, defining it as “a set of ideas about the goals of teacher preparation and the means of achieving them” (p. 220). Also aligned with this chapter’s purpose, she suggested that an understanding of the traditions of thought and practice that have characterized her field might help teacher educators locate their own curriculum development and reform efforts amongst alternatives. Based on broad historic 48  traditions of teacher preparation during the 19th and 20th centuries (i.e., the normal-school, liberal arts and university traditions) and using vignettes of specific teacher preparation programs, the practical expression of 5 different conceptual orientations towards teacher preparation were described (i.e., the academic, practical, technological, personal, and critical/social curricula). Although world view was not explicitly developed for these conceptual orientations, the framework of dimensions used to capture the complexity of curriculum in her analysis included context and the importance of social forces, a central purpose, appropriate content and teaching methods, and design and structure. Particularly important was how her analysis clearly linked conceptual orientations with the enactment of curriculum. In light of the different practice roles pharmacists have assumed in the past 140 years, Fieman-Nemser’s (1990) approach seemed particularly promising for examining pharmacy education historically. Her notion of conceptual orientation and its use of a framework of curriculum dimensions was subsequently adopted for the purposes here. Building on the perspectives of Hargreaves (2000) and Feiman-Nemser (1990) as well as the previous discussions of curriculum complexity in Section 3.2, the meaning of conceptual orientation as intended for use in this study was further developed with insights gained from contemporary scholarship on curriculum reform in higher education (Wolf & Christensen Hughes, 2007). Typified by Wolf’s (2007) faculty-driven, data-informed and educational-developer supported model, Hill’s (2007) learning fractal model and Hubball and Burt’s (2004) framework for learning-centered curricula, contemporary approaches to curriculum reform have openly embraced the complexity of curriculum and developed robust and comprehensive dimensional frameworks that capture their vision of curriculum. Aligning well with the dimensions of curriculum complexity discussed previously, these models and frameworks for curriculum 49  reform pay close attention to the complex contextual nature of curriculum, its purpose, the “what” and “how” aspects, coherence of design and structure, and quality, accountability and impact. Also critical are processes of reform that fully respect the challenges inherent in curriculum reform efforts (for faculty, students, institutions and academic units) which acknowledge and advocate for congruence between conceptions of curriculum and its enactment. Instead of prescriptive solutions that tinker with complex curriculum reform issues (Austin & Duncan-Hewitt, 2005; Parekh, 2006; Schnieder & Schoenburg, 1999), these contemporary approaches to curriculum reform seek purposeful, enduring and sustainable contextually-bound solutions that meet the unique needs and characteristics of programs and curricula. They also emphasize rigorous integration and alignment of curriculum dimensions at all levels of development, implementation and evaluation (Hill, 2007; Hubball & Burt, 2004; Wolf, 2007). Stressing incremental and continuous as opposed to episodic and ad hoc reforms, and using iterative and cyclic faculty-driven collaborative strategies, these approaches to curriculum reform intentionally link the conception and enactment of curriculum. Further, they incorporate principles and practices informed by contemporary thinking and research on learning, and curriculum and pedagogical practices are integral aspects of these processes. Paradigm shifts from teaching to learning (Barr & Tagg, 1995), outcomes-based education (Ascough, 2011; Harden, 2007; Hubball, Gold, Mighty, & Britnell, 2007), continuous assessment and evaluation (Abate, Stamatakis, & Haggett, 2003; Council of Ministers of Education, Canada, 2007; Hill, 2007), curriculum integration (Hubball & Burt, 2004; Pearson & Hubball, 2012; Raman-Wilms, 2001), learning theories (Bransford, Brown, & Cocking, 2000; Fenwick, 2000; Phillips, 1995), learning styles (Austin, 2004; Pashler, McDaniel, Rohrer, & Bjork, 2008), and student engagement (Kuh, 2001; Kuh,  Kinzie, Schuh, & Whitt, 2005) are among some of the important 50  trends in higher education that have been recognized as important for improving learning, the student experience and teaching practice; many of these are included in contemporary curriculum reforms (Bain, 2004) . Importantly, reform leaders advocate strongly for context-specific research-based curriculum reform solutions that build on and emerge from within academic units; an acknowledgement of the critical importance and on-going need for continuous improvement of teaching and learning in higher education based on a culture of scholarship and scholarly activity directed at curriculum teaching and learning optimization (Hill, 2007; Hubball & Gold, 2007; Wolf, 2007). While these models and frameworks have been applied successfully in multiple higher education contexts (Albon & Hubball, 2004; Devine, Daly, Lero, & MacMartin, 2007; Hubball & Pearson, 2010) there appears to be need for critical analysis of their overall impact on the quality of higher education (Knight, 2001; Regehr, 2010).  Based on the preceding discussions, curriculum has been presented as complex, contextual, temporal, and guided by deep seated beliefs.  The notion of conceptual orientation, referring to a coherent array of overlapping and interacting dimensions, issues, and factors that help frame the complexity of curriculum, has also been developed. Table 2 compares key dimensions of curriculum from the above discussions. Drawn from the literature explored, perspectives on the dimensions of curriculum from curriculum theorists, the teacher preparation and contemporary higher education literature, and those of this author are included in the table. The particular dimensions used to frame the notion of conceptual orientation for this study and guide the development of the history of pharmacy education presented next are provided in the last column. Importantly, this array of overlapping and interacting curriculum dimensions aligns closely with Hubball and Burt’s (2004) framework for learning-centered curricula adopted as the theoretical framework for this study (to be described in greater detail in Chapter 4, Section 4.2).51  Table 2: Comparison of key dimensions of curriculum  Curriculum Dimensions  Curriculum Theorists Teacher Preparation Literature Contemporary Higher Education Literature Author’s Perspective Conceptual Orientation (for this study) World view *   *  Context * * * * * Purpose * * * * * Approach to planning *     Design and structure * * * (with attention to coherence) * * (with attention to coherence) What is taught (content knowledge; which is privileged) * * * * * How it is taught (teaching methods and practices) * * * * * Teacher and learner roles *     How people learn (theories of learning) *   *  How is learning demonstrated and judged (assessment and evaluation practices) *  * * * 52  3.4 A Brief History of Pharmacy Education and Curricula in Canada Analysis of the historical literature on pharmacy education in Canada, while fragmented, provides interesting insights into the complex interplay between societal change, pharmacy practice and pharmacy education. Riedel & Stieb (2001) have linked the changes in pharmacy practice and education in Canada with three major contextual transformations in society since Confederation. Their analysis aligns well with corresponding developments in the US18 (Hepler, (1987). These perspectives, among others, provide an opportunity to examine the conceptual orientations towards pharmacy education that have emerged in the past 140 years along with corresponding perceptions of the importance of science and the basic pharmaceutical sciences in each. Interestingly, and not surprising, the changes in pharmacy education described below parallel the changes in practice roles described previously in Section 2.4. Table 3 provides a summary of the conceptual orientations towards pharmacy education and curricula in Canada since Confederation19The agrarian era, existing in Canada until the 1940s was typified by apprenticeship training for pharmacists in the role of preparer and seller of medicinal drugs (Louis & Twaites, 1996; MacCara, 2012). Ensuring quality, purity, safety and safe storage of drugs and medicinal agents was also a critical aspect of apprenticeship training. Apprentices, often as young as 14 years of age, signed indenture agreements or apprenticeship contracts calling for 4-7 years of service in exchange for learning under the tutelage of an established practitioner (commonly a physician or pharmacist) (Raison, 1967). Although variable and unstandardized during much of .                                                   18 Canada and the US have a long history of synergy and cooperation regarding the development of pharmacy practice and education. While there continues to be differences regarding extent of public funding for universities, entry-to-practice degree programs and perspectives on pharmacy practice, especially with respect to scopes of practice and reimbursement models, today both countries share a common philosophy of practice, pharmaceutical care, and grapple with similar issues and challenges regarding optimization of pharmacy programs to meet the health needs of their citizens (Kehrer, Schindel, & Mann, 2010). 19 The dates included are meant to be suggestive only and acknowledge significant overlap between eras.  53  Table 3: Conceptual orientations towards pharmacy education and curricula in Canada since Confederation Context           (Era/Years) Program Purpose Design and Structure (program name, length and design) What was Taught (content focus) How it was Taught (teaching methods) How is learning judged (assessment/ evaluation) Agrarian Society (up to 1940) Apprenticeship training Apprenticeship, 4-7 years, unstandardized following finishing school models; contractual obligations Qualitative and empirical sciences; tacit practical knowledge Coaching, shadowing, one-on-one tutelage Written and oral board exams Industrialization Society (1940-1970) Developing pharmaceutical scientists University-based Bachelor programs; 1-4 year courses, variable apprenticeships required (to 1960); 1 + 4 year BSc(Pharm) programs  (1960-1970); building blocks approach with practice deferred to the end; apprenticeship largely eliminated by1970 Natural/basic pharmaceutical sciences dominant; practice focus minimal Lectures, laboratories, teacher-centered Written exams, science laboratory reports and practicals Information/ Knowledge-Based Society (1970-present; change slow up to 1990, rapid change following) Developing clinical pharmacists University-based 1 + 4 year BSc(Pharm) programs; building blocks approach; experiential learning built in; 2 + 4 year PharmD programs begin to emerge emphasizing patients, clinical and experiential learning  Biological, biomedical and clinical sciences (therapeutics) increasingly important; basic pharmaceutical sciences decreased; experiential and practice learning emphasized Lectures; active learning; science labs minimized, practice labs emphasized; learning-centered approaches dominant; learning technologies emerge Multiple assessment strategies used; national board exams increasingly important 54  this era, formalized apprenticeship training programs for pharmacists, where they existed, provided a combination of practical experience and course work. Often attained through private schools, correspondence courses, or evening lecture series offered by experienced pharmacists or physicians20, formal study was voluntary, focused on foundational textbooks, required much memorization, and was largely ungraded (Canadian Academy of the History of Pharmacy [CAHP], 1969; British Columbia Pharmaceutical Association [BCPhA], 1940)21. Referred to in the pharmaceutical education literature as the finishing school model, the purpose of formal pharmacy education was to “finish” or “round out” apprentices, making them fully competent as employee pharmacists. The path to licensure was frequently tiered requiring successful completion of minor and major board exams for promotion from Certified Apprentice to Certified Clerk to Licentiate of Pharmacy. Licensure exams were administered by the pharmacy Associations or Colleges (licensing bodies) in each province (Buerki, 1999; Raison, 1969; Riedel & Stieb, 2001). Although the understanding of science during this era was primarily empirical, qualitative and descriptive22, the knowledge of pharmacognosy, galentical pharmacy, materia medica, practical pharmacy23                                                 20 In an attempt to standardize pharmacy practice and apprenticeship training these types of supplemental educational opportunities were typically organized and run by provincial pharmacy Associations or Colleges (Raison, 1967).  and chemistry along with the tacit understandings of medicinal drugs and their preparation accumulated over many centuries, was the basis of the pharmacist’s professional status and fiercely guarded livelihood (Beales & Austin, 2006; Hepler, 1987; Kremers & Urdang, 1976). The suggestion that in the1930s 75 % of all prescriptions were prepared in pharmacies and required the compounding skills of the pharmacist, highlights their 21 Borrowing primarily from British models of self-study for apprentices, typical textbooks included the British Pharmacopoeia (1885), Maisch’s “A manual of organic materia medica” (1887), Remington’s “The Practice of Pharmacy” (1886) and Semple’s “Aids to Chemistry” (1881) (BCPhA, 1911). 22 The definition of “empirical science” adopted for this study can be found in the Glossary (Empirical, 2013). 23 The definition of the knowledge domains of “pharmacognosy”, “galentical pharmacy”, “materia medica,” and “practical pharmacy” adopted for this study can be found in the Glossary (Hurst, 1934).  55  specialized knowledge and lends support to the importance and central role of empirical science in the pharmacists education and practice (Savage, 1994). In addition, aligning the pharmacist’s role of this era with the notion of an “empiricist-apothecary,” as developed in Section 2.5, appears appropriate. While much the history of pharmacy education in Canada up to 1940 can be viewed as a series of attempts to improve, rather than replace, the apprenticeship system of training pharmacists, the importance of apprenticeship, or the need for practical training of any type, began to wane as modern science-based programs within universities became established (Buerki, 1999; Raison, 1969; Riedel & Stieb, 2001).   With the rise of industrialization in society in the late 19th and early 20th centuries, the pharmacy profession in Canada entered the industrial era (1940 - 1970) (Riedel & Stieb, 2001). The decades immediately following World War II were a particularly intensive time of change and growth in the country and profession (Buerki, 1999; Louis & Twaites, 1996; MacCara, 2012). Characterized by sweeping changes in pharmacy knowledge, education and practice as the profession struggled to align with universities and the ideology of science in society, the importance of the natural and basic pharmaceutical sciences peaked (Buerki, 1999; Hepler, 1987; Riedel & Stieb, 2001; Taylor, 1911). Buoyed by the medical discoveries of the day24, increasing public demand for prescription drugs and patent medicines25                                                 24 Scientific developments in the late 19th and early 20th centuries revealed the powerful potential of applying biomedical science to therapeutics. European discoveries in 1890 (a biologically derived cure for diphtheria) and 1910 (design of the first chemotherapeutic agent, Salvarsan, to destroy the syphilis pathogen) stimulated the development of the research-based US pharmaceutical industry in the 1920s and 1930s. Discovery of insulin in 1922 (by Canadians Banting and Best), isolation of penicillin in 1929 (by British researcher Fleming) and discovery of sulfa antibacterial agents in 1935 (by French researchers Trefoulël, Nitti and Bovet) added to the excitement and potential of drug discovery and the basic pharmaceutical sciences in pharmacy programs (Khan, Deimling, & Philip, 2011; Hughes, 1943; Swann, 2001).  , and a strong desire to contribute to 25 Patent medicines were proprietary medicines manufactured by physicians and pharmacists. Often referred to as “quack” remedies, patent medicines were marketed directly to the public as special remedies for specific diseases or ailments, often with widely exaggerated claims of success.  Some recipes were standard formulations from the British Pharmacopoeia but others contained addictive drugs such as cocaine or heroin as well as high levels of alcohol.  Since the recipes were secret neither the public nor the dispensing physician or pharmacist knew if the 56  medical advancement (Chew & Sharrock, 2007; Hughes, 1943; Swann, 2001), disciplinary scientific knowledge was adopted as the basis of pharmacist’s new specialized knowledge, education and training. Apprenticeships, diplomas and certificates were gradually replaced with standardized four year university-based BSc(Pharm) degree programs and rigorous training in the natural and basic pharmaceutical sciences26                                                                                                                                                             product was harmful. Naylor’s Pectoral Ointment, Laboror’s Own Remedy and Mrs. Winslow’s Soothing Syrup are examples of patent medicines sold in Canada (Raison, 1967). . The finishing school model of curriculum design typical of the agrarian era was inverted to a building blocks approach in which the scientific foundations of pharmacy education preceded practice-oriented experience and training. In most BSc(Pharm) programs the requirement for apprenticeship, practical or internship training as part of degree completion was severely reduced, took place after graduation, or eliminated (Riedel & Stieb, 2001). In these scientific curricula descriptive pharmacognosy, galentical pharmacy, materia medica and practical pharmacy were converted to botany and plant physiology, bacteriology, natural products, organic and medicinal chemistry, pharmacology, and pharmaceutics including physical pharmacy and drug analysis (Hepler, 1987). Practical synthesis and analytical laboratories, associated with each scientific discipline, dominated curricula along with disciplinary lectures. Newly trained Doctor of Philosophy (PhD) scientists well grounded in the pharmaceutical sciences were hired to teach and develop research programs generously supported by governments and the pharmaceutical industry. Establishing post-graduate MSc and PhD programs in drug research and development became increasingly important. Within BSc(Pharm) classrooms teacher-centered approaches to education were prominent and assessment methods were typically high-stakes often including practical laboratory testing and 26 Establishing university-based 1 + 4 BSc(Pharm) programs as the first entry-to-practice degree in Canada took more than 70 years . The first university-based pharmacy program was offered in Ontario (1892) and the last in Newfoundland and Labrador (1965).  In the interim, university-based pharmacy programs took many forms ranging from 1 to 4 years of science-based coursework supplemented with various apprenticeship, practical or internship training requirements.  Degree designations of Bachelor of Pharmacy (BP) and Bachelor of Science in Pharmacy (BSP) were common prior to the BSc(Pharm) degree becoming established.  57  written midterm and final exams (Austin & Gregory, 2007; Barr & Tagg, 1995; Louis & Twaites, 1996). The focus of these programs was on the drug and drug product while their purpose was to prepare pharmacists with scientific knowledge and technical expertise approximating pharmaceutical scientists (Buerki, 1999; Hepler, 1987; Riedel & Stieb, 2001).   The industrial era was a particularly difficult time for pharmacists professionally. Although demand for prescription medicines and profits for pharmacists soared (Buerki, 1999; Dove, 2011), their once specialized knowledge and social role as empiricist-apothecary (preparer and seller of medicinal drugs) was gradually subsumed by the pharmaceutical industry.  In addition, while the basic pharmaceutical sciences were legitimized within pharmacy programs, practice was marginalized. Described cynically as the “lick, stick, count and pour” model of pharmacy practice (Skau, 2007, p. 1), pharmacists practiced in the shadow of physicians, having limited involvement with patient therapy, and deferring responsibility for health outcomes back to the physician. Pharmacies became the channel of distribution for the pharmaceutical industry and the pharmacist’s role changed, as suggested in Section 2.5, from empiricist-apothecary to pharmacist-scientist and dispenser of prepackaged drug products (Hepler, 1987). Many pharmacists felt they could not practice to their potential and that their education was increasingly irrelevant to practice (Riedel & Stieb, 2001).That less than one percent of all prescriptions required compounding skills by 1973, underscores the loss of professionalism felt by pharmacists (Dove, 2011; Savage, 1994). Hepler (1987) describes the impact of the industrial era on pharmacy education and practice in this way,  [During the industrial era] pharmaceutical education had accommodated itself to the Industrial Revolution, had legitimized itself academically and in the process had been reformed…for all its progress, [pharmacy] education seemed to have lost its purpose of producing professionals. It had compartmentalized its curricula along disciplinary lines and seemed to have replaced the objective of educating professionals with the typical 58  objectives of…sciences faculties: discipline-oriented teaching, peer relationships, publications and external funding. (p. 371)  Reclaiming the professional status and role of pharmacy within the health care system was the embodiment of the information era of pharmacy education and practice which Riedel & Stieb (2001) have aligned with the development of a knowledge-based society in Canada (1970-present). Corresponding to the clinical movement in pharmacy practice (Dove, 2011; Wood, 2001), the information era signified the beginning of a long 40 year period of recovery from the “de-professionalization that resulted from industrialization” (Hepler, 1987, p. 379). Based on cost, demand and public safety issues related to the prevention of drug misuse, underuse and overuse (Wu, Bell, & Wodchis, 2012; Zed et al., 2008), pharmacists began to reassert exclusive claim within the health care system as society’s drug specialist involved in drug use control, medication management and patient-centered care (CPhA, 2013; Hepler & Strand, 1990). The concurrent emergence of the pharmaceutical care model of practice in 1990, “intended to invoke analogies with the ideals of medical care and nursing care” (Hepler, 1987, p. 376), redefined and operationalized the pharmacist’s renewed professional role to that "entail[ing] the direct interaction of the pharmacist with the patient for the purpose of caring for the patient's drug-related needs" (Strand, Cipolle, & Morley, 1992, p. 6). The intent of the pharmaceutical care movement was “self-actualization - the full achievement of [the pharmacist’s] … professional potential” (Hepler & Strand, 1990, p. 534). Although the philosophy and practices of pharmaceutical care were slow to penetrate professional practice frustrating many pharmacy leaders and practitioners (Jungnickel et al., 2009; Rosenthal, Austin, & Tsuyuki, 2010), pharmacy schools embraced the movement and the need for overhauling curricula of the industrial era. The purpose of program revisions was the development of clinical education for pharmacists that emphasized the patient instead of drugs, drug products, dispensing and technical 59  expertise. The dominance of the basic pharmaceutical sciences was reduced with the inclusion of clinical or applied pharmaceutical sciences such as therapeutics and pharmacokinetics, in the hope of converging of the sciences with practice. The biomedical sciences of anatomy, physiology and pathophysiology played an increasingly important role along with a refocusing of curricula from plants to the human body. While the building blocks design of the industrial era remained, experiential training opportunities for students in community, hospital and other health care settings were reintroduced and grew steadily in importance within curricula (Stieb, 2001). Despite great resistance from traditional pharmaceutical scientists, new clinical scientists and clinicians were incorporated into Faculties, Schools and Colleges of Pharmacy and a welcome addition in the practice setting for their enhanced professional knowledge. In the profession, while some pharmacists adopted their new role wholeheartedly others were reluctant to assume the patient care responsibilities commensurate with their education, particularly in the community pharmacy setting27                                                 27 The opposite situation was also true. Many pharmacists felt that the practice environment did not allow them to practice at their full potential or use their clinical education (Dove, 2011; Kassam & Kwong, 2009; Munger, Gordon, Hartman, Vincent, & Feehan, 2013).  . Nationally, coordinated efforts were undertaken to develop outcomes-based pharmacy curricula (AFPC, 2010), national accreditation standards (CCAPP, 2013) and national board exams that replaced provincial exams (Pharmacy Examining Board of Canada [PEBC], 2010). Following decades of often wrenching curriculum restructuring efforts, curricula typical of the information era, which emphasized outcomes-based, clinically-oriented pharmacy programs with less reliance on the basic pharmaceutical sciences were accepted as a minimum accreditation requirement for all Canadian BSc(Pharm) programs (AFPC, 2010; CCAPP, 2013; Hubball & Burt, 2004; PEBC, 2010). Teaching-centered approaches to pharmacy education were replaced with learning-centered approaches and traditional science-based laboratories replaced with pharmacy practice skills labs and small group case-based therapeutics 60  tutorials. While lectures continued to be prominent, active learning increased in importance as did the variety of assessment methods (Abate, Stamatakis, & Haggett, 2003; Barr & Tagg, 1995). As articulated by Hepler and Strand (1990) twenty years ago, “pharmaceutical care practice restored what had been missing for years: a clear emphasis on the patient’s welfare, [and] a patient advocacy role with a clear ethical mandate to protect the patient …” (p. 534). In terms of the progress made during the information era of pharmacy education Hepler (1987) puts it succinctly, “After half a century of loitering at the cross roads, pharmacy watched education approach from one direction and practice from another. Their joining has made it possible for both practice and education to move forward” (p. 373).  3.5 Pharmacy Education Today, the Blueprint for Tomorrow and this Study Today, the clinically-oriented pharmacy programs and curricula of the information era have fully embraced the clinical movement, pharmaceutical care, and the role of the pharmacist as clinician and medication therapy expert (AFPC, 2010; Dolovich, 2012). Four decades in the making, the education of pharmacists’ has shifted slowly but profoundly since the industrial era as have assertions about the importance of pharmacists in the health care of Canadians (CPhA, 2013). Addressing the new specialized knowledge envisioned for contemporary practice roles, the principles and practices of learning-centered education in pharmacy education and curricula have been building momentum since the early 1970s (Hymel & Foss, 1990); these have been adopted widely since the early 1990s and continue to be optimized (Abate, Stamatakis, & Haggett, 2003; Bradberry et al., 2007; Wolf et al., 1993). Nationally accredited outcomes based programs (AFPC, 2010) that “inform students about what they can expect to achieve from a program of study” (Hubball & Gold, 2007, p. 9) emphasize increased experiential learning, curriculum integration, active learning, small group and collaborative learning, technology use, 61  and continuous assessment and evaluation at all program levels. In addition, curriculum optimization efforts are attempting to address the multitude of internal and external pressures facing the profession as discussed earlier in Section 2.5 (Bradberry et al., 2007; Blouin et al., 2009; Hubball & Burt , 2007; Purkerson Hammer & Paulsen, 2001; Perrier, Winslade, Pugsley, Lavack, & Strand, 1995). While these changes have appeared to enhance student learning, the learning experience, practice abilities (Boyce & Lawson, 2007), and practice change, particularly in community settings, continues to lag prompting some to suggest that contemporary curriculum reform efforts require radical rethinking (Austin & Duncan-Hewitt, 2005; Crabtree, 2012; Duncan-Hewitt and Austin, 2005; Jungnickel et al., 2009; Kassam & Kwong, 2009; Rosenthal, Austin, & Tsuyuki, 2010; Speedie et al., 2012).  The national Blueprint for Pharmacy initiative, as mentioned previously, has articulated a bold vision for the future of pharmacy in Canada. With goals emphasizing “optimal drug therapy outcomes for Canadians through patient-centred care” (CPhA, 2013, p.6) by 2020, academic pharmacy has been challenged with ensuring curriculum optimization and revision efforts prepare new graduates for emerging roles and the future of pharmacy practice. One of the many issues vying for attention in the discourse on curriculum reform concerns the role and status of the basic pharmaceutical sciences in revised pharmacy programs (Skau, 2007). Specifically called into question has been the perceived dilution of the basic pharmaceutical sciences in contemporary pharmacy education as well as the balance between the basic pharmaceutical sciences and practice-oriented and experiential learning opportunities in contemporary pharmacy education (Cutler et al., 2009; Skau, 2007; Woster, 2003). Woster (2003), for example, has suggested that revised pharmacy programs are creating “chemophobes” (p. 1) while Albon (2010) has questioned whether contemporary programs are creating generations of pharmacists 62  that are afraid of the basic pharmaceutical sciences and chemistry in particular. Austin and Gregory (2007), concur suggesting that it may not be the basic pharmaceutical sciences but “science- in all its dimensions- [that] is becoming devalued by students, practitioners, and curriculum planners” (p. 615). With very little research available exploring this issue in the Canadian context (Austin & Gregory, 2007), this study intends to investigate the current role and status of the basic pharmaceutical sciences in UBC’s contemporary BSc(Pharm) program in an attempt to fill this existing knowledge gap. How this study was conducted will be the focus of Chapter 4 to be developed next.               63  CHAPTER 4: METHODOLOGY AND METHODS  This study inquired into the scientific foundations of UBC’s BSc(Pharm) program with particular attention to the role and status of the basic pharmaceutical sciences. As introduced briefly in Section 1.4, the study was designed as a theoretical empirical inquiry using Stake’s (2010) notion of qualitative intrinsic case study. Semi-structured interviews, classroom observations, and documents analyses were employed as data collection methods to provide multiple sources of information for detailed, in-depth exploration of the case, UBC’s BSc(Pharm) program. Chapter 4 begins with an exploration of the field of educational research in an attempt to locate theoretical empirical inquiry within it and construct an argument as to why Stake’s (1995, 2005) qualitative intrinsic case study approach employing multiple data collection methods was an appropriate methodological choice. The chapter continues by describing the study pragmatics. The conceptual structure of the study and the theoretical framework used to guide data collection will be presented along with descriptions of the study setting, its participants and the methods used to collect, manage and analyze the data collected. The chapter concludes with comments on issues of trustworthiness, ethical considerations and limitations of the study. It is hoped that once readers have finished this chapter they have a clear sense of the study design, the route taken to answer the research questions and why the methodological choices were made.  4.1  Why Case Study?  Today the field of educational research is characterized by an enormous and ever expanding body of research literature.  What becomes immediately clear upon entering this field is the inherent respect for the complexity of human behavior, experience, and action in educational settings, and the research enterprise created to study it. Much like the sociological 64  imagination and the challenges of curriculum described in Chapters 2 and 3 respectively, educational research is a multifaceted endeavor comprising a complex array of views, perspectives and schools of thought about what is important, what can be learned, and the ways to investigate it (Denzin & Lincoln, 2008). While disagreements amongst the various schools continue, intense disputes of the past have given way to a continuum of belief systems that reflect more realistically how thinking in the world has become more holistic and complex (Kimpston, Williams, & Stockton, 1992; Lather, 2006; Moss et al, 2009).  While acknowledging that different belief systems and world views address different priorities, privilege different research strategies, and create different types of knowledge (Mazzei & Jackson, 2009), there is agreement and adamancy that the research questions drive the research design and methodological choices (Stake, 2010). Creswell (2007) acknowledges the “baffling number of…approaches” (p. 6) available to the educational researcher and the difficulties of making informed methodological choices. Research suggests that methodological choice for a given research study should be grounded in an explicit understanding of its implicit ontological and epistemological commitments (Bassey, 1992, 1999; Cousin, 2009; Shulman, 1997). What is examined next is why a theoretical empirical inquiry using Stake’s (2010) intrinsic case study approach and a qualitative methods perspective is particularly well-suited for this research.  Research in education can be represented by three broadly overlapping categories underpinned by deep assumptions (worldview), an ethos of systematic, critical and ethical inquiry, and social responsibility (Bassey, 1992, 1999; Cousin, 2009; Creswell, 2007; Shulman, 1997)28                                                 28 In terms of social responsibility, Shulman (1997) suggests that educational researchers have a responsibility for communicating and disseminating the outcomes of their research to the educational context, the community of educational scholars and to the general public. . The categories have been characterized as empirical, reflective-integrative and creative research.  Empirical research, representing the largest proportion of research in the field, is 65  characterized by systematic data collection; careful attention is paid to research questions, methodological choice, research design, rigorous data analysis and interpretation, and conclusions drawn. For empirical research the central focus is on data collection necessary to answer research questions posed. Austin and Gregory’s (2007) study for example, one of the only Canadian empirical research studies to investigate the scientific foundations of contemporary BSc(Pharm) programs, used student interviews and focus groups as data sources to examine student perceptions of the value, role and impact of the basic pharmaceutical sciences on their education. Reflective-integrative research utilizes and builds on existing empirical research for meta-analysis in an attempt to develop models, frameworks and theories for helping bring understanding to educational issues. A large and vital part of educational research is of this sort. Many of the works cited in Chapters 2 and 3 of this thesis (Feiman-Nemser, 1990; Hubball & Gold, 2007; Riedel & Stieb, 2001) as well as the chapters themselves are examples of reflective-integrative research. Creative research is educational research focused on novel solutions to problems, new ideas, and creation of unique educational artifacts and tools. The development of the influential pharmaceutical care concept (Hepler & Strand, 1990), and the Blueprint for Pharmacy visioning documents (CPhA, 2013) could be characterized as examples of creative research. Recognizing that categorization in education is slippery business, these research categories have vague boundaries, size, and much overlap. Creative research for example, builds on empirical and reflective-integrative research to extend current understandings in novel directions while empirical research requires a reflective-integrative literature review. Reflective-integrative researchers must read the empirical research for meta-analysis.  Based on this interpretation of the field of educational research, this study was designed as an empirical research study using a range of data collection methods to provide multiple sources of 66  information to address the study’s purpose and answer the research questions posed. Three other important issues impact the study’s design. The first issue is rooted in the fundamental purpose of the research and whether a particular research study (and the researcher) seeks understanding, change or some variation (Bassey, 1992, 1999). Empirical research (the only category discussed here), for example, can be divided into three subcategories each with a different underlying purpose. Like the broad categories of educational research described above, the subcategories of empirical research presented next have vague boundaries and much overlap.  Theoretical empirical research, the first subcategory, seeks understanding; the purpose is to investigate an educational topic or issue in its natural setting with minimal disruption or disturbance. The aim of theoretical empirical research is to provide an in-depth account or description that enhances understanding and provides useful perspectives and insights about the educational topic or issue of interest (Bassey, 1992, 1999). While analysis and interpretation of empirical data requires judgment, the findings of theoretical empirical research develop with minimal expectation of change or actions in mind. Evaluative empirical research, the second subcategory of empirical research, seeks understanding and judgments about change and potential actions; the purpose of this type of research is not only to explicate understanding but to make explicit value judgments about the suitability, appropriateness or impact of an educational topic, issue or intervention. While not advocating change directly, evaluative empirical research embodies explicit actions and an implicit expectation that others may act on them (Bassey, 1992, 1999). Action research, the final subcategory, seeks understanding, judgment and change; the purpose is on improvement of the practical situation often at the local level. Action researchers work closely with study participants in an on-going iterative process of understanding, judgment 67  and change regarding an educational topic or issue (Bassey, 1992, 1999). Valuable for locating the research literature within this typology, the Austin and Gregory (2007) study cited earlier could be classified as theoretical empirical research while previous classroom and curriculum reform research on the UBC BSc(Pharm) program (Albon & Hubball, 2004; Hubball & Burt, 2004) represent examples of action research. In terms of refining the purpose, methodological choices and design of this study, conceptualizing empirical research in this way was particularly helpful. Although this study was anticipated to help inform curriculum reform efforts currently underway in the Faculty (FPS, 2012), it was deemed premature to think about developing specific action plans or enacting curriculum change before an in-depth understanding of the current program was established. While the implications of this research were anticipated to provide guidance on curriculum change related to the role and status of basic pharmaceutical sciences in the UBC BSc(Pharm) program, the primary focus of this study was about understanding; how the findings of this research might be used by the Faculty or others to enact curriculum reform now and over the next decade of the Blueprint era was of secondary importance. Guided by this perspective, the study was designed as theoretical empirical research with the primary purpose of understanding the current situation regarding the basic pharmaceutical sciences in the UBC BSc(Pharm) program. The second issue impacting the broad categories of educational research is the generalizability of research findings. Referred to as “the degree to which findings from one context or under one set of conditions may be assumed to apply in other settings or under other conditions” (Shulman, 1997, p. 13), generalization receives a lot of attention in the educational research literature. There are different forms of generalization possible depending on study design. Studies involving samples of people thought to be representative of larger populations 68  can produce statistical generalizations that support inferences about the population. Although effective sampling of large populations is often difficult, expensive and unrealistic in educational settings, survey research about educational topics and issues can lead to statistical generalization (Bassey, 1999; Cousin, 2009; Creswell, 2007; Stake, 2010). More commonly for empirical research in educational settings is the study of singularities (Erickson, 1986; Palys & Atchison, 2008). Focusing on particular situations, events or bounded systems that include people, the study of singularities can produce predictive or interpretive assertions without any measure of statistical probability. As Bassey (1999) describes them, these assertions are “qualified generalizations carrying the idea of possibility but no certainty…[or] fuzzy generalizations” (p. 46). While this terminology is awkward, the concept of fuzzy generalization does capture the dilemma faced by empirical educational researchers studying singularities. Generalizing beyond the particular situation, event, or sample investigated becomes uncertain and must be made with caution (Regehr, 2010). Based on this analogy, the design of this study was further honed as a theoretical empirical study of a singularity, the UBC BSc(Pharm) program. Generalization beyond this program to other Canadian BSc(Pharm) programs, for example, would require careful thought. The issue of generalizability of this study will be discussed further in Section 4.3.   The last issue of importance to empirical educational research is the deeply held beliefs or world views that underpin and drive the research. Educational researchers, like the social scientists and curriculum theorists discussed previously, try to make sense of the world from different theoretical perspectives about the nature of reality. Referred to as ontological belief systems, the influence of world view on educational complexity, research design, and what can be known (i.e., epistemological assumptions) is debated widely in the educational research 69  literature (Cousin, 2009; Creswell, 2007). Briefly summarized, the positivist worldview, which underpins the quantitative paradigm of educational research, has been characterized as regarding reality as single, objective, and fragmented. Educational complexity from this perspective can be understood rationally in terms of factual knowledge describing human experience, actions and events, and laws that govern the relationships between them. Influenced heavily by the natural sciences model of research, the positivist-quantitative research paradigm often concentrates on confirming theory and testing hypotheses; what can be measured, analyzed statistically, and generalized is an important aspect of this research. In terms of what can be known, the epistemological assumption is that research findings represent objective reality, accurately reflect common understandings of complex educational phenomena, and are independent of the researcher and learner. Survey methodology, often associated with positivist worldview and quantitative research design, is often used by empirical researchers to examine and enhance understanding of complex phenomena in educational settings (Bassey, 1999; Creswell, 2007; Guba & Lincoln, 2005; Palys &Atchison, 2008; Shulman, 1997).  In contrast, the interpretive worldview underpins the qualitative paradigm of educational research. Interested in exploring meanings of people’s experiences, and how people make sense of their lives and the world, reality from this perspective, is regarded as socially constructed. To the interpretive educational researcher, educational complexity cannot be fully understood in terms of the quantitative approaches of the positivist. Instead, interpretivists believe that understanding human experience, actions and events in educational settings requires in-depth study of the research participants in their natural educational settings using time intensive methodologies (Table 4) (Lincoln & Guba, 1985). The epistemological assumptions of the interpretivist-qualitative research paradigm are that meaning and understanding is embedded in 70  lived human experiences and can be best understood in terms of their own experiences of them. The researcher, who is actively involved in the research process, builds abstractions, concepts, and theories from observations, interviews, and interactions using complex variables that are   Table 4: Common qualitative research approaches and key interpretive questions29Approach  Key Interpretive Questions case study What are the characteristics of this particular entity, phenomenon, or person? What are the characteristics of this single case or of these comparison cases? ethnography What are the cultural patterns and perspectives of this group in its natural setting? What are the cultural characteristics of this group of people or of this cultural scene? grounded theory How is an inductively derived theory about a phenomenon grounded in the data in a particular setting? What theory or explanation emerges from an analysis of the data collected about this phenomenon? phenomenology What is the experience of an activity or concept from these particular participants’ perspective? What is the meaning, structure, and essence of the lived experience of this phenomena by an individual or by many individuals? action research How can teachers solve or understand an identified teaching problem and improve practice based on data they have collected and analyzed? historical research How does one systematically collect and evaluate data to understand and interpret past events? How do historians know when they know something?  difficult to measure. Study of individuals, small samples and singularities are preferred and generalization must be approached cautiously30                                                 29 Key questions underpinning the qualitative research methodologies in Table 4 were adapted from Creswell (2007), Denzin and Lincoln (2008), Gay, Mills, and Airasian (2009), and Palys and Atchison (2008).  .   30 Several key issues emerged from this mapping exercise including: 1) ontology, epistemology and methodology are linked, 2) methodologies embody different perspectives on reality, value judgments about the importance of lived experience in educational settings and the varying potential for generalization, 3) methodological choice determines the specific data collection procedures and research design to be used, the kinds of knowledge that can be created from their application, and the depth of understanding generated, 4) methodological choice is not a technical exercise but implies a commitment to the inherent belief system that underpins it; the research questions 71  Based on the preceding discussion including Table 4, case study with a qualitative methods perspective was deemed an appropriate methodological choice for this thesis work. Designed as a theoretical empirical study of a complex singularity, the UBC BSc(Pharm) program, the intent was to develop a comprehensive, in-depth understanding about the role and status of the basic pharmaceutical sciences in the program. A qualitative perspective was chosen to facilitate depth of understanding and rich descriptions about the current situation in its naturalistic setting (Lincoln & Guba, 1985). The study’s purpose, its research questions and a commitment to the inherent ontological and epistemological belief system that underpins qualitative case study helped justify this methodological choice. In addition, while several case study typologies have been developed for various investigational purposes, as a research approach, case studies have been described as holistic processes leading to in-depth understanding of bounded systems (Bassey, 1999; Creswell, 2007; Merriam, 1998; Stake, 2010; Yin, 2003). The term “bounded” refers to the ability to separate out, by time and place, the particular event, program, institution or social group of interest for detailed study (Merriam, 1998; Stake, 2010; Yin, 2003). Unit of analysis is used instead of bounded system in some case study literature to emphasize the boundedness of a case (VanWynsberghe & Khan, 2007).  The UBC BSc(Pharm) program, a bounded system comprising a 1+4 year entry-to-practice professional degree program uniquely available at UBC and in BC, represented a good candidate for qualitative case study investigation. Although vigorous debates about defining case study continue despite a long history (Becker, 1999; Hamel, Dufour, & Fortin, 1993; VanWynsberghe & Khan, 2007), for this study, case study was viewed as a methodology as well                                                                                                                                                              drive this choice, and 5) one’s personal ontological positioning does not preclude using alternate paradigms of inquiry; the more ways we go we go about investigating a particular educational issue or phenomena the better we can understand it (Gay, Mills, & Airasian, 2009; Palys & Atchison, 2008). 72  as a product of the inquiry314.2 Pragmatics of the Study  (Creswell, 2007).  In terms of the specific case study approach used, Stake’s (1995, 2005, 2010) notion of intrinsic qualitative case study was adopted. Conceptualizing the case, the UBC BSc(Pharm) program, as a unique, complex, functioning “thing” (Stake, 2010, p. 25) comprising its own intrinsic issues worthy of study seemed particularly appropriate. An intrinsic case study approach also kept the study focused on understanding the current situation regarding the role and status of basic pharmaceutical sciences in the UBC BSc(Pharm) program; other types of case studies within Stake’s typology, such as instrumental or collective case studies, have broader purposes (Stake, 2010; Yin, 2003). Stake’s (2010) intrinsic case study approach also provided the flexibility to involve a range of qualitative methods to investigate the case in its naturalistic setting. Inclusion of interviews, classroom observations and document analyses allowed for extensive interaction with study participants and collection of a comprehensive data set for answering the research questions, addressing the study’s purpose and learning about the case.  Based on the preceding discussion, this case study of the UBC BSc(Pharm) program was designed to optimize understanding of the case rather than to generalize beyond it. The epistemological question driving the case study design was “What can be learned from the single case?” (Stake, 2005, p. 443). The study design will be described next. Conceptual Structure of the Case Study  Designing this study began with conceptualization. Informed by Stake’s (1995, 2005, 2010) perspectives, identifying the case to be studied provided the initial entry point for the study design. Viewing UBC’s BSc(Pharm) program as a complex functioning system (“thing”) with                                                  31 For this study, “methodology” refers to the process of inquiry used to study a bounded system (a case) and research efforts undertaken to understand its uniqueness. This thesis, a case study about the UBC BSc(Pharm) program, is also the product of the study. 73  boundaries, integrated working parts and a well-established and critical purpose helped clarify and refine the study’s purpose and research questions, confirm choices about research methodology and methods, and organize the investigational activities. Figure 2 provides the conceptual structure for the case study (Stake, 2005). Developed to gather and focus thinking about the case, Figure 2 situates UBC’s current BSc(Pharm) program (the case) within the complex interplay of pharmacy practice and pharmacy education historically as well as indicates some of the complex internal and external contextual pressures influencing the case today32. Conceptualizing the case study in this way highlighted the case’s complexity, historical embeddedness, and contextuality. It also helped clarify the study’s focus and what could be learned about the case. Through the process of “progressive refocusing” (Stake, 1995, p. 22), the case study’s purpose and research questions were honed, the working parts of the case to be studied identified, and the investigational activities established and sequenced33                                                 32 The conceptual structure of the case study was developed based on the histories of pharmacy practice and education in Canada as presented earlier in Chapters 2 and 3, respectively. Internal and external pressures on the current program are indicated in the small rectangles and the inward pointing arrows. . To complete the study’s conceptual structure a theoretical framework was adopted to help guide decisions about 33 The working parts of the case are indicated in Figure 2 as the pie-shaped sub-components of the current BSc(Pharm) program. Included are the basic pharmaceutical sciences courses, faculty members (as disciplinary experts), and Faculty and curriculum review reports. The data collection methods to be used to investigate the working parts are shown in the lower pie-shaped segment and include interviews, classroom observations, and document analysis.  74  Figure 2: Conceptual structure for the case study  75  what information in particular to collect from the working parts of the case by the data collection methods identified. The theoretical framework will be described next.  Theoretical Framework Hubball and Burt’s (2004) framework for learning-centered curricula was chosen as the theoretical framework for this study.  Providing a particularly useful lens for exploring and analyzing curriculum complexity, their robust and comprehensive dimensional framework not only aligned well with the notion of conceptual orientation adopted for this study (Table 2) but helped guide decisions about the particular information needed to address the study’s purpose and answer the research questions. Described briefly, this flexible, heuristic framework views curriculum holistically and integrates the learning context with curriculum planning, teaching and assessment activities (Figure 3). Learning context acknowledges the critical importance of context in educational settings, the importance of understanding the internal and external factors affecting it, and how it influences the program purpose, planning, assessment and teaching  Figure 3: Theoretical framework adopted for the study (Hubball & Burt, 2004)          76  aspects of curriculum design and reform. Planning activities take into account learning context factors and refer to the articulation of learning outcomes which in part, drive the process of content selection and program structuring, design, and coherence. Assessment activities take into account learning context factors and refer to the methods used to gather data on student learning as well as the standards to judge achievement. Acknowledging assessment as a powerful force driving the learning process, emphasis is not placed on any one single method of assessment but on a range of methods comprising formative and summative approaches (Hubball & Gold, 2007). Instructional methods or teaching practices take into account learning context factors and refer to the application of various learning strategies, on a continuum from teaching-centered to learning-centered, that promote active learning and provide opportunities for individual work, partner work, small group work and large class activities (Ambrose, Bridges, Lovett, Dipietro, & Norman, 2010). Practical and robust, Hubball and Burt’s (2004) framework for learning-centered curricula has been time-tested and applied successfully across higher education contexts including pharmacy (Albon & Hubball, 2004; Devine, Daly, Lero, & MacMartin, 2007; Hubball & Pearson, 2010). For the purposes of this study the particular information collected from the working parts of this case study was framed by the following curriculum dimensions: context, purpose, what is taught (content knowledge), how it is taught (teaching methods), overall design and structure (with attention to coherence), and how learning is demonstrated and judged (through assessment and evaluation).  Study Setting and Case Context The primary settings for this case study were the offices, teaching spaces and meeting places of the George T. Cunningham Building, home of UBC’s Faculty of Pharmaceutical 77  Sciences for more than 50 years. In addition, the tiered, theatre-style lecture halls in UBC’s Health Sciences Instructional Resources Centre (IRC) where much of the large-class teaching in the BSc(Pharm) program has taken place since the early 1970s were used (Louis & Twaites, 1996).  Located on the Vancouver campus of one of Canada’s largest research intensive universities, the Faculty offers, in addition to the BSc(Pharm) program, post-graduate master, doctoral and professional degree programs. Continuing pharmacy professional development rounds out the programs offered. Over 5000 pharmacists, pharmaceutical scientists and advanced clinical practitioners have graduated from the Faculty since it opened in 1946.  The Faculty represents one of twelve on the UBC Vancouver campus joining medicine34, dentistry and nursing amongst health sciences Faculties and Schools. The Faculty has established, maintained and continues to cultivate strong relationships with external provincial and national organizations including health authorities, teaching hospitals, pharmacy regulatory and accreditation bodies, and professional associations and societies (FPS, 2012)35.  While both the George T. Cunningham Building and the IRC lecture halls have undergone extensive renovation and modernization they retain the distinct architectural flavor of the eras in which they were built36Study Participants, Recruitment and Consent .  As of March 28, 2011, the study’s ethics approval date, the volunteer pool comprised                                                  34 The UBC Faculty of Medicine includes 19 academic departments, two schools and 19 research institutes and centres (available at www. http://med.ubc.ca/about/departments-schools-centres/). 35 The governance structure for the Faculty, showing faculty roles and responsibilities, can be found at www.pharmacy.ubc.ca/aboutus/factsfigures. The Faculty comprises the portfolios of Research & Graduate Studies, Academic programs, and Practice Innovation each with an Associate Dean that reports to the Dean. Within the Academic portfolio, Directors oversee Student Services, the Entry-to-Practice program [BSc(Pharm)], the post-graduate Doctor of Pharmacy (PharmD), experiential education (OEE) and continuing pharmacy professional development (CPPD).  The Director, Entry-to-Practice program, oversees the development, delivery and enhancement of the BSc(Pharm) program with the assistance of Program Coordinators in Years 1 to 4 and individual faculty course coordinators. Sampling for this study was sensitive to the variety of roles faculty play in the Faculty.  36 Pictures of the George T. Cunningham Building and the IRC lecture halls 2 and 6, where classroom observations took place, can be found at http://www.maps.ubc.ca/PROD/index_detail.php?show=y,n,n,n,n,y&bldg2Search=n&locat1=625 and http://www.students.ubc.ca/classroomservices/buildings-and-classrooms/?code=WOOD, respectively. 78  all full-time, part-time and emeritus faculty members in the UBC Faculty of Pharmaceutical Sciences; a roster of approximately 60 individuals. At that time the Faculty employed 34 full-time equivalent faculty members within the five disciplines of pharmacy (pharmaceutical chemistry, pharmacology, pharmaceutics, clinical pharmacy and pharmacy practice). The faculty contingent (both full-time and part-time appointments; approximately 45 members in total) included approximately 70% professorial research-track and 30% instructor teaching-track positions. In addition, approximately 35% of these were basic pharmaceutical scientists (16/45) while 65% held clinical and practice appointments (29/45). The Faculty also maintained a close relationship with emeritus faculty (approximately 15), of which approximately five continue to be active in Faculty and University affairs, and the profession locally, provincially, and nationally. Based on these parameters the initial volunteer pool for the study comprised 50 full-time, part-time and emeritus faculty members from which study participants were selected.  Purposive sampling was used to select study participants from the volunteer pool (Gay, Mills, & Airasian, 2009; Palys & Atchison, 2008). Approximately two-thirds of the volunteer pool was invited to participate in the study with an expectation that approximately half would participate. Selecting a study sample representative of the uniqueness, diversity and complexity of the case as well as one that could proffer in-depth understanding was the primary focus of the purposive selection process. Sampling criteria included sensitivity to administrative status, academic ranks, discipline affiliations, and teaching responsibilities and context. Gender, years of service, practice experience, diversity of opinions and level of involvement in pharmacy affairs locally, provincially and nationally were also included in the sampling criteria. Although the extensive insider knowledge of the researcher was helpful for purposive selection, “critical reflexivity” (Bishop, 2005, p. 113) was practiced to attempt to minimize researcher bias during 79  sample selection and to maintain focus on learning about the case (Stake, 2010). Based on the purposive sampling criteria and proportional representation, a sample of approximately 25 study participants was anticipated to include nine basic pharmaceutical sciences faculty, 13 members from clinical and pharmacy practice, and three emeritus faculty.  Recruitment of study participants from the volunteer pool began with individualized e-mail and hard copy invitations (Gay, Mills, & Airasian, 2009; Palys & Atchison, 2008). Copies of the study email and hard copy invitations can be found in Appendix A. Email addresses were obtained from Faculty email lists compiled and circulated to faculty members on a regular basis by the Dean’s Office. Hard copy letters of invitation in sealed envelopes were delivered through the Faculty mailroom. Volunteers that responded to the initial study invitation were contacted to set-up an initial information meeting about the study and to address any questions or concerns regarding the study and their potential involvement. The study’s purpose and background, participant roles, data collection procedures (the interview protocol and questions, classroom observation process, and course document analysis to be discussed below were provided at the meeting) and informed consent were discussed at this meeting. While most of the initial meetings took place in the George T. Cunningham Building, some had to be scheduled for alternate locations to meet personal needs and circumstances of the volunteers (particularly for some emeritus faculty and those working in teaching hospitals). The information meetings took approximately 20 minutes. No attempt was made to seek consent at these meetings unless freely offered by the study volunteer and each was encouraged to take the time necessary to decide whether or not to participate. The final decision to participate was the volunteer’s. Those volunteers that agreed to participate were asked to provide written consent and were included in the study unless they chose to withdraw. The letter of consent has been included in Appendix A. 80  Two copies of the letter of consent were provided to study participants at the initial meeting (one to keep and one to return to the researcher).  The signed consent forms were collected, placed in a sealed envelope and stored in a locked cabinet in the researcher’s office in the George T. Cunningham Building. Any faculty member that responded to the study invitation but declined to participate further was thanked at the meeting (if applicable) and in a follow-up email message. Although publicly accessible, for the purposes of this study email addresses were considered confidential information, stored on a password protected and encrypted portable memory device designated for use in this study only, and when not in use, stored along with the consent forms. To refine sample selection, make adjustments to data collection tools and processes where necessary (e.g., interview questions, interviewing techniques and classroom observation processes) and attempt parsimonious data collection (Lingard & Kennedy, 2010; Merriam, 1998) invitations to participate in this study were sent in three rounds dated June 3, 2011, June 22, 2011 and October 3, 2011 to allow for on-going data analysis and decision making during data collection. In total 31 invitations were sent with 24 faculty agreeing to participate; two basic pharmaceutical scientists and five clinical and practice faculty declined the invitation. One emeritus faculty member later withdrew for health reasons. This data set was not included in the study and there were no further withdrawals. Study sample characteristics, comprising 23 participants, are presented in Table 5. Data Collection Procedures To address the purpose of the study and answer the research questions the data to be collected comprised of semi-structured interviews, classroom observations, course documents, a range of historical documents, and research journal entries. All study participants (n=23) took part in the interviews while only those basic pharmaceutical scientists currently teaching in the81  Table 5: Study sample characteristics Discipline Affiliation Study Participants  Academic  Ranks Average Years of Faculty Experience (high/low) Faculty with Pharmacy Degrees Average Years of Practice Experience (high/low) Faculty Currently Practicing Previous Undergraduate Teaching Experience in Faculty Medicinal chemistry, pharmaceutics, pharmacology  13 Assistant, Associate and Full Professors; Emeritus faculty including senior administration  19.8  (45/4)  8 2.9  (0.5/8) 0 Minimal; mostly graduate teaching assistantships, graduate level lecturing; some associated with previous positions or with faculty appointments at other universities Pharmacy practice, clinical pharmacy    10 Lecturers, Instructors, and Senior Instructors; Assistant, Associate and Full Professors including senior administration; Emeritus faculty    15.6  (60/1.5)    10 15.6  (43/2) 5  Minimal; mostly precepting, tutoring, and residency training, some lecturing; some associated with previous positions or with faculty appointments at other universities 82  program (8) participated in the classroom observation and provided course documents. Described below are the procedures used for data collection.  To answer research question one, historical information specific to the UBC BSc(Pharm) program was required (Gay, Mills, & Airasian, 2009; Kaestle, 1992;  Palys & Atchison, 2008). The UBC calendar archive containing calendar entries dating back to the inception of the program in 1946, the historical pharmacy literature pertaining to the UBC Faculty of Pharmaceutical Sciences, and as shown in Table 6, major accreditation and Faculty external review documents were used to situate the current BSc(Pharm) program in historical context. While the UBC calendar archive37                                                 37 UBC Calendar Archive available at: http://www.calendar.ubc.ca/archive/vancouver/index.cfm.  and the historical pharmacy education literature were public documents or available through UBC’s Special Archives library, the major Faculty accreditation and external review documents developed for UBC’s BSc(Pharm) program were not. A letter of request was sent March 28, 2011 to the Office of the Associate Dean of Academic Programs in the UBC Faculty of Pharmaceutical Sciences to access documents created between 1990 and 2007 for use in this study. Appendix B provides a copy of the letter of request. Through subsequent verbal agreement, the Faculty’s approved 2012 accreditation document was included as an additional data source for the case study. The products of the historical document analysis, the focus of Chapter 5 of this thesis, included: written summaries for each accreditation and Faculty review document (focused on the curriculum dimensions of interest in this study; 10 summaries in total were generated); curriculum development timelines for the UBC pharmacy program since inception; an historical account of the conceptual orientations towards curriculum evident for the UBC BSc(Pharm) program (with specific emphasis on the role of science and the basic pharmaceutical sciences in each), and; a graphical representation of changes in program enrollment and faculty composition (comparing basic pharmaceutical scientists and clinical and 83  Table 6: Faculty and curriculum review documents for UBC pharmacy programs Date Title Purpose November 2012 Faculty of Pharmaceutical Sciences BSc(Pharm) Self Assessment Report for Accreditation (Single digital file; 260 pages) Prepared for CCAPP accreditation of the BSc(Pharm) program (23 standards reviewed); the Faculty’s fourth accreditation review. October 2007 The University of British Columbia Review of the Faculty of Pharmaceutical Sciences (Single binder, 600 pages) Review of academic strengths and balance of the Faculty in teaching, scholarly activity and service; and to advise on future development November 2005 Faculty of Pharmaceutical Sciences BSc(Pharm) Self Assessment Report for Accreditation (Three binders, 600 pages) Prepared for CCAPP accreditation of the BSc(Pharm) program (25 standards reviewed); the Faculty’s third accreditation review. April 2001 Faculty of Pharmaceutical Sciences, New BSc(Pharm) Curriculum Report to CCAPP (Single binder, 100 pages) Addressing deficiencies in the BSc(Pharm) program as identified in the 1999 CCAPP Accreditation Report September 1999 Faculty of Pharmaceutical Sciences BSc(Pharm) Self Assessment Report for Accreditation (Single binder, 300 pages) Prepared for CCAPP accreditation of the BSc(Pharm) program (25 standards reviewed); the Faculty’s second accreditation review. March 1995 The University of British Columbia Review of the Faculty of Pharmaceutical Sciences (Single binder, 400 pages) Review of academic strengths and balance of the Faculty in teaching, scholarly activity and service; to advise on future developments. Documentation for external review similar to 1994 Accreditation Self Assessment report. September 1994 Faculty of Pharmaceutical Sciences BSc(Pharm) Self Assessment Report for Accreditation (Single binder, 400 pages)  Prepared for CCAPP accreditation of the BSc(Pharm) program (24 standards reviewed); the Faculty’s first accreditation review. February  1990 The University of British Columbia Review of the Faculty of Pharmaceutical Sciences (17 page document) Review of academic strengths and balance of the Faculty in teaching, scholarly activity and service; to advise on future developments. May 1967 Report of the Pharmacy Planning Commission, Pharmaceutical Association of the Province of British Columbia (138 page document) Prepared following a comprehensive review of the practice of pharmacy in BC. Review of the BSP degree program was one aspect of the Commission’s Terms of Reference. Pre-1946 No formal documents available Perspectives developed using selected historical literature on pharmacy education in BC prior to the establishment of the first UBC BSP program. 84  practice-oriented faculty appointments). These historical products were included, along with the interview and classroom observation data collected, in the broader analysis and understanding of the study and the case. The curriculum revision and review documents for UBC’s BSc(Pharm) program were treated as confidential information, stored securely in a locked cabinet when not in use, and returned once the historical analysis was complete. Example written summaries for the 1999 Accreditation Self Study of the BSc(Pharm) program and the 2007 External Review of the Faculty of Pharmaceutical Sciences have been included in Appendix B. To answer research question two and aspects of question three semi-structured interviews were used to gather perspectives from study participants on the role and status of the basic pharmaceutical sciences in the UBC BSc(Pharm) program as well as their curriculum and pedagogical practices (DiCicco-Bloom & Crabtree, 2006). While most interviews took place in the participant’s office in the George T. Cunningham Building, some had to be scheduled off-campus (particularly for faculty working in teaching hospitals and some emeritus faculty). All faculty members that consented to participate were included in this aspect of the study (n=23). The date, time and place of the interviews were negotiated with study participants and the interview protocol and questions were provided beforehand to encourage prior preparation. The interviews took approximately 60 minutes and were conducted by this researcher. The interviews began with a preamble recapping the study plans and intent, the risks and benefits of participation, and issues related to confidentiality (Merriam, 1998). In addition, an overview of the interview format as well as potential follow-up procedures (i.e., follow-up interviews, member checking activities, and sharing of research findings) was provided. The structured component of the interview involved collecting data related to the purposive selection criteria (see Table 5), courses taught and typical approaches to teaching, learning and course design. 85  Interviewees were also probed on their decision-making regarding the scope, depth and selection of content included in their courses. The ‘unstructured’ component of the interview, the basis of Chapter 6, included open-ended questions seeking perspectives on the role and status of the basic pharmaceutical sciences in the UBC BSc(Pharm) program and how that has changed. The interview preamble and questions have been included in Appendix B. Attempts were made to follow reflexive approaches to interviewing (Fontana & Frey, 2005) and interviewees were thanked for their participation prior to and after the interviews. Interviews were audio-taped in duplicate using digital recorders (two recording devices were used to provide back-up in case of device failure) and journal notes were generated immediately following the interviews to record general impressions, typical or atypical issues that arose, and suggestions for improvements to the interview questions, techniques and format (Merriam, 1998). Within 24 hours the audio recording of each interview was reviewed to become familiar with the data, clarify the need for follow-up, begin analysis, and help make decisions regarding the next round of invitees. Audio-taped interviews were transcribed by a third party (except one) and reviewed by re-listening to the audio recording, reading the transcript and editing for accuracy (DiCicco & Crabtree, 2006). Time stamps were also added to the transcripts at this point to allow quick access to the original audio data (Merriam, 1998). Interview transcripts were then sent to the participant for review and adjustment to attempt to ensure that the final version was representative of the experiences of both the interviewee and interviewer; aural feedback was received on all transcripts with minor adjustments were made to three. Transcripts along with the audio files were organized for easy access and stored safely prior to broader analysis with the other data sources collected for the study. Twenty three semi-structured interviews were conducted between June 20th and 86  November 1st, 2011 comprising 22.4 hours of interview recordings and 382 pages of transcription.  To gather additional data on the curriculum and pedagogical practices of the basic pharmaceutical scientists teaching in the UBC BSc(Pharm) program (research question three), direct classroom observations were employed (Gay, Mills, & Airasian, 2009; Lincoln & Guba, 1985; Merriam, 1998; Palys & Atchison, 2008). Course documents were also collected for analysis including course syllabi, lecture hand-outs and typical exam questions. Only those faculty members that self-identified as basic pharmaceutical scientists and consented to participate were included in this aspect of the study (n=8). The classroom observations were conducted by the researcher and attempted to minimize disruption to the natural setting or functioning of the classrooms visited; the researcher assumed the role of passive, non-participant observer (Lingard & Kennedy, 2010). The date and time of the classroom observations were negotiated with the faculty member following review and discussion of the course. Preference was given to observation of specific sections of or modules within courses (i.e., a particular disease state or scientific concept) in order to examine how the participant’s conceptualization of the topic was manifest in the classroom and to experience the “rhythm and flow” (Merriam, 1998, p. 98) of classroom practices. On the specified dates and times students were informed that the observations were taking place using a script read by the faculty member. The naturalistic observations were recorded in field notes using an observation form developed for this purpose and comprised purposeful observations about: the classroom context and setting; the students and faculty member; the interactions and activities that took place; the curriculum dimensions of interest in this study, and; the researcher’s reflections. Since each participant was observed between 2 and 4 times, the researcher sat in different positions around the classroom to attempt 87  to experience different perspectives on classroom practices. No information about individual students was collected. The script used to inform students about the study and classroom observation form have been included in Appendix B. Debriefing sessions of between 15-40 minutes were held with each faculty member following the observations to discuss issues that arose; these sessions did not involve peer review of classroom practices but were meant to gather participant reflections and clarify observer issues (e.g., self-assessment of classroom practices, clarification of approaches to teaching the science and answering specific questions about the scientific content). Within 24 hours of the observation initial hand-written field notes and journal entries from the debriefing sessions were developed into full digital summaries of the in-class sessions. These provided detailed descriptions of the setting, what took place and the post session reflections; the time required to create the summaries was approximately equal to the in-class time. The classroom observation summaries were then sent to the participant for review and adjustment to attempt to ensure that the final summary was representative of the experiences of both the teacher and researcher. The classroom observations took place over two academic terms (i.e., September – December of the 2010-2011 and January - April of the 2011-2012 academic years, respectively) and a total of 22 hours of lectures were observed and 18 observational summaries generated and member checked. Aural feedback was received on all summaries; minor adjustments were made to four. An example of one of the classroom summaries has been included in Appendix B. Field notes, classroom summaries and course documents were used in the broader analyses of curriculum and pedagogical practices of the basic pharmaceutical scientists and for the development of vignettes of first-hand experiences of their classrooms; these data are presented in Chapter 7. The field notes, classroom summaries and course 88  documents were organized for easy access and stored safely along with the other data sources collected for the study. Data Analysis and Interpretation  To answer the research questions posed for this study and to develop an in-depth understanding about the case, the constant comparative method was used to varying degrees as appropriate for analyzing, interpreting  and making sense of the data sets collected; historic documents, interviews and classroom observations (Lincoln & Guba, 1985; Merriam, 1998; Lingard & Kennedy, 2010).  Creating the historical curriculum development timelines used in Chapter 5 for identifying and describing conceptual orientations towards pharmacy curricula involved comparison of the UBC calendar archive entries for UBC pharmacy programs, the historic literature available, and the summaries developed for the Faculty accreditation and review documents. Calendar descriptions for each pharmacy program between 1946 and 2011 (approximately 65) were read and compared to identify curriculum changes from year to year. This analysis often required examining the course offerings in each year to attempt to establish the changing focus of course content and the trending taking place within pharmacy curricula. In parallel, the historical literature and the accreditation and review summaries were read and compared to attempt to verify the archival analyses as well as establish important contextual factors impacting curriculum change. The final composition of the curriculum development timelines showed the curriculum changes below the timeline in enough detail to follow the shifting focus of the pharmacy programs; the contextual changes were included above the timeline. Conceptual orientations towards pharmacy curricula at UBC were identified along these timelines as points where curriculum change stabilized, contextual influences were clear, and a coherent view of the program and curriculum was supported by the historical literature and 89  the accreditation and review summaries. The specific curricula chosen were then described with attention to: the calendar archive information; the historic literature; the accreditation and review summaries, and; the theoretical framework of curriculum dimensions underpinning the study.  To help verify the trustworthiness of the analysis a colleague not involved in the study, independently reviewed some of the calendar archive entries and accreditation and review documents to establish that the historical findings and interpretations were supported. Interview analyses, an important aspect of the results presented in Chapters 6 and 7, followed a four step constant comparative process (Gay, Mills, & Airasian, 2009; Lincoln & Guba, 1985; Palys & Atchison, 2008). A common word processing program was used for organizing and keeping track of the interview data during the manual analysis process used. Initially the audio recording of each interview was listened to 3 times to become familiar with the interview data. The last listening involved reading the digital transcript at the same time, numbering the lines continuously, clarifying time stamps and highlighting in colour where answers to interview questions began and ended. Memoing in journal notes and on hard copies of the transcripts was also used at this early stage to identify particularly rich and insightful interviews; common words, phrases and potential emerging themes were also identified. Starting with the insightful interviews and then moving randomly through the remainder, the interview analysis involved 3 broad iterative phases each including extensive cycling and recycling through the data. The first phase involved reading the responses to each interview question line-by-line, using open coding to identify important issues and ideas raised, and pooling the coded answers to each question into a separate word processing document; these separate documents included the interview questions along with the coded sections of transcript copied and pasted underneath. The reading and open coding process continued until saturation was reached, in this 90  study once approximately 85% of the interviews had been read and coded (19/23). The second phase involved grouping similarly coded interview answers together (as an additional sub-section within the separate word processing documents) for closer review, further analysis and to identify broader categories and themes. As the most time consuming and intense aspect of the interview analysis process, this stage required “progressive refocusing” (Stake, 1995, p. 22) on coded segments of the interviews and revisiting the raw transcripts as necessary, until stable categories, themes and overall schema (connecting the codes, categories and themes) emerged.  Throughout this phase data discrepancies, unique responses, direct quotes, examples and historical perspectives were flagged for possible inclusion in the written summaries of the analysis. While fresh, and connection with the data vivid (Lincoln & Guba, 1985), the final phase of the analysis involved writing the summary of the analysis for inclusion in the relevant chapters. The interviews from all study participants were analyzed in two groups, one for the basic pharmaceutical scientists, the other for clinical and practice faculty. Seven separate documents and analyses were completed in total including: prefacing issues, role, and status for both groups, and; curriculum and pedagogical practices for basic pharmaceutical scientists only38                                                 38 Prefacing issues included perspectives on what the basic pharmaceutical sciences are, practice experience, and the future of the profession. Curriculum and pedagogical practices for basic pharmaceutical scientists included analysis of interview questions related to the following curriculum dimensions: what was taught (content scope, depth and selection), how it was taught (teaching methods), course design and assessment practices. . To help verify the trustworthiness of the analysis a colleague who was not involved in the study, independently analyzed and coded some of the interviews to establish that the study findings and interpretations were supported. Appendix B contains an example of the interview analysis process for the question asking basic pharmaceutical scientists about the role of the basic pharmaceutical sciences in the current program. Included are the study code identifiers for the participants and the transcript line numbers used in the analysis.  91  The vignettes of the first-hand accounts of the classroom visits that appear in Chapter 7 as specific examples of what happens in the classrooms of the basic pharmaceutical scientists were developed using original field notes, member checked classroom summaries and course documents. The process here was similar but much less intensive than the constant comparative analysis described above.  Data Management and Procedural Auditing  The data set for this study was extensive requiring careful labeling and organization for easy access, secure storage and auditing throughout the study (Gay, Mills, & Airasian, 2009; Lincoln & Guba, 1985; Palys & Atchison, 2008). The complete data set for the study included hard copy as well as digital files and included: signed consent forms; written summaries of Faculty accreditation and external reviews; roster and program enrollment analyses; interview audio files and transcripts; classroom observation field notes and summaries; course documents, and; the researcher’s journal notes. For digital files, a series of folders were used to categorize and organize the data according to the five pharmaceutical sciences disciplines (i.e., pharmaceutical chemistry, pharmaceutics, pharmacology, clinical pharmacy and pharmacy practice). Individualized sub-folders within the disciplinary folders were used to compile data for each study participant. For hard copy data a series of binders, organized in a similar fashion, were used. All data included dates, times and the location of collection. Participants were not identified by name on any pieces of data or study documents and a number coding system was used to link folders, sub-folders, study participants and data sets. Digital files were stored on a portable memory device (a memory stick) designated for use in this study only; a second memory device was used to create an independent back-up of all digital study data.  The data trail was audited independently by a colleague not involved in the study. Only the researcher had 92  access to the data set (except during the data audit) and when not in use, all hard copy and digital data were stored securely. Data will be stored for a 5 year period after completion of this study and then destroyed. Trustworthiness and Issues of Generalizability  Designed as a theoretical empirical inquiry using Stake’s (2010) notion of qualitative intrinsic case study, the primary focus of this study was to optimize understanding about the case rather than to generalize, in a statistical sense, from it. As qualitative naturalistic research, specific strategies and processes were incorporated into the study design to establish trustworthiness as a measure of the study’s quality and the overall reliability and validity of its findings (Creswell, 2007). Drawing on the perspectives of Stake (1995) and Lincoln and Guba (1985), Merriam (1998) outlines three criteria to enhance trustworthiness in naturalistic qualitative research. They include credibility, consistency and transferability.  Credibility establishes that a study is believable to the “critical reader” and approved by those who provided the information (Merriam, 1995).  In this study, credibility was established by employing triangulation of multiple data sources obtained through different research methods including interviews, classroom observations and document analyses (Stake, 1995, 2010).  Transcribed interviews and classroom observation summaries were shared with study participants as a form of member checking to attempt to rule out the possibility of misinterpreting the meaning of what the study participants said or did.  To establish congruency between the emerging findings and the raw data, a colleague who was not involved in the study, independently analyzed many of the historic documents and coded some of the interviews to establish that the study findings and interpretations were supported.  The researcher’s positionality and reflexivity were explained and 93  exercised in undertaking this study to make explicit dispositions, assumptions and biases that may have influenced the study’s findings. Consistency is a measure of the rigour of the study design and how competently the data collection and analysis techniques are carried out. Driven by the research questions, what was done, how the research was conducted, and how the study findings and conclusions were arrived at received careful and systematic attention throughout the study (Creswell, 2007; Lincoln & Guba, 1985; Merriam, 1998).  To ensure the research process was transparent enough to be understood by others, detailed records of the data collection, coding, and analysis procedures were kept.  The same colleague that provided independent analysis of some of the raw data acted as an “independent auditor.”  She reviewed the study’s “audit trail” of interviews, observations, and document analyses to verify that these study procedures supported the findings and interpretations.   Transferability or generalizability in qualitative research refers to the applicability of a study’s findings to similar contexts or settings (Lincoln & Guba, 1985; Merriam, 1998; Shulman, 1997; Stake, 1995).  While the primary purpose of this study was understanding the current situation regarding the basic pharmaceutical sciences in the UBC BSc(Pharm) program, the results may inform other educators or researchers who are interested in the scientific foundations of pharmacy education and the pedagogical practices of the scientists that teach them.  This research approach and findings may also assist researchers conducting naturalistic studies of similar pharmacy programs in Canada, the US and beyond. Two strategies recommended by Merriam (1998) were incorporated in the study design to achieve transferability; purposive sampling and thick description.  The purposive selection of a study sample representative of the Faculty roster provided a range of perspectives and opinions about the importance of the basic 94  pharmaceutical sciences in the current program. The results of the interview, classroom observations and document analyses, including evidence in the form of quotes from interviews, field notes and documents, provided a rich and detailed account of the study, the study setting and the research findings.  These two strategies provide the reader with the in-depth information required to judge whether the study’s findings may be relevant to other settings (Creswell, 2007; Lincoln & Guba, 1985; Stake, 1995). Ethical Considerations Following ethical research practice guidelines to ensure that study participants were treated with respect, dignity and care throughout the study was of paramount importance (Palys & Atchison, 2008). Obtaining informed consent, ensuring that harm or risk to participants was minimized, establishing honesty and trust between researcher and participant, and maintaining confidentiality was part of the study design. To ensure this study met appropriate ethical guidelines application, approval was obtained through UBC’s Behavioral Research Ethics Board. Prior to their involvement, study participants were introduced to the study including what their participation would involve, what risk they may run by being involved in the research and a description of the intent and outcomes of the research. Written informed consent was obtained from all study participants. To protect the confidentiality and privacy of the study participants a number coding system and pseudonyms were used, where necessary, and specific references to their courses and areas of expertise were removed.  Limitations  Optimizing understanding about the case was the primary focus of this study. Several limitations related to the study design, the data collected from the working parts of the case, and their analysis and interpretation, have the potential to impact the answers to the research 95  questions, the quality of the findings and what was learned about the case. Limitations that had the greatest potential impact are presented below.  The first limitation of this study is related to the role of the researcher as insider and primary instrument in this research (Merriam, 1998; Stake, 1995). Throughout this research study decisions were made about the study design, what data to collect and when, what data to analyze and what to privilege, and what lens to bring to bear on the interpretation. The mountainous data corpus could support other interpretations besides the one presented here. Personal bias was inevitable during the conduct of this study exacerbated by the insider status of the researcher. While awareness of these influences was heightened and reflexivity exercised throughout, the study’s findings are influenced by the beliefs and experiences of the researcher as a longtime faculty member, colleague of the study participants, educator, and science lover. Acknowledging this limitation, the understanding of the case presented endeavoured to be as congruent with the data collected and as unbiased as possible. Member checking, independent analyses and data auditing were incorporated into the research design to attempt to address potential researcher bias.   The second limitation of this study is related to the composition of the study sample purposively selected to participate in the study (Gay, Mills, & Airasian, 2009; Palys & Atchison, 2008). Although the sampling protocol and selection criteria were carefully developed for maximum variation within the sample, and the final sample was deemed representative, the voice of community pharmacy was not as strong as originally anticipated. Despite being invited to participate in the study through three rounds of invitations, many of the faculty currently practicing in the community declined to participate. Introducing a potential selection bias towards those that were interested in the study topic, the characteristics of the final study sample 96  may have been different from the overall volunteer pool. Whether or not additional community practitioners in the study sample would alter the study findings requires further research.  The third limitation of this study is the lack of easily accessible historical literature available on the profession of pharmacy in BC or the UBC pharmacy programs. Although Faculty and curriculum review documents for UBC pharmacy programs were freely available by request, other relevant historical information and literature about the profession and pharmacy programs was fragmented and difficult to find, particularly prior to 1990.  While the UBC calendar archive was an invaluable resource, finding other documents such as the BCPhA Pharmacy Planning Commission (MacPhee, Dyck, Dykeman, & Watson, 1967), information on pharmacy education in the early decades of the 20th century (Moir, 1957; Stewart, 1957), and the BCPhA Pharmacy Act Sale of Poisons Book (BCPhA, 1911) required labourious searching through the Faculty’s currently unorganized historical library or boxes of musty old documents currently stored but uncatalogued, in UBC’s Special Archives section of the Ike Barber Learning Centre. While key documents were found, lack of ready access to historic information made it difficult, but not impossible, to establish historic trends in practice and education, and identify conceptual orientations towards curriculum as part of the case study. Although difficult to infer, additional searching through these documents may have established a more nuanced historical context in which to situate the current program. As a future research project, creating a coherent history of pharmacy education in BC using the copious historic materials available would make a valuable contribution to the current gap in the history literature about the profession and pharmacy education in the province.   Two further limitations of this historical analysis are worth noting. The first is the lag time between the UBC calendar archive entries and when the event or change actually took place 97  in the program.  While this discrepancy may have changed the chronology presented slightly (judging by today’s standards this lag time may be up to a year), it should be noted that this lag time exists and that independent analysis of some of the historical data (calendar archive entries and Faculty accreditation and review documents) helped alleviate some of this incongruency. The second is more general and related to variable perspectives on how historical research is represented. The history developed here is presented in chronological fashion and as such, is open to postmodern criticism and even rejection, as it could be conceived as “grand explanations that seek to explain all of reality from a singular [modernist or positivist] perspective” (Slattery, 2006, p. 40).   The fourth major limitation of this study is related to the credibility of the interview and classroom observation data collected, analyzed and interpreted. While care was taken during the interviews to create a safe and respectful interaction and interview questions were triangulated to probe key aspects of interest from different angles, the responses from study participants was self-reported during one interview only. Although study participants appeared very engaged and interview transcripts were member checked, the interview data collected represented a construction of reality or a recollection of the truth on that day (Palys & Atchison, 2008). In addition, the skills and abilities of this researcher as a newcomer to qualitative research, interviewing and interpreting interview data had the potential to influence the interview data collected and the corresponding analysis and interpretation (Merriam, 1998). Assuming the study participants were responding “truthfully,” every effort was made during the study to monitor and improve qualitative research skills to minimize these limitations on the case report (Palys & Atchison, 2008).  98   Similar issues emerged regarding the classroom observation data. While there was congruence between the basic pharmaceutical scientist’s pedagogical practices described during the interviews and what took place in their classrooms, only a small number of classes were observed for each.  Even though carefully scheduled to attempt to observe the rhythm and flow of the classrooms and study participants acknowledged the observations as typical of their day-to-day teaching practices, the summaries generated represented a snap shot of classroom practices of the basic pharmaceutical scientists. Following their classroom practices over a longer period of time may have improved the accuracy of the observational data and the depth of understanding about the teaching practices of the basic pharmaceutical scientists and the case. Unfortunately, the timelines and exigencies of the study did not allow this. It should also be noted that both the classroom visits and interviews just described may have been further biased by the Hawthorne Effect which suggests that participant’s behaviour might change when they become engaged in a research study and they do what they believe they are expected to do when participating (Diaper, 1990). While the data does not support claims about the Hawthorne Effect actually occurring in this study, future studies will be mindful of such possibilities.   The fifth major limitation of this study is related to the groupings used for analyzing and interpreting the study data collected and results inferred. Despite representing all disciplines in the Faculty study participants were grouped as basic pharmaceutical scientists or as clinical and practice faculty. These broad groupings do not take into account the specific differences for example, between faculty in the various basic pharmaceutical sciences disciplines (medicinal chemistry, pharmaceutics, pharmacology) or between clinical pharmacy and pharmacy practice faculty. Accounting for these differences may not have changed the study findings but may have produced a more nuanced picture of the case. However, for the purposes of this study the broader groupings of disciplinary experts were felt sufficient to capture the most prominent issues and 99  diversity of perspectives between them. Exploring these differences through further research would help to build a more detailed understanding of the program and additional suggestions for optimization.   The final limitation of this study is related to the study’s purpose and possible lost opportunities. While the study design and research questions focused primarily on the basic pharmaceutical sciences and the scientists that teach them, a broader, more in-depth understanding of the case would incorporate analysis of the pedagogical practices of clinical and practice faculty for comparison. Although interview transcripts of clinical and practice faculty included an examination of their approaches to teaching and learning this data was not used. In addition, scheduling classroom visits with clinical and practice faculty would provide a valuable opportunity to see if and how the claims generated for the basic pharmaceutical scientists might apply to other faculty and whether or not the understanding about the case would be impacted.             100  CHAPTER 5:  SCOPE AND DEPTH OF THE BASIC PHARMACEUTICAL SCIENCES   This chapter provides the results of the historical document analysis of pharmacy education in BC and at UBC since Confederation. The intent is to answer research question one by examining what has been and what currently is the scope and depth of the basic pharmaceutical sciences in the current UBC BSc(Pharm) program. Chapter 5 also provides context for further examination of the basic pharmaceutical sciences in research questions two and three (Chapters 6 and 7, respectively). The approach to the document analysis was comprehensive to facilitate in-depth learning and thorough understanding about the historical aspects of the case (Stake, 2010). Specifically, the analysis attempted to identify distinctive conceptual orientations towards pharmacy curricula representative of the history of pharmacy education in BC, how the science and the basic pharmaceutical sciences content changed in each, and whether or not these conceptual changes aligned with the broader changes in pharmacy education in Canada as developed in Chapters 2 and 3. In addition, the historic analysis included examination of program enrollment and Faculty roster data to determine if and the extent to which either might be reflective of educational changes taking place. Situating the current program historically was a key aspect of the case study.  Using the Faculty and curriculum review documents and summaries generated (Table 6; Appendix B), the UBC calendar archive, and the available historical literature on curriculum development in BC and at UBC, curriculum development timelines were created since inception of the program in 1946. Through meta-analysis of the curriculum development timelines, specific curricula representative of conceptual orientations towards pharmacy curricula at UBC emerged for closer examination and description. Hubball and Burt’s (2004) framework was used to orient the meta-analysis and as with all analytical processes, fine tuning and adjustments were made where necessary but always aligned 101  closely with the original framework.  This responsiveness ensured that analysis was critical, appropriate, and focused at all times. Roster analysis and program enrollment information was used as additional indicators of changing perspectives and emphases. It is hoped that once readers have completed this chapter they have a sense of how pharmacy education and the UBC pharmacy program have changed, how the current program is situated  historically, and in particular, how the importance of science and the role and status of the basic pharmaceutical sciences in pharmacy education at UBC have changed.  5.1  Historical Document Analysis Curriculum Development Timelines  Figures 4-9 provide the curriculum development timelines for the UBC pharmacy program since its inception in 1946. Each timeline contains two types of information. The space above the timeline provides some of the important external and internal contextual factors affecting the profession and development of pharmacy education and curricula at UBC.  Included are influences from the federal government, national and provincial pharmacy organizations and regulatory bodies as well as UBC administration and Faculty-level change. Below each timeline information on curriculum change has been included, some minor, others major. Figure 4 for example, provides the curriculum development timeline for pharmacy education in BC from 1944 through 1958. As shown above the timeline, the British Columbia Pharmaceutical Association (BCPhA; the legislated governing and regulatory body for pharmacy in BC since the passing of the province’s first Pharmacy Act in 1891) and the Canadian Conference of Pharmaceutical Faculties (CCPF; established in 1944 as the national association representing academic pharmacy in Canada) were instrumental in establishing a pharmacy program at UBC (in 1945-1946) and developing related national program standards.  CCPF national standards for 102  Figure 4: UBC pharmacy curriculum development, 1944-1958  103  Figure 5: UBC pharmacy curriculum development, 1958-1972  104  Figure 6: UBC pharmacy curriculum development, 1972-1985  105  Figure 7: UBC pharmacy curriculum development, 1985-1997    106  Figure 8: UBC pharmacy curriculum development, 1996-2003  107  Figure 9: UBC pharmacy curriculum development, 2003-2013  108  the 3 and 4 year BSP degree programs were proposed in 1949 and 1956, respectively. In addition, the changes in deanship of the Faculty during this time period (1945, 1951 and 1952) and the introduction of universal health care in Canada by the federal government (in 1957) were key contextual factors impacting pharmacy education during this period. Below the timeline shows the incremental changes in pharmacy curricula during the time period beginning with the BCPhA self-study curriculum available prior to the opening of the first UBC program and ending with a fully mature 3 year BSP degree (1957-1958). While the curriculum development timelines in Figures 4-9 provide a sense of the contextual complexity in which pharmacy education and curricula developed at UBC and the tremendous effort expended regarding curriculum renewal and revision, they will not be described in detail here. Instead the timelines are provided as a visual representation of the extent of historic analysis undertaken to identify specific conceptual orientations towards pharmacy curricula evident in this history and will be drawn on as needed to help guide the historical discussion. Broadly, the UBC pharmacy program has included the 3 year BSP degree (in place for 16 years beginning September 1946 and ending with the last graduating class in 1962), the 4 year BSP degree (for 7 years beginning in September 1961 and graduating its last class in 1968) and the 1 + 4 year BSc(Pharm) degree (in place for the subsequent 45 years). During its 67 year history the UBC pharmacy program has developed under the leadership of 6 Deans (appointed in 1945, 1952, 1967, 1984, 1996, 2002, and most recently, 2013), 2 Acting Deans (appointed in 1951 and 2012) and has graduated over 5000 pharmacists. Specifically, four conceptual orientations toward pharmacy education describe these programs including the empiricist apprentice, pharmacist basic scientist, pharmacist pharmaceutical scientist and the pharmacist clinician curricula. Each will be described next including the historical context influencing their development39                                                 39 Readers are encouraged to have ready access to Figures 5 to13 while reading.  . 109  The Empiricist Apprentice Curriculum  Until the availability of the first BSP program at UBC in 1946 apprenticeship training, ranging from 4 to 7 years, was the only form of educating pharmacists in BC and formal education of any kind was limited and unstandardized (Fullerton & Enves, 1951). In larger cities like Vancouver, many practicing pharmacists, as apothecary masters to the apprentice, had completed apprenticeships or graduated from established schools in other jurisdictions (e.g., eastern Canada, eastern US and Britain). For students of means for example, the first school of pharmacy providing formal university-based education was the Philadelphia College of Pharmacy in 1821. By 1905 eighty schools of pharmacy were in operation in the US for those that could afford to attend them (Louis & Twaites, 1996; MacCara, 2012). In Canada, formal education for pharmacists was available at non-university-based programs in Manitoba, Ontario and Quebec as early as 1868 while the first university-based program in Canada was opened in Ontario at the University of Toronto in 1892. These programs were typically completed towards the end of the apprenticeship period and comprised one year of lecture-based course work in the empirically-based sciences of chemistry, pharmacy, materia medica and botany (Raison, 1967).   The roots of formal education for pharmacists in BC can be linked to the passing of province’s first Pharmacy Act in 1891 establishing the BCPhA to oversee and regulate the standards of pharmacy practice and education (Fullerton & Enves, 1951). Drawing from the British model of apprenticeship training and early formal programs in Canada, the original Pharmacy Act included educational standards comprising two courses of lectures in chemistry, pharmacy, and materia medica, and one in botany. Each course was equivalent to 50 lectures and although often unenforced, proof of completion (or equivalent) was required for BCPhA registration and licensure regardless of origin of training. A revised curriculum of formal course 110  work, published in the BCPhA Poisons Act of 1911 as the Outlines of Studies for Minor and Major Examinations, added the subjects of practical dispensing and practical prescriptions along with a series of supporting textbooks to the existing curriculum40 (BCPhA, 1911). Minor and major curricula focused on varying levels of understanding of the same 6 subjects. In terms of educational requirements for licensure, the rank of Certified Apprentice (granted with BCPhA registration, successful completion of a preliminary knowledge exam and the appropriate fee paid) was promotable to Certified Clerk after 2 years of Certified Apprentice experience and successful completion of written and oral minor exams. The rank of Licentiate of Pharmacy (fully qualified pharmacist), obtained after at least 2 years of Certified Clerk experience, required successful completion of both written and oral examination of the major curriculum. Diplomas and certificates for advancement were issued by the BCPhA Board of Examiners. Entirely self-study and voluntary, this curriculum formed the basis of formalized pharmacy education in BC for almost four decades (Louis & Twaites, 1996; Stewart, 1957). Founded on empirically-focused sciences and recommended textbooks, the purpose of this curriculum was to augment one-on-one apprenticeship training with the latest knowledge about drugs and the scientific advances and analytical procedures available for compounding, establishing purity and ensuring safe storage and handling of drugs and medicines (Hurst, 1934; Stewart, 1957). Designed on the finishing school model, the curriculum required extensive reading, much rote memorization and included high stakes examinations. Although private schools41                                                 40 Typical textbooks for this pharmacy curriculum, published in the late 1800s, have been listed Footnote 20. , correspondence courses, refresher courses, summer schools and articles were developed to address BCPhA concerns about the lack of educational standards for apprenticeships in BC, the curriculum for apprentices and clerks preparing for licensure exams remained unchanged (Stewart, 1957). After more than 41 Private schools in the Vancouver area included the Vancouver School of Pharmacy established in 1914, the BC School of Pharmacy and Science in 1920 and the Western School of Pharmacy in 1920 (Stewart, 1957). 111  30 years of unsuccessful negotiations with the provincial government and the UBC administration (once formed in 1908) regarding establishment of a pharmacy program at UBC (Moir, 1957), the BCPhA revised the curriculum in 1940 in anticipation of opening a private school offering a compulsory one-year required program for all apprentices and clerks seeking licensure in BC.  As shown in Table 7, the first standardized education for pharmacists in the province, conceptualized as the empiricist apprentice curriculum, included the familiar empirical sciences and an updated set of textbooks (BCPhA, 1940).  In August 1945 the UBC Board of Governors and the Senate of the University approved the establishment of a pharmacy program. Influenced by CCPF efforts nationally and existing programs at the University of Alberta and University of Saskatchewan a 3 year BSP degree was offered in September 1946 within the Faculty of Arts and Sciences. Admittance was based on senior matriculation or completion of first year basic sciences (including chemistry, physics, and mathematics) and one full year of apprenticeship (Moir, 1957).  The Pharmacist Basic Scientist Curriculum   Conceptualization of the pharmacist basic scientist curriculum emerged from meta-analysis of the first approximately 25 years of pharmacy curricula offered at UBC. Referring to Figures 4 and 5 this included the 3 and 4 year BSP programs (offered between 1946 and 1968) and the first years of the BSc(Pharm) extending to the early 1970s. While influences of the empiricist apprentice curriculum persist throughout and the basic pharmaceutical sciences (medicinal chemistry, pharmaceutics and pharmacology) become increasingly important in curricula of the mid-1960s and early 1970s, the basic, analytical and physical sciences related to botanical basis of drugs dominate pharmacy curricula during this period.  Reaching peak importance in the late 1950s and early 1960s, the 3 year BSP curriculum offered at UBC in 1960112  Table 7: The empiricist apprentice curriculum42Subject  Curriculum Content Chemistry Principles of general, inorganic and organic chemistry including preparations, properties, purification, standards of purity and conformity testing for aliphatic and aromatic substances and drug substances. Elementary stoichiometry was also included (percent composition and molecular formula calculations). Pharmacy  Knowledge of metrology (weighing and measuring), heat measurement, proper drug storage of botanical drugs, common laboratory methods (solution, precipitation, filtration, extraction, decantation and sublimation) and poisons. Materia Medica Knowledge of the official drugs listed in the British Pharmacopoeia (official names, source, active constituents, and official preparations), dosage forms (including mode of administration and routes of absorption and elimination), posology (principles of dosing), toxicology (classifying poisons and antidotes), therapeutic definitions, and forensic pharmacy (knowledge of the BC Pharmacy Act and all local and Dominion Laws that affected the practice of pharmacy and sale of poisons and habit forming drugs in BC). Botany Knowledge of the divisions of the vegetable Kingdom and the origin of plant-based drugs (including taxonomies, habitat, structure, nutrition, and reproductive characteristics), and vegetable histology and physiology.   Practical dispensing Knowledge required for preparing, labeling, wrapping and dispensing prescriptions from among the following dosage forms: solutions and mixtures, pills, emulsions, capsules, lotions, ointments, pills, powders, plasters and suppositories. Practical prescriptions Knowledge of interpretation of prescriptions, translation from Latin to English, criticism of prescription labeling and British Pharmacopoeia prescription preparation (compounding methods, weights, measures, and dose).                                                  42 Required textbooks for self-study included: Botany: A textbook for colleges by Hill, Overholts and Popp (1936) and Aids to Botany” by H.J. Bonham, B.Sc. (1934); The British Columbia Pharmacopoeia and Addenda (for Materia Medica); “Text Book of Pharmaceutics” by A.O. Bentley (1936) or “Aids to Dispensing” by A.O. Bentley (for dispensing and prescriptions; 1928); The British Pharmacopoeia, “Aids to Chemistry” publishes by Bailliere, Tindal & Cox, and “Smith’s College Chemistry –revised by Kendall (1935 Edition) (BCPhA, 1940).  113  conceptualizes the pharmacist basic scientist curriculum and is provided in Figure 10. Colour-coding (as specified in the figure key) is meant to delineate content areas in the curriculum while the size of the content blocks is meant to signify relative weighting. Three broad themes inherent in this curriculum become important for making sense of Figure 10 and describing its conceptualization. The first is the dominance of the science content indicated by the green, orange, yellow and blue areas of the figure. Within this scientific core, pharmacognosy, indicated in yellow, represents the central science43chemical, analytical and botanical sciences deemed important for understanding drug identification, isolation, synthesis and analysis processes and procedures involved in the preparation and safe use of drug products. The blue block, pharmacology, provided rudimentary understanding of drug action and toxicity in human systems and the treatment of disease.  Of the approximately 50 units of core curriculum course work required to complete this program 37 (75%) were science-based. The second theme evident in this curriculum is the modest attention paid to pharmacy practice. Indicated by the light purple areas of Figure 10, this aspect of the curriculum focused on compounding, dispensing, and drugstore management and ownership (about 25% of the core program). The last theme is practical training (dark purple area). A legacy issue from the empiricist apprentice curriculum and hotly debated provincially and nationally for 15 years in terms of relevance to the BSP trained pharmacist, the pharmacist basic scientist curriculum required 12 months of practical training under the tutelage of a qualified pharmacist (either before or after the program) for  licensure (Riedel & Stieb, 2001). Interestingly, practical training was reduced to 20 weeks following graduation in 1968 and eliminated entirely by 1972; a voluntary 2 week summer clerkship was introduced in the mid-1970s for students interested in gaining additional practical experience before licensure (Figures 5 and 6).  while the green and orange areas represent the basic                                                  43 The focus of pharmacognosy content in the curriculum was still largely empirical, qualitative and descriptive. 114  Figure 10: The pharmacist basic scientist curriculum (UBC BSP, 1960)  Year 1 Year 2 Year 3  Before or After English Organic Chemistry Elective  Practical Training  (included lab) (Pharmacy)  (12 months)      2 Physical    Education activities     Choice of Zoology   Thesis   (included lab) Plant Physiology Plant Biochemistry    Or (included lab) (included lab)   Physics     (included lab & tutorial)         Physical Chemistry Pharmaceutical    (included lab) Chemistry General    (included lab) Pharmacognosy     (included lab)    Pharmacognosy &     Biopharmacy     Bacteriology Pharmacy Accounting    (included lab) (Commerce Faculty) Organic Medicinals    (included lab)         Drug Store Retailing         Botanical Basis of     Pharmacognosy  Pharmacology    (included lab)     Principles Pharmacy Law & Ethics    of Pharmacy     (included lab) Compounding &      Dispensing Prescriptions    (included lab) (included lab)   Introduction to     Pharmacy (history,     terminology, literature)     Metrology                 Key Basic Sciences  Botanical Sciences  Pharmacognosy  Pharmacy  Pharmacology  Pharmacy Practice  Practical Experience  115   Legitimized by university affiliation, the pharmacist basic scientist curriculum provided standardized education for pharmacists in BC and signified the rightful place of pharmacy as a health profession within the Canadian health care system (MacPhee et al., 1967). Felt to be state-of-the-art and representative of the world-wide standard for becoming a licensed pharmacist, the qualitative, descriptive and voluntary focus of the empirical apprenticeship curriculum was replaced with modern sciences, experimentation and structured, compulsory courses. Intended to address the explosion of knowledge, technological innovation and medical advances since the turn of the century, the pharmacist basic scientist curriculum embodied the aspirations within the profession, at least academically, to contribute to drug discovery, medical knowledge and the treatment of disease. The Master of Science in Pharmacy (MSP) degree, first offered at UBC in 1960 (Figure 5), was indicative of the growing importance of drug research and development in the persona of the profession, its professionals and the image of pharmacy education. The stated purpose of the program was to prepare graduates for a range of careers associated with pharmacy including industry, government, research, retail establishments and hospitals. In terms of pharmacy practice, the curriculum provided a minimum basic training necessary to provide adequate and safe pharmaceutical service to the public (MacPhee et al., 1967).  Although the building blocks approach was emerging, its design and structure lacked clear definition and could be characterized as the purposeful selection and sequencing of courses needed to support the pharmacognosy core and meet the program’s purpose. Approximately half of the curriculum was taught by non-pharmacists in UBC Faculties and Departments other than Pharmacy. Laboratories, required in most courses, and traditional 50 minute lectures represented the predominant teaching methods and in any given week students completed up to 16 hours of laboratories, almost half of the required contact time. Laboratory reports, practical testing and 116  written midterm and final examinations were prominent strategies for student assessment and evaluation; much memorization was required. While the pharmacist basic scientist curriculum emphasized product chemistry and scientific technical laboratory skill development, for many critics it provided too much education for what pharmacists did in reality (in retail) and not enough of what society needed (drug-use-consultation) (MacPhee et al., 1967).  The profession at this time in BC was at a particularly low ebb that seemed to reflect the increasing disconnect between pharmacy education and the realities of practice. Both provincially and nationally, there was broad recognition of the impacts of industrialization on the role of the pharmacists, particularly in the community setting. Significant reduction in compounding alongside the concurrent growth of prefabricated drug products had affected their function dramatically. As the basis of pharmacy practice for decades, the art and mystery of medications and the craftsmanship in their preparation had largely disappeared. While most pharmacists maintained a high level of professional conduct and community service, amongst practitioners including new graduates, the image of pharmacy was waning. Increasing commercialization within drugstores, poor income for owners, the lack of salary advancement for employee pharmacists, long hours of operation (including night work, holidays and Sundays) and concern that retail pharmacy was being monopolized by big business44                                                 44 The number of corporate licenses issued in BC had risen steadily from 196 in 1956 to 353 in 1966 (MacPhee et al., 1967).  was having detrimental effects on professional identity, job satisfaction and the profession’s image. Although pharmacists were well-regarded by physicians, their roles were clearly delineated and the power differential stark. Diagnosis, drug therapy and patient care were the sole responsibility of the physician while pharmacists filled prescriptions.  Until 1972 and the passage of prescription labeling legislation, a collaboration between the BCPhA and the British Columbia 117  Medical Association (BCMA) (Figure 6), pharmacists in BC were not allowed to talk to the patient about the prescription, what it was for, or name the drug; their primary role was dispensing and drug distribution.  Pharmacists were isolated within the health care system45 While the sense of discontent and unhappiness amongst pharmacists was growing there was also optimism about the future. Pharmacists were well regarded by the public for their professional status and enjoyed high customer loyalty. Demand for prescriptions, on the rise and were the only health professionals that did not have a direct patient care element. Many pharmacists felt their expertise was underutilized and that they were over-educated for the typical jobs in retail pharmacy (Dove, 2011; MacPhee et al., 1967).  46 with the increasing population and new drug therapies, was coupled with an impending pharmacist shortage due in part to a shortfall in supply of pharmacy graduates from UBC. The role of the pharmacist was also being recast more broadly from a product focus to one of advisor and consultant to the physician on drug therapy (MacPhee et al., 1967) and the demand for hospital pharmacists was increasing steadily47        . Curriculum changes over the next 20 years would attempt to address many of these issues as described next.   The Pharmacist Pharmaceutical Scientist Curriculum   The pharmacist pharmaceutical scientist curriculum was identified by analysis of the incremental curriculum and contextual changes affecting the 4 year pharmacy programs offered  at UBC. The conceptualization of this curriculum is represented in Figure 11 by the 1 + 4 year                                                  45 This sense of isolation within the health care system was not the sole responsibility of practicing pharmacists. Both the BCPhA and the UBC Faculty seemed disconnected from the profession and their purpose of educating professionals. The Faculty had drifted away from community practice and faculty members were openly discouraging students from entering community pharmacy. On the other hand, the Faculty appeared to be well- connected within the university, share a close relationship with the BCPhA and to be heavily involved pharmacy governing bodies nationally (MacPhee et al., 1967). 46 For the ten year period between 1956 and 1965 the number of prescriptions in Canada had increased by 72%, the total value of prescriptions by 129% and the price per prescription by 33% (Dove, 2011).  47 The number of hospital pharmacy licenses issued in BC had tripled from 12 in 1956 to 36 in 1966. Early hospital practice often involved retired pharmacists interested in a secure government position (MacPhee et al., 1967). 118  Figure 11: The pharmacist pharmaceutical scientist curriculum (UBC BSc(Pharm), 1980)   Year 1 Year 2 Year 3 Year 4 Electives Microbiology Electives Electives  (Non-Pharmacy) (included lab) (Non-Pharmacy) (Pharmacy)       Human Pathology        Organic Medicinal   Practical Writing Biochemistry Products    (medicinal chemistry,     structure activity   Either* Biology   relationships)  (included lab)    or    Physics  Pharmaceutical  (included lab) Anatomy Analysis  *other course done in  (included lab)  pre-pharmacy year    Organic Chemistry    (included lab)   Pharmacology III   Pharmaceutics III  (drug classes III)  Physiology (drug stability and    pharmacokinetics)    (included lab) Clinical Pharmacy Physical Inorganic    Chemistry    (reaction kinetics and  Pharmacology I  thermodynamics) Physiology Lab  (drug classes I) Practicum  (included analytical lab)  (included tutorial) (Community)     Pharmaceutics I Pharmaceutics II Pharmacology II  (physical pharmacy, (physical pharmacy,  (drug classes II)  drug delivery systems I) drug delivery systems    (included lab) II)  Practicum   (included lab) Pharmacy Law, Ethics (Institutional)   and Organizations     Practicum     (Drug Information)       Key Basic Sciences  Biomedical Sciences  Pharmaceutical Chemistry  Pharmaceutics  Pharmacology  Pharmacy Practice  Practical Experience   119   BSc(Pharm) curriculum offered at UBC in 1980. With roots in the BSP and early 1 + 4 year  BSc(Pharm) curricula of the mid-1960s and early 1970s, respectively, the pharmacist pharmaceutical scientist curriculum reached peak importance in the late-1970s and early 1980s  (Figure 6) though its legacy extends through to contemporary programs of the mid-2000s to today. While this conceptualization of pharmacy education shares similarities with the pharmacist basic scientist curriculum it has distinct differences. Shifting slowly over 2 decades from plants and products towards human biology and drug therapy, curricula of the pharmacist pharmaceutical scientist replaced pharmacognosy and the botanical sciences with biomedical and the basic pharmaceutical sciences. Inspection of Figure 11 reveals, however, that although the content domains and curriculum focus were revised dramatically during the transition, the continued dominance of science in the education of pharmacists had not. Indicated by the green,  orange, yellow and blue areas of Figure 11 the scientific core of the pharmacist pharmaceutical scientist curriculum extended throughout all years of the program with the basic biomedical sciences earlier in the curriculum supporting the development of the basic pharmaceutical sciences towards the end. Over 80% of the core curriculum comprised science-based courses (43% biomedical sciences; 38% basic pharmaceutical sciences). Particularly evident was the centrality of the basic pharmaceutical sciences disciplines of pharmaceutics, medicinal chemistry and pharmacology for understanding the impacts of drug structure and chemistry on product formulation and mechanisms of drug action in human systems.  The disciplinary nature of these content areas became deeply rooted in the pharmacist pharmaceutical scientist curriculum and the persona of pharmacy education at that time. Understanding the basic pharmaceutical sciences at the molecular level underpinned the heavy theoretical focus of course content and reflected the traditions and approaches of independent scientific disciplines (FPS, 1995; Louis & Twaites, 120  1996; Riedel & Stieb, 2001). Pharmacy practice courses, shown towards the end of the curriculum as the light purple areas of Figure 11, received minimal attention although development of compounding and dispensing skills important for community and institutional practice were typically subsumed within pharmaceutics laboratories (a legacy of the practical pharmacy courses of the empiricist apprentice and pharmacist basic scientist curricula). Although the practical experience requirement for licensure in BC was eliminated in 1972, passage of prescription labeling legislation that same year signaled emergence of new clinical roles for pharmacists and opportunities to embed practical training within curricula (FPS, 1995; Dove, 2011). As an integral component of the pharmacist pharmaceutical scientist curriculum, clinical and experiential training is represented by the dark purple segments of Figure 11 and included 4th year practica in community, institutional and drug information settings.  It should be noted that even though discussion of treatment and amelioration of disease pervades the historic literature describing this curriculum, like the pharmacist basic scientist curriculum before it, the focus remained on drugs, drug products and technical skills as opposed to patients and drug therapy (FPS, 1995).    The impetus for reform of the pharmacist basic scientist curriculum can be linked, in part, to the BCPhA Pharmacy Planning Commission implemented in 1966 and completed in 1967 (MacPhee et al., 1967). Intended to address the low ebb in the profession in BC at that time, the Commission was charged with  inquiring into and reporting back on all aspects of the practice of pharmacy in the province and making recommendations about the future directions for the profession. Curriculum revision focusing on human biology, modern pharmaceutical sciences and disease treatment as well as accommodation of new roles for pharmacists as clinicians and drug use consultants was one of the Commission’s final recommendations. Interestingly, Donald 121  Brodie from the University of California, San Francisco, School of Pharmacy, one of the earliest and strongest advocates of clinical and advisory roles for pharmacists in health care in the 1960s (Hepler & Strand, 1990; Manasse, 1989), was consulted by the UBC Faculty for their submission to the Commission (MacPhee et al., 1967). Within one year of the Commission’s final report the pharmacist basic scientist curriculum was revamped with reduced emphasis on pharmacognosy and the basic botanical sciences and increased focus on the biomedical sciences, basic pharmaceutical sciences and the introduction of a practical clinical program (Figure 5). The first clinical course offered was a hospital clinical pharmacy elective in 1971 followed, over the next few years, by the establishment of a series of compulsory practica in community, hospital and drug information practice settings. This was a time of resurgence, optimism and rekindled interest in the profession in BC. In addition to educational change, prescription labeling legislation (mentioned earlier) and the implementation of Pharmacare in 1974 addressed many of the issues affecting the profession in the 1960s (Figure 6). In addition to dispensing and drug distribution, pharmacists were encouraged to assume the role of drug information specialists to the public while business benefited significantly as a major demographic in their customer base, senior citizens, received their prescriptions at no cost48 While the work of the Pharmacy Planning Commission signaled the reconceptualization of pharmacy education at UBC, the emergence of clinical pharmacy in the province, and the birth of clinical experiential learning in curricula, the resulting pharmacist pharmaceutical scientist curriculum reified the basic pharmaceutical sciences in the education of pharmacists. As curriculum change stabilized in the decade following the Commission (Figures 5 and 6), the Faculty directed a great deal of attention to development of its research capabilities, graduate  (Dove, 2011; FPS, 1995).                                                  48 When launched in 1974 the Pharmacare program covered all prescription drugs and those OTC drugs that could only be sold in pharmacies for 250,000 BC seniors over 65 years of age. The government would cover 100% of the prescription cost and paid pharmacists the cost of the drug plus a professional fee (Dove, 2011). 122  programs and contributions to the scientific community. The dominance of the basic pharmaceutical sciences and the ethos of discipline-based scholarly research and research divisions were strongly reflected in the conceptualization and enactment of the pharmacist pharmaceutical scientist curriculum (Louis & Twaites, 1996). The Faculty’s research capacity grew significantly at this time with the opening of its research wing and the addition of PhD trained basic pharmaceutical scientists to the Faculty roster (see Figure 13), many non-pharmacists49. The dean of the Faculty at that time fought strenuously with the UBC administration and the Faculty of Medicine to create a pharmacy-specific pharmacology division within the Faculty to develop the research expertise in this area and teach the pharmacology courses in the program50                                                 49 During Dean Riedel’s term, the Faculty roster increased from 13 full-time faculty in 1967 to 33 in 1984. Most new hires were PhD trained basic pharmaceutical scientists. The research wing of the George T. Cunningham Building, home of the Faculty since 1960, opened in 1971. During the same period graduates from pharmacy programs grew from 24 BSP graduates in 1967 to 96 BSc(Pharm) graduates in 1984 (Louis & Twaites, 1996).  . The stated purpose of the curriculum, like that of the pharmacist basic scientist, was the preparation of students for a range of science-based careers as well as community and hospital pharmacy.  The 1 + 4 building blocks design clearly defined the structure of this curriculum and included a pre-pharmacy year of sciences (students entered directly out of high school) followed by a 4 year program of the pattern: basic sciences, basic biomedical sciences, basic pharmaceutical sciences, applied pharmacology, clinical clerkships and electives. Independent autonomous discipline-based courses made up the majority of the curriculum. The first two years of the curriculum were taught by non-pharmacists outside the Faculty with minimum exposure to pharmacy courses or the profession while the last two pharmacy intensive years taught in the Faculty. Year 3 was a particularly challenging year for students as it represented an intense emersion in their professional knowledge; the limited 50 To have a separate pharmacology division within a Faculty, School or College of Pharmacy in Canada is unusual as most pharmacology research and teaching is provided through Faculties of Medicine ( Riedel & Stieb, 2001). 123  connection to practice of some of the basic pharmaceutical sciences and lack of integration between disciplines made it difficult for many students to see relevance (Albon, 2010; Louis & Twaites, 1996). Laboratories, up to 12 hours per week, and traditional 50 minute lectures were the predominant teaching methods while laboratory reports, practical testing and written midterm and final examinations formed the basis of student assessment and evaluation; teacher-centered approaches to classroom practice were prominent, students were passive participants in the learning process and memorization was a major aspect of student learning. While the pharmacist pharmaceutical scientist curriculum had shifted the content focus of the pharmacist basic scientist curriculum, the move towards patients, drug therapy and new clinical roles for pharmacist was only slight; the curriculum itself continued to reflect the strong scientific perspectives of the scientists responsible for curriculum decision-making. Amongst the biggest criticisms of the pharmacist pharmaceutical scientist curriculum were the fragmentation, isolation and siloing of content areas and autonomous experts along disciplinary lines and the lack of professional socialization (FPS, 1995). In the case of the basic pharmaceutical sciences, irrelevance of much of the science-based content to practice exacerbated the growing disconnect between education and practice.  While too slow for some, curriculum revision in subsequent decades would help narrow the divide. The Pharmacist Clinician Curriculum   The conceptualization of the pharmacist clinician curriculum is represented in Figure 12 by the current 1 + 4 year BSc(Pharm) curriculum offered at UBC during the 2010-2011 academic year. This program represents the case in this case study. Evolving over a 30 year period beginning with subtle curriculum changes as early as 1981, the pharmacist clinician curriculum evolved in stages from the dominance of the basic pharmaceutical sciences and a  124  Figure 12: The pharmacist clinician curriculum (UBC BSc(Pharm), 2010-2011)  Year 1 Year 2 Year 3 Year 4 Organic Chemistry Electives Electives Electives         Organic Chem Lab Biochemistry   Microbiology          Pathophysiology II  Statistics  Pathophysiology III    Drugs and Enzymes    Pathophysiology I  Pharmacy Management Anatomy Pharmacogenomics        Biophysical  Pharmacy I Drugs and Receptors Cases in Pharmaceutical     Sciences IV  Biophysical  Pharmacy II     Pharmacology III Practicum  Physiology   (Community)  Pharmacokinetics     Pharmacology IV           Pharmacology I Therapeutics III  Physicochemical    Properties Pharmacology II Therapeutics IV  of Drugs    Pharmacology Intro Therapeutics I Non-Rx Products III  Pharmacist, Patient,   Non-Rx Products IV  Society Therapeutics II Natural Health  Practicum    Products (Institutional) Pharmacy Practice Non-Rx Products I Pediatric and Geriatric  Lab I Non-Rx Products II Drug Therapy  Cases in Pharmaceutical Pharmacy Practice   Sciences I Lab II Pharmacy Practice   Cases in Pharmaceutical Lab III   Sciences II Cases in Pharmaceutical    Sciences III   Key Basic Sciences  Biomedical Sciences  Medicinal Chemistry  Pharmaceutics  Pharmacology  Pharmacy Practice  Practical Experience  Practicum Practicum 125  drugs, drug products and technical skills focus towards clinical pharmacy, pharmacy practice and direct patient care. Significant stepping stones in this transformation resulted from retreats and full curriculum reviews between 1987-1989 and 1997-2001, respectively (Figures 7 and 8). Curriculum changes resulting from the first review were initiated in 1991 with the revised curriculum fully implemented by 1994. Characterized by external review as a reorganization of the previous curriculum with slight movement towards earlier development of clinical skills and fiercely defended by the dean at that time as state-of-the-art, the curriculum maintained the dominant characteristics of the pharmacist pharmaceutical scientist curriculum (FPS, 1990). The biomedical sciences, basic pharmaceutical sciences, and ethos of scientific research and training remained embedded in the curriculum while the revised design added streams of therapeutics and professional practice courses51 earlier in the curriculum to existing summer, community and institutional practica, prior to and during Year 4. Years 1 and 2 continued to be taught largely outside the Faculty. The first UBC pharmacy program to be successfully accredited by the newly formed CCAPP national accreditation body52 (FPS, 1994), the design and dominant weighting of the scientific core of this “clinically enhanced” pharmacist pharmaceutical scientist curriculum remained intact through the BSc(Pharm) programs of the mid-2000s53                                                 51 Articulated by the dean as a major innovation in the revised curriculum, therapeutics content was included in a stream of “Drugs” courses, offered in Years 2 to 4, integrating therapeutics with medicinal chemistry and pharmacology. Professional practice courses were uncoupled from existing pharmaceutics courses and offered as independent courses in Years 1 to 3.   . It is important to note that the pharmaceutical care concept emerging at that time (Hepler & Strand, 1990) was to many in the Faculty an “ethereal concept” only and its influence on curriculum conceptualization was 52 The 1994 BSc(Pharm) program received accreditation for a 5 year period ending in 1999. 53 The last graduates of the clinically enhanced pharmacist pharmaceutical scientist curriculum were in 2006. Although the scientific core of these programs remained stable, the curriculum was continually enhanced with experiential learning opportunities, particularly after 1999 and the hiring of a Structured Practice Experience Program (SPEP) Director. Practica expanded from 8 weeks in 1985 to 20 weeks in 2004. Room for these changes in the curriculum was made by inclusion of a second summer clerkship and reduction in elective requirements for graduation.  126  minimal; criticisms of this curriculum echoed those of the pharmacist pharmaceutical scientist of the 1980s (FPS, 1990, 1994, 1995).   The second curriculum review, an intensive undertaking between 1997 and 2001 with implementation of a new BSc(Pharm) curriculum in 200354 (Figure 9), conceptualized the pharmacist clinician curriculum. Benefitting from several years of optimization, the recently accredited 2010-2011 BSc(Pharm) curriculum (Figure 12) embodied 3 decades of intense, often painful, self-examination and introspection by the Faculty about its own as well as the profession’s role and significance in addressing the health care challenges in BC and Canada (FPS, 1999, 2001, 2005, 2007). While the seeds of the pharmacist clinician curriculum may have been sown in the 1980s, major contextual influences, particularly after 1995, were instrumental in shaping its conceptualization (Figures 8 and 9). At the national level for example, AFPC deliberations about the profession and pharmacy education had embraced the pharmaceutical care concept and a move towards outcomes-based education in alignment with changes adopted earlier in the decade by US schools of pharmacy; adding to this national dialogue was the requirement that by 2000 the 6 year PharmD program would be the mandatory entry-to-practice qualification in all US schools (Wolf et al., 1993). By the late 1990s AFPC had developed and published two seminal documents to guide the development of pharmacy education and the CCAPP accreditation standards nationally55                                                 54 At this time two entry-to-practice pharmacy curricula were operating requiring double teaching for faculty. Following the 2005-2006 academic year, the final year of the clinically enhanced pharmacist pharmaceutical scientist curriculum, only the pharmacist clinician curriculum was offered. . The work of the National Association of Pharmacy Regulatory Authorities (NAPRA), the Pharmacy Examining Board of Canada (PEBC) and the Romanow Report on national health care reform also had a significant impact on educational 55 These influential AFPC documents included the “Educational outcomes for a Baccalaureate Pharmacy Graduate in Canada” and “Development of Levels and Ranges of Educational Outcomes Expected of Baccalaureate Graduates: A Supporting Document to the Educational Outcomes for a Baccalaureate Pharmacy Graduate in Canada” documents published in May 1998 and March 1999, respectively (FPS, 1999, 2001). 127  reform at that time56                                                 56 NAPRA’s Mutual Recognition Agreement was signed in April 2000 by all provinces and territories in Canada allowing pharmacists to practice anywhere in the country (this mobility agreement aligned with the  Federal Agreement on Internal Trade that came into effect in 1995); PEBC changed its national comprehensive certification process to include the practical objective structured clinical exam (OSCE) in May 2001 (a similar practical exam had been in use in BC the 1970s; the development of the national OSCE exam drew heavily from the BC experience); the Romanow Report recommended a greater, more prominent role for pharmacists in the Canadian health care system (FPS, 1999, 2001).    (Figure 8). At UBC, significant changes were also taking place under the leadership of Dr. Martha Piper, the university’s 11th President (1997-2006). Her Trek 2000 visioning process engaged the entire campus community in rethinking the university’s role in society and the world. A central aspect of the Trek vision was the importance of teaching, learning and the quality of instruction in the student experience at UBC. The Faculty embraced national level change and the President’s vision creating its first strategic plan in 1997 reasserting its purpose and mission. Among the plan’s 4 goals was the development of an outcomes-based curriculum that emphasized learners (to this point in the Faculty’s history students played only a minor role in issues of curriculum development), learning, and learning-centered approaches to curriculum design and teaching practice. Along with a strong scientific core and increased emphasis on clinical and pharmacy practice, development of active learning strategies in the classroom, more comprehensive approaches to assessment and evaluation at the course and program levels, and “practice ready” graduates emerged as important (FPS, 1999, 2001). While the conception and enactment of the pharmacist clinician curriculum were often out of sync in the decade after implementation in 2003, many subsequent national and local contextual factors such as CCAPP’s regulation of pharmacy technicians, CPhA’s Blueprint for Pharmacy, AFPC’s revised educational outcomes and UBC’s Trek 2010 initiative, helped focus optimization efforts (Figure 9). According to the Faculty accreditation and review documents, the 2010-2011 BSc(Pharm) program not only represented contemporary pharmacy practice and the evolving scopes of practice for pharmacists but personified the Faculty’s growth, maturation  128  and renewed self awareness about the profession’s critical role in health care, the need for comprehensive approaches to curriculum design, implementation, and pedagogical practice, and its critical role in educating pharmacists to address the increasingly complex and ever-changing health care landscape. While the research mandate of the Faculty remained important the educational mission surged. Positioning pharmacists and its graduates as the drug experts on the health care team, revising curricula to reflect a new specialized practical knowledge of medication therapy management, and reaching out beyond the Faculty to reconnect with its social responsibility as a profession and the needs of society were strong messages in the curriculum reform process (FPS, 2005, 2007, 2012).   Reflecting these Faculty perspectives Figure 12 depicts many important characteristics that distinguish the pharmacist clinician curriculum from its predecessors. As shown by the yellow, orange, green and blue areas, the dominance of the scientific core, typical of previous conceptualizations of pharmacy curricula, has been reduced while clinical pharmacy and practice pharmacy, represented by the purple areas, has increased. Clinical and pharmacy practice courses infuse Years 1 to 3 with experiential learning and practica incorporated earlier in the curriculum (including the summers), and becoming the primary focus in Year 4. Within the scientific core of familiar subjects, the biomedical sciences (shown in orange) and the basic pharmaceutical sciences (yellow, green and blue sections) have been reduced and found in Years 1-3 only; the scientific foundations comprise approximately half of the core curriculum down from over 80% in 1980 (25% each of the biomedical and basic pharmaceutical sciences down from approximately 40%; clinical and practice contributions increased from 13% to 50%). Pharmacogenetics was added to the medicinal chemistry stream (Kunzli, Riggs, & Reid, 2012). Amongst other distinguishing features, the stated purpose of the pharmacist clinician curriculum, 129  unlike its antecedents, was to train “competent generalist pharmacists” capable of providing pharmaceutical care and medication therapy management to patients across health care settings and developing the self-directed learning skills to adapt to the ever-changing health care environment; references to training students for careers other than pharmacy were largely removed from program descriptions (FPS, 2005, 2007, 2012). Built on a philosophy of pharmaceutical care and nationally-accepted educational outcomes reflective of contemporary pharmacy practice, the program maintained the 1 + 4 building blocks design and the traditional disciplinary knowledge domains but emphasized learning-centered approaches to curriculum design and teaching practice throughout (Hubball & Burt, 2004). To improve curriculum coherence for example, course streams were implemented to facilitate vertical integration of disciplinary knowledge while case-based Cases in Pharmaceutical Sciences (CAPS) courses in each year, encouraged horizontal integration between disciplinary streams. Earlier socialization into the profession was addressed in 2 ways. The proportion of the curriculum taught outside the Faculty by non-pharmacists was limited to the 1st year basic natural and biomedical sciences courses (i.e., anatomy, microbiology, physiology, and organic chemistry; biochemistry was taught in 2nd year) while introduction into the profession included a unique “White Coat” ceremony in Year 1 (implemented in 2005 and attended by family members) in which 1st year students were “cloaked” by dignitaries and professional leaders (Figure 9). In terms of teaching and learning practices, the 50 minute lecture continued to be a principal teaching method although active learning strategies such as case and problem-based learning, participatory workshops, web-based learning, oral presentations, literature evaluation and interprofessional learning opportunities were increasingly employed. Traditional science laboratories were eliminated from the program in 2006 while streams of pharmacy practice laboratories and 130  experiential courses throughout the program provided extensive pharmacy skills training and both introductory and advanced community and hospital clerkship experiences, respectively. Assessment practices included a variety of formative and summative assessment strategies used to measure cognitive learning, practical skills, problem solving abilities and achievement of program outcomes. In comparison with former curricula, reconceptualization of pharmacy education as the pharmacist clinician curriculum embraced a significant shift away from the centrality of understanding of the basic pharmaceutical sciences as scientific disciplines in their own right towards selective inclusion of these scientific foundations to support understanding of disease, drug therapy decisions and direct patient care. Graduates of the program were no longer considered scientists but as clinicians and practitioners with unique understanding of drugs and expertise in pharmaceutical care and medication therapy management (CPhA, 2013; FPS, 2007, 2012). While conceptually the pharmacist clinician curriculum articulated the Faculty’s optimism about the future of the profession, professional education and its role in each, optimization of this curriculum challenged decades of historical precedent regarding the role and status of the basic pharmaceutical sciences in the education of contemporary pharmacists (FPS, 1995). Key criticisms of the program lay rooted in the past and its inner workings (Stake, 2010) including limited practice exposure, students not being practice ready, fragmented and siloed disciplines and isolated autonomous disciplinary experts, limited integration, content weighted towards the sciences instead of practice, irrelevance of some of the basic pharmaceutical science content, and students being over-educated for the typical jobs in practice, particularly in community pharmacy57                                                 57 The mood in the profession at this time varies depending on the practice and geographic setting. Within urban BC, the pharmacists practicing in institutional settings (hospital practice) are able to practice to scope leading to high levels of job satisfaction. As government employees their mood and satisfaction levels fluctuate with the fiscal realities of governments. Hospital pharmacists represent only about 16% of the approximately 5000 pharmacists  (FPS, 2005, 2007, 2012).   131  Program Enrollment and Roster Analysis   Providing potential indicators reflective of changing perspectives and emphases within the UBC pharmacy programs and curricula, Figure 13 presents the plots of historic program enrollment and roster information collected from 1946 to 2011. Plot A provides program enrollment along with the changing roster composition over time while Plot B provides an expanded view of roster changes only. Analysis of program enrollment (Plot A) seems to support the findings of the Pharmacy Planning Commission (MacPhee et al., 1967) particularly prior to 1970. Despite program enrollments being capped at 50 to 75 students due to restricted teaching space in the Faculty, between 1950 and the mid-1960s the 3 and 4 year BSP programs did not attract a full contingent of students. Prior to 1950 enrollments exceeded the established cap to accommodate World War II veterans (Louis & Twaites, 1996). Particularly low enrollments in early 1960s corroborates the Commission’s findings regarding reduced interest in pharmacy as a career, low self image within the profession and the predicted pharmacists shortage. Interestingly, the curriculum changes in the late 1960s sparked by the Commission’s recommendations along with the passing of the prescription labeling legislation in 1972 seems to be associated with as resurgence of interest in the profession. As shown in Plot A, despite an enrollment cap of 75 students, the program enrollment climbed sharply exceeded the cap by the mid-1970s when it was eliminated.  Enrollments from that point rose steadily to approximately                                                                                                                                                              currently working in BC. In the urban community setting where most pharmacists practice there appears to be significant tension due to economic pressures on chain drug stores brought on by increasing numbers of pharmacies and competition, over-supply of pharmacists for available full-time positions, and loss of employment to cheaper certified pharmacy technicians. Within this practice setting pharmacists continue to focus much of their time on drug dispensing and distribution activities; job satisfaction is variable. Much like the situation in the 1960s community pharmacy is being driven by commercial interests rather than the improvement of health care and many pharmacists are feeling over-educated for the jobs available. The dynamics in rural practice are exacerbated by the difficulty in attracting and retaining qualified practitioners. There is also optimism regarding changing scopes of practice and the potential to move beyond drug distribution activities (College of Pharmacists of British Columbia, 2012; Dore, 2013). 132  150 by 2011 the capacity of the teaching facilities in the Faculty; in September 2011, enrollments climbed to 224 accommodated by the opening of the new pharmaceutical sciences building.   In terms of the Faculty roster, Plot B in Figure 13 shows not only the steady growth of faculty members overall since program inception but also how the roster composition changed with curriculum change. Associated with the increasing significance of the basic pharmaceutical sciences, the pharmacist pharmaceutical sciences curriculum and the Faculty’s research mandate, the number of PhD trained basic pharmaceutical scientists rises steadily until the mid-1980s and then begins to fall as the importance of clinical and pharmacy practice in the education of pharmacists builds. Simultaneously the clinical and practice faculty contingent rises steadily from the mid-1960s to accommodate the changes in curricular focus and the emergence of the pharmacist clinician curriculum. In 2005 the number clinical and practice faculty (increasingly PharmD trained) surpassed PhD scientists for the first time in the Faculty’s history.  This reflects in part, the changing ethos of the Faculty and the reallocation of resources towards the faculty expertise and credentials necessary to develop, implement and teach the pharmacist clinician curriculum.133  Figure 13: Program enrollment data and roster analysis, 1946-2011  Plot A Plot B Plot B 134  CHAPTER 6: ROLE AND STATUS OF THE BASIC PHARMACEUTICAL SCIENCES  Chapter 6 provides the results of interview analyses regarding the role and status of the basic pharmaceutical sciences in UBC’s current BSc(Pharm) program. The intent is to answer research question two as well as continue to build understanding about the case. This chapter also provides further context for examination of the basic pharmaceutical sciences and associated pedagogical practices in research question 3 (Chapter 7). While Chapter 5 helped situate the current BSc(Pharm) program historically and conceptualize it as the pharmacist clinician curriculum, the use of interviews allowed examination of its inner workings (Stake, 2010).  The ability to draw on the collective experiences and perspectives of the study participants, most of whom helped create the current program, have taught in it, and continue to be involved in its optimization, provided rich insight and a unique vantage point for informing the study. As key working parts of the case their voices, as scientists, practitioners, scholars and educators, were crucial for exploring the importance of science and the basic pharmaceutical sciences in the program as well as the extent to which the basic pharmaceutical sciences have a place in the knowledge base of the contemporary pharmacist.   The approach to exploring issues of role and status with study participants was purposeful. The semi-structured interviews began by collecting demographics along with viewpoints on issues felt important for prefacing and providing context for the discussions about role and status. Prefacing issues included participant’s perspectives on what the basic pharmaceutical sciences are, practice experience, its impact on teaching practices and whether or not it is required to teach in the program, the future of the profession (CPhA, 2013), and their approaches to teaching and learning.  The intent of exploring role and status last was to attempt to build rapport and establish a reflexive, conversational rhythm during the interviews that would 135  facilitate in-depth discussion of the topics. Where necessary, issues were explored from different angles using different questions to help clarify and triangulate meanings (Mathison, 1988; Stake, 2010). While this added to the complexity of the interview analysis it provided a very rich interview data set for answering the research question, informing the study and learning about the case.  The interview results presented in this chapter are selective. The chapter begins by introducing the study participants including a description of study sample demographics and general impressions of the group. Introductions are followed by a description of their views on the prefacing issues mentioned above. Approaches to teaching and learning will not be discussed here but are the primary focus of Chapter 7.  The chapter finishes with the study participant’s perspectives on the role and status of the basic pharmaceutical sciences in the current program. For comparison, the perspectives of basic pharmaceutical scientists and clinical and pharmacy practice faculty have been presented separately. It is hoped that once readers have completed this chapter they will have a sense of who this group of scientists, clinicians and practitioners is, some of their views on the practice-education interplay within the current BSc(Pharm) curriculum, the future of the profession, and in particular, their perspectives on the importance of science and the role and status of the basic pharmaceutical sciences in pharmacy education in the pharmacist clinician curriculum. 6.1  Introducing the Study Participants and Prefacing Role and Status   The purposive sampling procedures employed in this study provided a sample representative of the Faculty and those teaching in and contributing to the optimization of the current BSc(Pharm) program. Review of Table 5 indicates inclusion of approximately 40% of the Faculty roster at the time of the study (23/60), 46% of the initial volunteer pool (23/50), and 136  all academic disciplines and ranks. The wealth of faculty experience brought to bear on this study spanned 60 years and comprised early, middle and senior career faculty with intimate knowledge of the current BSc(Pharm) program (the pharmacist clinician curriculum) as well as emeritus faculty that added knowledge of the early 3 year BSP (the pharmacist scientist curriculum) and 4 year BSc(Pharm) (the pharmacist pharmaceutical scientist curriculum) programs offered at UBC. Senior administrative ranks were also part of the sample and the insider knowledge of the researcher helped to address selection criteria during purposive sampling. Approximately 80% of study participants (18/23) had earned previous pharmacy degrees and had at least some practice experience. Most basic pharmaceutical scientists with pharmacy degrees had minimal practice experience compared with their clinical and pharmacy practice colleagues and had not practiced in many years.  All those that had neither a pharmacy degree nor practice experience (5/23) were basic pharmaceutical scientists. In terms of teaching, most study participants had minimal experience prior to joining the Faculty (Table 5).   The study sample itself was a highly engaged and strong-minded group of people.  Made up of renowned scientists, clinicians and educators, each openly shared their views on the future of the profession, what they do in their classrooms, their opinions of the internal dynamics of the current program, and the place of science and the basic pharmaceutical sciences in the education of contemporary pharmacists. It was clear each had and continued to grapple extensively with what the focus of the curriculum should be, how it should and does align with pharmacy practice, and their roles and responsibilities as content experts and educators in the process of curriculum design, delivery and revision. While perspectives differed sharply, the group appeared to thrive in their work, enjoy the people they worked with and share a strong sense of collegiality and cooperation; the passion, commitment, and dedication towards the profession, program 137  improvement and the possibilities for the future was palpable and inspiring. In terms of participation in this aspect of the study, the group was accommodating, cooperative and a privilege to interview. At the same time a sense of despondency and isolation seemed pervasive regarding the Faculty’s inability to deal with longstanding issues and barriers impacting curriculum reform, many of them political. Frustration about the lack of progress on curriculum revision and optimization was evident in comments like, “we just go round and round at the Faculty. We’re like a broken record. It’s like, what gets done? …we are spinning our wheels and we don’t seem to know how to get beyond ourselves.”  There was also praise for this study as a possible way forward: “I applaud your willingness to take on this challenging and fraught sort of an area…I think it’s a very important conversation that we need to have…because this is a way that change can happen.” Congruency on What Constitutes the Basic Pharmaceutical Sciences  Establishing the meaning of the basic pharmaceutical sciences amongst study participants was important for prefacing the interviews. Three interview questions were used to establish the degree of congruence between perspectives: What is your discipline affiliation?, When you hear the phrase “basic pharmaceutical sciences” what disciplines of pharmacy come to mind?, and  How do you self-identify in terms of your expertise by completing the statement, “My background is in _______ and my area of specialization is ___________?.” No prompting about traditional views of the disciplines of pharmacy was given and if asked by participants for clarification, none was given.  Based on analysis of participant responses to these questions there was congruence between basic pharmaceutical scientists and clinical and practice faculty regarding the meaning of the basic pharmaceutical sciences.  These views also aligned well with those of the researcher 138  and the historic views of the disciplines of pharmacy as described in Chapters 2 and 3 (Skau, 2007). While there was some variation, over 80% of study participants (19/23) mentioned medicinal chemistry, pharmaceutics, and pharmacology as the main basic pharmaceutical sciences disciplines. Pharmacokinetics, pharmacodynamics, toxicology, and pharmacogenetics were added amongst the basic pharmaceutical sciences by approximately 20% of participants (5/23). One clinician described them this way: “the basic pharmaceutical sciences are anything that is not applied.” Interestingly, to some emeritus faculty educated in the early 3 and 4 year BSP programs at UBC and elsewhere in Canada, the basic pharmaceutical sciences were remembered vividly as the natural sciences of chemistry, biology, pharmacognosy, and physics. Based on this analysis the meaning of the basic pharmaceutical sciences adopted for this study referred to the disciplines of medicinal chemistry, pharmaceutics and pharmacology.  Pharmacy Practice Experience and Teaching Practices: Emerging Differences  Practice experience and its impact on thinking about curriculum and teaching practices was another important contextual issue for this study and prefacing the discussions of role and status. Interview questions asking about previous practice experience, strategies for keeping current and the impact of practice experience on their classroom practices were used to explore these issues.   As mentioned previously, most of the basic pharmaceutical scientists (8/13) had pharmacy degrees but had not practiced in years. While they openly acknowledged that they were not in tune with the day to day practice of pharmacy, most felt they were current in terms of the general trends and tensions impacting the profession. Keeping up was facilitated mainly through involvement in the Faculty community and was not a significant aspect of their scholarly activity. Learning vicariously through the experiences of clinical and practice colleagues along 139  with some reading, attending conferences and involvement in Faculty committees and meetings were important strategies for keeping current. As one basic pharmaceutical scientist put it,  clearly I don’t keep current with actual pharmacy practice, but you can’t really hang around a place like this and not be aware of what’s going on in very general terms. I’m surrounded by pharmacy practice people, I talk to them, they’re my friends and colleagues…I think [keeping up is]…a process of osmosis and just keeping my ears open.   In terms of the clinical and practice faculty interviewed, all had practiced before joining the Faculty, many extensively (practice experience averaged 15.6 years in either the community or hospital settings). Half continued to practice either as frontline pharmacists or as clinical consultants and most felt well-connected with the profession and day-to-day practice. Keeping up was a proactive, disciplined aspect of their scholarly activity whether currently practicing or not. In addition to the strategies used by the basic pharmaceutical scientists, giving lectures to external groups and participation in continuing pharmacy education events, extensive reading of practice-related journals, involvement in professional pharmacy organizations, and accessing well-established networks of community and institutional practitioners were identified as important strategies for keeping current.   For basic pharmaceutical scientists, the issue of whether or not a pharmacy degree and practice experience impacted their teaching practices or was necessary to teach in a pharmacy school generated a lot of discussion. To those with the credentials, having both made a difference to their perceptions of themselves as educators and what they did in their classrooms. Previous practice experience, regardless of extent, gave the faculty member a sense of credibility and security that was not apparent for faculty that had not completed a pharmacy degree or practiced. For them, their classrooms reflected their practice experience often including examples and stories from personal experiences and the ability to tailor course materials and content for “what the students need to know.” In the words of one emeritus scientist, 140  I didn’t ever hide the fact that I practiced because I think students, when they know you’ve actually been there…they regard you in a whole different light. Even though it was many, many years before I would use examples from my practice whenever it applied to the drugs I was teaching. It was very useful.    For those that had neither a pharmacy degree nor practice experience the impact on their teaching practices and self-perception as educators was more pronounced amongst junior scientists whereas senior faculty in the same position had grappled with and resolved the issue during their career:  It’s taken me a long time to sort of come to the understanding that I have now of pharmacy practice…[W]hen I first started, which is a long time ago…I taught [my area]…as a sort of independent science almost…not feeling that it was…particularly necessary for us to have…knowledge of what was happening [in practice]…[W]ith time though…I think it’s become more important to understand what the scope of practice is for pharmacists…and to position the material in a way that makes it more relevant to the students.  Although this issue was of concern to all basic pharmaceutical scientists, amongst those that had not practiced it appeared to have little impact on their ability to teach the fundamental basic pharmaceutical sciences content they were tasked with. While some basic pharmaceutical scientists felt that practice experience was not really necessary “to teach the fundamental science stuff” most had implemented strategies, to varying degrees, to improve connections between their course content and practice (e.g., talking with students and collaborating with practitioners and clinicians to keep course materials current and more aligned with therapeutics and practice). Regarding whether or not a pharmacy degree and practice experience was necessary to teach the basic pharmaceutical sciences was summarized succinctly in the following comment:  That is a complicated issue, because I think in some cases you don’t necessarily have to be a pharmacist to be teaching at a pharmacy school, but you have to be positioned in the right place, so if you’re teaching some fundamental…knowledge…you don’t need to be a pharmacist, as long as you’re an expert and you know that stuff cold…but in certain areas, pharmacy practice for instance, therapeutics for instance, I think it’s very important that you be a pharmacist.   141  It was also important to note, as pointed out wisely by an emeritus faculty member, that “being a pharmacist doesn’t make you a good educator….and [does not] ensure you will get good teaching.”   For clinical and pharmacy practice faculty, practice experience was a major contributor to and an essential part of the faculty member’s perceptions of themselves as educators and what they did in their classrooms. Being intimately connected to practice gave these faculty members a strong sense of credibility, security and identity as educators. When asked how their practice experience impacted them as educators and what they did in their classrooms the answer was typically,  the impact is huge, huge, and one of the things every year my students tell me in their evaluations and the informal feedback I receive is they appreciate the “real” piece that I bring to the classroom…it gives it more credibility, you need that credibility when you’re teaching.   To many, having the ability to draw on their practice experiences for real life examples was particularly helpful for adding relevance to the classroom environment and introducing an element of tangible practicality. Regardless of practice setting, their teaching practices attempted to model their practice role, approach to practice, and practice environment; creating reciprocity between practice and their classrooms was an important aspect of the types of classroom experiences they strived to create. Said one clinical pharmacist,  in my course I try to embody my approach to clinical practice. You know, for me to do a job in an ICU critical care ward, you really have to be on top of things. You really have to understand, you think, you have to apply, you really have to stand on your feet and do it right there. This is what I want to instill in the students.   In general, clinical and practice faculty perspectives regarding the impact of practice experience on themselves as educators and their teaching practices were uniformly positive with the 142  importance of practical knowledge outweighing theoretical understanding. This point was made concisely by a community practitioner,  I think it’s very important to be able to take the concepts that you’re discussing in the classroom and relate it to something in practice. And my experience is that the more you can do that, the more the students connect with it. And the more they see relevance to what you’re talking about. If you can’t relate it to practice, then they see it as somewhat theoretical and they don’t pay a lot of attention.   Practical experience also helped them feel well connected with the challenges in health care generally, those faced by pharmacists specifically, and the relationships of pharmacists with other health professionals.  Congruency on the Blueprint for Pharmacy and the Future of the Profession  All study participants were familiar with the Blueprint for Pharmacy and were attuned to its implications for the profession. While there was some disagreement about the wording of the Blueprint’s vision of “optimal drug-therapy outcomes for Canadians through patient-centred care” (CPhA, 2013, p. 6) there was unanimous agreement with the strategic direction advocated. Both basic pharmaceutical scientists and their clinical and practice colleagues felt that the goal of the Blueprint initiative was a good one but achieving it would be challenging. Expressing the need for pharmacists to take on a more prominent role on the health care team, provide more direct patient care and high-level medication management services, and show proactive leadership regarding health care reform, concerns were raised about whether either the profession or pharmacists were ready and able to accept the challenge:  There are major uncertainties about whether pharmacists will be able to achieve what the Blueprint articulates they will be doing, there’s uncertainty in my mind about whether pharmacists, and even the pharmacists of the future want to do the things that the Blueprint says they will be doing, and there’s uncertainty about whether pharmacists…will actually more deeply integrate into care than they already are.   143  Others felt that while the Blueprint’s vision was laudable it did not translate well into the community pharmacy setting where most pharmacists work and “the reality is that we still have people working as pharmacists counting pills.” The explosion of medical knowledge, the rapid change in medical technology and the increasing complexity of drugs and drug therapy were also cited as conspiring against the transition. While many felt the profession did not have a choice regarding change, others felt pharmacists were at risk of becoming obsolete if they did not embrace the Blueprint’s vision. Regarding the future of the profession one senior scientist put it succinctly, “I think if we don’t get more concerned about individual drug therapy and making sure that outcomes that reach individual patients are optimal, then we’re lost as a profession. It’s pretty much that straightforward in my mind.” 6.2  Faculty Perspectives on Role: Growing Solitudes   At this stage in the interviews study participants were sharing freely and openly. They were clearly engaged in the discussion as evidenced by long impassioned answers during the interviews and passages in the transcripts. Requiring little intervention, probing or further questioning on the part of the researcher, there was an obvious urgency and intention in their words and a distinct sense they wanted to be heard. As the interviewer it felt as though study participants were tapping deeply into their backgrounds, their experiences as faculty members, and their perspectives on the importance of their respective disciplines and content expertise in the knowledge base of pharmacists and the curriculum. Presented below are their perspectives on role. The corresponding views on status are presented later in the chapter. Once again the perspectives of basic pharmaceutical scientists and clinical and pharmacy practice faculty have been separated for comparison. Three broad questions were used to probe the issue of role: What is the role of the basic pharmaceutical sciences in the pharmacy curriculum?, What if we got rid 144  of them?, and  What do you think the knowledge base of the contemporary pharmacist should be? Exploring Role With the Basic Pharmaceutical Scientists  When asked about the role of the basic pharmaceutical sciences in the current curriculum and the education of pharmacists, the response from basic pharmaceutical scientists was consistent and clear. Each was adamant that the basic pharmaceutical sciences formed the scientific foundation of the knowledge base of the pharmacist and were critically important for understanding therapeutics and making informed decisions in practice.  While there was acknowledgement that the knowledge base of contemporary pharmacists was changing and that the scientific foundations of pharmacy practice were becoming increasingly applied, the basic pharmaceutical sciences disciplines remained essential to the knowledge base of pharmacists and the core curriculum. Many articulated well-formulated mental schema and models explaining why the basic pharmaceutical sciences were a critical aspect of educating pharmacists as well as how they did and should continue to build and align in the current curriculum to support drug therapy decisions in practice. Although the importance and contribution of each basic pharmaceutical science discipline varied with discipline affiliation, to the basic pharmaceutical scientists generally, the disciplines were almost inseparable and presented as an integrated whole. Knowing how the body works and its impact on drug chemistry, delivery and action were essential for understanding drug behavior in human systems, the proper use of drugs in drug therapy and how to solve drug-related problems encountered in practice. Along with the prerequisite and biomedical sciences, the knowledge base of the contemporary pharmacists was presented as a continuum, transitioning smoothly from the basic and natural sciences to the biomedical sciences to basic pharmaceutical sciences to therapeutics and practice. For the basic 145  pharmaceutical scientists there was a direct link between theory and practice; between the scientific foundations and decision making in practice. Summarizing the thoughts of many basic pharmaceutical scientists regarding the theory-practice link, a senior scientist stated cogently,  the basic pharmaceutical sciences should teach the students how to explore…[they] should cause the students to look more deeply into the therapeutics of the drug… make the students more creative in the therapeutic area. The more you understand the fundamentals, and the deeper you can go into the fundamentals, the more creative you can be in the application of those fundamentals.   Interestingly, the underlying assumption that the scientific knowledge base they were describing did support clinical decision making and was being used in practice in the way they envisioned went unquestioned.   When intentionally provoked about whether or not the basic pharmaceutical sciences had a place in the education and curricula of contemporary pharmacists and that some were suggesting they be severely reduced or eliminated entirely, the response from basic pharmaceutical scientists was blunt.  Responding emphatically an emeritus professor stated,  I think it’s wrong-headed. I believe that it would be a disaster because you would have persons who didn’t have the basic skills. They might have some superficial knowledge of the various things, but they wouldn’t have the depth to respond to that unusual patient, and every other patient is unusual.   Adding a touch of sarcasm, a senior scientist echoed,  I guess if you don’t want pharmacists out there who have the slightest understanding of how drugs get to where they’re supposed to go and what makes a drug stable or not, why is there a shelf life for a drug, why do we care so much about purity… then I would say, “Yeah, sure, throw it out.”   These comments, along with many other more lyrical ones, alluded to commonly held sentiments about this issue.  For the basic pharmaceutical scientists the ability of pharmacists to practice was intimately connected to their unique knowledge of drugs. To them the basic pharmaceutical sciences formed the basis of this specialized knowledge and getting rid of them would not only 146  be a mistake but would seriously undermine the ability of pharmacists to resolve practice-related problems. Many voiced concerns, should this happen, that drugs and drug products would be known in name only, and that drug therapy would be relegated to the notion of a black box in which patient health outcomes would be measured in terms of drug inputs and effectiveness outputs without any knowledge of how and why drugs do what they do in the treatment of human disease. Quoting one mid-career scientist,  if you don’t know how it works, if you don’t know the context in which it works, if you don’t know what the alternatives are and why structures are changed such that you end up with different drugs. If you just go by the name of the drug what have you got but a black box thing.   Some lamented the deemphasizing of scientific knowledge of drugs in the curriculum and wondered who would fill the drug knowledge gap on the health care team if pharmacists didn’t:  I’ve looked at medicine and medicine has gutted their basic medicinal sciences…we have guys writing prescriptions about drugs they do not understand at all, only what they’re supposed to do…I think their fundamental knowledge about drugs and what they do is wrong…we have people in medicine that really don’t understand much chemistry. That’s terrible. And I don’t want pharmacy going that route.   To most, the specialized knowledge of drugs uniquely positioned the pharmacist as the drug expert on the health care team and the basic pharmaceutical sciences, in particular, provided the foundation on which to build understanding about the proper use of drugs. Regarding the curriculum one emeritus faculty member cautioned,  I’m not saying we don’t review the basic sciences on a fairly regular basis because they’re important, but we should never kind of just say, well all [students] need to know is how they should be used and side effects…That’s not enough.     When asked what the knowledge base of the contemporary pharmacist should be most felt the pharmacist would fill the emerging niche as drug expert. In the eyes of the basic pharmaceutical scientists, the pharmacist of the future would have a thorough understanding of science and the basic pharmaceutical sciences, expert-level ability to apply it in practice and 147  possess the professional skills needed to communicate the science of drugs effectively and efficiently to both patients and physicians. In terms of curriculum junior scientists summed up the sentiments of the basic pharmaceutical scientists concisely,  I think that we are not training pharmacy technicians here who are just dispensing drugs. We are training people who need to be able to think, they need to be able to understand what they’re doing… they really should be able to stand up to the doctor and the patient and say, why this [drug] was chosen or actually make recommendations… and that should be based on science.   Exploring Role from the Clinical and Practice Faculty Perspective   Perspectives voiced by clinical and practice faculty regarding the role of the basic pharmaceutical sciences in the current curriculum and the education of pharmacists contrasted those of their basic pharmaceutical scientist colleagues. Whether from community or institutional practice, when asked about role the responses were thoughtful but tepid. It seemed clear however, that most had wrestled extensively with this issue. As evidenced by the high level of engagement, the long pauses needed to collect thoughts, and the paraphrasing required when formulating responses, reconciling the role of the basic pharmaceutical sciences in the current curriculum and the education of pharmacists continued to challenge them as faculty members, content experts and educators.   While all clinical and practice faculty felt the basic pharmaceutical sciences were and should remain part of the foundational knowledge of the pharmacist and the curriculum, most felt their role was a small one. Unlike the basic pharmaceutical scientists, there was no well-developed schema or mental models describing why the basic pharmaceutical sciences were important or how they figured into decision making in practice. Instead, the basic pharmaceutical sciences together with the prerequisite and biomedical sciences were seen as one of many important, and often competing, aspects of the knowledge base and education of practitioners.  148  To them the basic pharmaceutical sciences were not central to the knowledge base of the pharmacist but did provide important background knowledge about how and why drugs and drug products work as well as a general understanding of the complexities of drug action in human systems. Regarding their importance in day-to-day practice or in decision making about drug therapy both clinical and practice faculty felt they played a very minor function and that the theoretical understanding of drug chemistry, delivery and action as espoused by the basic pharmaceutical scientists did not support or translate well, if at all, into the realities of practice and therapeutic decision making for real patients. Contrary to the views of the basic pharmaceutical scientists there was no direct link between theory and practice and the connection between the scientific foundations and decision making in practice was tangential at best. When questioned about their current understanding of the basic pharmaceutical sciences, several had only vague recollections of what they had learned as students or had forgotten them completely. Pressing them to find instances where they actually used the basic pharmaceutical sciences in practice most struggled. If accessed in practice, pharmacology was seen as most relevant followed by pharmaceutics. Medicinal chemistry seemed to have very little usefulness in any practice setting. Specific examples cited were typically context specific. One pharmacy practice member stated for example,  one thing that does come to mind, physical, chemical properties of things is important in compounding, so [pharmaceutics] probably comes up a little bit…there is [also] crucial elements of that in the selection of a particular product; long acting things vs. injectable, all that kind of stuff makes a difference to drug therapy outcomes, so…the pharmacist needs to understand those if they’re to play a part in decision making about what patients get.   Others found the basic pharmaceutical sciences sometimes useful for solving rare practice- related problems that were not well supported by existing literature or evidence. Asked if the 149  basic pharmaceutical sciences impacted their practice one mid-career clinician summed up the feelings of many:  You know, it does. It’s not everyday. It’s on occasion when you’re trying to explain things. . . So if you’re making choices that you don’t have a lot of information on, then you go to what you do know. So you keep working your way down. What about the pharmacology of it? What receptor does this bind to?...sometimes you actually work your way down to the structure to explain things.  Of note, those practitioners that had completed science degrees prior to entering pharmacy school or were currently operating conventional science laboratories as part of a clinical research program felt differently:   I cannot see you teaching a student, or any person how a drug works without chemistry, biology, even physics background. You really have to understand science and how it works. I’m a strong advocate there. Some people think I’m nuts though.    When challenged about whether or not the basic pharmaceutical sciences were needed in the education and curricula of contemporary pharmacists, the response from faculty practitioners was measured. While most felt they did and could practice with limited knowledge of the basic pharmaceutical sciences they stopped short of recommending their removal from the program. To the clinical and practice faculty knowledge of the basic pharmaceutical sciences helped distinguish pharmacists amongst health professionals but in the current program was disconnected from the realities of drug therapy decisions and treating disease in real patients.  Despite the assertions of basic pharmaceutical scientists, practitioners felt that drug therapy was fraught with uncertainty regardless of the level of scientific understanding brought to bear on treatment options. Instead, working with real patients was still very much a black box situation and knowing the scientific basis of how and why drugs and drug products work was not nearly as important as knowing if they worked as judged by the available clinical evidence. Stated a clinical pharmacist,  150  the scientific landscape is absolutely littered with clinical trials that were based on an awesome concept of how this drug works mechanistically and it had absolutely no beneficial effect in reality, and/or caused a net harm, so I caution our students, “Whenever you fall back on a mechanistic explanation or rational, meaning a pharmacology based rational you’re in trouble.” It might be better to do nothing, than to do something based on that.  Guided by the realities of practice, their views about curriculum reflected this perspective. To many the strong emphasis on the basic pharmaceutical sciences in the program could be deemphasized significantly in favour of therapeutic skills building without degrading the clinical and practice decision making ability of the pharmacist. In addition, the science that did remain should be honed to a subset of theoretical knowledge for understanding in more general terms how and why drugs and drug products work and the complexities of drug action in patients. Using a specific example to illustrate this point a seasoned clinician stressed,  it’s enough to know that an ace inhibitor can lower your blood pressure and reduce your glomerular filtration rate by blocking angiotensin II production because angiotensin II does these five things, and blocking it’s production therefore should cause the following physiologic effects. That’s enough. And that’s as much therapeutic reasoning as goes into my practice and physicians’ decision making about this sort of thing.  In stark contrast to the perspectives of the basic pharmaceutical scientists, when asked how much of the basic pharmaceutical sciences are needed in the curriculum another clinician echoed, “I suspect we don’t need much more than what our colleagues in medicine get, which is, as I understand it, not very much.” Interestingly, most clinical and practice faculty did not seem aware of how or if their own scientific backgrounds as pharmacy graduates factored into the practice decisions they did make and few questioned whether relearning the basic pharmaceutical sciences would improve their effectiveness as practitioners. Reflecting on this very issue one basic pharmaceutical scientist speculated,  I think our clinical scientists and clinicians don’t even know that they’re using basic science all the time because it’s encoded in their DNA. When making therapeutic 151  decisions, it’s so buried, embedded, that they don’t even realize that they’re using it on a day-to-day basis.   When asked what the knowledge base of the contemporary pharmacist should be most felt the pharmacist would fill the emerging niche as drug therapy expert. In the eyes of the clinical and practice faculty, the pharmacist of the future would have some understanding of science and the basic pharmaceutical sciences, expert-level knowledge and ability to apply clinical evidence to therapeutic decision-making, and possess a broad range of professional skills needed to participate as integral members of health care teams and manage drug therapy for patients. In terms of the focus of the curriculum and the types of graduates the program should be producing one faculty practitioner summed up the sentiments of the clinical and practice faculty well:  My feeling is we haven’t got it right yet. And by getting it right, I mean we should be turning people out of here who are excited about pharmacy, who can go out and truly make a difference for patient care and build relationships with physicians. I’d like our graduates to be individuals that physicians want to associate with. And you know, the reality is that very few of our graduates are at that level yet. So, I think there’s a lot of work to be done. And it could be exciting work.   With the realities of the current workplace in mind, this sense of optimism shared by many practitioners was tempered by the need to move cautiously on curriculum reforms emphasizing practice over science:  I think we’d be doing a huge disservice to our students if we didn’t prepare them, at least in part, for the existing work place, because that Blueprint vision is well beyond a lot of the existing workplaces, and so we need to be careful. We’re already over-educating our students hugely for the job market that they enter often, and we could do an even more extreme job of that by losing some of that [science] stuff.  6.3  Faculty Perspectives on Status: Recognition and Convergence   The issue of status of the basic pharmaceutical sciences in the current program seemed to hit a nerve with study participants. While initial open-ended interview questions were intended to 152  gather general perspectives on the topic, the interviews quickly turned to curriculum critique and the politics of curriculum change. Asking interviewees to make judgments about the importance of the basic pharmaceutical sciences in the program seemed to trigger the response. Allowed to develop reflexively during the interviews, these conversational threads opened cracks in the otherwise collegial and cohesive persona of the study group exposing some of the underbelly of the case. Along with valuable insights into faculty perspectives and frustrations regarding the current curriculum, long held tensions emerged providing an opportunity to explore some of the internal case dynamics impacting curriculum design, emphasis and reform. It was at this point during the interviews that the sense of despondency and isolation mentioned at the beginning of this chapter began to surface. Based on initial responses, protocols for subsequent interviews were revised to allow greater attention on these issues. The subsequent questions and probes used to explore status focused on gathering general perspectives on the issue including value judgments about the current level of importance afforded the basic pharmaceutical sciences in the program, identifying supporting evidence and indicators of current status and whether or not it had changed over time, and finding strategies for addressing tensions that emerged regarding in particular, how much of the basic pharmaceutical sciences should be included in the curriculum.  Status and the basic pharmaceutical scientists  When study participants of all discipline affiliations were asked about the status of the basic pharmaceutical sciences in the current program the typical response was, “that depends on who you ask.” Amongst basic pharmaceutical scientists for example, the basic pharmaceutical sciences played a key role in the education of a well-trained pharmacist (reiterating perspectives voiced earlier) and were felt to be highly valued within the curriculum and broadly supported by 153  the faculty community. As renowned researchers and content experts in their fields most considered the number of basic pharmaceutical sciences courses in the program as well as the high proportion of distinguished professorial scientists teaching those courses to be evidence of importance and status. Recent and impending faculty hires into their disciplines were also cited as important indicators of the value the Faculty placed on the basic pharmaceutical sciences to address teaching and research mandates (see Figure 13 for modest roster changes following implementation of the current program in 2003). However, beyond the basic pharmaceutical scientist’s own opinions about the value and status of the basic pharmaceutical sciences in the program very little additional corroborating evidence was provided to support their claims. To them, the importance of the basic pharmaceutical sciences in the program seemed almost unquestionable and went largely unquestioned. As one emeritus scientist stated, “science and the basic pharmaceutical sciences have always had a role in the education of pharmacists and curriculum…it should continue that way.” At the same time the basic pharmaceutical scientists were keenly aware of the reduced overall weighting of the basic pharmaceutical sciences in the current program due to recent curriculum reforms and openly acknowledged the need for these revisions. In light of practice, health care and technological change most felt the recent reforms had helped modernize the basic pharmaceutical sciences and transition them from the isolated, stand-alone disciplines of the past to the contextualized, more applied focus of today; these curriculum changes were not perceived as a loss of status. When asked how much of the basic pharmaceutical sciences should be included in the program most could not provide a clear answer to this question but appeared comfortable with current emphases and felt they should not be reduced further. While the majority of basic pharmaceutical scientists had apparently accepted these changes and had adapted, some were more resolute and resistant continuing to complain of 154  the devaluing of the sciences in the program. Said one scientist, “we are not a BCIT, we’re not a technical school…as long as this stays a Bachelor of Science degree, I think we should be teaching some science. In fact, we under-teach science in this program in my opinion.”   Probing further by deliberately asking basic pharmaceutical scientists if they had discussed the basic pharmaceutical sciences with other faculty, particularly their clinical and practice colleagues, and whether or not they had heard anything from students, generated a lot of animated discussion and insight into their perspectives on the current curriculum. Exposing many long-held tensions, most seemed keenly aware of and sensitive to criticisms of the basic pharmaceutical science courses from clinical and practice faculty as well as students. Based largely on what seemed to be unsubstantiated rather than definitive evidence (other than the occasional mention of teaching evaluations) the criticisms they spoke of were focused on placement in the curriculum and relevance to practice. In terms of student concerns most had heard them and were resigned to a perceived hierarchy of importance set by students. Although annoyed at having to “justify” to students what they did in their courses one basic scientist summed up these perceptions clearly,  I know that the students classify their courses in terms of importance, right? So in their minds therapeutics beats out everything, but it’s not far above pharmacology. They see the value of pharmacokinetics, and the rest is this sort of big, amorphous lump underneath, so I know that’s how the students perceive and stratify importance. It’s a fact of life, right?    Asked where pharmaceutics and medicinal chemistry might fit in the student’s hierarchy, the same professor laughed, “down in the dungeon probably.” While most basic pharmaceutical scientists acknowledged this hierarchy amongst the student’s perceptions and agreed with it reluctantly, of these last two, medicinal chemistry seemed particularly isolated within the curriculum; an issue clearly frustrating its teachers. Directly attributed to discipline-based design 155  issues associated with the last curriculum reform many felt it had developed a reputation as a stand-alone course and though important, was being increasingly devalued by scientists, practitioners and students. One scientist stated the issue clearly,  the one that’s taken the hardest hit…is med chem…it’s actually gotten so compartmentalized out of the mainstream of the program, just because of the way the current curriculum topics are ordered…it’s out of order so by the time students are getting to it…they can’t quite see what the relevance is.   Perceived criticisms from clinical and practice faculty challenging the relevance of the basic pharmaceutical sciences in the curriculum raised deeper concerns for basic pharmaceutical scientists. Associated with isolation and a lack of meaningful communication between the scientific disciplines, its disciplinary experts and an inability to work towards broader integration with the practice disciplines and practice faculty, many spoke passionately about the lack of clear vision about what the program should be producing, what the knowledge base and skill set of its graduates should be, the difficulties of curriculum change in an autonomy-based university system, and the detrimental effects of the disciplinary “turf wars” of the past. Among the many issues raised by basic pharmaceutical scientists the science-practice divide was particularly emotive. While some felt clinical and practice faculty did not appreciate or respect the basic pharmaceutical sciences and its contribution to practice others felt simply that faculty practitioners “didn’t care. It didn’t matter to them. It wasn’t important.” Articulating the situation well one scientist described her perspectives this way:  Where basic sciences sit is very polarized in this Faculty. There are people that find it extremely important and they’re people who find it completely unimportant, that the things that directly relate to practice are the most important aspects or the only thing that matters…And, it’s really unfortunate because I think this place would provide a much better set of deliverables if, instead of having a tug of war, we actually worked together, and we’re tugging in the same direction.   156  Recognizing that “we have a tendency to kind of stick with what we’re familiar with” there were strong sentiments amongst basic pharmaceutical scientists that the Faculty dynamics of the past had to change. Calls for “taking a hard look at what we do,” creating a “blueprint for knowledge,” “letting go” of engrained disciplines and “reverse engineering” the curriculum starting with practice were some of the many suggestions for moving forward. Regarding relevance and the need to bridge science and practice in the Faculty and within the curriculum one scientist seemed to sum up the emotional spirit of this discussion well: I think every discipline needs to look at how it integrates with the others in a more objective way,… I think we should all be able to really…critically say, what are those building blocks that are just strictly essential to the students… so that they can truly say that they know fundamentally what they’re giving to patients,…I think if we value that, then I think that the next lens through which we translate that, is relevance. I really do…And I don’t give a [hoot] if the material illustrates principles if nobody uses them anymore, come on, do you mean to tell me you’re not creative enough to build those principles based on relevance to what is needed in practice? So that’s the kind of lens I’m talking about, and I don’t think I can articulate it any more clearly than that.  At the heart of these discussions seemed to be the need and desire to get together to talk seriously about curriculum, to find the balance between science and practice and how to integrate them effectively. Even if it meant “gang wars” or “starting fresh” possibly with a 2 + 4 PharmD model, moving away from individual disciplines and towards interdisciplinary teams was suggested as a way to start the discussions. Stated succinctly by one scientist,  I think that what has to happen is we’ve got to get everybody in a room and start to have those discussions, and I think we have started to do that…I think more importantly we need to educate each other about why this is important to everybody, and also educate the different constituencies how everybody actually wins.   Many also felt that navigating these curriculum changes would not only take strong leadership but a particular kind of leadership that included both an intimate knowledge of curriculum history and the people involved:  157  One thing’s for sure whoever’s going to drive the next state in this curriculum has to be someone with a lot of seniority around here, and who knows the people and what we’ve done, and how we’ve done it. Leadership is going to be the most important thing.  Interestingly, even though progress was variable, all basic pharmaceutical scientists had taken conscious steps of some kind within their disciplines to address these concerns. For many this included collaboration with clinical and practice faculty.  Status and the Clinical and Practice Faculty  Exploring the issue of status with clinical and practice faculty seemed to have a different feel. While equally intense and emotive as the discussions with their basic pharmaceutical scientist colleagues, the overall tone appeared less defensive. While this may have had more to do with the study design and the specific focus on the basic pharmaceutical sciences, there was a quiet confidence amongst clinical and practice faculty that was less evident amongst basic pharmaceutical scientists. The interviews and transcripts contained less evidence of self-reflection about the relevance of their course content and more confidence that their classroom practices were aligned with practice and the changes advocated for contemporary pharmacy education. Based on their own descriptions as presented earlier in this chapter they appeared to feel little need to justify the contributions they were making to the curriculum and the program. At the same time, there was a greater sense of urgency regarding the need for curriculum change.  Perhaps not surprisingly, clinical and practice faculty offered differing perspectives to their scientist colleagues on status of the basic pharmaceutical sciences in the current program. Based on similar evidence most agreed with the basic pharmaceutical scientists that the basic pharmaceutical sciences received high status and strong representation in the program but questioned their role in the education of contemporary pharmacists (reiterating perspectives described previously). While respectful of the current contributions of basic pharmaceutical 158  scientists as well as their status as distinguished professors, most clinical and practice faculty felt the theoretical focus and time devoted to the basic pharmaceutical sciences in the program was excessive, misaligned with practice and out of kilter with preparing “practice-ready” graduates. Contrary to the perspectives of the basic pharmaceutical scientists, the value and relevance of the basic pharmaceutical sciences in the program was questionable and required serious reexamination. When asked how much of the basic pharmaceutical sciences should be included in the program, like their scientist colleagues, most could not provide a clear answer to this question but many wondered why topics like pharmacology and pharmacogenomics received more attention than the therapeutics knowledge and skills critical for practice. Stated one faculty practitioner succinctly, “when everything we do is about optimal drug outcomes…we clearly don’t have enough of therapeutics in our curriculum. How did that happen?”  For many clinical and practice faculty the excessive weighting of the basic pharmaceutical sciences in the current program, a result of the last curriculum review, was directly related to and reflective of the status of the basic pharmaceutical scientists as professors, renowned experts and members of the traditional power base in the Faculty. To them, the influence over curriculum decisions afforded basic pharmaceutical scientists by virtue of their academic status directly affected the composition and focus of the curriculum. Exacerbating the issue was a lack of professorial ranked clinicians and practice faculty amongst the power base (comprised largely of non-practitioners), the limited influence lower ranked clinical and practice faculty felt they had in curriculum decisions, the inherent conflict between research and teaching mandates of the professorial scientists, and the competing interests of the Faculty. Articulating the issue well one faculty practitioner summed up the sentiments of many:  159  It’s complex but my sense of it, having observed the functioning of our Faculty for [many] years, is that decision making is not centered in people who are practitioners…decision makers who are not practitioners are not incentivized by people below them and there’s no pressure being put upon them by other faculty members, because there’s not a critical mass of practitioners at that level when curriculum decisions are being made. I also think the competing priorities of being a Faculty significantly undermine our willingness and ability to retool and give appropriate weight to training excellent practitioners, by that I mean the way the university is structured in terms of what people get praised for is completely and utterly divorced from the mission of training practitioners.   Deliberately asking clinical and practice faculty if they had discussed the basic pharmaceutical sciences with other faculty including basic pharmaceutical scientists, and whether or not they had heard anything from students, generated some additional perspectives on status and the focus and organization of the current curriculum. Citing hearsay rather than specific evidence many of the issues raised by clinical and practice faculty echoed those of the basic pharmaceutical scientists described earlier. In terms of student feedback many had heard “general grumblings” from students about the basic pharmaceutical sciences, iterations of “Why do I need to know this?, Am I ever going to use it?” type questions and the pharmacology-pharmaceutics-medicinal chemistry hierarchy of importance.  Interestingly, medicinal chemistry including pharmacogenomics, was cited repeatedly as being “out of step” with the rest of the curriculum and the focus of much student criticism. Others felt the level of status and importance proffered by students regarding the basic pharmaceutical sciences “may not be so much on the content as on the person teaching it, and the person’s willingness to make a connection to practice.” In this regard, many spoke of specific faculty members that teach the basic pharmaceutical sciences yet are rated by students as top teachers in the Faculty’s for their ability to help make theoretical content accessible and relevant to practice.  160   With respect to what clinical and practice faculty were hearing from their colleagues about the status of the basic pharmaceutical sciences in the program (there was no indication that they discussed these issues with their scientist colleagues), the issues raised touched on many of the tensions and internal dynamics voiced by the basic pharmaceutical scientists. While no one recommended removing the basic pharmaceutical sciences completely from the program, the lack of clear vision about what the program should be producing, what the knowledge base and skill set of its graduates should be, disciplinary isolation, and lack of meaningful interdisciplinary dialogue were among some of the factors impeding more realistic weighting, meaningful integration and broader acceptance of the basic pharmaceutical sciences in the program. The comment, “[a]cross my therapeutics colleagues, we speak the same language. Across that other continuum, we don’t speak the same language at all” was offered by a faculty practitioner to illustrate the extent of the current divide between science and practice and the magnitude of the challenge required to address the gap. There was also a perception among some that the basic pharmaceutical scientists were out of touch with the changes in education and practice, and particularly resistance to change. Articulating this common sentiment along with sensitivities witnessed, one faculty practitioner stated,  the importance of the pharmaceutical sciences in relation to what has been the traditional curriculum is changing. And its relative importance is not as great as it was at one time. And some people have a big problem with that…you know, everybody needs to change with the times and make themselves much more relevant. So, I think that if the basic pharmaceutical sciences could, by working together with all of the faculty, demonstrate the relevance of that information, then I think that would be a big improvement. So it’s declining and I can see people are upset about that.   While much of this discussion seemed laced with a sense of futility, like their basic scientist colleagues there was also an emergent sense that “things had to change, we need to do things differently.” In terms of possible suggestions for moving forward many felt that despite 161  recent hires in clinical and pharmacy practice (see Figure 13 for significant roster changes following implementation of the current program in 2003) that a stronger voice from clinical and pharmacy practice was necessary in curriculum discussions, setting up electives and honours degrees for those interested in greater exposure to the basic pharmaceutical sciences, and the notion of “reverse engineering” the curriculum were suggested. In addition, the use of collaborative, interdisciplinary groups instead of the isolated discipline-based discussions of the past was recognized as critical for future curriculum deliberation and decision-making. Realizing the “personality clashes,” “negotiations” and “compromise” inherent in this path, some were skeptical that the Faculty had the vision, leadership or will to set the priorities needed to make the tough decisions: If something’s a priority,…the way you’ll know it is a priority is you are able to name the things that have to die as a result of you accomplishing that thing. If you are unable to name those things, then it’s no more of a priority then all the other things you’ve got swirling around going on that you need to do. If someone wants to say, “We’re going to cut med-chem out of the curriculum, as controversial, horrible, or even ill advised as that might be, at least that would be able to say, “We have a priority, and here are some things that are going to die as a result.” Nothing has died [in the program] in 15 years. Nothing.   Others suggested “[w]e need a leader to take us down that path, and just be committed to it, realizing they’re going to get a lot of [grief] and just do it.”         162  CHAPTER 7: CURRICULUM AND PEDAGOGICAL PRACTICES OF THE BASIC PHARMACEUTICAL SCIENTISTS    Chapter 7 explores the curriculum and pedagogical practices of the basic pharmaceutical scientists that have contributed to and are currently teaching in the BSc(Pharm) program. The intent is to answer research question three while adding to the growing understanding about the case. While Chapters 5 and 6 provided valuable insight into the part that science and the basic pharmaceutical sciences have played and continue to play in the curricula and education of pharmacists at UBC, Chapter 7 focuses specifically on those responsible for teaching them. The chapter is presented in two parts. The first provides a broader examination of the curriculum and pedagogical practices of the basic pharmaceutical scientists developed through interview and course document analyses. In this section, interview questions focused on the study’s theoretical framework of curriculum dimensions and documentation representative of current course design, teaching and assessment practices form the basis of the analysis and discussion provided. Included as well is a sense of the characteristics and qualities of the scientists themselves as critical working parts of the case, active participants in the curriculum and educators. The second section of the chapter is more specific using visits to the classrooms of basic pharmaceutical scientists to observe what actually happens there. Entitled “Three Classes in a Week,” this section provides a closer look at the range of classroom practices used to teach the basic pharmaceutical sciences in the program through first-hand accounts of classroom experiences. While the chapter does not include broader analysis about how these practices might influence the role and status of the basic pharmaceutical sciences in the current program, it is hoped that once the chapter has been finished, readers will have a good sense of the curriculum and pedagogical practices used to design and teach the basic pharmaceutical sciences in the program, 163  the content currently taught, and the basic pharmaceutical scientists responsible for their designing and teaching.  7.1  Curriculum and Pedagogical Practices: Exploring Broadly  As mentioned above, this section of the chapter provides a broad examination of the curriculum and pedagogical practices of the basic pharmaceutical scientists participating in this study. Interviews with all members of this key group of study participants along with course documents from those actively teaching provided entry points for the examination. Mentioned briefly in Chapter 6 as important for prefacing and providing context for exploring the role and status issues described there, the interview components looking specifically at the approaches to course design and teaching practice voiced by basic pharmaceutical scientists provide the focus here. Responses to interview questions seeking information about previous teaching experience, current teaching responsibilities, and thoughts and perspectives on the dimensions of curriculum underpinning the study together with course outlines, class hand-outs and example exam questions provided the basis for analysis and summaries generated. As presented below, the broad examination of the curriculum and pedagogical practices of the basic pharmaceutical scientists provides insight into the decision-making processes and choices made regarding approaches to course design, what is taught in their courses and their teaching and assessment practices; issues of purpose and context also emerge. Table 8 provides a synopsis of the curriculum and pedagogical practices of the basic pharmaceutical scientists.   Setting the Stage  Prior to broader examination of their pedagogical practices each basic pharmaceutical scientist was asked about their prior teaching experiences as well as their teaching responsibilities in the current program. It seemed clear from their response to interview questions 164  Table 8: Curriculum and pedagogical practices of basic pharmaceutical scientists  Approaches to Course Design  Content Focus in Courses and Modules  Use of Learning Objectives Teaching Methods Active Learning Strategies  Assessments Practices   Approach: design based on selection of  disciplinary content knowledge at curriculum and course levels; sub-disciplines delegated to individuals for course or module development and teaching; seniority, expertise, interest and  left over topics used as delegation criteria; content and course design left to content expert, autonomy-based  decisions; honed incrementally with teaching experience, trial and error, and scientific advancement; no formal models of course design used  Coherence: limited; course content and objectives linked to assessment and exam questions tangentially   Purpose: molecular-level knowledge of drug chemistry, delivery and action in the treatment of human disease, how and why drugs work; selection based on interest, intuition, time available and conceptual frameworks; teaching language of science, concepts over memorization and transferability key; depth and scope choices influenced by time, experience, scientific advancement and pragmatics Context: changing; connection to practice increasingly emphasized Integration: minimal; limited sense of other disciplines; isolation and autonomy within and between disciplines evident; pharmacology increasingly integrated with therapeutics  Used in all disciplines and courses; adjusted as course material changed with scientific advancement; used for broad understanding and as a study guide for students; perspectives on usefulness variable; included in course outlines Coherence: objectives linked to exam questions  tangentially Approaches variable Major: teaching-centered; power point lectures with handouts; WebCT Vista support; lecture capture; content coverage with variable active learning; students passive, teacher as sage  Minor:  learning-centered; active learning;  teaching to comprehensive notes packages; team-based learning; students engaged, teacher as guide  Major: recapping, current events and news; questioning Minor: in-class problem solving; demonstrations; videos; case-based class discussion; small group work; polling and in-class quizzes  Outside Class Time: blogs and  discussion boards; community service opportunities; practice problem sets and exams  Major: summative; midterm and final exams; multiple choice, short and longer answer questions; calculations; some higher order case-based questions; exams not released to students, questions reused; supervised exam review Minor: formative quizzes Coherence: exam questions linked to objectives tangentially   165  that this group of scientists enjoyed their teaching, their roles as professors and educators, and the on-going challenges of developing their courses and teaching practices. Even with limited teaching experience or background in education prior to joining the Faculty (see Table 5), many had received student- and peer-nominated Faculty and university teaching awards for their classroom work, impacts on student learning and growth as educators. During this discussion many raised conflicts between research and teaching commitments. Despite openly acknowledging the importance of their research programs, the increasingly competitive nature of grant funding, and their obligations to the research mandates of the Faculty and university they took their teaching responsibilities seriously. Each described attempts to balance research and teaching responsibilities accepting that changes in their classrooms were often slow in spite of on-going commitments to improvement. In addition, most had engaged in some form of professional development activities to improve their teaching practices including teaching seminars and workshops. Many were also graduates of UBC’s Faculty Certificate Program in Teaching and Learning in Higher Education, a one year in-depth and structured teacher training program for faculty, offered in partnership with the UBC Centre for Teaching, Learning and Technology.  In terms of current teaching commitments, each basic pharmaceutical scientist taught approximately 23 hours per year in the program. Courses taught were part of the core curriculum, scheduled in Years 1 to 3, and were lecture-based. Basic pharmaceutical sciences lectures were evenly distributed throughout the week, comprised of either 1 or 2 hour blocks and scheduled in one of the major theatre style lecture halls available to the program. Enrollments in these courses were approximately 150 students. Interestingly, emeritus scientists had taught 166  approximately double that amount at approximately 47 hours per year likely due in part, to the increased emphasis on the basic pharmaceutical sciences in previous curricula. Approaches to Course Design   The approach to course design was consistent for most basic pharmaceutical scientists regardless of discipline affiliation. When asked during the interviews about designing their courses and whether or not a particular process was used, most needed time to articulate their thoughts on the issue; for many the design process was not immediately clear. Said one senior scientist and seasoned educator, “it’s hard to describe. It’s funny because you do it, but you don’t really think about the process.” While a more junior scientist stated, “I primarily have winged it,” closer examination of interview responses to this question revealed an informal but time tested approach in place. Drawing on disciplinary expertise and broad understanding of their fields of research, the process of course design amongst basic pharmaceutical scientists was described at two levels both almost entirely focused on selecting appropriate content. The first, associated with broader curriculum design, involved delineating and selecting the particular sub-disciplines or knowledge domains within each discipline that represented core disciplinary knowledge required of students. Typically, this selection process was decided through small group discussion amongst disciplinary experts and influenced by historical curricula, current conceptualizations of the field, knowledge gaps and the specific disciplinary expertise available to teach the material.  In the current BSc(Pharm) program for example, medicinal chemistry had been divided into foundational principles of drug chemistry (i.e., exploring, for example, the impacts of drug structure on solubility, stability and drug disposition in the body), drug targets in human systems (i.e., examining drug interactions with enzymes including metabolic enzymes and drug biotransformation, receptors and ion channels) and pharmacogenomics (i.e., exploring 167  genetic influences on drug disposition and action) while pharmaceutics had been organized into oral dosage forms (e.g., tablets, capsules and liquid dosage forms) and other drug delivery systems (e.g.,  injectable, parenteral, pulmonary and ophthalmic systems, among others). Pharmacology had identified foundational concepts of drug action and an extensive series of body systems-based disease state modules aligned with “some of the most important conditions [in society] that need to be taught” (i.e., mechanisms of drug action in diseases of the autonomic nervous, immune, pulmonary and gastrointestinal systems, among many others). While decisions about inclusion and sequencing of these major content blocks within the curriculum were made within each discipline by the disciplinary experts, ratification required broader Faculty approval. For the present curriculum this had taken place during an exhaustive curriculum renewal process prior to implementation in 2003 and although optimized considerably, the original curriculum design regarding the basic pharmaceutical sciences had remained almost unchanged.  The second level of course design involved delegation of sub-disciplines or knowledge domains to individual faculty members for development into full courses or specific modules within courses.  This selection process was often based on seniority, expertise, interest and those areas that “nobody else wants to teach.” At this stage, faculty members were given responsibility and autonomy as content experts for course or module development and teaching. While some variation in course design was evident amongst current basic pharmaceutical scientists, the process of course design began for most with syllabi and notes “inherited” from predecessors; some of this course material had existed, in part, for years and was representative of more traditional approaches to teaching the basic pharmaceutical sciences and past generations of pharmaceutical scientists. Regardless, the majority described approaches to course design focused primarily on appropriate content selection and sequencing. Although augmented with 168  rigorous research often involving textbooks, online resources, comparison with similar courses at other universities, review of relevant research literature and discussions with disciplinary colleagues, some described their process informally:  All I do is I just think about the core content that I need to deliver to them. I put in my power points and I sort of tweak here and there, seeing what I want to emphasize, whether I highlight key concepts, and then follow up with some questions that I think will be important. For the last year I started doing a couple of demonstrations in class, just to sort of break up the routine.    Those that had inherited courses or modules requiring limited modification typically replied, “[t]he material is already designed, that’s just historical.” For others the course design process appeared more deliberate and stepwise:  Assuming that I don’t have all of the information at my fingertips, I do a review of what are the drug therapies…for a particular condition…and then I would read the literature on those therapies and…determine what their mechanism of action was, what was known about how effective they were, and their adverse effects and so on. And then I would begin to create…the framework…around the drug. The focus is the drugs….how they work…their absorption, distribution and metabolism, and you know…adverse effects, and in all cases, it’s informed with the mechanism of action.  Interestingly, even though most basic pharmaceutical scientists had engaged in professional development programs and workshops to enhance their pedagogical practices, they openly acknowledged that they did not use formal approaches to course design informed by particular teaching models or the educational research literature; content selection including issues of scope and depth, seemed to take precedence over other dimensions of curriculum or coherence between them. On a historic note, the time tested nature of this approach to course design was verified by emeritus scientists. When asked how they went about designing their courses and whether or not they used particular models the typical response was,  not that I recall. You looked back at what you did, and what the Faculty agreed on and how it should look, and then that content was more yours, like in a particular time slot you knew you had to cover classes of drugs, but you might vary that depending on a teacher’s or professor-specific kind of area… I had some fundamentals I had to get across 169  and I would just try to figure out ways to do it…I also used 2 or 3 of the major textbooks by people I respected very much or the ones that students all used like Remington’s Pharmaceutical Sciences, Goodman and Gilman and then I supplemented that with the newest literature that I could find.  A Closer Look at Content Selection: Exploring Issues of Scope and Depth  Basic pharmaceutical scientists talked openly about the courses or modules they were responsible for and the challenges experienced and decisions required regarding issues of content scope, depth and selection. Immediately obvious during the interviews was the command each had of the subject areas and how they had attempted to translate that expertise into their courses and classrooms. Emphasizing the scientific foundations required for understanding at the molecular level, how and why drugs and drug products work in the treatment of human disease appeared to be the primary purpose of their course design and teaching efforts. To provide a sense of the theoretical nature of course content taught, one basic pharmaceutical scientist described it this way:  I deal with mostly how drugs have molecular interactions with enzymes and inhibit them. So I describe the process of enzyme inhibition. And then the different types of inhibition. I go through molecular interactions. I try to break down what type of molecular interactions can be important and actually at that level in the class, we quantitate those. And then we go through different examples of drug classes and the way that they inhibit different enzymes. There’s a small [amount of] pharmacology… to it, just in terms of providing some context, of why some enzymes are being inhibited and targeted in the human body…one of my favourite interactions is looking at antibiotic interactions with a transpeptidase enzymes, which form bacterial cell walls. I show why those inhibitors sort of act as suicide substrate inhibitors and how they form a covalent interaction.   When basic pharmaceutical scientists, like the one just quoted, were asked how they decided what content to include in their courses or modules, most had exercised their autonomy suggesting that although previous curriculum deliberation, former syllabi and broader research were helpful, personal interest, intuition, and the time allotted in the curriculum had the greatest influence on content selection. This latter point evoked much discussion at both the curriculum 170  and course levels of course design. Still fresh almost a decade after implementation, many scientists continued to lament the lack of time allocated to science in the current curriculum and recalled vividly the content decisions necessitated by the most recent curriculum reforms. Facing significant reductions in some areas as a result of increasing emphases on clinical and pharmacy practice in the curriculum, content decisions regarding the basic pharmaceutical sciences required serious rethinking and fundamental decisions about what was core disciplinary knowledge and how it could be better contextualized, particularly regarding pharmacy practice and the broader changes in the profession and health care. Identifying fundamental concepts, navigating the balance between scope and depth of topics with time available in the curriculum, and finding relevant illustrative examples that remained true to the fundamentals while making broader connections to practice were critical considerations in these deliberations and decisions. In addition, requiring greater reliance on student’s prior knowledge and ability for self-directed learning were also seen as important. One senior scientist described content decisions during the last curriculum reform this way,  we got cut by half, and so…we had to make some very tough decisions and choices, because there was no way that we were going to be able to teach what we did in 72 [hours] in 36 with quality and so…we had to make two fundamental decisions. Number one, what are the key issues and specifics that we want our students to get, and then the other question was how much depth you could do in each…We made a fundamental decision [about] the major oral dosage forms that patients get…tablets and capsules…and then we clumped the liquid dosage forms altogether under one area…There was all sorts of specialty type things that had to be thrown out because we just didn’t have the time, so we stuck to the fundamentals…we had to really assume that the students had a much better understanding of physical chemistry…one of the reasons why the prerequisites I think are really critical…We decided that we would give readings or other things for the students to look at and say, “You need to be familiar with this, but we will not go into depth over this issue.” I think that’s good, because they have to do some self learning, we can’t be spoon-feeding them everything.   It is interesting to note that while the demands of curriculum reform had focused attention on integration between the science and practice disciplines, there was only limited discussion of or 171  call for greater integration between the basic pharmaceutical sciences disciplines themselves. While the purpose of the revised basic pharmaceutical sciences curriculum remained on the fundamentals, the basic pharmaceutical scientists and their disciplines appeared isolated from each other.   The dynamics of content decision-making within individual courses reflected those described for curriculum level reforms but provided greater insight into individual decision- making practices. Although nuanced, the process of choosing course content in individual courses could be described as an iterative process of continual refinement. “T