2008 Rho Chi lecture: one easy piece.

One of the classic movies of modern film making, Five Easy Pieces, starred the incomparable Jack Nicholson as counterculture hero cum pianist. Using the piano as a metaphor for rebellion against societal barriers to individual freedom and honest expression, Mr. Nicholson's character embarked on a quixotic pursuit to play 5 classic works on the piano. Mastering these pieces was intended to demonstrate, symbolically at least, that his version of reality was superior to the version embraced by mainstream America. In the end, of course, exactly the opposite occurred, as his deranged view of reality proved to be incompatible with any version of "normal" or with the tolerance levels of modern society. And so I stand before you offering my version of reality to mainstream pharmacy under the title "One Easy Piece." You will judge whether my piece is melodic or deranged, but be assured, I am deeply honored to be the 2008 Rho Chi Lecture Award recipient and for your consideration of my remarks. Rho Chi is an academic organization, indeed the academic organization in pharmacy. Our motto is rooted in Rene' Descartes' proof that the world we perceive is factual, not chimeric, and is expressed as "I think, therefore I am." In that tradition I am asking us to revisit our Cartesian roots and think about the reality of our lives as pharmacy educators, to ask "What is an academic program in pharmacy?" To most of us the immediate response will be familiar: an academic program in pharmacy is a collection of coursework, facilities, faculty, administrative policies, budget, operating procedures, and other resources organized into a curriculum for pharmacy students. To assure minimum quality, these resources must be structured to meet standards and guidelines of an accrediting body, the American Council on Pharmaceutical Education (ACPE). We are all well aware of that periodic exercise to assure minimum quality, ie, the self-study process followed by site-visit report and Council thumbs up or thumbs down. As a survivor of 6 self-study exercises while a faculty member and/or dean at a school of pharmacy, as an occasional site-visit team member representing ACPE, and as a participant in accreditation matters for other health professions, I have reluctantly concluded that we have lost our way in assuring minimum standards in pharmacy education. Let me put it in the starkest possible terms: our approach to defining an academic program is fatally flawed. I base my conclusion in equal parts upon the current (2007) Standards for Accreditation of Doctor of Pharmacy Programs and the recent experience of accrediting new academic programs. It is clear to me the current approach causes us to focus excessively, if not exclusively, on individual elements of the curriculum while ignoring the all-important context in which that curriculum is delivered. In summary I believe our approach is fundamentally flawed because we have come to view an academic program in pharmacy as simply a delivery system for curriculum elements. Our current system of ambiguous standards and piecemeal check-offs constitute the error in logic known as reductio ad absurdum, ie, we have reduced all the curriculum pieces into an irreducible minimum, but in the process we have lost sight of a unifying goal. In a previously published commentary I observed that the current (2007) PharmD accreditation standards deleted pharmaceutical care as the foundation of pharmacy practice and education. (1) In place of pharmaceutical care, an institution is now invited to advance its preferred philosophy of practice and education, and lacking any enforceable boundaries on practice philosophy, almost any approach is acceptable. Not surprisingly this leads to a circumstance where almost any curriculum is acceptable. Economists have described this condition by the phrase "bad money drives out good money." Briefly, this means when gold coins and counterfeit (eg, copper) coins are mingled in the marketplace, gold coins will disappear in preference to counterfeits because people will understandably horde gold but exchange copper. …