Overview of Credentialing in Pharmacy
Introduction
Pharmacist credentials may be divided into three fundamental types.
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The first type -- college and university degrees -- is awarded to mark the successful completion of a pharmacist's academic training and education.
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The second type -- licensure and relicensure -- is an indication that the pharmacist has met minimum requirements set by the state in which he or she intends to practice.
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The third type of credential -- which may include advanced degrees and certificates -- is awarded to pharmacy practitioners who have completed programs of various types that are intended to develop and enhance their knowledge and skills, or who have successfully documented an advanced level of knowledge and skill through an assessment process.
These three paths to pharmacist credentialing are illustrated in Figure 1. The sections that follow provide information on each of the credentials offered in pharmacy, the credentialing or accreditation body involved, whether the credential is mandatory or voluntary, and other related information.
Figure 1.
.U.S. pharmacy credentials and oversight bodies. ACPE = American Council on Pharmaceutical Education, ASHP = American Society of Health-System Pharmacists, NABP = National Association of Boards of Pharmacy, ACCP = American College of Clinical Pharmacy, AACP = American Association of Colleges of Pharmacy, BPS = Board of Pharmaceutical Specialties, CCGP = Commission for Certification in Geriatric Pharmacy, NISPC = National Institute for Standards in Pharmacist Crendentialing, PTCB = Pharmacy Technician Certification Board.
Preparing for the Pharmacy Profession
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Credential earned: Bachelor of Science degree in Pharmacy; Doctor of Pharmacy degree
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Credential awarded by: School or college of pharmacy
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Accreditation body for professional programs in pharmacy: American Council on Pharmaceutical Education (ACPE). The U.S. Department of Education has recognized the ACPE accreditation of the professional degree program in pharmacy.
Until July 1, 2000, an individual who wished to become a pharmacist could enroll in a program of study that would lead to one of two degrees: a bachelor of science degree in pharmacy (B.S. Pharm. or Pharm. B.S.) or a doctor of pharmacy (Pharm.D.) degree.
As of 1998, two-thirds of all students studying in professional programs in pharmacy were enrolled in Pharm.D. programs. The Pharm.D. degree became the sole degree accredited by ACPE for pharmacists' entry into practice in the United States, as of July 1, 2000, with the institution of new ACPE professional program accreditation standards. Pharm.D. programs typically take six years to complete and generally involve two years of preprofessional coursework and four years of professional education. A few programs offer the professional education over three years of full-time education.
B.S.-level pharmacists who have been in the workforce may also return to a college or school of pharmacy to earn the Pharm.D. degree. These programs, which are tailored to the individual's background and experience, may follow "nontraditional" pathways; however, they must produce the same educational outcomes as does the entry-level Pharm.D. degree.
State boards of pharmacy require a Pharm.D. or B.S. degree from a program approved by the boards (almost always an ACPE-accredited program) for a candidate to be eligible to take the state licensing examination. A listing of accredited professional programs offered by colleges and schools of pharmacy is published annually by ACPE and is available on the ACPE Web site (www.acpe-accredit.org).
Entering Practice and Updating Professional Knowledge and Skills
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Credentials earned: Licensure as registered pharmacist (R.Ph.); relicensure.
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Credential awarded by: State board of pharmacy
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Licensure process overseen by: State regulatory authorities
Before a graduate of a school or college of pharmacy can practice pharmacy in the United States, he or she must become licensed. The licensure process is regulated at the state level by the boards of pharmacy.
Candidates for licensure in all states but California must pass the North American Pharmacist Licensure Examination (NAPLEX), a computer- adaptive, competency-based examination that assesses the candidate's ability to apply knowledge gained in pharmacy school to real-life practice situations. California administers a unique examination process. Most states also require candidates to take a state-specific pharmacy law examination. Currently, 36 states use the Multistate Pharmacy Jurisprudence Examination (MPJE), a computer-adaptive assessment that tailors each examination to address the pharmacy law and regulations of the state in which the candidate is seeking licensure.
Both the NAPLEX and the MPJE are developed by the National Association of Boards of Pharmacy (NABP) for use by the boards of pharmacy as part of their assessment of competence to practice pharmacy. Development of these examinations is directly related to NABP's mission, which is to assist its member boards and jurisdictions in developing, implementing, and enforcing uniform standards for the purpose of protecting the public health. The NAPLEX and MPJE examinations are administered by appointment, daily, throughout the year at a system of test centers located in all 50 states.
In addition to the NAPLEX and MPJE, some states require a laboratory examination or an oral examination before licensure is conferred. All state boards also require that candidates complete an internship before being licensed. The internship may be completed during the candidate's academic training or after graduation, depending upon state requirements.
State licensure is an indication that the individual has attained the basic degree of competence necessary to ensure the public health and welfare will be reasonably well protected. Individuals who have received a license may use the abbreviation "R.Ph." (for "registered pharmacist") after their names.
Nearly all state boards of pharmacy also require that registered pharmacists complete a certain number of continuing-education units (CEUs) before they can renew their licenses. The CEUs must be earned through participation in a continuing-education (CE) program whose provider has been approved by the American Council on Pharmaceutical Education (ACPE). The symbol used by ACPE to designate that the CE provider is approved is
Note that ACPE approves providers of CE, not individual CE programs. CEUs may be secured by attending educational seminars, teleconferences, and meetings; reading journal articles; or completing traditional home study courses or computer-based education programs. Receipt of a satisfactory score on an assessment that is created by and submitted to the CE provider is sometimes required as a documentation of completion of a CE program. ACPE publishes an annual directory of approved providers of continuing pharmaceutical education, which is available on the ACPE Web site (www.acpe-accredit.org).
Licensure and relicensure are mandatory for pharmacists who wish to continue to practice their profession.
In their regulatory role, state boards of pharmacy are ultimately responsible to the state legislature.
Developing and Enhancing Knowledge and Skills
Pharmacy practitioners who wish to broaden and deepen their knowledge and skills may participate in a variety of postgraduate education and training opportunities. They include the following:
Academic Postgraduate Education and Training
Pharmacists who wish to pursue a certain field of study in depth may enroll in postgraduate master's or doctor of philosophy (Ph.D.) programs. Common fields of study for master's candidates include business administration, clinical pharmacy, and public health. Common fields for Ph.D. studies include pharmacology, pharmaceutics, pharmacy practice, and social and administrative sciences.
Residencies
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Credential earned: Residency certificate
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Credential awarded by: Residency training program
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Program accreditation: The American Society of Health-System Pharmacists (ASHP) (independently or in collaboration with other pharmacy organizations)
ASHP is the chief accreditation body for pharmacy practice and specialty residency programs in pharmacy. A total of 505 programs nation-wide now hold ASHP accreditation. ASHP also partners with other organizations, including the Academy of Managed Care Pharmacy, the American College of Clinical Pharmacy, the American Pharmaceutical Association, and the American Society of Consultant Pharmacists, in accrediting residency programs.
The majority of pharmacists who pursue residency training do so in the area of pharmacy practice. These residencies sometimes focus on a particular practice setting, such as ambulatory care. Pharmacists may also pursue specialty training in a certain course (e.g., pharmacokinetics), in the care of a specific patient population (e.g., pediatrics), or in a specific disease area (e.g., oncology).
Residency programs last one to two years. The typical training site is a practice setting such as an academic health center, a community pharmacy, a managed care organization, a skilled nursing facility, or a home health care agency.
The Health Care Financing Administration (HCFA), an agency of the federal government, recognizes residency accreditation bodies within the health professions.
Fellowships [a]
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Credential earned: Fellowship certificate
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Credential awarded by: Fellowship training program
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Program accreditation: No official accreditation body
A fellowship is an individualized postgraduate program that prepares the participant to become an independent researcher. Fellowship programs, like residencies, usually last one to two years. The programs are developed by colleges of pharmacy, academic health centers, colleges and universities, and pharmaceutical manufacturers.
There is no official accreditation body for fellowship programs; however, the American Association of Colleges of Pharmacy and American College of Clinical Pharmacy have issued guidelines that are followed by many fellowship program directors.
Certificate Training Programs
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Credential earned: Certificate of Completion
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Credential awarded by: Educational institutions and companies, pharmacy organizations, and others
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Provider accreditation: American Council on Pharmaceutical Education
A certificate training program is a structured and systematic postgraduate continuing-education experience for pharmacists that is generally smaller in magnitude and shorter in duration than degree programs. Certificate programs are designed to instill, expand, or enhance practice competencies through the systematic acquisition of specified knowledge, skills, attitudes, and behaviors. The focus of certificate programs is relatively narrow; for example, the American Pharmaceutical Association offers programs in such areas as asthma, diabetes, immunization delivery, and management of dyslipidemias.
Certificate training programs are offered by national and state pharmacy organizations and by schools and colleges of pharmacy and other educational groups. The programs are often held in conjunction with a major educational meeting of an organization. The American Council on Pharmaceutical Education (ACPE) approves providers of such programs. The symbol used by the ACPE to designate that a certificate training program is provided by an accredited provider is
Traineeships
Traineeships, in contrast to certificate training programs, are defined as intensive, individualized, structured postgraduate programs intended to provide the participant with the knowledge and skills needed to provide a high level of care to patients with various chronic diseases and conditions. Traineeships are generally of longer duration (about five days) and involve smaller groups of trainees than certificate training programs do. Some are offered on a competitive basis, with a corporate sponsor or other organization underwriting participants' costs. Pharmacy organizations currently offering traineeships include the American College of Apothecaries, the American Society of Consultant Pharmacists, and the American Society of Health-System Pharmacists Research and Education Foundation.
Certification
Introduction. Certification is a credential granted to pharmacists and other health professionals who have demonstrated a level of competence in a specific and relatively narrow area of practice that exceeds the minimum requirements for licensure. Certification is granted on the basis of successful completion of rigorously developed eligibility criteria that include a written examination and, in some cases, an experiential component. The certification process is undertaken and overseen by a nongovernmental body.
The development of a certification program includes the following steps:
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Role delineation. The first step is to define the area in which certification is to be offered. This is done through a process called role delineation or "task analysis." An expert panel of individuals in the proposed subject area develops a survey instrument to assess how practitioners working in the area rate the importance, frequency, and criticality of specific activities in that practice. The instrument is then sent to a trial of pharmacists who are practicing in that field.
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Development of content outline. On the basis of responses to the survey, a content outline for the certification program is developed.
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Preparation of examination. The written examination component of the certification program is developed on the basis of the content outline.
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Other activities. Appropriate measures are taken to ensure that security and confidentiality of the testing process are maintained, that the examination and eligibility criteria are appropriate, and that the knowledge and skills of those who are certified do, in fact, reflect competence.
