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2005 年台灣藥學教育白皮書 林慧玲 1 許光陽 2 闕壯卿 2 李安榮高雅慧 6 蔡義弘 7 張建雄 8 魏道昌 3 4,5 簡伯武 9 1 陳基旺 台灣藥學會鑒於藥師養成的需求, 起始改進藥學教育 本白皮書參酌美國藥學教育學會標準, 對藥學教育的使命 規畫 評估 課程 招生 學生輔導 教師素質與評估 圖儀設備 實習場所與經費來源, 訂定準則 此白皮書經全國藥學院 / 系教師及台灣臨床藥學會與中華民國藥師公會全聯會代表, 於全國教育研討會及多次教育會議討論制定 我國與美國藥師養成教育最大的落差, 包括需一年的課程補強 : 藥物治療學 藥品資訊與分析 公共衛生及流行病學 社會學及行為科學 健康照護體系經濟學, 以及需有一年之進階藥學實習 此外, 各校的醫院藥學實習 社區藥局實習等初級執業經驗課程的實習場所及課程水準參差不齊, 亟需標準化 我國藥學教育所面臨最大的問題, 是藥學專業師資嚴重不足 藥學院 / 系如何建立延攬臨床藥學師資的管道, 確為提升藥學教育的當務之急 更重要的是, 藥學教育改進必須經由執業環境的改善加以落實, 因此執業法規與政策應配合檢討, 而藥師執照考試之時間點更涉及整體制度變革, 這些都是未來藥學教育改進必須進一步探討的議題 關鍵詞 : 藥學教育, 白皮書 ( 醫學教育 2006;10:165~85) 背景 2003 Pharm. D. [1] 2003 7 1 2005 5 American College of Pharmacy Education ACPE ACPE standards 2000 2003 [2,3] 2005 2005 6 十 1 2 3 4 5 6 7 8 9 2006 3 17 2006 9 27 100 1 醫學教育第十卷第三期 2006

166 林慧玲許光陽闕壯卿李安榮簡伯武高雅慧蔡義弘張建雄魏道昌陳基旺 2005 7 2005 2005 2005 2005 9 2005 7 12 5 / 2005 12 2005 2005 前言 十 2003 Pharm.D. 2006 [1] 2008 American College of Pharmacy Education; ACPE [2,3] /

2005 年台灣藥學教育白皮書 167 使命 規劃與評估標準 [2,3] 藥學院 / 系之使命 目標與方針 pharmaceutical care / 有系統的規畫 系統性評估目標達成程度 [2,3] 組織與行政標準藥學院 / 系與大學間之關係 醫學教育第十卷第三期 2006

168 林慧玲許光陽闕壯卿李安榮簡伯武高雅慧蔡義弘張建雄魏道昌陳基旺 // / 大學內與相關醫療機構之組織與行政關係 / 藥學院 / 系之組織與行政 藥學院 / 系所之院長 / 系主任職責 / /

2005 年台灣藥學教育白皮書 169 課程目標與核心能力 [2,3] [2] 1. 2. 3. [3] 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 核心課程的範疇及內容 ACPE [2,3] 2004 [4] 1. biomedical sciences anatomyphysiology pathophysiology microbiologyimmunology biochemistrymolecular bi- 醫學教育第十卷第三期 2006

170 林慧玲許光陽闕壯卿李安榮簡伯武高雅慧蔡義弘張建雄魏道昌陳基旺 ologybiostatistics 2. pharmaceutical sciences medicinal chemistrypharmacognosypharmacology toxicologypharmaceutics pharmaceutical analysis 3. behavioral, social, and administrative pharmacy scienceshealth care economicspharmacoeconomics practice management 4. clinical sciences pharmacy practiceprescription processing gerontology 5. professional experience advanced pharmacy practice experience APPE clinical clerkship 課程規劃四年制藥學課程與 ACPE 標準及美國大學核 心課程比較 [2,3, 5-8] 2003 [4] [9] ACPE University of California at San Francisco UCSF University of Southern California USC University of North Carolina UNC 2 drug information & analysis services public health & epidemiology social & behavior scienceshealth policy & health economicstherapeutics 3~4 策略 University of Illinois at Chicago UIC 實習標準化

2005 年台灣藥學教育白皮書 171 [2,3] ACPE [2,3] ACPE [2,3] / [9] 640 [9] 加強藥學行為學 藥學社會學 藥事行政管理科學及臨床科學課程 ACPE [2,3] Clinical SkillsClinical 醫學教育第十卷第三期 2006

172 林慧玲許光陽闕壯卿李安榮簡伯武高雅慧蔡義弘張建雄魏道昌陳基旺 Pharmacokinetics 1 十 [10] 3 UIC [8] 表 1. 藥物治療學的範疇 + + + + + + Solid tumor + Neutropenic fever 進階藥學執業經驗的規劃 ACPE [2,3] [2,3]

2005 年台灣藥學教育白皮書 173 [2,3] documentation of services taking of drug histories [2,3] / [2,3] [2,3] / managed care [2,3] APPE 4 3 1 2 12~14 36~42 專業課程整合 biomedical sciences a problem-based learning 教學與學習過程 efficiencies and effectiveness critical thinking [2,3] 醫學教育第十卷第三期 2006

174 林慧玲許光陽闕壯卿李安榮簡伯武高雅慧蔡義弘張建雄魏道昌陳基旺 1. [2,3] 2. [2,3] 3. [2,3] 4. B.S. [2,3] 學習成效評估 formative summative [2,3] [2,3] 課程評估 [2,3] [2,3] [2,3] 教師的標準 [2,3] 教師與職員量的因素 UNC

2005 年台灣藥學教育白皮書 175 UCSF USC 1:2.7 1: 6.4 1:10.3 1: 3.9 1:12.2 1:21.8 1:8.6 1:10.2 1:19.5 1:14-32 1:75-267 5 教師與職員質的因素 教師評核 / 教師自我評量 台灣藥學教育師資之規劃 醫學教育第十卷第三期 2006

176 林慧玲許光陽闕壯卿李安榮簡伯武高雅慧蔡義弘張建雄魏道昌陳基旺 [11] [11] 十 十 108.3 70 60 2010 2020 / 1:50 實習師資 6 USC USC 70-80% 10-15% 5-10% 60% : 60% 15% 15% 10% 課程師資 PBL [2,3] 圖書與教學資源 / 實體設備 [2,3]

2005 年台灣藥學教育白皮書 177 / 誌謝 2005-2007 參考文獻 1. [ ] 2004 2. Revision of ACPE standards 2000 draft 1.2, 2002. available at http://www.acpe-accredit.org/pdf/acpe _Revised_Standards_Draft_1.2_with_Appendices. pdf [Accessed April 26, 2005] 3. ACPE standards 2000, available at www.acpe-accredit.org/pdf/standards2000.pdf [Accessed April 26, 2005] 4. 2004; 7: 14 5. Curriculum of Pharm D program. University of North Carolina, available at http://pharmacy.unc.edu/index. cfm? fuseaction=pharmd.showcurriculum [Accessed April 26, 2005] 6. Curriculum of Pharm D program. University of Southern California, available at http://www.usc.edu/ schools/pharmacy/pharmd/programs/ [Accessed April 26, 2005] 7. Curriculum of Pharm D program. University of California at San Francisco, available at http://pharmacy. ucsf.edu/ [Accessed April 26, 2005] 8. Curriculum of Pharm D program. University of Illinois at Chicago, available at hhttp://www.uic.edu/ pharmacy/offices/oaa/oaa1/epc/curriculum.html [Accessed April 26, 2005] 9. 2005;4:15 10. 十 11. 十 [ ] 醫學教育第十卷第三期 2006

178 林慧玲許光陽闕壯卿李安榮簡伯武高雅慧蔡義弘張建雄魏道昌陳基旺 附錄 1 2005 年台灣藥學教育白皮書 完成始末與參與人員 2002 2003/7 2005/5 2005 2005/6 2005/6 2005 2005/7 2005 2005 2005/9 / 2005/7-2005/12 5 2005/12 2005 /

2005 年台灣藥學教育白皮書 179 附錄 2 台灣藥學教育核心課程與 ACPE 標準及美國大學核心課程比較 ACPE NTU UNC UNC UCSF (Pre-requisite) Pre-pharm Pre-pharm Pre-pharm biomedical sciences UCSF (quarter) USC General Biology and Lab. 6 General Biology with lab 4 Biology 12 General Biology (for science majors only) 2+3 Physics with lab 8 Physics (1 lab in electricity and magnetism) 8 Physics with lab (for science majors only) 2+3 Calculus 6 Calculus 3 Calculus 8 Calculus (for science majors only) General Chemistry and Lab. 4 General Chemistry with lab 8 General Chemistry and Lab. 12 General Chemistry with lab (for science majors only) 2+3 2+3 Organic Chemistry and Lab. 8 Organic Chemistry with lab 8 Organic Chemistry lecture & lab/advanced Organic Chemistry Analytical Chemistry and Lab. 4 Analytical Chemistry with lab 3 12+3 Organic Chemistry with lab (for science majors only) variable Anatomy and Lab. 3 Anatomy/Physiology with lab 4 Gross Anatomy 3 Biological Systems I-II 5+5 Histology 2 Physiology and Lab. 4 Physiology 4 Physiology 4 Mammalian Physiology with lab 1+1 Pathophysiology 2 Pathology 3 Microbiology and Immunology and Lab 3 Microbiology with lab 4 Microbiology 4 Microbiology with lab 1+1 Immunology 3 Immunology 3 Biochemistry 3 Biochemistry 3 Biochemistry 4 Biochemistry 1+1 Pharmaceutical Biochemistry I-II 3+3 Molecular Biology 1+1 Biostatistics and Practice 3 Statistics 3 Biostatistics 2.5 Statistics 1+1 pharmaceutical sciences Medicinal Chemistry 5 Medicinal Chemistry 1-3 6 Pharmaceutical Chem/Pharmacology 5+4.5 +4.5 Pharmacology and Lab. 6 Pharmacology 1-2 4 Pharmaceutical Chem/Pharmacology (Pharmacology) and (Clinical Pharmacy & Therapeutics) Pharmacognosy 3 Outline for Chinese Drugs 2 Pharmaceutics I/II and Lab. 3+4 Basic Pharmaceutics 1-2 3+3 Pharmaceutics I-IV 4+3+3 Physical Chemistry 3 Physical Chemistry (Thermodynamics ) 4 Chemical Kinetics 2 Biopharmaceutics 3 Pharmacokinetics and Biopharmaceutics 3 Biopharmaceutics 3.5+3 Biochemical and Molecular Sites of Drug Action 4 Principles of Pharmacodynamics 3 Pharmacokinetics 4+3 Drug Metabolism 3 Genetics & Pharmacogenetics 2 Pharmaceutical Analysis and Lab. 3 USC 醫學教育第十卷第三期 2006

180 林慧玲許光陽闕壯卿李安榮簡伯武高雅慧蔡義弘張建雄魏道昌陳基旺 附錄 2 台灣藥學教育核心課程與 ACPE 標準及美國大學核心課程比較 ACPE NTU UNC UNC UCSF UCSF (quarter) USC behavioral, social, and administrative pharmacy sciences X Health System 2 Health Policy 3 Health Care Delivery Systems 2 2 Health Economics 2 Pharmaceutical Economics & Outcomes Studies 3 Economics 1+1 2 Interpersonal Communication 1+1 Orientation in Pharmacy 2 X Social Science 3 *Social and Behavioral Sciences 2+3 General Psychology 3 Psychology or Sociology 1+1 1 Pharmacy Operations 3 Management 2 Management within Health Care Organizations 2 Pharmacy Administration & Pharmacy Law 2 Pharmacy Law and Ethics 3 Pharmacy Law & Ethics 3 Pharmacy Law & Ethics 3 Pharmaceutical Ethics 2 pharmacy practice Dispensing Pharmacy 3 Professional Experience Program 0.5*5 Pharmacy Practice I -III 4+4+3 Pharmacy Practice & Experience I/II 5+4 Pharmaceutical Care Lab I-V(3+3+2+2+2hrs) 5 (Dispensing Pharmacy) Public Health & Epidemiology 2 Clinical Pharmacokinetics 3 Clinical Pharmacy & Therapeutics 4 Pharmacotherapy 1-7 3*3 +2*4 Therapeutics 6*3 Therapeutics I-XI 5+6* 2+4* 2+3* 2+2*4 Problems in Pharmacotherapy 5 Molecular Genetics & Therapy 2 Professional Elective 1-4 3*4 (Clinical Pharmacy & Therapeutics) (Clinical Pharmacy & Therapeutics) (Clinical Pharmacy & Therapeutics) Nutrition 2 / Introduction to Nonprescription Drugs 2 Non-Prescription Drugs and Self-Care 3 Over the Counter Pharmacy Products 4 Drug Literature Analysis and Interpretation 4 Drug Information 1.5*2 Pharmacy Literature Review & Statistical Analysis 2 Bioinformatics 2 Study design 2 USC

2005 年台灣藥學教育白皮書 181 附錄 2 台灣藥學教育核心課程與 ACPE 標準及美國大學核心課程比較 ACPE professional experience NTU UNC UNC UCSF UCSF (quarter) USC Pharmacy Practice 6 Pharmacy Practice & Experience I/II 5+4 USC Dispensing Pharmacy Lab. 2 Introduction to Community and Hospital Pharmacy Clerkship Practicum: Community Pharmacy (elective) 2 4 Parenteral Therapy Externship 2 Practicum: Industry (elective) 2 Advanced Pharmacy Practice Clerkship 4 Elective - Pathway Introductions 2 Required Clerkship (APPEs) *4 6*4 Clerkship (Amb. Care) 4 Elective/Pathway 2+7+15 Elective Clerkship (APPEs) *2 6*2 Clerkship (Inpatient Medicine) 4 Advance Pharmacy Practice Experiences (APPEs) 0-12 (Choose from 38 rotations) Clerkship (Med Specialty) 4 Clerkship (Elective**) 4*4 ** 1 month may be a non-traditional externship (e.g., industry, vet. practice, FDA) AHEC Seminar Course 1+1 (Humanities & Chinese 6 Foreign Language 9 Speech) Freshman English 6 English 6 English 8 English Composition 2+3 Constitution 4 Literature 3 Electives 2+2-3 *Humanities 2+3 General History of China 4 History 6 Humanities or social sciences 28 Elective 1-3 3 醫學教育第十卷第三期 2006

182 林慧玲許光陽闕壯卿李安榮簡伯武高雅慧蔡義弘張建雄魏道昌陳基旺 附錄 3 美國大學治療學課程及學分數 UNC UNC UIC UIC USC USC Core Core Core Pharmacotherapy 1: Introduction to Pharmaceutical 3 Principles of Drug Action & Therapeutics I (well- 3 Therapeutics I 5 Care ness, special populations, nutrition, disease preven- tion & alternative med) Pharmacotherapy 2 (Dermatology/Endocrinology) 2 Principles of Drug Action & Therapeutics II (CNS, 4 Therapeutics II 2 endocrine & metabolism, transplantation) Pharmacotherapy 3 (Pulmonary/Gastroenterology) 2 Principles of Drug Action & Therapeutics III 4 Therapeutics III 6 (CNS, pain, substance abuse) Pharmacotherapy 4 (Cardiology/Nephrology) 2 Principles of Drug Action & Therapeutics IV 2 Therapeutics IV 4 (women's & men's health, respiratory disorders) Pharmacotherapy 5 (Neurology/Psychiatry) 2 Principles of Drug Action & Therapeutics V (cardiology, 3 Therapeutics V 6 toxin, venom) Pharmacotherapy 6 (Hematology/Oncology) 3 Principles of Drug Action & Therapeutics VI (infectious 3 Therapeutics VI 3 disease) Pharmacotherapy 7 (Infectious diseases) 3 Principles of Drug Action & Therapeutics VII (renal, 4 Therapeutics VII 4 GI, dermatology, EENT) Principles of Drug Action & Therapeutics VIII 3 Therapeutics VIII 2 (bone & joint, hematology, oncology) Therapeutics IX 2 Therapeutics X 3 Therapeutics XI 2 Elective Community Pharmacy I-II 3+3 Molecular Therapeutics 3 Pharmacy Practice in Women's Health 3 Complementary / Alternative Therapeutics 3 Drugs of Abuse 3 Health Care Needs of Special Populations 3 Sleep & the Pharmacological Management of Its 3 Disorders Disease State Management 3 Psychiatric Pharmacy Practice 3 Clinical Problem Solving 3 Therapeutic Drug Monitoring 3

2005 年台灣藥學教育白皮書 183 附錄 4 UNC 美國各校臨床藥學實習比較 Core (4wk/unit; 4units) UNC UIC UIC USC USC (6wks/roatation, total 7 roatations) (Choose from the following rotations); Required Clerkship 4; Elective Clerkship 2 Advanced Pharmacy Practice Clerkship 4 Ambulatory care 4*2 Acute Care Clinical Practice 6 Clerkship (Amb. Care) 4 Nutrition 4*2 Acute Care Geriatrics 6 Clerkship (Inpatient Medicine) 4 Hospital Practice 4 Advanced Community Pharmacy 6 Clerkship (Med Specialty) 4 Administrative 4 Advanced Geriatrics 6 AHEC Seminar Course 1+1 Drug Information 4*2 AIDS/Immune Disorders 6 Elective (4wk/unit; 4units) Kinetic 4*2 Anticoagulation Therapy 6 Clerkship (Elective**) 4*4 Medicine 4*2 Antimicrobial Therapy 6 ** 1 month may be a Critical Care 4*2 Applied Clinical Pharmacokinetics 6 non-traditional externship Geriatric 4*2 Cardiovascular Drug Therapy 6 (e.g., industry, vet. practice, FDA) Surgery 4*2 Chemical Dependency 6 Psychiatry 4*2 Clinical Pharmacy Research 6 Pediatrics 4*2 Clinical Transplantation 6 Community Practice 4 Community Pharmacy 6 Home Health 4 Critical Care 6 Advanced Ambulatory Care 4 Dermatology 6 Advanced Medicine 4 Directed Clinical Project I 6 Advanced Specialty 4*2 Directed Clinical Project II 6 Advanced Community 4 Directed Clinical Project III 6 Directed Clinical Project IV 6 Drug Information 6 Drug Utilization Evaluation 6 Geriatrics 6 Health Care System Administration 6 Home Health Care 6 Hospital Pharmacy Practice 6 Inpatient Clinical Practice 6 Inpatient Psychiatric Pharmacy 6 International 6 Long Term Care 6 Nutritional Support 6 Ob-Gyn 6 Oncology 6 Outpatient Psychiatric Pharmacy 6 Pain Management 6 Pediatric Drug Therapy 6 Pharmaceutical Industry 6 Pharmacy Administration 6 Primary Care 6 Radiopharmacy 6 Surgery 6 醫學教育第十卷第三期 2006

184 林慧玲許光陽闕壯卿李安榮簡伯武高雅慧蔡義弘張建雄魏道昌陳基旺 附錄 5 台灣各藥學系與美國藥學系師資之比較 ( ) ( ) ( ) ( ) 225(4 ) 15 (1:15) 12 (1:19) 3 (1:75) 800(200/,4 ) 25 (1:32) 19 (1:42) 6 (1:133) 800(160/,5 ) 37 (1:22) 34 (1:24) 3 (1:267) 400(100/, 4 ) 29 (1:14) 26 (1:15) 3 (1:133) 960(240/,4 ) 37 (1:26) 33 (1:29) 4 (1:240) 750(150/, 5 ) 34 (1:22) 28 (1:27) 6 (1:125) 52(12/,4 ) -- -- -- UNC 480 45 (1:10.8) 31 (1:15.6) 14 (1:34.4) UCSF 488 76 (1:6.4) 40 (1:12.2) 48 (1:10.2) USC 720 70 (1:10.3) 33 (1:21.8) 37 (1:19.5) 附錄 6 美國南加大藥學院 (USC) 教師聘任標準 ( ) ( 5%) ( 95%) 90-100% 40-50% 5-10% 5-10% 20-30% 10-15% -- 20-30% 70-80% ( ) 0-5% -- 5-10% -- -- --

White Paper on Pharmacy Education in Taiwan 2005 In order to comply with the current need to foster competent pharmacists to serve the public, the Pharmaceutical Society of Taiwan implemented changes in pharmacy education that addressed the standards of educational quality within the pharmacy curriculum as well as the length of the curriculum. A White Paper was produced in a format similar to that of the American College of Pharmacy Education Standards 2000 publication. In this White Paper, the overall standards for the mission, planning, and evaluation of pharmacy education were outlined. Furthermore, standards for organization and administration were put forwards together with a range of standards for the curriculum, for students, for faculty members and staff, for the facilities themselves and for their resources; detailed guidelines were set out as well. The contents of the White Paper have been evaluated and discussed at the National Meeting on Pharmacy Education as well as at many subsequent educational meetings organized by faculty members from all the Colleges and Schools of Pharmacy across Taiwan. In addition, they have also been discussed by representatives of the Taiwan Society of Health-System Pharmacists and by the National Union of Pharmacist Associations in the Republic of China. The greatest gaps that need to be filled by changes in pharmacy education include one year intensive courses in the areas of pharmacotherapy, epidemiology, health economics, social pharmacy and drug information as well as a one year unit of advanced pharmacy practice experience. In addition, the quality of the basic pharmacy practice experience unit, including the pharmacy practice setting (hospital and community) and the preceptors, need to be standardized. The most serious problem in pharmacy education in Taiwan is a lack of clinical faculty members and Colleges and Schools of Pharmacy need to set out to identify and recruit qualified clinical faculty members. In addition, the practice environment, law, regulations and policies related to pharmacy practice as well as the board examination need to be closely linked to bring about an evolution of pharmacy education in Taiwan. The important issues outlined above are essential to the reform of pharmacy education in Taiwan over the next few years. (Full text in Chinese) Key Words: education, pharmacy, white paper. ( J Med Education 2006; 10: 165~85 ) 1 School of Pharmacy, College of Medicine, National Taiwan University; 2 College of Pharmacy, Taipei Medical University; 3 School of Pharmacy, National Defense Medical Center; 4 College of Pharmacy, China Medical University; 5 Department of Pharmacology, College of Medicine, National Cheng Kung University; 6 Institute of Clinical Pharmacy, College of Medicine, National Cheng Kung University; 7 College of Pharmacy, Kaohsiung Medical University; 8 College of Pharmacy and Science, Chia Nan University of Pharmacy & Science; 9 Department of Pharmacy, Tajen University. Received: 17 March 2006 ; Accepted: 27 September 2006. Correspondence to: Ji-Wang Chern, School of Pharmacy, College of Medicine, National Taiwan University. 1 Jen-Ai Road, Section 1 Taipei 10051, Taiwan.