Another Learning Experience

Everyone slept in a little longer this morning since we did not have to leave the hotel until 9 am for King’s College. The pharmacy school was much closer than our previous scheduled activities and we only had to take a short train ride to reach our destination. We found out that London still has a rush hour at 9 am! The train we needed to take was so full that five students could not squeeze in. Then only two of the remaining five students could fit on the next overcrowded train. Even though our morning transit was hectic, we managed to regroup without losing anyone and made it to King’s College.

When we arrived at King’s College we learned about their pharmacy program and took a tour of the university. After five years of pharmacy school, students obtain a Masters in Pharmacy. There is no bachelor’s degree like we have at SDSU. Their last year of schooling is similar to our clinical rotations year. King’s pharmacy program has more emphasis on social and behavioral skills and less chemistry focus compared to other colleges of pharmacy in England. Most graduates will work in a community pharmacy with the rest of the students choosing hospital pharmacy. Very few students will go into industry since chemists usually take these jobs. There are other pharmacy schools in England that are more science based and many of their students find jobs in hospital or industry. At King’s College there are approximately 100 students in each class and most students get into the pharmacy program the first time they apply.

During our tour of King’s College, we walked through 6 different laboratory rooms which all focused on different areas of science such as pharmaceutics, medicinal chemistry, and biophysical science. It appears that King’s pharmacy program has a greater focus on research with more lab rooms and equipment than SDSU. Their students are also required to complete a research project during their 4^th year. In the dispensary lab, they had a mock pharmacy set up with various OTC products, a computer, and a video camera. Three times a year, students have a mock patient interaction recorded and reviewed to help improve their communication skills.

After exploring King’s College, we walked over to the affiliated teaching hospital, St. Thomas, to learn more about hospital pharmacy in England. There are several different pharmacist levels throughout the hospital. Junior pharmacists rotate to a different area every 6 weeks, while “band 7” pharmacists have 9 month specialty rotations. Both are assigned to specific patients to monitor drug safety and utilization. The senior pharmacist monitors more complex patients and works closely with physicians. During the first 24 hours of hospitalization, a pharmacist reviews the patient’s drug history. St. Thomas is very clinically advanced with over 100 pharmacists in a 2000 bed hospital.

St. Thomas Hospital lacks some technology that is used in the United States. We visited the stroke unit and looked at some examples of patient charts. The hospital does not have electronic prescribing, but some patient information is kept by electronic records. Pharmacists do not use computers to screen for drug interactions or duplications. On the wards, stock drugs are stored in locked cabinets but there is not an inventory procedure in place. Without an electronic dispensing system such as Pyxis, it may be harder to catch and prevent drug related errors and detect drug diversion.

In England, some pharmacists are allowed to prescribe medications with some exceptions on controlled substances. Before being able to prescribe, pharmacists must take a six month course and complete other requirements. Physicians need to countersign the prescriptions written. Qualified pharmacists usually prescribe in clinics but there is not a defined role in the hospital yet.

Everyone took a break for lunch before heading to the Royal Pharmaceutical Society of Great Britain (RPSGB). This organization regulates the pharmacy profession and everyone must register with the RPSGB. There are approximately 48,000 pharmacists in Great Britain with 17% of these non-practicing. Of the working pharmacists, about 55% are women.

The RPSGB also had a museum containing pharmacy-related items from the 1500s such as books, medications, and equipment used for medication production. One display showed how certain medical conditions were treated in the past. Opium was commonly used to treat pain while mummified human could be crushed to treat wounds or induce vomiting. Solidified human blood was said to help asthma and seizures. At least our remedies have advanced from the 1500s!

When our tours concluded, everyone kept busy for the rest of the day. Several students headed to the laundry mat to wash clothes since our Europe trip is half over which is hard to believe. Another group walked through Kensington Gardens and saw Kensington Palace where Princess Diana once lived. The guys ventured to the Tower of London and Tower Bridge since the girls gave high recommendations on this tourist attraction. It was very interesting day learning about pharmacy in England; we discovered several similarities but also some major differences compared to the United States.