For Steve Caiola, MS, being a pharmacist isn’t just a profession. It’s also a privilege.

“Health-care professionals have a covenant with patients,” he says. “Patients give us the privilege of influencing their lives. Along with that privilege comes the obligation of maintaining competence, developing the next generation of people to be better than you are, and helping your profession grow."

Caiola, an associate professor at the UNC School of Pharmacy, has spent much of his career doing just that. Since coming to UNC in 1969, he has served in a variety of positions involved in training pharmacists. He has received his share of accolades for his contribution to pharmacy in the state, most recently being named the 2007 Acute Care Practice Forum Pharmacists of the Year by the North Carolina Association of Pharmacists.

“If you were educated at UNC, he improved your education. If you practice in the state, it is highly likely that you have attended a high-quality continuing education program that he produced,” John Kessler, president of the health-care software company SecondStory Health, LLC, said of Caiola when presenting him with the award.

Caiola, however, deflects such praise toward his colleagues.

“I didn’t do it myself,” he says. “I was privileged to have worked with others who made it happen. It’s pretty humbling that people would recognize that I had a part in it, but my part in it was really more of a cohesive coordinator role rather than doing it all myself.”

Focusing on the Point of Care

The list of Caiola’s activities with the University, the School, and professional organizations takes up six pages in his CV, and he is still adding to it. In September 2007, he was named chair of the School’s new Division of Pharmacy Practice and Experiential Education, a post he held until he entered phased retirement in 2011.

Before PPEE was established, faculty and programs dealing with pharmacy education and the treatment of patients at the point of care were spread across the School’s four existing divisions, which focused their research on drug development, outcome studies, and pharmacotherapy.

The new division brings those programs and faculty together in one unit. PPEE houses the School’s Professional Experience Program, the Pharmaceutical Care Laboratory, and the Postgraduate/Continuing Education Program. Caiola says the division faculty will develop and emphasize best practices for pharmacists in caring for patients at the sites where they receive that care.

“We need to teach our students how to apply their knowledge and skills to most effectively care for patients in real practice sites,” he says. “PPEE will allow us to concentrate our efforts at the interface between pharmacist and patient and between pharmacist and caregiver.

“My goal is for every patient’s experience with a pharmacist to be one of caring and support. I want to fuel the fire within our students to be that kind of practitioner every day.”

Aside from accounting for about forty percent of the School’s doctor of pharmacy curriculum, PPEE also offers an MS in pharmaceutical sciences program with a specialization in health-system pharmacy administration. Caiola is excited about the program, in part because he holds a similar degree from Ohio State University. UNC previously had a master’s program, but discontinued it about a decade ago. At that time, Caiola says, schools of pharmacy across the country were changing their baccalaureate programs into PharmD programs, and most decided to discontinue their master’s program and pour their resources into the PharmD instead.

As of 2007, only three schools in the country—OSU, the University of Kansas, and the University of Wisconsin—offered an MS degree in health-system pharmacy.

“Their two-year graduates do a master’s program combined with a residency, and they have a skill set that you just can’t get any other way,” Caiola says. “They are probably eight to ten years ahead because of the experience they get in those two years.”

Caiola says UNC is well-equipped to offer a program of that caliber.

“We have one of the best residency programs in the country,” he says. “We have great people leading the pharmacy department at UNC Hospitals, and we have a university that has five outstanding health-science schools. None of the three universities that offer the MS-residency program have all of those resources on the same campus.”

The program enrolls four students each year. UNC Hospitals sponsors two two-year residencies for students from the MS program, while Duke University Medical Center and Wake Forest University Baptist Medical Center each sponsors one two-year residency. Caiola says other health systems have expressed interest in the program and may provide additional residencies in the future.

Students take 30 to 40 hours of graduate courses, complete a master’s project, and work in hospital residencies that would likely require 40 to 60 hours per week. Caiola says that it is an intense two years, but that the rewards are well worth the short-term sacrifice.

It is important to train pharmacists who understand how a health system works and how pharmacy fits into that system, Caiola says, adding that the MS experience offers knowledge and training that students cannot get from a PharmD program.

“Some of the biggest misadventures in the healthcare system stem from the way drugs are used because there are multiple professions involved and they each have a narrow role in the process,” he says. “The physician prescribes the drug, the pharmacist sends the drug, and the nurse gives the drug to the patient. But who’s looking over the whole system to see if it works? Pharmacists are now saying, ‘We want to do that. We can help the physician pick the best drug. We can help the physician and nurse find the best way to get the drug into the patient. We can help everybody monitor the patient. We can get the patient out of here on the right drug.’

“If you want to train a health-system pharmacy leader of tomorrow, the MS program, combined with a residency, is the way to go.”

Improving Continuing Education

In North Carolina, pharmacists need to participate in ten hours of continuing education each year to renew their license. Half of that total must be done through contact programs that allow for live, two-way communication between the presenter and the attendee, such as seminars. The other five hours can be done through home study.

Starting in 2008, the North Carolina Board of Pharmacy raised the required number of hours annually to fifteen, including eight live hours. The increase brings North Carolina in line with most other states, but Caiola, who oversees the School’s Postgraduate/Continuing Education Program, and some of his colleagues have been working on an even more drastic change.

“I do believe that you need the live hours and that you need the live interaction with the expert,” Caiola says. “But I also believe that there are a lot more educational things than standard, traditionally recognized programming. Going to a seminar may mean that I sat, I heard, I forgot.”

Caiola is part of an NCAP taskforce looking at implementing a continuous professional development model. In CPD, pharmacists continually assess the skills they need to excel in their practice and to steer their careers in the direction they want. They then document these needs, develop a plan to address them, and carry out the plan. As a result, the training that pharmacists receive through continuing education would be more relevant to their needs.

The CPD model already has been adopted in the United Kingdom, New Zealand, and Ontario and Alberta, Canada. Five states’ pharmacist associations, including North Carolina’s, are conducting a project to test the model’s effectiveness. In the North Carolina study, ninety-five pharmacists did two hours of home study about the CPD process through a CD-Rom in summer 2006. Forty-four of them decided to enroll in a nineteen-hour certificate program to actually apply the CPD process for the whole year. At the end of the program, they will be surveyed about the effectiveness of the experience, and the responses will be compared with their answers on the same questionnaire from the previous year, as well as responses from a control group.

“I was really interested in CPD because I really wanted more information from pharmacists that told me what they need in order to be better practitioners,” Caiola says. “The documentation of their self-assessment gives me feedback on what the pharmacists say they need, and it will help us build much better educational programming. Right now, getting that information is worse than pulling teeth.”

Caiola isn’t the only one interested in CPD. The N.C. Board of Pharmacy is considering the model as a potential alternative to the traditional system in the future. It is even allowing the pharmacists who took part in the CPD project to substitute their CPD experience in place of a listing of continuing education hours in their 2008 license renewal application. These pharmacists still have to fulfill the live-hour requirement, and some will be audited for documentation of their participation in CPD.

There were also other tweaks to the requirements in 2008. One of the changes allows pharmacists to earn home-study hours by reading any material they want, as long as it is pertinent to their practice. They must document what they read, what they got out of the material, how they will use that information, and afterwards, how it has influenced their practice. The board also credits pharmacists for documented cases of what Caiola calls unplanned learning—situations where pharmacists have to do some substantive research on topics that spontaneously arise during their practice day.

“When I look up the information, call an expert or a colleague, look in a journal, do a review on the Web, get the answer, and get back to the patient and say, ‘This is what I found out, and this is how it influences your care,’ I’ll remember that information,” Caiola says. “That’s the best education, because you use it, and it influences the patient’s care.

“We’re quantifying these kinds of things. We will audit some of the pharmacists that report that they followed a CPD process to see if they are really doing enough to at least maintain if not improve their competence. But the odds are, if they follow the process, select their eight live hours to meet their self-defined needs and document a few of their unplanned learnings, even if they accomplish just  some of their remaining learning plan, they are going to be better practitioners than if they just attend a program that has little relevance to their practice needs, that they went to just to get the hours and keep their license.”