INTRODUCTION:

Pharmacists' patient care roles have expanded dramatically worldwide from traditional dispensing services to direct medication management, chronic disease monitoring, counselling, and preventive care^1,2.

Equipping the students with enhanced competencies requires evolutionary, rather than incremental changes in the curriculum to match the changing practice needs³.

In India, pharmacist’s roles are increasing in areas like clinical pharmacy, patient education, and community health outreach⁴. However, the pharmacy curriculum remains rooted in conventional drug-focused education rather than competencies like problem-solving, communication, and leadership which are vital for meeting healthcare system demands⁵.The inception of pharmaceutical education in India was commenced at the Banaras Hindu University back in 1932 by Professor M.L. Schroff, thereafter, it has been an arduous journey spanning 80 years for the pharmacy profession in this country⁶. Unfortunately, there is an ongoing debate and uncertainty about the current standards and doubts that if it matches the established international practices⁶. Implementation of knowledge-oriented paradigm of development in pharmacy education would empower India to grasp its demographic potential⁶. Due to the diversity and high intellectual capacity, India has a huge potential to grow in this fascinating field, provided there is a willingness towards adopting global standards of specialized care. During the early years of inception, the profession focused mainly on compounding⁷. Since, the compounding tasks were significantly minimized over the last 10 years, the focus of the profession has become simple “dispensing” ⁷. This dispensing practice without any briefing of the rational use of medications to the patients and accompanying family paves way for serious medication misuse⁸. This assumes significant importance especially in the Indian setup where there are many senior citizens with chronic diseases, who cannot understand the complexities of the medication management and usage⁹.

It has been emphasized that pharmacist’s role needs to be expanded to areas such as pharmaceutical care concepts, enabling the contemporary pharmacist a health care professional rather than a drug dispenser alone^6,10. They must develop adaptive expertise despite learning from a fragmented and outdated curriculum¹¹.

In 1990, Hepler and Strand introduced the concept of pharmaceutical care suggesting the focus of pharmacy practice as patient care¹². The international pharmacy organizations and academic experts in Pharmacy education have adopted pharmaceutical care as the fundamental focus of pharmacists' activities¹³. However, for most of the graduate pharmacy students, there is a distinct ambiguity between what they have learned during their student days and the reality that they are facing in their work¹⁴. There is a need for students to learn “how to think” rather than “what to think”¹⁵. Increasingly competency-based educational frameworks and programs are being adopted in the healthcare fields, such as pharmacy¹⁶, nursing¹⁷ and medicine¹⁸.The ultimate aim of the competency-based educational designs is to cement the societal role of the pharmacists, thus enhancing the quality of healthcare and patient safety^19-21.

It has been proposed that there is a need to initiate efforts to revamp the current Indian pharmacy curriculum⁶. The need for undertaking a pharmacy workforce study, reviewing the existing education programs and comparing it with the international standards has been emphasized²².

However, there has not been much research in knowing the roots of the problem at the students and faculty level. There is an urgent need to evaluate the existing curriculum with contemporary practice needs, especially in key pharmacy education regions of Southern India which supply graduates across India and globally.

This study aimed to explore student perspectives in five Southern Indian states, Kerala, Tamil Nadu, Andhra Pradesh, Telengana and Odisha on how well their curriculum integrates knowledge, skills and values required for current pharmacy practice.

MATERIALS AND METHODS:

A prospective cross-sectional study using a self-administered survey instrument containing 20 items was conducted amongst the pharmacy students from five Southern Indian states, Kerala, Tamil Nadu, Andhra Pradesh, Telengana and Odisha. The questionnaire focused on various important elements of competency education as outlined by the International Pharmaceutical Federation (FIP) in its 2021 report²³.

Initially, we distributed the draft survey to 5 randomly selected pharmacy professionals to assess the validity. Then, a further 10 pharmacy students analyzed it for clarity and the relevance to our local framework, after which final refinements were made.

The final questionnaire was sent via an online link with consent to participate to upper year pharmacy students of year 3 and above eliciting quantitative ratings and qualitative suggestions regarding Indian pharmacy curriculum between December 2022 to April 2023. The online questionnaire platform, Qualtrics was used. The participation was voluntary, anonymous with no provision of incentives. The responses received were not tracked. Steps were ensured to not link the questions with any compulsory coursework. The appropriate sample size was calculated as 200-220 in line with the established sample size software calculator Raosoft with the accepted margin of error and confidence level. The questionnaire included close-ended ratings on 5-point Likert scale(quantitative) and open-ended suggestions regarding curriculum changes(qualitative). The comprehensive data collected from the students were analysed using the SPSS, version 29 and R.

Quantitative responses were analyzed using descriptive statistics. Thematic analysis of suggestions was performed to identify five key themes as described in the results below. Data visualizations including charts and word clouds were generated. The ethical approval for the study was obtained from St. Stephen’s college, Kerala and the students gave consent to participate.

RESULTS:

A sample of 210 pharmacy students pursuing pre final and final year B.Pharm, PharmD and Master’s degree responded to the questionnaire. The distribution of the students across the states were from Kerala (89), Tamil Nadu (54), Odisha (30), Andhra Pradesh (20) and Telangana(17).

Respondents predominantly fell within the age group of 20-25 years, accounting for approximately 83.7% of the sample, indicative of a young demographic primarily in the early stages of their professional education (Figure 1). A slight majority were female, making up 52.9% of participants, compared to 47.1% male, suggesting a balanced gender representation within the cohort.

In terms of educational attainment, a significant portion were enrolled in Pharm.D programs—30.5% in their 5th year and 17.9% in their final year. Students in their 3rd year of B.Pharm constituted 20.5% of the respondents, while those in their final year of B.Pharm made up 13.2%, cumulatively indicating that nearly 34% of participants were B.Pharm students. A smaller segment of the respondents, approximately 12%, were pursuing Masters degrees in pharmacy, which highlights the presence of postgraduate-level students in the sample. The educational level distribution is depicted in Figure 1.

Learning and critical thinking theme (Figure 2)

The majority (61%) agreed that they were able to have an in-depth understanding with sufficient curiosity to learn. However, a similar percentage of respondents agree that current curriculum emphasizes memorization over clinical reasoning (Figure 3). Students' self-reported engagement and critical thinking skills development from the curriculum received mixed reviews. Between 40-50% gave neutral or negative ratings. (Figure 2)

Career preparedness and skills development theme (Figure 3)

Around 39% reported their education did not adequately develop job skills and a similar proportion felt that the curriculum does not encourage them adequately to fulfill them in their role as pharmacists (Figure 3).

Collaboration and communication theme (Figure 4)

Communication, entrepreneurship, and patient counselling skills were viewed as inadequate by 55-60% of students. (Figure 4).

Virtual learning and personal wellbeing theme (Figure 5)

A significant proportion of respondents (60%) agree that appropriate infrastructure for virtual learning is provided, and their well-being is taken care of. (Figure 5). This reflects a positive reception of the technological resources and online platforms used for virtual education.

Figure 1. Gender, Age and educational level distribution of the cohorts

Figure 2. Learning and critical thinking theme

Figure 3. Career preparedness and skills development theme

Figure 4. Collaboration and communication theme

Figure 5. Virtual learning and personal wellbeing theme

Omitting the neutral responses, we analyzed the student’s satisfaction in six key areas according to the course’s degree (Table 1). The results are almost uniform across the cohorts, with the agreement that memorization over clinical reasoning is higher and the opportunities for collaborative learning, laboratory experiment, patient counseling, job market and leadership skills are low.

Curriculum relevance and clinical training theme (open-ended suggestions):

In the open-ended suggestions, key themes were integrating additional clinical knowledge, reducing dated content, improving soft skills training, and increasing practical learning.

New Topics and Skills: Respondents suggest adding subjects with a focus on self-development skills, and mental well-being. There is a call for inclusion of topics like pharmacogenomics, pharmacovigilance, toxicology, bioinformatics, and artificial intelligence (AI).

Practical Knowledge: Many students express a desire for more practical knowledge through hands-on experience, laboratory work, research and industry exposure. This includes case studies, hospital visits, and ward rounds. They felt hospital visits will improve their knowledge in areas such as Radiopharmaceuticals.

Current Trends and Technologies: Students are looking for the syllabus to be updated with current trends, such as new disease treatments (including COVID-19), and emerging technologies in pharmacy.

Irrelevant Content: There is feedback about removing content perceived as irrelevant, such as certain parts of pharmaceutical analysis and medicinal chemistry that are not seen as directly applicable to current pharmacy practices.

Reduction of Overload: Some responses indicate a need to reduce the syllabus to where it is too extensive or not used in the current pharmacy field, suggesting a more focused and practical approach.

Outdated Topics: Suggestions include removing older syllabus content that is not aligned with modern practices and giving more prominence to skills required in real-life scenarios.

DISCUSSION:

This research has thrown light on the students’ perspectives regarding the existing pharmacy curriculum in Southern Indian states. To the best of our knowledge, research of such kind hasn’t been carried out in the region relating to the pharmacy curriculum assessment and reforms across a diverse array of students in various stages of pharmacy education from undergraduate to master’s degrees.

We specifically included a question with a “negative” response asking if the current curriculum emphasized memorization over clinical reasoning and nearly 60% of the students agree with this despite having sufficient curiosity to learn (Figure 1). This is not an exclusive situation to our region, as lecture-based, teacher-centered traditional pharmacy education pedagogy, remains the most common practice around the world²⁴. A study from China has shown an innovative student-centered teaching method, composed of Self-study, Test, Question and Discussion (STQD), has the potential to foster students' learning skills in pharmacy education²⁵.

Quality assurance in Pharmacy education essentially means monitoring availability of 'Right' students and monitoring the process of effective teaching, learning practice in such a way that the trained graduate is useful to the needs of community as well as pharmaceutical industries²⁶. In the quest to making patient centered pharmacy curriculum, the Pharmacy Council of India (PCI), successively implemented a master’s degree in 1997 and a Doctor of Pharmacy (PharmD) program in 2008²⁷. Despite these major reforms, student’s learning experience suffers from impediments. In our survey, 48% of the respondents pursued PharmD and 12% master’s degree, suggesting a strong representation from advanced-level pharmacy students. They voiced similar concerns as BPharm students (Table 1). A survey conducted among PharmD students in India to investigate their overall experience during their clinical rotations has shown that 38% of the current PharmD students were dissatisfied with their training program and they identified major drawbacks in its quality and reliability²⁸.

The findings of our survey mirror studies suggesting pharmacy curriculum in India has not sufficiently integrated abilities expected from 21st century pharmacists into education^6,29. Respondents indicated preferences for reduced focus on memory-based learning of drug information and isolated concepts, and greater emphasis on application to pharmacy practice through clinical exposures, communication training, and critical thinking.

Not surprising was that the respondents reported that therapeutics, medication management, and patient counselling as very essential focal points for the pharmacy learning. As contemporary pharmacy education is more focussed on clinical skills, solving the drug related problems and patient centric approach, the topic of compounding pharmacy and extemporaneous preparation of medications considered to larger extent to be a dying art and not in need of much attention in pharmacy schools⁷. However, there are few who will feel that it is a fundamental tool for any pharmacist and with the need for commercial compounding skills to meet the demands of the essential and unavailable formulations of the syrups and semi solid formulations in the market and these needs are to be met by the compounding ppharmacists whenever it is required³⁰.

While foundational pharmaceutical science knowledge remains essential, students voiced needs for regular updating of content to keep pace with the field's rapid advancements. Increased practical learning opportunities were desired, consistent with literature on strengths of experiential education³¹. Opportunities to know about the good clinical practice in clinical trials and involvement in research were emphasized by the students³².

Further, there was a significant interest in the role of AI in pharmacy such as drug discovery³³.

In the current modern and advanced pharmacy workforce, non-technical skills (NTS) or soft skills assist to determine an employee's ability to fit into an organization³⁴.

It is understandable that there is no unanimous definition for soft skills. They are difficult to measure but define a person as a mature, responsible, cognizant, and creative human being. Some of these skills are contained in the Accreditation Council for Pharmacy Education (ACPE) Standards³⁵. These skills are considered essential to efficiently work with co-workers, patients, and patients’ family, and form a positive work culture and environment. Increasingly, NTS training has been incorporated in healthcare education, including pharmacy³⁶.

Suggestions for enhancing soft skills like patient counselling reflect growing awareness of pharmacists' clinical roles in India's healthcare ecosystem³⁷.

These important and transferable skills will aid the pharmacist to be a better entrepreneur, conflict manager, team leader and prepares them to meet the ever-growing challenges in the healthcare organisation. Incorporating clinical application, problem-solving, and communication skills can help bridge competency gaps voiced by our students³⁸. This has been linked to positive improvements in similar contexts³⁹.

It is imperative that healthcare education and training programs have a societal obligation to provide graduates that are competent practitioners with skills required for lifelong professional development. Moreover, programs must undergo periodical review²⁸, evaluation, and revision to enable they are fit-for-purpose in the constantly changing landscape of healthcare requirements with the emerging diseases and novel pharmacological management requirements. An example fitting to this need was the deadly Covid pandemic. As rightly stated by Rhoney et al, this pandemic has opened opportunities for pharmacy education to evolve in various sectors⁴⁰. Our students reflected similarly anticipating that the current syllabus should incorporate novel therapies for new diseases such as Covid.

Virtual learning has been viewed positively by our students similar to previous studies. Previous research has shown that the use of online and internet technology by students and academics was viewed as beneficial for both⁴¹.

The student’s insights from our studies emphasizes the requirements of evidence-based curriculum restructuring in these states to produce competent and dynamic pharmacists who are better prepared to handle the evolving infectious diseases and demanding nature of the profession in the years to come. Pharmacy Education and skill development training assumes paramount importance to meet the challenges of the ever-demanding healthcare needs and to cater the expanding population and the emerging diseases around the globe, this is possible only if there are competent pharmacists who can carry the mantle when they enter the job market.

Study Limitations:

Our study findings should be interpreted in line with the study's limitations in mind. The first is related to nonresponse bias, which could lead to erroneous results as the nonrespondents might have differing views than the respondents. Secondly, the restriction of the sample to limited population from few colleges and schools of pharmacy. Therefore, we cannot generalize the findings from this study beyond these five states. Finally, investigating limited set of variables that were being measured with single items would restrict the research conclusions. It is suggested that further larger study and follow up research that could examine competency outcomes after curriculum reforms can be used by Pharmacy education regulatory authorities of the country and the relevant stakeholders.

CONCLUSION:

Pharmacy education in Kerala, Telangana,Andhra Pradesh, Tamil Nadu and Odisha requires continued alignment with practice needs through emphasis on competencies like critical thinking, communication, and service orientation. Reduced focus on content memorization and updated information coupled with integration of clinical skills and knowledge, soft skills training can optimize curriculum to produce skilled pharmacists in this region which is considered to be a major educational hub creating pharmacy graduates for the national and international job seekers. As the pharmacy education and training is the key to the nation's healthcare contribution, a careful and well thought curriculum alignment is the need of the hour in line with the established and developed countries model where the pharmacy educational standards are maintained high.

ACKNOWLEDGEMENTS:

The authors sincerely thank Dr.Sami Shaban who supported the design of the questionnaire and all the students who responded the online questionnaire.

CONFLICT OF INTEREST:

The authors have no conflicts of interest regarding the research.

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Received on 15.10.2024 Revised on 17.02.2025

Accepted on 30.04.2025 Published on 01.07.2025

Available online from July 05, 2025

Research J. Pharmacy and Technology. 2025;18(7):3221-3227.

DOI: 10.52711/0974-360X.2025.00463

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. Creative Commons License.

Select Questions	Course’s Degree cohorts
	B.Pharm		Pharm D		Masters
	*Agree* %	*Disagree* %	*Agree* %	*Disagree* %	*Agree* %	*Disagree* %
Memorization vs clinical reasoning	66	34	82	18	66	34
Collaborative learning opportunities	48	52	44	56	48	52
Laboratory experiment opportunities	43	57	26	74	48	52
Skills/Patient counseling	29	71	28	72	38	62
Development/Job market skills	38	62	37	63	48	52
Entrepreneur/leadership skills	19	81	14	86	24	76