May I first express the appreciation of Mrs. Moore and of myself for your presence here this evening and for the warm welcome you have given us. It is heartening to one who has assumed a new task in a new city to be received with the graciousness and hospitality you have shown.
The problems of pharmacy and of pharmaceutical education are almost entirely new to me. It is true that as a medical student I attended and passed a classical course in materia medica and pharmacology, and I do mean classical. We practically memorized the little red book, which I still have in my office, entitled "Epitome of the U. S. Pharmacopoeia and National Formulary". I wrote prescriptions every day and compounded some, but I was not subjected to the discipline of the professor of pharmacology in another school with which I was later associated, who served notice on the first day of the course that one fatal dose of a drug in one prescription written gave an automatic failure in the entire course. I do agree that when one is dealing with human life there is no penalty too great for a gross deficiency of knowledge.
However, my practical use of the knowledge I gained in materia medica and pharmacology has been sharply limited. Although I hold a license to practice medicine in Missouri and hope to secure a similar license in the Commonwealth of Pennsylvania, I have never practiced medicine. My specialty, as I am sure you know, is pathology. I have therefore, I must confess never written a prescription or prescribed a drug as a practicing physician since the day I graduated from medical school, twenty-six years ago this June at the Ohio State University. I hasten to add that if the Commonwealth sees fit to issue a license to me, I do not intend to practice. I have asked for it only in what I believe is proper courtesy that all physicians in a state should qualify for and hold a license.
It is therefore clear to all of you that my grasp of the problems of pharmacy and pharmaceutical education is not such that I can discuss intelligently with you today any directly related ideas and opinions. I do pledge you that I will make every effort to inform myself so I can work with the faculty in developing the school and its educational program. In fact, my own education has already been undertaken by your able Dean Reif. In numerous conferences in the last six months he has been considerate and thoughtful of my ignorance. I look forward to continued association with him and to closer contact with the faculty. In addition, I have read a number of books and reports on pharmaceutical education.
It is a principle of education and of knowledge that new information and new concepts are arranged in the mind of the learner on the framework of existing information and concepts. From time to time old information and old untenable concepts are discarded. It is this process that I have been pursuing for the past six months in relation to pharmacy. I would like this evening to "think out loud" with you on some problems of health education in a university with particular reference to pharmaceutical education. I emphasize that "thinking out loud" is not the same as expressing an opinion or arriving at a conclusion or decision.
Shortly after I accepted the position of vice chancellor of this university I gave some thought to the preparation of a directive to myself. Clearly it was not to try to serve as super dean of each of the five schools for which position I was not qualified. Rather my task was to think of the health professions collectively and leave to the deans and faculties of each school the responsibility for the units of the health professions. My directive was and is as follows:
First, to help create for the students and faculties a social environment in which there will be a full realization of the position of health and of those in the health professions in our society and our civilization.
Second, to bring together the students and faculties of all professions in an educational environment which will provide a stimulating experience, which will permit each to realize his or her full intellectual, civic, and spiritual potentialities, and which will prepare them to serve the people in their chosen profession.
Third, to provide administrative lines which recognize the unity of the health professions, the distinctive needs of each profession, and the collaboration of those interested in the same scientific field.
In my preceding discussion, I have spoken repeatedly of the professions or of a profession. Let me say at once that I recognize pharmacy as one of the health professions. Health care could not be provided without the pharmacist. He occupies a distinctive place in the health team and I have chosen as the title of this talk, "The Pharmacist as a Member of the Health Team." I use the term profession in contrast with vocation or trade and when we contrast two situations or things we should have criteria for the separation. I believe the criteria of the professions put forward by Dr. Abraham Flexner many years ago are still sound and are the best expressed.
In the report entitled, "Findings and Recommendations of the Pharmaceutical Survey, 1948" published by the American Council on Education there are two short statements related to this problem of professions and the professional man. One is the first item under the title of "Common Understandings of the Committee." It states, "The pharmacist must be a professional man who understands thoroughly what he is doing, who comprehends the scientific bases of drugs and drug action, who is able to evaluate critically the products he handles, who is competent to advise physicians and members of the other health professions concerning drugs and their uses and who works at his profession creatively and advances its service."
Previously I have referred to the schools of the health professions and a health center in a university atmosphere. Let us attempt to delineate the essential components of the schools and center. As I see it there are four essential components.
With these four generalities-a directive to myself for the schools of the health professions and the health center in Pittsburgh, the criteria of the professions, the objectives of pharmacy, and the essential components of a university health center, let us get on with this task of "thinking out loud" with particular reference to pharmacy.
First, the provisions of health care will increasingly depend on team work. There are many members of the team, some at the professional level and some at the technical level. Let us review for just a moment a patient with a peptic ulcer who is admitted to a hospital under the care of an internist specializing in gastroenterology. Within minutes of admission he comes in contact with a nurse. The same or next day he goes to the X-ray department where the radiologist and X-ray technicians make observations and take and develop pictures after swallowing a radio-opaque compound provided by the pharmacist. Soon the pathologist and the laboratory technician do blood counts, urinalyses and other tests and evaluate them. The dietitian is called in to utilize her knowledge of foods and nutritional elements. Perhaps medical treatment is decided upon and the pharmacist is asked to provide certain compounded powders. Or maybe surgical treatment is the one of choice and the dentist is asked to survey the state of oral hygiene before an inhalation anesthetic is administered. At some stage the medical social worker interviews the patient and surveys the socio-environmental factors in his life and home which may have contributed to the formation of the peptic ulcer. On discharge the medical record librarian carefully reviews and preserves the record so that it will be useful in future treatment and follow-up of the patient. Although I could go on and bring in many others such as the expert in psychosomatic medicine, the psychiatrist, the anesthesiologist and others these few are sufficient to make the point.
Health care as it is practiced is team work under the leadership of the member of the team who is directly responsible for the patient. If this be true and I believe it is, then the education of the members of the team should be carried out under analogous conditions. It is this reasoning which has led me to recommend to the Chancellor and Trustees and they have accepted, that we bring the four schools of the health professions-medicine, dentistry, nursing, and pharmacy, into the closest physical and intellectual collaboration.
This means first that we are planning and will start to build in early June of this year one building on DeSoto, Terrace, and Lothrop Streets to house all teaching, department, and research activities of the four schools. It is expected the building will be ready for occupancy at the opening of school in September, 1956. There will be a common student center, a common library, a common auditorium, and common lecture and seminar rooms. Laboratory facilities will be used by different schools in relation to the actual schedules.
This program means, second, that those of like scientific interest will have their own offices and research laboratories in the same general area. It does not mean that the faculty of the School of Pharmacy will be on one floor, and of the School of Medicine on another floor, but rather that all the pharmacologists of all schools will be on one floor and all the pathologists from all schools on another floor. The program of physical and intellectual contiguity does not include educational and administrative integration. Let me repeat the third directive to myself, "To provide administrative lines which recognize the unity of the health professions, the distinctive needs of each profession, and the collaboration of those interested in the same scientific field." Each school is to have its own faculty, responsible to the dean of that school for the educational program and teaching in that profession. This is a program of collaboration by team work, not a program of integration and fusion.
Now, let me "think out loud" about this matter of faculty which I have just mentioned. It is my firm belief that high quality university education cannot be provided without a core of faculty who devote themselves primarily and largely to education and research within the school and health center throughout the year. However, let us not forget the third criterion of Flexner for the professions, "They are not merely academic or theoretical, however, but are definitely practical in their aims. "In other words, those responsible for the instruction of students in the practice of the profession should take some continuing part in this practice. In medicine, the faculties of the clinical departments are responsible for patient care in the hospitals and clinics. In dentistry, the faculty is responsible for dental care in the clinic and hospital. As I see it, there should be an analagous relation of the faculty of the school of pharmacy.
For intellectual leadership the faculty of the school should be organized into departments. Please note that I justify departments for intellectual leadership not for administrative convenience. I do not know what departments a school of pharmacy should have, but the Pharmaceutical Survey I referred to earlier mentions six broad subjects-pharmacy, physical sciences and mathematics, pharmacology and related sciences, microbiology and public health, pharmacognosy, and pharmacy administration.
A faculty has many responsibilities all related and it is difficult to say which is the most important. The first and primary reason for the existence of a faculty is to provide opportunities and an atmosphere in which students may learn. By this wording I imply and mean that learning is more important than teaching. One of the Specialty Boards in Medicine has expressed this idea well in the following, "The Board is interested in the fact that the candidate has embarked on a career of study voluntarily and has thereby expressed the desire to excel and to participate personally in the world's progress. …. The responsibility of acquiring the knowledge rests with the candidate. …."
A second obligation of a faculty is to advance human knowledge. There is a direct and an indirect reason for this obligation. The direct reason is that each of us owes it to our heritage to leave the world a better place in which to live and this can be done only by adding to knowledge. The indirect reason is that a faculty member should be able to stimulate the imagination and curiosity of the students and I doubt he can do that unless he has a large "bump of curiosity" himself as to drive him to seek out the truth about something -- that is to do research. This second reason assumes major significance if a program of graduate education is to be undertaken and I believe all the schools of the health professions should have graduate programs leading to degrees of Master of Science and Doctor of Philosophy.
This topic of the responsibilities of a faculty lead into a related area of the fields of activity of the members of the health team. Every member of the health team has a limited field. The physician does not qualify to fill a root canal. The dentist does not attempt to treat a patient with cirrhosis of the liver. The nurse does not presume to evaluate the microscopic section of a tumor of the breast. I do not imply that the limits of each are set in perpetuity but I do mean that no member of the team should assume responsibilities beyond those for which his own training is adequate. Human life is too precious to be placed in danger with inadequate knowledge.
Now, let us continue this process of "thinking out loud" on the type of students. The university health center revolves about students and patients. The students are the basic element of a university. One of my great concerns is the provision of admissions policies and educational opportunities so excellent that the loss from admission to graduation will be small. A school has an obligation to salvage all students who drop by the wayside if it is possible. The record in pharmacy throughout the country is that 40 percent of students admitted never graduate. It is true that this is somewhat better than the average for college students but it is far too high for a professional school. I do not know whether the fault is poor admissions policies, or poor educational program or lack of counselling, but I hope this school can make a contribution to solution of the problem. If all three are good the loss should not exceed 10 to 15 per cent. I propose to have a professional staff in the vice chancellor's office who can assist each of the schools in an attempt to correct the situation.
Finally may I speak more directly to those of you here this evening as representatives of the community, either as practicing pharmacists or from industry. The Trustees of the University have outlined the duties of the vice chancellor. One of these is -- "To stimulate broad interests in health and hygiene to the end that the greatest good will result to the people of Pittsburgh and Western Pennsylvania and at the same time be of benefit to the country at large and mankind in general." I interpret this to mean the schools of the health professions should be a part of the community, and serve the people of the community. This includes serving the professional groups of the community by offering refresher courses, continuation courses, and special lectures.
In conclusion, may I again express my appreciation for your presence here this evening. I bespeak your tolerance of an administrative officer who believes that educational matters should be decided by educators, that professional education is in the public service, that health is a unity and health care requires team work, and that the best administrator is one who administers least. I bespeak your cooperation and support in creating in Pittsburgh a truly great health center.
-Robert A. Moore