Colleges of pharmacy provide varying amounts of didactic and clinical hours in pediatrics resulting in variability in the knowledge, skills, and perceptions of new graduates toward pediatric pharmaceutical care. The Pediatric Pharmacy Advocacy Group (PPAG) endorses the application of a minimum set of core competencies for all pharmacists involved in the care of hospitalized children.
Children are not merely small adults when it comes to medication dosing and administration. Children undergo significant growth and physiologic change over time, resulting in variations in pharmacokinetic and pharmacodynamic parameters. Additionally, pediatrics is a heterogeneous population and can include children of varying weights and sizes, from the premature infant weighing 600 grams to the adolescent athlete weighing several hundred pounds. Although improving, there is a paucity of research and data regarding medications in children. Specific pediatric studies have not traditionally been performed to determine efficacy, optimal dosing, pharmacokinetics, or adverse effect profiles of many medications. Much of current practice in medication use for children is extrapolated from adult studies. Off-label prescribing is commonplace, although its frequency is influenced by many factors including practice setting and patient age.1–5
Colleges of pharmacy provide varying amounts of didactic and clinical hours in pediatrics resulting in variability in the knowledge, skills, and perceptions of new graduates toward pediatric pharmaceutical care. In a survey by Prescott et al,6 the mean number of didactic hours in Doctor of Pharmacy programs related to pediatric topics was 21.9 ± 22.9 with a range of 1 to 153 hours. A limited number of pharmacists pursue formal advanced training in pediatrics through completion of residencies or fellowships, which are optional following licensure. To date, there are about 46 first year postgraduate pharmacy residencies (PGY1) at children's hospitals and 47 American Society of Health System Pharmacy-Accredited second year postgraduate pharmacy residency (PGY2) programs.7 As a result of the limited number of pharmacists trained in pediatrics, extensive on-the-job training is often necessary to reach a minimum level of competency.
RATIONALE AND RECOMMENDATIONS
Any pharmacist caring for children in a hospital setting should demonstrate proficiency in core knowledge and skills before practicing independently. Pharmacists who have not completed residency training in a pediatric facility may have to gain this minimal level of competency through institution-based on-the-job training programs. Currently, there are no suggested minimal competencies for entry-level pharmacists caring for children in the health-system setting. Table 1 includes suggested topics for skill and knowledge development for entry-level pharmacists caring for hospitalized children. Though this is not an exhaustive list, it may give employers some guidance on content to include in their programs. Employers should evaluate what services their institutions offer and try to match their minimal competencies to encompass those areas. For example, an institution whose sole pediatric population is in the neonatal intensive care unit should direct their training to the minimal competencies necessary to care for neonates.
A variety of training models would be appropriate to achieve the recommended goals. Possible options include self-directed learning modules, instructor-led learning, continuing education programming, experiential learning with a PGY2-trained pediatric pharmacist, and case-based and/or skill-based activities. Examples of some of these strategies have been published.8–10 Each of these approaches could involve the use of pre- and postassessment tools to gauge the learner's understanding and application of the material. One example of an existing program is the on-line continuing education program, “Pediatric Age-Based Competencies,” available through PPAG. This program consists of a variety of different presentations on introductory pediatric topics. Table 2 includes a list of resources that employers can utilize to develop training modules or make available to entry-level pharmacists for self-directed learning.
Most entry-level pharmacists receive limited formal training in pediatric pharmacotherapy within their Doctor of Pharmacy curricula. On the basis of the pediatric population within their institutions, employers should establish a minimal level of competency for entry-level pharmacists caring for hospitalized children. PPAG acknowledges that these minimal competency training programs are essential. However, at this time, PPAG cannot endorse one program over another. The selection of a training program must be based on the institution's patient demographics, services offered, resources available, and time allotted for training programs.
Adopted by PPAG Board of Directors: September 25, 2014.