Thai Pharmacy Education

Sawasdee ka from Thailand!

As the end of the week comes to a close I would like to have the opportunity to share our experience at Mahidol University as well as share what we have learned about pharmacy education in Thailand.

At Mahidol Univserity we were blessed to have the Associate professor of Clinical Pharmacy, Surakit Nathisuwan, present information on pharmacy education and practice in Thailand. To begin one must understand that college education in Thailand is slightly different than that in the United States. In Thailand students are placed in their classes based on age. So every high school senior at the age of 18 must take a national exam. Based on a students exam school he/she will have the ability to pick a college to attend (ie higher scores allow you to enter into the better public colleges). If a student does not make it to a public school their parents may pay to send them to a private college; however, these schools generally provide equal if not inferior education in comparison to public schools. Currently, there are only 18 schools of pharmacy in Thailand, a vast difference from the number of schools in our country.

Mahidol University is considered the number one pharmacy school in the country. As I mentioned previously all students begin the 6 year pharmacy program at the age of 18. Because of this students must decide to enter into the profession of pharmacy in high school and thus are not given an opportunity to change majors or go to pharmacy school later in life. While this may be a major difference between Thai and American culture, it still makes for diverse classes because each student comes from a different social background.

The curriculum for pharmacy education is very similar to that of schools in the US. They begin with basic sciences and then slowly progress into the profession of pharmacy. Similarly to that in the US, students complete rotations at various points during their years, with much of these field experienced being during their last year. These rotations within the field of pharmacy are called "clerkships" in Thailand. Each student is required to have completed 2,000 hours of clerkship prior to graduation (the ACCP board for pharmacy school accreditation requires 1500 hours in the US).

In 2003, it became mandatory that all pharmacy students sit for National Pharmacy Licesure Examination. This exam contains both a written multiple choice exam as well as a skills based exam featuring a wet lab and live practice (aka OSPE - Objective Structered Pharmaceutical Exam). Once these exams have been passed the student becomes a licensed pharmacist in Thailand. Similar to the United Stated, in 2015 it became mandatory for all practicing pharmacists to complete continuing education requirements. Pharmacists are required to complete 100 credit hours every 5 years with at least 10 hours per year. These hours can be completed through live conference sessions, online articles, or journal publications.

Moving forward into the profession of pharmacy it is important to note that Thailand is considered an upper middle income country (compared to others around the world) with a population of approximately 64 million people. There are currently close to 25,000 registered Thai pharmacists, leading to a significantly larger patient to pharmacist ratio compared to that of physicians or nurses. I find these numbers to be exceptionally interesting especially knowing that only 16% of those pharmacists work in community settings. Why is this fact so interesting you may ask? Well because there are so many community pharmacies! For example, in Bangkok you can find a minimum of 2 pharmacies on every street. So if there are so many pharmacies and so little community pharmacists, who is running these hundreds of pharmacies? Based on this math and surveys conducted only 30% of pharmacies in Thailand are actually run by a pharmacist. The other pharmacies pay a registered pharmacist to post his or her license on the pharmacy wall but never actually work in the pharmacy. These stores are run by local business owners and not persons working in the healthcare field. This has become a huge problem in Thailand and created a significant amount of distrust in the profession of pharmacy.

This recent distrust in pharmacy may seem like a stark contrast to that in the United States seeing that pharmacist continue to be the most trusted healthcare professional; however, when you think about the distrust patients have begun to have in medications and vaccines, our problems are really not that different. To compare, when a Thai physician prescribes a medication or recommends a vaccine the patient completely trusts this medical decision. On the other hand, in the United States there has been a recent increase in the number of individuals who have decided not to get vaccines for one reason or another. There is also a significant amount of distrust in pharmaceuticals due to either side effects or the idea that industry is pushing the unnecessary use of medications. Neither situation is ideal and both require a lot of work within our societies.

No matter what the situation may be I still firmly believe that it is important for individuals to take the opportunity to educate themselves and be able to make informed decisions alongside their medical team to help provide the best possible care for their patients. Given the accessibility Thai patients have to healthcare and lack of resources, it has been incredible to learn from these Thai pharmacies. The profession of pharmacy here has made great advancements in the last two decades alone; I would almost argue more than those made in the US. These pharmacists have done so much to improve the field and give patients the best possible healthcare. It is an honor to learn from them and their patients. A special thank you to Dr. Nathisuwan for taking time out of his day to educate us on pharmacy education and practice in Thailand.

Until next time,
Casey