University Times

Pharmacy’s new dean discusses the changing role of pharmacists and the direction of her school.

Last month, long-time School of Pharmacy faculty member and interim dean Patricia D. Kroboth was appointed the ninth dean in school’s 125-year history, effective May 1.
Kroboth joined the pharmacy faculty as assistant professor in 1980. Her work in clinical pharmacokinetics and pharmacodynamics fostered the development of the clinical pharmaceutical scientist Ph.D. program in 1984, one of the first translational research training programs in U.S. schools of pharmacy.
That same year, however, a proposed University-wide restructuring plan called for the School of Pharmacy to be closed, with its faculty and programs to be absorbed by the medical and the nursing schools. The day the proposal was made public is still known to veterans of the school, including Kroboth, as “Black Tuesday.”
“I remember it well,” she said. “It’s still vivid, as if it were a just few weeks ago. But we’re a very different school than we were 20 years ago.”
During those 20 years, Kroboth has worn many hats at the pharmacy school, including serving as director of the clinical pharmaceutical scientist training program, director of the Pharmacodynamic Research Center and chair of the school’s two academic departments, pharmacy and therapeutics, and pharmaceutical sciences.
She was promoted to associate professor with tenure in 1987 and to professor in 1995. In 2001, she was appointed the school’s associate dean for faculty and academic planning.
Kroboth’s research, which focuses on the relationship between concentrations and responses to drugs, has been funded by a number of grants from the National Institutes of Health (NIH), foundations and pharmaceutical companies.
She is a fellow of the American Association of Pharmaceutical Scientists and the American College of Clinical Pharmacy.
Kroboth received a Bachelor of Science degree in pharmacy from the State University of New York at Buffalo in 1971 and earned master’s and Ph.D. degrees in pharmaceutical sciences in 1980 and 1983, respectively, at Pitt’s School of Pharmacy.
In July 2002, she was named the school’s interim dean, something she said changed her professional life.
“When I became interim dean, it didn’t hit me until about three months into it,” Kroboth said. “I was sitting at a seminar of somebody with whom I had a wonderful research collaboration and I suddenly felt very nostalgic about the fact that I no longer thought much about these kinds of things. It was a reckoning that I had made a transition. I was at the point where I had left without saying good-bye. I sat there and it hit me so hard in the seminar I had to choke back tears: It was very powerful, as I was saying to myself, ‘Oh, my word, look what I’ve done!’ So it was a huge change, but it’s worked out. At this point I’m very comfortable.”
Last week, Kroboth was interviewed by University Times staff writer Peter Hart.

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University Times: How would you describe the overall health of the School of Pharmacy?
Dean Kroboth: When I look back over 20 years since the time of Black Tuesday, I see so many differences. At that time we had about 30 faculty total, and we’re at approximately 90 today, so we have more clinical faculty as well as more researchers. We have many partnerships, for example with the VA Hospital and with UPMC, which back then did not even exist as we know it today. There were no centers within the school back then. We now have four.
Although most of our students still come from Pennsylvania, we have an extraordinary national applicant pool. In this past year we had 30 applications for every open position. Our students have a 100 percent pass rate on certification exams, virtually year after year. And we have 100 percent placement of our graduates in the field. Part of that is due to the current shortage of pharmacists, but even before the shortage we had that.
The School of Pharmacy also has a number of international programs and individual faculty members who are doing some great things internationally. The past year we sent a student to study in Europe;
he will get his doctorate from our program, but he’s being trained at the University of Leiden in The Netherlands. We have international collaboration with ISMETT (the Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione) in Palermo, with the school of pharmacy at that university. We’re developing programs in India; we have a sister school in China. We’re breaking new ground and trying to use the excellence of our research to extend to international collaborations.
This is the fourth year running that we are in the top 10 for NIH funding for our research. The school has been on an upward trajectory for years. We need to stabilize our gains, such as with the NIH rankings. I’d like to see us in the top 5 every year. How do we keep this trajectory going up is the question.

UT: What’s the biggest trend currently affecting pharmacists?
Dean Kroboth: Historically schools of pharmacy have focused on working in hospitals and developing good patient-care roles. This means working in teams with nurses, nutritionists, physicians and others so that we get the right drug for the patient and so that it’s being monitored to ensure patient safety as well as the efficacy of the drug.
Over the course of the last 10 years, patients are being sent home sicker. There are more potent drugs available by prescription, but also many more drugs and treatments and therapies and nutritional products available over the counter. Patients are being required more and more to manage their own health care.
In addition to all the traditional things we’ve been doing, one of the things I believe is very important is to work with partners in the community so that pharmacists are not just dispensers of the product, they’re dispensers of knowledge: to help people gain access to health care, to increase awareness of individual needs, to see that health care extends beyond the pharmacy, to educate people about drugs in particular but also about their health and finally to lead the patient to accept responsibility.
So the responsibilities of pharmacists have increased.
Pennsylvania is not one of the most progressive states. But the state just approved allowing pharmacists to administer immunizations. The regulations are still being written, but it’s approved.
And the state recently approved collaborative practice agreements between pharmacists and physicians, which means that pharmacists can work to order laboratory tests, change dosage, change drugs, under protocol in agreement with specific physicians.
If somebody with diabetes comes in, for instance, the pharmacist would know that for certain types of patients it would be okay to use this type of insulin or drug and then go through the educational component with the patient.
Those things have happened largely in hospitals. The next step is to move that into the community. That’s where the frontier is now.
One of the approaches we have taken is, if anyone comes into a clinic, to make sure they have filed for whatever kind of assistance they can get, if patients are eligible for Medicaid, for instance, including expediting paperwork. So it’s an educational service we’re providing that can they help reduce costs by knowing about these programs.

UT: Have the changing roles of pharmacists influenced the school’s teaching and curricula?
Dean Kroboth: Twenty years ago, we had an extremely good curriculum that could have stood up to any school of pharmacy’s. However, if you take a look at the way we all taught, it was largely classroom instruction and then there was about three months of learning in the field: that would include in community pharmacies, hospital pharmacies, and then a little time as part of a health care team. That was the standard model.
We went from that to doing very problem-based learning, student-centered learning, collaborative learning, where people work in groups.
In the process of thinking about this change, while we were developing the Pharm.D. program, we eventually got to where we have only about 12 hours of large classroom instruction, and all the rest of it is small-group or individualized sessions, which requires different roles for faculty. It did require people to think about teaching in a different way. [The transition] took place over about four years. It was very intense. We were glad when we got through it.
Now we have a four-year curriculum where starting in the first year students are interacting with patients. It gives them an immediate foot in the door to pharmacy practice. The curriculum is really positioning students to think about drugs in the context of disease and in the context of individual patients, learning about those adjustments that should be made for patients, for instance with decreasing renal function or drugs you don’t want to see being used by an older person.
Each year the intensity of that patient-based interaction increases.
Then they spend their entire fourth year in the professional program in those kinds of experiences, under the supervision of a pharmacist, providing information and working with health care teams.

UT: You mentioned the national shortage of pharmacists. Recent data indicate there are 5,500 vacancies in chain drug stores alone and 2,800 unfilled hospital pharmacist positions. The number of prescriptions that are filled annually is up to 3 billion and expected to hit 4 billion in a couple years. Is the shortage critical?
Dean Kroboth: If you look back 20 years ago, there were many years when there were 74 schools of pharmacy, and now we have over 90. In the last 10 years or so Pennsylvania has added two schools, which means a 50 percent increase in schools of pharmacy in our state. Every American Association of Colleges of Pharmacy conference you go to, you hear about more schools that are starting toward getting accreditation. That at least is addressing some of that shortage.
Some schools are opening branch campuses; the University of Minnesota, for instance, in Duluth, and the University of Florida.
In terms of our student body and in terms of our available facilities, we are at capacity. We are constrained both by classroom size as well as by the number of mentors that we have for students in the experiential component of our curriculum.
I think the shortage is something we have to be vigilant about, but at the present time that’s not the highest priority. I see a bigger issue right now as putting pharmacists in situations where they’re providing more care. At least I see that as a priority for our school and our region.
What I would hope would happen, and we are working to see it happen, is for pharmacists to work with teams in the community in the way we’re seeing it in hospitals. The teams at the very least would include a physician and pharmacist, but for patients who have a more complex situation it could include visiting nurses, home health care providers, social workers, health coaches.
I think it’s no accident that there has been legislation recently – the Medicare Modernization Act of 2003 – that said society does have a need for a medication therapy management service, and that there’ll be re-imbursement for those types of services.
Now, you might ask, why hasn’t that happened in the community already? Because right now the pharmacist gets paid for selling a product. It’s almost a conflict of interest: You’re getting paid for a product when in some cases the right thing to do is say, “You don’t need this drug.”
But if somebody has 10 medications, which for some patients is not an unreasonable number, that person would benefit having someone go through their medications carefully with them to make sure they know how to take them, when to take them, that there were no interacting drugs, that the dosage is appropriate, and if there are side effects, who the patient should call – even for them to understand it’s okay to call somebody. All that could easily take an hour.
That information could be shared, as long as the patient agrees and there is the proper approval, with all the people who are involved.
That’s where as a society we have to say, for instance, if this person learns how to use an inhaler properly, maybe it will keep him or her out of the emergency room, and that would be a huge cost savings for society.
My vision is the pharmacist will have a place – whether it’s in a pharmacy or a senior center or a library or other public places – some space where patients can come in, make an appointment and sit down with their bag of drugs and review their entire list of everything they take. That’s one of the things we’re working toward, identifying ways where there is auditory privacy. Right now most pharmacists stand behind a counter where you hear everything that everybody wants.

UT: What other goals are on your agenda?
Dean Kroboth: Our admissions reflect the applicant pool from which we draw. What we would like to do is get more diversity in our applicant pool, which is predominantly female – 70 percent to 30 percent male – and predominantly white.
This is true pretty much the same around the country. But I think it’s very important that we have a student population that reflects the diversity of the patients whom they will serve. By having a diverse profession we learn about better ways to convey information to people so they will learn to take better care of themselves.
Ultimately, we have very potent medications that are being put into the hands of people and we say: “Go take care of yourself.” What we need to do is be able to motivate people, first of all that they fully understand what they’re supposed to do when they’re no longer in the health care environment and they’re back home, and that they understand enough to be motivated on a daily basis to take care of themselves, whether it’s taking medication or adding exercise to the regimen, or whatever else it takes to live a healthy life.

UT: What do you see happening at the school, say, five or 10 years from now? How does your role as dean fit into that?
Dean Kroboth: Well, I see more partnerships, definitely. Our success, whether it’s in education or research or patient care, is because our faculty have collaborated with others not only within the school but outside the school, and in some cases with other institutions.
In order to be successful, you have to be aware of everything going on around you, at the University, in the city, around the nation, because that influences what your opportunities are and what directions you can take.
The role of a university is to help incubate ideas, but we need the laboratory to test them out. One of the wonderful things is that the University is focusing on community development and that fits in perfectly with what we’re doing. I’m seeing this from the pharmacist’s perspective on how to work collaboratively to enhance the quality of life in our community. That’s a shared goal.
But just because we say we want to move more into the community, and we’ve talked a lot about new ideas and programs, that’s not to say that we want to abandon the excellent programs we have. We want to increase the scope of our impact.
In research, it’s not just being in the top 10; it’s making sure we’re addressing problems that will make a difference. That’s also where we can work with partners to identify and meet society’s needs.
In terms of my role as dean, actually I’ve tried to change my personal role during the time that I was interim dean. I’m more active at the state level now.
Being dean also changed my concept of alumni from an abstraction to realizing these are my former students!
I had never done fundraising before, but one of the things I most enjoy is to talk about programs I care about, and I like working with people and interacting with people and that’s evolved into fundraising.
If you take one of my endeavors to reach out to the community to develop new models of practice, that very much calls upon my years as a practitioner and those skills. And my role as dean has called on skills as a clinician, the whole mindset of how I came to think about a problem, and then separately the concept of research, and the writing that goes along with research to help clarify the ideas.
It doesn’t have so much to do with credentials, but it’s the melding of past experiences in this particular way.
In our vision statement, we talk about mitigating disease. We talk about using various therapeutic agents – we don’t say drugs, and the reason is that we have faculty working in delivery of gene products, and we also have nutrition specialists.
We also talk about enhancing the quality of life. If you go back a number of years, we were not dealing with prevention, as a society; we were instead dealing with treating diseases that existed.
But take a look at lipitor, or any of the statin drugs, essentially those are preventive medicines that surely enhance the quality of life.
The other thing about being visionary is that it has its limitations: Can I picture exactly what the school will look like in five years? The answer is “no” because, in fact, as I look back over any one five-year stretch, many things happened that I would not have thought of.
What I do know is that there will be opportunities for us to create something better than we have now, and we will be ready to move ahead, whether it’s education, research or practice.
As somebody said, “Serendipity occurs to the prepared mind.” I look forward to five years from now to look back and say, “I didn’t expect that, but we were ready.”