Bachelor of Pharmacy Programs in United Arab Emirates

The United Arab Emirates (UAE) pharmacy education has undergone significant reform in recent years to introduce more clinical and social pharmacy courses to replace many traditional pharmaceutical sciences courses that were typically dominate pharmacy curricula. The aim of this work was to carry out a comprehensive comparative analysis on all Bachelor of Pharmacy (BPharm) programs in the UAE and to describe the developments of BPharm curricula offered by UAE colleges of pharmacy after increasing the number of credit hours allocated for clinical and social pharmacy courses. BPharm curricula offered by all pharmacy colleges in the UAE were retrieved from their official websites. A comparative study on different curricula was carried out to investigate the structure of BPharm curricula after incorporating more patient-centered courses. Clinical and social pharmacy courses represent between 22% and 51% of the total BPharm credit hours. Non-clinical/social courses are no longer representing the majority of BPharm courses. PharmD degree program is offered by only one university. The course credit hour distribution of different BPharm programs is varied from one program to another. More clinical and social pharmacy courses are increasingly replacing the traditional pharmaceutical sciences subjects such as pharmaceutics, chemistry, biomedical, and basic sciences.


Introduction
United Arab Emirates (UAE) is an emerged federation of seven Emirates with a population amounted to 9.3 million in 2017 (1). The UAE is a role model of a multinational country where expatriates from more than 200 nationalities represent more than two-thirds of the population (1,2) In less than half a century, the UAE has emerged as one of the global nations with top education system. The country has established a first-rate quality higher education system, and has witnessed a rise in establishing public and private higher instructional institutions. Pharmacy is one of the most growing health sciences educational fields with nine pharmacy colleges distributed in almost all the Emirates of the country. In recent years, pharmacy education in UAE has progressed and many changes have been made to pharmacy undergraduate curricula to replace traditional courses with patient-centered pharmacy courses related to clinical and social pharmacy. This is in trend with the global changes in the pharmacy profession from product-oriented to a patient-centered (3).
There are handful publications that have described the pharmacy education in UAE and its status (4)(5)(6)(7)(8)(9). However, up to the knowledge of the author no published study has been identified in literature that performed a comparative analysis of different Bachelor of Pharmacy (BPharm) programs offered by UAE universities. Thus, the aim of this work was to carry out a comprehensive analysis on all BPharm programs in the UAE and to describe the developments of BPharm curricula offered by UAE colleges.

Background
Around 91% of higher education institutions in UAE are private establishments, and 9% of universities are governmental where 30% of them are located in the capital city of Abu Dhabi (Table 1) (10).
In medical sciences, including pharmacy, UAE students represent only 12% of the total students registered in private higher education institutions in 2016-2017 as shown in Table 2 from official data (10). More than 51% of students are from Arab countries such as Syria, Iraq, Saudi Arabia, Egypt, Palestine, Jordan, and Yemen. On the other hand, around 89% (n=175) of medical science students registered in governmental higher education institutions in 2016-2017 are UAE citizens, compared to 11% (n=19) expats.
Pharmacy education in UAE dates back to 1990s when two colleges of pharmacy were founded, which are Dubai Pharmacy College that is exclusively for female students and College of Pharmacy and Health Sciences at Ajman University, for both genders, in 1992 and 1996, respectively, to offer BPharm programs (7). Years later, more pharmacy colleges were established in Emirates of Sharjah, Ajman, Abu Dhabi, and Ras Al Khaimah. Recently, a new BPharm program has been granted an initial accreditation and it will be launched latter in 2019 (7). There are nine pharmacy colleges/departments ( Table  3), eight of them offer BPharm programs and one offers Doctor of Pharmacy (PharmD).  Two colleges are single-sex schools (for female students only), while the rest 7 are coeducational for both genders either integrated or segregated. In coeducational programs, female students typically represent about 70-80% of the total number of students. Students from all nationalities are allowed to pursue their pharmacy studies in almost all pharmacy colleges in UAE, except Dubai Women College (DWC), which is only for UAE citizens. Colleges are located in six Emirates, three in Ajman, two in Abu Dhabi, two in Dubai, one in Sharjah, one in Ras Al Khaimah, and one branch for Ajman University in Fujairah.

Local and International Accreditation
The Commission for Academic Accreditation (CAA), Ministry of Education, which is the local accreditation body of higher education programs in UAE, accredits all BPharm programs in UAE and the accreditation is renewable every five years (11). To date, only two BPharm programs offered by AAU and AU are internationally certified by the US based Accreditation Council for Pharmacy Education (ACPE) (12). No programs are currently accredited by other international accreditation bodies such as Canadian Council for Accreditation of Pharmacy Programs (CCAPP), the German Accreditation Agency in Health and Social Sciences (AHPGS), and the Australian Pharmacy Council (APC) (7).

Pharmacy Enrollment Ceiling
Approximately 800 new students enter to the colleges of pharmacy every year to pursue their pharmacy studies. CAA determines the number of admitted new students in BPharm programs for each college. The ceiling ranges from 50 to 150 students per college per year.

Teaching and Assessment Methods
English is the language of instruction in all pharmacy colleges. The teaching methods in almost all pharmacy colleges are didactic lecturing that combines problem-based learning (PBL) and outcome-based education (OBE) methods. Pharmacy colleges are also equipped with teaching laboratories to perform experimental sessions. Experiments cover pharmaceutics, chemistry, pharmacology, and biomedical areas. Clinical courses involve student role-playing a pharmacist using virtual pharmacies and experiential placements. Common assessment tools include exams, quizzes, case studies, and assignments. Recently, the colleges of pharmacy of Ajman University, University of Sharjah, and Al Ain University of Science and Technology have started implementing objective structured clinical examination (OSCE) as assessment tool for their students.

BPharm Program Development
Most of BPharm programs in UAE have recently undergone noticeable developments to accommodate recent changes in the field of pharmacy to incorporate more clinical and social pharmacy courses. This has led to a drastic decrease in the number of credit hours historically allocated to common pharmacy areas such as pharmaceutical chemistry, pharmacognosy, and pharmaceutics. For instance, the ACPE certified BPharm program offered by Ajman University has been totally updated in 2019 ( Figure 1). The percentage of credit hours devoted to clinical/social courses and trainings have been almost doubled from 17% to 32%. This notable increase resulted in a significant cut in chemistry, pharmacognosy, and pharmaceutics credit hours. Chemistry-related credit hours were decreased from 18% to 12%, whereas pharmaceutics courses were representing 21% of the previous BPharm curriculum credit hours are now account for 13% of new curriculum credit hours. Pharmacognosy-related courses were also reduced from 5% to 2%, while biomedical courses were negligibly decreased from 19% to 18%. However, general university requirement courses were increased from 16% to 19%. It is worth mentioning that the total program credit hours were increased from 150 into 160 hours.

BPharm Program Credit Hours
The total credit hours of BPharm programs ranges from 132 to 170 hours ( Figure 2

Credit Hour Distribution
The distribution of credit hours of different BPharm programs offered by UAE universities is shown in Table 4 and Figures 3 through 9. It is obvious that the course distribution of main pharmacy areas is varied from one college to another. Furthermore, the number of credit hours allocated for general university courses are enormously different form one program to another where it ranges from 0.0% credit hours in FCHS program to 29.5% (39 hours) of the BPharm program offered by HCT.

Clinical/ Social Courses and Training
A good number of credit hours of traditional courses in specialties such as pharmaceutics, chemistry, and biomedical sciences was replaced with courses related to patient care and counseling as well as some other courses dealing with pharmacoeconomics, management, marketing, pharmacovigilance, and pharmacogenomics. Clinical and social pharmacy courses represent between 22.1% (in RAK) to 51.4% (FCHS) of the total BPharm credit hours ( Figure  10).
Clinical/ social pharmacy courses vary from one program to another (Table 5). Pharmacotherapy course is the only clinical course that is offered by all programs ranging from 7 to 33 credit hours. All the colleges, but FCHS, offer pharmacy law and ethics course. The number of credit hours allocated for clinical training/experiential experience varies from one program to another ranging from 9 to 16 credit hours.

Non-Clinical/ Social Courses
The increase in the number of clinical/social pharmacy courses of newly revised BPharm curricula offered by UAE universities has led to relatively decrease in the credit hours allocated for "non-clinical/social" courses. The "slow crawl" of clinical courses to replace traditional ones is a controversial topic. Some academicians attributes this trend to the needs of job market, whereas others see it as a negative impact on the role of pharmacists in many areas such as research and development, quality control and assurance, pharmaceutical industry, and natural products industry.
Historically, pharmaceutics courses used to dominate BPharm programs in most of UAE universities. The recent program developments have led to a remarkable decrease in the credit hours of many pharmaceutics courses such as pharmaceutical technology and pharmacokinetics and biopharmaceutics. Pharmaceutics courses represent range from 11% to 16% in most of BPharm curricula in UAE, except the RAK pharmacy college where the pharmaceutics courses still dominate the BPharm program with close to 24% of the program total credit hours ( Figure  11).
Pharmacy-related chemistry courses were also affected by recent developments in BPharm curricula. Future pharmacists who are also known as chemists, especially in Commonwealth English countries, will be no longer taking the same number of credit hours previously devoted to traditional chemistry courses such as analytical chemistry and instrumental analysis, organic chemistry, and medicinal chemistry. The credit hours of chemistry courses in most BPharm programs in UAE range from 11% to 16%, except in RAK where the percentage is close to 20% ( Figure 12).  Among the common six chemistry courses typically taught in BPharm programs, medicinal chemistry, pharmaceutical analysis (including analytical chemistry and instrumental analysis), and organic chemistry represent the most common chemistry courses that are present in most BPharm curricula, in contrast to quality control/assurance and inorganic chemistry courses that are only offered by two colleges (Table 6). Medicinal chemistry and organic chemistry are the only courses that are offered in all programs.

PharmD Program
To date, GMU is the only university that offers a PharmD as an undergraduate-level pharmacy program, and more PharmD programs may be offered in the future by other universities. Despite the growing interest of offering PharmD in UAE, this program may lack one of its most important components, which is the residency. One of the barriers of PharmD programs in many countries is the unavailability of residency positions in hospitals, including those in United States, to accommodate the demands of PharmD students. For this reason, PharmD programs without residency may not be equated with its counterpart in other countries such as United States. Additionally, PharmD holders should be distinguished from BPharm graduates in terms of job description and employee grade and position levels. BPharm and PharmD holders have the same definition in the professional qualifications requirements (PQR) document of the UAE health authorities, which sets the professional qualification requirements needed for licensing healthcare professionals in the UAE.

Integrated Curriculum
Integrative teaching and learning in pharmacy has not been well implemented in the Middle East and North African (MENA) region. Many challenges and barriers may face the development and implementation of integrated BPharm curricula in UAE in particular and other MENA countries in general. First, the implementation requires increasing in the number of faculty members of different specialties of pharmacy. This is a challenging issue since almost all the pharmacy colleges in UAE are private, and hiring large number of faculty may not be a suitable direction from a financial standpoint. Second, since this pedagogical method is uncommon for students and faculty, resistance is likely to happen, especially if it lacks to incentives.

Recent Developments
The minimum total credit hours for BPharm programs in UAE and experiential education were among the main topics discussed in the Pharmacy Education Summit held in Ajman in March 2019, with the participation of UAE pharmacy colleges key figures and the Commission for Academic Accreditation (CAA) in UAE Ministry of Education, Accreditation Council of Pharmacy Education (ACPE) in USA and American Association of Colleges of Pharmacy (AACP). It was decided to set a minimum of 150 credit hours of BPharm programs and at least 960 contact experiential hours with 24 credit hours for training courses. It was also a discussion about the importance for BPharm programs in UAE to offer balanced blend of biomedical, pharmaceutical and clinical sciences, and that incorporating more social courses and experiential learning is important but without negatively affecting pharmaceutical sciences courses that are the backbone of pharmacy (20).

Conclusions
Pharmacy education in UAE has recently undergone drastic developments, and more clinical and social pharmacy courses are increasingly replacing the traditional pharmaceutical sciences subjects. Most of pharmacy colleges have developed their curricula toward patient centered pharmacy education. This has led to marked decrease in the number of credit hours dedicated for other courses such as pharmaceutics, chemistry, biomedical, and basic sciences. PharmD programs are not widespread in UAE, however, there is a growing interest of offering this degree program by a number of UAE universities, but some regulatory affairs need to be adopted.

Conflict of Interest
The author declares no conflict of interest.