With a timeline of three weeks, including travel, a lot of preparation needed to happen prior to boarding the plane for Japan. Learning objectives validated by faculty and the Assistant Dean for International Engagement were shared with the participants. Three hospitals and community pharmacies were observed. The participants were immersed into the curriculum at KUHW and were instructed to journal daily, noting all similarities and differences stated in the course objectives. Discussions were held daily. Students took pictures to document findings, which were validated with Japanese pharmacy faculty.
The group noted descriptive differences in all practice areas. U.S. pharmacists have collaborative practice agreements allowing more diverse practice opportunities. Japanese pharmacists have similar traditional roles in community, long-term care and oncology collaboration and receive a bachelor’s degree after five years of college with clinical rotations during their fourth year. Japan lacks the use of technicians, thus pharmacists serve both technical and clinical roles in most practice settings. This has a negative impact on Japanese pharmacists’ salaries in comparison to the U.S. Additionally, cultural differences direct patient preferences to herbal and self-care treatments. Drug expenditures in Japan are affected by the lack of trust in the generic market.
Participants met the learning objectives, noting pharmacists are well respected with unique roles in both countries. Cultural differences influence pharmacy practices and academics in each country and students understood differences that could benefit both populations.
Of the many differences that were noted during the study abroad experience, there were several variances that were observed during the outpatient site visits. The biggest differences noted by the faculty and students were the type and formulation of medications that were used for patient treatment. When a patient needs to take a prescription medication in Japan, the formulation that most patients prefer is powdered form over formulations such as tablets, capsules, or liquids. When patients have to take a medication in either tablet or capsule form, they do not receive these medications in an amber vial like they do in the U.S. Instead, Japanese outpatient pharmacies use multi-dose packets that contain all the medications that a patient needs to take for that specific time or day. Another major variance that was observed by the students was that patients in Japan preferred to use herbal products before they would use an OTC medication or visit a doctor to get a prescription medication.
Counseling in the outpatient setting is also practiced differently in Japan than it is in the U.S. Japanese pharmacists do not always counsel patients in a private area, and the counseling process usually involves family members, as well as the patient. This style of counseling is almost the complete opposite of how it is done in the U.S. In the U.S., a patient’s privacy is of the utmost importance, so counseling patients in a private area is mandatory. Due to this emphasis on privacy, the patient and the pharmacist are usually the only people involved in the counseling process, unless the patient is a minor or requests the presence of a family member during the counseling session.
The pharmacy programs found at KUHW and the U.S., specifically the University of Findlay, are quite comparable but do have some notable differences. Both universities utilize the 0 to 6 format
for their pharmacy degrees, meaning that it only takes a total of six years to complete the pharmacy program with a degree. However, a major variance between the two programs is that students from the U.S. graduate with a PharmD degree while KUHW students graduate with a bachelor’s degree, despite spending the same amount of time in college and covering similar material.
The curricula between the two universities are also very similar when compared side by side. Students from each university take similar courses throughout their academic careers, but the year these courses are offered vary. For example, Japanese students take law during their first and sixth years and are introduced into the pharmaceutical sciences earlier than UF students. UF students cover law in their fifth year and do not start learning about the pharmaceutical sciences until their third year. Another notable difference is that Japanese students spend their fifth year off campus gaining practical experience, and spend their sixth year back on campus performing research and studying for their licensing exams. UF students are required to have a research project completed by the end of their fifth year and spend their sixth year gaining practical experience and studying for their licensing exams.
To make a more pronounced impact on the way that pharmacy is practiced, it is crucial that we attempt to more thoroughly understand the differences in pharmacy practice between Japan and the United States. This trip served to identify commonalities and differences between the two countries in terms of academia, inpatient, and outpatient pharmacy practices. The data obtained are useful to lay the foundation of basic information needed for further research on this topic. Future studies are recommended to build upon this foundation of knowledge and to further define the differences in pharmacy education and practice between the two countries. Areas of particular interest for future studies include health insurance systems, pharmacy law, and academic clinical rotation content.
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