Pharmacy Practice and Education in Estonia
- practice (community, hospital and industrial);
- education and training.
3. Evaluation and Assessment
3.1. Organisation of the Activities of Pharmacists, Professional Bodies
3.2. Pharmacy Faculties, Students, and Courses
3.3. Teaching and Learning Methods—Student Hours
3.4. Subject Areas
3.5. Impact of the Bologna Principles
3.6. Impact of European Union (EU) Directive 2013/55/EC
4. Discussion and Conclusions
- increased collaboration between different health care professionals,
- more integrated training and common courses with medical students,
- more patient care competencies linking the pharmacy programme with practice,
- more reflection and practical implementation of theoretical knowledge,
- broader use of problem-based learning,
- introduction of business and entrepreneurship subjects to the pharmacy programme, and
- enhanced requirements for pharmacy students and for internship supervisors at community and hospital pharmacies given that pharmacy internship plays a very important role in implementing of professional competencies.
Conflicts of Interest
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|Community pharmacists||894 in 2019||A total of 41% of the community pharmacy staff are pharmacists. The total number of employees is 2180.|
|Community pharmacies||495 in 2019||A total of 343 are general and 152 are branch pharmacies. The main difference with branch pharmacies is the absence of any obligation to compound medicines. A branch pharmacy operates under the supervision of a general pharmacy. Starting in April 2020, branch pharmacies operating in communities with a population of >4000 will be either transformed into general pharmacies or closed.|
|Competencies and roles of community pharmacists||A pharmacist can be the owner, manager and responsible pharmacist. The main professional tasks are related to organization and provision of high-quality pharmaceutical care. Professional competencies include:|
|Is ownership of a community pharmacy limited to pharmacists?||Yes||Starting on 1 April 2020, >50 per cent of the shares of the private legal entity (the dominant influence) must be in the possession of a pharmacist, working as the manager in at least one of the general pharmacies (up to a maximum of four general pharmacies).|
|Rules of geographical distribution of community pharmacies||Yes||Pharmacies in a community with a population of <4000 can operate as branch pharmacies.|
|Are drugs and other health care products available to the public through other channels?||Yes/No||Community pharmacies have a monopoly on the sale of prescription and OTC medicines. Health care products are available in supermarkets, etc. In 2013, an online pharmacy, operating as a branch pharmacy, was created.|
|Are other persons involved in community pharmacy practice?||Yes||Assistant pharmacists and customer service specialists.|
|Their titles and numbers||774 in 2019||Assistant pharmacists form 33% of the community pharmacy workforce.|
Other personnel such as customer service specialists and cleaning workers form 26% of the community pharmacy workforce. People working in such positions do not have any special training. A customer service specialist is responsible for counselling of other goods (not medicines). It is common for pharmacy students to work as a customer service specialist.
|Duration of study for assistant pharmacists||3 years||Professional higher education, Tallinn Health Care College.|
|Subject areas||Basics of chemistry, pharmaceutical technology, pharmacology and social pharmacy, practical training on dispensing and counselling of medicines. This curriculum is highly practice oriented.|
|Competencies and roles||The main professional tasks are related to the organization and provision of high-quality pharmaceutical care. Professional competencies include:|
|Hospital pharmacists||71 in 2018||At the end of 2018, 71 pharmacists, 39 assistant pharmacists and 39 other personnel worked in hospital pharmacies. On average, a hospital pharmacy has five employees.|
|Hospital pharmacies||24 in 2019|
|Competencies and roles of hospital pharmacists||Professional competencies:|
|Companies with some aspects of production, R&D and distribution||21 (2019)|
|Companies with distribution only||64 (2019)||A total of 76% of the market volume of human medicines is provided by three major wholesalers: |
|Pharmacists working in industry||Circa 120||Official statistics not available.|
|Competencies and roles of pharmacists working in industry||Professional competencies:|
|Pharmacists working in other sectors||Circa 200||Official statistics not available.|
|Sectors which pharmacists are employed|
|Competencies and roles of pharmacists employed in other sectors|
|Registration of pharmacists||Yes||Pharmacists and assistant pharmacists providing pharmacy services in Estonia must be recorded in the national register of pharmacists and assistant pharmacists, kept by the Health Board. |
A license holder (community or hospital pharmacy) is responsible for informing the Health Board of the employment or dismissal a pharmacist or assistant pharmacist.
|Creation of community pharmacies and control of territorial distribution||Yes||As from 1 April 2020, a community pharmacy can be run only by a private legal person (pharmacist) holding, > 50 per cent of the shares of the private legal entity.|
A pharmacy license holder can manage up to four general pharmacies operating in a community with a population of >4000. Shareholders or members of a private legal entity holding a general pharmacy authorization must not include persons holding a wholesale distribution or manufacturing authorization, or a health service authorization.
The State Agency of Medicines supervises the holders of a pharmacy license.
|Ethical considerations and role of pharmacists||Yes||In 2012, a council composed of representatives of professional pharmacy organizations, of the State Agency of Medicines, and of the University of Tartu proposed quality guidelines for community pharmacy services; these were updated in 2016. In November 2016, the occupational qualification standards for pharmacists and assistant pharmacists were approved. As an extension, an updated version of the Code of Professional Ethics for Pharmacists was included with the standards. Overall the guidelines aim to formulate the principles of modern pharmacy services, i.e., the aspects of quality pharmacy services, and to define clear criteria for evaluating the quality of pharmacy services. The guidelines give all pharmacists the opportunity to evaluate the working of their pharmacy and improve the efficiency of their services.|
|Quality assurance and validation of HEI courses for pharmacists||Yes||The curriculum at the University of Tartu is subjected to international accreditation every seven years.|
|Professional continuing education courses for pharmacists||Yes||Starting in January 2015, it is compulsory for practicing pharmacists to take continuous professional development (CPD) courses at a rhythm of at least 40 academic hours every two years. Professional training can be participation in CPD courses, seminars, conferences, etc.|
|Total number of HEIs for pharmacy||2||In Estonia there is only one pharmacy school providing higher education in pharmacy on university level—the University of Tartu. |
In addition, Tallinn Health Care College provides professional higher education (3 years) for assistant pharmacists. The following sections describe the information concerning the Institute of Pharmacy at the University of Tartu only.
|Attached to a medical faculty||Yes|
|Do HEIs offer B.Sc. and M.Sc. degrees?||Yes||The integrated B+M curriculum for pharmacy provides a tunnel degree (5 years) for continuous education.|
No specialization is available during pharmacy training.
|Do HEIs offer a M.Sc. Pharm. Degree after a B. Sc. degree in another discipline?||Yes||There is a distance learning system (3 years of study) for assistant pharmacists graduating from the Tallinn Health Care College who wish to become pharmacists.|
|Number of teaching staff (nationals)||18||Includes seven full-time and 11 part-time staff with one visiting professor from the US (social pharmacy).|
|Number of professionals from outside the HEIs, involved in education and teaching||Circa 35||Professionals with a medical background are involved in teaching of courses such as bioethics, pharmaco-epidemiology and pharmaco-economics. |
Pharmacists employed at the State Agency of Medicines, community and hospital pharmacists intervene as visiting lecturers (n = 10).
Pharmacists intervene as supervisors of traineeships at community and hospital pharmacies (circa 20–25).
|Number of places at entry following secondary school||36|
|Applicants per place||Circa 150||Approximately 3.5–4 applicants for each place.|
|Number of graduates that become professional pharmacists||Circa 20–25|
|Entry requirements following secondary school|
|Specific pharmacy-related, national entrance examination||No||Based on the results of secondary school examinations: mathematics, chemistry or biology (70%) and mother tongue (Estonian) (30%).|
|Is there a national numerus clausus?||No|
|Home students||0 €|
|Distance learning||Circa 2500€ per year|
|Major changes before 2019 in Estonia||Yes|
|Year 1||Year 2||Year 3||Year 4||Year 5||Total|
|Year 1||Year 2||Year 3||Year 4||Year 5||Total||%|
|GENERIC + traineeship||14||25||-||14||728||781||23|
|“Comparable degrees with diploma supplement”||Yes||The Diploma Supplement is issued systematically in Estonian, and if needed in English.|
|“Two main cycles (B and M) with entry and exit at B level”||No||At the University of Tartu, the pharmacy studies are not divided into Bachelor and Master cycles. However, professional higher education provided at Tallinn Health CareCollege is in principle comparable with a “Bachelor level” of pharmacy studies at university.|
|“European Credit Transfer System (ECTS) system of credits”||Yes||The ECTS system was adopted in autumn 2009. However, the ECTS system is not linked to lifelong learning system.|
|“Addressing obstacles to mobility”||Yes||The rigid chronology of the course system complicates mobility. To solve the problem, a mobility window (up to 3 months of study abroad) is planned. Language skills and funding are other barriers.|
|The Directive States||How Does/Will This Directive Statement Affect Pharmacy Education and Training?|
|“Evidence of formal qualifications as a pharmacist shall attest to training of |
at least five years’ duration ...”
“ .. four years of full-time theoretical and practical training at a university or at a higher institute of a level recognised as equivalent, or under the supervision of a university;”
“…six-month traineeship in a pharmacy which is open to the public or in a hospital, under the supervision of that hospital’s pharmaceutical department.”
“The balance between theoretical and practical training shall, in respect of each subject, give sufficient importance to theory to maintain the university character of the training”
|The pharmacy curriculum is 5 years and this requirement is fulfilled.|
Our students have 4 years theoretical and practical training at the university and this requirement is fulfilled.
Our students perform the six-month traineeship. At least three months in a community pharmacy and the remaining three months at a community or hospital pharmacy.
From the point of view of the university, it is important to focus on theoretical knowledge in order to prepare the students for further studies (Ph.D.).
The skilful combination of theory linked to practice is a very important tool in a quality teaching process.
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Volmer, D.; Sepp, K.; Raal, A.; Atkinson, J. Pharmacy Practice and Education in Estonia. Pharmacy 2019, 7, 87. https://doi.org/10.3390/pharmacy7030087
Volmer D, Sepp K, Raal A, Atkinson J. Pharmacy Practice and Education in Estonia. Pharmacy. 2019; 7(3):87. https://doi.org/10.3390/pharmacy7030087Chicago/Turabian Style
Volmer, Daisy, Kristiina Sepp, An Raal, and Jeffrey Atkinson. 2019. "Pharmacy Practice and Education in Estonia" Pharmacy 7, no. 3: 87. https://doi.org/10.3390/pharmacy7030087