Canadian Pharmacy Students' Knowledge of Herbal Medicine
Johnson, Teela, Boon, Heather, Jurgens, Tannis, Austin, Zubin, Moineddin, Rahim, Eccott, Lynda, Heschuk, Shirley, American Journal of Pharmaceutical Education
Objective. To determine fourth-year Canadian pharmacy students' knowledge of herbal medicine and whether that knowledge is associated with mandatory instruction in herbal medicine.
Methods. Standardized multiple-choice tests assessing students' herbal knowledge were distributed to all fourth-year BSc pharmacy students at 5 pharmacy schools in Canada.
Results. The Quebec response rate was too low to include in the analysis. Herbal knowledge test scores were positively associated with having previously taken an herbal medicine class and completion of a pharmacy practicum. However, postsecondary education, age, and gender were not associated with herbal knowledge test scores. Students at the University of British Columbia had the highest score, followed by Alberta, Nova Scotia, and Ontario.
Conclusion. Pharmacy students' knowledge of herbal medicine varies depending on the school attended and higher herbal knowledge test scores appear to be most closely related to mandatory herbal instruction.
Keywords: herbal supplements, complementary and alternative medicine, assessment
According to the Natural Health Products Directorate (NHPD), 71% of Canadians have taken a natural health product (1) such as herbal remedies; traditional Chinese medicine, Ayurvedic, Native North American medicines; homeopathic medicines; and supplements such as probiotics, amino acids, essential fatty acids, vitamins and minerals. (2) As the demand grows, more pharmacists have begun to stock natural health prodcuts in their pharmacies. In 1999, the growth of natural health products sales in US pharmacies was surpassed only by the growth of Internet and practitioner-direct sales. By 2003, US expenditures on natural health products were estimated at $1.4 billion. (3,4) Together with the increase in sales has come an increase in the number of consumer inquiries. Consumers are looking to pharmacists for evidence-based information about natural health products. (3,5-9) The purpose of this study was to assess the herbal medicine knowledge of graduating Canadian pharmacy students and to explore factors that might be associated with increased herbal medicine knowledge. Herbal medicine was chosen as the topic of focus because herbs are commonly used and frequently identified as a key area where pharmacists' knowledge is lacking. (5,10-12) The popularity of herbal medicines (1,13,14) and their increasing clinical importance (9,15-19) were the 2 driving factors for initiating this study.
Since most natural health products sold in Canada and the United States are purchased from pharmacies, (3,20,21) the pharmacist's role with respect to natural health products is important to consider. (5,14) As health care professionals, it has been argued that pharmacists should be able to provide information about all the products stocked in their pharmacies--patients expect it, and ask questions. (3,6,7,9,12,20,21) Professional associations such as the Canadian Society of Hospital Pharmacists (CSHP), the American Society of Health-System Pharmacists, (22) and the American College of Clinical Pharmacy (ACCP) have each stated that pharmacists' responsibility to improve medication safety by monitoring and preventing adverse interactions includes the risks posed by herb-drug interactions. (9,19,23) The problem, however, is that many pharmacists appear to graduate with little knowledge of natural health products, making them ill-equipped to implement these recommendations. (11,18,24) Aware of this knowledge deficit, these organizations have released position papers advocating for more complementary and alternative medicine (CAM) education for pharmacists in their undergraduate schooling, asserting that without this education pharmacists cannot completely fill their role as information providers to their patients. (9,19,23)
The North American Pharmacist Licensure Examination (NAPLEX) has added a competency that specifically addresses knowledge of dietary supplements (natural health products are referred to as dietary supplements in the United States). …