Iraqi J Pharm Sci, Vol.21(1) 2012                                  Clinical pharmacy training program in Iraq 

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Implementation of a Clinical Pharmacy Training Program in Iraqi 

Teaching Hospitals : Review Article 
Jawad I. Rasheed *

,1
       and       Hassan M. Abbas* 

 

* Baghdad Teaching Hospital ,Medical City, Baghdad, Iraq. 

 

Abstract 
Pharmaceutical care is a patient-centered, outcomes oriented practice that requires the 

pharmacist to work in concert with the patient and the patient’s other healthcare providers to promote 

health, to prevent disease, and to assess, monitor, initiate, and modify medication use to assure that 

drug therapy regimens are safe and effective. In addition, the presence of clinical pharmacists has led to 

a higher quality of patient education and provision of complete detailed information for patients. In 

developed countries Pharm D has become the professional degree for practice of Pharmacy. The 

graduates will be enrolled in a pharmacy residency program; admission to the residency programs is 

available to Pharm D graduates of an accredited College of Pharmacy. The residency is also designed 

to prepare the residents to become Board Certified Specialists in their field.  In many developing 

countries three new pharmaceutical education programs have currently been established to serve the 

pharmaceutical care development. Firstly, a six-year curriculum leading to the doctor of pharmacy 

(Pharm. D) degree as the sole professional degree. Secondly, Pharmacy Residency and Fellowship 

Training Program have been developed to provide intensive training in pharmaceutical care practice to 

the pharmacists. Lastly, the continuing pharmaceutical education program (CPE) has been adopted to 

ensure the competency of all pharmacists to deliver the best knowledge and skills in pharmaceutical 

sciences in their specialties. In our opinion we lack for most of these programs, even the program of 

clinical pharmacy in ministry of health is not residency program and it is short and not subspecialized 

apart from being not recognized by academic institutes and references.  In conclusion, pharmacy 

profession has to change towards the more responsibility on patient care. New training program has to 

be adopted by medical education institutes to provide clinical pharmacists as a profession and to 

prepare board certified clinical pharmacists as specialists to cope with the advances in all medical 

fields. 

Key words: clinical pharmacy, board certification.  

 

  لمراجعتل: مقالت تطبيك البرنامج التدريبي للصيدلت السريريت في المستشفياث التعليميت في العراق
رشيد* إبراهيمجىاد 

،1
 و       حسن محمد عباس*        
 

 * ِسخشفً بغذاد اٌخؼٍٍُّ ، ِذَٕت اٌطب ، بغذاد ، اٌؼشاق

 

 الخالصة 
ٔحى اٌّشَط واٌّخىخهت ٔحى  إٌخائح اٌخٍ حخطٍب صُذٌٍ سشَشٌ  اٌشػاَت اٌصُذالُٔت هٍ اٌّّاسست اٌؼٍُّت  اٌّشوضة

َؼًّ بخٕاسك ِغ اٌّشَط وِمذٍِ اٌشػاَت اٌصحُت األخشَٓ ِٓ أخً حؼضَض اٌصحت ٌٍىلاَت ِٓ األِشاض واٌششوع باٌّؼاٌدت ِغ حمُُُ  

صُذٌٍ سشَشٌ َؤدٌ اًٌ  إداسة دوائُت  وسصذ وحؼذًَ اسخؼّاي اٌذواء ٌعّاْ ٔظُ اٌؼالج باٌؼمالُش بصىسة إِٓت وفؼاٌت. اْ وخىد

أوثش أِأا ؤخائح أفعً ٌٍّشظً  واسخخذاَ اِثً ٌٍذواء وباٌخاٌٍ خفط حىاٌُف األدوَت. وباإلظافت إًٌ رٌه، أدي وخىدهُ إًٌ اسحفاع 

د( هٍ  -ُذٌٍ ) فاسَفٍ اٌبٍذاْ اٌّخمذِت أصبحج شهادة اٌطبُب اٌص .خىدة حثمُف اٌّشَط، وحىفُش ِؼٍىِاث حفصٍُُت واٍِت ٌٍّشظً

اٌذسخت اٌّهُٕت اٌّطٍىبت ٌّّاسست اٌصُذٌت. حُث ٍَخحك اٌخشَدىْ فٍ اٌصُذٌت ببشٔاِح اإللاِت؛ إْ اٌمبىي فٍ بشاِح اإللاِت ِخاحت 

دة د  ِٓ وٍُاث ِؼخّذة فٍ اٌصُذٌُت. وحهذف االلاِت أَعا إًٌ اػذاد صُادٌت ِمُُّٓ  ٌُصبحى  ِخخصصُٓ ِؤهٍُٓ بشها -ٌخشَدٍ فاسَ

فٍ اٌبىسد  فٍ هزا اٌّداي. فٍ اٌىثُش ِٓ اٌبٍذاْ إٌاُِت فٍ اٌىلج اٌشاهٓ هٕان ثالثت بشاِح حذسَبُت خذَذة اٌخٍ أٔشأث  ٌخذِت اٌخُّٕت 

أوال، وظغ ِٕهح دساسٍ ٌّذة سج سٕىاث، ٌُؤهً إًٌ دوخىس صُذٌٍ وذسخت ِهُٕت وحُذة، ثأُا حُ حطىَش بشٔاِح  اٌشػاَت اٌصُذالُٔت.

ت واٌضِاٌت ٌخىفُش اٌخذسَب اٌّىثف فٍ ِّاسست اٌشػاَت اٌصُذالُٔت ٌٍصُادٌت. وأخُشا، حُ اػخّاد بشٔاِح اٌخؼٍُُ اٌصُذالٍٔ اٌّسخّش اإللاِ

ِٓ وخهت ٔظشٔا،  إٔٔا ٔفخمش ٌّؼظُ هزٖ  ٌعّاْ اٌىفاءة ِٓ خُّغ اٌصُادٌت ٌخمذَُ أفعً اٌّؼاسف واٌّهاساث فٍ اٌؼٍىَ اٌصُذالُٔت.

فٍ بشٔاِح اٌصُذٌت اٌسشَشَت فٍ وصاسة اٌصحت فهٍ ٌُسج بشاِح الاِت وّا أها لصُشة وٌُس ِخخصصت فعال ػٓ اٌبشاِح، حخً 

فٍ اٌخخاَ، ِهٕت اٌصُذٌت َدب أْ حخغُش ٔحى اٌّضَذ ِٓ اٌّسؤوٌُت ػًٍ سػاَت  .وىٔها غُش ِؼخشف بها ِٓ لبً اٌّؤسساث األوادَُّت

الػخّادها ِٓ لبً ِؤسساث  اٌخؼٍُُ اٌطبٍ ٌخىفُش اٌصُادٌت اٌسشَشَُٓ وّهٕت وإػذاد  اٌّشظً. وّا َدب حبٍٕ بشاِح خذَذ ٌٍخذسَب

 . اٌصُادٌت  اٌّخخصصُٓ بشهادة اٌبىسد اٌسشَشٌ ٌٍخؼاًِ ِغ اٌخمذَ فٍ خُّغ ِداالث اٌطب

 : الصيدلت السريريت ، شهادة البىرد المفتاحيت  الكلماث 

         

 
1
 Corresponding author E- mail : jawadnephroclinic@yahoo.com 

Received : 9/10/2011 

Accepted : 15/2/2012 

mailto:jawadnephroclinic@yahoo.com


Iraqi J Pharm Sci, Vol.21(1) 2012                                  Clinical pharmacy training program in Iraq 

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Introduction  
Clinical pharmacists started their 

contributions to medicine in the 1960s and 

have come to be crucial members of medical 

teams as seen today in hospitals in developed 

countries. The presence of clinical pharmacists 

resulted in a safer medication administration, 

better patient outcomes, lower use and 

therefore lower costs of drugs. In addition, 

their presence has led to a higher quality of 

patient education and provision of complete 

detailed information for patients 
(1-4) 

.The 

purpose of this paper is to provide an overview 

to institutions considering the implementation 

of a clinical pharmacy program as part of their 

health care system. We provide a review of the 

current literatures supporting this 

program.Involvement of clinical pharmacists 

in patient care in the inpatient hospital setting 

results in safer and more effective medication 

use 
(1)

. These pharmacists are typically 

involved in assuring appropriate prescribing 

and administration of drugs, monitoring patient 

adherence to therapy, providing drug 

information consultation to providers, 

monitoring patient responses and laboratory 

values, and providing patient and provider 

education
(5)

. Data suggest that medication 

errors are a significant contributor to errors in 

the emergency department, as well as in the 

inpatient setting 
(6)

, a study found that 3.6 

percent of patients were prescribed an 

inappropriate medication in the emergency 

department, and 5.6 percent of patients were 

prescribed one upon discharge 
(7)

.  

 

Development of Pharmaceutical 
Education  
Far East experience  

 Now, as there is an upsurge in 

clinical pharmacy, many developing countries 

have expanded their pharmacy curriculum to a 

5- or 6-year program that issues a doctorate of 

pharmacy degree. However, it is still to be 

determined whether these countries are 

genuinely interested in a practice-based model 

or simply want their graduates to enroll in the 

US system 
(8, 9)

.  Three new pharmaceutical 

education programs have currently been 

established in Far East to serve the 

pharmaceutical care development. Firstly, a 

six-year curriculum, leading to the Doctor of 

Pharmacy (Pharm D) degree as the sole 

professional degree adopted  in 1999 by many 

colleges of pharmacy. Students required to 

complete 6 clinical clerkship rotations in the 

final year of the program to assure that they 

will develop the technical skills, professional 

judgements and competencies necessary for 

entry into the pharmacy profession. Recently, 

the Pharmacy Council of India (PCI) decided 

to introduce PharmD (post-bacclaureate 

degree) courses for the first time in the country 
(8, 10)

.  Secondly, pharmacy residency and/or 

fellowship training programs have been 

developed since 2000 in order to provide 

intensive training in pharmaceutical care 

practice to the pharmacists. Prince of Songkla 

University and Naresuan University has 

currently adopted this program under 

supervision of The College of 

Pharmacotherapy. Areas of specialty that are 

available for training are internal medicine, 

infectious diseases, cardiovascular diseases, 

oncology, critical care and pediatrics
(11, 

12)
.Lastly, the Pharmacy Councils have 

established the continuing pharmaceutical 

education program (CPE) since 2002 to ensure 

the competency of all pharmacists to deliver 

the best knowledge and skills in 

pharmaceutical sciences in their specialties. 

The program allows a pharmacist to update 

his/her knowledge and skills by attending the 

pre-approved academic meeting or reading the 

pre-approved article-related to pharmaceutical 

sciences. At least 10 CPE hours yearly and a 

total of 100 CPE hours per 5 years must be 

achieved by a pharmacist prior to continue 

active status of his/her pharmacist license. 

Currently, al least 70 - 80% of pharmacists 

participated in this program
 (11, 13)

. 

 

Middle East experience  
Interestingly institutions in the 

middle- east countries like Saudi Arabia, 

Jordan, and Kuwait started 5-6 year Pharm D 

degree courses 
(14)

. Egypt too started their 

clinical pharmacy courses in the curricula of 

undergraduate, or specializing training courses 

in this field for postgraduates 
(15)

.The Saudi 

council for health specialties adopted a clinical 

pharmacy residency program; this council 

offered a residency program with accredited 

training for two years and eventually will grant 

the graduate a board certification of clinical 

pharmacy after passing the final exam 
(16)

.Residency Program in Clinical Pharmacy in 

Jordan was established in 1996 to prepare 

clinical pharmacists to work in medical teams 

to provide high quality medical services and to 

put the clinical pharmacists in the right way for 

improving their career, at the end they will be 

eligible for promotion for the job of specialist 

and consultant in clinical pharmacy. It is four 

year scientific training program after the B Sc 

pharmacy, through which the pharmacist will 

be resident working with a medical team and 

will be in direct contact with the patients. The 

candidate will prepare daily reports and attend 

lectures and medical meetings under 



Iraqi J Pharm Sci, Vol.21(1) 2012                                  Clinical pharmacy training program in Iraq 

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supervision. He will pass through twelve 

departments, cardiology, hematology, 

oncology, neurology, communication skills, 

and clinical pharmacy departments 
(17)

.In 2006 

they improved the program to specialization 

rather than general clinical pharmacy; 

accordingly the resident will choose one or two 

specialties at the final year of residency 

program. The clinical pharmacist will be 

specialist after finishing this program. He will 

be eligible for farther promotion in the 

profession as senior specialist and consultant 

in clinical pharmacy depending on the 

scientific work and research
 (17)

.  

  

The clinical pharmacy in developed countries  

A doctor of pharmacy degree 

program must have a multidisciplinary 

curriculum that produces pharmacists with 

sufficient mental acuity to differentiate their 

position from that of simply dispensers of 

drugs to that of providers of pharmaceutical 

care. The Pharm D program in the United 

States is the epitome of the practice-based 

model 
(18- 21)

. The American College of Clinical 

Pharmacy’s (ACCP) 10–15 year vision for the 

profession is that pharmacists will be health 

care providers who are accountable for optimal 

medication therapy in the prevention and 

treatment of disease. To achieve this vision, 

the profession must ensure that there will be an 

adequate supply of appropriately educated and 

skilled clinical pharmacists 
(22, 23)

. By the 

beginning of 1990s, the American association 

of colleges of pharmacy and the American 

pharmacy professional organizations jointly 

took an unanimous   decision to make Pharm D 

as the minimum requirement for practice of 

Pharmacy in their country.  This has positively 

influenced the pharmacy educational 

institutions and authorities through out the 

world to take proper precautions at their 

countries.   All the Western / European 

countries rose to the occasion and took timely 

decisions to introduce Pharm D 
(, 24, 25)

.  

 

The Cleveland Clinic Foundation, 
as a model for implementing the 
clinical pharmacy program  

 It is an integrated health care 

system, a one thousand bed tertiary and 

primary care hospital; it manages over 2 

million patient visits annually. The Department 

of Pharmacy provides services 24 hours a day. 

The 200 plus departmental personnel include 

pharmaceutical care specialists, staff 

pharmacists, managers, technicians, and other 

supportive staff. Admission to the residency 

program at Cleveland Clinic is available to 

Pharm D graduates of an accredited college of 

pharmacy. The residency is a specialized one-

two year training program which enables the 

successful resident to develop an expert level 

of competence in clinical pharmacy.  The 

residency is also designed to prepare the 

resident to become a Board Certified 

Specialist
(26)

. 

 

Board Certified Pharmaceutical 
Care Specialists  

The primary purpose of 

specialization in any health care profession is 

to improve the quality of care individual 

patients receive, to promote positive treatment 

outcomes, and ultimately, to improve the 

patient’s quality of life. Specialties evolve in 

response to the development of new 

knowledge or technology that can affect 

patient care.  Board certification for health care 

practitioners is well established as an essential 

element of quality assurance and professional 

privileging.  Future clinical pharmacy 

practitioners should be board-certified 

specialists; this is the vision of ACCP in 20–30 

years. Accordingly most clinical pharmacy 

practitioners will be board-certified specialists 

by adopting a training program 
(18)

. For more 

than 30 years, the Board of Pharmacy 

Specialties (BPS) has provided specialty-level 

certification programs for pharmacists – both 

nationally and internationally. Board of 

pharmaceutical specialties will grant the 

clinical pharmacist practitioners the specialist 

degree when they fulfill the requirements: 

pharm D degree, residency program, 

fellowship with thesis, and passing the 

specialty exam 
(27)

.  
 

 The program of clinical pharmacy   
  in Iraq  

The newly graduate pharmacists can 

be enrolled in this program for one year under 

training at teaching hospitals. They will be 

legally obliged to work as clinical pharmacists 

for five years according to the need. This 

program was established at ministry of health. 

It is a practical initial solution of the problem 

of clinical pharmacy in Iraq. Till now it is a 

successful program. But from the other side, 

the program is not recognized by ministry of 

higher education, and it is neither a residency 

program nor specialized. Actually it will not 

cover the advances in medicine and it is not 

going parallel with medical upgrading.Board 

certification program is the major step in 

upgrading of medical profession to improve 

patients care in Iraqi hospitals. Adoption of 

Arab board program followed by Iraqi board as 

part of improving patient care and promoting 

research were very successful expressing the 



Iraqi J Pharm Sci, Vol.21(1) 2012                                  Clinical pharmacy training program in Iraq 

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cooperation between ministry of health and 

ministry of higher education to improve health 

system in Iraq. At the same time, the process 

of improving pharmaceutical care was limited; 

there was simple role of educational institutes 

of ministry of higher education. The role was 

restricted to ministry of health in the form of 

one-year program of clinical pharmacy. As a 

conclusion, the practice of clinical pharmacy, 

as well as clinical pharmacy education, varies 

significantly throughout the world. To 

implement or at least to start such approach; 

there must be well-planned execution of good 

clinical pharmacy practice in developing Iraqi 

health system. Upgrading of primary pharmacy 

education will support local pharmacy practice 

and permits for international recognition of 

Iraqi graduates. This review may recommend 

application of new postgraduate training 

programs like board training or fellowships to 

support the practice of clinical pharmacy as 

initial step. Establishment of (the scientific 

council of clinical pharmacy) at ministry of 

higher education to create a recognized 

professional training program in clinical 

pharmacy will be the complimentary step in 

upgrading health system to provide an 

optimum patient care. Upgrading of clinical 

pharmacy profession through a board 

certification program will be the logic step in 

this regard.  

 

Acknowledgement 
We thank professor Alaa 

Abdulhussain ,  the dean of college of 

pharmacy. Professor  Ibrahim Adham,  for 

providing the necessary facilities.  

 

References  
1. Horn E and Jacobi J. The critical care 

clinical pharmacist: evolution of an 

essential team member. Critical Care 

Medicine 2006;34: S46-S51. 

2. Kucukarslan SN, Peters M, Mlynarek M 
and Nafziger DA. Pharmacists on 

rounding teams reduce preventable 

adverse drug events in hospital general 

medicine units. Arch. Intern. Med. 2003; 

163: 2014-2018. 

3. Buurma H, De Smet PA, Leufkens HG 
and Egberts AC. Evaluation of the 

clinical value of pharmacists’ 

modifications of prescription errors. Br. J. 

Clin.Pharmacol. 2004; 58: 503-511. 

4. Dooley MJ, Allen KM, Doecke CJ, 
Galbraith KJ, Taylor GR, Bright J and 

Carey DL. A prospective multicentre 

study of pharmacist initiated changes to 

drug therapy and patient management in 

acute care government funded hospitals. 

Br.J.Clin.Pharmacol. 2004; 57: 513-521. 

5. Society of Critical Care Medicine and the 
American College of Clinical Pharmacy. 

Position paper on critical care pharmacy 

services. Pharmacotherapy 2000; 20: 

1400-1406.   

6. Hafner, JW, Belknap SM, Squillante, 
MD, et al. Adverse drug events in 

emergency department patients. Ann 

Emerg Med 2002; 39: 258-267.    

7. Chin MH, Wang LC, Jin L, et al. 
Appropriateness of medication selection 

for older persons in an urban academic 

emergency department. Acad Emerg Med 

1999; 6: 1232-1242.   

8. Naushad M. Khan Ghilzai, Arjun P. 
Dutta. India to introduce five-year Pharm 

D program [letter]. American Journal of 

Pharmaceutical Education 2007; 71(2): 

Article 38. 

9. Melody Ryan,  Hong Shao, Li Yang, 
Xiao-Yan Nie, Suo-Di Zhai, Lu-Wen Shi, 

and William C. Lubawy. Clinical 

Pharmacy Education in China. American 

Journal of Pharmaceutical Education 

2008; 72 (6): Article 129.  

10. Lincy S. Lal and Padma G. Rao.  Clinical 
pharmacy education in India.  Am J 

Health-Syst Pharm. 2005; 62:1510-1. 

11. Paveena Sonthisombat, Sutthiporn 
Pattharachayakul, Chalermsri 

Pummangura. Development of 

pharmaceutical education emphasizing on 

pharmaceutical care: Thailand experience 

.The 4th Asian Conference on Clinical 

Pharmacy 2004. Home page. Available 

from www. 4.samford. edu/ 

schools/pharmacy/ijpe/104/accp04.pdf. 

Accessed May 20, 2011. 

12. Khurrum Ghani, Wasif Gillani, Maria 
Ghani. Pharmacy teaching and practices 

problems in Developing Countries: 

Review. International Journal of 

Pharmacy Teaching & Practices 2010; 1 

(1): 11-17. 

13. Singapore pharmacy board. A guide to 
compulsory CPE for pharmacists 2006. 

Home page. Available from 

www.spb.gov.sg.Accessed May 20, 2011. 

14. Mayyada Al-Wazaify,  Lloyd Matowe, 
Abla Albsoul-Younes, and Ola A. Al-

Omran. Pharmacy Education in Jordan, 

Saudi Arabia, and Kuwait. American 

Journal of Pharmaceutical Education 

2006; 70 (1) Article 18.  

15. Wafaa M.EI. Clinical pharmacy in Egypt. 

IJPTP, 2010; 1 (2): 18‐19. 
16. Saudi council for health specialties. 

Pharmacy Practice Residency Program, 

http://www.spb.gov.sg/


Iraqi J Pharm Sci, Vol.21(1) 2012                                  Clinical pharmacy training program in Iraq 

5 

 

first version  2002. Home page. Available 

from www.scohs.org. Accessed May 20, 

2011. 

17. Jordanian Royal Medical Services. 
Pharmacy Profession Evolution at the 

Royal Medical Services. Home page. 

Available from www.jrms.gov.jo.  

Accessed May 1, 2011. 

18.  American College of Clinical Pharmacy. 
Future Clinical Pharmacy Practitioners 

Should Be Board-Certified Specialists. 

Pharmacotherapy 2006; 26(12):1816–

1825. 

19. American College of Clinical Pharmacy. 
ACCP defines clinical pharmacy. ACCP 

Rep 2005;24(8):1–2. 

20. Shazia Jamshed, Zaheer Ud Din Babar, 
Imran Masood.The PharmD Degree in 

Developing Countries.  American Journal 

of Pharmaceutical Education 2007; 71 (6) 

Article 125.  

21. Accreditation Council for Pharmacy 
Education. Standards and guidelines for 

the professional program in pharmacy 

leading to the doctor of pharmacy degree. 

2006. Available from http://www.acpe-

accredit.org/pdf/ACPE_Revised_PharmD

_Standards_Adopted_Jan152006.pdf. 

Accessed May 20,2011  

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

22. American College of Clinical Pharmacy. 
The Definition of Clinical Pharmacy. 

Pharmacotherapy 2008;28(6):816–817. 

23. American College of Clinical Pharmacy. 
Interprofessional Education: Principles 

and Application. A Framework for 

Clinical Pharmacy. Pharmacotherapy 

2009; 29(3):145e–164e.  

24. American College of Clinical Pharmacy. 
A vision of pharmacy’s future roles, 

responsibilities, and manpower needs in 

the United States. Pharmacotherapy 

2000;20:991–1020. 

25.  American College of Clinical Pharmacy. 
The strategic plan of the American 

College of Clinical Pharmacy. ACCP Rep 

2002;21(10):S1–7. 

26. Cleveland Clinic Foundation Home page. 
Available from www.clevelandclinic.org. 

Accessed May 20, 2011. 

27. Board of Pharmaceutical Specialties. 
Candidate’s Guide 2011. Home page. 

Available from www.bpsweb.org. 

Accessed May 20, 2011.  

http://www.jrms.gov.jo/LinkClick.aspx?link=249&tabid=159
http://www.jrms.gov.jo/LinkClick.aspx?link=249&tabid=159
http://www.jrms.gov.jo/
http://www.acpe-accredit.org/pdf/ACPE_Revised_PharmD_Standards_Adopted_Jan152006.pdf.%20Accessed%20May%2020,2011
http://www.acpe-accredit.org/pdf/ACPE_Revised_PharmD_Standards_Adopted_Jan152006.pdf.%20Accessed%20May%2020,2011
http://www.acpe-accredit.org/pdf/ACPE_Revised_PharmD_Standards_Adopted_Jan152006.pdf.%20Accessed%20May%2020,2011
http://www.acpe-accredit.org/pdf/ACPE_Revised_PharmD_Standards_Adopted_Jan152006.pdf.%20Accessed%20May%2020,2011