COVID-19 impact on pharmacy education in Saudi Arabia: Challenges and opportunities

Abstract

The first case of COVID-19 was announced at the end of year 2019, and later many cases were identified worldwide. In Saudi Arabia, the first case was announced on 2 March 2020. To prevent the spread of this pandemic disease, many precautionary actions were taken by Saudi government. One of these actions was closing public and private schools and universities and transfer the educational activities to virtual platforms. All colleges of Pharmacy in Saudi Arabia, whether the 21 public or the eight private ones, were affected by those sudden transitions and their responses varied according to their preparedness levels. Here we shared our experience in king Saud University in the curricular components of pharmacy school that includes classroom teaching, laboratory teaching, experiential training, assessment, and extracurricular activity and student support during COVID-19 compulsory lockdown. Lastly, we presented the lesson learned toward pharmacy education from COVID-19 pandemic.

Full text

Short communication
COVID-19 impact on pharmacy education in Saudi Arabia: Challenges
and opportunities
Mansour Almetwazi
a
, Nourh Alzoman
b
, Shaza Al-Massarani
c
, Aws Alshamsan
d,
⇑
a
Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
b
Department of Pharmaceutical Chemistry, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
c
Departemnt of Pharmacognosy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
d
Nanobiotechnology Unit, Department of Pharmaceutics, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
article info
Article history:
Received 24 August 2020
Accepted 13 September 2020
Available online xxxx
Keywords:
Pharmacy education
COVID-19
Assessment
Lesson learned
abstract
The first case of COVID-19 was announced at the end of year 2019, and later many cases were identified
worldwide. In Saudi Arabia, the first case was announced on 2 March 2020. To prevent the spread of this
pandemic disease, many precautionary actions were taken by Saudi government. One of these actions
was closing public and private schools and universities and transfer the educational activities to virtual
platforms. All colleges of Pharmacy in Saudi Arabia, whether the 21 public or the eight private ones, were
affected by those sudden transitions and their responses varied according to their preparedness levels.
Here we shared our experience in king Saud University in the curricular components of pharmacy school
that includes classroom teaching, laboratory teaching, experiential training, assessment, and extracurric-
ular activity and student support during COVID-19 compulsory lockdown. Lastly, we presented the lesson
learned toward pharmacy education from COVID-19 pandemic.
Ó2020 The Author(s). Published by Elsevier B.V. on behalf of King Saud University. This is an open access
article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
1. Introduction
The World Health Organization (WHO) Regional Office in China
was informed on December 31, 2019, of cases of pneumonia of
unknown causes detected in Wuhan City, which were identified
later on to be among the first cases of COVID-19 reported (WHO,
2020a). On March 2, 2020, the Ministry of Health (MOH) in Saudi
Arabia announced the first positive case of COVID-19 (MOH,
2020a). Then, the WHO announced COVID-19 outbreak as a pan-
demic on March 11, 2020 (WHO, 2020b). As of August 11, 2020,
a total of 291,468 confirmed cases of COVID-19 were announced
in Saudi Arabia (MOH, 2020b). Many precautionary and preventive
actions were taken by the Saudi government to contain the spread
of COVID-19 including temporary closure of universities and other
educational institutions, and the transfer of all educational activi-
ties to virtual platforms (Alshammari et al., 2020).
The Ministry of Education (MOE) called for an online brain-
storming meeting with all Deans from public and private health
colleges in Saudi Arabia and gathered all recommendations. As a
result, MOE published a guidance for university-level examination
and assessment during COVID-19 temporary closure (MOE, 2020a).
All colleges of Pharmacy in Saudi Arabia, whether the 21 public or
the eight private ones, were affected by those sudden transitions,
and their responses varied according to their preparedness levels.
Pharmacy education in Saudi Arabia has been through several
evolutionary stages since 1959. Prior to 2002, King Saud University
(KSU) was the only university in the Kingdom that offers a phar-
macy degree. A four-year Bachelor of Pharmaceutical Sciences pro-
gram commenced in 1959, which evolved into a five-year program
by 1979 with the introduction of clinical pharmacy discipline to
the curriculum. By 2010, the five-year program was renamed as
Bachelor of Pharmacy (BPharm), and a six-year Doctor of Pharmacy
(PharmD) was introduced (KSU, 2020). Both curricula contain
classroom teaching, laboratory and tutorial sessions, as well as
experiential training, and both qualify graduates to be practicing
pharmacists.
During the first few days of COVID-19 outbreak, before the pan-
demic announcement, the College of Pharmacy at KSU has assem-
https://doi.org/10.1016/j.jsps.2020.09.008
1319-0164/Ó2020 The Author(s). Published by Elsevier B.V. on behalf of King Saud University.
This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
⇑
Corresponding author at: College of Pharmacy, King Saud University, P. O.
Box 2457, Riyadh 11451, Saudi Arabia.
E-mail address: aalshamsan@KSU.EDU.SA (A. Alshamsan).
Peer review under responsibility of King Saud University.
Production and hosting by Elsevier
Saudi Pharmaceutical Journal xxx (xxxx) xxx
Contents lists available at ScienceDirect
Saudi Pharmaceutical Journal
journal homepage: www.sciencedirect.com
Please cite this article as: M. Almetwazi, N. Alzoman, S. Al-Massarani et al., COVID-19 impact on pharmacy education in Saudi Arabia: Challenges and
opportunities, Saudi Pharmaceutical Journal, https://doi.org/10.1016/j.jsps.2020.09.008

bled an Emergency Response Team headed by the Dean and
involved Vice Deans and faculties who are involved directly in
the academic and training procedures. Here we shared the experi-
ence of our college in the aforementioned curricular components
during COVID-19 compulsory lockdown.
2. Transitions in classroom teaching
Immediately after the lockdown announcement, transition from
typical classroom teaching to virtual classes was compulsory.
Therefore, in order to ensure the delivery of unified material and
assessments, the college took several measures. First, all students’
sections of the same course were merged in the academic learning
system (Blackboard). Simultaneously, the college (information
technology (IT) unit created video series to guide faculty on how
to use Blackboard to conduct academic activities such as recording
lectures, building exams, and providing any other material. The
videos also covered alternative software options to record lectures
e.g. MS PowerPoint and how to convert such files into Blackboard
compatible format. All videos were revised by the Vice Dean of
Academic and Educational Affairs and approved by the Dean and
got immediately published on the college’s website, YouTube
channel, and Twitter account (YouTube, 2020a). Finally, the college
assembled an on-call technical-support team to assist faculty with
Blackboard. The team was led by the head of IT unit and composed
of male and female faculty members and students who are familiar
with or have been trained on Blackboard.
3. Transitions in laboratory teaching
Laboratory teaching in pharmacy education is essential because
it provides students with necessary hand-on skills that are indis-
pensable to pharmacists. In 2019, the National Center of Academic
Accreditation and Evaluation published national PharmD program
learning outcomes (PLOs). Henceforth, all national PharmD curric-
ula are expected to aim for those PLOs. Among the 18 learning out-
comes, nine outcomes are under the Skills and Practice domains.
This indicates the value of laboratory teaching to understand the
taught subject, improve teamwork skills, and build analytical and
critical skills. As a result of the sudden transfer to virtual teaching,
students inevitably missed the opportunity to comprehensively
acquire laboratory skills. In order to mitigate that impact, labora-
tory sessions were replaced with video demonstrations of experi-
mental work and shared with students. Although this approach
helped students to gain conceptual understanding, students are
still deficient of the hand-on skills. To compensate for this short-
coming, missed skills will be covered in other relevant courses.
Furthermore, the college submitted a recommendation to the Vice
President for Academic and Educational Affairs to be considered as
part of KSU reopening plan where a student section is divided into
two subgroups, and each subgroup will attend a two-period labo-
ratory session every other week. This arrangement aligns with pre-
cautionary measures, including social distancing and compensates
for the intermittent scheduling. Besides, video demonstrations will
be sent to students prior to their attendance to the hand-on session
to minimize their presence time in the lab.
4. Transitions in experiential training
Both Introductory Pharmacy Practice Experience (IPPE) and
Advanced Pharmacy Practice Experience (APPE) are mandatory in
PharmD programs. Two days before the WHO announced that
COVID-19 outbreak is considered a pandemic, the Experiential
Training Unit (ETU) had suspended the training for one week and
worked on a response plan. Regarding IPPE, the college transferred
the training to a virtual dispending platform that was supervised
and monitored by preceptors. IPPE trainees were evaluated accord-
ing to the ETU IPPE manual. On the other hand, APPE was more
challenging to handle as it is composed of an internship year, in
which hospital-based cycles are the majority. During training-
suspension week, all interns were requested to attend the WHO
Infection Control course named ‘‘emerging respiratory viruses,
including COVID-19: methods for detection, prevention, response
and control” (WHO, 2020c). Also, all APPE preceptors were con-
tacted to discuss possible scenarios and methods to provide opti-
mum training. By the end of that week, all interns’ schedules
were updated to be within King Saud University Medical City
(KSUMC) services. Nonetheless, interns were precautionary
banned from entering emergency departments and isolation areas.
Also, interns who in the last eight weeks visited any city or country
that reported COVID-19 cases or developed symptoms suspecting
COVID-19 were asked to declare or self-report to the ETU. Finally,
some cycles were switched to virtual platforms or were conducted
remotely. Interns kept up with regular meetings, discussed clinical
cases, and presented through virtual platforms. As a result, training
hours were not significantly affected, especially that KSU PharmD
curriculum internship exceeds the accreditation requirement.
5. Transitions in assessment
Beside teaching and training, assessment carried a great deal of
challenge after the sudden switch from traditional to virtual educa-
tion. Based on the aforementioned MOE guidance, many methods
of assessment were adopted and suggested, such as open book
exam, portfolio, online multiple-choice questions, assignment,
online presentation, mini-projects, and discussion board (MOE,
2020b). Our college also applied more interactive methods of
assessments, including reflections to specified classes where each
student gave feedback on what he or she had learned, liked, dis-
liked, and how to apply what was learned in practice. This method
is expected to encourage students as well as faculty members to
engage in the class in order to improve teaching and learning
quality.
Regarding final exams, the College Council approved online
exams on Blackboard only. Although students were given two
hours to finish a one-hour long exam, they still had to comply with
the university’s regulation that they will not be allowed to log in
the exam after 30 min. The university also changed the grading
system from traditional grading to a pass-or-fail system. Further-
more, due to the emotional stress students may encounter during
the pandemic, the College Council made all exams not cumulative
where the material covered represents only 20% of the material
taught. The rest 80% were assessed using the alternative assess-
ment methods mentioned earlier.
6. Transitions in extracurricular activity and student support
Although students’ clubs successfully conducted virtual activi-
ties and events, the annual College of Pharmacy Research Day
had to be postponed due to the pandemic. Since 2011, this event
has been held usually around April every year for undergraduate
and graduate students to present their research projects. Albeit,
students were still asked to submit their abstract to the research
committee to evaluate their projects and will be invited to present
their projects in the following year.
On a different note, Academic Advising is ongoing in our college.
During the lockdown, the Vice Dean for Academic and Educational
Affairs assigned staff to communicate with students and solve any
problem they encounter. Moreover, the college designated a What-
sApp account to establish hotline communication with students,
M. Almetwazi et al. Saudi Pharmaceutical Journal xxx (xxxx) xxx
2

where they can send messages anytime, and any issue was
resolved within 24 h. Emails and direct phone communication to
the Dean and Vice Deans were always welcome as well.
Last but not least, every year, the college organizes a cozy grad-
uation ceremony aside from the annual convocation the university
holds. As anticipated, both events were canceled due to lockdown.
Therefore, the college decided to celebrate our graduates in a
unique way. First, the graduates and the Dean recorded taking
the College of Pharmacy graduation oath from home and published
the video online (Youtube, 2020b). Second, the college surprised all
the graduates by sending each one of them a graduation cake with
a congratulation card from the Dean. This small gesture was well
received by the graduates and their families.
7. Lessons learned
Undoubtedly, university education will not be the same after
the COVID-19 pandemic passes (Witze, 2020). Virtual education
has become the new norm, but understanding students’ needs
from distance will be a challenge. Therefore, faculties will need
to acquire new tools and techniques to engage students. Similarly,
the traditional assessment method that only focuses on the exams
must be revised.
University closure and sudden turn to virtual teaching world-
wide have highlighted many conceptual, educational, and techni-
cal gaps. Each university within an educational system reacted
within its constraints. Pharmacy colleges in Saudi universities were
no exception. Although it may not be completely possible to copy a
college’s experience, we are sharing ours with an understanding
that a framework can be drawn and applied by the other Saudi
colleges.
Being part of KSU, our college was supported with multiple
enablers that facilitated such a quick transition in educational
style. KSU has invested generously in the electronic Learning Man-
agement System. For instance, whether used by an instructor or
not, all registered students were automatically synchronized in
Blackboard and their records were accessible to the instructor.
Moreover, KSU has subscribed to many software and platforms
that provided alternative or complementary virtual classes and
meeting options such as MS Teams and Zoom. Furthermore, the
Deanship of e-Transactions and Communication has increased its
technical support capacity to compensate for the suddenly massive
demand from e-learning users. At the college’s level, faculty coop-
eration was phenomenal. As soon as the College Council enforced
Blackboard for teaching and assessment, faculties complied with
that sudden switch. Also, many faculties volunteered in the col-
lege’s tech-support team to help their colleagues over. It is worth
noting that a number of instructors have been using Blackboard
for assessment and material sharing with students before the pan-
demic existed. This enabled quick sharing of knowledge among
colleagues. On a side note, the management system enforced by
academic accreditations participated indirectly to facilitate such
a quick educational transition. Beside the ISO 9001 certification,
the College of Pharmacy at KSU obtained accreditations and certi-
fications for the undergraduate program from the Canadian Coun-
cil for Accreditation of Pharmacy Programs (CCAPP), the
Accreditation Council for Pharmacy Education (ACPE), the National
Center for Academic Accreditation and Evaluation (NCAAA), and
the American Society of Health System Pharmacists (ASHP) for
the residency program. The positive impact of accreditations fulfil-
ment allowed harmonized and nearly unified teaching, training,
and assessment with high quality. Furthermore, the Saudi Pharma-
ceutical Society (SPS) is nested within the College of Pharmacy at
KSU. This enabled our students and faculty to be immediately
aware and participating in SPS activities, which included important
mini virtual conferences organized by SPS concerning Pharmacy
Education during COVID-19 pandemic.
Apparently, challenges still exist despite the aforementioned
enablers and strength points. Although we carefully planned and
implemented our measures, we faced unanticipated hurdles.
Blackboard downtime was longer than expected, especially during
peak synchronized teaching periods. Therefore, the College Council
instructed all departments to gather recorded lectures and share
them with students via One Drive-based links since KSU has
already provided each faculty member with one-terabyte storage
size. Moreover, the Vice Dean for Academic and Educational Affairs
has been submitting weekly follow-up reports to the Dean. This
process accelerated the resolution of conflicts or misunderstand-
ings when applying the newly enforced assessment methods. It
was also an opportunity to revise and update our teaching and
assessment policies and procedures.
Our college is associated with King Saud University Medical City
(KSUMC), which fairly secured the integrity of our APPE training.
This association is a major strength point not every national phar-
macy college got privileged with. Nonetheless, we had to embrace
weekly updates from KSUMC management on interns’ permission
to the hospital. Moreover, some hospital staff were too busy to
dedicate time to supervise or train interns. And to add insult to
injury, some interns faced family pressure to refrain from coming
to the hospital. As we believed that Pharmacy interns are part of
healthcare team and to assure that all interns provide the health
care services during this outbreak with full safety precautionary
we asked all preceptors in KSUMC to provide as many online clin-
ical training and case discussions as possible to cover all learning
objectives
We believe that COVID-19 has impacted Pharmacy Education
worldwide. Many pharmacy colleges can relate to the challenges
we experienced and speak to the opportunities we expose. We
anticipate a paradigm shift in Pharmacy Education where global
critical transitions, such as social distancing, will dictate. With
the unprecedented dependence on online services, simulation
has never been closer to the real world and pharmacy curricula
must live up to the new-norm expectation.
Declaration of Competing Interest
The authors declare that they have no known competing finan-
cial interests or personal relationships that could have appeared
to influence the work reported in this paper.
Acknowledgment
The authors would like to acknowledge all faculty members,
staff, students, and preceptors from different practice cites for their
unstoppable cooperate during this COVID-19 outbreak. The
authors akcnowledge the support of the College of Pharmacy
Research Center, Deanship of Scientific Research, King Saud
University.
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