Standardization in the Evaluation System of Pakistan's Pharmacy Institutes
I am immensely pleased that my letter “Unstandardized and Defective Evaluation Practices in the Examination System in Pharmacy Institutes of Pakistan”1 has been the center of attention among Pakistan's pharmacy academics and authorities controlling the examination system, leading to a debate on the existing unstandardized evaluation practice. However, a response letter from Mahmood and Usman2 suggests the need for an explanation of some of the facts and latest advances related to standardization in pharmacy education in Pakistan. 
 
At present, 3 types of examination systems are being used in Pakistan: semester without external evaluation, semester with external evaluation, and annual with external evaluation. The first is being practiced in all private and few public sector institutions, whereas the latter 2 are in use in most of the public sector and a few private institutes affiliated with public-sector universities. The grading scheme in all these systems is quite dissimilar. 
 
In collaboration with the Higher Education Commission of Pakistan, the Pharmacy Council of Pakistan devised the doctor of pharmacy (PharmD) curriculum in 2004 for both annual and semester systems without mentioning the need for external evaluation or the timeframe for adapting to a single system in the country. This is the root cause of unstandardization.3 Mahmood and Usman2 witnessed the defects of the annual system, which prompted institutions to slowly adapt to a semester system. However, this report was neither factual nor evidence-based, but rather a mere assumption. Standardization cannot be achieved by adapting a single examination system without incorporating a standardized grading procedure. 
 
A good examination system whether annual or semester, indicates what is taught and how it is taught. Moreover, evaluation outcomes allow teachers to tailor teaching strategies and methodologies that may improve both teaching and learning. Presently, such goals are a daydream, particularly in public sector institutes. My previous letter was not a comparison between semester and annual systems but rather an attempt to draw the attention of the authorities to a few points that need to be addressed in support of pharmacy students. 
 
Contrary to the opinions expressed by Mahmood and Usman,2 my letter1 indicated that the examination of theory in the annual system was quite fair. The real hitch was student failure of the practical examination because they failed the oral examination portion, which accounted for 20% to 30 % of the total grade. This situation was grave because students who failed either the theory (written) or practical (oral) portion had to retake both examinations, despite that the subjects were independent. Furthermore, there is no professional body comprised of institutional-level experts who are available to lend a hand to students by investigating this situation. 
 
In 2004, pharmacy academia separated the 2 examinations, which resulted in some improvement, but there was still a need to further refine the system. As a result of some of the remaining problems, some students fail and discontinue their education or require psychiatric care. Some reported cases of suicide could have been avoided by establishing a body of experts to probe the reasons for failure and counsel students. Counseling or psychoanalysis of failing students can play a pivotal role in improving the success rate among this group and decreasing depression that leads to suicide. 
 
Turning a blind eye to the grave incidences of suicides by considering them isolated reports in this and other countries, as mentioned by Mahmood and Usman,2 is beyond comprehension. In my opinion, based on my experience as officer in charge of examinations, a mentor needs to be vigilant to students who do not achieve the required outcome and has a paternal role to motivate and guide such fellows. A teacher may be more inclined to do so if he/she is held accountable for ghastly results, but at present, this is not occurring at most of Pakistan's institutes. In this context, a recent healthy development occurred when a vice chancellor of a public sector university ordered that a teacher would be held responsible if the failing rate in his class was more than 10%. 
 
I am encouraged that the National Test Service, a public sector organization, has taken the initiative to launch a pharmacy subjects-based Graduate Assessment Test (GAT), which is compulsory for those intending to pursue higher education.4 The Punjab Public Service Commission conducted an examination of over 10,000 candidates who were competing for 117 vacant positions in the Hospital Pharmacists/Inspector of Drugs in the Punjab Health Department. Despite the graduate assessment requirement, only 1290 candidates passed the examination and were invited to appear in front of a board of experts for final selection.5 
 
There is still a dire need for the Pharmacy Council of Pakistan to take an affirmative role in controlling/restricting growth in the number of pharmacy institutes in the country, improving the standard of education, and producing pharmacists needed to meet the national demand. Moreover, the council needs to ponder the prevailing employment situation before accrediting new pharmacy institutes because there is already an unemployment problem and the jobs that are available pay exceptionally low wages. If the number of pharmacy institutes in Pakistan is allowed to increase, increasing the number of pharmacists in the country, it will only exacerbate the unemployment problem.6 There is a dire need for a mandatory GAT-type test for the registration of pharmacists with provincial pharmacy councils, which is obligatory for pharmacy practice in Pakistan.