Pharmacy practice has changed a lot in the past 22 years but the pharmacy registration assessment has not — until now. The General Pharmaceutical Council has announced that the format of the assessment is set to change in 2016 to reflect changes in practice and the changes to the pharmacy degree that it introduced four years ago.
According to a recent meeting that the GPhC held on the subject, the content of the exam will not be substantially changing, and each question will still be mapped directly to the syllabus. However, instead of testing pure recall, the questions will be designed to test whether you can apply knowledge. The focus of the questions will be mainly on high-risk patients, conditions and medicines, and will not normally test trivial or obscure topics or drugs. And the assertion-reason questions (“Statements 1 and 2 are correct, and statement 2 is a correct explanation of statement 1”) have been scrapped because they have been deemed too ambiguous.
Pre-registration trainees who are sitting either the June or September assessment in 2015 will not be affected — the changes will be applied for the first time in the June 2016 exam. However, any trainee who fails the September 2015 sitting, and chooses to resit, will have to take the new style of exam in 2016.
The morning paper
The calculations in the morning assessment are a source of great anxiety to many trainees, with many turning to them first and spending extra time on them to the detriment of the other questions. In acknowledgement of this, the morning paper has been reduced in length from three hours to two will now consist exclusively of 40 calculations. For the first time, candidates will be provided with calculators, which means that real numbers can be used (e.g. patients may weigh 74kg instead of the usual 70kg) because the arithmetic no longer needs to be straightforward.
The calculations questions will not be multiple choice. Instead, space will be provided for rough working (although working will not be marked) and candidates will fill in their own free-text answers. The units will be provided in the answer box — but trainees should be aware that units may not necessarily match those given in the questions, so they should take care to ensure the magnitude of their answer is correct. Additionally, where appropriate, the number of decimal places an answer should be rounded to will be provided.
The afternoon paper
The afternoon assessment will now run for 2.5 hours, and consist of 120 multiple choice questions of two different types: 90 single best answer and 30 extended matching. The paper may also include some simple calculations, although a calculator will not be provided — these questions will assess a candidate’s sense of number and magnitude, rather than their mathematics skills.
In the current assessment, trainees are permitted to bring their own copy of the British National Formulary, tagged in any way they like, to the open-book paper. However, this will not be the case in 2016. Instead, candidates will be provided with a range of relevant artefacts, including summaries of product characteristics, patients’ medicines charts, extracts from the BNF and photographs of certain medical conditions to help them answer the questions. Extra reading time will not be provided, but is included as part of the overall 150 minutes.
Questions will usually be based around a patient in a real-life scenario, to help candidates think about applying their knowledge in practice.
Single best answer questions can be answered more quickly than the extended matching questions, which are more useful for testing therapeutic areas. As the name suggests, single best answer questions will require candidates to choose one answer from a list. However, in answering the question will need candidates to exercise some level of judgement because several options may technically be correct, but only one will be the best. Options will be given in alphabetical or numerical order and will be written in lower case.
For the extended matching questions, a list of options (usually eight) will be provided. The candidate will then be given a list of scenarios or patients, and be asked to match each one to one of the options. Each option may be used once, more than once or not at all. For both types of question, candidates should be able to provide an answer without looking at the options.
Single best answer
Mr A, who is 82 years old, has been in hospital for 3 weeks for the treatment of high severity community-acquired pneumonia. He has developed a Clostridium difficile infection. Mr A has no known drug allergies.
Which is the single most appropriate antibiotic to treat the Clostridium difficile infection?
A. co-amoxiclav tablets
B. co-trimoxazole tablets
C. doxycycline capsules
D. erythromycin tablets
E. vancomycin tablets
Extended matching questions
A. codeine phosphate liquid
B. diclofenac suppositories
C. ibuprofen liquid
D. morphine sulfate tablets
E. oxycodone injection
F. paracetamol tablets
G. pethidine injection
H. tramadol tablets
For the patients described, select the most suitable analgesic from the list above. Each option may be used once, more than once, or not at all.
1. A 4-year-old boy who has no long-term medical conditions has sprained his ankle earlier in the day and is experiencing mild pain. An ice pack was used immediately after the injury and the ankle is slightly swollen. The boy is allergic to penicillins.
2. A 66-year-old woman has severe chronic pain from ovarian cancer. She is prescribed levothyroxine sodium for hyperthyroidism and solifenacin succinate for urge incontinence. She has no known allergies. She has been using co-codamol 30/500 mg at the maximum recommended dose but this is no longer controlling her pain.
Passing the exam
The pass mark for both papers will be around, but not exactly, 70%. The actual pass mark will rely on decisions made about the difficulty of the questions by a new standards setting panel and may be adjusted once the assessment has been taken.
The GPhC is planning to pilot the new format of the exam before September, so some of the above may be subject to change. However, any alterations will be finalised before the new intake of trainees begin their training.