Pharmacy students in their fourth year are currently in the midst of their final university exams, or are awaiting their results. They will then be getting ready to begin their pre-registration year. Some of these students are the first to be educated under the ‘Future pharmacists’ learning outcomes, which were introduced in 2011, and will therefore be the first to sit the registration assessment in its new format in 2016.
For trainees, the pre-registration year should be exciting, challenging and rewarding but to make it a success they will need the right support from their tutors.
A summary of changes to the exam
For the 2016 registration assessment, all open book reference sources, including the British National Formulary (BNF), will be replaced with artefacts from clinical practice
. These artefacts could include BNF excerpts, patient information leaflets or clinical data. Candidates will also be allowed to use a calculator during the new two-hour, 40-question calculations paper
to mirror daily practice. The second part of the assessment will have a simplified format, with only two types of question — single best answer and extended matching
. Multiple completion and assertion reason questions will no longer be used
. On the whole, the questions will be more patient-focused and require candidates to apply their knowledge to decide on the best answer.
Exam versus the pre-registration year
Trainees can often become fixated on the registration assessment at the expense of other aspects of the pre-registration year – this could be a particular problem if individuals are anxious about the impending changes. Therefore, it is important to remind all trainees that the pre-registration year is not just about an exam, but about learning how to practise in a way that delivers the best outcomes for patients and members of the public
The registration assessment provides a national standard for all pre-registration trainees and, as such, is fair because the same paper is attempted by all candidates wishing to register as a pharmacist, regardless of university, training site or future career aspirations.
To complement the assessment, the practical training is designed to test that a trainee can demonstrate consistently high standards of personal effectiveness, interpersonal skills and safe and appropriate use of medicines and provision of health advice
. Successful demonstration of the relevant performance standards and outcomes should result in final sign-off by the tutor.
As a tutor, you need to undertake an appraisal of your trainee every 13 weeks, which provides the opportunity for open and honest two-way feedback. It is important that you are assessing them fairly and objectively to ensure they are given an opportunity to adapt their behaviour, if necessary. Feedback has been identified as one of the five principal factors underpinning successful learning and should motivate trainees to apply experience from early in the training year to make their future work better
. When providing feedback to your trainee, it should be constructive, evidence-based and delivered in a controlled, honest and open way. A trainee may need to receive more feedback at the earlier stage of their training year on their verbal communication style, while later in the year feedback on their leadership skills may be more beneficial.
You should also seek feedback on your own performance as a tutor from your trainee so that giving and receiving feedback is a two-way and regular practice for both of you.
Tutors need to be sure they are familiar with the pre-registration syllabus. When it is released for the 2015 intake, you must ensure you understand the content clearly Â– this will include being aware of which ‘Future pharmacist’ outcomes will be tested in the assessment.
In general, the MPharm graduate of 2015 will have had more patient contact and more interprofessional learning opportunities than those before. They will have a strong clinical and science knowledge base so, during the pre-registration year, they should learn how to bring all this knowledge together and use it on a daily basis.
Tips for writing practice questions
Many tutors provide their trainees with mock exam questions or even full papers. For the 2015–2016 trainee, any previously written questions will need to be reviewed in light of the changes. Tutors should ensure they are clear about these changes and provide accurate information to their trainee from the outset of their training year. The GPhC website currently has extensive information on the changes to the assessment for 2016, as well as exemplar questions.
If you write any practice questions, ensure you assess them critically before exposing your trainee to them. It can be useful to write questions reflective of real patient scenarios you have encountered in your practice.
You must ensure that for every question you write there is one, and only one, correct answer. Remember, the British National Formulary (BNF) will no longer be allowed in the exam hall and so testing your trainee on how quickly they can find a table in the BNF is no longer necessary.
The calculation questions will now ensure that the trainee can actually work out the correct answer — because these questions will no longer be multiple choice, trainees will not be able to guess answers. It is therefore critical that you take advantage of any opportunity to help the trainee hone their numeracy skills throughout the year, for example by asking them to calculate how many tablets to dispense or work out how much of a cream needs to be weighed when making a mixture.
Extended matching questions have a list of potential answers that must be matched to question stems. Each potential answer on the list may be used more than once, or not at all. If you are planning to write some extended matching questions, you should decide upon the theme (e.g. analgesics) and then write an option list, usually of eight options (e.g. diclofenac, ibuprofen, paracetamol, etc), a lead-in statement and then at least two question stems (e.g. a 50-year-old, who has a stomach ulcer but no other significant medical history, has requested an over-the-counter analgesic to treat a headache which he has been experiencing for the past two hours).
Well-constructed extended matching questions have a homogenous list of options that are fairly concise while the actual question stem will typically be longer to include necessary detail, for example, about the patient, their disease state and drug treatment. The trainee should be able to formulate a correct answer to the question without having to look at the options list.
Single best answer questions are designed to assess the higher levels of knowledge essential for pharmacy practice, such as data interpretation, problem solving and decision making. When writing single best answer questions, you should ensure that the question is clear and includes all necessary information, while avoiding distracting content. Your questions should usually be focused around a patient and may require the use of supplementary reference material to answer it (e.g. a set of laboratory test results, an image or an excerpt from the BNF).
For pre-registration trainees to perform well in the 2016 assessment, it is important that they have the correct knowledge base but they must also know how to apply their knowledge and make decisions.
Understanding their decision-making processes
Standard ten of the ‘Future pharmacist’ outcomes requires that MPharm students know how to make decisions
and so talking to your pre-registration trainee about what experiences they have had to date with decision making may be a good starting point. He or she may discuss team-based learning activities, advice they gave to a patient during hospital or community pharmacy placements or prescribing decisions they have made for a fictional patient during an undergraduate module.
It can be helpful to reflect upon decisions you have to make in your daily practice with your trainee and then encourage him or her to share similar experiences with you. This will help trainees to make structured conscious decisions of their own.
Throughout the pre-registration year, the trainee will be making decisions on behalf of patients and engaging patients in their own decision making. As a tutor, you need to ensure that this is an active rather than a passive process for your trainee and that he or she is consciously aware of the steps they are going through. Encouraging your trainee to maintain a learning log of daily activities and significant events in the workplace can be helpful, especially if he or she considers the entries later and develops them into a reflective portfolio. Your trainee may have already engaged in this process during their undergraduate study, so ask about prior experience in advance. Decisions can range from deciding on the most appropriate course of action for a patient with a productive cough to dealing with a patient who has missed their methadone supply for the past three days and now presents in the pharmacy. You need to take the time to support your trainee with making decisions and, ultimately, being able to defend them.
 Smith L. The registration assessment from 2016; more detail on the papers. General Pharmaceutical Council; February 2015.
 General Pharmaceutical Council. Pre-registration manual, version 3.2. London: General Pharmaceutical Council; 2015.
 Race P. Making learning happen. London: Sage Publications; 2005.
 General Pharmaceutical Council. Future pharmacists: standards for the initial education and training of pharmacists. London: General Pharmaceutical Council; 2011.