The pharmacy preregistration training year is important for the development of trainee pharmacists. It is the responsibility of the preregistration training provider and the tutor to give trainees the necessary support and exposure to a wide range of experiences.
However, when the preregistration year does not meet expectations, a trainee may become unhappy and request to transfer to an alternative placement. To minimise the risk of this happening, it is important to identify and address the reasons for discontent early on. The steps below demonstrate how to do this, using a case study as an example (see Box).
Box: case study — a trainee who wants more study time
Dele* is a preregistration trainee who has four hours’ protected study time per week. He tells his tutor that this is insufficient compared with the study time he used to have at university. In addition to his usual protected study time, he would like to:
- Take his study time at home because he has caring responsibilities for his parents;
- Take one day of annual leave per week during the last 26 weeks of his training;
- Spend one day each week at a busier branch;
- Bring forward any study time that falls after the General Pharmaceutical Council registration assessment to use it as part of his preparation.
Dele informs his tutor that if the above conditions are not met, he may be forced to look for an alternative preregistration training placement.
*This case is based on a real scenario and has been anonymised.
When issues with training arise, it can be difficult to know how to address the situation. The steps below can be used as a general guide to help tutors identify and resolve issues around trainee dissatisfaction. It is important to remain empathetic towards the trainee throughout the process, even if a solution to the problem cannot be found.
Step 1: Determine the root causes of dissatisfaction
Before potential solutions can be identified, it is important to speak to the trainee and understand why they are not content with the training they are receiving. Asking the trainee why they are unhappy and how they feel their tutor/training provider can help them to best address the situation.
If the reason for dissatisfaction is a personal grievance between the trainee and their tutor, then the training provider should take the appropriate steps to resolve this and seek advice from the organisation’s human resources (HR) team (if available) or organisations such as Health Education England (HEE), the General Pharmaceutical Council (GPhC) and Royal Pharmaceutical Society (RPS) Professional Support.
Study time should be agreed upon by both parties, ideally before or as soon as training commences
The circumstances in the case study are a result of Dele’s misguided expectations around the amount of study time owed during his preregistration training. This could be the result of a misunderstanding between Dele and the training provider.
Although the GPhC does not define how much study time should be given or what it should look like, it does state that the employer should be “providing you with appropriate time to study and reflect on your learning (by mutual agreement)”. Study time can take many forms, but should be agreed upon by both parties, ideally before or as soon as training commences.
Step 2: Identify potential solutions
The tutor should discuss the trainee’s situation with the relevant parties from the employing organisation (e.g. HR) in order to identify potential solutions acceptable to the trainee, the organisation and the rest of the pharmacy team. Consider whether a similar issue has arisen previously — perhaps at a different branch of a pharmacy chain. How was this managed? Can any learnings from the previous instance be applied to the current situation?
It may be necessary to seek guidance from an external party, such as the GPhC or RPS Professional Support. A discussion should be held around how to avoid a similar situation occurring in the future and how the necessary actions should be implemented. All discussions and evidence of action should be documented.
In the case study, there are several other ways in which Dele’s employer can support him. For example, if the pharmacy has long opening hours, flexible working arrangements could be instated — provided this can be managed within the pharmacy team. However, this would be more difficult to establish if it is a small independent pharmacy. Dele could also be more creative with how he uses his annual leave, as long as this is discussed and agreed with his tutor.
Step 3: Discuss potential solutions with the trainee and agree on a plan of action
An open conversation should take place between the trainee, tutor and a representative from the employing organisation, explaining why all, some or none of what the trainee is asking for can be granted.
Rejecting a trainee’s requests outright could negatively impact their training or the overall running of the pharmacy
Rejecting a trainee’s requests outright could negatively impact their training or the overall running of the pharmacy. Proposed solutions should then be discussed and a plan of action that includes realistic time frames should be agreed. This will go a long way towards helping the trainee feel heard and supported. The necessary steps required to improve the situation will depend on individual circumstances. Both the trainee and the tutor should try to find an acceptable solution for all parties, including the wider pharmacy team, and the agreed plan should be discussed and documented.
In Dele’s case, his employer and tutor explain that they are sympathetic to his situation, but the approval of study time and annual leave is at the discretion of the tutor and is subject to company policy, which Dele agreed to when he accepted the position.
While this is a difficult situation, approval of Dele’s requests would result in him being unsupervised for prolonged periods of time — the GPhC stipulates that at least 80% of the trainee’s working hours must overlap with their tutor’s. Dele’s absence from work could also impact on the running of the pharmacy, which could jeopardise both patient and staff welfare. Therefore, in this case, the employer is unable to approve Dele’s request, but alternative ways of working to support Dele are discussed and agreed upon. This included altering Dele’s working hours to help him meet his supervised training requirements with the allocated protected study time, while fulfilling his caring responsibilities.
Dele accepts the decision and a two-week trial period is introduced to determine whether he is better able to manage his work–life balance. If this is unsuccessful and Dele is still dissatisfied, another conversation must had so that he can re-evaluate his options.
Step 4: Monitor and re-evaluate progress
Regular monitoring and review should occur on an ongoing basis according to the agreed time frames. This could involve, for example, weekly or fortnightly catch-ups between the trainee, tutor and a representative from HR (if required) to ensure that the action plan is adhered to and continues to be agreeable for all involved. Regular progress meetings will also allow an opportunity for any new issues to be discussed and resolved in a timely manner.
If a trainee decides to leave, it is crucial that the relevant stakeholders are informed
Dele’s tutor will check in with him every week to see how he is managing for the remainder of his training. With the support of his tutor and the wider pharmacy team, along with the extra flexibility around his work hours, Dele was able to meet the necessary training standards with the allocated four hours of study time and provide his parents with the care they required.
What to do if a trainee still decides to move placements
If no solution can be found and the trainee still wishes to move placements, then it is important that an employer does all they can to assist the trainee in finding an alternative placement with minimal disruption to their training. This is especially important when circumstances are out of the trainee’s control, such as when the employer is no longer able to provide a tutor. However, if the problem is the result of a request made by the trainee that is deemed unreasonable, the employing organisation may not have any responsibility towards them. This is also the case with any unreasonable requests made by other staff members opting to leave the workplace.
If a trainee does decide to leave their current placement, it is crucial that the relevant stakeholders are informed. This includes the GPhC, HEE and the employing organisation’s HR team.
How employers and tutors can minimise trainee disappointment
An excellent induction period will help minimise any disappointment felt by trainees during their preregistration training. A conversation between the trainee and tutor outlining the expectations of both parties should occur prior to training, or as early into training as possible.
The ‘Kiddy Ring interview’ is a tool used by educational supervisors in medicine (see Table). It includes a structured conversation that lasts 30–45 minutes on the trainee’s first day. This allows both the trainee and tutor to discuss expectations, gives the tutor enhanced insight, and allows identification of areas which may require attention.
Employers should ensure trainees are allocated a suitably experienced pharmacist who understands their role as a tutor. If a tutor is inexperienced, a senior tutor should ideally be allocated to mentor and provide support to the junior tutor. The GPhC has clear guidance on what is required from a preregistration tutor.
In addition, tutors should encourage an open and safe learning environment with regular meetings or informal conversations with their trainee. This will help identify problems early on, allowing resolution before extreme action, such as switching sites, becomes a necessity. It is important that the wider pharmacy team is aware of the trainee’s role and their learning objectives, which can help avoid any misunderstanding among the team.
If any changes to training or employment occur, this needs to be communicated to the trainee as early as possible and the correspondence must be documented.
|Present job title||Expectations and aims (50% of interview)||Clinical, communications and motivation|
|Aspirations||Short-, medium- and long-term||N/A|
|Interests||Sports and/or pastimes||What does this say about the trainee? How will you relate to them?|
|Circumstances||Location, mobility, family, medical, constraints and finances||Impact on trainee and work|
|Early life||Birthplace, family, occupations and values||Emotional stability and negative events|
|Education||Type of school, subjects and weak areas||Grades and causes of failure|
|Early jobs||Type of work, duration and skills learned||Transferable skills and expected competency|
|Source: Reading and Newbury Vocational Training Scheme. Available at: http://www.readingvts.org/wp-content/uploads/2013/11/Adapted-Kiddy-ring.doc|
Additional sources of information and advice
- Regional HEE training programme directors if the training placement is listed through Oriel;
- The National Pharmacy Association provides support to community pharmacies;
- Large companies will have a centralised HR/training team which can provide advice;
- RPS Professional Support can provide confidential advice and support to members;
- The GPhC provides support on the regulation processes if a trainee is switching sites and can signpost the employer to the regulations for preregistration training. National preregistration facilitators can provide impartial advice to tutors and employers.
About the authors
Aamer Safdar is pharmacy, education, training and workforce development team lead at Barts Health NHS Trust;
Khalid Khan is head of training and professional standards at Imaan Healthcare and preregistration training programme director at Health Education England.