Creating effective assessment activities for foundation trainees 

Introduction

Foundation trainee pharmacists’ training year can be viewed as a transition from academic study to professional practice. During this 52-week structured placement, foundation trainees are expected to demonstrate competence across a wide range of clinical, professional, and interpersonal skills including independent prescribing. The GPhC provides a comprehensive set of learning outcomes presented in four domains which guide this year of development^​1​. In England, competencies in these outcomes are assessed using the NHS England practice-based assessment strategy^​2​.

This article shows how designated prescribing practitioners (DPPs) and designated supervisors (DSs) can use these two resources to create effective learning opportunities for foundation trainees that enable them to develop and demonstrate prescribing competencies correctly.

This article focuses on the assessment strategy as it applies to foundation trainee pharmacists undertaking their training in England, where programmes are managed by NHS England’s workforce, training and education directorate. Different arrangements and requirements exist in the other UK nations, where foundation training is overseen by their respective education bodies:

• In Scotland — NHS Education for Scotland;
• In Wales — Health Education and Improvement Wales;
• In Northern Ireland — Northern Ireland Centre for Pharmacy Learning and Development.

Trainees, supervisors and DPPs in these nations should refer to their national guidance for details specific to foundation training and assessment.

This article is part of a short series providing practical guidance for designated prescribing practitioners as they support the learning and development of future pharmacist prescribers. It is recommended that you read this article in conjunction with these resources from The Pharmaceutical Journal:

• ‘How to be an effective designated prescribing practitioner’;
• ‘How to optimise the 90 hours of dedicated prescribing practice during the foundation training year’;
• ‘Selecting an appropriate model of supervision for foundation trainees’.

Exploring GPhC learning outcomes and NHS England assessment strategy

Learning outcomes form one of the two parts of the GPhC ‘Standards for the initial education and training of pharmacists’^​1​.

The second part of the standards is related to requirements for all organisations providing initial education and training, which is outside the scope of this article.

The learning outcomes describe the competencies that trainee pharmacists are expected to demonstrate upon successful completion of their initial education and training. There are 55 GPhC learning outcomes, grouped into four domains:

• Person-centred care and collaboration; 
• Professional practice;
• Leadership and management; 
• Education and research.

These domains are linked closely to the nine standards for pharmacy professionals (see Figure 1^​3​), which are professional standards that foundation trainees will be expected to meet once they join the GPhC register. DSs and DPPs should already be familiar with these standards, which can be used as a practical framework for role modelling and the creation of opportunities for trainees to demonstrate competence against relevant learning outcomes. 

The learning outcomes also take into account the Royal Pharmaceutical Society (RPS) ‘Prescribing competency framework for all prescribers’, with the skills and attributes required by a prescriber integrated across all four domains of the GPhC learning outcomes^​4​.

Upon successfully completing their initial education and training, foundation trainees will be expected to have met the learning outcomes outlined in these standards at the required level of competence. They will be expected to have achieved this at the ‘does’ level of Miller’s Triangle for 51 of the 55 learning outcomes, which means they can act independently and consistently in a complex but defined situation (see Figure 2)^​5,6​.

Trainee pharmacists will be required to demonstrate one of the learning outcomes at a minimum of ‘Knows how’ (learning outcome 22) and three at a minimum of ‘Shows how’ (learning outcomes 25, 26 and 44) level of the Miller’s Triangle. The remaining learning outcomes should be demonstrated at the ‘Does’ level.

Assessment strategy

NHS England’s practice-based assessment strategy, which is used in the trainee pharmacists’ foundation training year, is a practice-based assessment strategy that has been developed by NHS England’s ‘Workforce training and education’ directorate^​2​. It was developed to provide a structured means of consistently assessing whether foundation trainees possess the skills, knowledge, understanding and professional behaviours required to meet the GPhC learning outcomes. The use of this assessment strategy has been made compulsory for all foundation training sites in England from 2025/2026 onwards.

The strategy utilises specific practice-based activities (including prescribing) that need to be demonstrated by trainees and recorded in their e-portfolio using the following evidence tools:

• Continuing professional development (CPD);
• Contribution to care logs;
• Final prescribing development review;
• Final sign off and declaration;
• Learning agreement;
• Learning needs analysis;
• Multisource feedback;
• Patient satisfaction questionnaire;
• Progress review;
• Reflective account;
• Supervised learning events.

There are 20 activities that all trainees must complete, along with an additional 8 prescribing activities for trainees on the full GPhC learning outcomes (see Tables 1 and 2). Trainees on the full learning outcomes are those who commenced their MPharm degree after the 2021 GPhC ‘Standards for initial education and training of pharmacists’ had been implemented^​1​. These standards include the incorporation of the skills, knowledge and attributes for prescribing, to enable pharmacists to independently prescribe from the point of registration.

Trainees who are not yet on the full learning outcomes will be working towards the interim learning outcomes, which do not include prescribing. These trainees include those who commenced their MPharm degrees prior to the implementation of the 2021 GPhC standards, and trainees who completed the overseas pharmacists’ assessment programme (OSPAP)^​1​. These trainees will not be able to independently prescribe from the point of registration. 

The strategy is designed so that a foundation trainee completing all the activities can generate multiple pieces of evidence against each GPhC learning outcome, at the appropriate level of Miller’s Triangle.

The activities are organised into two groups: professional development activities and observed clinical activities.

Professional development activities

The professional development activities are subdivided into four themed groups (see Table 1): 

• Personal development; 
• Supplying medicines;
• Education and research;
• Mandatory and specific development. 

Three additional personal development activities related to prescribing must be completed by foundation trainees on the full GPhC learning outcomes.

The completion of these activities is a mandatory requirement of the foundation training programme. These activities must be recorded in the e-portfolio using the following evidence tools provided within the portfolio:

• CPD;
• Contribution to care logs;
• Final prescribing development review;
• Final sign off and declaration;
• Learning agreement;
• Learning needs analysis;
• Multisource feedback;
• Patient satisfaction questionnaire;
• Progress review;
• Reflective account.

Some of these activities have fixed deadlines for completion and recording, such as the progress reviews, while others can be carried out more flexibly during the foundation training period, depending on the trainee’s individual training plan. Details about activities, evidence tools and time scales for each of these activities can be found in Appendix 4 of the ‘Foundation Trainee Pharmacist Programme: Assessment Activities and Tools Guide’^​6​.

Observed clinical activities

Observed clinical activities must also be completed by trainees (see Table 2). Trainees on the full learning outcomes must complete an additional five prescribing activities under the supervision of a DPP. The observed clinical activities fall into one of two themed groups: clinical and patient facing, and prescribing.

Observed clinical activities allow trainees to use their day-to-day practice experiences as evidence of their learning and reflection based on real events and patient interactions. Observed clinical activities enhance and guide a trainee’s learning by offering opportunities to receive structured feedback that highlights strengths and areas for development. Activities should be repeated consistently over time and across a variety of clinical cases. Observed clinical activities should be planned collaboratively between the trainee and supervisor. This approach allows supervisors to track the progress of the trainee across the duration of their training year. A trainee must be directly involved in providing care or a service in these activities to be able to be assessed at the ‘Does’ level of Miller’s Triangle.

The observed clinical activities must be documented within the e-portfolio using the following evidence tools:

• CPD;
• Contribution to care logs;
• Reflective account;
• Supervised learning events.

A minimum of three assessments need to be made of each observed clinical activity using a supervised learning events, which can take the form of:

• Mini-clinical evaluation exercise (mini-CEX);
• Direct observation of practical skills;
• Case-based discussion;
• Medicines-related consultation framework.

This allows the supervisor sufficient opportunities to directly observe the trainee and make an assessment of their ability to consistently demonstrate satisfactory performance.

Permitted supervised learning events for use with an observed clinical activity are shown in Table 3^​2​.

Supplementary evidence

Activities that are additional to those listed within the assessment strategy can also be uploaded to the e-portfolio as supplementary evidence. Supplementary evidence should use the reflective account evidence tool and be mapped to the relevant GPhC learning outcomes.

Examples of activities that could be submitted as supplementary evidence include completion of non-mandatory training (e.g. leadership training). 

Practical approaches to mapping assessment activities to learning outcomes

It is crucial that foundation trainees understand how the learning outcomes, development activities and assessment tools translate to the real world of clinical practice. Foundation trainees also need to know what needs to be achieved (the learning outcomes) and how achievement is measured (assessment activities and tools). Effective mapping work draws on Biggs’ Framework of constructive alignment, where learning outcomes, training experience and the assessment process work together in a complimentary fashion (see Box 2)^​7​.

Mapping learning outcomes also helps to frame individual activities as part of a broader competency framework that collectively allows the trainee to demonstrate the required breadth of experience, skills and knowledge.

For supervisors, mapping learning outcomes helps with planning and can improve the quality of feedback as assessment can focus on specific areas using a consistent framework shared by all foundation trainees. Mapping also helps to inform training needs analysis and provides an indication of progress against the development of prescribing skills. 

NHS England has published indicative learning outcome mapping, which is aimed to serve as a tool for supervisors in planning assessment activities for their trainees^​8​. Being able to see the full range of learning outcomes and assessment activities within one document can improve clarity and allow for more efficient use of time for both supervisors and foundation trainees^​9​. It is strongly recommended that DPPs and DSs access this tool and look at it closely but a selection of mapped prescribing activities are illustrated in Table 4^​8​.  

It should be noted that this mapping is indicative only. The strategy has been created in a way that allows many activities to routinely map to specific learning outcomes but depending on the context, it may be possible for additional learning outcomes to also be mapped. 

Practical steps for supervision

Some practical steps for effective supervision are provided in the article ‘How to be an effective designated prescribing practitioner’, a selection of which include:

• Being clear about roles and responsibilities and available support;
• Taking advantage of available resources to further develop supervisory skills;
• Commitment to development of competence and increasing confidence;
• Building and fostering an appropriate professional relationship with the trainees;
• Having a clear early plan, particularly regarding completing ;
• Building a professional network.

To effectively supervise trainee pharmacists, supervisors need to not only be aware of how the learning outcomes map to the assessment strategy and translates to practice, they should also be able to provide guidance to trainees about this, recognise any inappropriate mapping and provide opportunities for trainees to undertake appropriate activities to meet learning outcomes.

Foundation trainees should also be encouraged to conduct a self-assessment against the learning outcomes at the start of the training year. This will help highlight any competencies requiring early focus. Outcomes linked to priority areas, such as patient safety and prescribing decision-making, should be front-loaded to ensure these essential skills are well-developed.

Evidence building should be integrated into daily practice and gathered consistently across the full year, avoiding any last minute rush. Foundation trainees can be encouraged to consistently review their e-portfolio so they can visualise their progress and identify any gaps in evidence as early as possible.

Before undertaking an assessment, time should be given to identifying the assessment activity and selecting an appropriate assessment tool to use. Supervisors should also review the possible learning outcomes using a mapping guide to see what outcomes the activity covers. This is especially important for DSs or DPPs with limited supervisory experience. 

During the assessment, supervisors should note specific examples of any competencies that were demonstrated and also make note of those that were missed, providing feedback and a debrief at the end of the activity. Feedback should include:

• Acknowledgement of what the trainee pharmacist did well, and the learning outcomes achieved;
• Highlighting any missed opportunities and learning outcomes that could have been achieved but were not (and why they were not);
• Actionable next steps and guidance on how to close the gaps. This should include scheduling follow-up opportunities (e.g. repeating a mini-CEX focused on physical and clinical examination skills) to evidence improvement over time.

DPPs and DSs can also use coaching techniques, asking open questions that encourage self-reflection and help the foundation trainee to self-identify areas of development. Prompts such as: “Which outcomes did this activity demonstrate?” or “Looking back, what could you have done differently to achieve more outcomes?” can be helpful.

Trainees can also be guided towards appropriate models of reflection, such as Gibbs Reflective Cycle^​10​, Driscoll’s ‘What model’^​11​ and Kolb’s Experiential Learning Cycle^​12​.

For more on this, see the article ‘Reflective practice for pharmacist prescribers’. 

The following cases provide some examples showing how assessment activities and learning outcomes map to practice.

Case example 1: Mapping learning outcomes to a prescribing consultation observed clinical activity

A trainee pharmacist in general practice consults with a 58-year-old male with hypertension and type 2 diabetes mellitus. The patient’s blood pressure is 152/94 mmHg, his HbA1c is 62 mmol/mol, and his eGFR is 68mL/min/1.73m². The patient is on metformin 1000mg twice daily, no antihypertensives. The trainee pharmacist reviews the patient’s records and relevant clinical data, local formulary and the NICE hypertension guideline (NG136). 

During the consultation, the trainee pharmacist:

• Gains patient consent at the start of the consultation;
• Builds rapport and demonstrates empathy and with appropriate questioning establishes that the patient’s father was hypertensive and developed a cough with ACE inhibitors (family history);
• Discusses initiation of candesartan (Amias; Neon Healthcare) 8mg once daily, with the patient, after confirming that the dose is appropriate given the patient’s age, medical history and kidney function;
• Discusses side effects and safety nets effectively;
• Discusses lifestyle factors and medication adherence with the patient;
• Books a follow-up appointment; 
• Documents the consultation, updates the patient’s records, and informs the GP and diabetes nurse.

Outcome: The patient is started on candesartan and booked to come in for a follow-up appointment after four weeks.

Learning outcomes achieved:

Other learning outcomes that this activity could map to depending on the specific circumstance of the interaction include:

Assessment tools used: 

Mini-CEX, medication-related consultation framework

Case example 2: Mapping learning outcomes to a history taking observed clinical activity

A trainee pharmacist in a community pharmacy is attending a 35-year-old woman requesting treatment for recurrent migraines. She reports headaches three times per month, lasting several hours, accompanied by nausea and photophobia. She currently self-medicates with over-the-counter ibuprofen 400mg when needed but reports it is becoming less effective. She has no significant past medical history but is taking a combined oral contraceptive pill.

Her recent blood pressure measurement at the pharmacy was 118/76 mmHg and BMI is 22kg/m². She reports having no known allergies. Her mother had migraine and hypertension.

During the consultation, the trainee pharmacist:

• Uses appropriate questioning techniques to gather adequate information about the nature of the headache, headache triggers, medications used, family history, any red-flag symptoms and impact on daily life;
• Identifies possible medication overuse headache risk;
• Checks for drug interactions;
• Explores non-pharmacological triggers, such as stress, caffeine, dehydration, etc.;
• Clarifies patient goals and checks the patient’s understanding of the information being provided;
• Discusses self-care and lifestyle adjustments with the patient;
• Refers the patient to the GP for further assessment and possible preventative therapy.

Outcome: Patient is referred to the GP for further assessment and confirmation of migraine diagnosis.

Learning outcomes achieved:

Other learning outcomes that this activity could map to depending on the specific circumstance of the interaction include:

Assessment tools: 

Direct observation of practical skills, case-based discussion

Case example 3: Assessing trainee performance against learning outcomes and providing feedback

You are carrying out a mini-CEX with a trainee who is completing a prescribing consultation.

Before the activity you identified that learning outcomes 1, 2, 5, 30 and 32 were achievable. 

During the activity you noted that the trainee achieved learning outcomes 1 and 31 but missed learning outcomes 2, 30, 5 and 32.

After the activity the following feedback was provided:

• You acknowledged the patient’s anxiety about starting antihypertensive therapy and reassured them about ongoing monitoring;
• Your renal dose adjustment for ramipril was accurate and you double-checked with the BNF calculator; 
• You explained treatment options clearly but didn’t explore the patient’s lifestyle preferences or readiness to change;
• You chose an appropriate first-line antihypertensive but didn’t explain why this aligned with NICE guidance or consider alternatives for African or Caribbean patients.

Sample next steps:

• Review NICE hypertension guidelines;
• In future consultations, verbalise your reasoning to demonstrate evidence-based decision-making.