Preregistration pharmacy training is competency-based, where a trainee’s performance and competency is mapped against a framework of performance standards and learning outcomes outlined by the General Pharmaceutical Council (GPhC). Workplace-based assessment (WBA) tools are a valid and reliable way to assess competency in the workplace. They are also regularly used within other aspects of healthcare training, such as medicine and postgraduate pharmacy. Currently, there are no acknowledged WBA tools used in UK preregistration pharmacy training, and there has been limited research into their use in pharmacy training.
With proposed changes to foundation pharmacy practice, the pharmacy education and training department at Leeds Teaching Hospitals NHS Trust developed a novel WBA tool for pharmacy and assessed the views and experiences of preregistration pharmacist trainees and tutors on its use. This tool is available here:
An amalgamation of three recognised tools used within postgraduate pharmacy training (case-based discussion, mini clinical examination and direct observed patient consultation), the tool includes a six-point Likert scale ranging from ‘significantly below expectations’ to ‘significantly above expectations’, and focuses on activities, including consultation skills and treatment recommendations. Space for written feedback from tutors, specifically comments on where the trainee’s performance was ‘particularly good’ and ‘suggestions for development’, was also included. It was hoped that the tool would allow for tutors to work directly with their trainee in the workplace and assist trainees in meeting GPhC performance standards and learning outcomes that are more easily met through observation (e.g. demonstrating professional behaviour).
Trainees and tutors were briefed on use of the tool prior to its pilot during the 2018/2019 pharmacy preregistration training year.
Following the use of the tool for six months from the start of the 2018/2019 training, data were then collected on its use. A triangulation method, which included semi-structured interviews with the preregistration pharmacist manager (who was involved in designing the tool) and two focus groups, were carried out — one with preregistration pharmacist trainees (n=7) and one with tutors (n=5). Participants were recruited through email using an independent gatekeeper and written consent was gained from all participants prior to taking part in the research. Interview and focus groups were recorded and transcribed to allow for thematic analysis.
Three global themes emerged: the tool’s clarity of purpose, feedback to preregistration pharmacist trainees and the tool as an assessment. Views differed on why the tool was implemented and its purpose, highlighting the importance of a good implementation strategy when making significant changes in practice. Overall, trainees felt implementation of the tool was the most valuable aspect of their training, and particularly appreciated the instant feedback they received. Tutors also recognised its significance and found it helpful in providing more opportunities to directly observe their trainee in the workplace, which meets one of the purposes of the tool. However, interestingly, trainees did not necessarily perceive the tool as an assessment and the need for the inclusion of the six-point Likert scale was questioned. In light of this, it should be considered whether supervised learning events would be the way forward for pharmacy training — in line with medical training — therefore removing the Likert scale and changing the focus of the tool from assessment to supportive practice, which encourages feedback.
Despite study limitations, including the small sample size and experience of one trust, the tool was positively received by both trainees and tutors. These initial findings informed further further development of the tool, including reducing the Likert scale to three points for more clarity for use in the current 2020/2021 training year, and a new specific training session on the tool was held for stakeholders. The new version of the tool is available here:
Further feedback from the current cohort of preregistration pharmacist trainees at the trust will be gathered at the end of their training year to continue to support future development of the tool.
As new initial education and training standards for pharmacists are introduced in 2021, this research highlights the value of a WBA tool and how it encourages focused feedback, which trainees appreciate. It would therefore be interesting to explore how larger-scale rollout and implementation of the tool would be perceived by preregistration trainees, alongside its potential use in other sectors of pharmacy.
Nooria Azeez, advanced clinical pharmacist — respiratory medicine, Leeds Teaching Hospitals NHS Trust; Clare Roberts, advanced clinical pharmacist — education & training, Medicines Management & Pharmacy Services, Leeds Teaching Hospitals NHS Trust; and Helen Bradbury, associate professor, pharmacy education and professional lead for pharmacy, School of Healthcare, University of Leeds.
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