In June 2015, the registration examination for the General Pharmaceutical Council (GPhC) — Britain’s pharmacy regulator — had a pass rate of 74% (
The Pharmaceutical Journal 2015:295:100), down from 85% the previous year. This low overall pass rate, together with a higher failure rate in community pharmacy compared with the hospital sector, has drawn attention to current preregistration training schemes and has caused some in the profession to raise concerns over the quality of training offered in community pharmacy.
Not only do the reasons for the low pass rate need to be identified, we also need to make changes that will help future pharmacists meet the expectations of the more clinically focused registration assessment in June 2016, which is set to require a greater application of knowledge to patient care.
The GPhC accredits undergraduate degrees conferred by universities in Great Britain. In its document ‘Future pharmacists, standards for the initial education and training of pharmacists’, the GPhC outlines what it expects of university graduates and how they can be prepared for the preregistration training year. It is the responsibility of the preregistration tutor to ensure graduates become professionally competent to provide high-quality patient care. The tutor is responsible for attesting that a trainee has satisfactorily completed the 52-week training period. Tutors are expected to facilitate a trainee’s self-directed learning and supervise work-based training to reinforce those GPhC-defined outcomes, so as to achieve performance that demonstrates “does” and “shows how” in their field of practice as a pharmacist.
Community pharmacy trainees had a pass rate of 71% compared with hospital trainees, who had a 91% pass rate. This difference in pass rate might reflect the hospital recruitment process, since hospitals can select the best candidates and employ a more rigorous recruitment process. Another possible explanation for this low pass rate is that training in a hospital pharmacy exposes trainees to a more clinically focused learning environment and therefore they stand a better chance of passing the registration assessment.
In 2014, the GPhC produced guidance for tutors (‘Guidance on tutoring pharmacists and pharmacy technicians’) and the Royal Pharmaceutical Society has recently published draft guidance (‘Tutoring for preregistration trainees’).
However, several examples of bad quality tutoring in community pharmacy were identified when academics from King’s College London asked trainees to report their concerns (
The Pharmaceutical Journal 2014;293:428). These included complaints from trainees who had no training plans in place and were not given a suitable induction period. Some trainees complained that they had been left unsupervised without a tutor for lengthy periods, while some had received no feedback about their performance and their competence was not assessed. Other complaints included trainees who were not granted any study time and were not given a suitable handover after a change in tutor.
The GPhC only encourages tutors to attend training sessions rather than making them compulsory. It is difficult to maintain quality across the preregistration training scheme unless each of the 3,300 tutors have the skills required.
Employers, who are reimbursed for taking on trainees, have a responsibility to ensure they are offering high quality education and training to their preregistration trainees. Sending tutors on training programmes is one way to ensure they are able to perform their role competently and can fully support their trainees. But ultimately, accreditation of preregistration tutors would make certain that all trainees receive consistently high-quality support befitting the pharmacy.
Training providers should be accredited to deliver tutor training programmes, which should include regular evaluation of preregistration tutors to ensure that the quality and development of tutors is maintained. It would then be the responsibility of the employer to make sure that tutors complete such training programmes and are certified. In turn, it would ensure that tutors have gained the skills to effectively deliver their role.
The GPhC’s discussion paper on pharmacy education, ‘Tomorrows pharmacy teams’, which closed on 14 August 2015, reinforces the idea that pharmacists need to adapt to working in varied settings in order to become patient-centred clinicians. The barriers that exist between academics and those who are involved in work-based tutoring should be diffused to ensure a closer working relationship.
Applying knowledge in practice
If the preregistration year was integrated with the undergraduate programme (a much discussed idea implemented in only a few universities), preregistration sites and tutors could be quality assured by universities. Until this happens, innovative education solutions are another way to give future pharmacists the opportunity to apply knowledge in practice, regardless of which sector they are completing their preregistration year in.
Cross-sector experience during the preregistration year is vital for trainees and should be arranged wherever possible. However, if arranging these placements is proving difficult, trainees should attend training days designed to simulate the learning they might be missing out on. One example is the ProPharmace ‘Insight into hospital pharmacy’ training day, which was developed to allow trainees who are unable to attend a cross-sector hospital placement the opportunity to gain this experience through a series of workshops.
The development of problem-solving and critical thinking is possible through active learning strategies that include simulations, case studies, guided group discussions and practice-based exercises, as well as objective structured clinical examinations. Such techniques should be taught throughout the preregistration year, with input from experienced academics. There are also many innovative learning technologies that can be used in a classroom-based learning environment, such as video learning and virtual tools to engage trainees and enhance the learning experience. External preregistration training providers, such as ProPharmace, provide these resources.
The GPhC should introduce better quality management systems and act quickly to prevent low standards of training. At the very least, it should require tutors to undertake a certain level of training.
It could also improve regulation of training sites through the pharmacy inspection process. Additional questions to the new “show me, tell me approach” inspection, such as asking preregistration tutors to show the learning contract and in-house training plan, and asking trainees to talk about their experiences, could easily be introduced.
Finally, the board of assessors and the GPhC education team need to act more quickly to support training providers. ‘The guide to the registration assessment from 2016’, published on 28 August 2015, provides information on the format and framework for the assessment in 2016. This should have been published earlier because, by then, many trainees had already started their training.
The GPhC must ensure there is a minimum training requirement for tutors and should support initiatives that encourage trainees in different sectors to have comparable experiences. In this way, all trainees will have the best chance of passing the registration assessment.
Luigi Martini is professor of pharmaceutical innovation at King’s College London, and Noma Al-Ahmed is managing director of Propharmace, a pharmacy training provider.
Declaration of interest: Luigi Martini provides advice to Propharmace.