PJ view: It is time to think beyond the pharmacy registration exam

The way pharmacists entering the profession are assessed has to change to ensure they are equipped with the tools to thrive in today's NHS.
student writing notes looking at a laptop

It will be a huge relief to most provisionally registered pharmacists to finally know that they can stay on in the profession that they have been working in for nearly a year.

Figures from the General Pharmaceutical Council (GPhC) show that more than 90% of provisionally registered pharmacists passed the March 2021 registration assessment — fantastic news for a new generation of pharmacists who have already more than proved their mettle.

Working during a pandemic, coping with the uncertainty of their registration status and taking a completely new online exam has taken its toll; however, the experience of provisionally registered pharmacists this past year — as highlighted in our recent podcast  — has raised fundamental issues with the registration exam.

“Jumping through that hoop still seems unnecessary, when a lot of this stuff doesn’t even seem relevant,” one provisionally registered pharmacist told us about the exam after eight months in the job. And this illustrates the wider problem with having a high-stakes, all-or-nothing written exam as the gateway to what is now a largely clinical profession.

A ‘summative’ assessment — as the registration exam currently is — is a measure of the knowledge a candidate has retained, or how they are able to apply it, at a certain point in time. It is also a good way of having a clear bar that candidates either pass or fail.

But summative assessment is less effective at encouraging ongoing learning and improvement, as more ‘formative’ learning assessments do. It also tends to dominate other forms of ongoing learning.

As Hannah Kinsey, lecturer in pharmacy practice at the University of East Anglia, wrote in an opinion piece for us in 2020: “The multiple-choice format of the clinical paper promotes a surface approach to learning” and it takes precedence for trainees over their preregistration portfolio, which is designed to help them develop the practical skills they will need to thrive as a pharmacist in today’s health service.

Other healthcare professionals are assessed using both methods. For instance, GP trainees undergo an ‘applied knowledge test’, a multiple-choice test (summative); a ‘clinical skills assessment’, a role-playing test of clinical and communication skills with actors pretending to be patients (summative); and a ‘workplace-based assessment’, an ongoing record of learning recorded by the trainee over time (formative).

However, the building blocks for a change in approach are slowly coming into place for pharmacy. As part of its review of education and training standards, the GPhC has said that it is already looking at the timing of the registration exam.

This year, those on the interim foundation programme had access to an e-portfolio from the Royal Pharmaceutical Society to record their progress, and hopefully this will continue for those on the full foundation programme from this summer (as the preregistration training year will now be called).

However, the form of assessment is but one problem — The Pharmaceutical Journal has highlighted inequalities for a long time in the pass rates for the registration assessment, particularly for those in community pharmacy placements and certain ethnic minority groups.

The GPhC is due to publish its expectations of how the new pharmacy foundation year will work as the first graduates enter it this summer, and it is important that this includes a rethink of the way pharmacists are judged to be fit to enter the profession.

This is crucial to also ensure that all new pharmacists are properly equipped to take on all of the roles expected of them post-registration, particularly if the ambition is to eventually have everyone become an independent prescriber immediately post-registration. PJ

Last updated
The Pharmaceutical Journal, PJ, May 2021, Vol 306, No 7949;306(7949)::DOI:10.1211/PJ.2021.1.83048

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