Pre-registration training: is ‘good enough’ good enough?

Most pharmacy trainees have a good or very good experience during their pre-registration training. However, this is not the case for all, and a survey conducted on behalf of the General Pharmaceutical Council (GPhC) has identified inconsistencies in the current system of tutor training and supervision.

Concerns raised in the survey of 905 pre-registration trainees included: 40% did not feel that they had adequately covered the registration syllabus; 33% who would have liked to undertake cross-sector experience were not given the opportunity to do so; and 24% did not feel fully prepared for the registration assessment. In addition, 19% of trainees were ‘signed off’ as competent based only or mostly on observation, and 18% reported that they had insufficient supervision. Worryingly, by the end of their initial training, 13% of trainees still felt unprepared to practise as a pharmacist.

With this level of concern, we should be asking whether the current programme is fit for purpose and whether pre-registration tutors are providing satisfactory support, an issue raised by Aamer Safdar and Sian Howells of King’s Health Partners in their assertion that “a good student does not necessarily make a good pharmacist”
. That tutors are registered pharmacists, and that trainees pass their registration assessment, may not be sufficient, which calls into question whether just being competent is good enough.

The registration assessment seeks to ensure all pharmacists meet the knowledge and skills expected of a day-one pharmacist — the minimum competence to practise. Do the public and the profession expect more than that? In short, yes: the profession expects us “to be the best we can be” and the GPhC to “uphold standards and public trust in pharmacy”. GPhC places emphasis on the application of knowledge and skills to patient-centred care throughout the pre-registration training year, and this will be better reflected in changes to the registration assessment from 2016.

At the University of Nottingham, we have introduced a five-year MPharm degree with integrated pre-registration training in an attempt to improve the consistency and quality of the pre-registration training experience. The programme maximises the integration of science, clinical knowledge and professional skills and behaviours with patient-centred practice, in two six-month professional (pre-registration) placements, which we believe best prepares students to be pharmacists. University pre-registration facilitators quality assure, develop and support tutors and students during their placements against guidelines developed by the GPhC. We think this offers an excellent model for future five-year integrated MPharm courses. In the interim, pre-registration tutors would be well advised to read an article by Noma Al-Ahmad and Ping Liu on how to make the most of the guidance to support their trainees.

Meeting the expectations of patients and the profession requires trainees, and tutors, to develop their skills consistently in a safe, supervised, “all-teach, all-learn”
 environment, demonstrating both competence and performance. This does not start at the point of registration, nor the beginning of pre-registration training, but at the point of entry into the pharmacy degree. If we are to be the best we can be, then a focus on attitudes, values and professional behaviours is equally important for future pharmacists.

Claire Anderson is professor of social pharmacy at the University of Nottingham School of Pharmacy, and a member of the Royal Pharmaceutical Society’s English Pharmacy Board. Tom Gray is head of professional and clinical leadership at the school, and five-year MPharm lead.