The registration assessment for pharmacists in Britain is set to change in 2016 in the most radical overhaul since 1993. The assessment will soon have a stronger focus on patients and include questions on high-risk medicines, patients and clinical cases. Most questions will be scenario based, and will encourage candidates to apply their practical knowledge.
The changes are aimed at the first cohort of pharmacy students who completed their degree under standards introduced in 2011 by the British pharmacy regulator, the General Pharmaceutical Council (GPhC). The modifications shifted the focus of pharmacy degrees to be more clinical, reflecting the changes to practice in recent years.
Candidates will now have to use their judgement to choose the single best answer for some questions where several correct answers may be available, which mimics decision-making in practice. They will have access to a wider range of information sources, and will have to make treatment decisions based on photographs. Straightforward recall and retrieval of information will no longer be core to the assessment. Instead, the emphasis is on application of knowledge. Calculations will now use realistic numbers because calculators will be provided for the first time — patients no longer have to weigh 70kg for ease of arithmetic, for example.
However, some of the plans have received a mixed response, with the most controversial of the changes being that trainees can no longer bring their personal copy of the British National Formulary (BNF) to the assessment. Under the current rules, trainees can tag their BNF in any way they choose for ease of navigation. (The BNF is jointly produced by The BMJ and Pharmaceutical Press, which also publishes The Pharmaceutical Journal.)
In the new assessment, candidates will be provided with relevant extracts of the BNF, along with artefacts from clinical practice, such as summaries of product characteristics and drug charts. Critics are concerned that trainees will no longer be able to locate information quickly in the BNF, and believe this is an important skill in practice.
At a GPhC meeting in London on 3 March 2015 organised for stakeholders, its head of education Damian Day stressed that the BNF remains a core text but said: “We had to think about the risk of there only being an online BNF in maybe two or three years.” However, Karen Baxter, BNF editorial director, says: “While the BNF supports NHS aspirations for a digital future, we are aware that there remains a strong demand for the print BNF. Consequently we will continue to produce a print edition twice yearly while such demand continues.”
Day also said that it can be difficult to make a judgement about whether candidates have included cheat notes in their BNF. One way to avoid this problem would be to provide a clean copy to all candidates. However, Chris Langley, who sits on the GPhC board of assessors, emphasised that although the ability to locate information in the BNF is a skill that should be assessed, it should not be assessed under exam conditions. Instead, this should be tested during practice throughout the pre-registration year.
Time of change
The argument about whether candidates should have access to the full printed BNF or extracts of it will soon be out of date. Digital resources are becoming more popular in practice and any assessment should reflect this change. The prescribing safety assessment, an exam for junior doctors, is taken online and, crucially, candidates have access to the BNF on MedicinesComplete at any time. Olga Sierocinska King, senior policy and project officer at the Medical Schools Council, said the exam is designed to mirror practice as closely as possible. The GPhC has indicated that it does intend to move to an online assessment, but said this was not currently feasible.
The exam should only be a supplement to the pre-registration experience as a whole — a way to help ensure that any unsuitable candidates who have passed their pharmacy degree and were signed off by a tutor are not able to register. A written assessment cannot test all elements of the syllabus, but must focus on essential knowledge. There is no change to the requirement that trainees must complete all 76 standards throughout their pre-registration year.
Community versus hospital
In 2014, a survey from the GPhC indicated that trainee pharmacists who worked in the community sector were more likely to be dissatisfied with their training than their hospital counterparts. Since, arguably, a hospital placement is more likely to provide trainees with more in-depth clinical training, the new assessment style may put community trainees at a further disadvantage. When asked about this, Lisa Smith, GPhC assessment writing manager, said that the questions would not have a clinical bias but would be more patient focused, with some questions suited to community trainees and others more relevant to those from a hospital setting.
The GPhC says the best way to prepare for the new assessment is to gain experience throughout the pre-registration year, so tutors should closely examine the changes to the assessment in order to guide their trainees. Trainees will need to understand more about the tutors’ decision-making processes in practice, and those tutors who write example questions will need to note the new style. This suggests that any variability in tutor quality will be magnified, despite the regulator having no immediate plans to accredit tutors.
Instead, the GPhC plans to address this issue if the five-year integrated pharmacy degree is implemented. Under this system, the pre-registration year would be undertaken before the pharmacy student graduates. If this happens, the pre-registration experience is likely to change more substantially than in 2016. For now, though, these changes are to be welcomed as a move to improve the quality of new registrants and, ultimately, patient safety.