The pharmacy registration assessment must change if foundation pharmacist training is to succeed

The pharmacy registration assessment was the most challenging exam I have ever undertaken — the pressure to pass was enormous. Four years at university, followed by one year of preregistration training and my ability to register as a pharmacist rested on whether I was able to pass this assessment.

The exam cast a dark cloud over my preregistration training experience, often inhibiting me from making the most of opportunities to learn in the workplace because I was focused on revision.

For students of the future, pharmacy training is going to look a little different. From July 2021, foundation pharmacist training will replace preregistration pharmacist training and, ahead of its November council meeting, the General Pharmaceutical Council (GPhC) shared a draft vision of the future of pharmacy education and training (a final version is set to appear in December). The papers identify a new set of learning outcomes and standards for the initial education and training of the future workforce. The papers also indicate that the foundation training year will be followed by a registration assessment.

However, as a profession, we need to discuss the appropriateness of holding a registration assessment at the end of this foundation training year. Why? Because the mode of assessment drives students’ learning behaviours^[1]
. Therefore, the format and timing of the registration assessment is likely to influence the way trainees learn and, ultimately, the pharmacists they become.

Arrested development

I know this well, as over the past four years, I have been conducting research into the hospital preregistration training year by exploring alternative training models to improve the learning experience for trainees. During my research, I have consistently found the same barrier to adapting preregistration training to support the development of professional skills: the registration assessment.

Preregistration pharmacists focus a great deal of their time and energy on preparing for their registration assessment, practising exam-style questions throughout the year, and even using annual leave to revise. This is entirely understandable, given that their future careers are at stake.

The current registration assessment encourages preregistration pharmacists to acquire the sufficient breadth of knowledge necessary for passing. The multiple-choice format of the clinical paper promotes a surface approach to learning^[2]
. In addition, the assessment does not directly encourage the development of skills trainees need to practise effectively.

At present, the preregistration pharmacist portfolio is designed to support trainees to develop the skills needed for practice, but less emphasis is placed on compiling and evaluating this work — which results in trainees prioritising the acquisition of knowledge needed for the assessment, over the development of skills necessary for their portfolio.

Don’t forget prescribing

It seems the preregistration year tries to serve two purposes. The first, to equip preregistration pharmacists with the knowledge needed to pass the registration assessment. The second, to support preregistration pharmacists to develop the skills needed to practise. This dual purpose makes for a challenging year for trainees.

Soon, it will serve another purpose. In its new vision for the future of pharmacy education, the GPhC intends to incorporate independent prescriber training into foundation pharmacist training from 2025–2026. Given that the mode of assessment drives the learning behaviours of trainees, it is vital that the GPhC and the profession consider how the assessment of foundation pharmacist training is configured to best support the professional development of the future prescribing workforce.

Can’t scrap entirely

How will we do this? Well, abolishing the registration assessment altogether is not an option, because the pass rates vary widely from one university cohort to another, and the GPhC needs to make sure that all candidates have the minimum required knowledge considered safe to practice.

The pass rates for candidates’ first attempt in the June registration assessments over the past few years, for example, highlight this variation between university cohorts. In 2019, the lowest pass rate by a university cohort was 47%, while the highest pass rate by a cohort was 93%^[3]
. In 2018, the lowest pass rate by a cohort was 57%, while the highest was 94%^[4]
. Owing to this variation, the assessment should remain a part of the initial education and training of pharmacists, but it must change.

In its current place near the end of the preregistration year, the assessment does not support trainees to develop the skills needed for their future practice, because they are largely focused on acquiring sufficient knowledge to pass the assessment. That is why I propose that the registration assessment is integrated into the third or fourth year of the undergraduate degree.

Not a new idea

Locating the GPhC registration assessment towards the end of the pharmacy degree would allow successful candidates to progress to foundation pharmacist training. This will provide reassurance to employers providing placements for foundation pharmacists that all candidates meet the minimum standard for knowledge required to be considered a safe practitioner. It would also enable foundation pharmacist training to focus on supporting trainees to develop the skills needed to practise as pharmacists and prescribers.

Assessing healthcare professionals during their degrees is not a novel idea. For example, medical students are expected to sit their Prescribing Safety Assessment before starting their foundation doctor training (although some do sit it during their first year of foundation training)^[5]
. Taking into consideration the incorporation of prescriber training within the foundation pharmacist year, the future registration assessment’s exam content may also need to more closely reflect that of the Prescribing Safety Assessment.

Focus on portfolio

Incorporating the registration assessment at the end of the pharmacy degree would allow the portfolio to become the main form of assessment for foundation pharmacist training. The portfolio should seek to determine the competence of the foundation pharmacist from a variety of sources, and should be subjected to an independent evaluation. Since we know that the mode of assessment drives individuals’ learning behaviours, using the portfolio as the main form of assessment for foundation pharmacist training would support foundation pharmacists to focus on developing the skills required for their future practice.

The time is now

The development of foundation pharmacist training presents an exciting and challenging time ahead for the profession, but the scale of the task of implementing it should not be underestimated. The 2019–2020 preregistration pharmacist cohort continues to face significant challenges over the postponement of the registration assessment.

Therefore, there has never been a more appropriate time for the GPhC and the profession to consider how the assessment model for foundation pharmacist training should be configured. If the registration assessment, in its current format, remains located at the end of foundation pharmacist training programmes, it will continue to be a barrier for the future workforce to develop the necessary skills, attitudes and behaviours required for practice.

Incorporating a registration assessment that covers prescribing competence into the third or fourth year of the pharmacy degree would help ensure that foundation pharmacists can focus on the development of the professional, clinical and prescribing skills they will need in their careers.