Transforming undergraduate placements to support the initial education and training of pharmacists

In January 2021, the General Pharmaceutical Council (GPhC) published the revised ‘Standards for the initial education and training of pharmacists‘ (IETP), which announced that all newly registered pharmacists would be able to independently prescribe from September 2026.

Educational reform has taken place nationally to support this. At the University of Manchester, MPharm students have historically undertaken hospital placements across our acute hospital sites. Following the publication of the IETP, the clinical tutor team overhauled the content and delivery of these placements to meet the needs of the new standards. These changes included:

• Increasing the number and length of placements from 6 to 23 days in total across the whole MPharm (see Tables 1 and 2);
• Revising placement structure, to include more time in clinical environments; 
• Revising placement content linked to the undergraduate degree, to enable ‘spiral’ learning — where topics are revisited multiple times at increasing levels of complexity, allowing for deeper understanding and retention over time — and application of knowledge to the clinical context; 
• Increasing opportunities to interact directly with patients;
• Increasing opportunities for direct assessment and feedback from clinical tutors.

By making these changes, we hoped to provide students with the learning and assessment opportunities needed to develop their clinical knowledge and skills, with greater focus on consultation, communication and clinical reasoning skills to support them to prescribe by day one of practice.   

Placement structure

The university’s clinical tutor team runs hospital placements across four hospital sites: Oxford Road Campus, Wythenshawe Hospital, North Manchester General Hospital within the Manchester University NHS Foundation Trust and the Salford Royal Hospital within the Northern Care Alliance NHS Foundation Trust. Group sizes vary between 10–23 students per placement, depending on year group and location. Each placement is run in parallel at each site; the same placement structure and content is mirrored to offer students an equitable experience. 

Table 1 illustrates how placement hours have increased since the launch of the standards in 2021, from 6 to 23 days in total across the whole MPharm.

Table 2 illustrates the breakdown of total students taught, with 2,160 hours of timetabled placements delivered to 763 students over the academic year 2024/2025.

Following the IETP changes, each placement now has the following structure:

• Pre-work to complete prior to each placement with intended learning outcomes; 
• Group teaching elements related to the placement topic (e.g. stroke, diabetes mellitus);
• Individual and/or group work to reinforce topic learning;
• Ward visits to speak to the patient and a member of the ward team; 
• Opportunities for peer observation and feedback;
• Individual and/or group presentation; 
• Assessment and feedback from tutors;   
• Post-placement reflection.

Impact of changes

Experiential learning is essential for students to actively engage with their learning environment, familiarise themselves with their future practice settings, and to bridge the gap between education and practice via reflection and active experimentation^​1​. Versus a simulated learning environment, our hospital placements offer students the opportunity to develop their professional, communication, consultation and prescribing skills, all while gaining exposure to an authentic ward environment, with its real staff and real patients. Students are exposed to the pharmacy and wider multidisciplinary teams (MDT) on every placement and are expected to have a meaningful interaction with these teams, as well as patients, during every visit.

Placement assessments include talking to patients, progressing from starting a conversation in the first year to counselling on new medicines under supervision in second, third and fourth years. Students develop an understanding of drug history-taking and medicine reconciliation across all placement years, practising these skills with real patients under supervision, followed by tutor assessment of communication and accuracy of information.

Each student has a placement e-portfolio, on which they document assessments and feedback with tutors to review. Students also practise how to clinically check medicines, complete individual and group presentations, while completing oral case presentations on topics such as respiratory, infection, cardiology, care of older people, diabetes, anticoagulation, stroke and surgery.

By increasing placement provision and the number of patient-facing activities on the ward, it is hoped that students will benefit from increased exposure to the real-world care environment. Here, they can observe and work under supervision with the MDT, as well as deliver holistic person-centred care. By navigating their own learning, students increase their independence and develop confidence by practising skills in a safe and supportive environment. 

Perhaps the biggest change has been in the provision of fourth-year placements. In the academic year 2024/2025, the tutor team implemented two week-long placements for fourth-year students for the first time. The focus of these placements has shifted to maximising exposure to the ward, with students working through a range of activities including, but not limited to, pharmaceutical care reviews, supervised medicines reconciliation, supervised patient education, consultant-led ward rounds and interprofessional education opportunities such as MDT meetings. Students recorded a sample of their activities within a portfolio, which was reviewed by the tutor team. We hope that introducing this style of placement will support the continued implementation of entrustable professional activities, where, in the future, students may be deemed competent to educate patients about their medicines without a tutor present^​2​.

In an evaluation of these new week-long placements, students reported improved confidence and communication skills, greater awareness of the ward environment, as well as clinical knowledge and professional skills, such as being able to spot problems and identify potential solutions.

We hope our new style of placements will continue to support all our MPharm students to develop the confidence, independence and teamworking needed to become successful pharmacists and prescribers following implementation of the IETP, not just in the hospital setting, but across all sectors of practice.

The pharmacist clinical tutor team at the University of Manchester

Hafsa Atique-Ur-Rehman, Diane Mitchell, Kate Oates, Bernard Asuako, Hafsah Choudry, Charlotte Storer, Siobhan McIlveen, John Robinson, Michael Clyne, Daniel Jones, David Beaumont, Olivia Woods