Using entrustable professional activities to build the future pharmacist

The updated General Pharmaceutical Council (GPhC) ‘Standards for initial education and training of pharmacists’, published in 2021, recognise the role of training in practice settings in enhancing undergraduate pharmacist preparedness for practice​^​1​. This training is achieved by spending time on experiential learning while completing the MPharm degree.

While the shift is a positive step in pharmacy education, challenges remain in structuring and assessing learning outcomes and competencies in practice-based environments where every situation presents unique experiences, and every supervisor offers bespoke expertise and perspectives that will often differ from those in the academic setting​^​2,3​.

Previously, periods of experiential learning during the completion of MPharm degrees employed fixed, academic tasks to demonstrate learning, which often isolated students from actual team functions to complete separate assignments. While this approach achieves the goal of “occupying” the undergraduate, it can limit student engagement with real patient problems and detract from the authenticity of real-world learning, which ultimately risks the disengagement and isolation of the learner.

This approach also runs the risk of alienating the practice supervisors, who may not recognise their day-to-day role in these standardised academic tasks. Additionally, standardisation is challenging to achieve within certain sites, where roles and practices of pharmacists are unique and patient presentations cannot be pre-determined. It is also important to remember that a student’s practice in any experiential learning setting is an individual blend of knowledge, skill, prior experience, confidence and reaction to current situations. Each pharmacy undergraduate will be at a different place in their journey towards becoming a ‘safe beginner’ pharmacist.

Beyond standardisation

In practice, each experiential learning setting offers a range of expertise from a diverse team. Recognising and embracing the variety of expertise in experiential learning settings is crucial in widening the students’ authentic practice experience. Having students engage in a pharmacy community of practice as novice professionals offers an alternative and viable perspective on learning through the lens of the social learning theory. This perspective emphasises that student pharmacist learning is rooted in identity formation via authentic participation in professional activities, alongside both peers and experienced professionals. 

As a result, experiential learning should be built upon real-life tasks involving authentic interactions with team members, fostering a switch in focus from academic achievement alone to include professional identity. The goal is not only to achieve competence but also to cultivate an understanding of who students are becoming as practitioners^​4,5​​. An aim of the approach to experiential learning in undergraduate pharmacy programmes is to minimise participation in standardised academic tasks and foster a sense of purpose and belonging for our trainees through the use of entrustable professional activities (EPAs).

The role of EPAs in building professional identity

EPAs are units of professional practice that can be entrusted to learners under a range of supervision options​^​6​. They align with experiential learning in that EPAs help trainees apply their knowledge in real-world contexts and serve as benchmarks to ensure they demonstrate the competence required for independent practice​^​6​.

A focus on EPAs underscores the importance of real-world activities in experiential learning because it engages learners in the practice environment instead of isolating them by creating contrived learning scenarios. EPAs allow students to perform small yet meaningful tasks, gradually contributing to healthcare in ways that build their confidence and integrate them into professional practice​^​7,8​. Crucially, the success of EPAs relies on their integration with pharmacy undergraduate curricula, with a focus on preparatory activity and familiarisation with the EPAs, as well as post-experiential learning debriefing​^​9​. When experiential learning is viewed as separate from academic success, student engagement in EPAs can be challenging for practice educators​^​10​.

Developing a framework of core EPAs for Northern Ireland

The framework of EPAs developed for pharmacy trainees in Northern Ireland (NI) is based on the activity and guidelines of the International Association for Medical Education, and was adapted by the American Association of Colleges of Pharmacy, reflecting core skills of pharmacists practising in Great Britain and NI​^{​6,7,11,12​}. Developed with input from pharmacists across all three patient sectors of pharmacy, the framework of EPAs followed feedback from students and practice supervisors involved in pilots.

The five core EPAs represent what practice for a ‘safe beginner’ pharmacist should look like at the point of registration, regardless of the sector or area of practice (see Figure). Each core EPA is further subdivided into relevant ‘milestones’. These milestone EPAs provide a structured framework to evaluate undergraduate students’ preparedness to perform vital tasks and assess their development of skills and judgement for safe, effective practice. For example, ‘medication history’ and ‘checking prescriptions’ are milestones within the core ‘Medicines optimisation’ EPA.

Figure: The core EPAs for training of pharmacists in Northern Ireland 

The Pharmaceutical Journal/Shutterstock.com

Entrustment decision

The implementation of EPAs requires pharmacists to make entrustment decisions, as an approach to assessment in the workplace. Existing entrustment scales in other healthcare professions have primarily been developed for graduate and postgraduate settings, where greater autonomy is expected. The entrustment scale used within the curriculum in NI is based on scales developed for undergraduate education but is also uniquely adapted to recognise the nuances of pharmacy undergraduate student supervision (see Table)​^​13​. In developing the entrustment scale for undergraduate pharmacy students, we deliberately excluded levels 0 and 1, which are associated with observation-only roles.

While sometimes necessary, observation does not align with our goal of fostering active engagement and practical skill development. Instead, we wanted to encourage students to engage directly in tasks under supervision. Similarly, levels 4 and 5 of the entrustment scale were not included, as MPharm students, unlike postgraduate trainees, will never reach a stage of fully unsupervised practice. By using this adapted scale, we enable students to understand the progression of responsibility and the value of supervised practice as they grow in competence.

Unlike binary notions of ‘trust’ versus ‘no trust’ or ‘provide supervision’ versus ‘do not provide supervision’, this entrustment scale acknowledges that trainees at the undergraduate level are not ready to undertake tasks independently. Instead, the scale provides a nuanced approach to entrustment, balancing necessary oversight by practice staff, with incremental responsibility. The scale we developed uses retrospective entrustment — meaning that the degree of entrustment is based on the level of support a student needed during a task, rather than what level of supervision they will need in the future. This approach allows students to understand what level of responsibility they had during a professional task and supports their reflection on their input into patient care. Focusing on the level of support required, rather than facilitating complete autonomy, enables students to gain insight into professional growth in a way that feels empowering and builds confidence without compromising patient safety.

Practice supervisors in NI complete training on mentorship and facilitation skills to support students during experiential learning, which includes familiarisation with rubrics and EPAs related to specific periods of experiential learning. Particular emphasis is placed on how to support students in reflecting more deeply after each activity during experiential learning, as well as how to formulate an entrustment decision for a student.

A reproducible method

The 2021 GPhC standards’ emphasis on experiential learning represents a shift towards developing pharmacists who are ready for real-world practice. By adopting EPAs and learning rubrics that foster reflective dialogue, the NI pharmacy EPA framework places students in authentic practice environments, where they can engage in meaningful work alongside their professional community. This approach builds a culture of learning and fosters professional identity formation, ensuring that pharmacy students graduate not merely with a degree but as fully integrated members of the pharmacy profession who are committed to continuous development and improvement. The success of EPAs in NI hinges on their integration within the curriculum in both schools of pharmacy in NI, which combines structured preparatory practice with authentic tasks and debriefs at the end of each period of experiential learning. 

The role of practice supervisors is pivotal in supporting the evolution of student critical thinking and problem solving. In addition, all NI practice supervisors receive training in the use of EPAs and how to have a reflective conversation with student pharmacists. This approach has enabled consistency during experiential learning placements across all three sectors and all levels of the MPharm programme for students from both schools of pharmacy in NI. We believe that this approach offers a reproducible method for pharmacy educators across the globe.