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Education and training

Introducing accreditation for tutors and innovative teaching methods will help improve registration pass rates

The way preregistration trainees are taught must be changed in order to improve pass rates and preparation for practice.

The way preregistration trainees are taught must be changed urgently to improve pass rates and better prepare them for practice

Source: istockphoto.com

In June 2015, the registration examination for the General Pharmaceutical Council (GPhC) — Britain’s pharmacy regulator — had a pass rate of 74% (The Pharmaceutical Journal 2015:295:100), down from 85% the previous year. This low overall pass rate, together with a higher failure rate in community pharmacy compared with the hospital sector, has drawn attention to current preregistration training schemes and has caused some in the profession to raise concerns over the quality of training offered in community pharmacy.

Not only do the reasons for the low pass rate need to be identified, we also need to make changes that will help future pharmacists meet the expectations of the more clinically focused registration assessment in June 2016, which is set to require a greater application of knowledge to patient care.

Preregistration year

The GPhC accredits undergraduate degrees conferred by universities in Great Britain. In its document ‘Future pharmacists, standards for the initial education and training of pharmacists’, the GPhC outlines what it expects of university graduates and how they can be prepared for the preregistration training year. It is the responsibility of the preregistration tutor to ensure graduates become professionally competent to provide high-quality patient care. The tutor is responsible for attesting that a trainee has satisfactorily completed the 52-week training period. Tutors are expected to facilitate a trainee’s self-directed learning and supervise work-based training to reinforce those GPhC-defined outcomes, so as to achieve performance that demonstrates “does” and “shows how” in their field of practice as a pharmacist.

Community pharmacy trainees had a pass rate of 71% compared with hospital trainees, who had a 91% pass rate. This difference in pass rate might reflect the hospital recruitment process, since hospitals can select the best candidates and employ a more rigorous recruitment process. Another possible explanation for this low pass rate is that training in a hospital pharmacy exposes trainees to a more clinically focused learning environment and therefore they stand a better chance of passing the registration assessment.

Tutor standards

In 2014, the GPhC produced guidance for tutors (‘Guidance on tutoring pharmacists and pharmacy technicians’) and the Royal Pharmaceutical Society has recently published draft guidance (‘Tutoring for preregistration trainees’).

However, several examples of bad quality tutoring in community pharmacy were identified when academics from King’s College London asked trainees to report their concerns (The Pharmaceutical Journal 2014;293:428). These included complaints from trainees who had no training plans in place and were not given a suitable induction period. Some trainees complained that they had been left unsupervised without a tutor for lengthy periods, while some had received no feedback about their performance and their competence was not assessed. Other complaints included trainees who were not granted any study time and were not given a suitable handover after a change in tutor.

The GPhC only encourages tutors to attend training sessions rather than making them compulsory. It is difficult to maintain quality across the preregistration training scheme unless each of the 3,300 tutors have the skills required.

Employers, who are reimbursed for taking on trainees, have a responsibility to ensure they are offering high quality education and training to their preregistration trainees. Sending tutors on training programmes is one way to ensure they are able to perform their role competently and can fully support their trainees. But ultimately, accreditation of preregistration tutors would make certain that all trainees receive consistently high-quality support befitting the pharmacy.

Training providers should be accredited to deliver tutor training programmes, which should include regular evaluation of preregistration tutors to ensure that the quality and development of tutors is maintained. It would then be the responsibility of the employer to make sure that tutors complete such training programmes and are certified. In turn, it would ensure that tutors have gained the skills to effectively deliver their role.

The GPhC’s discussion paper on pharmacy education, ‘Tomorrows pharmacy teams’, which closed on 14 August 2015, reinforces the idea that pharmacists need to adapt to working in varied settings in order to become patient-centred clinicians. The barriers that exist between academics and those who are involved in work-based tutoring should be diffused to ensure a closer working relationship.

Applying knowledge in practice

If the preregistration year was integrated with the undergraduate programme (a much discussed idea implemented in only a few universities), preregistration sites and tutors could be quality assured by universities. Until this happens, innovative education solutions are another way to give future pharmacists the opportunity to apply knowledge in practice, regardless of which sector they are completing their preregistration year in.

Cross-sector experience during the preregistration year is vital for trainees and should be arranged wherever possible. However, if arranging these placements is proving difficult, trainees should attend training days designed to simulate the learning they might be missing out on. One example is the ProPharmace ‘Insight into hospital pharmacy’ training day, which was developed to allow trainees who are unable to attend a cross-sector hospital placement the opportunity to gain this experience through a series of workshops.

The development of problem-solving and critical thinking is possible through active learning strategies that include simulations, case studies, guided group discussions and practice-based exercises, as well as objective structured clinical examinations. Such techniques should be taught throughout the preregistration year, with input from experienced academics. There are also many innovative learning technologies that can be used in a classroom-based learning environment, such as video learning and virtual tools to engage trainees and enhance the learning experience. External preregistration training providers, such as ProPharmace, provide these resources.

Managing change

The GPhC should introduce better quality management systems and act quickly to prevent low standards of training. At the very least, it should require tutors to undertake a certain level of training.

It could also improve regulation of training sites through the pharmacy inspection process. Additional questions to the new “show me, tell me approach” inspection, such as asking preregistration tutors to show the learning contract and in-house training plan, and asking trainees to talk about their experiences, could easily be introduced.

Finally, the board of assessors and the GPhC education team need to act more quickly to support training providers. ‘The guide to the registration assessment from 2016’, published on 28 August 2015, provides information on the format and framework for the assessment in 2016. This should have been published earlier because, by then, many trainees had already started their training.

The GPhC must ensure there is a minimum training requirement for tutors and should support initiatives that encourage trainees in different sectors to have comparable experiences. In this way, all trainees will have the best chance of passing the registration assessment.

Luigi Martini is professor of pharmaceutical innovation at King’s College London, and Noma Al-Ahmed is managing director of Propharmace, a pharmacy training provider.

Declaration of interest: Luigi Martini provides advice to Propharmace.

Citation: The Pharmaceutical Journal DOI: 10.1211/PJ.2015.20069510

Readers' comments (4)

  • I would like to differ somewhat with the author of this article. The article makes some interesting proposals that are worth considering. However, I think we need a closer look at the underlying assumptions behind the proposals. The author appears to be pointing the blame on the tutors, an assertion which is not warranted by an understanding of the factors behind the low pass rate.

    The author highlights the general low overall pass rate in community versus hospital placements (71% versus 91%). As with other averages of this nature, these are broad generalisations. Not only do they not take account of intra-sector variations, they also do not give us an indication of other relevant factors related to the recruitment of pre-reg trainees.

    At the upper end, what was the variance in standard among hospitals? Is there an observable pattern by region or other parameters? Are there sufficient numbers of pre-reg trainees in hospital to differentiate between "best-in-class" and "worst"; or are the unsuccessful candidates (1 in 10) simply regarded as "random failures?"

    The community pharmacy figures also warrant closer analysis. How do the pass rates for independents compare with large multiples or small multiples? Are all multiples the same? How do the best community providers compare with hospitals?

    The question of numbers is an important one. Allied with this is the calibre of the candidates both in the different sectors and within each sector.

    It is generally understood that there are considerably more community placements than there are in hospital. Pay rates in hospitals for pre-reg are generally higher than in community; hence the competition for hospital placements that the author alludes too. Both factors (high pay plus fewer vacancies) mean that the hospitals are able to get higher calibre candidates, who consequently are more likely to pass.

    Anecdotal information at my disposal suggests that there is a pecking order that had developed in the selection of graduates. Hospitals generally have the first pick, followed by (some of) the larger multiples, and then the rest. If this is true, it would go some way towards explaining why hospitals would have a higher pass rate that community. Assuming that the figures show a correlation between types of community pharmacy (large multiple vs smaller ones vs independent etc) then we would have enough evidence to draw a conclusion.

    We also need to remember that the GPhC itself has tacitly pointed the finger at university entry requirements as well.

    With all this in mind, we must remember that the preregistration year offers an opportunity to learn to apply clinical knowledge to practice, amongst a range of other skills and behaviours that the graduate possesses or needs to develop. If the content of clinical knowledge possessed by the candidate is deficient from university, no amount of regulation of tutors will help the candidate in the exam. A multi-factorial approach needs to be adopted, taking into account all the various factors that have been raised above as well as on other fora.

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  • Merlvin, the article points no blame, of course there are many factors that have resulted in the low pass rate, we are simply offering solutions which we feel will make a difference to the quality of training delivered, based on our expertise. Setting a standard for pre-reg training delivery will no doubt make a difference.

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  • The article alludes to two possible reasons for the difference in pass rates between hospital and community pharmacy trainees.It seems very reasonable that the training received by graduates in hospital pharmacy has a more clinically focussed approach so that they stand a better chance of passing the registration assessment which has a leaning towards all things clinical.
    Unless the criteria for selection of graduates in hospitals are well documented and proven reliably to facilitate the selection of the ‘best’ candidates, this reason for the difference in pass rates is much less plausible.
    Accreditation of pre-registration tutors is very important for the sake of consistency in creating and maintaining a standard for pre-registration tutors.
    In the final analysis, the graduate bears the bulk of the responsibility to invest the necessary time and effort to pass the registration exam.

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  • F Buffey
    I am a hospital based pre-registration manager and tutor and have been for around ten years. My main concern at the moment is the pressure that all of the reports and discussions and statistics and changes are putting on trainees. The GPhC repeatedly tell us that trainees focus too much on the assessment during the preregistration year. Well of course they do!!!! They have to pass it in order to register and the number that pass seems to have decreased in recent years and now the whole structure and format of the assessment is changing. My trainees are spending a small fortune on additional training. I have never known there be so many opportunities to pay for additional support to help you pass the registration assessment. I have worked hard to produce a mock assessment for this year's intake but I cannot be sure that it will be anything like the 'real' assessment, despite poring over the published framework and studying the sample questions provided. The blueprint provided is a major improvement on previous information made available to tutors and trainees, but it still represents a 'bottomless pit' of potentially required knowledge and know how. My trainees have paid to attend additional mock assessments and 'training events' run by various institutions - all of whom have added that they are not sure that the questions they have set are at the right standard. They have all paid to access on-line training resources. All of this means that my trainees are more focused and more worried about the assessment than any previous cohort I have encountered. As a tutor I am feeling that I am letting trainees down as I am clearly not providing enough training, despite tutorials nearly every week throughout the year, if they feel the need to access all of this additional support. And that is the result of all this deliberation. Exactly what the GPhC claim they don't want.

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