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The importance of the role of the practice educator pharmacist

Significant changes were made to the preregistration trainee pharmacists’ placement year by the Royal Pharmaceutical Society of Great Britain in 2001. In addition, in 2002, a major review of practice support infrastructure took place within the Thames Valley region (now South Central North).

Consequently, practice educator pharmacist (PEP) posts were established in NHS acute hospital trusts in Berkshire, Oxfordshire and Buckinghamshire in 2003, in order to augment preregistration trainee pharmacist learning at regional and local level.

Currently, South Central Strategic Health Authority (SHA) funds these roles as part of the regional training contract delivered by Oxford Radcliffe Hospitals NHS Trust.

The overarching purpose of the PEP role is to support the training of preregistration trainee pharmacists and ensure an effective learning environment. When the role was introduced the aims were to:

  • Enhance the trainees’ learning experience
  • Support tutors to meet training and service commitments
  • Harmonise the learning experience across the region
  • Increase use of assessment by direct observation
  • Support the delivery of regional study days
  • Contribute to quality assurance of the programme 
  • Improve retention of high quality, newly qualified pharmacists

Panel 1: Ten quality standards for the role of the practice educator pharmacist

1.  Practice educator pharmacists (PEPs) will undertake continuing professional development in line with their training role.
    2.  PEPs will hold or be undertaking a relevant “train the trainers”type qualification (eg, in-house or external train the trainers,certificate of education, postgraduate certificate of education, Cityand Guilds, training module of a clinical diploma, NVQ assessor status).
    3.  PEPs will have a Knowledge and Skills Framework profile for job development.
    4.  PEPs will be appraised annually and the regional “360-degree appraisal” will be incorporated into this appraisal.
    5.  PEPs will attend a minimum of four PEP meetings annually (they are held every two months).
    6.  PEPs will participate in the Thames Valley peer review process forPEPs annually and achieve a satisfactory standard as defined in thepeer review documentation.
    7.  PEPs will be peer reviewed by the regional course director oranother PEP on the delivery of any teaching on the regionalpreregistration course.
    8.  PEPs will participate in delivery of the regional course as part ofthe course team. One teaching session per year must be delivered as aminimum.
    9.  PEPs will spend a minimum of 50 per cent work time pro ratadelivering and supporting preregistration training and development.This may include hands-on training, assessment, training of other staffor helping with the development and collection of quality assuranceinformation.
    10.  PEPs will be available to support training in other trusts in thecase of absence or illness of other members of the course team. 

    Evaluation of the PEP role

    Evaluation is an essential part of the education process that is analogous to clinical audit.1

    This evaluation aimed to provide meaningful qualitative and quantitative data and to reflect current practice.  The objectives were to:

    • Assess PEP performance against quality standards (see Panel 1 above)
    • Identify trainees’ and acute trust chief pharmacists’ views
    • Establish outcomes of the role, specifically: trainees’ achievement of performance standards, registration exam pass rates and retention in NHS band 6 pharmacists posts within the region

    Four complementary approaches were used:

    • A self-evaluation tool
    • Survey of trainees’ views
    • Survey of chief pharmacists’ views
    • Analysis of previous annual reports on the provision of SHA-funded pharmacy preregistration training

    Tool for self-evaluation of the PEP role

    A self-evaluation tool was devised using Partnership Quality Assurance Framework (PQAF)2,3 methodology, incorporating the quality standards described in the regional contract and PEP job description (see Panel 1 above).

    PEPs were asked to assess their practice against each standard, by choosing one of the following ratings: good practice (standard met at a higher level); standard met; standard at risk; standard not met.

    Preregistration trainee pharmacists’ views

    A questionnaire about the PEP role was sent to the 2005–06 cohort of 20 trainees half way through their training year. Questions related to the quality standards and the PEP’s standard job description. A five-point Likert scale was used for responses and trainees were invited to add comments throughout the questionnaire.

    Chief pharmacists’ views

    A questionnaire ascertaining understanding of the purpose of the PEP role and whether it was achieving its aims was distributed to acute trust chief pharmacists. Again, a five-point Likert scale was used for responses and participants were invited to add comments throughout the questionnaire.

    Analysis of previous annual reports

    Within each preregistration year, trainees are invited to complete a questionnaire determining their views about their regional and local training. These are administered six months into training and at the end of the year.

    Questionnaire results from previous cohorts were obtained from annual reports and analysed for the purposes of this evaluation.

    Results

    Self-evaluation

    All self-evaluation tools were completed by the eight PEPs.

    Quality Standards

    Overall, standards were met or met at a higher level in 63 per cent of cases by PEPs. Standards were deemed “at risk” in 27 per cent of cases and “not met” in 10 per cent of cases.

    Standard “not met” or “at risk” was described by the majority of PEPs for: achieving a Knowledge and Skills Framework outline (n=5 of eight PEPs); receiving an annual appraisal (n=5) and participating in peer review (n=6).

    Standard “met” or “met at a higher level” was described by the majority of PEPs for: undertaking CPD (n=6); attending PEP meetings (n=7); participating in peer review (n=6); delivering part of the regional course (n=7); spending a minimum of 50 per cent of time on pre-registration pharmacist training (n=6) and supporting training in other trusts (n=6).

    Outcomes

    Self-evaluation of outcomes of the PEP role produced some general themes. PEPs reported that training was more co-ordinated, structured and standardised across the region, including more one-to-one activity and increased time spent, meaning a higher quality experience.

    They described the role as helping trainees achieve their performance standards and fulfilling Royal Pharmaceutical Society requirements for passing the registration examination. Subsequently, many of the trainees have been retained as qualified pharmacists within the region.

    PEPs also believed that they supported the learning environment. This was achieved by:

    • Specific, up-to-date training
    • Helping tutors
    • Producing learning aids (eg,workbooks) 
    • A greater focus on assessment
    • Developing trainees’ skills earlier in the year with increased clinical focus
    • Improving the understanding of pharmacy staff regarding responsibility for training and trainees’ learning needs
    • Reinforcing the supernumerary position of trainees

    Trainees’ views

    Eighteen of the trainees in the 2005–06 cohort completed a questionnaire. The results are summarised in Table 1.

    Table 1: Preregistration trainees’ responses

     Strongly disagree
    Disagree
    Neither agree nor disagree Agree
    Strongly agree
    Understand the practice educator pharmacist (PEP) role0
    2
    2
    12
    2
    PEP’s role is different from preregistration tutor’s0
    5
    5
    7
    1
    PEP provides supportive learning environment0
     13
    14
    0
    PEP facilitates integration of theory and practice0
    1
    4
    13
    0
    PEP acts as role model0
    7
    6
    5
    0
    PEP supports cross-sector placement0
    7
    3
    7
    1
    PEP is a mentor1
    5
    6
    5
    0
    PEP is always available1
    4
    3
    10
    0
    PEP assesses my progress with performance standards0
    4
    8
    6
    0
    PEP undertakes continuous professional development0
    0
    7
    9
    2
    I intend to remain in local NHS after qualification0
    2
    8
    8
    1
    PEP spends minimum of 50 per cent of work time on preregistration training2
    5
    5
    5
    0
    PEP necessary to achieve performance standards0
    7
    5
    4
    1
    PEP may be same as tutor0
    1
    1
    11
    4
    Consistent training across Thames Valley0
    6
    6
    6
    0
    PEP makes particular use of direct observation1
    7
    6
    3
    1

    Chief pharmacists’ views

    All five chief pharmacists from acute trusts in the region completed a questionnaire. The results are summarised in Table 2.

    Table 2: Chief pharmacists’ responses

     Strongly agree
    Disagree
    Neither agree nor disagree
    Agree
    Strongly agree
    Focus is on preregistration training
    0
    0
    0
    5
    0
    Practice educator pharmacist (PEP) enhances and harmonises the preregistration learning experience
    0
    00
    4
    0
    PEP improves examination pass rates
    0
    1
    1
    3
    0
    PEP makes particular use of direct observation
    0
    0
    2
    2
    1
    PEP supports local tutors
    0
    0
    1
    2
    2
    PEP supports delivery of the regional course
    0
    0
    0
    4
    1
    PEP helps retain high quality preregistration trainee for first destination posts
    0
    12
    2
    0
    PEP identifies work for regional learning and development strategy group
    0
    1
    4
    0
    0
    PEP spends minimum of 50 per cent of work time on preregistration training
    0
    0
    1
    4
    0
    PEP necessary to achieve performance standards
    0
    2
    1
    2
    0
    Training is consistent across Thames Valley
    0
    2
    1
    2
    0
    Further capacity to develop PEP role
    0
    1
    2
    1
    0
    PEPs provide cross cover
    0
    0
    1
    3
    0
    PEP’s role different from preregistration tutor’s
    0
    0
    1
    3
    0

    Analysis of annual reports

    All trainees achieved the performance standards by the 52-week milestone in the academic year 2005–06. Likewise, in 2003–04, all trainees achieved the standards and in 2004–05, 96 per cent achieved the standards.

    There has been a strong improvement in registration examination results following the introduction of the PEP role in 2003 (see Table 3), with pass rates consistently higher than the national average.

    Table 3: Registration examination results (2002–06)

    Academic year
    Regional pass rate (%) National pass rate (%)
    Difference (±%)
    2002-0368
    82.4
    -14.4
    2003-04
    90.5
    91.4
    -0.9
    2004-05100
    91.8
    +8.2
    2005-06
    88.2
    86.5
    +1.7

    The percentage of trainees retained in NHS organisations in the region after qualification has steadily increased since the role was established. The percentage of trainees retained in the region post-qualification was 26 per cent in 2003–04, 33 per cent in 2004–05 and 37 per cent in 2005–06.

    Discussion

    Quality

    Evidence that the PEP role is enhancing the trainees’ learning experience across the region is supported by the fact that most quality standards are being met. The standards are directly and indirectly related to the trainees’ learning outcomes and further work may be needed to provide stronger links.

    Generally the standards that were less well met by PEPs concerned the management of their role, ie, peer review, appraisal and KSF outline. Peer review and the KSF outline are more recent changes introduced in the regional programme and the NHS, respectively, that might need more time to be implemented.

    PEPs reported that an outcome of their role was the provision of more co-ordinated, structured and standardised training. In comparison, trainees’ views were mixed about consistency of training across the region. There are many factors apart from the PEP role that contribute to consistency of training, such as the trainee’s ability and motivation, the learning environment of the workplace and the attitude of other members of staff.

    The extent to which the PEPs are supporting local tutors, so that tutors are able to carry out their training and service commitments, is beyond the scope of this evaluation. Boundaries between the role of the PEP and that of the tutor are not easily defined because there is overlap in the activities that they undertake. Indeed, there appears to be different levels of understanding about the role of the PEP — especially from the perspective of the trainees.

    The fourth aim of the PEP role was to increase the level of direct observation of trainees to assess them against the performance standards. Most PEPs considered that they spent a minimum of 50 per cent of work time supporting trainees.

    However, a smaller proportion of trainees agreed that PEPs made particular use of direct observation. This may be because the 50 per cent work time only partly relates to direct observation and involve all the other work that the PEPs undertake.

    Fifty per cent of trainees agreed that PEPs were always available when they needed to discuss their training. Most chief pharmacists viewed PEPs as meeting the minimum requirement of spending 50 per cent of their work time delivering and supporting training and increasing the use of direct observation.

    Outcomes 

    Since the introduction of the PEP role, increasing numbers of trainees have been retained within the region after qualification, thereby delivering a return on the investment in their training.

    This aim was achieved in the context of hospitals in the region facing strong competition from organisations in London and the home counties. Hospital pharmacy departments across the region have historically had lower staffing levels compared with some hospitals in London, so posts may not be available to recruit into.

    Additionally, an individual trainee may have already decided upon a career outside hospital pharmacy — this might be difficult for a PEP to influence.

    Conclusions

    The self-evaluation tool, chief pharmacists’ and trainees’ views and analysis of the previous annual reports have generated a positive evaluation of the role of the PEP. Themajority of quality standards have been met and improved outcomes have been achieved since the introduction of the role, ie, registration examination pass rates and first post destination results.

    This evaluation has focused on the process and outcomes of the role of the PEP. The goals of the evaluation were linked to the original aims of the PEP role and focused on quality improvement.

    The approach of asking PEPs to undertake a self-evaluation of their own role is useful to encourage ownership, responsibility and to provide motivation to change behaviour in line with continuous quality improvement.

    Acknowledgements

    Thanks to Jenny Dorey, Andrea Hollister and Jane Hough. Also thanks to the PEPs, chief pharmacists and preregistration pharmacy trainees who supported this work.

    References

    1.    Morrison J. ABC of learning and teaching in medicine: Evaluation. BMJ 2003;326:385–7.

    2.    Prototype document for appraisal and ongoing quality monitoringand enhancement (OQME).  Partnership Quality Assurance Framework ofHealthcare Education in England, 2004.

    3.    Partnership Quality Assurance Framework of HealthcareEducation in England. Report of the Independent External Evaluation ofthe Prototype Approval and Ongoing Quality Monitoring and EnhancementProcesses. Homerton School of Health Studies, 2005.

    Christopher John is professional pharmacy adviser, NHS workforce review team (formerly regional preregistration pharmacist training course director, Oxford Radcliffe Hospitals NHS Trust).

    Daniel Grant and Jill McDonald are regional preregistration pharmacist training course directors, Oxford Radcliffe Hospitals NHS Trust

    Citation: Hospital Pharmacist URI: 10032614

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