Is the registration exam failing trainees?

The Pharmaceutical Journal12 AUG 2015By Graham Phillips

Graham Phillips

Superintendent pharmacist of Manor Pharmacy Group. Graham Phillips is a second-generation pharmacist, and Managing Director of the award-winning Manor Pharmacy Group, of seven pharmacies in Hertfordshire plus one in Kent. Qualifying in 1982, his increasing interest in extended pharmacy roles led him to undertake a post-graduate clinical diploma at what is now known as King’s College School of Pharmacy in 1997. Having completed his diploma he now enjoys strong practice and research links with the School of Pharmacy, University of Hertfordshire. Working collaboratively with the School, Graham has developed the “teaching pharmacy” concept – the pharmacy equivalent of the GP Teaching Practice. This has borne significant fruit resulting most recently in the publication of a paper on the role of community pharmacy in Type-2 diabetes. He has worked with GPs and in Primary Care widely for fifteen years, including as a PCT Prescribing Lead, and PEC and Board member. He wants to see much-closer working relationships with GPs. He has been involved in pharmacy politics at local and national level, for 15 years including four years on the Council of the RPSGB – three as chair of the Education Committee. He sat on the RPS English Pharmacy Board. Graham has had a long-term interest in Public Health: he has been involved with NHS cancer-reform strategy and sits on the board of the National Obesity Forum. He was also a member of the Healthy Living Pharmacy reference group. Manor Pharmacy Group has won a numerous local and national awards – notably they were runners-up in the PJ “Care Awards” 2009. In November 2012 Graham was awarded “Leader of the Year” at the Pharmacy Business awards; Sameena Ashraf, one of Manor Pharmacy Group’s latest cohort, was awarded “Pre Registration Trainee of the Year” at the same awards. Graham was made a Fellow of the RPSGB in 2009.

A cursory examination of pass rates of the General Pharmaceutical Council (GPhC) registration assessment reveals an astonishing level of variation, from a high of 94.5% in 2012 to an all-time low this year of 74.0%. Overall pass rates as published by the GPhC are as follows:

2011: 85.5%
2012: 94.5%
2013: 78.0%
2014: 85.3%
2015: 74.0%

Is it credible to conclude that the quality of preregistration trainees and tutoring varied by as much as 21% in the three years between 2012 and 2015? Or is there a fundamental problem with the assessment itself and the way that it is set?

If a circa 74% pass rate is correct, it implies that perhaps 500 registered pharmacists from the 2012 cohort are not fit-for-purpose. Whereas if a circa 95% is the right pass rate, a similar number of pharmacy students have just been denied their professional future as the direct result of an arbitrary, inconsistent and seemingly randomly variable process.

The British Pharmaceutical Students’ Association has published a list of 18 concerns about the exam and it does not make for comfortable reading.

Of even greater concern is that the BPSA also published a similar list of concerns in 2013 when the pass rate also nose-dived. This was met by the usual bland obfuscation by the GPhC based on the predictable invocation of the public interest. But the truth of the matter is that the GPhC has end-to-end responsibility here. It is responsible for setting the undergraduate and preregistration training syllabus. It accredits all schools of pharmacy and it accredits every training environment.

Is it really in the public interest to allow so many students to enter a five-year training programme, accumulate at least four years of student debt and then fail them in such numbers? Albeit many of those who fail will go on to pass at the second or third attempt, is it right to demoralise 25% of the pharmacy profession at the very beginning of their careers? Do other professions accept such high and inconsistent attrition rates, especially at the final hurdle? I suspect not.

So perhaps the question we should all be asking is: “Are pharmacy students failing the registration exam or is the exam failing trainees?”

Graham Phillips

Preregistration tutor

St Albans, Hertfordshire

Citation: The Pharmaceutical Journal, 12 September 2015, Vol 295, No 7879, online | DOI: 10.1211/PJ.2015.20069110

Readers' comments (5)

Altaf Vaiya12 AUG 2015 23:53
I agree with your thoughts Graham, I echo what you have said. I also would like to add that 91 % of hospital based pre-registration students passed the exam, does this mean that the exam was more relevant to pre-registration students training in hospital or is it the fact that community based pre-registration students are not getting enough support. There is a large variation in the standard of pre-reg training in community and some tutors see students as an extra pair of hands and do not support these students. I really think the GPhC has to be able to support students and at the same time help support tutors maybe bring in some sort of governance for pre-reg training sites. Passing the exam alone does not make you a competent pharmacist the exam has a role to play and should be structured so that it reflects student understanding and knowledge needed to serve our profession.
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Chijioke Agomo13 AUG 2015 7:11
I agree with you Altaf.
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Graham Phillips14 AUG 2015 16:10
I go along with much of what you say, Altaf. I wrote previously about the need to control pharmacy student numbers here:

http://www.pharmaceutical-journal.com/opinion/correspondence/why-should-the-pharmacy-student-numbers-be-managed-differently-to-other-health-professions/20066898.article
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David Miller14 AUG 2015 17:16
Graham - The pass rates http://www.pharmaceutical-journal.com/news-and-analysis/news/pass-rates-for-gphc-registration-exam-vary-between-universities/20068574.article appear to be reasonably stable amongst students who have attended the top 5 Universities (table 2) and the variation appears to be largely amongst students who attended those Universities with the lowest pass rates (table 3). These have in particular been exceedingly low for the last two years although we have yet to see this year's past rates by University until after the September meeting of the GPhC Council.

Similarly the pass rates in hospitals over the years in question do not seem to to have the same fluctuation - I accept the two may be linked and hopefully someone can provide answers to that question?

Rather than bemoaning the exam failing students it may be we the profession that are collectively failing students? Why do these differences, where a significant minority in the last 3 years are unable to pass an exam designed to test the ability of a candidate to put knowledge into practice may be something more worthy of investigation and debate. Then the harder part being what are the solutions and how can we implement for the benefit of patients, public and the pharmacy profession going forward?
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Graham Phillips19 AUG 2015 7:52
Interesting points Dave: but as I point out in my letter, the GPhC has total and complete end-to-end responsibility. If we assume (for the sake of the argument) that certain Schools of Pharmacy are the problem then we must ask why the GPhC has granted them accreditation in the first place and/or on an ongoing basis. As to your broader point about the profession collectively failing students, I disagree. Pharmacy education at every level is woefully under-resourced compared with other health professions. If your point is that we need a fundamental rethink then I agree. I've argued for years for an integrated, 5year degree. Integration without control of student numbers would be impossible because there will always be limited numbers of PreReg places. I concur entirely with the points made her by Claire Anderson and colleagues:http://www.pharmaceutical-journal.com/your-rps/pre-registration-training-is-good-enough-good-enough/20068192.article
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