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Preregistration training at James Cook University Hospital

Adam Rathbone is halfway through his preregistration training. Here, he provides an account of his day-to-day training at James Cook University Hospital, Middlesbrough

By Adam Rathbone

Rumour has it that the pharmacy department at James Cook University Hospital was forgotten about during the hospital’s construction so the accommodation provided for pharmacists, technicians and the store of medicines for the hospital was somewhat haphazardly yet precisely placed next door to the morgue. Suffice to say, the pharmacy department at James Cook is very much alive and kicking!

The pharmacy department is made up of the main stores, the trials department, the procurement office, the aseptic unit, the medicines information office and the main dispensary. There are around 20 pharmacists and most of them are specialised in a particular area of clinical expertise.

The department provides services for 19 theatres and surgical and paediatric day units, three intensive care units, an acute coronary care unit, a paediatric intensive care unit, a neonatal intensive care unit, an additional delivery suite and two ophthalmology day units. The hospital’s accident and emergency department covers Teesside, South Durham and North Yorkshire.

The department also provides services to 37 wards in the hospital and dispensing and clinical services to hospices in the surrounding areas. The outpatient pharmacy provides dispensing services for a whole host of clinics, from dermatology to genito-urinary medicine.

The preregistration structure

Preregistration trainees are on rotation around 24 different areas of clinical expertise, most of which are linked to a specific member of staff. This allows trainees to develop relationships with every pharmacist at the site.

Because each rotation is spent with an individual, each rotation becomes individual and unique. While some pharmacists prefer to teach by allowing you to demonstrate your knowledge under their guidance, others prefer to hand-feed you small pieces of vital knowledge and, of course, there are those pharmacists who do not realise their own brilliance and blow your mind when they recite how to make up the ideal total parentral nutrition bag.

Crucially, in the first couple of weeks, the timetable is structured around the dispensary and medicines information. This ensured I had the skills to be useful during busy times in the dispensary. Rotating through medicines information so early in the year allowed me to develop key skills needed to find my own answers, as well as share the responsibility of answering queries.

Preregistration trainees at James Cook also spend time rotating through the mental health trust at a different hospital and are encouraged to take part in a two-week cross-sector experience.

This year the preregistration structure has changed and the trainees have been given their own wards to look after. At first, this was incredibly daunting. I had no previous experience of ward work and my clinical knowledge was limited to what I had studied during my MPharm.

In hindsight, however, the experience of being given so much responsibility so soon led to the rapid development of professionalism, knowledge and confidence.

On the ward, responsibility ultimately lies with the pharmacist assigned to that ward. However, given the nature of the preregistration year, many of the pharmacist’s roles are passed to the trainees. These include clinically checking prescribed items, suggesting amendments and ordering items (for hospital or outpatient use), as well as dealing with any queries that may crop up.

The hard work

The hardest part of completing the preregistration year at James Cook is fighting for office space. Although it would be inaccurate to say that that is the only challenge, many difficulties a preregistration trainee faces mirror those faced by registered pharmacists, such as answering queries and dealing with consultants, manufacturing problems, waste, and the ever present and growing issue of costs.

These challenges are, however, all manageable. Although each new issue can feel like climbing a mountain, mountaineers rarely climb alone, and the same can be said for challenges faced at James Cook. Trainees are supported by basic grade pharmacists, who feel like not-so-much-older siblings and who can relate to you. They are also supported by clinical pharmacists, who are more than willing to share their expertise and skills, and by specialist consultant pharmacists who exude experience.

Community experience

Although hospital preregistration training is nine to five, it is essential to find time to maintain over-the-counter and community knowledge for the registration examination.

Solid links with community pharmacists through placements are ideal and, thankfully, I have made several. Completing the odd shift here and there can help preserve community pharmacy skills acquired at university, as well as top up the knowledge learnt in the hospital. It is also an excellent opportunity to show off your new clinical skills.

The assessments

Completing previous sample papers can be a useful way of learning and gives you an opportunity to highlight weaknesses. Workbooks could be useful but generally it is difficult to find time to fill them in.

From discussions with friends and personal experience, reviews can be what you make of them. Before the first 13th-week review, not knowing what is expected can be worrying.

Evidence collection can be difficult in the first few weeks. Personally, I found it hard knowing what could be written up as evidence. But, once my review was over, I knew that everything was a piece of evidence. Every prescription, every query and every mistake are all good pieces of evidence to show that you are learning to be a pharmacist.

Personally, the best assessment for me is actually being on the ward and dealing with the queries.


The preregistration year can be an opportunity to experience new things, ask stupid questions, have fun and, most importantly, make mistakes. If you do not learn from your mistakes, at least it will give you plenty of evidence to write up.


Adam Rathbone is a preregistration trainee at James Cook University Hospital, Middlesbrough. He also blogs for Tomorrow’s Pharmacist


Citation: Tomorrow's Pharmacist URI: 11067614

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