Rotating your way through a hospital preregistration post: what you need to know
Preregistration trainees Christine Wassef and Talitha Orlandi give you a guide about a hospital preregistration post and provide tips to help you progress smoothly through your training
Pharmacy has withstood many changes over the years. One of the most exciting was the shift of the pharmacist’s role from behind-the-counter dispenser to sought-after drugs expert by patients and professionals. This expansion in role includes hospital pharmacy practice. Hospital pharmacist posts are desirable and competition for them is high. Similarly, hospital preregistration placements are well sought after by pharmacy graduates.
Within the hospital, the breadth and depth of the roles of hospital pharmacists and trainees lie in their close integration with the extended healthcare team to provide optimal pharmaceutical care. This team includes (but is not limited to) other pharmacists and trainees, technicians, dispensers, nurses, therapists, consultants, training doctors and dietitians.
Trainees are required to familiarise themselves with the various roles within each working team, as well as their own role within that team. Pharmacists are expected to be adaptable in applying their clinical knowledge. Regardless of the team, pharmacists and trainees are the resident drug experts. It is simply a matter of the approach that best suits the team.
Tip: Set a goal. Use the year to enhance both verbal and written communication skills.
Hospital trainees will rotate through nearly all roles a pharmacist fulfils within a hospital, thereby enriching their learning experience. Depending on the site, trainees may start the rotation at different points. Every individual has a different level of knowledge and experience so a basic starting point for everyone is helpful. Trainees will initially rotate through the hospital dispensary (inpatient and outpatient), stores, and the aseptic and manufacturing units. It is an opportunity to learn about the technical aspects of pharmacy in the hospital: how medicines are procured, manufactured, checked, dispensed and delivered to the patient.
Tip: Make notes. The topics mentioned above are often covered in the registration assessment.
Clinical ward rotations are one of the most attractive features of hospital preregistration posts. These will cover most specialties, including medicine, surgery, cardiology and care of the elderly. Each rotation is designed to enhance the trainee’s knowledge of the specialty area. Being on the wards allows you to experience the process of disease diagnosis, treatment, monitoring and initial follow up. Trainees also have the unique opportunity to be acquainted with the use of unlicensed and off-label medicines.
Tip: You may be able to observe medical procedures, if the opportunity presents itself — discuss this with the ward pharmacist on your rotation.
Hospital prescriptions and dispensing are different from those seen in community pharmacy, hence trainees complete a cross-sector placement in a community pharmacy. This offers the opportunity to have the hands-on experience dealing with FP10s, private prescriptions, emergency supplies and over-the-counter enquiries. Since this is the only opportunity that hospital trainees get to experience these practices, they should be well prepared for this rotation to gain the most from it. Training days throughout the year also cover essentials for the registration assessment, such as the Drug Tariff and pharmacy law.
Hospital rotations are prescheduled to provide structure so it is advisable to prepare for each rotation. For dispensary rotations, a review of the ‘Medicines, ethics and practice’ guide and dispensing guidelines. For the community pharmacy placement, revise OTC medicines and indications, as well as the MEP.
Clinical ward rotations involve reading the relevant National Institute for Health and Care Excellence guidelines, British National Formulary sections, as well as any accompanying hospital-related documentation. To excel in the clinical rotations, a review of the pertinent evidence-base would not go amiss. Read landmark trials.
Although trainees are provided with weekly self-study time, it is necessary to complement it with out-of-work study time. Preregistration tutors expect trainees to be accountable for their own learning. Trainees are encouraged to look up any new concepts (ie, new therapies, terminologies, disease, etc) to add to their learning portfolio.
Tip: Write it down, look it up later. These notes will serve as good revision aids for the registration assessment.
Preregistration tutors act as mentors for the training year. They are responsible for completing all assessments and ensuring trainees are progressing well. Trainees will usually be working with other pharmacists on a day-to-day basis, but ultimately report to the tutor. This is the go-to person for guidance throughout the year.
Tip: Plan to meet your tutor formally at least twice a month.
To summarise a typical day in the life of a hospital trainee: there is no typical day. Hospital is an acute setting. Every day poses its own set of needs and challenges. Ward pharmacists will usually be responsible for the medication management of all patients on their wards. Different patients, with varying healthcare needs, can be under the care of a single pharmacist. This is intertwined with having to cover a couple of hours in the hospital’s dispensary, answering drug queries, obtaining drug histories for new admissions and counselling patient discharges.
A trainee will shadow, support and gradually take on the responsibilities. Do not be overwhelmed. Expectations gradually increase as the year progresses. Initially, the trainee may be responsible for completing full drug histories for new patient admissions. This will slowly be compounded with reviewing inpatient prescriptions, addressing drug-related queries and taking on the entire pharmacist role.
What you need to develop
Key characteristics one must develop and expand on are time management and organisation skills: know who needs what when. Remain focused on the task at hand and prioritise. Regardless of the situation, have a systematic approach to dealing with drug histories, queries, prescription checking and counselling. Such an approach will ensure that nothing is missed.
For example, if answering a drug query, a few points to consider would include: who is the patient, what other medicines are they taking, who is asking, when does he or she need an answer by, etc. Perhaps some of these questions are obvious in certain scenarios. However, it is important always to use a systematic approach.
The goal of the year is to transform from a new pharmacy graduate into a band 6 pharmacist. Again, every trainee’s learning style and speed is different, which tutors appreciate. It is, however, the trainees’ responsibility to ensure that all their competencies are met by the end of the 52 weeks.
Opportunities are provided throughout the preregistration year to meet every competency, and more. It is simply a matter of staying organised, documenting new learning and seizing every opportunity. Regional NHS training days throughout the year are designed as an aid tool and cover a wide range of topics, from meeting the General Pharmaceutical Council standards and competencies to how to prepare for the registration assessment. Additionally, most hospitals have their own training days, which, again, are designed to cover key topics within the GPhC syllabus.
Tip: Read the GPhC preregistration manual. Consider the GPhC definition of fitness to practise: “Demonstrate the skills, knowledge, character and health required to do their job safely and effectively.”
Some final tips to stay on track:
1. SMART (specific, measurable, attainable, relevant and time-bound) objectives: set realistic goals and plan where and when each one can be achieved.
2. Time management is imperative.
3. Get involved. At work, offer to help, show initiative; outside work, participate in social events.
4. Keep up to date: aim to complete a monthly continuing professional development cycle.
5. You are not alone on this journey as a hospital trainee. Consider creating study groups.
Considering an application to a hospital preregistration post? Get organised.
1. Know your employer, browse its website.
2. Personalise your personal statement and application to the hospital’s job specifications.
3. Show interest. Volunteer experience at the hospital will go a long way.
4. Do not leave the application to the last minute.
The diversity of learning exposures and daily application of clinical pharmacy within a hospital makes hospital preregistration training exciting. Most trainees do stay on as hospital pharmacists once they have registered. There are many opportunities for career progression within this field, such as specialist clinical pharmacists and independent prescribing pharmacists. Whether you are currently a trainee or considering applying for the forthcoming year, the role does call for a motivated, organised, professional and reliable team player. An eagerness to learn is essential to success, as is commitment to hard work.
ACKNOWLEDGEMENTS All the preregistration trainees and hospital pharmacists who contributed to this article. Their contributions are much appreciated.
Citation: Tomorrow's Pharmacist URI: 11125710
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