Pharmacist pre-registration, Study notes of Pharmacy

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Pharmacist pre-registration

Tutor development resource

Contents

• Introduction
  • The role of a tutor
  • Being a professional role model
• 1. Evaluation and reflection
  • Introducing the pharmacist pre-registration training programme
• 2. Getting to know the pre-registration training requirements and creating a training plan
     • and tailoring the training plan 3. Entering into a learning relationship, individual learning needs analysis
• 4. Helping your trainee to learn and develop by agreeing development objectives
  • Assessing your trainee’s performance
• 5. Checking your own competence in assessing and learning how to record trainee progress
  • Sample
  • Sample
  • Recording progress
• 6. Giving feedback to your trainee
  • Supporting your trainee..........................................................................................................................
• 7. Using the STAR approach to troubleshooting
  • Scenario
  • Scenario
  • Scenario

The role of a tutor

As a pharmacist, a tutor must record their on-going learning to demonstrate that their practice remains safe and effective, including any training and development needed to act as a tutor.

Being a professional role model

As a tutor you are in a position of responsibility. You are responsible for guiding your trainee through their training to become a registered healthcare professional. It is important that you act as a professional role model at all times. You should:

• act as a professional role model for your trainee
• act as a mentor to your trainee, offering constructive feedback and advice throughout their training The aim of the following sections is to give you some practical support to help you fulfil your responsibility as a tutor and professional role model. Evaluate your performance and seek the opinion of others Reflect on the training and development you need as a tutor Plan how to address your needs to ensure you are fit and competent to practise in the role Put this into ACTION

1. Evaluation and reflection

The activities in this section are designed to help you:

• reflect on the training and development you need to prepare for the training period ahead
• reflect on your performance as a tutor, and
• identify any of your own development needs while in this role Alongside your self-evaluation, multisource feedback is a useful way to help you identify your strengths and developmental needs. Aim to get feedback from a range of sources, which could include:
• yourself (essential)
• colleagues who have observed your interactions with trainees
• network peers
• previous trainees
• other staff members that you have trained
• patients
• your current trainee as it is also essential that you give the opportunity to give feedback on your performance as a tutor

Introducing the pharmacist pre-registration training programme

All trainees train according to a personal plan. You should discuss and agree the plan with your trainee at the beginning of their training. It must:

• cover the performance standards ,
• consider the outcomes that the GPhC expects trainees to meet in standard 10 of Future Pharmacists: standards for initial education and training of pharmacists , and
• be approved by the GPhC You should:
• induct your trainee at the beginning of their training so they know what is expected of them and when it is expected
• identify your trainee’s training and development needs at the beginning of their training
• involve trainees in planning their progress while they are training
• set realistic targets for your trainee that you have agreed with them
• monitor your trainee throughout their training
• review your trainee’s progress regularly
• discuss the performance of your trainee with other people when this is appropriate

For example, part of a training plan could look like this: Week commencing Week no Activity/place of work/event Others involved in training / practice supervisor Standards to be achieved/ framework areas to be targeted 26 September 12 NHS & private prescriptions OTC – Hayfever BNF chapter on asthma Prepare for first review Dispensary manager and team

A2.3, C1.9, C1.

10.2.2 Validating therapeutic approaches and supplying prescribed and over- the-counter medicines 3 October 13 Basic endorsing, observe month end CDs, undertake and document GPhC 13 week Progress review external study day 2 - “Response to Symptoms” Dispensary manager Tutor Regional training team

A2.1,A2.3,B1.4,

Maintaining and improving professional performance Once you have a training plan, the next stage will involve an initial meeting with your trainee.

3. Entering into a learning relationship, individual learning needs analysis

and tailoring the training plan

As part of the GPhC application to enter the pre-registration scheme, you and your trainee must both sign a learning contract confirming joint commitment to the learning relationship. This must be returned to the GPhC. Important: the learning contract is in addition to, not instead of, any contract of employment between the trainee and the employer. It is important to have a discussion with your trainee at the beginning of the training period that clarifies:

• the trainee’s role and the expectations they may have
• your role and the expectations you have about them,
• the role of other practice supervisors or staff members
• any concerns you or your trainee have about the training
• This discussion will complement any more formal induction training. A formal induction which covers organisation specific policies and procedures, will be more relevant to the employment contract. This is a business relationship outside the remit of the GPhC pre-registration training scheme. Offer your trainee the opportunity to provide evidence of their current level of competence in relation to the performance standards. Their evidence could be based on based on relevant previous experience, if they have already completed some training elsewhere, for example. Asking for and reviewing this evidence will help you establish your trainee’s base level of competence and identify if you need to make any changes to training plan you have created in part 2. It’s also helpful to understand how the trainee prefers to learn and any learning support mechanisms they may have had access to in the past.

5. Checking your own competence in assessing and learning how to record

trainee progress

Review the following two samples of evidence and describe the strengths and areas for improvement for each. Compare your answers with the suggestions provided to improve the quality of the evidence you request.

Sample 1

Name of trainee: A Person Date : 20/02/xx “I took in a prescription for erythromycin tablets. I checked the prescription to ensure that it was legal. It was. From the PMR I noted that the patient had been prescribed theophylline tablets for the past 6 months and there could be an interaction between theophylline and erythromycin. The prescription for the antibiotic had been written by a locum doctor. I rang the doctor to explain the problem. He asked me to recommend an alternative. I said I would call him back. I then looked in the BNF and spoke to the pharmacist. When we had discussed the interaction and agreed an alternative antibiotic, I called the doctor. I should have been more prepared when I called the doctor for the first time. It would have been better if I had thought of an alternative drug beforehand. In future, I must remember to put myself in the doctor’s position and think of any questions that I would ask the pharmacist.” Which aspects of the performance standards does this provide evidence for? Performance Standards C1.2, C1.

Compare your analysis of sample 1 with our suggestions

Overall, a good opportunity was not fully used to demonstrate evidence of competence or further learning needs. Strengths:

• the trainee has reflected, identified a learning need and suggested an action for improvement Areas for improvement: There are several learning opportunities that the trainee has not identified. The trainee could:
• provide more specific information relating to their personal checking process for legality
• include details of the mechanism of the drug interaction and possible consequences if unmanaged
• suggest options for management including suitable alternative agents with reference to the type of infection being treated
• consider if this provides evidence for other performance standards The trainee should be encouraged to also reflect on what they would do when they become a pharmacist and they do not have a supervisor or other pharmacist to refer to?

Compare your analysis of sample 2 with our suggestions

Overall, being a substantial piece of work, the event could have provided a wealth of evidence but the trainee has given little evidence to the assessor. Strengths

• extensive detail about planning the event Areas for improvement: The trainee could:
• provide further detail about the actual event e.g. the nature of some of the queries
• evaluate the event and make recommendations for managing similar future events
• refer to the relevant performance standards where competence has been demonstrated
• identify learning points e.g. from queries that the trainee couldn’t answer on the spot or would like to know more
• provide some supporting evidence of the positive feedback referred to in the account

Recording progress

There is no standard prescribed format that trainees are required to follow when documenting evidence. You should discuss and agree with your trainee how they produce their portfolio of evidence to demonstrate their competence against the performance standards. They will be issued a username and password to enable them to use the GPhC on-line recording resources. An assessment summary form is included in the pre-registration manual and acts as a cumulative list to use throughout the year. You must make an entry on the trainee’s assessment summary once you consider your trainee has demonstrated a particular performance standard in a sufficient range of circumstances and to the standard expected of a newly registered pharmacist. Over the year this will become a cumulative record of the performance standards your trainee has achieved so far. Please retain a copy of this form for your own records. You may be asked by the GPhC to submit a copy. Generally, at the time of the first progress report, few areas will have been ‘signed off’ but you should consider the trainee’s overall development in terms of level of competence you would expect to see from a trainee who has only been in training for 13 weeks. You should expect your trainee to become more competent as their training progresses. Further performance standards may be ‘signed off’ at subsequent progress reports. Once a standard is signed off you should still expect to observe it in practice. If you later see that your trainee’s performance has fallen below the required standard you would be justified to revoke the sign off until you are satisfied that their performance has improved.

6. Giving feedback to your trainee

One important aspect of the tutoring role is to give feedback to help your trainee to develop their competence during their training and to become competent by the end of their training. You should:

• give your trainee regular constructive feedback to help them develop during their training
• give feedback in time for your trainee to use the feedback to improve their performance
• give feedback to your trainee that is specific and based on evidence
• encourage your trainee to get feedback from sources other than you
• give your trainee the opportunity to reflect on their feedback and then discuss it with you
• give feedback to your trainee in a suitable environment
• give your trainee the opportunity to give feedback on you as a tutor. You need to complete a formal review of your trainee’s progress after each 13 week period. Your trainee’s progress must be assessed as either satisfactory or unsatisfactory and you must keep a record of this. All unsatisfactory reports should be sent to the GPhC. Copies of satisfactory reports should be retained by you and the original kept by the trainee. The GPhC may ask to see these reports at any time. The third progress report that is undertaken at 39 weeks forms part of the application to sit the registration assessment. As well as the formal review process, it is good practice to document additional regular review meetings. This will help you to capture progress against shorter term objectives and any concerns or shortfalls against the training plan and agreed actions to address these. You should agree a format for your review sessions with your trainee to make sure that you are both prepared and able use the time effectively. You should give your trainee the opportunity to express their opinion of their progress. You should consider:
• the location and environment where the review will occur
• how and who will document the meeting
• the most suitable time for the review and how you will ensure that you are not disturbed unnecessarily

7. Using the STAR approach to troubleshooting

For all problems, big or small, you may find it helpful to use a ‘STAR’ approach: Specify the exact nature of the problem to your trainee, relating it to the performance standards and any facts that are available Talk it through to establish each of your views and discuss possible causes as soon as possible Agree an action plan, including a review date Review the situation at the agreed time Using the STAR approach, consider these example scenarios and compare your thoughts with the suggested action plans.

Scenario 1

By week 13, your trainee has demonstrated to you that they work accurately, including when under pressure, and so far they can be relied upon when given any task. You do not have any concerns about their capabilities, but other members of your staff (whose judgement you would usually trust) have increasingly been complaining to you that the trainee is difficult to work with. You raise these concerns with the trainee who maintains that the problem lies with the staff, stating: “They have not liked me from the word go and have got it in for me.” How are you going to deal with this? Suggested action plan Knowing that your trainee disagrees that there is a problem on their part, before going any further you should:

• get the facts and ask for specific examples to confirm whether the claims made by the other staff are a fair assessment of the trainee
• discretely observe the interactions between the trainee and other staff
• seek feedback from staff members that have worked with the trainee but not raised any concerns to make sure that this is not an individual clash If after this it is clear that there is a problem, proceed to try and resolve it using the STAR approach. Specify which of the performance standards they are not meeting or ask the trainee to reflect on any specific examples that have been provided and tell you which of the performance standards relate to the incident(s) Talk it through to find out if they now, in view of the facts you have collected, acknowledge any responsibility for the problem. Also try to establish their view as to what the cause is or what they think the best solution might be

Agree an action plan. This may be:

• setting of specific tasks with others to give the trainee the opportunity to demonstrate their ability to work within the team
• a strategy for the trainee to build a rapport with the other staff members and clarify their role
• setting a review date to discuss progress with this particular issue Review with the trainee how they are progressing with building a rapport and assess the quality of their working relations with colleagues. Ultimately if the issue cannot be resolved, it could have a significant impact on the trainee’s progress and well-being. It may be useful to arrange a short placement for them in another local pharmacy and get feedback from another practise supervisor to establish whether the problem follows the trainee or whether it is an issue with the team dynamics at your site. A permanent move may be the best option but further advice should be sought.

Scenario 2

Leading up to 26 weeks of training, you are concerned that your trainee is still making too many mistakes in the dispensary and you are not confident in their provision of advice to patients. You have brought errors to their attention as they have occurred, but they have been unable to provide any explanation for them. At the 26 week progress report you sign the trainee off as ‘satisfactory’ as generally they are making good progress in other areas. You highlight clearly your concerns about these mistakes but the trainee disagrees that any problem exists. What action will you take? Suggested action plan Specify which of the performance standards they are not meeting when these mistakes occur. Talk it through to find out if they now acknowledge the problem or can give a reason for it. Ask the trainee to reflect on the patient safety risks of the errors that you have observed. Agree an action plan:

• the trainee should keep a log of their dispensed items, perhaps using the paperwork that accredited checking technicians use, to highlight any trends with the errors that they make. It may also be useful to note whether the errors occur at a particular time of day
• the trainee could be asked to complete a reflective entry relating to any errors that they make
• the trainee should write down their self-checking procedure and refer to it as needed
• you may need to consider whether the trainee is being given enough time or support to carry out the task efficiently
• set a date to review and a target number of items to complete without error within the timeframe