Do Community Pharmacy Placements Support the new Integrated Approach to Pharmacy Education? Stakeholder and Student Perspectives Executive Summary Kathryn Moffitt MPharm. MRPharmS Corresponding Author Whickham Pharmacy 32 Front Street Whickham Newcastle Upon Tyne NE16 4DT 01914880956 Kathrynmoffitt@hotmail.com Kathryn Davison MSc. BSc(Hons). MRPharmS Supervisor University of Sunderland Faculty of Applies Sciences Dale 1.02 Chester Road Sunderland SR1 3SD Kathryn.davison@sunderland.ac.uk
Introduction The delivery of pharmacy education has shifted in recent years towards integrated teaching of the traditional stem subjects of pharmacy. Alongside this, opportunities for undergraduate work based placements should be in place to allow students to experience the provision of patient care first hand, and help contextualise information that is being learned. The ultimate aim being to increase the preparedness of students to provide patient-centred care and clinical service provision in today s evolving healthcare environment. The current undergraduate pharmacy programme (MPharm) in the UK spans four years and provides the first stage of student development. This is followed by an independent pre-registration year in practice prior to registration. Therefore, unlike other UK health professions, preparation for registration as a pharmacist is not solely the responsibility of the graduating university, and as a result, a distance has developed between education and professional practice. The Modernising Pharmacy Careers agenda aims to address this, whereby incorporation of preregistration training into a five-year undergraduate programme is proposed. Aims and objectives The aim of this project was to explore and establish the perspectives of both stakeholders and MPharm students regarding the current community pharmacy placement provision at the University of Sunderland. This would allow for the identification of any potential barriers, which may affect the placement experience as it currently stands and potentially give rise to suggestions for improvements in the future. Methodology Qualitative data was collected via five semi-structured interviews with a purposive sample of stakeholders. The interview guide was designed to obtain data on predetermined, structured measures required to meet the study objectives whilst still providing the opportunity to openly examine respondent perspectives. Interviews were transcribed verbatim and then thematically analysed to code data and identify key emerging concepts. Quantitative data was collected from the student cohort, via an electronic questionnaire. The literature review identified no appropriate pre-validated questionnaire suitable to obtain the required data and thus a novel questionnaire was designed. In order to inform the design of the questionnaire, a representative cohort of 8 students (2 from each level of study) were invited to discuss the research question in a focus group. All MPharm students were subsequently invited to complete an online questionnaire exploring their opinions towards current placement provision within community
pharmacy (95% response rate). Responses were statistically analysed and comments taken from both the questionnaire and focus group were explored for impact. Results Thematic analysis of coding produced from transcribed interviews with stakeholders Codes Produced Grouped Themes Emerging Concepts Tasks set Placement Activities Adjusting the placement to suit the students ability Placement duration Practice site limitations Staff participation Student competence Student motivation Student participation Student enjoyment Student preparation Student conduct Building a relationship Financial rewards Non-financial rewards Mentor training Feedback received Using students to your advantage Time pressures Excessive paperwork Mentor enthusiasm Mentor and staff preparation Staffing issues Practical placement activities affect placement success Student engagement is crucial to a successful placement Stakeholder Incentives include financial gain and personal satisfaction Practical barriers and meeting business needs are a priority consideration Practical placement activities and student engagement primarily influence placement success Recognition of business needs as a barrier between ideology and reality of placement provision There were two main emerging concepts that evolved from data analysis within the stakeholder group; practical placement activities and student engagement primarily influence placement success and recognition of business needs as a barrier between ideology and reality of placement provision. Stakeholders also identified
that because students are focused on achieving previously set tasks, they may not be gaining the full benefit from the placement. 82.4% of student respondents agreed with the statement If I had to walk into the role of a pre-registration pharmacist only having experience from placements, I would struggle, with 77.1% disagreeing that placement tasks are necessary to guide learning. However, findings also demonstrate that student perceptions of placements were positive for many statements. 82.8% of respondents agreed or strongly agreed that the coordination of placements by the university was done well and that the feedback system in place was appropriate (73.7%). Furthermore 80.8% of respondents agreed or strongly agreed that the majority of preceptors are enthusiastic and well prepared while 78.3% believed placements have provided me with a valuable learning experience. Stakeholders also commented that they found placements personally enriching. Both groups commented that placements needed to allow better simulation of a working day. Discussion The overarching findings from both the stakeholder and student group centre around the fact the placement activities and tasks undertaken are influencing the success of experiential placements. A proposal to remove the set tasks from the student objectives would therefore seem a feasible solution. However despite the tasks creating a significant barrier to practical learning they were identified as giving the placement a focus. When asked how the tasks could be improved, the stakeholders suggested many potential solutions, all of which centred on allowing the student active participation in the daily activities of the community pharmacy, something that 58.3% of students also wanted. Stakeholders suggested that students should integrate more within their respective pharmacy teams and become more involved in the day-to-day practical activities such as dispensing and counseling patients. Similarly comments left by students highlight that students want to experience a working day in a clinical environment, rather than predefined and restrictive tasks. The level of practical involvement and the ability to build a rapport with the student appears to be heavily influenced by student conduct whilst on placement. All the interviewees referred to student motivation and level of competence as a barrier to how much or how little they would gain from their time in the pharmacy, suggesting that those with improved communication skills were able to readily participate in direct patient care, whilst other less able students were relegated to an observer role. 61% of the level 1 students questioned had no relevant community pharmacy experience aside from allocated placements. This figure was reduced in subsequent levels, with 40% of level 2, 40% of level 3 and 27% of level 4 students without selfdirected experience. It is interesting to note that at the end of the four year MPharm
degree (Summer 2014), over a quarter of students potentially went on to begin preregistration training only having experience from placements organised by the University. 83.2% of students stated that if this were the case, they would struggle. Hence an important consideration should be to acknowledge how to bridge the gap between students who have managed to secure external work experience and those with experience solely from placements. Stakeholders conflict of priorities is as expected, as they are primarily pharmacist practitioners; their role as a mentor falling secondary to that. Stakeholders recognised that students can be of benefit to the pharmacy team and help lighten the load of the daily dispensary demands, however felt they could not allow participation unless they were fully available to support or oversee it. This concept could also be related to the level of trust the mentor has in the student s ability and reiterates the importance of a good relationship between mentor and student. Current assessment within placements is via an annual submission of a portfolio linked to placement tasks, which is then assessed by academic staff. 36.5% of students agreed and 29.1% strongly agreed that this was unnecessary. It is important that tasks and objectives are relevant to every placement or flexible enough to allow the demonstration of a broader competency rather than defined tasks. This is comparable to the pre-registration year wherein the supervising pharmacist signs off various competencies; Over a third (374) of students selected pre-registration style competencies as a suitable alternative assessment tool. Adopting such an approach would allow for the development of a shared assessment model, where both academics and mentors can contribute to student achievement, although how this works in practice is yet to be established. It is of interest to note that none of the stakeholders who participated in this study had experienced any form of formal training as mentors and had only read the mentor pack provided by the University of Sunderland as a means of preparing themselves to act in this role. All of the interviewees expressed interest in undertaking such training however, again highlighting their commitment to providing a beneficial placement experience to students. Conclusion Practical experience through clinical placements is an essential part of the education and training of pharmacists. Student respondents demonstrated there are many positives regarding placement provision, including university organisation and enthusiastic stakeholders. Stakeholders highlighted many positives including the non-financial rewards gained when facilitating student learning. However this study demonstrates the idealistic view that students attending placements are gaining an experience that will help them contextualise learning and prepare them for clinical practice, is not necessarily realised with the current placement provision at the University of Sunderland. There are clear barriers inhibiting the success of the placement experience as the provision stands, many of
which are easily preventable and should be a focus for improvement as the provision evolves. Those barriers include inappropriate task objectives, portfolio assessment, student engagement and the pressures of running a pharmacy business whilst also acting as a stakeholder.