Comparing the experiences of community and hospital pharmacy learners completing a pre-registrant research training program.

BACKGROUND AND PURPOSE: Research training programs in the community pharmacy sector have not been well established. This study showcases a year-long guided research training program undertaken in hospital and community workplaces by pre-registrant pharmacists, and compares the perceived impact on learners in both sectors. EDUCATIONAL ACTIVITY AND SETTING: A two-year cohort study (2021-2022) of pre-registrant pharmacists enrolled in a research training program requiring them to undertake an individual project at their workplace over one year at either a community or hospital workplace. Outcome measures were pre-registrant perceptions of training impact and type of projects completed. FINDINGS: The results of this study demonstrate that the year-long guided research training program delivered to 403 pre-registrant pharmacists was perceived to be impactful to both community and hospital pre-registrant pharmacists and gave them the confidence to pursue further research and see research skills as an important attribute for the profession. Barriers to research included lack of time for both sectors but workplace support and lack of project ideas were especially noted in the community sector. Research project designs were mainly cross-sectional surveys or retrospective audits. SUMMARY: Programs seeking to adopt a similar model may wish to pay particular attention to supporting community pharmacy learners in providing a pre-selection of project ideas, offering training to workplace supervisors, ensuring enough academic support is given and having more check-in points/deliverables to ensure more feedback opportunities.

Development and Validation of Entrustable Professional Activities for Provisionally Registered (Intern) Pharmacists in Australia.

OBJECTIVE: The purpose of this study was to describe the development and validation of entrustable professional activities (EPAs) for a pharmacy intern training program in Australia. METHODS: Performance outcomes with EPAs suggested as an assessment in the intern year were identified and EPAs were developed. The EQual rubric, designed for EPAs in graduate medical education settings, was used to validate the EPAs. Eight subject matter experts were recruited to validate 14 EPAs using prespecified cutoffs in the EQual rubric to determine the degree of alignment with established key domains of the EPA construct. Descriptive statistics for the EQual rubric scores were calculated for each of the 14 EPAs overall and for each of the 3 domains. Any EPA falling below the prespecified cut score required revisions and a second round of validation. RESULTS: Eight responses were recorded for the first round of validation. Seven EPAs were below the discrete units of work cutoff (4.17); 2 of these EPAs were also below the EPA curricular role cutoff (4.00). All scores described in the EPAs as entrustable, essential, and important tasks of the profession were above the cutoff (4.00). Seven subject matter experts responded to the second round of validation. All 7 revised EPAs scored above the EQual rubric's overall cutoff of 4.07. CONCLUSION: Fourteen EPAs were validated for use with provisionally registered (intern) pharmacists. To our knowledge, this is the first time that the EQual rubric has been used in the evaluation and validation of pharmacy EPAs.

The development and validation of a global advanced development framework for the pharmacy workforce: a four-stage multi-methods approach.

BACKGROUND: Studies have indicated that a generalisable and translatable global framework is a useful tool for supporting career progression and recognising advanced practice. AIM: To develop and validate a global advanced competency development framework as a tool to advance the pharmacy profession globally. METHOD: A four-stage multi-methods approach was adopted. In sequence, this comprised an assessment of initial content and a cultural validation of the advanced level framework. Following this, we conducted a transnational modified Delphi followed by an online survey sampling the global pharmacy leadership community. Finally, a series of case studies was constructed exemplifying the framework implementation. RESULTS: Initial validation resulted in a modified draft competency framework comprising 34 developmental competencies across six clusters. Each competency has three phases of advancement to support practitioner progression. The modified Delphi stage provided feedback on framework modifications related to cultural issues, including missing competencies and framework comprehensiveness. External engagement and case study stages provided further validity on the framework implementation and dissemination. CONCLUSION: The four-staged approach demonstrated transnational validation of a global advanced competency framework as a mapping and development tool for the pharmacy professions. Further study is needed to develop a global glossary of terminologies on advanced and specialist practice. Also, developing an accompanying professional recognition system and education and training programmes to support framework implementation is recommended.

A Review of Entrustable Professional Activities in Pharmacy Education.

Objective. To review the published literature describing how entrustable professional activities (EPAs) are currently used in health professions education with a focus on pharmacy education.Findings. English-language searches in the databases CINAHL Plus and MEDLINE were conducted for January 2011 through March 2021, which identified 21 publications for inclusion in this review. The following themes were identified: frameworks for the development of EPAs, the implementation and evaluation of EPAs for workplace learning, and gaps in knowledge and future directions for EPAs.Summary. Currently, no standardized approach exists for developing EPA frameworks for health disciplines. Also, the ways that EPAs are implemented and evaluated as an educational tool in practice settings are inconsistent. An opportunity exists to further establish the development, implementation, and evaluation of EPAs in all clinical practice settings. Much can be learned from other health professions to ensure successful translation of EPAs into pharmacy education.

Strengthening Primary Healthcare through accelerated advancement of the global pharmacy workforce: a cross-sectional survey of 88 countries.

OBJECTIVE: Advancing the pharmacy workforce contributes to strengthening primary healthcare and accelerating progress towards universal health coverage. This study aimed to identify key enablers to support policy development for national pharmacy workforce advancement. DESIGN: A cross-sectional country-level questionnaire was distributed from July 2018 to March 2019. SETTING: National-level or country-level pharmacy workforce development policy. PARTICIPANTS: Professional leadership associations and national agencies of the International Pharmaceutical Federation (FIP). The FIP global database included 129 countries. MEASURES: The questionnaire was designed to collate data on the scope of advanced and specialist practice in respondent countries. Multiple correspondence analysis and subsequent cluster analysis were conducted to explore the associations and patterns of country-level attributes of systems in place for the pharmacy workforce advancement in order to develop a general transnational model for country-level advanced practice development. RESULTS: Eighty-eight countries (68.2% response rate) responded to the questionnaire. Factors that enhance and contribute to advanced practice policy development include the country's socioeconomic factors and the availability of national practice advancement concepts. The essential advancement concepts include the availability of framework and professional recognition systems, programmes assisting advanced practice development and workforce advancement and recognition opportunities. Cluster analysis identified three clusters of country respondents. First cluster included low-income and middle-income with poor pharmacy advancement implementation, second cluster included a higher socioeconomic status with weaker pharmacy workforce advancement implementation and third cluster included upper middle-income to high-income countries and high rates of pharmacy advancement implementation. CONCLUSION: The key factors identified in this study can be used to support a transnational approach to pharmacy workforce advancement. The three clusters identified highlighted that workforce advancement was not an exclusive trait of higher-income countries. Lessons from countries that have already adopted concepts of advancement in pharmacy practice could be adopted to other countries to accelerate the progress of advanced practice globally.

Development of a Vertically Integrated Pharmacy Degree.

Whilst curriculum revision is commonplace, whole degree transformation is less so. In this paper we discuss the rationale, design and implementation of a unique pharmacy program by a research-intensive faculty. The new Monash pharmacy curriculum, which had its first intake in 2017, was built using a range of key innovations that aimed to produce graduates that demonstrate key conceptual understanding and all the skills required to deliver world-best patient outcomes. The key elements of the re-design are outlined and include the process and principles developed, as well as key features such as a student-centred individualised program of development arranged around specific, authentic tasks for each skill and earlier enhanced experiential placements where students become proficient in entrustable professional activities. It is hoped the dissemination of this process, as well as the lessons learnt in the process, will be useful to others looking to transform a health curriculum.

Developing a Global Community of Practice for Pharmacy Workforce Resilience-Meet GRiT.

Workforce resilience in pharmacy is required to ensure the practice, education, and administrative systems remain viable and sustainable over time and when facing challenges. Whether it is addressing burnout of pharmacists or students, or the structure and policies/procedures of employment and professional organizations, working to increase resilience across all individuals and sectors is essential to relieve pressure and promote better well-being, especially during the recent pandemic. The purpose of this article is to describe the development of a community of practice global group focused on development of resilience within the pharmacy workforce that is inclusive of students, pharmacy interns/preregistration and registered pharmacists. The steering group meets monthly and has representation of 24 members across eight countries. Members meet to discuss pertinent issues they are facing in practice, as well as to share and progress ideas on education, research, and practice initiatives. To date, members have collectively implemented resilience training in pharmacy education, researched burnout and resilience in both students and pharmacists, and facilitated international collaborations both within and outside core group members. Future activities will focus on strengthening the community of practice in order to harness the power of the collective.

The development, validity and applicability to practice of pharmacy-related competency frameworks: A systematic review.

BACKGROUND: Global reforms in the education of health workers has culminated in the implementation of competency-based education and training (CBET). In line with the CBET model, competency frameworks are now commonplace in the health professions. In pharmacy, these frameworks are used to regulate career entry, benchmark standards of practice and facilitate expertise development. OBJECTIVE: This systematic review assessed the development, validity and applicability to practice of pharmacy-related competency frameworks. METHOD: PubMed/Medline, CINAHL, Embase, ERIC, Scopus, ProQuest and PsycINFO electronic databases were searched to identify relevant literature. Additional searching included Google Scholar, electronic sources of grey literature, and the Member Organisation websites of the International Pharmaceutical Federation (FIP). The findings of this review were synthesised and reported narratively. The review protocol is registered on PROSPERO with reference number CRD42018096580. RESULTS: In total, 53 pharmacy-related frameworks were identified. The majority (n = 38, 72%) were from high income countries in Europe and the Western Pacific region, with only three each from countries in South East Asia (SEA) and Africa. The identified frameworks were developed through a variety of methods that included expert group consultation used alone, or in combination with a literature review, job/role evaluation, or needs assessment. Profession wide surveys and consensus via a nominal group, Delphi, or modified Delphi technique were the primary methods used in framework validation. The competencies in the respective frameworks were generally ranked relevant to practice, thereby confirming validity and applicability. However, variations in competency-related terminologies and descriptors were observed. Disparities on perception of relevance also existed in relation to area of practice, length of experience, and level of competence. For example, pharmaceutical care competencies were typically ranked high in relevance in the frameworks, compared to others such as the research-related competencies. CONCLUSION: The validity and applicability to practice of pharmacy-related frameworks highlights their importance in competency-based education and training (CBET). However, the observed disparities in framework terminologies and development methods suggest the need for harmonisation.

The effectiveness and impact on performance of pharmacy-related competency development frameworks: A systematic review and meta-analysis.

BACKGROUND: Competency frameworks for education, training and development are widely used in the health professions, including pharmacy. Published studies suggest that competency frameworks have an impact on professional performance. Professional performance that is consistent with up-to-date knowledge and skills influences health care quality and patient safety. This review assessed the effectiveness of competency frameworks in facilitating improvement in pharmacists' performance. METHOD: PubMed/Medline, CINAHL, Embase, ERIC, PsycINFO and Scopus electronic databases were searched to identify relevant literature. The findings of the included studies were synthesised qualitatively, and via a meta-analysis. The meta-analysis evaluated the odds of improved competency behaviour as a proxy measure of impact on pharmacists' performance. Study quality was assessed using 12 criteria adapted from the EPPI-Centre guidelines v0.9.7. The protocol for this review is registered on PROSPERO with reference number CRD42018096580. RESULTS: In total, nine interventional studies were identified for review. The review findings showed observable and significant improvement in pharmacists' performance when competency frameworks are used to appraise performance, identify knowledge gaps, and tailor learning activities. A meta-analysis that involved a total of 348 pharmacists undergoing repeat peer assessment showed pooled odds for improved competency behaviour of 4.41 (95% CI: 1.89-10.29, I2 = 83%). Subgroup analyses showed pooled odds with corresponding 95% CI of 6.50 (1.77-23.97, I2 = 77%) vs 2.95 (0.59-14.72, I2 = 93%) for the studies that were conducted in countries within or outside Europe, respectively; 10.51 (3.73-29.62, I2 = 24%) vs 2.39 (0.96-5.95, I2 = 87%) for studies with reassessment conducted at ≤6 months from baseline, or more, respectively; 6.68 (1.63-27.45, I2 = 88%) vs 2.80 (0.86-9.07, I2 = 74%) for studies involving hospital or community pharmacists, respectively; and 2.80 (1.22-6.45, I2 = 77%) for studies with low risk of bias. CONCLUSION: These findings suggest competency frameworks facilitate improvement in pharmacists' performance; however, further evaluative studies are needed.

Experiential Education in the Time of COVID-19: An Australian Experience.

The pharmacy degree at Monash University is a four year undergraduate Bachelor of Pharmacy with Honours (BPharm(Hons)), followed by a one year Master of Pharmacy incorporating a preregistration year of supervised practice, known in Australia as internship. The first cohort of the BPharm(Hons) will graduate in 2020. A key principle of the new curriculum was that clinical experiential placements should commence early in the curriculum, be fully integrated with the didactic curriculum, and prepare students for internship by developing their competence in performing useful and relevant tasks in the workplace. Entrustable Professional Activities (EPA) are used as the framework for their experiences.

Effectiveness of multimedia interventions in the provision of patient education on anticoagulation therapy: A review.

OBJECTIVE: A literature review was conducted to identify available evidence on the use of multimedia patient educational interventions on anticoagulation therapy. METHODS: A literature search was conducted on 9/4/2020 via six research databases. Publications that evaluated the effects of these interventions on anticoagulation therapy were included. RESULTS: The review included ten original research studies (five randomized controlled trials, four observational studies and a pre- and post-interventional study), a systematic review and meta-analysis, three systematic reviews, a scoping review, and a literature review. Multimedia interventions significantly improved knowledge after education, but no significant differences found when compared to traditional methods. There was insufficient evidence to conclude whether knowledge retained over time. Patients were equally satisfied with both methods. Multimedia interventions significantly reduced healthcare professional's time required for education. Heterogeneity in intervention, methodology and results limited comparison and combination of findings across studies. CONCLUSION: Multimedia patient educational interventions on anticoagulation therapy have similar outcomes to traditional methods in knowledge improvement and satisfaction, but they save health personnel time. PRACTICE IMPLICATIONS: There is lack of evidence to support the effectiveness of multimedia interventions in educating patients on anticoagulation therapy. Larger randomized studies evaluating their benefits in health outcomes and clinical practice are warranted.

Trends in advanced practice and specialisation in the global pharmacy workforce: a synthesis of country case studies.

OBJECTIVES: This study aims to gain a better understanding of the drivers and barriers to the development of advanced practice and specialised systems around the world. Through the synthesis of in-depth country case studies, this paper aims to identify current models of advanced practice and specialisation in pharmacy and illustrate trends, drivers and barriers in policy development. This is the first analysis of its kind to examine pharmacy specialisation and advanced practice in this depth from a global perspective. METHODS: A synthesis of country case studies was carried out. The country case study template was reviewed and approved by an expert working group drawn from a cross section of International Pharmaceutical Federations (FIP) experts and special-interest groups. FIP member organisations and country-level contacts from regulatory, professional and government agencies and universities were approached to contribute to the case study database. The data were collected between January and May 2015. Descriptive comparative analysis and qualitative thematic analysis were both used to analyse the data. KEY FINDINGS: Case study submissions were received from 17 countries. The findings demonstrate that the pace and depth of change in advanced practice and specialisation are occurring at different rates across countries and regions, although many countries appear to be moving towards recognising advanced and specialised practice of pharmacists and developing frameworks and/or formalised recognition systems. CONCLUSIONS: Country-specific examples are useful in identifying factors that may contribute to the rate at which developments in advanced practice and specialisation in pharmacy are taking place and enable progress in around the world.

A global survey on trends in advanced practice and specialisation in the pharmacy workforce.

OBJECTIVES: Despite the increasingly complex care and demanding health challenges shaping pharmacy, little work has been carried out to understand the global status of advanced and/or specialised pharmacy practice scopes and the models in which they exist. This study aims to describe the current global status of initiatives relating to advancement of pharmacy practice. METHODS: A global survey was conducted between January and May 2015 to collect country-level data from member organisations of the International Pharmaceutical Federation (FIP), and national-level contacts from regulatory, professional and government agencies or universities; data requests were sent to 109 countries. The collected data were triangulated (comparing multiple sources from single countries, e.g.), cleaned and analysed by descriptive and comparative statistics. KEY FINDINGS: Full data sets from 48 countries and territories were obtained. The findings demonstrate varying systems of advanced pharmacy practice and specialisation often linked to income level. The study found that there are variations within terminology and definitions, frameworks for specialisation and advanced practice, professional recognition mechanisms and benefits across countries. CONCLUSIONS: This survey of 48 countries and territories was the first of its kind to describe the range of specialisation and professional recognition systems for advanced pharmacy practice worldwide. Despite the variance, it is clear from this global study that professional advancement and the recognition of advancement in practice are developing around the world and this could be due to the increasingly complex nature of pharmaceutical care delivery and a consequent need to be able to endorse professional capabilities.

The impact of a Calderdale Framework designed advanced pharmacy assistant role on inpatient pharmacy services.

Background Pharmacists in Australian hospitals do not see all inpatients. Effectively utilising pharmacy assistants in non-traditional roles may provide an opportunity to increase the number of patients seen by pharmacists. Objective To implement a Calderdale Framework designed advanced pharmacy assistant role on an inpatient unit and evaluate the impact of the role on the provision of clinical pharmacy services provided by the pharmacist in an Australian University hospital. Setting The study was conducted in a single 24-bed medical IPU at a tertiary hospital in Queensland, Australia. Method A quasi-experimental two-cohort comparison design, completed over three phases from 30/5/2016 to 30/9/2016 was employed. To evaluate the impact of the advanced pharmacy assistant on an inpatient unit an 8-week period of usual care was compared to the same time period on the same unit where the pharmacist provided usual care with the support of an advanced assistant. Pharmacist and assistant satisfaction was also surveyed. A training and lead-in phase was completed to ensure the advanced pharmay assistant was competent in completing the delegated tasks. Main outcome measure The primary outcome was percentage change of medication management plans documented by the pharmacist with an advanced assistant comparative to the pharmacist without. Results The number of documented medication management plans significantly increased by 9.5% (p = 0.019; CI 1.86-17.14). Plans documented within 24 h and time to documentation remained unchanged. Completeness increased in community pharmacy documentation. The percentage of completed discharge medication records rose by 15.6%, (p < 0.001; CI 7.78-23.16). Interventions documented increased by 55 and the percentage of patients with clinical reviews documented increased by 35%. There were fewer missed doses recorded and pharmacists spent more time on clinically based tasks. Pharmacist and assistant satisfaction also improved. Conclusion The use of the Calderdale Framework enabled structured pharmacy assistant role redesign that impacted significantly on the provision of clinical pharmacy services on an inpatient unit.

Medication-related issues associated with the documentation and administration of long-acting injectable antipsychotics.

Background There are significant research gaps into understanding the extent of medication errors within mental health and variation in the uptake of standardised medication safety practices. Long-acting injectable antipsychotic (LAIA) preparations are a common treatment modality for the administration of antipsychotic medicines. Aim of the review To examine the literature on medication-related errors and practice issues associated with the documentation and administration of LAIAs. Method Electronic databases were searched for articles exploring medication errors in mental health, charting and administration of LAIAs, standardised medication charts, documentation of LAIAs and strategies or interventions to improve medication safety with LAIAs. Results Nineteen articles met the inclusion criteria. Medication errors in mental health were mostly related to the clerical or procedural aspects of prescribing. Standardised charts have been shown to reduce prescribing and administration errors. Divergent practices across mental health services were reported and this lack of standardisation in ordering and administering LAIAs contributes to errors. Discrepancies between guidelines and current practice with the administration of LAIAs were also identified. Evidence demonstrates that clinical pharmacy services reduces medication errors, and increased pharmacist involvement in LAIA care coordination improves communication and documentation with LAIAs. Further investigation focusing on standardisation of charting, administration and documentation of LAIAs is required. Conclusion Limited studies were identified that assess the charting, administration and documentation of LAIAs. Future research is required to review current local practices with LAIAs and identify substandard areas so that specific clinical interventions can be implemented and evaluated.

Evaluation of a Situational Judgement Test to Develop Non-Academic Skills in Pharmacy Students.

Objective. To design, implement, and psychometrically evaluate a situational judgement test (SJT) to use as a formative assessment of pharmacy students' non-academic skills in an Australian-based university. Methods. An SJT was developed using a previously validated design process including involvement of subject matter experts. The first phase included design of a blueprint through stakeholder consultation and the development of bespoke attribute definitions and a tool specification. Following on from this, SJT items were developed through subject matter expert interviews and in-depth review process. Results. Students (702) from four different cohorts (first through fourth years) of a Bachelor of Pharmacy degree program completed the situational judgment test. Data from 648 students was eligible for inclusion in the analysis. The SJT demonstrated good reliability, appropriateness for use (difficulty and quality), fairness, and face validity. The variability in students' scores suggested that the SJT may be a useful metric to identify students most in need of additional support. Conclusion. Evaluation of the SJT demonstrated that the tool was valid, reliable, fair and appropriate to use as a formative assessment. Through implementing an SJT such as this, pharmacy students are provided the opportunity to receive feedback on their non-academic skills and consider how to approach challenging or unfamiliar situations before entering the profession.

Transnational comparability of advanced pharmacy practice developmental frameworks: a country-level crossover mapping study.

BACKGROUND: Previous work by the International Pharmaceutical Federation Education Initiative (FIPEd) demonstrates that even though some country-specific variations occur in pharmacy practice, there exists a set of practice-related competencies that are globally applicable. This study aimed to evaluate the transnational comparability of the Royal Pharmaceutical Society Advanced Pharmacy Framework (RPS-APF, Great Britain) and the Advanced Pharmacy Practice Framework for Australia (APPF). The objective was to obtain preliminary data on the transnational applicability of the developmental competencies contained in the two frameworks. METHOD: A crossover mapping study involving 42 advanced-level pharmacists from four countries was conducted. Qualitative interview (n = 17) was also carried out to explore practitioners' perception of the frameworks. RESULT: The average postregistration experience of the practitioners in the crossover study was 19 years. Directly observed within-subject agreement per advanced practice competency ranged from 45% to 86%. This agreement was significant for 87% of the competencies evaluated (k ≥ 0.21; P ≤ 0.05). The lowest agreement was in the 'governance' competency (k = 0.13; P = 0.21). Wilcoxon sum rank test showed a statistically significant within-subject difference in the 'collaborative practice' cluster (P = 0.043). This was not observed in the other five advanced practice clusters. From the qualitative interviews, practitioners generally perceived the two compared advanced-level frameworks as similar in content and indicated they found the described competencies to be useful for clarifying expectations of practice and identifying skills development needs. CONCLUSION: These findings provide preliminary evidence of the comparability and transnational applicability of the advanced pharmacy practice competencies contained in the two national competency development frameworks evaluated.

Structured Multi-Stakeholder Workshops to Advance a Global Transformative Roadmap for Pharmaceutical Workforce.

In November 2016, the International Pharmaceutical Federation (FIP) endeavored to create an environment to foster a shared vision to lead a transformative pharmaceutical workforce roadmap. Three milestone documents were developed and presented at the Global Conference on Pharmacy and Pharmaceutical Education. Workshops with the key themes and connecting Pharmaceutical Workforce Development Goals (PWDG) were conducted and analyzed. This Note serves to summarize the key aspects of these workshops, reporting on the innovative approaches used to generate guidance for stakeholders regarding implementation. INNOVATION: Seven workshops with a uniform structure were developed. These were designed to improve communication, harmonise outcome-generation, and allow for aggregate analysis. A team of seven conducted each workshop, each team consisted of: a Chair, a facilitator, one rapporteur, and four speakers purposively selected from FIP member organisations and other key stakeholders with expertise for sharing a variety of perspectives. Guidelines and templates were developed for all roles and each team was briefed in advance. KEY FINDINGS: Approximately 200 personnel participated in the seven workshops, with around 20 country representatives per workshop, covering all six World Health Organisation regions. Three key aspects of workforce transformation, using the PWDGs, were explored in each workshop: drivers for implementation; challenges to implementation; and ways of encouraging implementation. Drivers for implementation mentioned were enhancing collaboration and engagement. Challenges to implementation were identified as variance in terminology. Several ways of encouraging implementation were acknowledged, such as communication strategies, advocating for workforce development and sharing best practices to foster partnerships. NEXT STEPS: The unique format of the workshops, the innovative approach to include stakeholders across an array of settings and the parallel structure in all the seven workshops, aided in creating reliable findings. The achievability of the PWDGs depends on several factors. Engagement with stakeholders and engagement from and between professional associations are important factors to achieving workforce development goals.