What can the uptake of online pharmacy education in Scotland, during the COVID-19 pandemic, tells us about the future of CPD?

Pharmacy CPD in Scotland has been evolving towards online, asynchronous delivery since 2014. The COVID-19 pandemic accelerated this movement by restricting face-to-face education (Zlotos & Stewart, 2021). This study utilised Google analytics to describe web traffic, and electronic e-learning completion records to describe learner activity on the Virtual Learning Environment of a national CPD provider in Scotland. The aim was to describe patterns of learning activity in the years spanning the COVID-19 pandemic, to help predict what future education practice may look like. This study identified that there was an increase in estimated time spent on learning from 8085.5 vs 16,061.5 hours of learning in 2018-19 and 2020-21, respectively. Completion of non-mandatory clinical modules and mandatory service modules increased each year. Mandatory, service focussed modules were most popular each year and the number of completions peaked to coincide with new services or updated content. The findings suggest asynchronous, online pharmacy education continues to grow in popularity. CPD providers should prioritise Mandatory, Service focussed education for pharmacy staff; although, they cannot neglect non-mandatory and Clinical education too. Future education for CPD should be designed to reflect the growing and diverse learner population.

Measuring the evolution of online pharmacy education in a national CPD programme, in Scotland, pre-pandemic (2013-14 vs 2018-19).

Continuing professional development (CPD) is a regulatory requirement for pharmacy professions in Great Britain. Formal CPD is available in various formats including face-to-face, webinar, and e-learning. CPD may be clinical or non-clinical and may be aligned to core services or not. Literature highlights varied preferences for CPD formats and topics, and in Scotland there was a move towards online CPD in the pharmacy profession. This study utilised electronic attendance and completion records of CPD activities from a national CPD provider in Scotland. The aim was to measure and describe the nature of CPD provision and uptake within Pharmacy in Scotland, comparing records from 2013-14 and 2018-19. Thus, benchmarking the nature of CPD before the COVID-19 pandemic resulted in social distancing restrictions. This study identified that the CPD workforce (NES staffing), and CPD opportunities provided, had evolved towards e-learning delivery. Face-to-face courses were fewer (63 reduced to 58) as were webinars (14 reduced to 6). There were fewer attendances in both. e-Learning was accessed four times more frequently in 2018-19 than 2013-14 (4040 vs 922 completions). Service focussed education was popular in both years. Asynchronous e-learning had become a popular method of CPD for the pharmacy profession before the COVID-19 pandemic, while face-to-face courses and webinars were less popular than 5 years previous. Asynchronous and service focussed CPD should be prioritised over synchronous and general CPD. Learner access and participation data should be utilised to predict future learner needs and preference.

Evaluation of Inter-Professional Education (IPE) with medical, nursing and pharmacy students through a simulated IPL Educational Intervention.

INTRODUCTION: Inter-Professional Education (IPE) is becoming an integral part of many professional programmes throughout the United Kingdom, ensuring health professionals are competent to work as part of an inter-professional team upon entry into their profession. IPE has become a fundamental component of curriculum content in health and social care degrees. AIMS: Research aim - to evaluate a simulated IPE intervention. METHODS: A one day IPE intervention, "Evening On-Call" was run involving nursing and medical students and pre-registration pharmacists (student pharmacists in year 5 of training) in an on-call setting. This IPE incorporated manikin and actor patients in a simulated ward. During the intervention, the 3 groups of students are assessed under observation on their clinical, prioritisation and communication skills. Participants perceptions of this intervention were evaluated by completion of a questionnaire to capture their perceptions regarding the experience, the pre-IPL briefing and post-IPL feedback and perceived relevance of this training. Free text sections collected additional comments and a follow-up questionnaire was sent 6 months later. RESULTS: Initial questionnaire feedback was predominantly positive for each professional group. The majority perceived the simulated IPL had given them a greater understanding of other professionals' roles, had enhanced their professional confidence and would help them prioritise workload once qualified. The 6-months follow-up questionnaire supported the initial questionnaire findings. Some responses highlighted that participants believed the simulated IPL had helped them work more effectively with other healthcare professionals, communicate more effectively and better prioritise their workload. There may be some evidence of sustained self-reported effectiveness in teaching certain professional and clinical skills to participants using this type of simulated intervention.

The future of CPD for general practitioners, registered pharmacy staff and general practice nurses in Scotland - qualitative responses from a national survey.

In the United Kingdom, undertaking continuing professional development (CPD) is required for revalidation with regulatory authorities for general practitioners, general practice nurses and registered pharmacy staff - pharmacists and pharmacy technicians. A survey of CPD preferences and activities of these four professions has been published and this paper focuses on one qualitative question in the survey: 'Please describe any changes that you anticipate in the way in which you will undertake CPD over the next 12 months.' Responses were analysed using content analysis, then codes and themes were developed into a coding framework. 1,159 respondents provided comments to the question and five themes were identified: options for learning, time, appraisal and revalidation, people in transition and use of technology. There was a desire for face-to-face courses, for interactive learning and for variety of learning methods. Respondents valued learning with others and Practice-Based Small Group Learning was considered to be flexible and promoted inter-professional learning and socialisation. Lack of time for learning was seen as a barrier for respondents. Respondents considered that CPD was needed to support them as their roles developed in primary healthcare.

Practice-Based Small Group Learning (PBSGL) in Scotland: the past, the present and the future.

Practice-based Small Group Learning (PBSGL) originated in Canada and transferred to Scotland in 2003 with a successful pilot involving 45 general practitioners (GPs). The Scottish programme has grown considerably since then and now has 3,400 members drawn from GPs, GP nurses, pharmacists and other professions. Members get together in small groups and discuss case presentations written by authors who have drawn on their own experiences with real patients. The group review a distillation of the current evidence base included in the module and propose changes to their own practice. Members make a commitment to change and log these changes in a shared document.In Scotland, 34% of groups are inter-professional, reflecting the dynamic changes to the primary health care team as it meets the health care needs of the Scottish population. Professional (and inter-professional) socialisation is a key feature of many PBSGL groups. Some groups have peer support as a central function to their meetings.The programme has recruited a small team of module writers and authors and most modules are now produced in Scotland by primary health care members. In addition, over 1,000 members have been trained up to be peer facilitators for their small group. The PBSGL programme in Scotland has ensured that continuing professional development of the primary health care team is available to teams across Scotland and that PBSGL groups can control the content and logistics of their own meetings.

CPD preferences and activities of general practitioners, registered pharmacy staff and general practice nurses in NHS Scotland - a questionnaire survey.

In the United Kingdom, taking part in continuing professional development (CPD) is required for revalidation for general practitioners, general practice nurses and registered pharmacy staff - pharmacists and pharmacy technicians. The literature has many research studies which describe one profession's activities, or a specific learning method or topic. Few studies compared the CPD preferences across these four professional groups or compared their CPD activity. A survey was designed by the authors with assistance from colleagues within NHS Education for Scotland (NES). It was sent to the four professions and 2,813 clinicians responded. More than 75% of all respondents spent between 0 and 10 h per month on CPD activities. Participation in formal Protected Learning Time (PLT) varied across different NHS boards in NHS Scotland and ranged from 23.9% of respondents in the board with the lowest participation, to 68.6% in the board with the highest participation. All professions indicated a greatest preference to learn with other members of their profession. The preferred time for learning during the day varied amongst professions. The CPD activity of greatest preference for all professions was discussion with peers. There were some minor differences in learning preferences and activities from professionals working in remote and rural areas and in areas of socio-economic deprivation in Scotland.

Practice-Based Small Group Learning (PBSGL) in Scotland - a survey of registered pharmacy staff and general practice nurses.

INTRODUCTION: Practice-based small group learning (PBSGL) has grown in primary healthcare in Scotland, and is used regularly by 2244 GPs and GP specialist trainees. The programme has been available to general practice nurses (GPNs) and pharmacy staff since uni-professional and inter-professional pilot studies were considered successful. Growth has been slower compared to GPs uptake but has now reached significant levels. It seemed timely to evaluate the use of the programme by these professions. METHOD: A questionnaire previously used by GPs was adapted. It consisted of 16 questions and two free text questions asking respondents what had motivated them to join PBSGL, and what encouraged them to maintain membership. The questionnaire was converted into an electronic format and emailed to pharmacy and GPNs in Scotland who were PBSGL members. RESULTS: A range of pharmacy staff and GPNs were involved in PBSGL and the mean number of modules studied by pharmacy staff was 3.93 and 4.48 by GPNs in the last year. A high percentage were likely or very likely to continue with membership (pharmacy staff - 95.6%, GPNs - 90.1%). The dominant reasons to join and stay in the programme related to learning issues: meeting learning needs, learning from peers and professional socialisation.

Piloting the United Kingdom 'Prescribing Safety Assessment' with pharmacist prescribers in Scotland.

BACKGROUND: Prescribing is a complex task requiring considerable knowledge and skills. The Prescribing Safety Assessment (PSA) was developed by the British Pharmacological Society and the United Kingdom (UK) Medical Schools Council. Between February and June 2014, over 7000 final year medical students undertook the PSA, with an overall pass rate of 94%. Independent prescribing for suitably trained pharmacists was introduced in the UK in 2006. To date there has been little focus on any objective measures of prescribing safety. OBJECTIVE: To determine the PSA performance of a pilot group of pharmacist prescribers in Scotland relative to medical students and to test the feasibility and acceptability of running the PSA. METHODS: A group of 59 pharmacist prescribers took part in ten events. The PSA consisted of 30 questions to be completed over 60 min. All questions had been used in the 2014 assessments for final year medical students. The PSA was undertaken online under invigilated conditions, mirroring the medical student assessment. One month later, participants were invited to complete an online evaluation questionnaire. RESULTS: The mean overall PSA scores (±SD) were 87.5% ± 8.7 (range 52-98) compared to a 88.5% for medical students. Based on an Angoff passmark of 76.0%, 53 pharmacists (89.8%) passed compared to an overall pass rate in PSA 2014 of 94%. Pharmacists performed equivalently to medical students in all assessment areas, with a slightly lower performance in the prescribing, drug monitoring and data interpretation questions offset by better performance in prescription review and adverse drug reactions. Feedback was positive in relation to appropriateness, relevance and level of difficulty of the PSA although several commented that they were practicing in very specific clinical areas. CONCLUSION: These pilot events have benchmarked the PSA performance of pharmacist prescribers with final year medical students, and feedback confirmed feasibility and acceptability.

A Scenario-Based Virtual Patient Program to Support Substance Misuse Education.

Objective. To evaluate virtual patient (VP) programs for injecting equipment provision (IEP) and opiate substitution therapy (OST) services with respect to confidence and knowledge among preregistration pharmacist trainees. Methods. Preregistration trainee pharmacists pilot-tested the VP programs and were invited to complete pre/post and 6-month assessments of knowledge and perceived confidence. Results. One hundred six trainees participated and completed the pre/postassessments. Forty-six (43.4%) participants repeated the assessments at six months. Scores in perceived confidence increased in all domains at both time points postprogram. Knowledge scores were greater posteducation than preeducation. Knowledge scores were also greater six months after education than preeducation. Knowledge scores at six months were lower than posteducation for both programs. Conclusion. Virtual patients programs increased preregistration pharmacists' knowledge and confidence with regard to IEP and OST immediately after use and at six months postprogram. There was a loss of clinical knowledge over time but confidence change was sustained.

Ten years of practice-based small group learning (PBSGL) in Scotland - a survey of general practitioners.

INTRODUCTION: Practice-based small group learning (PBSGL) has grown in Scotland since its pilot in 2004. There are now over 2,100 clinicians in 370 groups across the UK. The programme is used by all 14 territorial health boards in NHS Scotland. It seemed timely to undertake an evaluation of the programme. METHOD: A questionnaire was developed and piloted. It consisted of 16 questions with two free text questions asking respondents what had motivated them to join PBSGL, and what encouraged them to stay. The questionnaire was converted into an electronic format and emailed to all qualified general practitioners (GPs) in Scotland. RESULTS: A wide range of GPs were involved in PBSGL and the mean number of modules studied per year was 6.8. The vast majority (589 (88.2%)) of respondents met in their own home or practice and were either very likely (549 (82.2%)) or likely (93 (13.9%)) to continue with the programme. The dominant reasons to join and stay with the programme related to learning issues: meeting learning needs, learning from peers and issues of peer support. CONCLUSION: PBSGL has become an established continuous professional development resource for many GPs in Scotland. It is well-received and likely to continue.

GP and pharmacist inter-professional learning - a grounded theory study.

BACKGROUND: Practice Based Small Group Learning (PBSGL) is an established learning resource for primary care clinicians in Scotland and is used by one-third of general practitioners (GPs). Scottish Government and UK professional bodies have called for GPs and pharmacists to work more closely together to improve care. AIM: To gain GPs' and pharmacists' perceptions and experiences of learning together in an inter-professional PBSGL pilot. DESIGN AND SETTING: Qualitative research methods involving established GP PBSGL groups in NHS Scotland recruiting one or two pharmacists to join them. METHOD: A grounded theory method was used. GPs were interviewed in focus groups by a fellow GP, and pharmacists were interviewed individually by two researchers, neither being a GP or a pharmacist. Interviews were audio-recorded, transcribed and analysed using grounded theory methods. Data saturation was achieved and confirmed. RESULTS AND CONCLUSION: Three themes were identified: GPs' and pharmacists' perceptions and experiences of inter-professional learning; Inter-professional relationships and team-working; Group identity and purpose of existing GP groups. Pharmacists were welcomed into GP groups and both professions valued inter-professional PBSGL learning. Participants learned from each other and both professions gained a wider perspective of the NHS and of each others' roles in the organisation. Inter-professional relationships, communication and team-working were strengthened and professionals regarded each other as peers and friends.

Integration of an online simulated prescription analysis into undergraduate pharmacy teaching using supplemental and replacement models.

OBJECTIVE: To describe student use and perceptions of online simulated prescription analysis following integration of supplemental and replacement models into pharmacy practice teaching. METHODS: Strathclyde Computerized Randomized Interactive Prescription Tutor (SCRIPT) is a simulated prescription analysis tool designed to support a pharmacy practice competency class. In 2008-2009, SCRIPT scenarios were released to coincide with timetabled teaching as the supplemental model. In 2009-2010, SCRIPT also replaced one-sixth of the taught component of the class as the replacement model. Student use and performance were compared, and their perceptions were documented. RESULTS: In both cohorts, the majority of use (over 70%) occurred immediately before assessments. Remote access decreased from 6409 (supplemental) to 3782 (replacement) attempts per 100 students. There was no difference in student performance between the cohorts, Students reported group and individual use and 4 targeted approaches using SCRIPT. CONCLUSION: E-learning can reduce the staff time in pharmacy practice teaching without affecting student performance. SCRIPT permits flexible learning that suits student preferences.

Scottish pharmacists' perceptions and experiences of a practice-based small group learning pilot: a qualitative study.

INTRODUCTION: CPD is an important feature of healthcare professions and regulatory bodies consider it mandatory. Studies of CPD activity of pharmacists showed that 10% were undertaking no CPD. Practice-based small group learning (PBSGL) is a well-received and popular learning resource for GPs in Scotland. From 2011, a pharmacy pilot was undertaken: pharmacists were trained as peer-facilitators and existing PBSGL modules were adapted. Four NHS boards took part and this study aimed to explore the perceptions and experiences of pharmacists. METHODS: A qualitative research approach was adopted using focus groups and in-depth interviews. Interviews were audio-recorded and transcriptions made. Transcripts were coded and themes developed using grounded theory methods. RESULTS: Participants welcomed PBSGL: it was a feasible learning method, acceptable and had educational impact. They appreciated its interactive nature and discussions founded on their experiences in practice. Participants liked the self-reliance of PBSGL in that they were not dependent on specialist practitioners. There were logistical challenges that impacted on the success of group discussion; some pharmacists were less familiar with small group work. Pharmacists felt isolated during work and appreciated peer discussion. There was a tentative welcome to inter-professional learning but group composition and module topics might impact on the success of this. CONCLUSION: Pharmacists were able to change their learning practice in uni-professional PBSGL groups and were able to learn from each other. There may be further learning opportunities if pharmacists participate in inter-professional groups.

Audit of budesonide/formoterol prescribing for asthma in community pharmacy in the U.K.

The rapid action of the long acting beta agonist formoterol allows it to be used as both a preventer and reliever in the management of asthma. The Symbicort® SMART dosing regime has been shown to reduce the number of asthma exacerbations. The aim was to determine the current prescribing of Symbicort®, the prescribing of the SMART regimen and the co-prescribing of a short acting beta agonist with this regimen by means of an audit of prescriptions dispensed in a pharmacy multiple in the U.K. Anonymised data were collected on a standard form. Symbicort® prescribing data for six months were extracted from the pharmacy Patient Medication Record (PMR). Data were stratified by age and analysed to determine adherence with Symbicort® SMART prescribing as defined by the U.K. product license. Data were received from 51 of the 118 (43.2%) pharmacies contacted. Complete information from 2484 PMRs was included in the study. 2.81% (70/2484) of patients were prescribed SMART as defined by the U.K. summary of product characteristics. Of the 18-35 year age group 7.44% (27/363) were prescribed SMART correctly. However, Symbicort® was prescribed twice a day and when required, with either the co-prescription of a SABA, or at an unlicensed dose in 2.46% (61/2484) and 0.28% (7/2484) patients respectively. The incidence of Symbicort® SMART prescribing in this study is low but may be underestimated due to unclear dosing instructions.

A web-based tool for teaching pharmacy practice competency.

OBJECTIVE: To implement and assess the effectiveness of the Strathclyde Computerized Randomized Interactive Prescription Tutor (SCRIPT) in teaching a competency-based undergraduate pharmacy course. DESIGN: Data on students' access to SCRIPT, collected by quantitative electronic data capture, were analyzed to determine student usage patterns and correlations between usage and grades in class assessments. Data on students' perceptions were collected by electronic questionnaire and semi-structured interviews. Teaching staff members also were interviewed. ASSESSMENT: Two hundred forty-three students accessed SCRIPT a median of 23 times each. Students accessed SCRIPT predominantly at times outside normal teaching hours and tended to access the tool more often in the 48 hours preceding class assessments. Feedback from students indicated overall satisfaction with the tool to compliment the timetabled teaching sessions but highlighted that more specific feedback on the examples was required. All staff comments were positive. CONCLUSIONS: Students and teaching staff members valued SCRIPT as a tool to compliment teaching of the competency-based pharmacy practice classes in the MPharm degree. Future developments of SCRIPT will include expanded feedback for students, the capability to link the release of each SCRIPT exercise with the date the content is taught in class, and additional tools to facilitate "just in time" teaching.