The influence of learning environment on trainee pharmacy technicians' education and training experiences.

BACKGROUND: In Great Britain (GB), pharmacy technicians (PTs) are registered professionals, with their education and training regulated; little is known about this or the learning environment in which it takes place. OBJECTIVES: This study aimed to profile recently registered pre-registration trainee pharmacy technicians (PTPTs) in GB and capture views on PTPTs' training experiences, focussing on differences in community and hospital settings. METHODS: A mixed methods study was conducted in 2013-14, following university ethics approval. One-to-one, semi-structured telephone interviews with face-to-face and distance education providers, and hospital and community pharmacy employers of PTPTs explored views on education delivery, work-based learning, and assessment. Interviews were transcribed verbatim, analysed thematically and findings informed design of a census survey of all 1457 recently registered PTs, investigating satisfaction with various aspects of their training. Quantitative data were analysed using SPSS v20, employing comparative statistics (Mann-Whitney U, Chi-Square). RESULTS: Six-hundred and forty-six questionnaires were returned (response rate 44.3%), 632 were usable. Three-quarters (75.9%) of respondents had trained in community; the majority (88.0%) were female, the average age was 35.26 ± 10.22. Those based in hospitals were more satisfied with their training: hospital trainees worked in larger teams and tended to be better supported, they had more study time, and were more likely to complete their training in the intended two-year period. Interviews with staff in 17 Further Education colleges, 6 distance providers, 16 community pharmacies and 15 NHS organisations confirmed survey findings and offered explanations into why differences in training experiences may exist. CONCLUSIONS: This study has identified differences between PTPTs' work-based experiences in hospital and community pharmacy. Perceiving PTPTs as 'apprentices' vs. 'employees' may define how their training is managed by employers. Clarity in PTs' roles, responsibilities, and expected competencies upon registration can ensure training is structured and delivered in a suitable and equitable manner across sectors.

Using longitudinal mixed methods to study the development of professional behaviours during pharmacy work-based training.

Recent longitudinal investigations of professional socialisation and development of professional behaviours during work-based training are lacking. Using longitudinal mixed methods, this study aimed to explore the development of professional behaviours during a year of intensive work-based (pre-registration) training in pharmacy. Twenty trainee pharmacists and their tutors completed semi-structured interview and professional behaviour questionnaires at four time points during 2011/2012: months 1, 4 and 9 during training and 4 months after registration; tutors participated in months 1 and 9. Interviews were analysed thematically using template analysis, and questionnaires were analysed using ANOVA and t-tests. Self-assessed (trainee) and tutor ratings of all elements of professional behaviours measured in questionnaires (appearance, interpersonal/social skills, responsibility, communication skills) increased significantly from the start of pre-registration training to post-registration. Some elements, for example, communication skills, showed more change over time compared with others, such as appearance, and continued to improve post-registration. Qualitative findings highlighted the changing roles of trainees and learning experiences that appeared to facilitate the development of professional behaviours. Trainees' colleagues, and particularly tutors, played an essential part in trainees' development through offering support and role modelling. Trainees noted that they would have benefited from more responsibilities during training to ease the transition into practising as a responsible pharmacist. Longitudinal mixed methods can unpack the way in which professional behaviours develop during work-based training and allow researchers to examine changes in the demonstration of professional behaviours and how they occur. Identifying areas less prone to change allows for more focus to be given to supporting trainees in areas where there is a development need, such as communication skills and holding increasing responsibility.

Fitness for purpose of pharmacy technician education and training: The case of Great Britain.

BACKGROUND: To enable pharmacists to become increasingly patient-centered, clinical professionals, they need to work with suitably trained and competent support staff; pharmacy technicians (PTs) may be the most appropriate to take on additional roles and responsibilities. However, clarity on PT roles, particularly in community pharmacy, is lacking, and pharmacists may be reluctant to delegate due to concerns over PTs' competence. OBJECTIVES: This paper aims to explore the fitness for purpose of PT education and training in Great Britain. METHODS: A mixed methods study was conducted in 2013-14. Semi-structured interviews were undertaken with face-to-face and distance education providers; and different types of community (n = 16) and hospital pharmacy (n = 15) employers. Interviews explored views on education delivery, work-based learning and assessment, and quality assurance; they were transcribed verbatim and analyzed thematically. Interviews informed a questionnaire that was piloted and distributed (with reminders) to all 1457 recently registered PTs. Survey data were analyzed using SPSS v20, employing comparative statistics (Mann-Whitney U, Chi-Square). University ethics approval was obtained. RESULTS: Staff in 17 Further Education (FE) colleges, 6 distance providers, 16 community pharmacies and 15 NHS organizations were interviewed. Participants from different sectors, education providers and employing organizations questioned whether standards met current practice requirements. Certain topics were considered as redundant or over-taught whereas others, such as professionalism (attitudes, behaviors), were perceived to be lacking. Hospital interviewees felt that PT education and training lacked clinical detail, whereas many community interviewees felt that requirements for PTs were more advanced than required. Various comments suggested that PTs' roles in community pharmacy were not clearly defined or sufficiently different from other support staff. In order to define appropriate and up-to-date education and training standards, comments suggested the role of PTs in all sectors of practice needed to be clearly defined. There were usable responses of the questionnaire returned from 632 PTs. Three-quarters (475; 75.9%) of respondents had trained in community. The majority (n = 550; 88.0%) were female, with a significantly larger proportion of females in community pharmacy (90.7%) than hospital (77.4% - X2 = 20.021, P < .001). The average age of respondents was 35.26 ± 10.22. Respondents working in hospital were more likely to agree (n = 121; 84.0%) that their role in the workplace was clearly defined (U = 10740.500, Z = -2.563, P = .010) than their community colleagues (n = 303; 73.9%). CONCLUSIONS: Role clarity is required for PTs so that regulatory standards can be designed to meet current and future practice needs. This will support effective skill mix configurations to enable pharmacists, particularly in community, to take on extended, clinical roles.

Exploring the process of professional socialisation and development during pharmacy pre-registration training in England.

OBJECTIVES: To explore the process of professional socialisation in pharmacy trainees during pre-registration training. METHODS: A prospective, longitudinal qualitative design was used. A purposive sample of 20 trainees from community and hospital pharmacy in North West England was recruited. A total of 79 semi-structured interviews were conducted with trainees on three occasions during training and once four months after training. Data were analysed thematically using template analysis. KEY FINDINGS: Early on in training, non-pharmacists played a significant role in socialising trainees into the work setting; pharmacists played the stronger role towards the end. Pre-registration tutors were strong role models throughout training. Training experiences differed between settings, where services provided and patient mix varied. Hospital trainees learnt about specialist medicines on ward rotations. Community trainees developed knowledge of over-the-counter, and less complex, medicines. In hospital, trainees were exposed to a range of role models in comparison to community where this was generally limited to a small pharmacy team. Newly qualified pharmacists were challenged by having full responsibility and accountability. CONCLUSION: This study showed the experiences encountered by trainees that affect their professional socialisation. More standardisation across training sites may reduce the variation in experiences and professional socialisation and development. Formal training for pre-registration tutors and support staff that play a key role in supporting trainees could be considered. Support for newly qualified pharmacists may allay the challenging transition they face when entering practice.

An exploration of the utility of appraisals for the revalidation of pharmacy professionals in community pharmacy in Great Britain.

BACKGROUND: With revalidation in pharmacy in the United Kingdom fast approaching, appropriate systems of revalidation in community pharmacy are required. With little known about the potential use of appraisals for evaluating fitness to practice in pharmacy professionals (pharmacists and pharmacy technicians) in this sector, research was undertaken to explore their potential utility in a revalidation process. OBJECTIVES: To examine existing structures and processes in community pharmacy appraisals in Great Britain (ie, England, Scotland, and Wales) and consider the views of pharmacy stakeholders on if, and how, appraisals could contribute to revalidation of pharmacy professionals. METHODS: Semi-structured telephone interviews were conducted with senior staff (eg, superintendents and professional development managers) from chain community pharmacies as well as pharmacy managers/owners from independent pharmacies. Senior staff from locum agencies and pharmacy technician stakeholders were also interviewed. RESULTS: Appraisals were in place for pharmacists in most chain pharmacies but not in independent pharmacies. Locum pharmacists were not appraised, either by the companies they worked for or by the locum agencies. Pharmacy managers/owners working in independent pharmacies were also not appraised. Pharmacy technicians were appraised in most chain pharmacies but only in some independent pharmacies. Where appraisals were in operation, they were carried out by line managers who may or may not be a pharmacist. Appraisals did not seem to cover areas relevant to fitness to practice but instead focused more on performance related to business targets. This was particularly true for those in more senior positions within the organization such as area managers and superintendent pharmacists. CONCLUSIONS: Existing systems of appraisal, on their own, do not seem to be suitable for revalidating a pharmacy professional. Considerable changes to the existing appraisal systems in community pharmacy and employer engagement may be necessary if they are to play a role in revalidation.

Existing arrangements for monitoring community pharmacies in England: can they have a role in the revalidation of pharmacists?

BACKGROUND: Maintaining and regulating professional competence in health care is a growing concern. Tasked with developing a system of revalidation for pharmacy professionals, the pharmacy regulator in Great Britain commissioned a series of studies to evaluate existing sources of evidence as potential contributors to the revalidation process. OBJECTIVES: To explore the utility of existing regulatory inspections and service commissioners' contract monitoring processes in the community pharmacy sector as sources of evidence of the fitness to practice of pharmacists in England. METHODS: Thirteen semistructured telephone interviews conducted with representatives of the regulatory Inspectorate and community pharmacy commissioners. RESULTS: Interviewees described current processes for inspecting and monitoring community pharmacy premises and the services they provided. Their focus was primarily on the pharmacy and not on the pharmacist. Views were given as to how the roles of the Inspectorate and service commissioners might be developed to incorporate aspects of revalidation. Particular issues were raised in relation to the revalidation of self-employed locum and independent owner pharmacists. CONCLUSIONS: Existing inspection and contract monitoring processes have little utility in providing evidence of the fitness to practice of individual community pharmacists in England. However, there may be potential for the Inspectorate and service commissioners to develop a role in revalidation, particularly for locum pharmacists and/or independent pharmacy owners. Moreover, they may take a role in providing the infrastructure required to support the process of revalidation for community pharmacists. Current financial pressures and restructuring in the National Health Service, however, are obstacles to the development of revalidation processes.

Revalidation arrangements for pharmacy professionals in industry and academia in Great Britain: a qualitative study.

BACKGROUND: Pharmacy, like other health professions in Great Britain (GB), is currently considering potential future revalidation arrangements for its members. To date, evidence about performance appraisal arrangements for pharmacy professionals working in nonpatient-facing sectors has been scarce. OBJECTIVES: This study aimed to explore the use of appraisals and other sources of evidence for the purposes of revalidating pharmacy professionals working in the pharmaceutical industry and in academia. METHODS: A qualitative study was undertaken; the sampling strategy was purposive and telephone interviews were carried out with pharmacy professionals working in pharmaceutical companies and schools of pharmacy in GB. The interviews were semistructured and the topic guides were designed to elicit participants' experiences of appraisal systems and views about the relevance of such systems to revalidation. The data generated were analyzed using the framework technique. RESULTS: Fourteen pharmacists and pharmacy technicians working in pharmaceutical companies and schools of pharmacy in GB took part in interviews. All participants had experience of appraisals but did not tend to link these to revalidation. Other sources of evidence relating to work performance were described and some aspects of pharmaceutical industry requirements were seen as potentially relevant to revalidation. The importance of being assessed by someone with an adequate understanding of the area of practice was emphasized in both sectors. CONCLUSIONS: Although industry and academia are "nonpatient-facing" sectors, much work undertaken within them is still professional pharmacy practice. There are defined governance roles in industry, which need to be undertaken by reliable and competent practitioners. Those responsible for any future revalidation system in pharmacy must ensure it is underpinned by an adequate and up to date understanding of the context and nature of the work undertaken by those it covers to ensure that measures of fitness to practice are valid.