Innovations in education and training to enable development of pharmacists as clinicians.

Rushworth, Gordon Frank

Abstract

The NHS is in urgent need of clinical healthcare capacity in terms of front-line clinician staff, to deal with the burgeoning complexity and volume of care being delivered. These clinicians need to be accountable for the delivery of direct clinical care to patients, meeting the demands of clinical services and patients. In the UK, from 2026 onwards, all new pharmacists will be independent prescribers at point of registration. There is an opportunity for pharmacists to evolve their traditional role - from that of medicines governance, supply and ancillary advice - to one in which they have a central role within the NHS as a clinician. The aim of this programme of research was to explore innovations in education and training that would enable development of pharmacists as clinicians. The programme is comprised of six public outputs investigating four separate educational interventions, including: a pharmacy longitudinal clerkship (PLC) and interprofessional education (IPE) placements at undergraduate level, and the use of simulation-based education (SBE) and an Advanced Clinical Examination & Assessment (ACE) course within the advanced pharmacist space. Output 1 used Donabedian's conceptual model to characterise the development and implementation of the first cohort of a PLC model for student pharmacists (SPs). It used interpretivist philosophy and qualitative semistructured interviews of SPs and tutors, informed by the Theoretical Domains Framework (TDF), to undertake an initial evaluation. Seven themes were identified and mapped to seven TDF domains. These reported increased levels of student confidence, enthusiasm for a pharmacy career, and general practitioner (GP) positivity about the PLC. Output 2 reported on two further cohorts of the PLC model. Qualitative semi-structured interviews of SP and GP tutors were used to explore stakeholder perceptions of influences of behavioural determinants on SP development. Interview design and analysis were informed by the TDF. Seven SPs and five GPs were interviewed. Key themes included: knowledge – utilisation and practical application; skills – triangulation of skills under supervision; beliefs about capabilities – confidence building with clinical and patient contact; professional role and identify. The evaluation showed the benefits of the PLC model by embedding SPs in clinical teams and the clinical environment over a prolonged period. It was expected that this training would translate into a more confident transition to postgraduate professional practice. Output 3 reported on the evaluation of a separate week-long innovative hospital-based IPE placement involving SPs and medical students. Evaluation focused on level 1 and 2 of the Kirkpatrick Four-Level Training Evaluation Model. Focus groups were used to explore the students' views and experiences. Thematic analysis was undertaken using the TDF. Three key categories with multiple sub-themes were identified: Category 1, overall perception of experience; Category 2, student interactions; Category 3, suggestions for improvement. Overall, students valued their participation in the week and reported many benefits of learning with and from other students. Output 4 was a commentary giving some critical thought on the current state of advanced pharmacist practice within the UK, as well as giving primary thinking on how UK pharmacists, service models, and pharmacist education systems need to adapt to meet the demands of advanced pharmacist practice. It challenges pharmacy's historic dogma, discusses a requirement for teaching to transcend simplistic concepts of medicines-harm, considers the need for the standardisation of clinical skills and discusses the necessity for formal advanced practice programmes and preceptorship models. It finally proposes a model for Advanced Pharmacist Practitioners and the ultimate future vision of autonomous practice. Output 5 reported on the implementation of innovative SBE to support the development of advanced general practice clinical pharmacists (GPCPs). An interpretivist philosophy was applied where pre and post simulation questionnaires were used to support an evaluation focused on level 1 and 2 of the Kirkpatrick Four-Level Training Evaluation Model. Increased confidence and self-reported competence were reported in all areas pertaining to application of consultation and clinical skills. Qualitative comments from the participants regarding the training course were also favourable, highlighting the value of the training in developing clinical competence and confidence when dealing with a variety of general practice scenarios. Output 6 explores the potential behavioural determinants influencing the implementation of skills gained from ACE courses by GPCPs. The work used an interpretivist philosophy and qualitative methodology, with theoretical underpinning using the TDF. Seven dyadic (paired) interviews were conducted. Three main themes were identified: 1. Factors influencing implementation of advanced clinical skills by pharmacists; 2. Social and environmental influences affecting opportunities for pharmacists in advanced clinical roles; 3. Perceptions of pharmacist professional identify for advance practice roles. The work identified numerous behavioural determinants related to the implementation of advanced clinical skills including: the course supporting clinically autonomous practice; frustration around social and environmental factors limiting implementation causing alienation; need for clarification of professional identity/roles. This programme of research identified numerous innovations in education and training which would allow pharmacists to develop as clinicians over a variety of career stages and healthcare settings. There is commonality between PLC and IPE placements in terms of affording SPs exposure to clinical environments as part of undergraduate education. The benefits observed during individual placements are also likely to be synergistic if combined into a longitudinal IPE placement. SBE was used effectively in both undergraduate and advanced pharmacist education, and can be expected to augment clinical teaching at all levels of pharmacist education. ACE courses would make a suitable component of a competency-based training programme for advanced pharmacist practitioners, where skills learned on the course can be integrated into practice in a preceptored and supervised environment. This is similar to how clinical skills were implemented and practiced during PLC placements. Recommendations included the need to develop education and training across the continuum of pharmacist practice, and should be linked to an accepted career structure. Clinically supervised, curriculum-based training programmes delivered in clinical practice should contain elements of IPE and SBE to augment the learning experience for any career level. Review of current education and training pathways are urgently needed such that exposures to the beneficial innovations described in this thesis might be utilised to expeditiously create pharmacist clinicians with these skills, to enhance healthcare capacity in support of clinical care delivery to patients.

Citation

RUSHWORTH, G.F. 2023. Innovations in education and training to enable development of pharmacists as clinicians. Robert Gordon University, PhD by Public Output thesis. Hosted on OpenAIR [online]. Available from: https://doi.org/10.48526/rgu-wt-2271597

• Thesis Type: Thesis by Publication
• Deposit Date: Mar 14, 2024
• Publicly Available Date: Mar 14, 2024
• DOI: https://doi.org/10.48526/rgu-wt-2271597
• Keywords: Pharmacists; Prescribing; Pharmacist education; Pharmacy students
• Public URL: https://rgu-repository.worktribe.com/output/2271597
• Additional Information: The file accompanying this record consists of the document that was produced to contextualise the public outputs (which form the main body of the thesis). Citations for the public outputs in question are located near the beginning of the document.
• Award Date: Oct 31, 2023