1. Quality Education for a Healthier Scotland Pharmacy The Scottish Hospital Pharmacists’ Vocational Training Scheme : Stage 2 Fiona McMillan Lead Pharmacist Educational Development NHS Education for Scotland

2. Quality Education for a Healthier Scotland Pharmacy What is the Pharmacy Vocational Training Scheme? Stage 2  A structured training scheme for junior pharmacists who are working in secondary care. It equips them with a broad range of skills to enable them to work confidently, consistently systematically and safely, to provide optimal patient care for a variety of different patient groups.  General Level Framework Modernising Pharmacy Careers

3. Quality Education for a Healthier Scotland Pharmacy The Model Learning by experience and reflection on actions Kolb’s learning cycle Active experimentation Concrete Experience Reflection Conceptualising Source: Kolb, 1984

4. Quality Education for a Healthier Scotland Pharmacy Why is vocational training important? Standardised and comprehensive experience of all areas within hospital pharmacy Links theory to practice Learning in workplace builds confidence and dealing with unpredictability Facilitates analysis of situations Enables observation of role models and team working Facilitates development of professionalism Linked to KSF

5. Quality Education for a Healthier Scotland Pharmacy Development Process The overall staged development process is: StageAccreditation UGUniversity Undergraduate (Summer Student) IPre-Registration Pharmacist 2General Hospital Pharmacist Practitioner 3Advanced Hospital Pharmacist Practitioner 4Hospital Pharmacist Leader

6. Quality Education for a Healthier Scotland Pharmacy Pharmacist Stage 2 The necessary skills and experience over the whole range of hospital pharmacy activities General Hospital Pharmacist Practitioner

7. Quality Education for a Healthier Scotland Pharmacy Stage 2 Vocational Training Scheme Commenced ~ 15 years ago Revised several times - most recently in 2009 Training and assessment aligned to medical and dental models Competencies: Professional focus : 9 competency areas, clinical pharmacy and application of pharmacy practice Evidence: CPD records, case studies, feedback forms Portfolio assessment: Medical Review in Training Assessments QA processes New opportunities for learning [virtual room, presentations on web, induction sessions, peer sessions]

8. Quality Education for a Healthier Scotland Pharmacy Pharmacy Vocational Training Scheme What is required for Stage 2 ? Completion of a competency based framework -9 elements MI, Clinical Gov, Dispensing services, aseptic services Development of ‘evidence’ [CPD records, clinical case studies, feedback forms] Development of a personal portfolio or work Completion of a variety of modules/reading for discussion with tutor

9. Quality Education for a Healthier Scotland Pharmacy Pharmacy Vocational Training Scheme So what did they experience? Clinical practice ~1 year practice rotated into clinical areas of medicine, surgery +2 specialities - the role of medical gases when caring for patients clinical setting Application of Pharmacy practice ~1 year practice rotated into variety of areas to enable learning about e.g. the role of the pharmacist in preparation of aseptic products for individual patients, legislation relating to preparation of aseptic products.

10. Quality Education for a Healthier Scotland Pharmacy Pharmacy Vocational Training Scheme So what did they experience? Application of Pharmacy Practice Analysis of prescribing: Audit, MUE undertaken Patient safety and Clinical Governance - risk assessment, analysis of significant event undertaken. The pharmacist as a teacher -teaching of several different groups of healthcare professionals -development of training plans for a variety of settings

11. Quality Education for a Healthier Scotland Pharmacy Pharmacy Vocational Training Scheme So what did they experience? Assessment Assessment of portfolio by panel Final assessment of trainee - representation from SOPs - confirmation of systematic approach to professional skills - application of problem solving skills - awareness of personal limitations - presentation of aspect from portfolio - 4 practice scenarios - confirmation of portfolio evidence [if required]

12. Quality Education for a Healthier Scotland Pharmacy Pharmacy Vocational Training Scheme Facts and Figures Commenced=Folders issued June - June June 2007 - 31 st May 2008 Number commenced = 24* Number completed = 19 June 2008 - 31 st May 2009 Number commenced = 28 Number completed = 15 June 2009 - 31 st May 2010 Number commenced = 49 Number completed =19* ~ 70% completion rate* 2 years after starting.

13. Quality Education for a Healthier Scotland Pharmacy Trainees started training by Health Board Area

14. Quality Education for a Healthier Scotland Pharmacy Trainees completed training by Health Board Area 10 years [Completed to date]

15. Quality Education for a Healthier Scotland Pharmacy Trainees completed training 10yr : 2007-10 AA 13 7 DG 3 3 F 1 1 GG 46 12 Gr 6 2 High 3 3 Lanark 23 12 Loth 15 6 Tay 16 4

16. Quality Education for a Healthier Scotland Pharmacy Trainees commenced June 2007 – Dec 2007

17. Quality Education for a Healthier Scotland Pharmacy Trainees completed ~2 years later [Av tome for completion= 2 years] Transferable e.g. Glasgow to Lanarkshire

18. Quality Education for a Healthier Scotland Pharmacy Qualitative research n=14 How do Stage 2 trainees like to learn? ‘ I like to learn by reading and then.. practical experience’ ‘Stage 2 gives you a structured pathway.’ ‘It helps me focus where my learning needs to be to observe someone else.’ ‘Working in practice then looking into it myself’ ‘It made you reflect..’ ‘A doing way of learning.’ ‘To have direction…but good to be left up to your own devices..’

19. Quality Education for a Healthier Scotland Pharmacy Qualitative research n=14 What were the main areas of learning? ‘ Clinical… nice structured way of going through a patient’ ‘I had to go away and read about the conditions…’ ‘I learnt a lot from the specialised cases that I wouldn’t have been exposed to if I didn’t do the training.’ ‘Provided some reassurance.. Care plans being seen by someone who was evaluating them.’ ‘Gives me confidence…. suitable standard.’ ‘I hadn’t had formal MI..’ ‘Medical gases quite interesting’

20. Quality Education for a Healthier Scotland Pharmacy Qualitative research n=14, What was their area of least learning? ‘[Medical gases]…I wouldn’t use gas testing again…’ focus now on clinical application of gases ‘Resource management, procurement.. I am not involved in that area.’ focus now changed due to service redesign ‘Distribution not particularly relevant.’ focus now changed due to service redesign Conclusions drawn from qualitative research undertaken in 2009 was that trainees learnt more when the experience could be related to their own personal everyday practice or an area of practice that they may wish to explore in a more senior role.

21. Quality Education for a Healthier Scotland Pharmacy Summary of experience ‘ I have gone into MI. If I hadn’t been doing the rotation I wouldn’t have had the opportunity…’ ‘I probably wouldn’t have got a rotation.’ ‘Stage 2 gave me confidence. How to deal with things.’ ‘Probably the training opportunity it gives you.’ ‘Opened my eyes it is a more structured training.’ ‘The knowledge of the background activity.’ ‘Made me decide what I wanted to do in my career.’ ‘It gave me an overview.’Good in giving you a baseline.’

22. Quality Education for a Healthier Scotland Pharmacy Qualitative Research n=14 What was their overall experience? ‘Overall a good experience.’ ‘It develops you all round as a pharmacist.. I don’t think you would get this without Stage 2.’ ‘A lot of late nights.. It has been worthwhile..I have got something to show..’ ‘..quite daunting..but when you get into it, it is manageable.’ ‘It is good to have that experience behind you.’ ‘To begin with I hated it.. but towards the end I could see that it was very beneficial..’

23. Quality Education for a Healthier Scotland Pharmacy Pharmacy Vocational Training Stage 2 Conclusions Stage 2 of The Scottish Pharmacy Vocational Training Scheme has been revised in light of service redesign in Scotland. It is a training scheme that aims to develop pharmacists through learning by their everyday experiences and not by underpinning knowledge alone. Research informs that whilst Stage 2 of the Vocational Training Scheme is challenging, it is viewed by the majority of trainees as; being a way of receiving a broad structured training and feedback from experienced senior pharmacists increasing their confidence giving a sense of improved quality of the pharmaceutical care that they are able to provide helping inform their career choice by providing a well structured grounding in all aspects of hospital pharmacy.

24. Quality Education for a Healthier Scotland Pharmacy Pharmacy Vocational Training Stage 2 What’s next? Development of different formats for training e - portfolio, Online training, virtual room] Improving QA processes Strengthening of application criteria – tutors Calibration of tutors, development of tutor network Development of trainee peer support sessions

25. Quality Education for a Healthier Scotland Pharmacy Pharmacy Vocational Training Potential developments Development of community scheme? Development of further modules? Development of specialisation [Stage 3, 4] Underway –Older people, critical care