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DO PREREGISTRATION TRAINEES BENEFIT FROM CROSS-SECTOR TRAINING? By Barry Jubraj, MSc, MRPharmS, Sheila Chantler, BPharm, MRPharmS, Julie Mycroft, BSc, MRPharmS, and Katey Wilkins, DipClinPharm, MRPharmS In this article, the authors report on their recent experience of organising a formal cross-sector training programme for hospital preregistration trainees from the Chelsea and Westminster Healthcare NHS Trust and the Royal Marsden NHS Trust and trainees from Sainsbury’s pharmacies
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n 2001 the Royal Pharmaceutical Society launched a new preregistration training programme,1 which included new performance standards for trainees to achieve (see w w w.rpsgb.org.uk/ education). The new programme is intended to provide a more patient-focused preparation for practice, with a strong emphasis also on trainees’ professional behaviour and selfmanagement, and to encourage effective working between the hospital and community sectors. To achieve the performance standards, community preregistration trainees must receive some training in a hospital setting and vice versa. Organisation and delivery of this training poses a challenge to all preregistration tutors and trainers, and demonstrates the need for formalising working partnerships between the two sectors.
PLANNING THE DELIVERY OF CROSS-SECTOR TRAINING In 1999, a relationship was established between Chelsea and Westminster (C&W) Healthcare NHS Trust and J. Sainsbury Plc, whereby hospital preregistration trainees spent one week in community practice. This venture proved to be highly popular with the hospital trainees, some of whom gained locum opportunities with Sainsbury’s after qualifying. In addition, the pharmacy departments at the C&W Hospital and the Royal Marsden Hospital (RMH) have a history of co-operation and collaboration, which has been facilitated by their nearness. Preregistration tutors at each site were aware of the forthcoming cross-sector obligations and agreed to build on the existing relationships between the organisations in order to provide this training.
THE CROSS-SECTOR SCHEME General The NHS Pharmacy Education and Development Committee and the National Pharmaceutical Association developed resource packs for cross-sector training periods to accompany the Society’s new training workbooks produced for the performance standards programme. These packs established a framework for periods spent in both hospital and community pharmacy. The packs included cross-references to the Society’s performance standards, 682
which needed to be achieved in order to fulfil the requirements for preregistration training. The hospital resource pack was adapted, with permission, in order to include specific information about C&W and RMH. A two-week period in November 2001 was identified for the cross-sector training to take place for all preregistration trainees. November was chosen as this allowed a settling-in period for the trainees after their start in August, and avoided the Christmas period and the approach to the final examination. There were nine trainees from Sainsbury’s, nine from C&W and two from RMH. Sainsbury’s allocated the hospital trainees to pharmacies as close as possible to their addresses in London. By contrast, the Sainsbury’s trainees travelled to London from all parts of England and accommodation was provided centrally. Seven Sainsbury’s trainees were primarily based at C&W and two had their base at RMH. An evening event was held midway through the placement to allow trainees from both sectors, along with their tutors and trainers, to socialise and to exchange experiences in an informal atmosphere. The hospital programme A timetable for the community trainees was produced (copies available from the authors), which allowed them to rotate through sections within the hospital pharmacy. Working hours were 9am to 5.30pm Monday to Friday only. C&W provided training in clinical pharmacy, patient services, medicines information and procurement. RMH covered clinical pharmacy, manufacturing and quality assurance, and patient services. Key preregistration trainers were identified to deliver the training and meetings were held locally to outline the key objectives, tasks and evidence required within each section Barry Jubraj is principal pharmacist for education and training and Katey Wilkins is preregistration trainee co-ordinator at Chelsea and Westminster Hospital. Sheila Chantler is pharmacy training and development consultant, Sainsbury’s. Julie Mycroft is principal pharmacist clinical services at the Royal Marsden Hospital. Correspondence to Ms Wilkins at Pharmacy Services, Chelsea and Westminster Healthcare, 369 Fulham Road, London SW10 9NH (e-mail
[email protected])
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and to agree the methods of teaching. Before the placement, an induction pack was provided for each trainee. The pack contained information about dress code, health and safety, absence procedures and general information about the hospitals. Occupational health forms were completed and honorary “work” contracts provided. The placement began with an induction day, which provided small group training in the form of lectures and workshops. The subject matter included clinical information, guidance on practice activities such as patient profiles, and practical requirements about such issues as confidentiality. The trainees subsequently rotated through each pharmacy section under the supervision of the relevant trainer. There was an opportunity to carry out many of the tasks that hospital trainees undertake. However, what is expected of the cross-over scheme is that trainees from each sector will gain awareness and understanding of practice in the other sector, rather than develop competence. Time was also allocated in the programme for the collection of evidence. Assessment of evidence was conducted by the preregistration trainers who supervised trainees within their rotations. Other work, such as patient profiles, was assessed by the local preregistration tutors. The placement ended with an afternoon of feedback. The community programme The Sainsbury’s preregistration tutors responsible for hosting the hospital trainees were invited to attend a training day. This provided information about the new preregistration requirements, responsibilities towards trainees and other expectations about what was required from them. Tutors were also introduced to the resource pack on their training day which familiarised them with the areas and issues most likely to be raised by the hospital trainees. There was no formal training plan or timetable provided as there had been for the hospital programme. This was in accordance with the guidelines in the resource pack, which stated that trainees were expected to work through the pack before the training period, highlighting any areas where further help would be needed. Therefore, individual trainees were expected to reflect on any particular areas that they needed to cover before coming on the placement. 9 November 2002
ARTICLES The hospital trainees attended a halfday induction training session at one of the Sainsbury’s pharmacies before the two-week placement, in order to be briefed on company and procedural issues. This enabled the full two-week placement to be spent in the pharmacy. The time in-store was spent undertaking activities identified in the resource pack. Activities were based in the dispensary, providing over-the-counter services and exploring the developing role of the community pharmacist. Sainsbury’s preregistration tutors reviewed and assessed evidence during the placement.
EVALUATION OF THE PLACEMENT BY THE TRAINEES The hospital timetable included protected time for a discussion of the placement and the opportunity for community trainees to evaluate the programme. Hospital trainees were also asked to evaluate their experiences in the community, although their session was conducted back at base because it was difficult to run a group feedback session during the community placement. A hospital preregistration tutor conducted both evaluations. We appreciate that this could introduce bias in terms of the honesty of feedback received from the trainees (see “Changes for next year”). The trainees completed the evaluation form at the end of the resource pack. However, preregistration tutors at Sainsbury’s, C&W and RMH wanted more qualitative information about experiences gained during the hospital and community placements, with a view to future development. The feedback sessions involved asking trainees the following questions: l l l
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What was good about the experience? What would you change or improve? How would you feel if you had the opportunity to shadow your counterpart rather than the system used in this placement? How do you feel about the duration of the placement? Do you have any other comments?
Evaluation by Sainsbury’s trainees Sainsbury’s trainees were positive about the structured programme and the use of a comprehensive resource pack, which guided them through the placement. They expressed satisfaction with the length of the placement. They appreciated the insights gained into the role of hospital pharmacists and the nature of hospital pharmacy practice. Ward round experience was also rated highly. A number of suggestions were made for improvement. The common theme was that trainees wanted more clinical experience, including more time with specialist pharmacists, and less time in the dispensaries. This was because the trainees believed that they were gaining sufficient dispensary experience at their community base. The trainees also believed that certain aspects of the cross-sector programme were not relevant or necessary, for example, quality assurance 9 November 2002
and good manufacturing practice. Trainees commented that they sometimes were unsure of what they should be doing. They believed that shadowing their counterpart would overcome this uncertainty. Evaluation by hospital trainees In common with the Sainsbury’s trainees, hospital trainees believed a two-week placement to be sufficient. Hospital trainees felt valued for their clinical knowledge and the placement allowed them to fill gaps in their knowledge for the registration examination. A valuable insight into community pharmacy practice was gained, which helped to inform future career decisions, including the possibility of undertaking locums. The resource pack was found to be useful, although a suggestion was made that it should be developed to ensure consistency and standardisation of training, regardless of the Sainsbury’s store attended. When trainees compared their experiences at different stores, they agreed that all the training received had been worthwhile but that the emphasis sometimes differed. In addition, the trainees would have liked to have gained experience of other services, such as domiciliary oxygen provision and measurement of garments. It was also suggested that trainees should shadow each other, rather than swap sites for the two-week placement. This would ensure that there was no confusion about trainees’ roles and tasks, and would also allow the shadowed trainee to gain training experience as required by the Society’s performance standards. Trainees also believed that, being hosted by their peers, they might feel more comfortable in their new environment. Evaluation by preregistration tutors and trainers Feedback by community and hospital preregistration tutors and trainers occurred both informally during the placements and afterwards in formal meetings. This process was co-ordinated by the preregistration tutors and was documented along with trainee feedback. The intention was to gain views in the areas that trainees had also commented on. In addition, it was necessary to evaluate the practicalities of the placements. Everyone agreed that two weeks was sufficient time for the placement and that the resource packs provided a suitable framework for achieving the relevant performance standards. Developing and implementing the programme was challenging but rewarding, particularly when trainees demonstrably gained new knowledge and skills. Tutors and trainers made several suggestions for development of the scheme. During the cross-over, communication between organisations required occasional intervention regarding obligations and expectations of tutors and trainees. These were resolved amicably by the preregistration tutors, but it was thought that improvements could be made for subsequent programmes. Suggestions to develop communication included a specific contract for THE PHARMACEUTICAL JOURNAL (VOL 269)
all trainees, tutors and trainers. This would cover aspects of learning and details such as hours of work, punctuality, submission of evidence and other obligations of tutors and trainers specific to the crossover placements. This would supplement the learning contract in the Society’s workbook, which has to be completed by the trainee with the tutor at their main placement. It was suggested that a hospital preregistration tutor could run a session on the Sainsbury’s preregistration trainee regional induction day. This would be useful to outline the structure of the training programme for trainees, what to expect, and the ground rules through the use of a contract. The preregistration tutors and trainers supported the view that shadowing other trainees would be beneficial to all those involved. For this to succeed, trainees would need to be more experienced in their own sector before hosting cross-sector trainees. Therefore, the cross-sector programme should be conducted later in the preregistration year. Such an arrangement would require four weeks to be designated for the cross-over period, although the host trainees would still be able to work normally towards achieving their performance standards while acting as hosts. Indeed, acting as hosts in this way may itself help trainees to meet some of the performance standards.
DISCUSSION The evaluation process has highlighted some important issues. There were differences between perceived needs and wants on the part of the trainees and preregistration tutors and trainers, for example, the inclusion of quality assurance and good manufacturing practice in the hospital period for community trainees. The suggestion from the trainees not to cover these areas may have demonstrated a lack of familiarity with some areas of the registration examination syllabus and the importance of gaining an appreciation of the NHS as a whole. However, when it was made clear during feedback sessions that these aspects were on the syllabus, trainees acknowledged their importance. For example, the rating of the calculations session provided changed dramatically from “boring” to “very useful” once it was realised that a score of 70 per cent was required in a calculation paper in the registration examination. This could highlight a “surface level” approach to learning that may be encountered during training or study. The desire to spend more time with specialist pharmacists was understandable, becuase this is frequently perceived as being more interesting. However, trainers believed the priority should be to develop the necessary knowledge, skills and attitudes for practice. Increased trainee preparation for the placement, by way of a more thorough briefing from tutors, could help with these issues. The practicalities of the placements were critically evaluated. For a first placement of this kind, the logistics generally worked satisfactorily. By keeping a log of all issues that were encountered during the 683
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Suggestions for organisations wishing to start a preregistration cross-over training programme l
Build on previous working relationships, which may accelerate the process of setting up a scheme
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Explore your locality for possible partnerships, eg, other tospital Trusts and community pharmacists in your area. For C&W and RMH close proximity allowed more flexibility in the hospital timetable because students could travel easily between sites
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Use the resource packs already available in the Royal Pharmaceutical Society workbook as a framework for developing your training plan. Although permission will be needed to adapt them, local supplementary information can easily be written and personalises the training
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If it is not possible to provide all the training in the resource pack from one centre, consider whether it is possible to join forces with another centre that can
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Give careful consideration to the timing of the placements and the possibility of trainees shadowing each other
placement, a more meaningful discussion about future arrangements was possible. This would be a recommendation for all departments developing such schemes.
CHANGES FOR NEXT YEAR The preregistration tutors have used the evaluation and feedback to plan developments for next years’ scheme. Preparation for the scheme needs to be improved, particularly for the trainees and their expectations. The presence of a hospital tutor on the Sainsbury’s preregistration trainee study day and tutors’ study day will be an integral part of this process. At these meetings, learning contracts will be signed by preregistration trainees and their cross-sector placement tutors and trainers, and any questions or comments about obligations and expectations can be resolved. Correspond-
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ing work will need to be undertaken for the hospital trainees. It was clear that the induction day was useful to save repeated teaching and to encourage group learning. It has been agreed to extend this to cover general topics such as some core aspects of medicines information and manufacturing and quality assurance. Community and hospital trainees will also have a joint study day looking at domiciliary oxygen therapy and measuring garments, which were identified as training needs common to community and hospital trainees. Moving the placement to later in the preregistration year will allow trainees to better host and train their counterparts. It is agreed that this will provide a less pressured learning environment and training experience for each set of trainees. In addition, being nearer the examination, trainees will
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have developed a greater awareness of their gaps in knowledge and skills which may increase the motivation to learn. We believe that honesty in feedback after the placement may be improved if the feedback session was conducted back at base by the regular preregistration tutor, covering the same aspects of the placement as outlined earlier in this article. Given our intitial experiences there are some general suggestions that we would make for organisations thinking of setting up a crossover programme and these are given in the Panel.
SUMMARY This first experience of cross-over training placements between preregistration trainees from one community pharmacy company and two London teaching hospitals has proved successful. However, we consider this to be work in progress and several improvements, based on feedback received, will be made to next years’ programme. Two weeks was sufficient time for trainees to complete their resource pack tasks. ACKNOWLEDGEMENTS We would like to express our grateful thanks to all the trainers and preregistration trainees at each centre, who worked so hard to make the placement worthwhile. We are also grateful to Virginia Wykes, formerly of the Royal Pharmaceutical Society’s education division, for her helpful advice and comments in the writing of this article.
REFERENCES 1. Wykes, V. Launch of the Society’s new preregistration training scheme. Pharm J 2001;267:174.
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