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RESEARCH

Support Needed by Pharmacy Students in Experiential Placements: Stakeholders’ Expectations Susanne M Owen, Ieva Stupans, Greg Ryan, Leigh M McKauge, Jim Woulfe ABSTRACT Background: From July 2010, Australian state and territory pharmacy registration boards will be replaced by a national body that will register health professionals and also accredit university pharmacy programs. Traditionally, assessment during the pharmacy internship year and national examination provide consistency at the post-graduation stages, but the endpoints of university programs have been derived within state and territory contexts. Aim: To determine the skills needed to gain competence within university pharmacy programs; and to identify the levels of support required by early and late placement students. Method: Students, academics and professional/registration/ preceptors were involved in state and territory focus groups. 140 participants completed a chart about their expectations regarding levels of supervising preceptor support required by students during experiential placements. Manual collation and comparative analysis was undertaken for early and late placement students. Results: Early placement students were consistently viewed by all stakeholder groups as needing assistance or minimal assistance. For late placement students, there were wide variations in responses in regard to levels of support expectations for competency functional areas and within and across state and territory groups, especially among academics from various institutions. Conclusion: There is variability across states and territories with respect to competency development in academic programs. This may present challenges within a national accreditation and registration context. J Pharm Pract Res 2010; 40: 97-100.

INTRODUCTION Since 2002, university pharmacy programs in Australia have been accredited by the Australian Pharmacy Council. After graduation, students are required to undertake a 12-month internship prior to qualifying for registration as pharmacists. Registration of newly qualified pharmacists has been regulated by eight pharmacy boards located in each State and Territory. From July 2010, under the auspices of the National Registration and Accreditation Scheme for Health Professions, the eight State and Territory registration Susanne M Owen, DipT, BA, MEd, DEd, Senior Research Fellow, Ieva Stupans, BPharm(Hons), PhD, Associate Professor, Division of Health Sciences, School of Pharmacy and Medical Sciences, University of South Australia, Greg Ryan, RN, MA, PhD, Associate Professor and Director, Pharmacy Education Unit, Faculty of Pharmacy, The University of Sydney, Leigh M McKauge, BPharm(Hons), GradCertEd, MPhil (Education), MPS Lecturer and Placements Pharmacist, School of Pharmacy, The University of Queensland, Jim Woulfe, BA, DipTEFLA, MEd, Project Manager/Educational Designer, Pharmacy Education Unit, Faculty of Pharmacy, The University of Sydney, Sydney, New South Wales. Address for correspondence: Susanne Owen, Division of Health Sciences, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide SA 5001, Australia. E-mail: [email protected]

boards will be replaced by a national registering authority, the Pharmacy Board of Australia. The Pharmacy Board of Australia will also assume responsibility for accreditation of university pharmacy programs from the Australian Pharmacy Council.1 An outcome of this new national authority is to align accreditation and registration and ensure consistency with the competency standards for graduates from different university programs. Competency standards are used by professional and registration authorities for health professionals, to ensure that practitioners have achieved the required knowledge and skills.2 For pharmacists, the skills and knowledge required, are outlined in the Pharmaceutical Society of Australia’s Competency standards for pharmacists in Australia. 3 Assessment of these competencies occurs during the internship year and include: • functional area 1 – practise pharmacy in a professional and ethical manner; • functional area 2 – manage work issues and interpersonal relationships in pharmacy practice; • functional area 3 – promote and contribute to optimal use of medicines; • functional area 4 – dispense medicines; • functional area 5 – prepare pharmaceutical products; • functional area 6 – provide primary health care; • functional area 7 – provide medicines and health information and education; and • functional area 8 – apply organisational skills in the practice of pharmacy. Prior to the internship year, the university and experiential placements provide opportunities for students to develop their skills and knowledge. Benner4 and Dreyfus et al.5 emphasise the value of systematically identifying graduated descriptors related to the developmental stages of competencies. They highlight incremental improvements from the novice to competent phases in terms of levels of support needed, time taken for tasks, application of knowledge to clinical problems and degree of client focus. In Australia, university pharmacy programs and the internship year are a continuum, i.e. after a gradual improvement in skills, knowledge and professional attributes, competence is assessed at the point of registration. However, previous work has identified that explicit links to competencies within Australian pharmacy programs are generally not evident.6 Pharmacy education research in the UK has also highlighted a lack of connectedness of university pharmacy programs to professional competencies, and there was considerable variation in students’ perceptions of their learning outcomes dependent on the institution. 7 Similarly, Australian physiotherapy students’ perceptions of learning outcomes within their studies highlighted that students lacked understanding of the value of documented outcomes in facilitating their learning.8

Journal of Pharmacy Practice and Research Volume 40, No. 2, 2010.

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The imminent restructuring of the registration process for Australian pharmacists will provide opportunities to strengthen the links between academics, professional/registration authorities, and practitioners in terms of building skills, knowledge and attitudes of future pharmacists. Preparing students to meet competency standards in a nationally consistent manner will also require identification of the support required during the training process. This study aimed to determine the skills needed to gain competence within university pharmacy programs; and to identify the levels of support required by early and late placement students. METHOD To identify descriptors for various phases in the learning process, in February 2009 following a literature review and consultation with national student leaders and reference group members about the ideal characteristics of early and late placement students in terms of the eight professional competencies, a lengthy document was produced. The project team designated ‘early’ placement to refer to students starting their university program whereas ‘late’ placement referred to students who were completing their program. A convenience sample of over 200 academics, students, professional/registration authorities and preceptors of all Australian states and territories were interviewed – 35 group consultations and 12 individual consultations. Students were the predominant stakeholder group as they were encouraged by their university student leaders to attend the consultation sessions. During the consultation sessions, participants were invited to complete a chart on which they could indicate their expectations about the support needed by students for each of the eight professional competencies. Participants indicated their expectations of the support needed by students during early and late placements. A five-point Likert type scale was provided: 1 = with assistance (direction, instruction), 2 = with minimal assistance, 3 = with guidance (prompting, cues), 4 = with minimal guidance, and 5 = independently. There was also opportunity for free response comments. The data for each competency and stakeholder group completing the chart were manually collated and analysed. For ease of presentation, the data were converted to indicative scores: with assistance = 1, with minimal assistance = 2, with guidance = 3, with minimal guidance = 4, and independently = 5. As these data were derived from arbitrary scores, statistical analyses were not undertaken and mean scores were treated as indicative results. Additional comments provided by respondents were manually collated and key themes identified. RESULTS One hundred and forty-five respondents (76 students, 32 academics, 37 professional/registration authorities and preceptors) completed the chart. Approximately 75% of consultation session attendees filed the charts. For ease of presentation, mean converted data were calculated for the functional areas and stakeholder groups for early and late placements using indicative numerical figures. Early Placement Stakeholder groups indicated that the support they expected for early placement for each of the professional competencies were considerable assistance, direction and instruction. 98

Students indicated that minimal assistance was needed for each of the eight competencies in early placement (mean score 2.1). ‘Early on depends on topics covered in class – can be limited…at this stage.’ (student) ‘Students are mostly inexperienced, haven’t learned enough to apply in real life.’ (student) The mean score for academic stakeholders across the eight competencies was 1.5. For professional/ registration/preceptor stakeholders, the mean score was 1.7 indicating that considerable assistance was needed. Stakeholder groups’ mean scores about the anticipated levels of support across the eight functional areas for early placement students are shown in Table 1. The anticipated level of support across stakeholder groups were that for early placements across the eight competencies, students would need assistance (1) (direction, instruction) or minimal assistance (2). These data suggest that students noted that in the ‘early’ stage, more support would be needed for some competencies. For example, greater support would be needed around provision of primary health care (functional area 6), contributing to the optimal use of medicines (functional area 3) and medicines information (functional area 7) than for dispensing medicines (functional area 4). Table 1. Mean scores of stakeholders' views about support required for functional areas for early placement students Competency functional area* Stakeholder group

1

2

3

4

5

6

7

8

Students (n = 76)

2.4 2.2 1.9 2.1 2.2 1.9 1.9

Academics (n = 32)

1.5 1.6 1.4 1.8 1.7 1.4 1.5 1.4

Professional/registration/ preceptors (n = 37)

2

2

1.6 1.7 1.9 1.4 1.5 1.7 1.5

1 = assistance; 2 = minimal assistance; 3 = guidance. *1 = practise pharmacy in a professional and ethical manner; 2 = manage work issues and interpersonal relationships in pharmacy practice; 3 = promote and contribute to optimal use of medicines; 4 = dispense medicines; 5 = prepare pharmaceutical products; 6 = provide primary health care; 7 = provide medicines and health information and education; 8 = apply organisational skills in the practice of pharmacy.

A student comment provided some explanation for functional area 6: ‘No OTC lectures…are generally given until first block of placements in third year and expanded upon in fourth. Therefore initially students may not have any knowledge apart from a pharmacological background.’ Late Placement Stakeholders Stakeholders’ responses for late placement students across all states and territories and across all functional areas indicated that they perceived lower levels of support were required than for early placement students. There were some variations between stakeholder groups. The mean score across the eight functional areas was 4 for students (minimal guidance). For academics and professional/registration/preceptor groups the mean scores were 3.2 and 3 (guidance), respectively. Across all functional areas of competencies, students consistently indicated expectations of lower levels of support being required at the late placement phase, with academics and profession/registration/preceptors generally aligned and indicating higher levels of support were required.


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Figure 1. Stakeholders’ views from one Australian state about support needed by late placement students for each functional area. 3

Figure 1 is an example of one state’s responses from student, academic and professional/registration/ preceptors about anticipated levels of support for each functional area. Generally representative of results and derived from one state, Figure 1 indicates that for many of the functional areas, levels of support anticipated to be required by late placement students were clustered between ‘2.5’ and ‘3.5’ (guidance).

Academics In examining the results of stakeholder groups, there were considerable variations between responses of institutions within and across states/territories in terms of expectations of support needed by late placement students. For example, for academics, there were ten institutions involved in the completion of the chart. Mean scores for each academic institution and for each functional area are shown in Figure 2.

Figure 2. Academics’ mean scores for support needed by late placement students.


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For functional area 1 (practise pharmacy in a professional and ethical manner) and functional area 2 (manage work issues and interpersonal relationships in pharmacy practice), mean scores for academics from different institutions varied widely (range 2 to 4) but results were generally clustered around 3 (guidance) (Figure 2). Academics’ views on working relationships and students’ improvement in communication by the time of graduation is illustrated by the following quote: ‘(Students are) more confident in ability to counsel and communicate with patients; starting to become more focused on their course and where it is leading.’ For functional area 3 (optimal use of medicine), there were varied responses of expectations about levels of support needed for late placement students. They ranged from minimal assistance (2) to independently (5), with some comments indicating that lower levels of supervision were needed as illustrated by the following quote: ‘(students are) confident in communication with staff/ patients, knowledgeable in most medications’. A comment from an academic (who indicated higher levels of support for this aspect) expressed caution about students in terms of being ‘confident, eager to practice, impatient with respect to graduation’. Functional area 8 (apply organisational skills in the practice of pharmacy) had results ranging from 2 (minimal assistance) to 3.5 (guidance), which indicated higher levels of support were expected than for other functional areas. On the other hand, for functional area 4 (dispensing), a more technical and mechanistic process, there were expectations of lower levels of support needed for late placement students, with all academic groups indicating 3 (guidance) and most indicating with minimal guidance (4 or above). DISCUSSION Australian stakeholders consulted on graduated descriptors for competencies and expectations of levels of support for pharmacy students in experiential placements consistently opined that early placement students needed assistance or minimum assistance. For late placement students and expected outcomes, our results were similar to large scale research in the UK, with marked variations in anticipated levels of support between stakeholder groups within Australian states and territories.7 The range was from minimal assistance to minimal guidance for several of the functional areas within the same stakeholder group, albeit in different states and territories. In terms of consistency of views across stakeholder groups and jurisdictions, sometimes there were considerable variations. The variations in late placement expected outcomes regarding support, particularly among academics from various pharmacy programs and institutions seemed to reflect local contextual factors with registration boards traditionally operating separately within each Australian state or territory. However, with the establishment of the Pharmacy Board of Australia, as the national board for registration and accreditation of university programs from mid 2010, a need for greater consistency across states and territories in terms of the endpoint of university programs and experiential placements and student progress towards the competency functional areas may be anticipated.

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Universities have achieved a degree of consistency across disciplines via the university-derived ‘graduate attributes’, with commonality across institutions in relation to outcomes in areas such as communication, professionalism and ethics. Given this achievement of consistency in ‘graduate attributes’, there is potential within Australian pharmacy schools to achieve similar consistency of outcomes in relation to the profession and progress towards these competencies. A limitation of this study was that the sample size was small and a convenience sample of stakeholders was used. However, this work suggests that a consistent understanding about the endpoint of university programs in terms of student progression towards these competencies is desirable. A coherent understanding by academics of the competencies, developmental aspects and expectations at the point of graduation, will improve the quality of university program planning and also communication and links with professional bodies. Future directions for this work could include comparative analysis of undergraduate and graduate entry degree program students to examine potential differences in responses. In conclusion, this small study highlighted various perspectives across stakeholder groups in relation to the endpoints of pharmacy university preparatory programs. Given the establishment of national registration and accreditation boards and workforce planning for Australian health professions, and increasing mobility of students and interns between states and territories, clear outcomes and linking of university and internship programs and assessment are essential directions for the future. Wider application is also evident because of the Australian government’s involvement in workforce planning across states and territories and across health professions. Acknowledgments The funding support provided by the Australian Learning and Teaching Council through the Department of Education Employment and Workplace Relations in Australia is gratefully acknowledged. Competing Interests: None Declared. References 1. National Health Workforce Taskforce. National registration and accreditation scheme for health professions. Canberra: Australia’s Health Workforce Online; 2008. Available from . 2. Gonczi A, Hager P, Oliver L. Establishing competency-based standards in the professions. National Office of Overseas Skills Recognition. Research paper No. 1. Canberra: Australian Government Publishing Service; 1990. 3. Pharmaceutical Society of Australia. Competency standards for pharmacists in Australia. Canberra: Pharmaceutical Society of Australia; 2003. Available from . 4. Benner P. From novice to expert: excellence and power in clinical nursing practice. Menlo Park: Addison-Wesley; 1984. 5. Dreyfus HL, Dreyfus SE. The relationship of theory and practice in the acquisition of skill. In: Benner PA, Tanner CA, Chesla CA, editors. Expertise in nursing practice: caring, clinical judgment, and ethics. New York: Springer Publishing Company; 1996. p. 29-47. 6. Owen S, Stupans I. Experiential placements in pharmacy. Quality indicators for best practice approaches to experiential placements in pharmacy programs. Adelaide: University of South Australia; 2008. Available from . 7. Willis SC, Hassell K, Seston E, Hann M. Using learning outcomes for undergraduate pharmacy education to assess final-year students’ perceptions of their preparedness for pharmacy practice. Int J Pharm Pract 2009; 17: 351-8. 8. McMeeken J, Webb G, Krause K, Grant R, Garnett R. Learning outcomes and curriculum development in Australian physiotherapy education. Melbourne: The University of Melbourne; 2005. Received: 15 April 2010 Revisions requested after external review: 6 May 2010 Revised version received: 18 May 2010 Accepted: 21 May 2010
