Development of a Postgraduate Community Pharmacist Specialization Program Using CanMEDS Competencies, and Entrustable Professional Activities

Evaluating competency-based medical education: a systematized review of current practices

BACKGROUND

Few published articles provide a comprehensive overview of the available evidence on the topic of evaluating competency-based medical education (CBME) curricula. The purpose of this review is therefore to synthesize the available evidence on the evaluation practices for competency-based curricula employed in schools and programs for undergraduate and postgraduate health professionals.

METHOD

This systematized review was conducted following the systematic reviews approach with minor modifications to synthesize the findings of published studies that examined the evaluation of CBME undergraduate and postgraduate programs for health professionals.

RESULTS

Thirty-eight articles met the inclusion criteria and reported evaluation practices in CBME curricula from various countries and regions worldwide, such as Canada, China, Turkey, and West Africa. 57% of the evaluated programs were at the postgraduate level, and 71% were in the field of medicine. The results revealed variation in reporting evaluation practices, with numerous studies failing to clarify evaluations' objectives, approaches, tools, and standards as well as how evaluations were reported and communicated. It was noted that questionnaires were the primary tool employed for evaluating programs, often combined with interviews or focus groups. Furthermore, the utilized evaluation standards considered the well-known competencies framework, specialized association guidelines, and accreditation criteria.

CONCLUSION

This review calls attention to the importance of ensuring that reports of evaluation experiences include certain essential elements of evaluation to better inform theory and practice.

Pharmaceutical public health competencies for Thai pharmacists: A scoping review with expert consultation

Background

Thai pharmacists' roles have increasingly shifted to a system-focused role in providing public health services. A competency framework in this area is essential to workforce development.

Objective

This study aimed to summarize and synthesize the literature on pharmaceutical public health competencies of Thai pharmacists.

Methods

The Scopus, MEDLINE, and Web of Science (Clarivate) databases were searched. The search criteria included "public health", "health promotion", "primary care", "community pharmacy", "pharmacy" and "pharmacist". Documents published in English and Thai between January 2011 and December 2020 were also examined. Unpublished documents were included. A 3-step inductive coding technique was used to develop the competency framework. To validate the findings, a 2-round, modified Delphi method was employed with 20 Thai pharmaceutical specialists between August 2022 and January 2023. The Scale-level Content Validity Index (S-CVI) was used to assess validity.

Results

The database search yielded 1429 articles. Fifty-seven articles were selected. The analysis identified 5 competency domains. The domains, along with their related competency elements and behavioral statements, were provided for expert assessment. The S-CVI scores in the first and second rounds were 0.78 and 0.93, respectively. The terminology and categories of competencies have been improved. This outcome resulted in a pharmaceutical public health competency framework for Thai pharmacists. The framework consists of 5 competency domains: 1) individual and family health promotion (3 competency elements with 10 behavioral statements), 2) community empowerment for well-being communities (6 competency elements with 23 behavioral statements), 3) information management and evidence-based practice (3 competency elements with 10 behavioral statements), 4) communication for health promotion (3 competency elements with 6 behavioral statements), and 5) pharmacoepidemiology and support for public health emergencies and epidemics (2 competency elements with 5 behavioral statements).

Conclusion

Pharmaceutical public health competencies for Thai pharmacists were developed through extensive literature review and expert consultation.

Development of the entrustable professional activity 'medication reconciliation' for clinical pharmacy

BACKGROUND

Entrustable professional activities (EPAs) are observable process descriptions of clinical work units. EPAs support learners and tutors in assessment within healthcare settings. For use amongst our pharmacy students as well as pre-registration pharmacists we wanted to develop and validate an EPA for use in a clinical pharmacy setting at LMU University Hospital.

METHODS

The development of the clinical pharmacy EPA followed a set pathway. A rapid literature review informed the first draft, an interprofessional consensus group consisting of pharmacists, nurses, and medical doctors refined this draft. The refined version was then validated via online survey utilising clinical pharmacists from Germany.

RESULTS

We designed, refined and validated an EPA regarding medication reconciliation for assessment of pharmacy students and trainees within the pharmacy department at LMU University Hospital in Munich. Along with the EPA description an associated checklist to support the entrustment decision was created. For validation an online survey with 27 clinical pharmacists from all over Germany was conducted. Quality testing with the EQual rubric showed a good EPA quality.

CONCLUSIONS

We developed the first clinical pharmacy EPA for use in a German context. Medication reconciliation is a suitable EPA candidate as it describes a clinical activity performed by pharmacists in many clinical settings. The newly developed and validated EPA 'Medication Reconciliation' will be used to assess pharmacy students and trainees.

Evaluating the Strengths and Barriers of Competency-Based Education in the Health Professions

OBJECTIVE

This study aimed to define competency-based education (CBE) for pharmacy education and describe how strengths and barriers of CBE can support or hinder implementation.

FINDINGS

Sixty-five studies were included from a variety of health professions in order to define competency based pharmacy education (CBPE) and identify barriers and benefits from the learner, faculty, institution, and society perspectives. From the 7 identified thematic categories, a CBPE definition was developed: "Competency-based pharmacy education is an outcomes-based curricular model of an organized framework of competencies (knowledge, skills, attitudes) for pharmacists to meet health care and societal needs. This learner-centered curricular model aligns authentic teaching and learning strategies and assessment (emphasizing workplace assessment and quality feedback) while deemphasizing time."

SUMMARY

This article provides a definition of CBE for its application within pharmacy education. The strengths and barriers for CBE were elucidated from other health professions' education literature. Identified implementation strengths and barriers aid in the discussions on what will support or hinder the implementation of CBE in pharmacy education.

Entrustable professional activities-based objective structured clinical examinations in a pharmacy curriculum

BACKGROUND

The integration of Objective Structured Clinical Examinations (OSCEs) within the professional pharmacy program, contributes to assessing the readiness of pharmacy students for Advanced Pharmacy Practice Experiences (APPEs) and real-world practice.

METHODS

In a study conducted at an Accreditation Council for Pharmacy Education (ACPE)-accredited Doctor of Pharmacy professional degree program, 69 students in their second professional year (P2) were engaged in OSCEs. These comprised 3 stations: best possible medication history, patient education, and healthcare provider communication. These stations were aligned with Entrustable Professional Activities (EPAs) and Ability Statements (AS). The assessment aimed to evaluate pharmacy students' competencies in key areas such as ethical and legal behaviors, general communication skills, and interprofessional collaboration.

RESULTS

The formulation of the OSCE stations highlighted the importance of aligning the learning objectives of the different stations with EPAs and AS. The evaluation of students' ethical and legal behaviors, the interprofessional general communication, and collaboration showed average scores of 82.6%, 88.3%, 89.3%, respectively. Student performance on communication-related statements exceeded 80% in all 3 stations. A significant difference (p < 0.0001) was found between the scores of the observer and the SP evaluator in stations 1 and 2 while comparable results (p = 0.426) were shown between the observer and the HCP evaluator in station 3. Additionally, a discrepancy among the observers' assessments was detected across the 3 stations. The study shed light on challenges encountered during OSCEs implementation, including faculty involvement, resource constraints, and the necessity for consistent evaluation criteria.

CONCLUSIONS

This study highlights the importance of refining OSCEs to align with EPAs and AS, ensuring a reliable assessment of pharmacy students' clinical competencies and their preparedness for professional practice. It emphasizes the ongoing efforts needed to enhance the structure, content, and delivery of OSCEs in pharmacy education. The findings serve as a catalyst for addressing identified challenges and advancing the effectiveness of OSCEs in accurately evaluating students' clinical readiness.

Defining a competency framework for health and social professionals to promote healthy aging throughout the lifespan: an international Delphi study

The promotion of healthy aging has become a priority in most parts of the world and should be promoted at all ages. However, the baseline training of health and social professionals is currently not adequately tailored to these challenges. This paper reports the results of a Delphi study conducted to reach expert agreement about health and social professionals' competencies to promote healthy aging throughout the lifespan within the SIENHA project. Materials and methods: This study was developed following the CREDES standards. The initial version of the competence framework was based on the results of a scoping review and following the CanMEDS model. The expert panel consisted of a purposive sample of twenty-two experts in healthy aging with diverse academic and clinical backgrounds, fields and years of expertise from seven European countries. Agreement was reached after three rounds. The final framework consisted of a set of 18 key competencies and 80 enabling competencies distributed across six domains. The SIENHA competence framework for healthy aging may help students and educators enrich their learning and the academic content of their subjects and/or programs and incentivize innovation.

Competency Framework for Podiatric Medicine Training: A Validation Report Based on an Adapted E-Delphi Across Canada

OBJECTIVES

Competency-based medical education has been introduced into many health professional curricula. Based on CanMEDs, a framework has recently been developed for podiatric medicine education in Canada. This study aimed to validate the framework through a consensus of various podiatric medicine experts across Canada.

METHODS

An adapted Delphi method was used for content validation. Two structured online questionnaires were used to gather expert opinions and agreement on the roles and core competencies described in the framework previously developed. The validation consensus threshold was set at a minimum of 80% agreement. The summary of comments and suggestions was used to reformulate certain items after the research team reached a consensus.

RESULTS

Out of the 51 experts invited from the Canadian Podiatric Medicine Association, 19 completed the first-round questionnaire (mean podiatric experience = 24.5 years; standard deviation 17.6). After the first round, "Podiatric Expert", "Communicator" and "Scholar" roles have been modified. After these modifications, a consensus was obtained at the second round completed by 13 experts. Overall, 95% of the experts agreed that the competency framework was relevant even if some indicators would need to be adapted to suit the requirements of each province and territory.

CONCLUSION

This validated framework supports the excellence and the quality of our podiatric educational program. It also promotes the adoption of a uniform education of podiatrists in Canada and worldwide.

Do You Have Any ID? Exploring Opinions and Understanding of Year 4 MPharm Students on Professional Identity

OBJECTIVE

To investigate Year 4 Master of Pharmacy students' understanding and sense of professional identity (PI) and explore the factors that positively and negatively impact PI formation in the undergraduate program.

METHODS

Three focus groups were conducted in January 2022 with 5-8 participants per group. Audio from the focus groups was recorded and recordings were transcribed verbatim. Reflexive thematic analysis was employed to construct themes and subthemes.

RESULTS

Four themes, with associated subthemes, were generated. The themes were 'Understanding PI', 'Experience of Master of Pharmacy degree', 'Interaction and comparison with others,' and 'Development of self'.

CONCLUSION

Participant understanding of PI reflected the wider literature, including ambiguity as to what it means to a pharmacist in training. The lens of legitimate peripheral participation in a community of practice was used to reflect on curricular and educational approaches to support undergraduate PI formation. Participants expressed that patient-focused learning experiences and opportunities to participate in authentic professional activities alongside peers and more experienced members of the pharmacy community positively contribute to PI formation. This suggests that a sociocultural perspective where learning is viewed as legitimate peripheral participation in a community of practice provides a valid theoretical basis to underpin curriculum design.

A Review of Entrustable Professional Activities in Pharmacy Education

Objective. To review the published literature describing how entrustable professional activities (EPAs) are currently used in health professions education with a focus on pharmacy education.Findings. English-language searches in the databases CINAHL Plus and MEDLINE were conducted for January 2011 through March 2021, which identified 21 publications for inclusion in this review. The following themes were identified: frameworks for the development of EPAs, the implementation and evaluation of EPAs for workplace learning, and gaps in knowledge and future directions for EPAs.Summary. Currently, no standardized approach exists for developing EPA frameworks for health disciplines. Also, the ways that EPAs are implemented and evaluated as an educational tool in practice settings are inconsistent. An opportunity exists to further establish the development, implementation, and evaluation of EPAs in all clinical practice settings. Much can be learned from other health professions to ensure successful translation of EPAs into pharmacy education.

How progress evaluations are used in postgraduate education with longitudinal supervisor-trainee relationships: a mixed method study

The combination of measuring performance and giving feedback creates tension between formative and summative purposes of progress evaluations and can be challenging for supervisors. There are conflicting perspectives and evidence on the effects supervisor-trainee relationships have on assessing performance. The aim of this study was to learn how progress evaluations are used in postgraduate education with longitudinal supervisor-trainee relationships. Progress evaluations in a two-year community-pharmacy specialization program were studied with a mixed-method approach. An adapted version of the Canadian Medical Education Directives for Specialists (CanMEDS) framework was used. Validity of the performance evaluation scores of 342 trainees was analyzed using repeated measures ANOVA. Semi-structured interviews were held with fifteen supervisors to investigate their response processes, the utility of the progress evaluations, and the influence of supervisor-trainee relationships. Time and CanMEDS roles affected the three-monthly progress evaluation scores. Interviews revealed that supervisors varied in their response processes. They were more committed to stimulating development than to scoring actual performance. Progress evaluations were utilized to discuss and give feedback on trainee development and to add structure to the learning process. A positive supervisor-trainee relationship was seen as the foundation for feedback and supervisors preferred the roles of educator, mentor, and coach over the role of assessor. We found that progress evaluations are a good method for directing feedback in longitudinal supervisor-trainee relationships. The reliability of scoring performance was low. We recommend progress evaluations to be independent of formal assessments in order to minimize roles-conflicts of supervisors.

Factors influencing pharmacist interest and preparedness to work as on-site aged care pharmacists: Insights from qualitative analysis of free-text survey responses

BACKGROUND

High rates of suboptimal medication use exist in residential aged care facilities (RACFs). Pharmacist interventions can improve medication appropriateness. In 2023 there will be a phased implementation of pharmacists working on-site in Australian RACFs.

OBJECTIVE

To explore factors influencing Australian pharmacists' interest and perceived preparedness to work as on-site pharmacists in RACFs.

METHODS

A national cross-sectional anonymous online survey of Australian pharmacists was conducted. Pharmacists were recruited using a broad advertising strategy. The 36-question survey included three free-text questions that are the focus of this study. The questions asked participants (1) what influenced their interest in the role, (2) what influenced how prepared they felt for the role, and (3) if they had any other comments about the role. Responses were thematically analysed by two investigators using an inductive approach.

RESULTS

Most survey respondents (n=546, 84.9%) answered at least one free-text questions. Four factors influenced interest: on-site pharmacist role, aged care setting, individual pharmacist circumstances and employment model. Four factors influenced preparedness: familiarity with aged care setting, resident-level clinical skills; ability to communicate and work with a multidisciplinary team, and experience with system-level quality use of medicines activities. Four factors important for successful roll-out emerged from the 'other comments': pharmacist attributes, pharmacist workforce planning, resources and support, and RACF stakeholder engagement.

CONCLUSION

Key factors influencing pharmacist interest and preparedness to work on-site in RACFs and factors important for success were identified. These findings will support the national roll-out of the role, particularly as most identified factors are currently modifiable.

Development and evaluation of Entrustable Professional Activities embedded in an e-portfolio for work-based assessment in community and public health dietetics

Entrustable professional activities (EPAs) is a recent concept that helps operationalise competency-based education. In this paper, we report on the development of EPAs and incorporation into an e-portfolio for work-based assessment of final year dietetics students in a community and public health professional placement. We aimed to determine the utility of the EPAs for work-based assessment in this context. We used action research methodology to conduct broad consultation with students and supervisors using anonymous surveys and focus groups to understand their beliefs and attitudes towards work-based assessment. Consequently, 40 EPAs with an accompanying four-point entrustment scale were developed and mapped to the National Competency Standards for Dietitians in Australia. The EPAs and assessment tool were piloted and evaluated via an anonymous online user survey across three cohorts of students (n = 133) and supervisors (n = 67). Following mediocre pilot year evaluation results, EPAs were revised and reduced in number. While students positively evaluated the e-portfolio, their appraisal of the EPAs and entrustment scale was less positive compared to supervisors. Supervisor evaluation of the EPA-based e-portfolio supported the validity, feasibility and acceptability of this novel assessment method in a community and public health setting. Assessment using EPAs, and the resulting educational data collected by the tool, offers potential for individual learners to identify areas needing development during placement, as well as potential to inform curriculum improvements and increase understanding of learning opportunities and outcomes for dietetic students in community and public health settings.

Challenges and opportunities for educating health professionals after the COVID-19 pandemic

The education of health professionals substantially changed before, during, and after the COVID-19 pandemic. A 2010 Lancet Commission examined the 100-year history of health-professional education, beginning with the 1910 Flexner report. Since the publication of the Lancet Commission, several transformative developments have happened, including in competency-based education, interprofessional education, and the large-scale application of information technology to education. Although the COVID-19 pandemic did not initiate these developments, it increased their implementation, and they are likely to have a long-term effect on health-professional education. They converge with other societal changes, such as globalisation of health care and increasing concerns of health disparities across the world, that were exacerbated by the pandemic. In this Health Policy, we list institutional and instructional reforms to assess what has happened to health-professional education since the publication of the Lancet Commission and how the COVID-19 pandemic altered the education process.

Competency Framework for Podiatric Medicine Training in Canada: An Adapted Delphi Study

PURPOSE

Podiatrists are generally defined as professionals with high-level skills in the prevention and management of local foot conditions that are not systemic diseases. Across countries, different academic trainings are implemented due to the specific context and practice of podiatric medicine. It is thus essential to support country-specific podiatry education for the development of highly skilled podiatrists. Therefore, we report the development of a podiatric medicine competency framework to support training in Canada.

PARTICIPANTS AND METHODS

A Delphi process was conducted by 12 stakeholders (including 8 podiatry experts) from the University of Québec at Trois-Rivières which is the only university offering the degree of Doctor of Podiatric Medicine (DPM) in Canada. The developed framework is (1) based on the seven key roles of the Canadian medical education directives of specialists (CanMEDs) and, (2) closely aligned with the requirement of the College of Podiatrists of Québec which sets the standards of entry to practice in Québec.

RESULTS

The developed framework represents the state of the development process and the consensus of the podiatry experts. It reflects the expected profile of the institution's DPM graduates based on seven key roles (podiatry expert, communicator, collaborator, health advocate, leader and manager, scholar, and professional). This developed framework is an arborescence of complex skills defined in tangible indicators that characterize each expected part of a core competency. Twenty-four core competencies have been determined and divided into 84 enabling competencies and 288 observable indicators.

CONCLUSION

This competency framework has been designed to support high-quality education and to develop podiatry. Next steps include: (1) validation of this framework by external experts, (2) development of rigorous evaluation methods and, (3) concrete actions for its implementation and assessment. This framework would help to define the scope of practice and capabilities of podiatric medicine, both in Canada and internationally.

Entrustable Professional Activities in Clinical Education: A Practical Approach for Advanced Nursing Education

BACKGROUND

Competency attainment is foremost in the ethos of this project that provides a practical guide to implementing entrustable professional activities (EPAs) as one approach to competency acquisition in the clinical education component of a health care program. EPAs are units of work that provide evidence of required competencies for the clinical education component of a program of study for educators, preceptors, and students.

PROBLEM

The American Association of Colleges of Nursing has raised the importance of competency-based education and need for a practical approach to assess clinical competency challenges (eg, EPAs) in nursing education.

APPROACH

The implementation of EPAs in the clinical component of advanced nursing education is detailed as an example in this article. Prioritizing a systematic approach, the Knowledge to Action framework, was chosen to guide the process.

CONCLUSION

Nursing must act now to put in place a robust competency acquisition and validation system.

A pilot study on the use of the nominal group technique to refine core pharmacy roles and to determine what competencies may be missing from pharmacy education

INTRODUCTION

To describe the use of the nominal group technique (NGT) to refine pharmacy core roles and to compare these roles with current pharmacy outcomes and other literature to highlight potential deficiencies.

METHODS

The NGT process was used for this proposal review. The process was conducted in four key stages: silent generation, round-robin, clarification, and voting. A convenience sampling of five pharmacy faculty and administrators that have researched the areas of practice-readiness and pharmacy competencies formed the panel of participants for the NGT process.

RESULTS

Study findings offer seven core roles that define pharmacists' scope of practice: knowledge, patient care skills, professional, scholar, system-based practice/manager, collaborator, and advocate/health promoter. Development of these core roles revealed several missing pharmacy competencies or ones only covered in optional learning objectives: conflict management, professional advocacy, scholarship, empathy, personal health, transitions of care, health outcomes, quality improvement, and health insurance.

CONCLUSIONS

The development of pharmacy roles is one way to ensure students are adequately prepared for pharmacy practice following graduation. Mapping of competencies to core professional roles would allow schools/colleges of pharmacy to have one cohesive document to guide pedagogical and assessment practice. More research and consensus building will be needed before these core roles could be disseminated more broadly.

Validity evidence for summative performance evaluations in postgraduate community pharmacy education

INTRODUCTION

Workplace-based assessment of competencies is complex. In this study, the validity of summative performance evaluations (SPEs) made by supervisors in a two-year longitudinal supervisor-trainee relationship was investigated in a postgraduate community pharmacy specialization program in the Netherlands. The construct of competence was based on an adapted version of the 2005 Canadian Medical Education Directive for Specialists (CanMEDS) framework.

METHODS

The study had a case study design. Both quantitative and qualitative data were collected. The year 1 and year 2 SPE scores of 342 trainees were analyzed using confirmatory factor analysis and generalizability theory. Semi-structured interviews were held with 15 supervisors and the program director to analyze the inferences they made and the impact of SPE scores on the decision-making process.

RESULTS

A good model fit was found for the adapted CanMEDS based seven-factor construct. The reliability/precision of the SPE measurements could not be completely isolated, as every trainee was trained in one pharmacy and evaluated by one supervisor. Qualitative analysis revealed that supervisors varied in their standards for scoring competencies. Some supervisors were reluctant to fail trainees. The competency scores had little impact on the high-stakes decision made by the program director.

CONCLUSIONS

The adapted CanMEDS competency framework provided a valid structure to measure competence. The reliability/precision of SPE measurements could not be established and the SPE measurements provided limited input for the decision-making process. Indications of a shadow assessment system in the pharmacies need further investigation.

An online Delphi study to investigate the completeness of the CanMEDS Roles and the relevance, formulation, and measurability of their key competencies within eight healthcare disciplines in Flanders

BACKGROUND

Several competency frameworks are being developed to support competency-based education (CBE). In medical education, extensive literature exists about validated competency frameworks for example, the CanMEDS competency framework. In contrast, comparable literature is limited in nursing, midwifery, and allied health disciplines. Therefore, this study aims to investigate (1) the completeness of the CanMEDS Roles, and (2) the relevance, formulation, and measurability of the CanMEDS key competencies in nursing, midwifery, and allied health disciplines. If the competency framework is validated in different educational programs, opportunities to support CBE and interprofessional education/collaboration can be created.

METHODS

A three-round online Delphi study was conducted with respectively 42, 37, and 35 experts rating the Roles (n = 7) and key competencies (n = 27). These experts came from non-university healthcare disciplines in Flanders (Belgium): audiology, dental hygiene, midwifery, nursing, occupational therapy, podiatry, and speech therapy. Experts answered with yes/no (Roles) or on a Likert-type scale (key competencies). Agreement percentages were analyzed quantitatively whereby consensus was attained when 70% or more of the experts scored positively. In round one, experts could also add remarks which were qualitatively analyzed using inductive content analysis.

RESULTS

After round one, there was consensus about the completeness of all the Roles, the relevance of 25, the formulation of 24, and the measurability of eight key competencies. Afterwards, key competencies were clarified or modified based on experts' remarks by adding context-specific information and acknowledging the developmental aspect of key competencies. After round two, no additional key competencies were validated for the relevance criterion, two additional key competencies were validated for the formulation criterion, and 16 additional key competencies were validated for the measurability criterion. After adding enabling competencies in round three, consensus was reached about the measurability of one additional key competency resulting in the validation of the complete CanMEDS competency framework except for the measurability of two key competencies.

CONCLUSIONS

The CanMEDS competency framework can be seen as a grounding for competency-based healthcare education. Future research could build on the findings and focus on validating the enabling competencies in nursing, midwifery, and allied health disciplines possibly improving the measurability of key competencies.

Benefits of EPAs at risk? The influence of the workplace environment on the uptake of EPAs in EPA-based curricula

INTRODUCTION

Entrustable Professional Activities (EPAs) have been applied differently in many postgraduate medical education (PGME) programmes, but the reasons for and the consequences of this variation are not well known. Our objective was to investigate how the uptake of EPAs is influenced by the workplace environment and to what extent the benefits of working with EPAs are at risk when the uptake of EPAs is influenced. This knowledge can be used by curriculum developers who intend to apply EPAs in their curricula.

METHOD

For this qualitative study, we selected four PGME programmes: General Practice, Clinical Geriatrics, Obstetrics & Gynaecology, and Radiology & Nuclear Medicine. A document analysis was performed on the national training plans, supported by the AMEE Guide for developing EPA-based curricula and relevant EPA-based literature. Interviews were undertaken with medical specialists who had specific involvement in the development of the curricula. Content analysis was employed and illuminated the possible reasons for variation in the uptake of EPAs.

RESULTS

An important part of the variation in the uptake of EPAs can be explained by environmental factors, such as patient population, the role of the physician in the health-care system, and the setup of local medical care institutions where the training programme takes place. The variation in uptake of EPAs is specifically reflected in the number and breadth of the EPAs, and in the way the entrustment decision is executed within the PGME programme.

DISCUSSION

Due to variation in uptake of EPAs, the opportunities for trainees to work independently during the training programme might be challenging. EPAs can be implemented in the curriculum of PGME programmes in a meaningful way, but only if the quality of an EPA is assessed, future users are involved in the development, and the key feature of EPAs (the entrustment decision) is retained.

The Pharmacy Game-GIMMICS® a Simulation Game for Competency-Based Education

The profile of the profession of pharmacists has profoundly changed over the last decades. Pharmacy education has moved towards competency-based education. The pharmacy game, called GIMMICS^®, developed at the University of Groningen, is unique in combining simulation with serious gaming to teach a wide range of competencies. In this article, we describe the learning goals, the assessment methods, the teaching tools, and the students’ view of the pharmacy game. The learning goals are to train the competencies of collaboration, leadership, communication, and pharmaceutical expertise. The core of the game is the simulation of community pharmacy practice activities, such as patient counseling, processing of prescriptions, and collaboration with other health professionals. Students are assessed individually and as a pharmacy team. The pharmacy team, with the largest number of patients wins the game. Student evaluations show that they value the course. Currently, seven universities from around the globe have adopted the pharmacy game in their curriculum, adjusting the course to their country’s pharmacy practice and educational system.

Competency-based education in pharmacy: A review of its development, applications, and challenges

RATIONALE, AIMS, AND OBJECTIVES

There has been a resurgence of interest in the application of competency-based education (CBE) in health care professionals' education in recent years, including the pharmacy profession. This model strives to prepare a competent pharmacy workforce to help meet societal needs for effective, safe, and economical health care services. The aim of this narrative review is to provide an overview of the applications of CBE in the education and training of pharmacists, the process for constructing a competency-based pharmacy curriculum, and the potential advantages and challenges associated with its implementation.

METHOD

A comprehensive literature review was conducted via PubMed and Scopus databases using a variety of keywords related to the topic (from 1975 to 2019). Other electronic resources (Google Scholar and the Education Resources Information Center) were searched to identify educational outcomes of pharmacy programmes emphasizing competency development and competency frameworks/standards for the pharmacy profession that were published up to 2019.

RESULTS

CBE has been increasingly adopted in pharmacy education, mainly in developed countries. A number of competency frameworks have been advanced to support the design of CBE curricula, accreditation standards of pharmacy programmes, and professional pharmacy registration/licensure. Several examples of the application of competency-based pharmacy education (CBPE) were identified at undergraduate, postgraduate, and professional development levels. Transforming a traditional pharmacy programme into CBPE offers several potential benefits but can also be associated with significant challenges. Successful implementation of CBPE programmes requires strong and supportive institutional leadership; proper curricular design, implementation, and management; and focus on faculty training and development.

CONCLUSION

The adoption of CBPE can enhance the ability of pharmacy education to meet the rapidly evolving societal health care needs. This model has been applied in developed countries at different levels throughout the pharmacist's learning continuum. It has also been investigated in some developing regions.

Alignment of CanMEDS-based Undergraduate and Postgraduate Pharmacy Curricula in The Netherlands

In this article the design of three master programs (MSc in Pharmacy) and two postgraduate specialization programs for community or hospital pharmacist is described. After a preceding BSc in Pharmacy, these programs cover the full pharmacy education capacity for pharmacists in primary and secondary health care in the Netherlands. All programs use the CanMEDS framework, adapted to pharmacy education and specialization, which facilitates the horizontal integration of pharmacists’ professional development with other health care professions in the country. Moreover, it is illustrated that crossing the boundary from formal (university) education to experiential (workplace) education is eased by a gradual change in time spent in these two educational environments and by the use of comparable monitoring, feedback, and authentic assessment instruments. A reflection on the curricula, based on the principles of the Integrative Pedagogy Model and the Self-determination Theory, suggests that the alignment of these educational programs facilitates the development of professional expertise and professional identity of Dutch pharmacists.

Development and inclusion of an entrustable professional activity (EPA) scale in a simulation-based medicine dispensing assessment

BACKGROUND AND PURPOSE

Effective, safe, and patient-centred dispensing is a core task of community pharmacists. Entrustable professional activities (EPAs) offer a way of defining and assessing these daily practice activities. Although EPAs have become popular within competency-based medical education programs, their use is new to pharmacy education and assessment.

EDUCATIONAL ACTIVITY AND SETTING

A simulation-based assessment framework containing a scale of entrustment was developed to evaluate the readiness of Year 4 undergraduate pharmacy students to safely manage the supply of prescribed medicine(s) in a community pharmacy. The assessment framework was piloted in a fourth year "Transition to Practice" course with 28 simulation-based assessments conducted.

FINDINGS

An entrustment framework was developed and implemented successfully with Year 4 undergraduate pharmacy students. The EPA for medicine dispensing integrates competency domains that include information gathering, providing patient-centred care, clinical reasoning, medicine dispensing, and professional communications. On a scale ranging from level 1 to level 5, the majority (73%) of entrustment ratings were level 2 or level 3; and of the students who achieved different ratings between clinical scenarios, 75% of students improved on their second simulation attempt. There was a strong correlation between the global EPA ratings with the total score achieved across the domains.

SUMMARY

Using simulation-based assessment, entrustment decision making can be incorporated in "entry to profession" undergraduate and postgraduate pharmacy courses to assess students' readiness to transition between learning and professional practice.