Student pharmacist practice-based interprofessional education in Scotland: a qualitative study of stakeholders' views and experiences

Scottish Government funding supports practice-based experiential learning (EL) for student pharmacists. We explored views and experiences of key stakeholders on current practice and future development of interprofessional education (IPE) in EL including barriers and enablers. A pre-piloted schedule was used for online qualitative semi-structured interviews. eMail invitations were sent to 37 stakeholders with an information sheet and consent process. Interviews were analyzed thematically by two researchers independently. Recruitment continued until data saturation and wide representation were achieved. Twenty interviews were conducted with eight EL facilitators, seven faculty and five policy stakeholders. "Nature and experience of current IPE in EL activities" and "Future developments" were the two main themes. Barriers and enablers were also identified at macro, meso, and micro socio-institutional levels. The essence of the analysis highlighted stakeholders' views of the importance of building on current IPE while challenging the ethos and culture of EL practices. All stakeholders should be involved in co-production, training, piloting, and evaluation of curricular developments to overcome logistic barriers and enhanced enablers. Finally, the importance of workload management strategies and continuity of funding for success was also stressed by those interviewed. Future research could include designing frameworks for developing and implementing IPE within EL.

Pharmacy technician-led general practice support hub: a feasibility study

Introduction

Workforce pressures in general practice have led to Scottish Government initiatives to integrate pharmacy teams into general practice. The focus is completion of prescribing management-related activities releasing general practitioner time for patient-focused workload.1 Activities include medicines reconciliation from immediate discharge letters (IDL), processing outpatient prescription requests (OPL) and special request prescriptions (SR). Pharmacists effectively mobilise GP capacity completing these tasks.2 However, pharmacists may aspire to advanced practice roles including medication review case-load management. Therefore, alternative workload delivery models including centralised pharmacy technician-led general practice support hubs to complete IDL, OPL and SR tasks must be considered. National guidance outlines that pharmacy technicians may complete these tasks autonomously with minimal supervision.3 Unknowns include whether pharmacy technicians can lead this service delivery and the definition of the supervisory support required.

Aim

To evaluate the feasibility of a pharmacy technician-led hub for completion of SR, IDL and OPL.

Methods

Feasibility was studied over 4 weeks (12 April – 7 May 2021) during routine service delivery across three medical practices (approx. 23 800 patients) in NHS Greater Glasgow and Clyde. Quantitative real-time self-reported data on the volume of tasks (SR/IDL/OPL), task completion time and volume of pharmacist referrals was collected by pharmacy technicians and pharmacists and analysed in Microsoft Excel®. Qualitative data describing why pharmacy technicians referred tasks to pharmacists was collected and categorized using thematic analysis and Microsoft Excel® by the lead author. Ethical approval was not required for this service evaluation.

Results

4485 total tasks were completed: SR 87% (n=3917); IDL 7% (n=323); OPL 6% (n=245). Pharmacy technicians completed most (71%; n=3181) prescribing management-related tasks. A service delivery gap (21%; n=921 of tasks) where workload exceeded technician resource, necessitated pharmacist support. Referral rate for tasks beyond technician competence was 11% (n=383). The locally agreed 48-hour benchmark turnaround to process tasks was achieved for the majority of tasks. Breaches of the target were noted: 53 (1%) SR; 10 (3%) IDL and 5 (2%) OPL. Technicians and pharmacists completed tasks in numerically similar times. 383 tasks were referred to a pharmacist. 134 (35%) tasks could only be completed by a pharmacists due to the need for a prescribing decision or pharmacist-specific knowledge. 226 (59%) could be completed by a technician with additional knowledge or training. Examples include queries requiring interpretation of clinical parameters or blood monitoring or answering medicines information enquiries. 6% (n=23) of referrals were uncategorised due to incomplete data collection.

Discussion/Conclusion

This study provides new information describing the workload volume achieved by pharmacy technicians and characterising the supervisory role of the pharmacist. Pharmacy technicians convincingly completed most activities. Service delivery gaps need addressed including maintenance of service delivery during periods of authorised absence and professional development time. Pharmacist referral rate can be improved by upskilling pharmacy technicians. The volume of SR tasks drives the workload and could be managed more effectively by converting suitable SR tasks to controlled repeats. A Health Improvement Scotland initiative is developing this work stream. Additional projects must identify training gaps to understand technician development needs and analyse achievement of advanced pharmacist activities where technician-led hub exists.

References

1. Scottish Government. Achieving Excellence in Pharmaceutical Care: A Strategy for Scotland. Edinburgh. The Scottish Government, 2017

2. Maskrey M, Johnson CF, Cormack J et al. Releasing GP capacity with pharmacy prescribing support and New Ways of Working: a prospective observational cohort study. Brit J Gen Pract. 2018;68(675):e735-e42

3. Scottish Pharmacy Practice and Prescribing Advisers Association. National Pharmacotherapy Service Specification V4, 2021

Interprofessional education during experiential learning placements for student pharmacists in Scotland. Exploring current support provision and stakeholder views

Introduction

Increasing global awareness that interprofessional team working is essential within modern healthcare systems has led to regulatory bodies mandating the inclusion of interprofessional education (IPE) within undergraduate curricula. The General Pharmaceutical Council specifies in the 2021 initial education and training standards the requirement for an interprofessional learning plan in which “IPE must mirror practice”.1 Pharmacy educators are intensifying their efforts to ensure student pharmacists are presented with opportunities to develop collaborative competencies. Curricular development and implementation initiatives must explore structures and processes to ensure that experiential learning (EL) environments are conducive to supporting student pharmacists’ interprofessional learning.

Aim

To explore structures and processes needed to support effective planned and unplanned IPE during EL placements for student pharmacists.

Methods

A mixed methods approach underpinned by the Biggs 3P theoretical framework was adopted.2 This included (1) A document analysis reviewing resources including student pharmacist/EL facilitator university handbooks and NHS Education for Scotland Preparation for Facilitating Experiential Learning (PFEL) training - a mandatory requirement for all EL facilitators hosting student pharmacists on placement in Scotland. (2) A pre-piloted online survey distributed to EL facilitators. Survey development, guided by the Interprofessional Facilitation Scale, aimed to encourage EL facilitators to self-evaluate their own IPE facilitation skills.3 The final survey tool included ten items with responses rated on a 4-point Likert scale (Poor, Fair, Good and Excellent) and a demographic section (3) Online semi-structured focus groups/dyadic interviews conducted with six EL facilitators, four practice educators and two academic staff were recorded and transcribed. Descriptive statistics were employed for quantitative data generated from the survey tool; for qualitative data content analysis was applied to develop emerging themes. Ethical approval was granted (S292) from the School of Pharmacy and Life Sciences Ethics Review Committee at Robert Gordon University.

Results

(1) The document analysis concluded that although the resources reviewed could not be specifically classed as training to support IPE, data collected provided context to EL placements and the training and pre-activities that student pharmacists and EL facilitators complete. Three main themes emerged: “Lack of specific IPE training focus”, “Varied terminology”, “Lack of IPE pre-learning activities”. (2) The survey was completed by ninety EL facilitators working in various practice settings: hospital 41.1% (n=37); primary care 25.6% (n=23); community 21.1% (n=19); academia 2.2% (n=2); other 8.9% (n=8). Survey responses indicated that 51.1% (n=46) and 42.2% (n=38) of respondents rated their ability to role model positive interactions with other healthcare professionals as good and excellent. However, responses to items relating more specifically to IPE facilitation skills indicated a lower confidence level. (3) Initial themes emerging from focus groups/dyadic interviews include “Profession-related perceptions of IPE”, “Factors influencing IPE delivery and student learning”, “Factors influencing future developments”.

Discussion/Conclusion

This exploratory study has provided valuable insight into multifactorial aspects affecting IPE during EL placements; this will be used to guide future development of IPE initiatives. One limitation is that student pharmacists were not included in this study; the next phase of this research programme will explore student pharmacists’ perceptions of IPE in EL.

References

1. General Pharmaceutical Council. Standards for the initial education and training of pharmacists. [homepage on the Internet]. London: GPhC; 2021. Available from: https://www.pharmacyregulation.org/sites/default/files/document/standards-for-the-initial-education-and-training-of-pharmacists-january-2021.pdf

2. Biggs, J.B. From Theory to Practice: A Cognitive Systems Approach. High Educ Res Dev, 1993, 12(1), 73-85

3. Sargeant J., Hill T., Breau L. Development and testing of a scale to assess interprofessional education (IPE) facilitation skills. J Cont Educ Health Prof, 2010, 30(2), 126-131

Health Care Needs of Deaf Signers: The Case for Culturally Competent Health Care Providers

There is a need for culturally competent health care providers (HCPs) to provide care to deaf signers, who are members of a linguistic and cultural minority group. Many deaf signers have lower health literacy levels due to deprivation of incidental learning opportunities and inaccessibility of health-related materials, increasing their risk for poorer health outcomes. Communication barriers arise because HCPs are ill-prepared to serve this population, with deaf signers reporting poor-quality interactions. This has translated to errors in diagnosis, patient nonadherence, and ineffective health information, resulting in mistrust of the health care system and reluctance to seek treatment. Sign language interpreters have often not received in-depth medical training, compounding the dynamic process of medical interpreting. HCPs should thus become more culturally competent, empowering them to provide cultural- and language-concordant services to deaf signers. HCPs who received training in cultural competency showed increased knowledge and confidence in interacting with deaf signers. Similarly, deaf signers reported more positive experiences when interacting with medically certified interpreters, HCPs with sign language skills, and practitioners who made an effort to improve communication. However, cultural competency programs within health care education remain inconsistent. Caring for deaf signers requires complex, integrated competencies that need explicit attention and practice repeatedly in realistic, authentic learning tasks ordered from simple to complex. Attention to the needs of deaf signers can start early in the curriculum, using examples of deaf signers in lectures and case discussions, followed by explicit discussions of Deaf cultural norms and the potential risks of low written and spoken language literacy. Students can subsequently engage in role plays with each other or representatives of the local signing deaf community. This would likely ensure that future HCPs are equipped with the knowledge and skills necessary to provide appropriate care and ensure equitable health care access for deaf signers.

Assessment of community pharmacists' communication and comfort levels when interacting with Deaf and hard of hearing patients

BACKGROUND

Deaf and hard of hearing patients who use sign language face considerable communication barriers while accessing pharmacy services. Low comfort-levels between community pharmacists and Deaf and hard of hearing patients result in poor interactions and increase patient safety risks.

OBJECTIVE

1) To examine the way community pharmacists interact with Deaf and hard of hearing patients in Malaysia, and their level of comfort in such interactions. 2) To examine how comfort-levels vary by the preferred communication methods, resources and employer support.

METHODS

This cross-sectional study was conducted among registered community pharmacists practicing in Malaysia. Questionnaire items included comfort-levels of community pharmacists when interacting with Deaf and hard of hearing patients, used and preferred communication methods, necessary resources, and perceived employer's level of support. Based on the list of registered pharmacies, the questionnaire with a pre-paid return envelope was mailed out while pharmacies close to the university were approached in person. This questionnaire was distributed online using Google Form. Comparisons between comfort-levels and study parameters were analyzed using independent t-tests and ANOVA.

RESULTS

A total of 297 community pharmacists responded (response rate 29.2%). Higher comfort-levels were reported in those who had received between 1 to 5 prescriptions as compared to those who did not receive prescriptions from Deaf and hard of hearing patients (MD= -0.257, SD=0.104, p=0.042). More than 80% used written information and only 3.4% had used the services of a qualified sign language interpreter throughout their community pharmacist career. Significantly lower comfort-levels (p=0.0004) were reported in community pharmacists who perceived training in sign language as a necessity to interact with Deaf and hard of hearing patients (M=3.6, SD=0.9) versus those who were not interested in sign language training (M=3.8, SD=0.6).

CONCLUSIONS

The results suggest that community pharmacists were neither extremely comfortable nor averse when interacting with Deaf and hard of hearing patients. The lack of significant findings in terms of comfort-levels may indicate other potential drivers for their choice of communication method when interacting with Deaf and hard of hearing patients.

Exploration of inter-professional learning in experiential Learning for student pharmacists in Scotland: A qualitative study

Introduction

Additional Cost of Teaching for Pharmacy (ACTp) funding from Scottish Government supports the development of experiential learning (EL) placements for student pharmacists [1]. Interprofessional learning (IPL) has been built into initial education for many healthcare professionals [2]. In 2019, a National Pharmacy EL Stakeholder event recommended exploring the further development of IPL within EL for the MPharm.

Aim

To scope existing IPL in EL and explore the feasibility for further development within the MPharm in Scotland

Methods

Online qualitative interviews were conducted with key stakeholders from Schools of Pharmacy, NHS Education for Scotland, EL sites, and Scottish health boards. All were involved in the development/delivery of these activities. The interview schedule was developed by the research team, reviewed for face and content validity, piloted prior to use, and modified based on early interviews. All interviews were audio-recorded, transcribed, and independently thematically analysed by two researchers. Interviews continued until data saturation and good representation from all settings were achieved. All ethical approvals were sought prior to the interviews.

Results

Twenty interviews were conducted with three key themes emerging; (1)current IPL within EL activities, (2)future developments, and (3)perceptions of enablers and barriers to developing/delivering IPL within EL. There were limited examples of existing IPL within EL activities including: a pilot pharmacy longitudinal clerkship and hospital-based pharmacy/medical student IPL week. Some stakeholders indicated that current IPL involves mainly campus-based activities but other EL based initiatives were planned but not yet implemented. Respondents indicated that future developments should be carefully planned in collaboration with other stakeholders and tailored to students’ stage of study to ensure their success. There was significant support for incorporating IPL within EL initiatives as part of the MPharm course to complement traditional ways of teaching.

“I think if we don't do it, we're missing a big trick… Doing something in a classroom or doing something within a small tutorial is a very false way of learning, whereas in practice, where they're going to end up working together, it seems ideal.”

Many enablers were highlighted mainly relating to the expected benefits of such activities on students, facilitators, patients, and the healthcare system. Logistics and planning difficulties were perceived to be barriers to implementation of IPL within EL.

“We've tried to do it, it was with the medical school and they were receptive to it, but the logistics just didn't work out… when you've got two very different timetables to try and bring together, it is very, very difficult to do.”

Conclusion

Pharmacy stakeholders highlighted that the majority of IPL currently undertaken in Scotland is not based in EL settings but they supported developing it. Enablers and barriers articulated highlight the need for careful planning of these activities. A strength of this study is it involved a broad range of key stakeholders from across Scotland ensuring representativeness of views and ideas. A limitation may be that, given the Scottish focus, findings may lack direct transferability to other countries. Future research should focus on designing a framework for developing and implementing IPL within EL in Scotland.

References

1. NHS Education for Scotland, 2020. Experiential learning for student pharmacists in Scotland. [online]. Edinburgh: NHS Education for Scotland. Available from: https://www.nes.scot.nhs.uk/our-work/experiential-learning-for-student-pharmacists-in-scotland/ [Accessed 07/10/2020].

2. Barr H. Interprofessional Education-The Genesis of Global Movement. 2015. https://www.caipe.org/resources/publications/barr-h-2015-interprofessional-education-genesis-global-movement. [Accessed 4 Aug 2020]

Survey of undergraduates' perceptions of experiential learning in the MPharm programme: The TELL Project

Objective:

To determine the perception of undergraduate pharmacy students of their experiential learning (EL) placements both in the community and hospital settings.

Methods:

A cross-sectional survey was conducted utilizing a six-item online survey consisting of one open-ended and five closed-ended questions, the latter utilising five-point Likert-type scales ranging from strongly disagree (1) to strongly agree (5). All undergraduate pharmacy students from the School of Pharmacy (N=496) were included in the study. Survey questions assessed students’ perceptions on the effectiveness of the EL, tutors and placements sites, and organisation and structure of the EL. Thematic content analysis was performed on the open-ended comments, where relevant themes were generated.

Results:

From the 139 responses (response rate: 28%), 121 responses were analysed, and of these, 72.5% already had part-time jobs in community pharmacies. Close to 85% felt that their part-time work should contribute to EL hours, which is currently not recognised by the university. Respondents were positive about the effectiveness of EL in developing their professionalism and communication (M=3.84, SD=1.05), clinical (M=3.42, SD=1.22), and technical skills (M=3.32, SD=1.25) Respondents provided favourable feedback about their experience in the hospital as it gave them a real-world exposure to the role of a hospital pharmacist. Community placements were not viewed favourably and this was mainly attributed to the poor experience with tutors whom they felt used them as an extra pair of hands. This was thought to impede their learning experience. They also felt that hospital placements were of insufficient duration, reported by 72.5% of respondents. Respondents also felt they should be sent to other sites such as primary care for placements.

Conclusions:

Tutor-training is key to ensure tutors are aware of the responsibilities and expectations. Similarly, quality assurance measures should be adopted to ensure tutors and placement sites are capable of providing students with an effective placement experience. While placement durations are a concern, the focus should be on the quality of the placement experience, and ensuring there is structure and flexibility. Content changes are also needed to include emerging placement sites such as primary care to prepare students for evolving pharmacist roles in the changing healthcare system.

An overview of the characteristics of the novel avian influenza A H7N9 virus in humans

The novel avian influenza A H7N9 virus which caused the first human infection in Shanghai, China; was reported on the 31st of March 2013 before spreading rapidly to other Chinese provinces and municipal cities. This is the first time the low pathogenic avian influenza A virus has caused human infections and deaths; with cases of severe respiratory disease with pneumonia being reported. There were 440 confirmed cases with 122 fatalities by 16 May 2014; with a fatality risk of ∼28%. The median age of patients was 61 years with a male-to-female ratio of 2.4:1. The main source of infection was identified as exposure to poultry and there is so far no definitive evidence of sustained person-to-person transmission. The neuraminidase inhibitors, namely oseltamivir, zanamivir, and peramivir; have shown good efficacy in the management of the novel H7N9 virus. Treatment is recommended for all hospitalized patients, and for confirmed and probable outpatient cases; and should ideally be initiated within 48 h of the onset of illness for the best outcome. Phylogenetic analysis found that the novel H7N9 virus is avian in origin and evolved from multiple reassortments of at least four origins. Indeed the novel H7N9 virus acquired human adaptation via mutations in its eight RNA gene segments. Enhanced surveillance and effective global control are essential to prevent pandemic outbreaks of the novel H7N9 virus.