Jg Davies

Assessment of Clinical Competence: Designing a Competence Grid for Junior Pharmacists

Aim. This paper describes the development of a competency framework for clinical practice undertaken by junior pharmacists. Method. A peer group consisting of clinical practitioners and academics developed competency clusters. Competencies were assigned to each cluster and the associated behaviours described. The resulting “grids” were circulated to clinical practitioners, senior pharmacy managers and junior pharmacists for comment. A four point scale was developed to evaluate performance of the junior pharmacist for each behaviour. Outputs. The competency grids comprise three clusters: personal, problem solving and clinical. These are currently under investigation to determine their measurement properties.

Evaluating skills and competencies of pre-registration pharmacists using objective structured clinical examinations (OSCEs)

Introduction: This paper describes data collected over a period of 4 years in the former South Thames Region, UK, where objective structured clinical examination (OSCEs) have been used to assess pre-registration pharmacists in a secondary care setting. The study aims to describe a quantitative measure of competence using OSCE style assessments of graduate, pre- registration pharmacists. Method: All pre-registration pharmacists within the South Thames Region undertook a series of OSCEs; data were collected over a period of 4 years. Competence was assessed in each OSCE workstation using a pre-defined checklist. Results: In total, 223 pre-registration graduates participated; two thirds (67.9%) were female and the majority (62.7%) were trained in district general hospitals. Overall, 17.2% of graduates were deemed competent at the beginning of their pre- registration year compared to 68.3% at the end. This represents a significant improvement in clinical skills performance over the year (Wilcoxon signed rank test, Z 1⁄4 212.024; p 1⁄4 0.005). Discussion: The training program undertaken by pre-registration pharmacists significantly improved the clinical competence of these graduates in the areas measured, with two thirds considered competent overall at the end of the year. Of particular concern is the apparent inability of graduates to monitor prescriptions appropriately. The findings of this study have significant implications for workforce training and career planning. New graduates should not be working in isolation but should be considered as training grades and given support within the clinical team to develop their skills. Newly registered pharmacists should not be expected to undertake the range of tasks currently allocated to them, without appropriate supervision and further competency assessment.

A pilot study to evaluate clinical competence in junior grade pharmacy practitioners

This pilot project investigated pharmacists’ performance, using a previously designed and evaluated competency assessment grid, over a 12 week period in eight active and one control sites. At baseline and 12 weeks later, assessors defined the clinical service provision “expected” and then assessed junior pharmacists’ service against these specifications. The observed and expected competencies for each task were then compared. A number of assessors from the active sites were interviewed to determine the ease of use, the process adopted and the time taken to carry out the assessment of a student. Over the 12 week period students in the active group (n 5 24) showed a significant improvement in their ability to perform key tasks in all but one area whilst there was no significant change in performance in the control group (n 5 4). Evidence indicated that a variety of approaches were used when carrying out assessments using the grids by the five assessors interviewed. Additionally, the effects of using the grid on the assessment process had a range of organisational benefits across the active sites, highlighting the flexibility of the grids in diverse departments. The results indicate that the competency assessment grids can detect a change in pharmacists’ performance and that this might reflect the pharmacists’ awareness of the behaviours being assessed.

17.00–18.00 Traning for the future

In 2001, the Kennedy Report highlighted important issues relating to failings in the quality of care provided to patients. A fundamental principle identified within this report was that ‘a patient is entitled to be cared for by healthcare professionals with relevant and up-to-date skills and expertise’; that is, the practitioner should be fit for purpose. Kennedy made a number of recommendations, including the need for regulation aimed at maintaining the competence of healthcare professionals. Recently, a survey of junior doctors described significant variation in the perceived abilities of those graduating from medical schools across the UK. This study evaluates the perceptions of pharmacy graduates of their fitness to perform basic clinical pharmacy activities during their pre-registration year in primary and secondary care settings.