Is there a role for workplace based postgraduate diplomas in the development of community pharmacists?

Background: Community pharmacists have not fulfilled expectations for an extended role and their education and training is recognised as contributing to this. Postgraduate diplomas may provide the additional development required. These courses are predominantly distance learning based despite evidence that multifaceted approaches are more effective. Furthermore, the role of learning theory in developing or assessing pharmacist education is unclear. UEA obtained funding to provide a workplace based diploma for community pharmacists based in eastern England. The aim of this PhD was to investigate the role of this diploma in community pharmacist development. Methods: Mixed methods were used. In-depth interviews were conducted with a purposive sample of 15 diploma students in October 2011 after one year of the course. Follow-up interviews were completed one year later. Interviews were conducted in summer 2012 with four community pharmacy employer representatives. A service provision, employment and CPD survey was conducted annually with diploma students (n=39) and a comparison group (n=18). A patient satisfaction survey was conducted in the main workplace of these pharmacists at the outset of the course and repeated as it concluded. Results: Students described positive effects on their development and practice including improved confidence and inter-professional relationships. The diploma scaffolded learning and a reduction in the potential barriers to CPD was demonstrated. The opportunities for interacting with peers and other healthcare professionals were important. Workload pressures were detrimental. Employers recognised pharmacists needed development but favoured training they controlled. No significant change was seen in the provision of services or patient satisfaction. Discussion: This work contributes to understanding community pharmacists’ needs from a learning theory perspective. Professional isolation impacts negatively on the development of their practice and the social learning facilitated by the diploma appears fundamental to the positive results obtained. Whether a workplace based diploma is the best way to achieve this is unclear

The community pharmacy setting for diabetes prevention: views and perceptions of stakeholders

Background: Diabetes prevention programmes delay or prevent the onset of type 2 diabetes in people with pre-diabetes. To increase accessibility, national guidelines recommend delivering diabetes prevention programmes in primary care settings, including community pharmacy. This study aimed to explore the English community pharmacy setting as an option for delivering diabetes prevention services. Methods: Two focus groups and nine semi-structured interviews were conducted with stakeholders including, community pharmacists, general practitioners and commissioners. The topic guide was framed using the COM-B theoretical model for behaviour change to elicit practitioners’ capability, opportunity and motivation to engage with providing or referring to community pharmacy diabetes prevention services. Data were analysed thematically, and barriers/facilitators mapped to the COM-B framework. Results: Five themes were identified: ‘Pre-diabetes management and associated challenges’, ‘The community pharmacy setting’, ‘Awareness of community pharmacy services’, ‘Relationships and communication’ and ‘Delivery of community pharmacy services’. Community pharmacy was highlighted as an accessible setting for delivering screening and follow-on lifestyle interventions. Key factors for enhancing the capability of community pharmacy teams to deliver the interventions included training and appropriate use of skill mix. Delivering diabetes prevention services in collaboration with general practices was identified as key to the provision of integrated primary care services. Whilst financial incentives were identified as a motivating factor for delivery, service promotion to patients, public and healthcare professionals was perceived as crucial for enhancing engagement. Conclusions: This research highlights a role for community pharmacy in diabetes prevention. New service models should seek to integrate community pharmacy services in primary care to facilitate patient engagement and better communication with general practices

Longitudinal placements for trainee pharmacists: Learning whilst improving patient care

Introduction: Longitudinal Integrated Clerkships (LICs) have demonstrated benefits for students' learning and development in medical education globally. The model emphasises importance with respect to continuity and time in the workplace for learners. There is a need to explore how LICs become a viable training model for learners. An amalgamative LIC model was drawn upon to inform the design of a placement for trainee pharmacists on a hospital ward. This study sought to determine the local viability of a longitudinal placement for trainee pharmacists, using communities of practice learning theory to interpret findings.  Methods: A design-based research approach informed study design. A longitudinal placement was implemented on two hospital wards for 13 weeks. Trainees (n = 3) were interviewed four times over a 14-week period. Ward staff (n = 14) were interviewed at week 14. Interviews were transcribed verbatim. Qualitative longitudinal analysis, using the trajectory approach, was conducted using abductive analysis. The coded data were organised into a framework and subthemes were created.  Results: Trainees acquired membership within the multi-disciplinary ward team over time. This led to an enriched learning experience and the trainee's professional development improved as they attained more responsibilities. This enabled them to make a greater contribution to patient care; more medication consultations occurred, and discharge times improved.  Discussion: The local viability of the longitudinal placement appears to be linked to the trainee's ability to acquire membership within the ward community of practice. Membership gave trainee's access to learning opportunities, supporting their development, and they earnt the trust of staff, leading to more responsibilities for providing patient care. Further research into developing longitudinal placements that support trainee healthcare professionals to acquire membership within communities of practice is warranted

Learning from community pharmacists' initial experiences of a workplace-based training program

Introduction:  To prepare community pharmacists for the provision of clinical and patient-focused services, a novel postgraduate course for community pharmacists in the United Kingdom was developed. The program incorporated personal development planning against a personal development framework, workplace mentoring, employment of work-based assessment tools, activities that encouraged increased inter-professional working, reflection, and opportunities for peer support. Objectives were to identify course components that support development, describe the effect on practice, and explore the perceived advantages and disadvantages of this model of postgraduate education. Methods:  Interviews were conducted with a purposive sample of 15 community pharmacists after they had completed approximately one year of the three-year course. A topic guide covering approaches to learning, rationale for course selection, course experiences to date, and impact on practice was used. Interview recordings were thematically analyzed. Results:  Two themes were identified. ‘Support for learning’ describes the components of the course that provided support for learning, including opportunities to learn with and from others, workplace mentoring, and facilitated access to general practitioners. ‘Outcomes of learning’ encompasses how the course was a way of effecting change within existing roles and the increase in confidence and motivation to change practice. Conclusions:  The model has merit in supporting community pharmacists to develop the confidence and competence required for extended clinical and patient-focused roles. While this model of learning seems to provide educational value, further research is required to determine whether the additional resources required to provide workplace mentoring, use work-based assessment tools, and encourage inter-professional working are justified

The community pharmacy setting for diabetes prevention: a mixed methods study in people with ‘pre-diabetes’

Background: Diabetes Prevention Programs (DPPs) comprising intensive lifestyle interventions may delay or even prevent the onset of type 2 diabetes in people with pre-diabetes. However, engagement with DPPs is variable with session times and transportation being reported amongst barriers; this may be addressed by community pharmacy (CP) involvement given its recognition for accessibility. Objectives: To explore factors influencing engagement with the National Health Service (NHS) DPP and the role of CP in diabetes prevention.  Methods: Nine hundred and sixty-two questionnaires were posted to people with pre-diabetes identified from five general practices in Norfolk, England between November 2017 and May 2018. Follow-up semi-structured interviews (n = 10) and a focus group (n = 6) were conducted with a sample of questionnaire respondents. Questionnaire data were analysed quantitatively using SPSS and qualitative data analysed inductively using thematic analysis. Themes relating to engagement and the role of CP in pre-diabetes were further analysed using the COM-B model of behaviour change.  Results: A total of 181 (18.8%) questionnaire responses were received, a quarter of whom reported to have either dropped out or declined attending the national DPP. DPP engagers were more likely to report the program location and session times as convenient. Community pharmacy was perceived as an acceptable setting for delivering diabetes prevention services (DPS) and a preferable alternative for regular pharmacy users and people with work and social commitments. Participants felt that opportunity to engage with CP DPS is enhanced by its accessibility and flexibility in making appointments. Knowledge about the DPS provided in CP and previous experience with CP services were central influences of capability and motivation to engage respectively.  Conclusions: This research outlines factors that could influence engagement with community pharmacy-based DPS and provides evidence to inform intervention development. Further research would be required to determine the feasibility and cost-effectiveness of such interventions

A brief conversation analytic communication intervention can change history-taking in the seizure clinic

Question design during history-taking has clear implications for patients' ability to share their concerns in general and their seizure experiences in particular. Studies have shown that unusually open questions at the start of the consultation enable patients to display interactional and linguistic markers which may help with the otherwise challenging differentiation of epileptic from nonepileptic seizures (NES). In this study, we compared the problem presentation approach taken by trainee neurologists in outpatient encounters with new patients before and after a one-day conversation analytic training intervention in which doctors were taught to adopt an open format of question design and recognize diagnostically relevant linguistic features. We audio/video-recorded clinical encounters between ten doctors, their patients, and accompanying persons; transcribed the interactions; and carried out quantitative and qualitative analyses. We studied 39 encounters before and 55 after the intervention. Following the intervention, doctors were significantly more likely to use nondirective approaches to soliciting patient accounts of their presenting complaints that invited the patient to describe their problems from their own point of view and gave them better opportunity to determine the initial agenda of the encounter. The time to first interruption by the doctor increased (from 52 to 116 s, p<.001). While patients were given more time to describe their seizure experiences, the overall appointment length did not increase significantly (19 vs 21 min, n.s.). These changes gave patients more conversational space to express their concerns and, potentially, to demonstrate the interactional and linguistic features previously found to help differentiate between epilepsy and NES, without impacting the length of the consultations

Neurologists can identify diagnostic linguistic features during routine seizure clinic interactions: results of a one-day teaching intervention.

The diagnostic distinction between epilepsy and psychogenic nonepileptic seizures (PNES) can be challenging. Previous studies have demonstrated that experts in conversation analysis can identify linguistic and interactional features in transcripts and recordings of interviews with patients that reliably distinguish between epilepsy and PNES. In this study, ten senior neurology trainees took part in a one-day intervention workshop about linguistic and interactional differences in the conversation behavior of patients with epilepsy and those with PNES. Participants were familiarized with a 12-item questionnaire designed to capture their conversational observations immediately after talking to a patient with seizures. After the intervention, 55 initial outpatient visits of patients referred to seizure clinics were video and audio recorded. All medical diagnoses were confirmed two years after initial presentation on the basis of a chart review (including MRI and EEG findings) by a fully trained epilepsy expert. Postvisit questionnaires relating to patients confirmed to have epilepsy (n=20) or PNES (n=13) were analyzed. Doctors' mean responses to 6 of the 12 questions about linguistic and interactional observations differed significantly between the groups with epilepsy and PNES. Receiver operating curve analysis showed that a summation scale based on items demonstrating significant between-group differences correctly classified 81.8% of patients as having epilepsy or PNES. This study shows that a brief Conversation Analytic teaching intervention can enable neurologists to identify linguistic and interactional features supporting the differentiation of epilepsy and PNES as they take their patients' history in routine seizure clinic consultations, potentially improving diagnostic accuracy

An evaluation of an MPharm workshop exploring the needs of disabled service users

Background: Funding of the M.Pharm. degree limits the provision of clinical placements and opportunities for experiential learning (Langley, Wilson & Jesson, 2010). At the University of East Anglia, an opportunity was identified to increase student exposure to service users in classroom time. In consultation with the University’s Expert by Experience committee, a workshop was designed to enable 4th year M.Pharm. students to engage with service users with individual needs relating to sight; speech; learning; and/or dexterity and mobility. Working in groups, students rotated through three workstations in 1.5 hours. This evaluation explores the extent to which the workshop developed student understanding of service users’ individual needs. Method: Separate questionnaires were sent to all 85 participating students and five service users immediately following the workshop, via an emailed web link. Open questions were used to capture views on the workshop and how it could be improved. Opinions on how participation in the workshop may influence students’ future practice were also sought. Content analysis was performed on the responses received (Bengtsson, 2016). Results: Responses were received from 28 (33%) students and five (100%) service users. Students enjoyed being “able to listen and talk to real patients” [Student 5] and having discussions which were “not just focussed on medications” [Student 3]. Service users commented favourably on student participation and respectfulness during the session and valued the opportunity to influence future practice. Not making assumptions about capabilities and increased confidence in supporting patients with disabilities were the main learning outcomes for students. Service users also felt the workshops reinforced “how important good communication is” [Participant 5]. Students would have liked to have known more about the service users attending in advance of the session. There were contrasting views on optimal group size. Conclusion: The feedback received suggests this is a useful approach to influencing students’ future practice. Suggestions for improvement will be incorporated into future iterations. References Bengtsson, M. (2016). How to plan and perform a qualitative study using content analysis. NursingPlus Open, 2, 8-14 Langley, C., Wilson, K. & Jesson, J. (2010). Learning with other health professions in the United Kingdom MPharm degree: multidisciplinary and placement education. Pharmacy Education, 10, 39-4

Supported communication skills training: Evaluation of a pilot workshop for pharmacy undergraduates

Objective: Healthcare professionals may lack the skills and confidence to support patients with communication impairments (Burns et al. , 2 0 1 2 ) . S u p p o r t e d communication skills training has been used to address this across a range of professions, including speech and language therapy (Finch et al., 2017) occupational therapy and physiotherapy students (Cameron et al., 2015). A pilot of supported communication skills training with pharmacy undergraduates was undertaken to evaluate the benefits and assess the value of incorporation into the University of East Anglia (UEA)’s M.Pharm. degree.Design: The training consisted of one taught session (two hours, covering components of healthcare communication, communication impairment and the knowledge, skills and resources which can support communication) followed by one practical training session (one hour, communicating with people with aphasia who are trained to train and provide feedback). All UEA pharmacy undergraduate students were invited to participate in the pilot training. A post-training evaluation form was distributed to all students immediately following the training, consisting of five 5-point Likert scale questions and three open questions.Results: Twelve students volunteered for the pilot, ten of whom completed the evaluation. Students were unanimously positive about the training, with all agreeing both training sessions were useful, that their knowledge and confidence in supporting people with communication impairment had increased and that they would recommend the training to their peers. Students particularly valued the experiential aspect of the training (e.g., “the amount of time we had and the variety of people we met. It changed my perspective a lot”) and shared how it had influenced their future practice (e.g., “I'll definitely be more understanding and won’t feel the need to rush them as they're speaking”).Conclusion: Our findings suggest this training can have the same positive impact on pharmacy undergraduates as it has with other healthcare professionals. As a result plans are in place to include it within UEA’s M.Pharm. degree

An assessment of Emotional Intelligence in M.Pharm. undergraduates

Background: Emotional Intelligence (EI) is the ability to perceive, understand and manage emotions. Higher EI is associated with effective leadership and improved patient outcomes (Sfantou et al., 2017). EI may be developed through training, however the majority of UK pharmacy schools do not explicitly teach leadership. An assessment of M.Pharm. students’ EI may determine whether current teaching supports EI development. Aims: To measure M.Pharm. students’ EI and explore any variation between and within year groups. Method: All M.Pharm. students at one UK university were invited to complete the short form trait EI questionnaire (TEIQue-SF) online (Petrides, 2009). TEIQue-SF measures an overall global trait EI score and produces separate scores in four domains: well-being, self-control, emotionality and sociability. Participants rated their agreement with 30 statement items on a 7- point Likert scale (1 = strongly disagree, 7 = strongly agree). A mean score was calculated for each measure with higher scores indicating greater EI. An open question was included to capture leadership experience. Descriptive and inferential statistics were used to characterise participant responses and explore the relationship with leadership experience. Results: Eighty-two (22%) students participated and the mean ± SD EI score was 5.02 ± 0.7. There was no correlation between EI and year of study. Mean EI score was higher in students with self-identified leadership experience (5.10 ± 0.61) than those without (4.61 ± 0.13, ISTT, p<0.001). Figure 1 illustrates the distribution of domain scores across the different cohorts. Statistical analysis of EI scores across the four domains was prohibited due to the distribution of response. Figure 1: Distribution of EI domain scores by cohort Conclusion: Possible explanations for the higher EI scores in those with leadership experience include that those with higher EI are more likely to seek leadership positions or that leadership experience supports the development of higher EI. Further investigation is required to explore how the M.Pharm. degree can support EI development