The Pharmacist Registration Examination Rebecca Elvey (BA, MA (Econ)) Research Associate Samuel D Jee (BSc) Research Assistant Penny Lewis (PhD, MRPharmS) Research Associate Harsha Parmar (MRPharmS) Teaching Fellow Ellen I Schafheutle (PhD, MRes, MSc, MRPharmS) Lecturer in Law & Professionalism in Pharmacy Mary Tully (PhD, MRPharmS) Clinical Senior Lecturer Sarah Willis (BA, MA) Research Fellow Jason Hall (PhD, MSc, BSc, PGCE, MRPharmS) Senior Lecturer School of Pharmacy and Pharmaceutical Sciences 1 st The University of Manchester Floor Stopford Building Oxford Road Manchester M13 9PT Correspondence Dr Jason Hall [email protected]0161 275 2720
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The Pharmacist Registration Examination
Rebecca Elvey (BA, MA (Econ)) Research Associate
Samuel D Jee (BSc) Research Assistant Penny Lewis (PhD, MRPharmS) Research Associate Harsha Parmar (MRPharmS) Teaching Fellow Ellen I Schafheutle (PhD, MRes, MSc, MRPharmS) Lecturer in Law & Professionalism in Pharmacy Mary Tully (PhD, MRPharmS) Clinical Senior Lecturer Sarah Willis (BA, MA) Research Fellow Jason Hall (PhD, MSc, BSc, PGCE, MRPharmS) Senior Lecturer
School of Pharmacy and Pharmaceutical Sciences 1st
The University of Manchester Floor Stopford Building
programs and protocols based upon analysis of epidemiologic and
pharmacoeconomic data, medication use criteria, medication use
review, and risk-reduction strategies;
• manage human, physical, medical, informational, and technological
resources, through the ability to ensure efficient, cost-effective use of
these resources in the provision of patient care;
• manage medication use systems, through the ability to apply patient-
and population-specific data, quality improvement strategies,
medication safety and error reduction programs, and research
The Pharmacist Registration Examination – September 2010 48
processes to minimize drug misadventures and optimize patient
outcomes; to participate in the development of drug use and health
policy; and to help design pharmacy benefits;
• promote the availability of effective health and disease prevention
services and health policy through the ability to apply population-
specific data, quality improvement strategies, informatics, and research
processes to identify and solve public health problems and to help
develop health policy.
To be capable of the above, pharmacy graduates also must be able to:
• communicate and collaborate with patients, care givers, physicians,
nurses, other health care providers, policy makers, members of the
community, and administrative and support personnel to engender a
team approach to patient care;
• retrieve, analyze, and interpret the professional, lay, and scientific
literature to provide drug information and counselling to patients, their
families or care givers, and other involved health care providers;
• demonstrate expertise in informatics;
• carry out duties in accordance with legal, ethical, social, economic, and
professional guidelines;
• maintain professional competence by identifying and analyzing
emerging issues, products, and services.
2.3.10 Summary/comparison of the different countries
This section draws out some of the similarities and differences between the
training and registration procedures for pharmacy across the different
countries.
Our research has found that the length of time required to become a qualified
pharmacist is typically five years. In the USA it may also take six years if a
pre-pharmacy course is carried out for two years prior to the four year doctor
of pharmacy. The way that these years are formatted differs between the
The Pharmacist Registration Examination – September 2010 49
countries that were compared. For example, the systems existent in GB,
Australia and New Zealand generally require students to complete a
pharmacy degree, followed by a year of supervised practice. The USA seems
somewhat different, in that practice experience is integrated more with links to
colleges and schools of pharmacy, and courses may indeed differ depending
on the college or state one is training in. In Canada there appears to be more
integration of practice into the earlier years of the course rather than
segmenting the educational (taught in university/college) and practical side of
pharmacy.
Findings from this research also highlight differences in terms of the people
who are involved in the practical training of pre-registration trainees. There is
at least one individual that is intimately involved in the training and
assessment of pre-registration pharmacists: a tutor or ‘preceptor’ with a
required amount of experience in practising pharmacy. Although there is an
indication that these individuals may receive some orientation and support in
their role as a preceptor (as stipulated in the accreditation guidelines of the
USA), New Zealand demands the most requirements of their preceptors. This
includes ensuring they have a minimum of three years post-registration
experience and have completed preceptor training in accordance with the
pharmacy council. One year of practice experience seems to be the norm in
the other countries that were examined, though in GB the tutor also needs
three years experience in the field they are working and tutoring in.
The amount of assessment taking place within each of the pre-registration
systems between the countries varied. In comparison to the GB system,
Australia New Zealand, Canada and the USA appear to have in place a wider
range of measures to assess competences and performance. The newly
formed National Intern Training Program that is being rolled out in Australia21
has a comprehensive range of assessments including observations from
supervisors, written examinations, oral interviews, and practical examinations,
to name but a few. In New Zealand and Canada there are observation
assessments that take place throughout the practice training such as OSCEs.
In the USA there was more emphasis on examination-based assessment
The Pharmacist Registration Examination – September 2010 50
such as the NAPLEX and MPJE. As with the USA, a written examination-
based assessment – as opposed to a more practical assessment such as an
OSCE – is the final assessment for pre-registration trainees in GB. However,
while the GB examination is paper based, the NAPLEX and the MJPE are
administered using ‘computer-adaptive’ technology. This means that all
candidates do not answer the same questions; the examination papers sat by
pre-registration trainees during the month of testing (June or September) will
be the same.
Assessing the competencies of practical-based experience may create
problems for some preceptors monitoring pre-registration trainees as has
been found in research in the USA.31 Other work has demonstrated similar
findings. For example, Hill et al. conducted a review of the assessment
methods of an Advanced Pharmacy Practice Experiential (APPE) Program. 32
The review of the school’s assessments methods suggested that the existing
forms were cursory and did not allow for detailed assessment of students’
competence in performing clinical responsibilities. They lacked objective
criteria, were not competency related, did not require midpoint grading, and
provided little guidance to preceptors in grading. After reviewing assessment
instruments from several other pharmacy schools as well as guidelines
published by the Accreditation Council for Pharmaceutical Education and the
American Association for Colleges of Pharmacy, the authors decided to
develop a competency-based assessment process with detailed grading
rubrics. Studies such as this highlight some of the complexities of assessing
practice-based placements in pharmacy.
Lastly, there are some differences between the countries examined in terms
of regulatory boards. Canada, for example, has 12 regulatory authorities. In
the USA there are also a number of pharmacy boards which may create
problems in terms of consistency in the training and development of future
pharmacists. These countries do however outline general guidelines for
subordinate authorities in terms of requisites for the registration of
pharmacists. One could argue that a national system of regulation, such as in
GB may provide a more consistent means of regulating registration.
The Pharmacist Registration Examination – September 2010 51
3 The effectiveness of the pharmacist registration examination
3.1 Introduction
The registration examination takes place twice per year (in June and
September) and consists of written closed and open book papers which
assess knowledge and understanding using MCQs. In the closed book paper
candidates attempt 90 questions in 90 minutes. In the open book paper –
open to selected reference sources (BNF, Drug Tariff and Medicines Ethics
and Practice) – candidates attempt 80 questions in 150 minutes. Twenty of
these questions require calculations, though electronic calculators are not
allowed to be used.
The aim of this part of the study is to assess how effective the closed and
open book examinations are in assessing pre-registration trainees in a range
of competencies, knowledge and understanding.
3.2 Method
It was initially proposed that the questions from past papers of the registration
examination would be mapped against the pre-registration performance
standards, and, the questions in the registration examination would be
reviewed to determine what they were assessing in terms of competencies,
knowledge and/or understanding. Initially, a number of questions from the July
2009 examination were mapped against the pre-registration performance
standards,6
by a pharmacist member of the research team (PL). This involved
assigning the relevant performance standards, of which there are 76, to each
examination question. However, this task proved unsuccessful as few
questions mapped straightforwardly onto a performance standard directly.
As a result of this, PL met with two members of the expert panel (IS & AL) to
discuss and review the mapping already undertaken. (These members of the
expert panel are from The University of Manchester and have specialised
knowledge and experience in pre-registration training and assessment in
The Pharmacist Registration Examination – September 2010 52
community and hospital pharmacy respectively.) Following this joint reviewing
of the examination questions, in terms of what performance standards were
being covered, PL and the expert panel concluded that many of the
examination questions underpinned some the performance standards but did
not directly examine them. Following consultation with the commissioner at
the RPSGB, it was therefore decided to map the examination questions onto
the examination syllabus instead6
– of which there are 35 elements.
The elements were coded and mapped by another pharmacist member of the
research team (HP). Each element was coded (see appendix 1) and
subsequently mapped to the examination questions from the open and closed
book papers in June 2008, September 2008, June 2009 and September 2009.
In order to ‘map’ a question onto the examination syllabus, the content of each
question was analysed and then mapped onto the appropriate element(s) of
the syllabus. For example, if a question assessed the action and use of a
drug, as well as assessing knowledge on the side effects of the drug, it was
mapped onto both elements 14 and 17 of the examination syllabus (i.e.
actions and uses of a drug and adverse effects of medicines, respectively).
The coding of the four examination papers was tabulated in order to obtain
descriptive statistics about what elements of the examination syllabus could
be mapped to the registration examination. If the content of the question did
not map onto the examination syllabus, it was recorded as ‘did not map’ (see
appendix 4). Questions that were missing from the examination papers
obtained from the RPSGB were also accounted for when tabulating the data.
The questions in the registration examination were also reviewed to determine
what they assessed in terms of knowledge and/or understanding. Definitions
of knowledge and understanding were obtained from the Oxford English
Dictionary:33
Knowledge:
• Acquaintance with a fact; perception, or certain information of, a fact or
matter; state of being aware or informed; consciousness (of anything).
• Acquaintance with facts, range of information,
The Pharmacist Registration Examination – September 2010 53
Understanding:
• To comprehend; to apprehend the meaning or import of; to grasp the
idea of.
• Comprehension of something
The content of each question was analysed by two members of the research
team (PL and HP), and once again, where necessary, members of the expert
panel were consulted for advice in this exercise. In order to classify a question
that assessed knowledge, knowledge was interpreted as ‘facts and concepts
that pre-registration trainees would know from their undergraduate degree and
pre-registration experience’. In order to classify a question that assessed
understanding, understanding was interpreted as ‘the ability to use and apply
knowledge and concepts to answer a question correctly’. In some cases, a
question could be classified as assessing both knowledge and understanding.
The classification of the four examination papers was tabulated in order to
obtain descriptive statistics about the assessment of knowledge and/or
understanding in the four examination papers. If the content of the question
did not map onto knowledge and/or understanding, it was recorded as ‘did not
map’ (see appendix 4).
In some instances questions had been removed by the RPSGB from some of
the examination papers due to errors / problems with specific questions, and
these were noted and recorded as ‘removed from paper’ (see appendix 4).
3.3 Results
This section reviews the findings from both the closed book and the open
book examination papers in sequence.
3.3.1 Closed book examination paper
This section of the report focuses on the closed book registration examination
paper in 2008 and 2009. Table 3.1 displays the number of times the
The Pharmacist Registration Examination – September 2010 54
examination syllabus entries were covered in the closed book examinations
between June 2008 and September 2009.
Table 3.1: Number of times syllabus entries were assessed in the closed book examination
Element of examination (codes 1-35)
June 2008
Sept. 2008
June 2009
Sept. 2009 total
1 RPSGB Code of Ethics 6 10 5 4 25 2 Clinical governance 1 1 1 3 6 3 Continuing Professional Development in pharmacy 1 1 1 0 3 4 Principles of audit 2 2 2 1 7
5 Roles & training requirements for pharmacy support staff 0 0 0 0 0
6 Sale and supply of medicines 14 14 14 15 57 7 Conditions for operating a registered pharmacy 0 0 1 0 1 8 National Health Service 0 0 1 1 2 9 Health and safety 0 0 0 1 1 10 Environmental Protection 1 2 0 2 5 11 Consumer protection 0 0 0 0 0 12 Data protection and health records 1 0 2 1 4 13 Evidence-based practice 4 0 12 8 24 14 Action and uses of drugs 56 25 37 44 162 15 Non-prescription remedies 12 8 13 12 45 16 Differentiating minor illness from more serious disease 6 9 11 9 35 17 Adverse effects of medicines 13 16 11 9 49 18 Contra-indications 4 4 12 8 28 19 Drug interactions 4 5 6 7 22 20 Counselling requirements 5 5 4 5 19 21 Optimising patients' drug therapy 1 0 13 1 15 22 Interpretation of test results 2 2 2 0 6 23 Health promotion and disease prevention 5 1 7 4 17 24 Calculation 1 1 1 3 6 25 Dilution 0 0 1 0 0 26 Formulation and preparation 0 0 0 0 0 27 Good dispensing practice 0 2 1 0 3 28 Special Handling Requirements 0 0 0 0 0 29 Stability of dispensed preparations 1 2 1 0 4 30 NHS funding for pharmacy services 3 4 4 3 14 31 Prescribing guidelines, data and formularies 0 1 0 2 3 32 Operating procedures in primary and secondary care 0 0 1 3 4 33 Quality Assurance of stock 0 0 1 0 1 34 Responding to adverse drug reactions 1 0 0 2 3 35 NHS complaint procedures 0 0 0 0 0
The Pharmacist Registration Examination – September 2010 55
The examination syllabus entry that was assessed most frequently in all of the
four closed book papers (2008-09) was syllabus entry 14 (‘action and uses of
drugs’). Its assessment ranged between 26 and 56 times amongst the set of
89/90 questions (one question had been omitted from the June 2009
examination paper). The other most commonly assessed syllabus entries
were syllabus entries 6 (sale & supply of medicines), 17 (adverse effects of
medicines), and 1 (RPSGB Code of Ethics)
One question (question 58) in June 2008 did not fall into any of the
examination syllabus entries and could therefore not to be mapped. In
September 2008, five questions (14, 30, 31, 32, and 61) did not map well onto
any of the examination syllabus entries and could therefore not be mapped.
3.3.1.1 Areas of duplication of assessment
As noted above, in all examination papers, from June 2008 to September
2009 inclusive, the examination syllabus entry that was been assessed most
frequently was syllabus entry 14. Across the four examinations, the mean
number of times this element was assessed in the closed book paper was 41,
in comparison to the overall mean for the other entries which was 4.1. In
addition to this particular element of the syllabus, many questions mapped
onto other codes as well at the same time. Those syllabus entries that were
frequently mapped to questions that also mapped onto syllabus entry 14 were:
• Evidence-based practice (code 13)
• Non-prescription remedies (code 15)
• Differentiating minor illness from more serious disease (code 16)
• Adverse effects of medicines (code 17)
• Contra-indications (code 18)
• Drug interactions (code 19)
• Counselling requirements (code 20)
• Health promotion and disease prevention (code 23)
The Pharmacist Registration Examination – September 2010 56
3.3.1.2 Areas of under assessment
In comparison to the highly assessed syllabus entries, in particular entries 1,
6, 14, and 17, all other elements of the examination syllabus are consistently
assessed considerably less frequently. The mean number for the assessment
of all elements of the examination syllabus was 4.1 times per examination.
Those entries which were assessed less than four times were therefore
considered to be under assessed (excluding ‘Calculation’ (code 24) which is
not part of the closed book examination). Those that were assessed at least
once but less than four times are:
• Continuing Professional Development (CPD) in pharmacy (code 3)
• Conditions for operating a registered pharmacy (code 7)
• National Health Service (code 8)
• Health and safety (code 9)
• Good dispensing practice (code 27)
• Prescribing guidelines, data and formularies (code 31)
• Quality Assurance of stock (code 33)
• Responding to adverse drug reactions (code 34)
Five elements of the examination syllabus were never assessed in the closed
book examination between June 2008 and September 2009:
• Roles and training requirements for pharmacy support staff (code 5)
• Consumer protection (code 11)
• Formulation and preparation (code 26)
• Special Handling Requirements (code 28)
• NHS complaint procedures (code 35)
3.3.1.3 Differences between years
As can be seen from Table 1, there are differences in the number of times
syllabus entries were examined in the closed book papers in 2008 and 2009.
Five elements from the examination syllabus have only been assessed in the
2009 examination papers:
The Pharmacist Registration Examination – September 2010 57
• Conditions for operating a registered pharmacy (code 7)
• National Health Service (code 8)
• Health and safety (code 9)
• Operating procedures in primary and secondary care (code 32)
• Quality Assurance of stock (code 33)
3.3.1.4 Assessment of knowledge and/or understanding
The closed book paper appears to place the greatest emphasis upon
knowledge alone. In each closed book paper analysed, the number of
questions that assessed both knowledge and understanding is similar, with
the exception of the September 2008 paper. In all papers analysed, the least
emphasis was placed upon understanding alone (see Table 3.2).
Table 3.2: Number of times syllabus entries assessed knowledge and/or understanding (number of questions) in the closed book Element of examination (codes 1-35; K, U, K+U)
This section of the report focuses on the findings from mapping the open book
examination papers in 2008 and 2009. Tables 3.3 and 3.4 display the amount
of times the examination syllabus entries and knowledge and/or
understanding, respectively, were covered in the open book examination
between June 2008 and September 2009.
Five elements from the examination syllabus have only been assessed in the
2009 examination papers:
• Conditions for operating a registered pharmacy (code 7)
• National Health Service (code 8)
• Health and safety (code 9)
The Pharmacist Registration Examination – September 2010 58
• Operating procedures in primary and secondary care (code 32)
• Quality Assurance of stock (code 33)
3.3.2.1 Areas of under assessment
The elements of the examination syllabus which have a mean result for the
number of times an entry has been assessed of less than three (the average)
are considered to be under assessed. Those that were assessed at least once
but less than three times include:
• Principles of audit (code 4)
• Roles and training requirements for pharmacy support staff (code 5)
• Conditions for operating a registered pharmacy (code 7)
• Environmental Protection (code 10)
• Differentiating minor illness from more serious disease (code 16)
• Prescribing guidelines, data and formularies (code 31)
• Operating procedures in primary and secondary care (code 32)
• NHS complaint procedures (code 35)
There are eleven elements of the examination syllabus that were not
assessed during any of the four open book examination papers in 2008 and
2009:
• Clinical governance (code 2)
• CPD in pharmacy (code 3)
• National Health Service (code 8)
• Health and safety (code 9)
• Consumer protection (code 11)
• Data protection and health records (code 12)
• Dilution (code 25)
• Formulation and preparation (code 26)
• Good dispensing practice (code 27)
• Special Handling Requirements (code 28)
• Quality assurance of stock (code 33)
The Pharmacist Registration Examination – September 2010 59
Table 3.3: Number of times syllabus entries are assessed in the open book examination
Element of examination (codes 1-35) June 2008
Sept. 2008
June 2009
Sept. 2009
Total
1 RPSGB Code of Ethics 4 3 3 4 14 2 Clinical governance 0 0 0 0 0 3 Continuing Professional Development in
h 0 0 0 0 0
4 Principles of audit 0 0 2 0 2
5 Roles & training requirements for pharmacy support staff 0 0 1 0 1
6 Sale and supply of medicines 11 15 11 14 51 7 Conditions for operating a registered pharmacy 0 1 0 0 1 8 National Health Service 0 0 0 0 0 9 Health and safety 0 0 0 0 0 10 Environmental Protection 0 0 1 0 1 11 Consumer protection 0 0 0 0 0 12 Data protection and health records 0 0 0 0 0 13 Evidence-based practice 0 0 3 0 3 14 Action and uses of drugs 29 31 34 38 132 15 Non-prescription remedies 5 1 3 6 15 16 Differentiating minor illness from more serious
di 0 0 1 0 1
17 Adverse effects of medicines 4 4 8 16 32 18 Contra-indications 2 2 3 4 11 19 Drug interactions 3 4 3 2 12 20 Counselling requirements 2 2 2 1 8 21 Optimising patients' drug therapy 0 0 6 1 7 22 Interpretation of test results 3 3 1 0 7 23 Health promotion and disease prevention 1 2 2 3 8 24 Calculation 21 21 20 21 83 25 Dilution 0 0 0 0 0 26 Formulation and preparation 0 0 0 0 0 27 Good dispensing practice 0 0 0 0 0 28 Special Handling Requirements 0 0 0 0 0 29 Stability of dispensed preparations 0 1 0 3 4 30 NHS funding for pharmacy services 4 4 6 4 18 31 Prescribing guidelines, data and formularies 1 0 0 0 1
32 Operating procedures in primary and secondary care
0 0 1 0 1
33 Quality Assurance of stock 0 0 0 0 0 34 Responding to adverse drug reactions 0 3 1 5 9 35 NHS complaint procedures 0 0 0 0 0
The Pharmacist Registration Examination – September 2010 60
3.3.2.2 Questions in the registration examination mapped against the examination syllabus
Just like in the closed book examinations, syllabus entry 14 (‘action and uses
of drugs’) was also assessed most frequently in the open book papers. This
element of the syllabus was assessed between 29 and 41 times in the four
examination papers (mean = 33.5.). The second most frequently assessed
syllabus entry was 24 (‘calculations’), which was assessed between 20 and 21
times in 2008 and 2009. Syllabus entry 6 (‘sale and supply of medicines’)
followed in frequency and was assessed between 11 and 15 times.
In June 2008, five questions (question 49-51 and 61-62) were missing from
the examination paper and were therefore unable to be mapped onto the
syllabus. In June 2009 one question (question 14) was unable to be mapped
onto the examination syllabus as it did not correspond to any of the elements
assessment.
3.3.2.3 Areas of duplication of assessment
Some elements of the registration examination syllabus were being assessed
much more than others; there was clearly some over assessment/duplication
in this respect. The mean result for the number of times an entry was in the
open book papers from June 2008-September 2009 was 3. In all examination
papers from June 2008-September 2009 inclusive, the examination syllabus
entry that was assessed most frequently was entry 14 (‘action and uses of
drugs’). In addition to this particular element of the syllabus, many questions
mapped onto other codes as well at the same time. Syllabus entries that were
frequently mapped to questions that also mapped onto syllabus entry 14 were:
• Adverse effects of medicines (code 17)
• Contra-indications (code 18)
• Drug interactions (code 19)
• Counselling requirements (code 20)
The Pharmacist Registration Examination – September 2010 61
3.3.2.4 Difference between years
Two elements from the examination syllabus were only assessed in 2008.
These were:
• Conditions for operating a registered pharmacy (code 7)
• Prescribing guidelines, data and formularies (code 31)
Seven elements from the examination syllabus were only assessed in the
2009 examination papers. These were:
• Principles of audit (code 4)
• Roles and training requirements for pharmacy support staff (code 5)
• Environmental Protection (code 10)
• Evidence-based practice (code 13)
• Differentiating minor illness from more serious disease (code 16)
• Optimising patients’ drug therapy (code 21)
• Operating procedures in primary and secondary care (code 32)
3.3.2.5 Assessment of knowledge and/or understanding
The open book paper also places the greatest emphasis upon knowledge
alone. In each open book paper analysed, the number of questions that
assessed understanding alone was similar, with the exception of the June
2009 paper.
Table 3.4: Number of times syllabus entries assessed knowledge and/or understanding (number of questions) in the open book Element of examination (codes 1-35; K, U, K+U)
trainees will inevitably undertake a great deal of work during their pre-
registration year which is monitored and developed by their tutor, but formal
and objective tests seem to be lacking.
4.2 Registration requirements for pharmacists in selected other countries
The Pharmacist Registration Examination – September 2010 67
When we examined the pharmacy registration processes internationally, we
discovered that there were a number of similarities in the way the regulators
control pharmacist registration. Commonly, it takes a total of five years’
training to become a pharmacist in GB, Australia, New Zealand and Canada.
In the USA it often takes more than five years. All candidates studying for their
pharmacy qualification in GB, Australia and New Zealand are required to
undertake a degree in pharmacy followed by a year of supervised practice.
Throughout the degree programme there may be practice-based experience
but the majority of real-world practice will take place in the year following the
degree (i.e. the pre-registration year in GB). In Canada and the USA there
appears to be more variation in terms of the amount of practical experience
that pre-registration trainees undertake according to the province or state they
are training in. There is also no ‘set’ year of practising pharmacy under
supervision after completing a pharmacy degree. It seems that such work
experience in distributed through the period of study.
The idea of distributing practical experience throughout the undergraduate
course is something that is already in place in Bradford University in GB36;
here, students do two six-month blocks of supervised practice at different
stages rather than having a one-year block at the end of their degree.
Perhaps the incorporation of more supervised practice throughout a pharmacy
degree, rather than merged into one year at the end of the degree, provides
students with a better grasp and knowledge of practical experience which is
conducive to learning practical-based subjects in the MPharm. This is indeed
what was recommended in the Pharmacy White Paper.37
Having one individual as a student or pre-registration trainee’s tutor/preceptor
seems to be common place in each country, though the experience and
requirements of these individuals varies. However, as previously discussed,
there may be some subjectivity in assessments of pre-registration trainees if
this comes from one individual acting as a supervisor and an assessor. This of
course may be more of an issue in GB whereby tutors fill in progress reports –
one of the main ways trainees are measured and assessed throughout their
pre-registration training; they do not have external monitors assessing them,
The Pharmacist Registration Examination – September 2010 68
nor do they undergo different assessments, apart from the registration
examination at the end of supervised practice. In New Zealand, and Canada,
for example, OSCEs are used which may be considered a more superior
assessment of someone’s competencies or fitness to practise.38
Perhaps in
GB there can be more assessment during the pre-registration year which will
focus both on areas of practice and additionally on areas which cannot be
feasibly assessed in the registration examination.
4.3 The effectiveness of the pharmacist registration examination: mapping of examination questions against syllabus & knowledge versus understanding
In another part of this study39
, the research team carried out an examination
of the closed and open book examination papers between 2008 and 2009 and
mapped the examination questions against the pre-registration syllabus.
Findings from this research showed that both the open and closed book
examination papers do not place the same amount of emphasis on each
element of the pre-registration examination syllabus. This is clear from our
findings that many questions map onto specific elements such as ‘action and
uses of drugs,’ ‘sale & supply of medicines,’ and ‘adverse effects of
medicines,’ whereas some elements of the syllabus are not covered at all by
any questions. These are areas which are of particular importance in
pharmacy practice, particularly in community and hospital practice, where the
majority of newly registered pharmacists will practise. The elements of the
pre-registration syllabus that went unassessed in both the open and closed
papers were consumer protection (code 11), dilution (code 25), formulation
and preparation (code 26) and special handling requirements (code 28). Our
findings suggest there is an unequal amount of focus on the elements of the
pre-registration examination syllabus in the pre-registration examination
papers. Perhaps it can be expected that some elements may be more
assessed than others, particularly if these are deemed to be very important
aspects of a pharmacist’s future role upon becoming registered.
The Pharmacist Registration Examination – September 2010 69
Our assessment of the registration examination suggests that it particularly
focuses on the assessment of knowledge which is not surprising considering
the aims stated in the pre-registration trainee workbook.6 Assessments have
the ability to direct learning in a particular direction.40
This relatively narrow
focus on the assessment of knowledge in the registration exam means that
particular emphasis and importance rests on the appropriate assessment of a
broad range of competences and understanding in the regular performance
reports.
Indeed, the written registration examination is currently only part of the
registration assessment which is otherwise assessed continuously and signed
off / passed by the tutor in quarterly progress reports. Understanding may be
much better and more appropriately assessed in practice, but how objectively
and independently this is done in different pharmacy sectors and settings
cannot be commented on based on this project. Other healthcare professions
separate supervisory and assessment functions, and others (medicine in
particular) put particular emphasis on not only obtaining regular assessment,
but involving numerous assessors in this process. How effective these
approaches are in the other healthcare professions, and how some relevant
features could be incorporated into pharmacist pre-registration assessment,
would require further study. Equally, the effectiveness, validity and objectivity
of the current assessment using the completion of progress reports by tutors
for pharmacy pre-registration trainees would require further exploration.
In fact, there has been some research over the last decade, which has
highlighted potential problems with in-practice assessments. This has
indicated that some students or trainees in healthcare professions such as
nursing and medicine are progressing through their clinical training without
encountering failure in assessments that measure performances in abilities
they struggle with. Evidence from nursing has demonstrated a ‘failure to fail’
students even though they may be underperforming.41 Assessment of clinical
competency is complex and is generally based on direct observations from a
mentor which will involve subjective value judgements that vary from person
to person.41 There have been findings of nurse mentors passing students on
The Pharmacist Registration Examination – September 2010 70
clinical assessments even when there were doubts about their performance.42
This could be, in part, due to mentors being unprepared to assess the
competency of students in practice placements.42 Further evidence coming
from the medical setting has also demonstrated the ‘failure to fail’ tendencies
mentors may have. A recent study43
has shown that medical tutors may not
fail medical students due a number of factors such as attitudes towards a
student, attitudes about failing a student and motivation to comply with norms,
such as what they think they should do, or what other tutors were doing. In
that study, focus groups were conducted with a number of medical educators
(GPs, hospital doctors and non-clinical tutors) to understand what was behind
the decision process of passing students that may not possess satisfactory
skills and competencies in medicine. Attitudes and beliefs played a major role
in the process whereby, for example, a tutor may not fail a student because
their attitudes toward that student were positive; the student may be well-like
by tutors or was perceived to be aware of their difficulties.
Other factors may play a role in not failing students as another study in
Canada has shown. In this study, conducted by Dudek et al.,44
semi-
structured interviews were conducted with 21 clinical supervisors at the
University of Ottawa. A number of barriers were identified that prevent
supervisors from reporting a trainee who has been performing poorly. These
include lack of documentation (supporting evidence for judgements), lack of
knowledge of what to document, the anticipation of an appeal process, and
lack of remediation options. The failure to fail students who may not be
meeting the necessary requirements for progressing in their chosen field,
such as nursing and medicine, may be widespread. With these issues
appearing to be prevalent in nursing and medicine, it is likely that they are
also occurring in pharmacy.
This research has ultimately identified some possible shortcomings of the
registration examination and its potential implications for the pharmacist
registration process in GB. This research has also considered the registration
systems in place within other healthcare professions in GB and other systems
of pharmacy registration outside of GB and how they may offer a different
The Pharmacist Registration Examination – September 2010 71
approach to assessing and registering pharmacists. With this information, we
are able to make a number of recommendations concerning the registration
assessment of pharmacists in Great Britain. Many of these would need to be
informed by further research, which we also highlight.
At the time of writing, Modernising Pharmacy Careers (MPC) (part of Medical
Education England (MEE)) is reviewing pharmacy undergraduate education
and pre-registration training. They are assessing the content and continuing
relevance of pharmacy training and identifying options for change. Their report
is expected to be published late 2010.
The Pharmacist Registration Examination – September 2010 72
5 Recommendations
We would like to provide the following recommendations to be considered
concerning the pre-registration examination. As stated in our discussion,
these would need to be informed and supported by further evaluation and
research.
• The tutor should continue to undertake formative assessment of the
trainee and provide feedback to support their professional development
• Separate the supervisor (tutor) and summative assessor function to
improve objectivity and consistency between different tutors
• Review who can be a tutor: The training requirements for tutors should
be addressed. Standards for tutors should be developed. Appropriate
training would need to be developed, with which tutors would need to
be accredited, to ensure they can comply with the appropriate
standards.
• Increase the number and type of formative assessments during the
pre-registration year. Increase the number of people and disciplines
involved in these assessments. These assessments should focus on
skills, understanding and competencies central to the practice of
pharmacy.
• The final registration assessment should not just focus on the
assessment of knowledge but should also assess a wider range of
skills and competencies.
• Further training, support and/or mentoring during the first year following
registration could be considered, following the medical model of
foundation 1 & 2 training
The Pharmacist Registration Examination – September 2010 73
6 References
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(2) Larson MS. The Rise of Professionalism: A Sociological Analysis. Berkeley: University of California Press; 1977.
(3) Department of Health. Trust, assurance and safety - the regulation of health professionals in the 21st century. 2010.
(4) Council for Healthcare Regulatory Excellence. Assuring patient safety through regulation. 2009.
(5) General Pharmaceutical Council. Standards of conduct, ethics and performance. Accessed 10/09/10; available from: http://www.pharmacyregulation.org/pdfs/other/gphcstandardsofconductethicsandperflo.pdf
(6) Royal Pharmaceutical Society of Great Britain. Preregistration trainee workbook 2009/10. 2009
(7) Royal Pharmaceutical Society of Great Britain. Preregistration trainee workbook 2010/2011. Accessed 10/09/10; available from: http://www.pharmacyregulation.org/pdfs/preregistrationpharmacists/2ctraineeworkbook201011.pdf
(8) Royal Pharmaceutical Society of Great Britain. Frequently Asked Questions (FAQs) for Pre-registration Tutors. 2010.
(9) General Optical Council. Opticians' registers. 2010. Accessed 15/06/10; available from: http://www.optical.org/en/our_work/Registration/Opticians'_Registers.cfm
(10) The College of Optometrists. Scheme for registration trainee handbook. 2009.
(11) General Optical Council. GOC optometry core curriculum, core competencies and learning outcomes. 2010 Accessed 25/09/10; available from: http://www.optical.org/goc/filemanager/root/site_assets/educational_curricula/goc_optometry_core_curriculum.pdf
(12) Association of Optometrists. Work based assessment visits 2010/11.2010. Accessed 24/09/10; available from: http://www.assoc-optometrists.org/uploaded_files/work_based_assessment_visits_280410.pdf
The Pharmacist Registration Examination – September 2010 74
(13) General Medical Council. The medical register. 2010. Accessed 15/06/10; available from: http://www.gmc-uk.org/doctors/medical_register.asp
(14) Academy of Royal Medical Colleges, Department of Health, NHS Scotland, Department of Health, NHS Wales. The UK foundation curriculum. 2010. Cardiff, Crown copyright.
(15) General Dental Council. Who we regulate. 2010. Accessed 15/06/10; available from: http://www.gdcuk.org/About+us/Who+we+regulate/
(16) General Dental Council. Outcomes for registration. 2010. Accessed 25/09/10; available from: http://www.gdc-uk.org/NR/rdonlyres/4D5C3858-0F32-4EFD-B0E4-A3F79A991D30/0/Learningoutcomesdraftpublication.pdf
(17) Committee of Postgraduate Dental Deans and Directors, Scottish Executive, Department of Health, Department of health Welsh Assembly Government. A curriculum for UK Dental Foundation Programme Training. 2010.
(18) Committee of Postgraduate Dental Deans and Directors. COPDEND Dental Foundation Training Policy Statement . 2010. Accessed 04/06/10; available from: http://www.copdend.org.uk/
(19) Australian Health Practitioner Regulation Agency. Pharmacy Board of Australia. 2010. Accessed 12/07/10; available from: http://www.ahpra.gov.au/Health-Professions.aspx
(20) Pharmaceutical Society of Australia. Intern training programme. 2010. Accessed 12/07/10; available from: http://www.psa.org.au/site.php?id=4291
(21) Marriott JL, Nation RL, Roller L, Costelloe M, Galbraith K, Stewart P et al. Pharmacy Education in the Context of Australian Practice. American Journal of Pharmaceutical Education 2008; 72(6 (Article 131)).
(22) Pharmaceutical society of Australia. Competency standards for pharmacists in Australia. 2010 Available from: http://www.psa.org.au/site.php?id=1123
(23) Pharmaceutical Society of New Zealand. Requirements of the EVOLVE Intern Training Programme. 2010. Accessed 21/09/10; available from: http://psnz.org.nz/public/evolve/documents/RequirementsoftheInternTrainingProgramme.pdf
(24) Pharmaceutical Society of New Zealand. EVOLVE intern programme. 2010. Accessed 21/09/10; available from: http://www.psnz.org.nz/public/evolve/training_an_intern_pharmacist/training.aspx
(25) Royal Pharmaceutical Society of New Zealand. Guidelines for employing an intern. 2010. Accessed 21/09/10; available from:
The Pharmacist Registration Examination – September 2010 75
(26) National Association of Pharmacy Regulatory Authorities. A framework for assessing Canadian pharmacists' competencies at entry-to- practice through structured practical training programs. 2010. Accessed 10/07/10; available from: http://www.napra.org/Content_Files/Files/Framework_for_Assessing_Canadian_Pharmacists_Competencies.pdf
(27) National Association of Pharmacy Regulatory Authorities. Professional competencies for Canadian pharmacists at entry to practice. 2007.
(28) Accreditation Council for Pharmacy Education. Accreditation standards and guidelines for the professional program in pharmacy leading to the doctor of pharmacy degree. 2006.
(29) National Association of Boards of Pharmacy. NAPLEX. 2010. Accessed 12/07/10; available from: http://www.nabp.net/programs/examination/naplex/
(30) National Association of Boards of Pharmacy. MJPE. Accessed 12/07/10; available from: http://www.nabp.net/programs/examination/mpje/
(31) Ried LD, Nemire R, Doty R, Brickler MP, Anderson HH, Frenzel-Shepherd E, Larose-Pierre M, Dugan D. An automated competency-based student performance assessment program for advanced pharmacy practice experiential programs. American Journal of Pharmaceutical Education 2007; 71(6):128.
(32) Hill LH, Delafuente JC, Sicat BL, Kirkwood CK. Development of a competency-based assessment process for advanced pharmacy practice experiences. American Journal of Pharmaceutical Education 2006; 70(1).
(33) Oxford English Dictionary. 2010. Accessed 21/09/10; available from: http://oxforddictionaries.com/
(34) Lockyer J. Multisource feedback in the assessment of physician competencies. Journal of Continuing Education in Health Professions 2003; 23(1):4-12.
(35) Violato C, Lockyer J, Fidler H. Multisource feedback: a method of assessing surgical practice. BMJ 2003; 326(7388):546-548.
(36) Bradford University. Pharmacy MPharm 5 years practice-integrated. 2010. Accessed 23/09/10; available from: http://www.brad.ac.uk/pharmacy/our-courses/undergraduate/pharmacy-mpharm-5-year-practice-integrated/
(37) Department of Health. Pharmacy in England: Building on strengths - delivering the future. 2010.
The Pharmacist Registration Examination – September 2010 76
(38) Sloan DA, Donnelly MB, Schwartz RW, William S. The objective structured clinical examination: The new gold standard for evaluating postgraduate clinical performance. Annals of Surgery 1995; 222(6).
(39) Jee SD, Willis S, Elvey R, Lewis P, Parmar H, Schafheutle EI, Tully M, Hall J. Re-sitting assessments and competence. The University of Manchester. 2010.
(40) Ofsted. Assessment for learning: the impact of National Strategy support. 2008. Accessed 20/09/10; available from: http://www.ofsted.gov.uk/Ofsted-home/Publications-and-research/Browse-all-by/Documents-by-type/Thematic-reports/Assessment-for-learning-the-impact-of-National-Strategy-support
(41) Dolan G. Assessing student nurse clinical competency: Will we ever get it right? Journal of Clinical Nursing 2003; 12(1):132-141.
(42) Duffy K. Failing students: a qualitative study of factors that influence the decisions regarding assessment of students' competence in practice. Caledonian Nursing and Midwifery Research Centre, School of Nursing, Midwifery and Community Health, Glasgow Caledonian University. 2003.
(43) Cleland JA, Knight LV, Rees CE, Tracey S, Bond CM. Is it me or is it them? Factors that influence the passing of underperforming students. Medical Education 2008; 42(8):800-809.
(44) Dudek NL, Marks MB, Regehr G. Failure to fail: The perspectives of clinical supervisors. Academic Medicine 2005; 80 (10 SUPPL.).
The Pharmacist Registration Examination – September 2010 77
7 Appendices
7.1 Appendix 1: Comparison of registration requirements for healthcare professionals in GB
Pharmacy Optometry Medicine Dentistry Years of training required for full registration
5 years 4 years 6 years 5 years
Standard registration training
4 year Master of Pharmacy (MPharm) plus one year pre-registration training post
3 year BsC Optometry plus one year on the ‘Scheme for registration’ (SfR)
5 year Bachelor of medicine, Bachelor of surgery (MBChB) plus 2 year foundation programme
5 year Bachelor of dental surgery (mostly BDS one BChD - Leeds)
Alternative registration training models
5 year ‘sandwich’ course (Bradford) – integrates undergraduate course with pre-registration training
4 year Master of Optometry degree (Manchester) – integrates undergraduate course with pre-registration training
4 year graduate entry and 6 year ‘integrated’ courses available
4 year graduate-entry programmes available
Requirements for entry to registration training MPharm
Must achieve either a 2:2 BsC in Optometry and have a valid Certificate of clinical competency, or (if fail to achieve a 2:2), complete the GOC’s ‘optometry progression scheme’
MBChB BDS entry requirements
Registration categories
One ‘standard’ type of registration for all practising pharmacists. An annotation to the register entry is made for those with prescribing rights.
Two levels: student and full Compulsory ‘student registration’ with the GOC is required from start of BsC throughout training. Full registration upon successful completion of the SfR and the Final Assessment Examination. An additional ‘register entry’ is made for those with supply or prescribing ‘specialty’ rights.
Three levels: provisional, full and specialist Provisional registration – after obtaining MBChB. Full registration - Satisfactory assessment outcomes plus confirmation of overall satisfactory performance during the F1 year. Both surgical and medical attachments are required for GMC registration. After the F2 year, doctors can go on to GP or specialist training, leading to either GP registration or specialist registration. In November 2009, the GMC introduced the licence to practice. To practice medicine in the UK all doctors are required by law to hold both registration and a licence to practice.
One standard type of registration is required for all dentists. There are 13 specialist lists which specialist dentists join.
The Pharmacist Registration Examination – September 2010 78
Pharmacy Optometry Medicine Dentistry
Where the different registration levels allow registrants to practise
Entry onto the RPSGB register allows the registrant to practise as a pharmacist in private practice (community pharmacy or a pharmaceutical company) or for the NHS (hospital or community setting) or other sectors such as the prison service.
Full registration allows the optometrist to practise in private practice, or the NHS (hospital or community setting)
Provisional registration entitles newly qualified doctors to work in F1 Posts in hospitals or institutions approved for F1 service Full registration is required for unsupervised medical practice in the NHS or private practice in the UK Those new to full registration are required to work in an approved practice setting (APS) for 12 months
Registration with the GDC allows a dentist to work in private practice in the UK. (Although this would not be considered ‘good practice’.) In order to work as an associate in general dental service/personal dental service, a dentist must enter their name on the dental list of the PCO – this requires the completion of one year of vocational training (VT)
Where pre-registration training takes place.
Supervised training in employment – the majority take place in a clinical (pharmacy practice) environment usually in either community pharmacy or hospital but with 2 weeks cross-sector experience. There is also a ‘split scheme’ – where time is divided between two sites, and a ‘joint scheme’ with six months in a patient-care setting and the other six in industry, a university or other setting such as the NPA.
High street or hospital practice, usually with a little cross-sector practice (not compulsory but considered good practice).
Year 1 (F1) – all in secondary care settings, usually with three, 4-month attachments in medical and surgical settings. Most learning takes place in clinical areas, but there is protected time for educational activity. Year 2 (F2) Placements usually consist of three 4-month specialty placements, and possibly also embedded ’tasters’ of a week in another specialty. Can be all in secondary care or may include a general practice or academic medicine placement.
Teaching and assessment take place within the university dental school and in Manchester includes some practice in the dental hospital and multi-surgery dental outreach clinics. No time is spent in general dental practice.
Work based experience and how it is assessed
Assessed using: Observation – both formal and informal Role plays, simulations Testimonials Projects or assignments The tutor assesses competence and signs off the trainee against each standard.
he SfR trainee handbook lists the GOC’s 82 competencies. These are assessed through a process of ‘work based assessment’, a two-stage process: The supervisor works with the student, directly supervising them on the premises. Two different assessors visit the workplace to do the stage 1 and stage 2 assessments.
Foundation doctors have a clinical supervisor and an educational supervisor Assessors • assessors must be trained in giving feedback, understand the role of the tool being used, assessment methodology and be competent in the competence they are assessing • most assessors should be supervising consultants, GP principals and doctors in training who are more senior than the foundation doctor, experienced nurses or allied health
For the proposed foundation training, assessments are designed to be work-based assessments. Proposed tools include:
The Pharmacist Registration Examination – September 2010 79
Pharmacy Optometry Medicine Dentistry professional colleagues • Dental VT ‘test of knowledge’
Other assessment methods
The registration examination assesses knowledge and understanding by asking candidates to analyse and evaluate practice-based problems. A paper examination with two MCQ papers, one closed book (90 questions), one open book (80 questions, 20 of which are calculation style).
The final assessment is conducted at an assessment centre (a university). This is an OSCE with 14 stations (five minutes each).
All assessments are based on performance in the workplace
For the BDS, students are assessed against the learning outcomes. These are divided into generic and specific outcomes – the specific outcomes are areas of knowledge, understanding and competence on which students are assessed. Curricula vary between schools of dentistry. Assessment methods include:
• Written examinations – short answer and MCQ format, to assess knowledge
• OSCEs – to assess clinical competencies and understanding
• Coursework – e.g. researching an illness and producing a report
• Portfolios – students collect evidence of clinical competencies which have to be signed off
• Final examination includes ‘real patient’ and ‘unseen patient’ assessments
Regulatory authority The General Pharmaceutical Council (GPhC) General Optical Council (GOC) General Medical Council (GMC). General Dental Council (GDC)
Training programmes accredited by
The Royal Pharmaceutical Society of Great Britain (RPSGB) The College of Optometrists
Foundation curriculum agreed by the academy of medical royal colleges and the 4 national departments of health.
General Dental Council (GDC) COPDEND
The Pharmacist Registration Examination – September 2010 80
7.2 Appendix 2: Comparison of registration requirements for pharmacists in GB and abroad Great Britain Australia New Zealand Canada USA
Years of training required for full registration
5 years 5 years 5 years 5 years 5-6 years
Standard registration training
4 year Master of Pharmacy (MPharm) plus one year pre-registration training post
4 year Bachelor of Pharmacy (BPharm) plus 1 year of supervised training, during which time an approved intern training course must be completed
4 year Bachelor of Pharmacy (BPharm) plus 1 year
1 year Pre-pharmacy course, followed by a 4 year intern
training programme of Pharmaceutical Society of New Zealand
Bachelor of Science in Pharmacy
1 or 2 year Pre-pharmacy course, followed by 4-year Doctor of Pharmacy (PharmD) (BSc.
Pharm)
Alternative registration training models
5 year ‘sandwich’ course (Bradford) – integrates undergraduate course with pre-registration training
Some graduate-entry MPharm degrees taught in 6 semesters over 2 years
No. Some graduate-entry PharmD programmes available.
Some ‘accelerated programmes’ available.
Registration categories
One ‘standard’ type of registration for all practising pharmacists. An annotation to the register entry is made for those with prescribing rights.
1. general registration 2. limited registration: • postgraduate training or
supervised practice • area of need • teaching or research • in the public interest 3. provisional registration 4. non-practising registration 5. student registration
Two: intern and pharmacist Varies between provinces: generally includes student, intern and ‘general’. Alberta has five.
Varies between states: includes student, intern, ‘standard’ and speciality categories.
Work based experience and how it is assessed
Assessed using: Observation – both formal and informal Role plays, simulations Testimonials Projects or assignments The tutor assesses competence and signs off the trainee against each standard.
Must be assessed as competent in all eight categories of the Competency Standards. • Discussion Papers • Training Day • Health Promotion Project • NPS Pharmacy Practice
Review • CMI Assignment (preceptor
evaluation) • MCQ On-Line Assessment
Module • Workbook including diary
3 assessments against the competence standards during the year Assessed by the preceptor.
monitoring of students’ practice in accordance to competences undertaken by preceptor.
monitoring of students’ practice in accordance to competences undertaken by preceptor.
The Pharmacist Registration Examination – September 2010 81
and intervention records Other assessment methods
The registration examination assesses knowledge and understanding by asking candidates to analyse and evaluate practice-based problems. A paper examination with two MCQ papers, one closed book (90 questions), one open book (80 questions, 20 of which are calculation style).
Australian Pharmacy Competency Assessment Tool (APCAT) Examination • A paper examination with
MCQ format with 120 practice-based questions, some of which are calculation style. Open book examination.
Final oral examination
Pharmacy council final assessment at the end of the year which consists of: • 5 OSCEs assessing clinical
application of clinical knowledge and professional competence for a range of practice scenarios
• An oral interview conducted by 2 assessors,
•
The PEBC Qualifying Examination:
• Part I - written MCQ Part II - OSCE
The NAPLEX - Computer-based examination, uses adaptive technology to deliver selected-response and constructed-response questions, many of which are asked in a scenario-based format
Provincial jurisprudence examinations.
The MJPE tests the pharmacy jurisprudence knowledge of prospective pharmacists. It is a computer-adaptive examination.
Regulatory authority
The Royal Pharmaceutical Society of Great Britain (RPSGB)
The Pharmacy Board of Australia Provincial regulatory authority (usually a ‘College of pharmacy’)
The Pharmacy Council of New Zealand
State pharmacy board
Training programmes accredited by
The Royal Pharmaceutical Society of Great Britain (RPSGB)
Australian Pharmacy Council The Pharmaceutical Society of New Zealand
Degree programmes accredited by
Accreditation council for pharmacy education Canadian Council for
Accreditation of Pharmacy Programs
The Pharmacist Registration Examination – September 2010 82
7.3 Appendix 3: Coding of the registration examination syllabus
Code Examination syllabus entry description 1 RPSGB Code of
Ethics You must be able to demonstrate an understanding of, and be able to interpret, all parts of the Code of Ethics: • the concepts of ethical decision-making, liability, accountability and professional responsibility as described in part 1 • the standards of professional performance described in part 2 • the service specifications described in part 3 • the standards of good professional practice described in the Practice guidance section of The Medicines, Ethics & Practice guide
2 Clinical governance You must be able to demonstrate an understanding of: • the purpose and principles of clinical governance • the application of clinical governance in pharmacy practice
3 Continuing Professional Development (CPD) in pharmacy You must be able to demonstrate an understanding of: • the meaning of lifelong learning • the meaning and principles of Continuing Professional Development • the RPSGB system for undertaking and recording professional development
4 Principles of audit You must be able to demonstrate an understanding of: • the purpose and process of audit and its application in improving practice
5 Roles and training requirements for pharmacy support staff You must be able to demonstrate an understanding of: • the roles commonly undertaken by healthcare staff in their support of pharmacy services • the training and/or qualifications required for such roles
The Pharmacist Registration Examination – September 2010 83
6 Sale and supply of
medicines You must be able to demonstrate an understanding of: • the legal requirements for the sale and supply of medicines and controlled drugs from pharmacies • the legal requirements for the sale and supply of poisons, chemical reagents and spirits from pharmacies • the requirements for the labelling and packaging of all the above substances • the requirements for the supply of supplementary information for all the above substances • the requirements for dealing with medicines returned to the pharmacy
7 Conditions for operating a registered pharmacy You must be able to demonstrate an understanding of: • the requirement to register a pharmacy • the meaning and application of supervision and personal control • the role of the superintendent pharmacist
8 National Health Service You must be able to demonstrate an understanding of: • aspects of NHS legislation of relevance to pharmacy
9 Health and safety You must be able to demonstrate an understanding of: • the employer and employee's legal responsibilities for the health and safety of themselves and others • the principles of risk assessment and management
10 Environmental Protection You must be able to demonstrate an understanding of: • aspects of legislation that pertain to the safe disposal of special and controlled waste from the pharmacy
11 Consumer protection You must be able to demonstrate an understanding of: • aspects of legislation that pertain to the protection of consumers of pharmacy related products and services
The Pharmacist Registration Examination – September 2010 84
12 Data protection and health records You must be able to demonstrate an understanding of: • aspects of legislation that pertain to the keeping and disclosure of data on computer and other recording systems
13 Evidence-based practice You must be able to demonstrate an understanding of: • the principles of obtaining and applying evidence to inform and enhance practice
14 Action and uses of drugs You must be able to demonstrate an understanding of: • the mechanism of action, administration, absorption, distribution, metabolism and excretion of commonly prescribed and purchased licensed medicines • the principle uses of these medicines • correct dosages and dose adjustments for patients with particular needs because of their age or condition
15 Non-prescription remedies You must be able to demonstrate an understanding of: • the actions and licensed uses of medicinal products available without prescription that are commonly used to treat minor ailments
16 Differentiating minor illness from more serious disease You must be able to identify and to demonstrate an understanding of: • the symptoms of conditions that require referral to a medical or other healthcare practitioner • conditions not requiring referral and how they may appropriately be treated by non-prescription medicines, by short -term action that does not involve medication or by lifestyle change
17 Adverse effects of medicines You must be able to demonstrate an understanding of: • the recognised adverse effects of commonly prescribed and purchased medicines
18 Contra-indications You must be able to demonstrate an understanding of:
The Pharmacist Registration Examination – September 2010 85
• the circumstances in which commonly prescribed and purchased licensed medicines are contra-indicated
19 Drug interactions You must be able to demonstrate an understanding of: • the principle interactions that can occur between medicines, prescribed and purchased, and between these medicines and foods or other substances
20 Counselling requirements You must be able to identify and demonstrate an understanding of : • circumstances or situations in which patients or other clients require information • the nature of that information and the most appropriate way to provide it to the individual
21 Optimising patients' drug therapy You must be able to demonstrate an understanding of: • the purpose and principles of medicines management and pharmaceutical care
22 Interpretation of test results You must know, demonstrate an understanding of and be able to interpret: • the normal ranges for blood pressure and key blood components • the normal ranges for therapeutic blood levels of drugs with a narrow therapeutic index • the normal ranges for key parameters of bodily function • the implications of figures outside these ranges
23 Health promotion and disease prevention You must be able to demonstrate an understanding of: • the concepts of health promotion and health education • recommendations for key health parameters • the basis for health improvement programmes • the social, environmental, lifestyle and dietary factors that influence health • how awareness of the stages of behavioural change can help the pharmacist to make interventions appropriate to the individual • actions the pharmacist and pharmacy support staff can take to promote health and prevent disease
The Pharmacist Registration Examination – September 2010 86
24 Calculation
You must be able to: • perform accurately all types of calculations relating to pharmacy practice
25 Dilution You must be able to demonstrate an understanding of: • the correct procedures for the dilution of solid, semi-solid and liquid dosage forms, including selection of the correct diluent
26 Formulation and preparation You must be able to demonstrate an understanding of: • how to develop a suitable formula for preparing sterile and non-sterile products in community and hospital practice • how to apply suitable methods and procedures for the preparation of sterile and non-sterile products in community and hospital practice
27 Good dispensing practice You must be able to demonstrate an understanding of: • the principles and practices involved in ensuring an accurate and efficient dispensing process
28 Special Handling Requirements You must be able to demonstrate an understanding of: • the additional precautions necessary when preparing and dispensing cytotoxic and other products requiring health and safety precautions
29 Stability of dispensed preparations You must be able to demonstrate an understanding of: • the factors affecting the stability of medicinal products (including those dispensed extemporaneously) and the impact of these factors on storage and labelling
30 NHS funding for pharmacy services You must be able to demonstrate an understanding of: • the Drug Tariff, why it is used and how • the procedure for checking the validity of exemptions claimed • the procedure for obtaining the correct charges for prescriptions
31 Prescribing guidelines, data
The Pharmacist Registration Examination – September 2010 87
and formularies You must be able to demonstrate an understanding of: • the purpose of prescribing guidelines and of data from pricing authorities • the purpose of local formularies • the sources of evidence used in the development of prescribing guidelines, data and formularies
32 Operating procedures in primary and secondary care You must be able to demonstrate an understanding of: • the reasons for standardising operating procedures in hospital and community pharmacies • the main areas covered by such procedures/protocols
33 Quality Assurance of stock You must be able to demonstrate an understanding of: • the principles of and methods for assuring the quality of pharmacy products and materials supplied to and from the pharmacy
34 Responding to adverse drug reactions You must be able to demonstrate an understanding of: • the correct actions to take in response to a client reporting an adverse drug reaction, including the national reporting scheme
35 NHS complaint procedures You must be able to demonstrate an understanding of: • the principles of the NHS complaint procedure with reference to complaints about pharmaceutical service
The Pharmacist Registration Examination – September 2010 88
7.4 Appendix 4: Mapping of closed and open book registration examination questions to knowledge and/or understanding and examination syllabus
Tables 7.1 and 7.2 below provide all of the raw data from the mapping exercise that was carried out on the closed and open book examination papers in June 2008, September 2008, June 2009 and September 2009. Table 7.1: Mapping questions from closed book examination to knowledge and/or understanding and syllabus entries
June 2008 September 2008 June 2009 September 2009
Question K, U, KU
Syllabus entry 1-35
K, U, KU
Syllabus entry 1-35
K, U, KU
Syllabus entry 1-35
K, U, KU
Syllabus entry 1-35
1 K 14,15,16 K 17 K 14 KU 14,15 2 KU 14,17,18,1
9 KU 15,18 K 19 KU 14,24
3 KU 14,22 K 30 KU 14, 18 KU 13,14,15,16,20
4 K 13 K 14,15 K 6 K 12 5 K 14,17,18 KU 24 K 14,17,18 K 34 6 KU 14,15,16 U 24 KU 14,15,16 KU 13,14 7 U 24 K 17 U 3 KU 24 8 KU 14,19 K 19 KU 21 KU 14,18,19 9 KU 23 K 14 K 6 K 13,14 10 K 14,29 U 6 KU 14,19,20 KU 13,14,16 11 K 14 K 1 K 13,21,22 KU 13,14,15 12 KU 14,17,19 KU 14,22 K 1 KU 31 13 K 1 K 29 KU 24 K 14 14 K 14 K did not
map KU 13,14,21 K 14
15 K 14,19 K 14,17 K 14,17,19 K 1 16 K 2 U 1 KU 13,14,15,1
6,20 U 2
17 KU 14,17 KU 15,16 U 1 KU 14,17 18 K 16 K 22 K 16 KU 1,6 19 KU 4 K 15 KU 4 K 14 20 KU 14,15 K 14,15 KU 13,14,21 KU 16 21 K 14,17 K 19 K 17 K 14,15 22 K 1 K 17 K 15 K 14,15 23 KU 14,17 K 1,6 K 6 K 14,17 24 KU 14,22 K 23 K 17 KU 24 25 K 23 K 16 K 14 K 8 26 K 14,15 K 19 K 29,33 K 14 27 K 14.17 KU 16 K 20 K 14,17,19 28 K 14,20 KU 16 K 20 K 14,17,19 29 K 14,20 KU 16 K 6 K 14,17,19 30 K 6 K did not
map K 6 K 6
31 K 6 K did not map
K 6 K 6
32 K 6 K did not map
K 6 K 16
33 K 6 K 14,16,17 KU 6,30 K 16 34 K 14 K 14,17 KU 6,30 K 14,15
The Pharmacist Registration Examination – September 2010 89
35 K 14 K 14,17,19 K 30 K 14,15 36 KU 6,30 K 14,20 K 30 KU 6,30 37 KU 6,30 K 14,17,20 KU 14,15,16,1
8,23 KU 6,30
38 KU 6,30 K 6 KU 14,15,16,18,23
K 2
39 K 14,15 K 6 KU 14,15,16,18,23
K 4
40 K 14 K 6 KU 14,15,16,18,23
K 2
41 K 14 K 6 KU 14,15,16,18,23
KU 32
42 KU 14,17 K 14,17 KU 14,17,21 KU 14,17 43 KU 14,17 K 14,17 KU 14,17,21 KU 9,32 44 KU 14,17 K 14,17 KU 14,17,21 K 14 45 KU 14,17 KU 14 K 13,14,21 K 14 46 K 14,15 KU 14 K 13,14 K 14 47 K 14,15 KU 14 K 13,14,18 K 14 48 KU 14 K 6 U 32 K 14 49 K 14 K 6,15 K 13,14 KU 31 50 KU 14 KU 14,17 KU 13,14,21 K 14,15,23 51 KU 6 K 14 K 1,6 K 6 52 K 14 K 6,30 K 14,17 K 14,19 53 KU 14,20 K 6 K 14 K 20 54 KU 14,15,16 K 14 KU 6,7 KU 13,16 55 K 6 K 20 KU 14,15,18 K 23 56 K 14 K 14 KU 13 K 32 57 K 14,15 K 31 KU 22 K 14 58 K did not
map removed from paper
K 14 K 6
59 KU 1 K 1 KU 12 K 6 60 KU 14 U 2 K 1,15 K 6,30 61 K 14,17 K 14 KU 15,16 KU 16 62 K 14,18 K 4 K 14 K 14,18 63 K 1 K 15 K 16 K 1 64 K 14,23 K 1 KU 23 KU 14,18 65 K 14,20 K 16 U 3 K 14,18 66 K 14,18 K 1 K 14,19 K 6,15 67 K 3,14 K did not
map K 17 K 6
68 K 14 KU 3 K 14 K 6 69 K 14,17 K 18 K 8 K 6 70 KU 14,15,16 K 29 K 17 K 14,17 71 K 6 K 17 K 14,15 K 1,32 72 K 6 K 14,18 K 6 KU 6,14,15,16 73 KU 13,14 KU 14,17 KU 13,14,21 K 13 74 K 13,14 KU 27 KU 13,14,21 KU 13,14,17,18,
19 75 KU 13,14 U 1,27 KU 14,19 KU 14,20 76 KU 14,20 KU 17 K 6 KU 22 77 KU 12 K 6,30 K 12 K 14,15,18,19 78 K 6 KU 14,20 KU 14,18,19 K 14,18 79 KU 15 U 1 K 14,18 KU 16 80 KU 23 K 14,18,19 K 14,15 KU 14,15,17 81 KU 14,15 K 4 KU 16 KU 14,20,21 82 KU 16 K 16 KU 17,18 KU 14 83 KU 1 K 6,10 KU 6 KU 14,18 84 K 4 KU 15 KU 1 KU 10
The Pharmacist Registration Examination – September 2010 90
85 KU 14 K 6 KU 4 KU 23 86 KU 1,6 K 6,30 KU 1,27 K 10 87 KU 23 U 1,6,10 KU 25 KU 6 88 KU 6,10 KU 16 K 23 KU 14 89 KU 14,21 KU 1 KU 14,20,21 KU 14,20 90 K 34 KU 14,17 removed from
paper KU 34
Table 7.2: Mapping questions from open book examination to knowledge and/or understanding and syllabus entries June 2008 September 2008 June 2009 September 2009
Question K, U, KU
Syllabus entry 1-35
K, U, KU
Syllabus entry 1-35
K, U, KU
Syllabus entry 1-35
K, U, KU
Syllabus entry 1-35
1 K 14 K 14,20 KU 13,14 K 14 2 K 14 K 17,20 K 14 K 14 3 K 14 KU 14,18 K 14 K 14 4 KU 19,20 KU 14,24 K 1 K 14,20 5 K 14 KU 30 KU 14,21 KU 24 6 K 14 KU 23 K 13 K 23 7 K 6 KU 14 K 6 K 6 8 K 22 KU 14,22 K 6,10 K 14,19 9 K 22 K 19 U 14,21,22 KU 14,18,23 10 U 24 K 14,18 K 14,19 KU 14,17,19 11 K 14 KU 30 K 14,17,18,1
9 KU 14,17,21
12 K 14 KU 14 U 14 K 14,15,17 13 K 15 K 22 U 6,15 K 14,17,18 14 KU 14,19 K 14 U did not
map KU 14,15
15 K 14 K 15 K 14,30 KU 14 16 K 6 K 14 U 14,21 KU 14 17 K 24 K 14 U 6 K 14,18 18 K 14 KU 14 K 13,14 KU 14 19 KU 6 K 23 KU 6 K 6 20 KU 24 K 14 U 14,23 KU 14,17,18 21 K 14,31 K 14,34 K 14 KU 14,17,34 22 K 14,18 K 14,34 K 14,18 KU 14,17,34 23 K 14,20 K 14,34 K 14,20 KU 14,17,34 24 K 14 K 14 KU 6 KU 14,17,34 25 K 6 K 14 U 14 K 30 26 K 6 KU 6 K 14 K 30 27 K 14,17 KU 6 K 14 K 30 28 K 14 K 14 K 14,19 K 14,17 29 K 14,17 K 14 K 14,17 K 14 30 K 14 K 14 K 14 K 14,17 31 K 17 KU 30 K 14 K 6 32 K 14,18 K 6,7 K 14 K 6 33 K 17 K 14,19 K 14,17 K 23 34 KU 14,15,19 K 14,17 K 30 KU 14,17 35 K 6 K 14 KU 6 K 14,15 36 K 14 K 6 K 14 K 6 37 K 6 K 1 KU 14 K 1 38 KU 6 K 14 K 6 K 14 39 K 1 K 6 K 14 K 6 40 K 14 KU 1 K 30 K 14 41 K 6,30 K 6 K 6 KU 1
The Pharmacist Registration Examination – September 2010 91
42 K 14 K 22 K 21 K 6,14,15 43 KU 14,15 K 6 K 20 K 14,15 44 K 1 K 6 K 17 K 1 45 K 23 KU 19 K 14,17 K 14,29 46 K 6 K 6 K 30 KU 6 47 KU 14 K 14 K 14,17 K 6 48 K 30 K 6 K 1,5 K 6,29 49 removed from
paper KU 14 KU 6 KU 14
50 removed from paper
KU 14,17 KU 14,17,34 KU 6,14
51 removed from paper
K 6,30 KU 15,16,21 KU 1,6
52 KU 30 KU 6 KU 30 KU 30 53 KU 15 KU 14,29 U 23 KU 14 54 KU 14 K 1 KU 6,15 KU 14 55 KU 14,22 KU 14,19 KU 14,21 KU 14 56 KU 30 K 6 KU 4,14 KU 14,29 57 KU 1,14 KU 14,17 KU 14,21 KU 14,15 58 KU 6 KU 6 KU 30 KU 14 59 KU 14 KU 14 KU 14,17,18 KU 6 60 KU 1 K 6 KU 1,32 KU 6 61 removed from
paper U 24 U 24,25 U 24
62 removed from paper
U 24 U 24 U 24
63 U 24 U 24 U 24 U 24 64 U 24 U 24 U 24 U 24 65 U 24 U 24 U 24 U 24 66 U 24 U 24 U 24 U 24 67 U 24 U 24 U 24 U 24 68 U 24 U 24 U 24 U 24 69 U 24 U 24 U 24 U 24 70 U 24 U 24 U 24 U 24 71 U 24 U 24 U 24 U 24 72 U 24 U 24 U 24 U 24 73 U 24 U 24 U 24 U 24 74 U 24 U 24 U 24 U 24 75 U 24 U 24 U 24 U 24 76 U 24 U 24 U 24 U 24 77 U 24 U 24 U 24 U 24 78 U 24 U 24 U 24 U 24 79 U 24 U 24 U 24 U 24 80 U 24 U 24 U 24 U 24