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Framework for Competence Development in Pharmacy
Graham Davies,Professor of Clinical Pharmacy & Therapeutics,King’s College, London
Tempus PQPharm Conference on the Competencies in PharmacySchool of Pharmacy, University of Belgrade; 24th May 2011
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Content
1. Drivers changing the education landscape
2. Current activity • Competency (professional development)
Frameworks
3. Infrastructure building – delivering practitioners fit for purpose
3
Drivers for Change……….
Medication related problems• International data on adverse drug events – e.g. US, Australia, UK
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Deaths in England and Wales from medication errors and adverse effects
Audit Commission 2001 A spoonful of sugar
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Medicines adherence rates can diminish over time
n=120 accepting HAART (Horne et al JAIDS.2007;45{3}:334‐341) Significant increase in the number of participants reporting low adherence over follow‐up (Cochran’s Q =39.9, df = 3, p<0.001)
21.431.6
40.9 44.4
78.668.4
59.1 55.6
0%
20%
40%
60%
80%
100%
1M 3M 6M 12M
high adherencelow adherence
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Drivers for Change……….
Changing health care systems
• Integration of acute and community care – long‐term conditions
• Increased patient choice and expectation• Health care professionals – role clarity – whose job is it?• Competence – can professionals do the job?• Performance – do professionals deliver what is needed?
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Progressive regulation & revalidation...
•Linked to societal needs (safety, services, policy)
•Outcomes, not credits
•Competence, not hours
•Collaborative, not sectoral
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Where are we now?
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The typical response……..
Mandatory Continuing professional
development (CPD)
but the problem with CPD is……….
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Continuing
Professional
Development
lifelonglearning,ongoingprocessregardless ofyour age orthe stage ofyour career
focused onyour personal/ individualcompetencein aprofessionalrole
improve your personal skillsto improve patient care andyour career progression
What is CPD?What SHOULD CPD deliver?
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Why is competence so important?
‘A patient is entitled to be cared for and by healthcare professionals with relevant and up‐to‐date skills and expertise.’
Kennedy Report (p14)
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1. Bristol Inquiry into Paediatric cardiac surgery ‐Kennedy Report (2000)
2. Clinical governance & professional regulation
3. Anti–professional attitude – professions are driven by self‐interest and promotion.
4. Public involvement (‘Informed consent’, Information and Choice)
Why is competence so important?Why is competence so important?
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Competency iceberg
Effective and persistent behaviour
Knowledge
Skills
Abilities
Values, attitudes and beliefs
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Fuzzy concepts
Competence• Overarching capacity
Competences• Functional, the what
Competencies• Qualities, the how
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Competency Frameworks ‐ Australia
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Competency Frameworks ‐ Canada
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Competency Frameworks ‐ UK
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Competence approaches have their critics…..………
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Competence, like truth, beauty and contact lenses, is in the eye of the beholder
Dr Laurence J Peter
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Critical accounts
Competence approaches• Reductive• Shopping lists• Job specific• Central control• Adequacy not excellence
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Professional competence
Habitual and judicious use of communication, knowledge, technical skills, clinical reasoning, emotions, values, and reflection in daily practice for the benefit of the individual and community being served
Epstein and Hundert, 2002
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Competency ‐ supporting a Career Pathway for Pharmacists
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Undergraduate & preregistration
General post‐registration
General Level Specialist or Advanced Level
Professional Development Frameworks
Pharmacist development model
Consultant PharmacistConsultant Pharmacist
Higher level practice (2)
Advanced PractitionerAdvanced Practitioner
SI or PhwSISI or PhwSI
Higher level practice (1)
Workplace education; work‐based learning
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Competency Frameworks ‐ UK
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General Level Framework (UK)
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GLF StructureGLF Structure
11/07/2008 15th ISPW - Queenstown, New Zealand
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Likely impact of frameworks?
Do they improve performance?
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LogrankP = 0.0048
Intervention = GLFn = 30 hospitals
Time - months14121086420-2
Prob
abili
ty.7
.6
.5
.4
.3
.2
.1
0.0
-.1
Intervention
Controlled trial GLF in junior pharmacists
Non-intervention
(Antoniou et al. Pharmacy Education 2005)
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Community pharmacistsPractice pharmacists
Performance improvement in Community Setting
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Undergraduate & preregistration
General post‐registration
General Level Specialist or Advanced Level
Professional Development Frameworks
Pharmacist development model
Consultant PharmacistConsultant Pharmacist
Higher level practice (2)
Advanced PractitionerAdvanced Practitioner
SI or PhwSISI or PhwSI
Higher level practice (1)
Workplace education; work‐based learning
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National Competency profiles –advanced practice
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Attributes of higher level practitioner?
1. Expert in area of practice
2. Able to work in multidisciplinary teams
3. Dissemination and contribution to evidence
4. Training, support and mentorship of staff
5. Managing a team and a caseload
6. Leadership skills
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Advanced to Consultant Level Framework ‐Clusters
1. Expert Practice
2. Building Working Relationships
3. Research & Evaluation
4. Education, Training and Development
5. Management
6. Leadership
36 Current level of practice
0.0
0.5
1.0
1.5
2.0
2.5
3.0Mean cluster score
Expert Practice
Working relationships
Leadership
Management
E&T and Development
Research & Evaluation
Specialists intraining
Experiencedpractitioners
Leading-edgepractitioners Kn
owledge and skills
Expe
riences and
“eviden
ces”
Level 1-Foundation
Level 2-Excellence
Level 3-Mastery
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Attaining Competence ‐ Problems for the Pharmacy Profession1. The service provided – what does the job entail?
• Lack of clear career strategy• Appoint pharmacists to posts on their potential• No robust standard approach to measuring quality of
practice
2. Education and Training Support – outdated models?• Lack of workplace based learning models – integrate,
working, studying and assessment• Competence seen as training not education i.e. not an
academic function
Integrating Competency Frameworks into Education: The London, East & South East Joint Programme Board Experience
Reforming the Education Model
Key Ingredients
Clarify the goal of educationBuild infrastructure to ensure a quality system which delivers the goalEstablish a modern curriculumEnsure assessment strategy is appropriate – driven by competence and performance
Joint Programmes BoardCollaboration between 9 universities and the NHS in the south East of England.
Geography represents approximately 40% of the population of England.
Developing & delivering a modern work‐based post‐registration curriculum for pharmacists.
UniversitiesLondon BrightonKing’s College Medway Portsmouth UEAReading KingstonHertfordshire
Curriculum - Principles• Integrate working and learning and a recognition that
majority of learning should be work-based:– Patient safety at the heart of the approach– Curriculum must support the role of pharmacists
• Adopt the principles of self-directed and independent study – not be dominated by classroom delivery.
• Emphasise the unique scientific basis of the profession to improve medicines use by society.
So, why do workplace learning?
Learning about the context of health care
Professional knowledge and reasoning
Professional skills: history taking identifying drug related problems, procedures etc
Socialisation: behaving like a pharmacist
Work Learning
Assessment
The challenges of workplace based learning
Observation
Participation
Assessment of task Assessment of learning acquired to date
Miller’s pyramid
Does
Shows how
Knows how
Knows
performance assessment in vivo
performance assessment in vitro
clinical context assessment
factual assessment
Performance-based, MiniPAT, MiniCEX, etcOSCE style
Case studies/ PBL /Portfolio
MCQ / Exams
Supporting post-registration development
Miller Cambridge Pyramid
Competence
Human FactorsSystem factors
Performance
It’s what pharmacists do that’s important…………
Represents vast majority of junior pharmacists in catchment
Accreditation of Training Centres
EastOfEngland& Essex15
SouthEastCoast10
SouthCentral10
South London16
North London20
>70 accredited hospitals
Trainee Performance
Basic Knowledge – MCQ scores – cf old system
Yes, definitely
definitely not
Contrıbutıon to my development
Career development
Student perceptions of personal development
SummaryNeed new education models in pharmacy where:
Patients are the focus so that learning and working are better integrated
Competence is at the heart of the system
Adopt more appropriate assessment methods• Not just knowledge – competence & performance• Integrates basic science• Draws on view of other professionals.
Employers and academic departments must collaborate better
The system should be informed by workforce planning
Framework for Competence Development in Pharmacy
Questions?
Graham Davies,Professor of Clinical Pharmacy & Therapeutics,King’s College, London
Tempus PQPharm Conference: Competencies in PharmacySchool of Pharmacy, University of Belgrade; 24th May 2011
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