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

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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