Professionalism development and assessment in the pre-registration pharmacist placement in England: transformative moments and maturation periods.

OBJECTIVES: Development of new patient-facing roles for pharmacists and reports of poor patient care in the UK has led to questions concerning how pharmacists develop professionalism. This study explored how professionalism is developed and assessed during the post-graduation year in practice or pre-registration placement. The perspectives of two staff at the professional regulator UK (General Pharmaceutical Council), eight service users, seven pre-registration trainees, and 12 pre-registration tutors were recruited. METHODS: An interpretative paradigm was adopted. Data collection involved a semi-structured group interview, focus groups and a qualitative e-questionnaire. An inductive reasoning approach informed data analysis and interpretation. KEY FINDINGS: All groups provided insights into examples of transformative moments which potentiated professionalism development, the first being awarding the 'pre-registration trainee' title. All groups reported that contact with patients and trainee reflection aided professionalism maturation from a 'self-centred student' to becoming a 'responsible professional' where more than 'doing' is demanded. Furthermore, tutors stated the rate of professionalism development was affected by the sector of training and its opportunities for patient contact. Tutors felt they alone, not the registration exam, assessed professionalism using a variety of assessment approaches. Importantly, no tutors reported patient involvement in the assessment of trainees' professionalism, yet service users expected to be involved. CONCLUSIONS: Transformative moments and maturation periods during pre-registration training develop professionalism and enable trainees to 'become' a pharmacist. Careful planning of placements to optimise professionalism development across pharmacy sectors and consistent patient involvement in assessing trainee professionalism is recommended.

Medication-related risk factors and its association with repeated hospital admissions in frail elderly: A case control study.

BACKGROUND: Repeated hospital admissions are prevalent in older people. The role of medication in repeated hospital admissions has not been widely studied. The hypothesis that medication-related risk factors for initial hospital admissions were also associated with repeated hospital admissions was generated. OBJECTIVES: To examine the association between medication-related risk factors and repeated hospital admissions in older people living with frailty. METHOD: A retrospective case-control study was carried out with 200 patients aged ≥75 years with unplanned medical admissions into a large teaching hospital in England between January and December 2015. Demographic, clinical, and medication-related data were obtained from review of discharge summaries. Statistical comparisons were made between patients with 3 or more hospital admissions during the study period (cases) and those with 2 or fewer admissions (controls). Regressions were performed to establish independent predictors of repeated hospital admissions. RESULTS: Participants had a mean age of 83.8 years (SD 5.68) and 65.5% were female. There were 561 admission episodes across the sample, with the main reasons for admissions recorded as respiratory problems (25%) and falls (17%). Univariate logistic regression revealed five medication-related risks to be associated with repeated hospital admissions: Hyper-polypharmacy (defined as taking ≥10 medications) (OR 2.50, p < 0.005); prescription of potentially inappropriate medications (PIMs) (OR 1.89; p < 0.05); prescription of a diuretic (OR 1.87; p < 0.05); number of high risk medication (OR 1.29; p < 0.05) and the number of 'when required' medication (OR 1.20; p < 0.05). However, the effects of these risk factors became insignificant when comorbid disease was adjusted for in a multivariable model. CONCLUSION: Medication-related risk factors may play an important role in future repeated admission risk prediction models. The modifiable nature of medication-related risks factors highlights a real opportunity to improve health outcomes.

Assessment of the quality and content of website health information about herbal remedies for menopausal symptoms.

OBJECTIVE: To assess the quality, readability and coverage of website information about herbal remedies for menopausal symptoms. STUDY DESIGN: A purposive sample of commercial and non-commercial websites was assessed for quality (DISCERN), readability (SMOG) and information coverage. MAIN OUTCOME MEASURES: Non-parametric and parametric tests were used to explain the variability of these factors across types of websites and to assess associations between website quality and information coverage. RESULTS: 39 sites were assessed. Median quality and information coverage scores were 44/80 and 11/30 respectively. The median readability score was 18.7, similar to UK broadsheets. Commercial websites scored significantly lower on quality (p=0.014), but there were no statistical differences for information coverage or readability. There was a significant positive correlation between information quality and coverage scores irrespective of website provider (r=0.69, p<0.001, n=39). CONCLUSION: Overall website quality and information coverage are poor and the required reading level high.

Suits you? A qualitative study exploring preferences regarding the tailoring of consumer medicines information.

OBJECTIVES: To explore participants' opinions and preferences on tailored written medicines information. METHODS: Forty-five participants were recruited to eight focus groups, run concurrently in Australia (23 participants in four groups) and the UK (22 participants in four groups). Participants were provided with exemplar leaflets for a cardiovascular medicine based on the angiotensin-converting enzyme (ACE) inhibitor ramipril, which was tailored for a man aged 55 with hypertension. Reference to other indications of the medicine, children's doses, pregnancy and breast-feeding information were removed. A topic guide directed the discussion and explored preferences and opinions on tailored leaflets. Focus group discussions were recorded, transcribed verbatim and content analysed using adapted cross-case study analysis. KEY FINDINGS: Participants welcomed the concept of tailored information, desiring shorter and more relevant information. Information tailored to their condition or disease was most sought-after, followed by tailoring by age or gender. However, some participants voiced concerns about the potential for the wrong information being given to patients who would be unable to recognise that it was incorrect. Other concerns included how tailoring might impact upon the quality of information available and the feasibility of delivery, especially regarding the legal implications (Australia) and the cost (UK). A key finding was the participants' desire for a truly individualised approach to tailoring medicines information, as opposed to the generalised tailored information provided in the study. Participants said they would value having spoken communication with a healthcare professional at the same time as they received tailored leaflets. CONCLUSIONS: Most participants welcomed tailored leaflets but overall valued a more personalised approach than the generalised tailored information we provided. Despite concerns about quality and delivery, many felt tailoring written medicines information could improve the relevance of the information to the individual and potentially encourage them to value it.

It's for your benefit: exploring patients' opinions about the inclusion of textual and numerical benefit information in medicine leaflets.

OBJECTIVES: To explore consumers' beliefs and preferences for benefit information in medicine leaflets and examine their understanding and reaction to treatment benefits. METHODS: Forty-five participants were recruited to eight focus groups, run concurrently in Australia (23 participants in four groups) and the UK (22 participants in four groups). Participants were provided with amended leaflets based on the medicine clopidogrel, containing textual and numerical benefit information presented using numbers needed to treat (NNT). A topic guide which explored use of leaflets, preferences and opinions was used to direct discussion. Focus group discussions were recorded, transcribed verbatim and content analysed using adapted cross-case study analysis. KEY FINDINGS: The consensus was that the inclusion of benefit information was a positive factor. Many participants felt that textual benefit information offered an incentive to take a medicine, although some Australian participants had concerns that included benefit information could create anxiety. The presentation of numerical benefit information provoked strong feelings of disbelief and shock. Participants were surprised that so few people would benefit. Some participants struggled to understand and interpret the NNT and others found it difficult to comprehend the magnitude of the benefit information, instead operating on initial and often crude assumptions of what the data meant. In both countries the provision of numerical benefit information appeared to shake participants' faith in drug treatments. Participants were concerned about how this might affect the 'less-informed' patient. However, in the UK, participants stated that their adherence to treatment was also reinforced by their doctor's advice. CONCLUSIONS: Participants wanted to receive information about the benefits of their medicines. However, they may misinterpret the numerical information provided.

Pilot testing of guidelines to support good practice in the development of professional portfolios.

AIMS: The aims of this study were to evaluate whether the introduction of new evidence based portfolio guidelines helped students and assessors to understand the expectations for completion of a clinical practice portfolio, and whether this understanding resulted in the submission of evidence consistent with the guidelines. METHODS: New evidence based portfolio guidelines were introduced to an undergraduate BSc (Hons) Radiography (Diagnostic) programme. A total of 134 students completed 12 item questionnaires relating to using the portfolio guidelines. Semi-structured interviews were undertaken with 12 students and 5 lecturer practitioners. Documentary analysis was undertaken on 26 portfolios. RESULTS: Survey data indicated that the new guidelines increased students' understanding of portfolio evidence requirements. Statistically significant increases in scores were evident for only two out of 12 questions; these related to understanding the need for critical reflection and which elements of the portfolio would be rewarded in assessment. Survey data also indicated some dissatisfaction with the role of lecturer practitioners and clinical assessors in relation to portfolio development. Interviews provided more mixed perceptions of the contribution of enhanced guidelines and identified some reasons for dissatisfaction with the lecturer practitioner and clinical assessor role. Documentary analysis indicated that whilst the guidelines improved students' and lecturers' understanding of evidence requirements, this did not translate into portfolio evidence which matched guideline expectations. Portfolio evidence was restricted to meeting the minimum profession specific task requirements and often indicated a mis-match between guideline expectations and assessor assessment judgements. CONCLUSIONS: New evidence based guidelines improved understanding of evidence and presentation requirements for clinical practice portfolios. Consistent interpretation of portfolio guidelines however requires structured preparation and ongoing support of students, assessors and lecturers if the pedagogic aims for clinical portfolio use are to become an integral part of providing evidence of meeting professional competence requirements.

The development of evidence based guidelines for clinical practice portfolios.

AIMS: Although the use of portfolios is widespread within healthcare education, agreement on their purpose, content, assessment and value is still debated. The objective of this study was to achieve consensus on quality criteria for clinical practice portfolios that would act as guidance for students and lecturers. METHODS: A Delphi survey was undertaken to seek consensus on the opinions of 23 'expert participants' through a series of rounds of structured questionnaires. The Delphi tool was produced as an on-line survey questionnaire and panel experts were invited to score statements using a discrete 7 point visual analogue scale. The statements were written as quality criteria relating to portfolio development which had been identified from the literature and by the research team. The survey employed three rounds of feedback and consensus was measured as 80% agreement for each quality criteria scoring 5 and above. RESULTS: Consensus was reached on 31 quality criteria which were categorised into 4 areas: structured collection of labelled evidence; nature of evidence; critical reflection; and assessment and judgement. Mean scores for the final wording of the quality criteria ranged from 5.3 to 6.8 with the standard deviation for all of the mean scores being below 1.5. There was consensus that these quality criteria were relevant to health and social care professionals involved in developing clinical practice portfolios. CONCLUSIONS: The Delphi process facilitated exchange of ideas amongst panel 'experts' about the content and evaluation of clinical practice portfolios, with most debate relating to judgement of competence and rewarding originality and creativity. These issues illustrate the tensions between educational values and professional constraints. The Delphi process proved to be an effective method for achieving consensus on quality criteria for clinical practice portfolios and enabled the development of validated guidelines.

Learning for real life: patient-focused interprofessional workshops offer added value.

OBJECTIVES: This paper reports relevant findings of a pilot interprofessional education (IPE) project in the Schools of Medicine and Healthcare Studies at the University of Leeds. The purpose of the paper is to make a contribution towards answering 2 questions of fundamental importance to the development of IPE. Is there a demonstrable value to learning together? What types of IPE, under what circumstances, produce what type of outcomes? DESIGN: Pre-registration house officers (PRHOs), student nurses and pre-registration pharmacists attended a series of 3 workshops intended to develop participants' understanding about each other's professional roles, to enhance teamworking and to develop communication skills. Evaluation covered the process of development of the workshops, the delivery of the workshops and their effects on both facilitators and participants. RESULTS: The course was well received by the participants. The learning reported by the participants reflected 2 project objectives. Participants emphasised communication skills--both with other professionals and patients--and the development of increased awareness of others' roles. These 2 aspects were interlinked. CONCLUSIONS: The project aims and 2 of the learning outcomes were achieved. There was a demonstrable value to learning together, particularly with regard to interprofessional communications. This project was effective and can make a contribution towards answering the question 'What types of IPE, under what circumstances, produce what type of outcomes?'