June 2014

The Pharmacy Vocational Training Scheme: Learning from experience, learning in practice.

Stages 2, 3 4.

June 2014

Review date February 2015

Background

The Pharmacy Vocational Training Scheme[1,2,3] originated in 1995 and is supported by the NHS Scotland Directors of Pharmacy, both Schools of Pharmacy in Scotland and The Royal Pharmaceutical Society.

The Training Scheme was originally introduced for junior pharmacists within secondary care,with the view to provide them with a comprehensive structured training programme over a two year period. Over the past five years, the training scheme has been redesigned and redeveloped to meet the changing needs of the service. Developments have also included the introduction of Specialist Training Frameworks.

Introduction

The Pharmacy Vocational Training Scheme is a structured, work-based training experience for hospitalpharmacists to enable them to deliver safe and effective pharmaceutical care. It is available for pharmacists working within secondary care within NHS Scotland. Currently available at Stage 2 (Generalist Level), it is being developed at two furtherlevels;

  • Stage 2 [general/foundation training]
  • Stage 3 [specialist clinical training]
  • Stage 4 [education, leadership and research modules].

Pharmacists should have completed Stage 2 prior to embarking on Stage 3 training. However, it is envisaged that whilst undertaking Stage 3 training they may start a module within Stage 4.

There will be instances where the previous level of training has not been achieved and there are pre requisites to help where previous stages of training have not been achieved.

What is the aim of the Vocational Training scheme?

The aim of the Pharmacy Vocational Training Scheme (VTS) is to facilitate the acquisition of knowledge and skills necessary for pharmacists to participate fully in their post as a general (hospital) pharmacist. The emphasis is on developing competence (the ability to perform tasks consistently to the required standard)using activities in the workplace and a structured training rotation. The training is based on gaining experience by undertaking a task, demonstration of competence and reflection on learning from undertaking the task. This may require the task to be undertaken on a specified number of occasions.

Stage 1(Pre registration training) training is undertaken in either community or hospital pharmacy.

Stage 2 (General/foundation training) is for junior pharmacists (Band 6 or equivalent), currently working in secondary care, who need to develop general skills and gain a broad experience in pharmacy practice prior to specialising in a clinical area of practice.

Stage 3(Specialist training) is for more senior pharmacists (Band7 or equivalent) who need to develop more specialist skills, in particular clinical skills.

Specialist modules that are available/in developmentare:

  • Cancer
  • Clinical Trials
  • Critical care
  • Infection and Antimicrobial Stewardship
  • Older people
  • Public health
  • Rheumatology

Stage 4(Advanced training)is currently under development but it is anticipated that it will comprise of 3 advanced modules:

  • Education
  • Leadership
  • Research.

Currently there is a course entitled ‘Taking the Pharmacy Vision Forward : a leadership course for pharmacy staff’that comprises 6 days of face - to -face learning over a 9 month period. The course requires demonstration of application of leadership theory with pharmacy practice by participants undertaking a series of short work based projects throughout the course. To this end, the days are scheduled throughout the year to enable projects to be commenced, undertaken and evaluated. Participants are also required to develop professional CPD records as evidence of undertaking the course. A certificate of completion is issued at the end of the course.

A competency framework is currently being developed and will replace the e portfolio for Leadership that was launched several years ago.

Further opportunities for multidisciplinary leadership training are also sign posted after completion of the pharmacy course. They include opportunities to attend a multi - professional course ‘Leadership and Management’ which is organised by the NES, Medical Directorate andLeading for the Future which is organised by the NES Leadership Unit.

How do I register to start training?

There is registration information on the NES Pharmacy website. Eachyear there is the opportunity to register for training, three times per annum, in September, January and May. Registration is online. After registering trainees are expected to undertake the relevant induction training prior to starting completing their competency framework.Details of the induction materials are on the NES Pharmacy website.

Requirements prior to startingthe different stages of Vocational Training

There are some requirements that trainees need to undertake prior to starting training at Stages 2 and 3.

To undertake Vocational Training Stage 2 (VT2), currently, the trainee needs to be employed in secondary care within the NHS in Scotland and they ideally should have undertaken their Pre Registration training (PRPS) within secondary care. However, this is not mandatory.

Prior to embarking on Stage 2 trainees need to understand the fundamentals of aseptic dispensing, dispensing and the provision of pharmaceutical care. They need to have completed the following :

  • aseptic training - aseptic dispensing and checking processes, the aseptic environment , formulation and stability of aseptic products, the preparation of intrathecal injections (written modules available, simulation for preparation of 3 products required.
  • dispensing training -the in- patient and out - patient dispensing processes
  • the provision of pharmaceutical care to patients using the documentation provided (webinar available)
  • the Adverse Drug Reaction reporting modules (available on NES website)

In each instance they need to develop as a piece of evidence a testimonial and have a discussion with their tutor.

Prior to embarking on any module of Stage 3 of The Pharmacy Vocational Training Scheme, trainees need to have completed the following resources:

  • the provision of pharmaceutical care to patients using the documentation provided (webinar available)
  • the audit process (completed an audit, see NES CPD web pages)
  • the reporting of an analysis of a Significant Event (completed and SEA, see CPD web pages)
  • the process of Critical appraisal (completion of Critical appraisal modules 1 and 2, plus MCQs)
  • patient safety (webinar available)
  • risk management (webinar available required)
  • leadership theory (webinar or attendance at a course introducing leadership theory)
  • the Adverse Drug Reaction reporting modules (available on NES website)

In each instance they need to develop as a piece of evidence a testimonial and have a discussion with their tutor or Educational Supervisor.

Prior to starting a specific Stage 3 module, there are some further pre requisites depending on the specialist module.

All pre requisites should be demonstrated by having a discussion with the tutor after completing the relevant resource to ensure that the pre requisite is met. Where there is no resource, guidance should be sought from the Educational Supervisor.

Pre requisites for the Antimicrobial module of Stage 3 of The Pharmacy Vocational Training Scheme

  • Pre requisites for Stage 3 of the Pharmacy Vocational Training Scheme

Below are the specific pre requisites for the VT3 Infection and Antimicrobial Stewardship module that are required to be completed as well as the generic VT3 pre requisite activities before you start your VT3 training.

Critical appraisal skills Level 1 and 2. If you have previous experience of critically appraising literature, then there is no need to undertake any activities that are included as part of the presentations.

• Health Associated Infection (Mandatory training package)

  • Health Associated Infection (Mandatory training package,)

Vocational Training: Stage 2

Completing Stage 2 of the training scheme ensures that pharmacists achieve a ‘well rounded’ ‘general’, structured training within their first two years of starting within the hospital setting. It also enables trainees to gain experience in some areas that they may not have been able to experience had they not been part of the training scheme.[4,5] Stage 2 of the Vocational Training scheme has been mapped to the KSF.

The training is recognised by the Directors of Pharmacy and the Schools of Pharmacy (SOPs) in Scotland as well as Queens University, Belfast. For details of any Approved Prior Learning (APL) trainees should contact the various universities.

The training takes approximately 18 months to 2 years to complete during which trainees complete tasks and develop a variety of different forms of evidence to demonstrate that they have achieved competency for a particular performance standard. The evidence is collated into a portfolio which is then submitted as part of the assessment process.

Trainees who are unable to complete within the 2 years period should indicate an estimated date for final assessment unless due to exceptional circumstances this is not possible.

The in-practice training provides trainees with the opportunity to gain knowledge, skills and experience in the following key rotational areas of :

  • Dispensary
  • Aseptic services
  • Clinical Pharmacy
  • Medicines Information.

For each rotation there are a specified set of competencies which are used to plan, conduct and evaluate the trainee’s performance.

There are also rotational practice activitieswhich the trainee must complete, to help them achieve the competencies.

The rotation is also supported by a series of ‘modules’ that help the trainee develop underpinning knowledge for their rotation.

Competence is also required to be demonstrated in some ‘wider’ areas e.g. medical gases, procurement and formulary management. This helps the trainee gain an insight into the ‘wider’ practice of pharmacy which should, as the trainee progresses, complement their practice.

The workplace rotations are intended to be flexible to accommodate individual learning needs and service requirements. For example, experienced trainees moving into hospital practice from another area of pharmacy, such as community pharmacy, may be able to demonstrate their competence in some rotations in a shorter time than a newly qualified pharmacist. In such instances the previous experience should be recorded in the paperwork with ‘gaps’ identified and targeted as part of their rotation.

Frameworks for training

What is the framework for each of the stages of training?

For each stage of the Vocational Training Scheme, the trainee completes a competency framework and provides evidence in the form of an e-Portfolio.

Within VT2 training there are 9 domains:

  • aseptic dispensing
  • clinical services
  • cost effective use of medicines
  • dispensing services
  • education and Training
  • medical gases
  • medicines information
  • patient safety
  • professionalism.

Within VT3 training each framework comprises specialist clinical areas with the more generic aspects of training being covered in the VT4 modules of Education and training, Leadership and Research.

What type of evidence can be collected?

A wide variety of different types of evidence can be collected within the VT ePortfolio. For VT2 trainees, the main form of evidence is the development of GPhC CPD records. However, both VT2 and VT3 trainees are also required to collect and develop:

  • case based discussions (CbDs)
  • feedback forms
  • mini – clinical evaluations (mini – CEX)
  • presentations
  • short reports
  • training plans.

What does the e - Portfolio comprise of?

The e-Portfolio is a resource to help trainees collect and organise their evidence online. The format of the e-Portfolio has been designed to enable tutors and assessors to view the evidence in a systematic fashion. There are areas for:

  • forms - appraisal, completion of section of framework, rotation details, meeting with tutor, declaration of work and templates for; aseptic dispensing, dispensing services and medicines information
  • logs - care plans, case studies and reflective and action based logs
  • compilation of references (personal library)
  • resources (underpinning knowledge modules).

Support for training

There is a variety of support available for VT2 and VT3 trainees when they are undertaking training namely:

  • locality tutors (LT) (VT2 trainees)
  • specialist tutors (ST) (VT2 trainees)
  • pharmacy Practice Education Coordinators (PECs) (VT2 and VT3 trainees)
  • vocational Training tutors
  • local site based trainers (VT2 and VT3 trainees).

The LT and ST role are similar in principle. However, the LTs have a greater responsibility for larger areas (usually regional) and provide guidance and support to STs and tutors within this larger remit.

The LT also delivers training sessions, attends National meetings and ensures that the VT curriculum is in line with service redesign as well as being involved in portfolio assessments and final assessments where they may be required to be the Chair a panel.

Vocational Training Specialist Tutors are expected to support other pharmacists locally during training towards Stage 2 of The Pharmacy Vocational Training Scheme within their sector of practice within their Health Board Area. This will involve acting as a role model in practice and supporting pharmacists with achievement of the competency framework, hosting local peer review sessions for trainees and guiding and advising the tutors of trainees. Support with this role will be available from your Regional Practice Education Coordinator (PEC).

Pharmacy Practice Education Coordinators, employed by NES, are responsible for different regions within Scotland and will meet with trainees shortly after registration to ensure that they are informed prior to starting training. They may also run local induction and peer sessions to ensure that trainees progress with their training throughout the 18month to 2 year period.

Vocational Training Tutors are experienced pharmacists. They are required to register with NHS Education for Scotland as part of the Vocational Training Scheme and are expected to keep themselves abreast of developments by attending at least every 3 years a Vocational Training Peer session at least every 3 years. They are expected to facilitate training but will not observe practice on a daily basis.

It is anticipated that tutors will meet with trainees on a monthly basis to;

  • review progress
  • sign off/discuss completed evidence
  • develop objectives
  • complete appraisal forms.

The tutor has a supportive role, and is involved in facilitating the trainee’s learning and assessing their development.

They do this by:

  • helping the trainee to identify their development needs
  • supporting, advising and encouraging the trainee during their training
  • undertaking

a)formative assessments (to monitor and review the trainee’s progress)

b) summative assessments(to check that the trainee has met the required standards).

At the end of each rotation, the workplace tutor will use the competency framework to carry out a summative assessment, which will check that the trainee has met the required standard. Evidence should be reviewed, competencies signed off and any ‘gaps’ for further training identified.

The criteria for tutors, is under development. However, within their application to register as a tutor they are required todetailtheir; professional journey/experience to date, training/mentoring experience and their commitment to CPD (for which they may submit a Significant Event Analysis).

Trainers are experienced technicians and pharmacists who may sign off activities whilst the trainee is within their section. Trainers are not currently registered with NHS Education for Scotland, nor do they routinely attend training however, any trainers are welcome to attend any of the training days

Mentors are pharmacists who have recently completed the training scheme. They may informally advise new trainees and may share their experiences of completing the training scheme.

Are there resources for training?

Once registered for training,trainees will receive/be able to accessa copy of the competency framework and modules which they will need to refer to whilst undertaking training. There are induction materials for trainees and tutors as well as a series of webinars available via the NES website.

Assessment

What is the format of the assessment processes?

VT2 and VT3 trainees are assessed throughout their training on a regular basis.

For VT2 trainees this tends to be by their tutor at their base. For VT3 trainees there are In Training Reviews (ITRs) that are peer review sessions that are held on a regular basis.

In Training Reviews for VT3 trainees

In Training reviews are designed to be supportive and to enhance learning whilst providing feedback on progress. The sessions are attended by 3 or 4 members of the Specialist Group, NES and the specialist trainees.

The format comprises – presentation from each trainee (case study), training completed to date and objectives for the next 3 months. All trainees are present at the session and are expected to contribute. Written feedback is provided. Vc is available where possible. Trainees need to attend at least one ITR during their VT3 training.

Appraisal

Tutors forVT2 are expected to submit regular appraisal forms to NES. Appraisal forms are monitored and where required guidance and support is provided to tutors and trainees. Submission of a suitable final appraisal indicates that the tutor supports the trainee coming forward for final assessment.

Formative assessment

There are two diets of assessment per annum in May and November.

When trainees are ready to submit their portfolio for assessment they should register for assessment via their locality tutor (VT2) or their Educational Supervisor (VT3). Names for assessment will then be passed to NES.

For VT2 and VT3 trainees there is a portfolio assessment and a final assessment. They are generally about 3 weeks apart. See Appendices A,B and C)

Portfolio assessment

Trainee portfolios are submitted to NES by the deadline specified. The portfolios are examined by pairs of assessors using a standard marking schedule. Trainees receive written feedback and are advised what they need to prepare for discussion at their final assessment. Should the trainee require toprepare only a few minor items ( 5 items) for discussion at the final assessment then they will be invited to attend the final assessment. Should they require to prepare more than a few minor items (>5 items) for discussion at final assessment then they will be deferred to the next set of assessments.

After a successful portfolio assessment the trainee is invited to attend for a final face - to- face assessment.