Framework for Competence Development in Pharmacy

Transcription

1 Tempus PQPharm Conference on the Competencies in Pharmacy School of Pharmacy, University of Belgrade; 24 th May 2011 Framework for Competence Development in Pharmacy Graham Davies, Professor of Clinical Pharmacy & Therapeutics, King s College, London

2 Content 1. Drivers changing the education landscape 2. Current activity Competency (professional development) Frameworks 3. Infrastructure building delivering practitioners fit for purpose 2

3 Drivers for Change. Medication related problems International data on adverse drug events e.g. US, Australia, UK 3

4 Deaths in England and Wales from medication errors and adverse effects Audit Commission 2001 A spoonful of sugar 4

5 Medicines adherence rates can diminish over time 100% 80% 60% 40% high adherence low adherence 20% % 1M 3M 6M 12M n=120 accepting HAART (Horne et al JAIDS.2007;45{3}: ) Significant increase in the number of participants reporting low adherence over follow up (Cochran s Q =39.9, df = 3, p<0.001) 5

6 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? 6

7 Progressive regulation & revalidation... Linked to societal needs (safety, services, policy) Outcomes, not credits Competence, not hours Collaborative, not sectoral 7

8 8 Where are we now?

9 The typical response.. Mandatory Continuing professional development (CPD) but the problem with CPD is. 9

10 What What SHOULD is CPD? deliver? lifelong learning, ongoing process regardless of your age or the stage of your career Continuing Professional focused on your personal / individual competence in a professional role Development improve your personal skills to improve patient care and your career progression 10

11 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) 11

12 Why is competence so important? 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) 12

13 Competency iceberg Effective and persistent behaviour Knowledge Skills Abilities Values, attitudes and beliefs 13

14 Fuzzy concepts Competence Overarching capacity Competences Functional, the what Competencies Qualities, the how 14

15 15 Competency Frameworks Australia

16 16 Competency Frameworks Canada

17 17 Competency Frameworks UK

18 18 Competence approaches have their critics..

19 Competence, like truth, beauty and contact lenses, is in the eye of the beholder Dr Laurence J Peter 19

20 Critical accounts Competence approaches Reductive Shopping lists Job specific Central control Adequacy not excellence 20

21 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,

22 22 Competency supporting a Career Pathway for Pharmacists

23 Pharmacist development model Undergraduate & preregistration General postregistration Higher level practice (1) Higher level practice (2) Advanced Practitioner Consultant Pharmacist SI or PhwSI General Level Specialist or Advanced Level Professional Development Frameworks Workplace education; work based learning 23

24 24 Competency Frameworks UK

25 25 General Level Framework (UK)

26 26

27 GLF Structure 27 11/07/ th ISPW - Queenstown, New Zealand

28 Likely impact of frameworks? Do they improve performance? 2

29 .7 Controlled trial GLF in junior pharmacists Probability Intervention Intervention = GLF n = 30 hospitals Logrank P = Non-intervention Time - months (Antonio u et al. Pharmacy Education 2005) 29

30 Performance improvement in Community Setting Community pharmacists Practice pharmacists 30

31 Pharmacist development model Undergraduate & preregistration General postregistration Higher level practice (1) Higher level practice (2) Advanced Practitioner Consultant Pharmacist SI or PhwSI General Level Specialist or Advanced Level Professional Development Frameworks Workplace education; work based learning 31

32 32 National Competency profiles advanced practice

33 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 33

34 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 34

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36 Mean cluster score Specialists Level 1- in training Foundation Experienced Level 2- practitioners Excellence 36 Current level of practice Leading-edge Level 3- practitioners Mastery Expert Practice Working relationships Leadership Management E&T and Development Research & Evaluation Knowledge and skills Experiences and evidences

37 Attaining Competence Problems for the Pharmacy Profession 1. 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 37

38 Integrating Competency Frameworks into Education: The London, East & South East Joint Programme Board Experience

39 Reforming the Education Model Key Ingredients Clarify the goal of education Build infrastructure to ensure a quality system which delivers the goal Establish a modern curriculum Ensure assessment strategy is appropriate driven by competence and performance

40 Joint Programmes Board Collaboration between 9 universities and the NHS in the south East of England. Geography represents approximately 40% of the population of England. Universities London Brighton King s College Medway Portsmouth UEA Reading Kingston Hertfordshire Developing & delivering a modern work based postregistration curriculum for pharmacists.

41 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.

42 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

43 The challenges of workplace based learning Work Observation Participation Learning Assessment Assessment of task Assessment of learning acquired to date

44 Miller s pyramid Supporting post-registration development Does Shows how Knows how Knows performance Performance-based, assessment MiniPAT, vivo MiniCEX, etc performance OSCE style assessment in vitro clinical Case studies/ context PBL assessment /Portfolio factual MCQ / assessment Exams

45 It s what pharmacists do that s important Competence System factors Human Factors Miller Cambridge Pyramid Performance

46 Represents vast majority of junior pharmacists in catchment

47 Accreditation of Training Centres >70 accredited hospitals North London 20 East Of England & Essex 15 South Central 10 South East Coast 10 South London 16

48 Trainee Performance

49 Basic Knowledge MCQ scores cf old system

50 Student perceptions of personal development Yes, definitely definitely not Contrıbutıon to my development Career development

51 Summary Need 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

52 Tempus PQPharm Conference: Competencies in Pharmacy School of Pharmacy, University of Belgrade; 24 th May 2011 Framework for Competence Development in Pharmacy Questions? Graham Davies, Professor of Clinical Pharmacy & Therapeutics, King s College, London