The Pharmaceutical Journal Vol 264 No 7090 p513-517
April 1, 2000 Articles

Enhancing the performance of graduates: the new pharmaceutical care centre at the Robert Gordon University, Aberdeen

The practical aspects of pharmaceutical care are being taught to undergraduates in a new pharmaceutical care centre in the school of pharmacy at the Robert Gordon University, Aberdeen. Graeme Smith, an assistant editor on The Pharmaceutical Journal, returned to his alma mater to attend the official opening of the centre on March 23 and view its facilities

The pharmaceutical care centre in the school of pharmacy at Aberdeen's Robert Gordon university is a new £400,000, custom-built, state-of-the-art facility incorporating mock-ups of a general medical practitioner's surgery, a hospital location, a community pharmacy, consulting rooms, a dispensary and a drug information centre. It is used on the school's undergraduate MPharm course and the postgraduate diploma and MSc courses in clinical pharmacy and prescribing sciences to supplement practice-based, experiential learning and to facilitate the development of skills required for new professional roles. Use of the centre is intended to enhance the performance of pharmacy graduates through simulated experience-based learning before they enter the clinical environment. According to Professor Clare Mackie (head of the school and a member of the Crown review committee), the centre's creation is particularly pertinent following the publication last year of the final report of the Crown review of prescribing, supply and administration of medicines. Since the Government is considering the implementation of the Crown recommendations, which include proposals to extend prescribing rights to non-medical health care professionals, including pharmacists, the centre will have a major role to play. Professor Mackie says: "The centre enables us to simulate real-life clinical situations which are students are likely to be presented with after they qualify, enabling them to fast-track their learning in a protected environment. It allows them to fine-tune their knowledge and skills and match this with what will be required of them in their professional roles before they enter the clinical environment. This will not only enhance the students' learning experience, but will protect patients." The pharmaceutical care process being taught follows the now classical model of identifying patients' needs, formulating a care plan to meet those needs and monitoring and reviewing the progress of treatment. The model is incorporated in the Clinical Resource and Audit Group document "Clinical pharmacy practice in primary care". Learning activities within the care centre are highly patient- and problem-based and require students to demonstrate competence in the full range of skills that are required by today's practitioners. These include cognitive skills such as problem solving and care planning, together with a range of practical skills, such as communication, counselling, and negotiation, and the competent use of clinical equipment such as sphygmomanometers. The centre's main facilities are described below. Reception/notes area The reception area incorporates a waiting area in front of a reception desk. Facilities at the reception desk include access to a local computer network and a local telephone exchange. The computer network enables access to the general medical practice information management package GPASS, the usual Microsoft office software and the internet. The network is designed to facilitate transfer and integration of information between different areas of the care centre including the mock pharmacy, dispensary, consulting rooms and the hospital location. Three bays behind the reception desk house 10,000 sets of primary and secondary care case notes. These case notes are real, but anonymised, and reflect the spectrum of disease states that are commonly presented in primary and secondary care and are incorporated into teaching sessions for undergraduate and postgraduate courses. Consulting rooms/community pharmacy At the centre of the consulting rooms and community pharmacy area is a video camera which can be turned through 360 degrees. This means that activities in any part of the area can be recorded and replayed for discussion and appraisal either to individual students on a local monitor or to a whole class on a large screen in the dispensary.
	Pharmacy students dispensing mock prescriptions in the centre's clinical skills laboratory. The student on the telephone is discussing aspects of the prescription with the prescriber, who will have written the prescription in the GP consulting area
	Mr Omar Shakoor, lecturer, demonstrates patient counselling in the mock community pharmacy
	Mr Scott Cunningham, lecturer, demonstrates how to review a patient's drug therapy in the GP consulting area
	A "patient" undergoing a lung function test in the near patient testing consultation area
	A tutorial discussion about a patient's case notes under way in the clinical skills laboratory

Hospital location/near patient testing consulting area

The hospital area has been designed to reflect the situation in secondary care. It includes a consulting couch, washing facilities and such equipment as intravenous infusion devices, an electrocardiograph machine, and a cardiac monitor. The equipment is demonstrated to students, who are given hands-on experience of its use. The area is also used to demonstrate and test student competence in carrying out near patient testing techniques such as those for lung function, INR, blood glucose and lipids.

GP consulting area

The general practice consulting area has basic consulting room equipment, such as a desk, chairs and an examination couch, and is staffed by three part-time medically qualified teacher practitioners who are sponsored by Aventis. These teacher-practitioners man the consulting area during teaching sessions (some of which involve real patients who have been invited by the school of pharmacy to take part) and demonstrate basic examination techniques. These practitioners will assist students in resolving simple prescription problems in the early years of their course and more complex care issues in the later years.
Students, who start learning in the centre from the very beginning of the pharmacy degree course, are able to contact the GP teacher practitioners to discuss therapy prescribed. They also gain experience in and are assessed on their ability to manage care issues concerning the drug therapy of individual patients.
In order to demonstrate to the students how different levels of patient information facilitate the process of discussing and resolving care issues with other health care staff, teaching sessions are designed to allow access to varying amounts of information from the prescription, from the pharmacy held patient medication record and from the full medical notes.

Community pharmacy area

The mock community pharmacy area is used for demonstrations and allows students to show competence in dealing with patients who present with minor ailments or in responding to symptoms. The pharmacy is stocked with a wide selection of over-the-counter medicines and includes an area for the display of health promotion leaflets.
This area also includes a computer allowing access to a typical community pharmacy PMR system.

Professions allied to medicine area

Other health care professionals, such as nurses, physiotherapists and dietitians, have the use of a consultation room for professions allied to medicine. The incorporation of these professions into teaching sessions demonstrates to students the relative roles of each of the professions within the health care team and the importance of a team approach to the pharmaceutical care of patients.

Clinical skills laboratory

The main teaching laboratory area of the care centre - the clinical skills laboratory - acts as the dispensary. It is staffed by three full-time members of staff and two part-time teacher-practitioners supported by Boots and Lloyds. The area has desk height benches, which facilitate group work and whole class instruction by teaching staff. Computer terminals are available at the end of each bench for the labelling of dispensed products. The computer terminals allow access to a community pharmacy patient medication record system. A modern drawer unit system lines one wall of the dispensary and carries an extensive range of prescription-only medicines.
The dispensary is used to demonstrate the application of legal procedures, ethical issues, communication and counselling skills and the identification and resolution of compliance problems.

Drug information centre

The drug information centre houses around 30 computer terminals which allow students to access local online drug information sources, eg, the electronic BNF and Martindale online, as well as internet databases such as Medline, Pharmline and Cinhal. Paper based reference information sources are also available, eg, Merec Bulletin, SMRC Bulletin, Drug and Therapeutics Bulletin, and medical and pharmaceutical reference texts.
The DI centre is used to demonstrate to students the range of drug information sources that are available, the advantages and disadvantages of each and good strategies for obtaining drug information. Students also gain experience in formulating, delivering and following up both verbal and written advice for health care staff.
As well as queries relating to individual patients, the information sources are used to facilitate teaching of the principles of development of practice or hospital level formularies and guidelines.
A conference table has been included in the drug information centre to allow for simulated practice of drug and therapeutics committee meetings. At these meetings, each student is given a different role: two act as GPs, one as a consultant, one as a drug information pharmacist and one as a health service manager. Each discusses and makes his or her case for inclusion of a drug in an imaginary formulary after having done the appropriate research. The whole group then decides whether the drug will be included.

The future

Professor Mackie expects that the centre will have a part to play in the drive towards clinical governance. "The clinical governance framework, introduced following the Bristol heart inquiry, makes trust managers responsible for the clinical performance of their staff. Therefore, there is now an even greater emphasis on ensuring clinical competence and I expect that, in the future, the centre will be used to meet the continuing professional development needs of a range of health care professionals."