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Bruce Warner and David
Gerrett, of the pharmacy
academic practice unit at the University of Derby
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Recent developments and our own experience have led us to question the
viability of the traditional model of the lecturer-practitioner (LP).
Could the advent of multiprofessional deaneries provide an alternative
framework?
The role of the LP has become increasingly recognised within the profession
of pharmacy since the 1990s, having previously been well established
in medical and nursing education. By forming an interface between practice
and the learning process, the practical application of theory is disseminated.
Put simply, it adds reality to education. Furthermore, in its policy
document “Making a difference” the Government recognises
the role of the LP in preparing students for practice.
However, many questions remain about the effectiveness of he LP model.
The optimum balance between teaching and practice, whereby neither is
compromised, is still to be determined, as is the value to general pharmacy
education of an LP who has become highly specialised. Furthermore, it
is unclear how the profession will deal with LPs’ continuing professional
development (CPD). Will the educational role in itself constitute CPD,
as recognised by the College of Pharmacy Practice, or will practitioners
have to demonstrate ongoing competence in all areas in which they are
involved?
Generic or specialist skills?
Pharmacists build on a generic skill base, gained by virtue of their
undergraduate education and preregistration training. Building on this
platform of common knowledge, pharmacists become experienced generalists
or specialists.
In common with other health professional, there is a trend for pharmacy
LPs to become increasingly specialised, but this will have consequences.
As the focus of their chosen area narrows, there may come a point when
highly specialised pharmacy practitioners are best placed to educate
multiprofessional groups specifically within their focused area of practice.
As such, their use as LPs for generalist training may diminish.
Conversely, generic skills will take a pharmacist to a certain level
of competence but at what level does this become adequate for those pharmacists
who are pursuing a specialist role? This is perhaps something that developing
competency frameworks will address in regard to new roles and the development
of consultant pharmacists.
Policy makers and managers need to optimise the balance between generalism
and specialism as well as teaching and practice. This balance must be
such as to preserve practice competence.
At the pharmacy academic practice unit at the University of Derby, we
experimented with a model of the LP whereby a university employee was
placed in practice for two days a week under reciprocal agreements with
both primary and secondary care. Clinical services were exchanged for
expertise in maintaining academic material. This model was chosen to
allow generalist practice competence to be maintained by a salaried academic.
Whereas most pharmacy LPs are more aligned with practice and have little
formal training in education, we hoped to come “from education” to
practice. We found that one day a week made continuity of practice difficult
in a secondary-care clinical setting where the LP had little previous
experience. The model proved more successful in primary care, where the
LP’s experience was more extensive.
So what should be done? Should we seek to optimise the existing model
and the balances? Alternatively, is the path to follow the medical model
and, as is happening in Trent to other health care professions, transfer
pharmacy education to the new multiprofessional deanery based at the
Trent Strategic Health Authority?
Pharmacy education and practice is at the crossroads. Dhillon and Curtis
describe the deanery
model, where postgraduate education is situated
within strategic health authorities and aligned to universities (PJ,
21 August 2004, p256). The uncertainty described above and the recent
innovation of a multiprofessional deanery makes us wonder whether the
LP as we know it has run its course and whether the model used in Derby
needs to be revised?
The nature of the multiprofessional deanery is currently being developed
and it may take some time for pharmacy educators to understand its functioning
and implication. If it follows the medical model the status of both students
and tutors is likely to differ from current pharmacy models.
It might be argued that the commercial interests of pharmacy would preclude
its integration within deaneries, although the extensive business interests
of general practice does not seem to be in conflict with the medical
model.
Should we let a multiprofessional deanery pay specialist practitioners,
who are required to become educationally sound, to take students on a
rotational basis as is the case in medicine. In the process we risk the
demise of the traditional LP and the rise of the consultant pharmacist
with a discrete educational input? This solution would circumvent many
of the problems that universities face in employing LPs. By remaining
in practice, LPs do not fit neatly into the academic model. Remuneration
is at odds with other academic staff. Each LP post is unique because
practice situations vary considerably. Universities have to pay for such
expertise over and above the educational skill. Finding professionals
with these skills is not always easy, and they will need to demonstrate
a research commitment as demanded by the publishing ethos of most higher
education institutions. Interprofessional education
One of the arguments for the multiprofessional deanery is to facilitate
interprofessional education. Generic core skills are developed through
a learning process whereby different professionals interact and develop
collaborative practice. This raises the baseline from which professionals
are judged fit to practise and allows them to build experience from
there on their way to a specialist role.
Given the previous discussion regarding specialism by LPs, at what
point in the process of specialisation are they able to engage? As
they become
more and more specialist do they become less able to be part of interprofessional
education?
The deanery model promotes the role of the specialist practitioner
with educational qualifications. Tutors within placements are paid
to teach
and we believe this model would lead to stronger links with academia
and a greater acceptance of education within mainstream employment.
For current pharmacy LPs this would have an even greater impact as
they are
less focused in education than their medical counterparts. Although
both primary care and secondary care employers may have their own pharmacy
tutors, few of these will be formally aligned with an academic institution
in the way that many medical consultants and GP trainers are.
So where are we going? We must not lose sight of the fundamental issue
that pharmacy is a vocational profession underpinned by a substantial
science component. The unwritten role of the LP is to bring vocation
to the educational socialisation of students. We need somebody to do
this job, be it an LP or a consultant pharmacist, and we need a structure
to support them.
Our overall assessment is to move towards the deanery model, but we
urge researchers to determine whether this proves to be a wise move
or a shot
in the dark! |
The
Pharmaceutical Journal