The Pharmaceutical Journal
Vol 280 No 7502 p597-598
17 May 2008

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Introduction to community pharmacy: the University of Manchester experience

The School of Pharmacy and Pharmaceutical Sciences at the University of Manchester has adopted a novel approach in an attempt to provide pharmacy undergraduates with an understanding of the role of the community pharmacist and exposure to the community pharmacy environment.
Ian Smith and Jason Hall explain

The benefits that pharmacy undergraduates could obtain from exposure to actual working pharmacies have been discussed in several articles.^1–3

These benefits include increased knowledge concerning medicines, development of dispensing skills, increased knowledge of law and consideration of ethical issues.¹

It has been reported that some of these benefits are difficult to deliver in the academic environment.⁴ Many undergraduates currently spend their summer months working for one of the large multiple community pharmacy groups following a company training course which provide students with a structured exposure to a range of pharmacy experiences.

However, it would be difficult for schools of pharmacy to make vacation work a requirement of the MPharm programme and these vacation work programmes have not been designed to accommodate the large number of MPharm undergraduates that are in the UK.

This article describes the approach that the School of Pharmacy and Pharmaceutical Sciences in Manchester has adopted to give students in the first year of the MPharm course some experience in community pharmacies.

Background

Over the past few years there has been a move within the schools of pharmacy to provide students with exposure to both hospital and community pharmacies.

In Manchester the third and fourth year students follow a programme of problem based learning at three teaching hospitals in greater Manchester.⁵

This programme of visits works well because they are tied in with disease management lectures so the students have the opportunity to see patients with conditions that they have studied in the module.

Arranging a similar programme of visits for third- and fourth-year students to community pharmacies was considered by the practice staff at the University of Manchester but it was realised that the variable nature of the work in community pharmacy meant it would be difficult to tie visits in with the specific disease states covered in the therapeutic lectures in disease management.

Instead, it was considered that a visit to a community pharmacy would be of greater benefit to the first-year students, as it would provide them with an early understanding of the role of the community pharmacist and exposure to the environment in which community pharmacists works.

This visit could help students better understand the application of both the scientific training and practice training delivered later on in the course. However, it quickly became apparent that such visits for first-year students would be difficult to organise.

Some of the barriers identified were:

• Finding sufficient number of community pharmacists and pharmacies interested in taking students

• The time required by staff to find the pharmacists and to co-ordinate and monitor the programme of visits

• Finding time in the already full timetable for the visit

Also, educationally, ensuring the quality of training provided in each community pharmacy was not possible without considerable investment to provide resources to train, assess and accredit the pharmacy staff in the community pharmacies. The workplace experience would be, on the whole, reliant on the pharmacy and the pharmacist involved and since some of the pharmacies would not able to provide the full range of experiences there would be little consistency in the experience that each student receives.

There were also concerns around such aspects as health and safety (eg, issues surrounding allowing large groups into non-public areas of the store), whether students would be able to do anything other than observe and, if they did more than that, how would they be indemnified.

Also, from an ethical perspective, in the new code of ethics it highlights that consent from the patient should be obtained when a third party is listening in on a private consultation.

An alternative method of providing students with early exposure to community pharmacy practice and to experience what a pharmacist does, was proposed. It involved groups of students visiting a community pharmacy during hours when the pharmacy was closed.

The Boots teacher-practitioner approached the local Boots area pharmacy manager about the idea and an agreement was reached which included some financial recompense for using the store facilities. It was agreed that the large Boots store in the centre of Manchester could be used to run a pilot to assess the benefits and practicalities of conducting an orientation experience in this way.

What happened?

All the first-year students were invited to attend from 6.30pm until 8.30pm for one evening event. To ensure that the number of students would be manageable and to ensure that the students would feel part of the experience, the year was broken up so that groups of 20 students attended each evening session and the students were further subdivided into two groups of 10 to complete the activities on the night. This required nine evening sessions to be arranged.

The students were informed about the visit during the first week of their studies and the evenings were arranged during weeks 6, 7 and 8 of the first semester.

The pharmacy practice staff in the university supported the evening event and two members of staff were required for each evening. The learning objectives and outcomes were identified. A plan and a process for each evening was produced, as well as a checklist of the important items that the students would need to experience. This was done to ensure that there was consistency for all the groups.

On arrival at the pharmacy, the students were taken to a training room in the store where they were given a 30-minute presentation introducing them to the structure of the visit, the objectives for the visit, and the health and safety, security and confidentiality requirements of the students.

During the introduction it was emphasised that the evening was not about teaching the students the detail of the pharmacist’s role, but about contextualising their undergraduate course so they would understand what skills and knowledge they would develop over the next four years, before undertaking preregistration training.

There was also an interactive discussion with the students on the changing role of the community pharmacist.

At 7pm the store closed to the public (although Boots staff remained in the store to restock shelves, etc), and the students were divided into two groups. One group was taken to the dispensary and the other to the pharmacy counter for a 45-minute session, after which the groups changed over.

Dispensary The students in the dispensary were taken through the journey of a prescription, starting with the patient handing the prescription in at the dispensary. Two of the students were asked to role play the patient and the pharmacist while the rest of the group discussed the knowledge and skills that were required at each stage of the dispensing process.

The journey then progressed through the labelling and selecting of the product to the final accuracy check and to handing the medicine out to the patient with the appropriate advice. The process was repeated for a private prescription and a Controlled Drug to show the differences and enable the students to understand the different requirements for record keeping and storage.

Pharmacy counter The other half of the group was taken around the medicines area and pharmacy counter. The different product ranges were highlighted and the difference between general sale list and pharmacy products outlined.

The students then role-played a responding-to-symptoms scenario, and products were used to help them understand the knowledge needed when advising a patient on the correct medicine to take for their condition.

Students were then taken into a patient consultation room and shown the process and paperwork used in some of the services which are currently being provided such as the patient group directions for the provision of emergency hormonal contraception and patient testing as part of a health screening review.

Feedback

At the end of the evening a questionnaire was completed by the students to obtain their feedback and thoughts about the benefits and concerns they might have having attended the evening.

A preliminary review of this feedback has indicated that the vast majority of the students enjoyed the experience and found it of benefit. Before the event the staff had a concern about how it would have been perceived by students who had had previous work experience in a community pharmacy or those currently working in a pharmacy.

Although some students in these positions did question the need to attend this event, the feedback from the same students afterwards was they did find it of benefit and viewed the experience in a very positive light.

Informal feedback from the university staff indicated that they enjoyed participating in the evening, were pleased with the way the evenings went and were pleased with the way the students engaged in the experience.

Although the process does not give direct access to patients this was not thought to be an issue by staff as the students were actively engaged in role playing in a real pharmacy and staff had the opportunity to fully discuss learning points as they arose which would have been much more difficult if the student had been observing real patients.

Conclusion

Visiting a community pharmacy when it is closed helps to overcome many of the logistical problems encountered when trying to find placements for 200 first year pharmacy students and this experience was viewed in a positive light by teaching staff and students alike.

ACKNOWLEDGEMENTS We would like to thank Wendy Coglan, Victoria Crabtree, Jenny Inch, Harsha Puri, Nicola Turner and Mary Zargarani, who are staff at the University of Manchester and who supported the student visits, and Boots the Chemists.

References

1. McClelland C. Daisley R. Student holiday work. Tomorrow’s Pharmacist 1999:74–76.

2. Nathan A. What an experience! Working in the vacation. Tomorrow’s Pharmacist 2003:29–30.

3. Shooter B. Support students in need of work experience. Pharmaceutical Journal 2002;268:683.

4. Rees J, Collet J, Crowther I, Mylrea S. Personal learning outcomes of structured work-based learning in a summer placement in community pharmacy. International Journal of Pharmacy Practice 1998;6:91–95.

5. Silverthorne J, Mackellar A, Thomas S, Price G, Cantrill J. Problem based learning in the fourth year of the MPharm at Manchester. Pharmaceutical Journal 2005;274:117–20
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