Tomorrow's Pharmacist October 1999 p36-38
Edited by Pamela Mason

Preregistration assessment

Assessment in the preregistration year: the competence - based training programme

By Lindsay Taylor, MA (learning and teaching), MRPharmS

You will be well aware that the pregistration year involves assessment. This article gives practical guidance on collecting evidence to demonstrate competence.

Most students are only too well aware that the preregistration year means assessment - a word that leads immediately to thoughts of the all important examination. Moreover, the majority of students will understand the implications of the formal examination and have considerable experience of preparing for such events. Vital information about entry procedures is sent to students directly, together with bulletins from the Royal Pharmaceutical Society that give explicit details about dates and reference sources, for example. Guidance for the actual ordeal is also provided, in the form of sample questions, and many preregistration trainees are given the opportunity to do a mock examination by the organisation for whom they work.
While passing the exam is quite naturally an overriding concern for many preregistration trainees, it is not the only prerequisite for registration as a pharmacist (see panel).
The examination assesses knowledge related to core practice using multiple choice questions. However, in the practice of pharmacy, as in many other professions, it is not just possessing a specialist knowledge that is important; it is also vital to develop the skills that enable pharmacists to relate that knowledge to a particular work based situation.

Competence

You will realise that the other assessment in the core component for preregistration training and experience is that of the competence based training programme (CBTP). Preregistration trainees have to satisfy their tutor of their ability to relate what they learn in the workplace to their own performance by demonstrating competence. The goal - defined as the ability to perform consistently to the required standard - is met when the preregistration trainee has produced sufficient evidence to satisfy the tutor. He or she will then pass the assessment.

Why do I have to collect evidence?

When it comes to the assessment of skills, it is, of course, possible to set up tutor assessed exams, but the situation does not always reflect what happens in practice. A system to meet such criteria would be extremely difficult to organise - not to say expensive. The approach that is increasingly used in many workplace assessments is for candidates to present evidence that can be judged objectively, especially when others have been involved in its collection.
To pass the assessment, however, a required standard must still be reached. Instead of the attainment of a certain mark being the indicator, very detailed "performance criteria", qualified by definitions for guidance, are used to determine what is expected of the trainee in each element of the syllabus.

When do I need to collect evidence?

You will need to make the collection of evidence an ongoing task throughout the preregistration year. At each landmark appraisal (ie, at 13, 26 and 39 weeks), the evidence you provide will enable your tutor to judge which of the assessment criteria best describe your competence at that stage. The exact performance criteria you are working towards at any one time, and the type of evidence that might be used to meet it, are best decided during the course of your regular discussions with your tutor.

Is this anything to do with "evidence based practice" I have heard so much about?

Put very simply - yes. The onus is on you to provide objective evidence on which your tutor can ultimately make his or her judgment of your competence, rather than use what may be a biased opinion. The situation is similar to that of a clinical pharmacist using the best evidence (ie, that from a primary source, based on a double blind randomised clinical trial) to justify the inclusion of a new drug in a formulary.

What is evidence?

Many trainees (and tutors?) have difficulty deciding what can and cannot be used as evidence. Basically, any activity that a preregistration trainee is asked to perform during the course of their working day can be used. It does not have to be - although it can be - specially organised.
A simple example of an activity that could be used as evidence is:

You recognise that a prescription only medicine (POM) item could be for a child, but that there is no age printed on the prescription. You check with the parent whether the patient is under 12, and get the age added to the prescription form as a legal requirement under the Medicines Act.

The evidence would need to include a photocopy of the original prescription and an account of what was done and why. The evidence could be assigned to several performance criteria, including 1.1.1 and 1.2.1 of the practical (task-based) units (see the Royal Pharmaceutical Society's preregistration manual for details).
What turns this everyday activity into evidence is the formality of recording what you did, evaluating the learning outcome and which of the performance criteria have been met on that occasion. While one piece of evidence is not normally enough to demonstrate competence - which is defined in the manual as a consistent performance - it is possible that some of the performance criteria can be met quite early on in the year.
Using the example above, it would not take too many instances where a potential problem is identified when prescriptions are taken in, for the preregistration trainee to be deemed competent. Remember that if you are doing your preregistration training in two different establishments, it is crucial for the two tutors to plan how you will have the opportunity to achieve all the competencies.

How do I record what evidence I collect?

The simple answer is - systematically. An example of the format you may like to follow is given in your manual. Many companies also have their own preferred style. Remember that it is the outcome of the activity rather than the process that is important in this instance. Even if what you learnt was along the lines of "if I meet the same situation again, I'll try a different approach," that is a most valuable learning outcome and one that can be used in your favour in discussions with your tutor.

How much evidence do I have to collect?

The answer to this question is how long is a piece of string? It is of course quite understandable that the many performance criteria, and the need to provide evidence for them all, is a daunting prospect. The secret lies in careful organisation and planning.
An actual answer is of course completely dependent on so many variables, including the time of the year, the trainee, the tutor and the previous experience of both. The opportunity to demonstrate evidence of some of the performance criteria, especially some in the professional unit, are often the most problematic. Consequently, the evidence might need to be secondary rather than primary. (Refer to the manual for details).
What is even more important is not so much the quantity of evidence, but how it is organised and presented to the tutor. A mass of photocopied prescriptions and other bits of paper is not going to be well received, whereas an orderly folder with clear evidence of time spent on its organisation will be. It will also help with another vital feature of the appraisal - planning what you need to work on and/or achieve for the next meeting.

What is good evidence?

This is a difficult question - and one that is often raised by preregistration trainees. The Royal Pharmaceutical Society does not give any guidelines, other than the general advice that defines competence as being consistently reaching the required standard. This is assessed at each appraisal according to one of the four criteria given on the appraisal form.
However, the following general points should help:

Agree what is and is not acceptable with your tutor
Try to be concise when writing up your records
Try to use numbers and specific targets where possible/appropriate.
Discuss with other trainees what is expected of them
Agree to differ at times

My tutor and I realise the importance of planning our workload prior to the appraisals, but where do we start?

Before the actual appraisals! Hopefully, you will have had an induction period which introduced you to the company and its systems, and which also gave you the opportunity to set targets for the year. The first of these targets should be to meet regularly, preferably with a set agenda and realistic targets that you want to achieve.
Before your first meeting, it would be a good idea to have completed a self- assessment of your status in relation to the performance criteria, which can then form a basis for the first discussion with your tutor. Set targets and goals, as well as arranging where and when you will next meet, each time. You should then progress to the point at which you can be reasonably certain that your tutor can sign off the competences you have been working towards at the 13 week appraisal. The manual gives plenty of guidance to your tutor as to how the meeting should be conducted and how constructive comments should be given. If you are unsure what to expect or not satisfied with the process, the first person who can help is your tutor - ask!
It is obvious from this very brief consideration of the assessment procedures that all those concerned will have to work to achieve the standards set in both aspects of the core component of the prerequisites for registration. However, the onus is really on you, the preregistration trainee, to fully understand and comply with all the assessment criteria. Good luck!

Ms Taylor's book, 'Pharmacy preregistration handbook: a survival guide' will be published by the Pharmaceutical Press early in the year 2000.

At the time of writing, Dr Taylor was teacher-practitioner at De Montfort University, Leicester. She is now NHS information and services manager, AAH Lloyds Pharmacy.

Tomorrow's Pharmacist October 1999 p36-38 Edited by Pamela Mason