Inside Tomorrow's Pharmacist (2001)

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Lifelong learning — what you need to know

Lifelong learning — what you need to know by Trudy Thomas

The new Code of Ethics and Standards adopted by the Royal Pharmaceutical Society this year states that pharmacists must "continually review the skills and knowledge required for their field of practice, identify those skills or knowledge most in need of development or improvement and audit their performance as part of the review."

In a nutshell, the Society is telling pharmacists they need to practise continuing professional development (CPD) and become lifelong learners.

Continuing professional development

CPD is very different from the learning that takes place as part of formal education. For many of us this may have boiled down to cramming facts to pass exams. The degree you have probably barely recovered from is just the start of your professional learning career. You are embarking on a journey of learning that will last a lifetime. Hey, come back!

Lifelong learning is simply the learning we experience after leaving full-time education. You might question whether after four years at university and a year as a preregistration trainee, there can be anything left to learn. But pharmacy changes all the time. There are new challenges every week — sometimes it feels like every day.

A recent challenge

As a newly qualified pharmacist, you will be accustomed to the idea that emergency hormonal contraception (EHC) is available over the counter and that pharmacists have to question and advise customers on its use. However, for pharmacists like myself, who have been practising for some time, the introduction of EHC has been an earth shattering change to everyday practice. It is a change that has meant all community pharmacists have had to learn new skills fast, and not just clinical information either. Handling an EHC request is different from any other medicine sale. I am still refining my skills in dealing with EHC requests each time I undertake one. You don't get it right first time. This is a real case for learning by reflective practice, but more about that later.

The huge change that the introduction of EHC brought to the profession made it easy to identify an area where as a pharmacist I needed to learn and develop skills. As individuals, however, often working in professional isolation, it can be very difficult for pharmacists to identify what their learning needs are.

Identifying needs

We often think we know things, but do we really? How do we know what we don't know? It is worth sitting down once a year to formulate your personal development plan. Those of you who land up working within big organisations will find this is very much part of corporate life.

Forming a personal development plan involves thinking about where you are now and where you would like to be and where you need to be. What you want to learn isn't always what you need to learn. You may have to take into consideration the needs of your customers, the organisation you work for and other organisations that impact on your work such as the health authority and the local primary care organisation and the NHS as a whole.

CPD in the NHS

In 1999 the Government issued a health service circular entitled 'Continuing professional development — quality in the new NHS.' It states that CPD is an important element in the delivery of a range of Government objectives for the NHS. It requires that all health care professionals who work within the NHS, even in part, as pharmacy contractors do, must show competence throughout their careers, to ensure the NHS delivers relevant services of high quality. CPD, it proposes, is a partnership between the individual and the NHS organisation, with the patient as the focus.

Clinical governance is dominating the activities of the medical professions. It's about doing the right things to the right people at the right time and in the right way and demonstrating that this is the case. Clinical governance applies to pharmacists too. There is no excuse for patients suffering a poor quality service in pharmacy — ignorance certainly isn't an acceptable defence.

The good news

Well I'm sure by now you have got the message that CPD is a necessary thing if you want to stay a pharmacist. However, what I haven't hit you with yet, is that CPD doesn't have to be a chore — it can be a pleasure. If you get the learning bug like I did many years ago, finding out things which help you do your job better can give you such a buzz. I have become such a learning junkie that I am heavily involved in training others — so be warned it can be addictive!

So having discovered it's not such a bad thing this learning lark — how do you go about it?

Training courses and the like

Surely if you want to learn, you just go to all the pharmacy postgraduate education workshops and do as many of the distance learning packages you can get through?

The RPSGB stipulates in its Code of Ethics and Standards that pharmacists should undertake a minimum of 30 hours' continuing education. However, the Society adds that this continuing education should be structured to meet personal needs. The continuing education you undertake should meet the needs identified in your personal development plan.

People often think of learning as going on a training course, completing a distance learning package, reading the continuing education articles in The Pharmaceutical Journal and answering the multiple choice questions. All good stuff. However, continuing education is only part of CPD. The Centre for Pharmacy Postgraduate Education (CPPE) may be running a fabulous workshop on asthma, for example, but if you have already attended an asthma training course run by the National Asthma Campaign a year ago, might not your time be better spent doing something else?

In addition, it is not going on the course which is important, it is what you do with the knowledge you have gained from the course. As part of your CPD you will need to think about putting your learning into practice and assessing the outcomes gained from the changes you make. This assessment will lead you back to your personal development plan. Have you fulfilled the need? What happens next?

CPD on the job

In spite of encouraging you to have a beautiful personal development plan, I now have to tell you that not all CPD is planned. CPD is about making effective use of daily activities to learn. Errors and mistakes can be very painful, but we all make them, and the most positive way of approaching a mistake is to turn it into a learning opportunity. This again is a focus for the NHS as a whole. In June 2000 the Department of Health issued a document entitled 'An organisation with a memory.' This paper sets the way forward for the NHS to learn from adverse events and to ensure that changes are made to prevent problems occurring in the future.

However, not all on-the job learning need come from errors. Every day something will happen in the pharmacy which raises a question. This is a learning need. At this point you should write it down, because you may not be able to attend to your learning needs for some time. You have to prioritise them, otherwise you could end up doing 30 hours continuing education a week!

Reflecting on your practice, as I mentioned earlier, is a very powerful method of learning. It involves thinking about what happened, what could be improved for next time and identifying any learning needs.

These unplanned learning needs can be slotted into your personal development plan, which you will need to revisit and update at regular intervals.

Other sources of learning

So, either through reflection on practice or by some other method, you have identified a learning need. You might need to find at least part of the answer straight away — you might consult the British National Formulary or ring the National Pharmaceutical Association. If you want to follow this up, you may have an article at home or a long-since neglected distance learning pack you can use as a resource. The internet is a good starting place — web sites such as the online BMJ and PJ Online have search facilities and allow searching across multiple journals. You can access these sites direct or via the CPPE web site (www.cppe.man.ac.uk).

We all have our preferred learning styles — some people like to read, some listen, some experience for themselves in order to learn best. Do what comes naturally, but be open to new experiences — you may find something which really lights your fire.

Write it down

Whatever you do to fulfil your need, write it down. Many pharmacists are far exceeding the 30 hours continuing education the Society recommends, but they have no evidence of this. The Pharmaceutical Society requires we keep evidence and clinical governance will require us to keep evidence. For many pharmacists this is the real stumbling block to CPD. As pharmacists in the new age you will be used to documenting what you do, compiling a portfolio and undertaking competence based training. You have a huge advantage over those of us who have been practising since the dark ages.

How you document your CPD is up to you. Personally I keep an intervention diary. I don't write something in it every time I practice as a pharmacist, but I record important details in it and jot down any questions I want to investigate at a later stage, together with my findings in brief. You might like to use a more structured form such as the one provided by the NPA.

Sometimes pharmacy raises questions that can't be looked up in a book — ethical issues; things which can be very difficult to sort out in your own mind. You might have to make a snap decision — but reflect on your experiences and if possible discuss them with another pharmacist. Some CPPE tutors have discussion and study groups running in their areas which you may like to consider joining. Other people will be one of the most useful resources in lifelong learning. It may be that in the future, review of a pharmacist's competence may be by other practising pharmacist, ie, peer review.

Further qualifications

When you have been qualified for a number of years, you may wish to update your knowledge and skills across a whole range of subjects and seek formal recognition for your work. You may consider a further qualification such as a certificate, diploma or MSc. These are great springboards into new ways of working and can help you take on new roles within the pharmacy arena.

Skills from life

However, CPD isn't always about things directly involved with pharmacy. You may have skills from outside pharmacy that can help meet needs identified within your daily working.

Undoubtedly one of the major outside influences on my career as a pharmacist has been becoming a parent. I am not advocating that the Code of Ethics should include a compulsory parenting clause by any means. However, I know that for me, surviving the experiences of young children has made me more confident in the advice I give to parents who visit the pharmacy.

Of course, the Royal Pharmaceutical Society is not going to accept "changed infant's nappy last night" as part of the evidence that it requires of my continuing education. However, trying to sort my own child's nappy rash may well have raised questions about what is the evidence base on the prevention and treatment of nappy rash? Is my learning in this area really up to date? I've identified a need and off I go again!

The Society has been running CPD pilots looking at ways to support pharmacists in their CPD. They have been using facilitators to help and motivate people. These pilots look set to be extended, so you may find yourself involved in this kind of scheme early on in your career. Whatever happens, not doing CPD for pharmacists is only an option if we want to stand still as a profession or as individuals. Your CPD has already started. Enjoy!

Trudy Thomas is a locum community pharmacist, tutor for the Centre for Pharmacy Postgraduate Education and a prescribing advisor to a PCG