Inside Tomorrow's Pharmacist (2001)

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Hospital preregistration experience — a slice of life from Oxford

Hospital preregistration experience — a slice of life from Oxford by Kathryn Marsh

My placement was at the John Radcliffe teaching hospital in Oxford, which is one of four hospitals — the Churchill, the Radcliffe Infirmary, the Horton and the John Radcliffe – within Oxford Radcliffe Hospitals NHS Trust, and my training provided experience in each of the four hospitals. Including myself there were four preregistration trainees working there for six months or more and several others from overseas on shorter placements. All of us were able to share ideas and experiences, which was particularly important with the practical side of things such as fulfilling competencies. We had joint training afternoons where we had clinical talks and workshops and also completed tests such as the calculation examination.

Variety

In addition to the main preregistration tutor, I was assigned a senior pharmacist at each hospital who acted as my mentor and who dealt directly with any problems I had at that hospital. Each of the preregistration trainees had a different rotation schedule so I was not always based on the same site as another student. The different hospitals within the trust are very different in workload as well as type of work, but I found the variation stimulating, and it certainly made the six months go very quickly.

A teaching hospital contains a huge number of clinical specialties within one trust, so I was able to experience different disciplines. I spent time in almost every department; and those I found particularly interesting were the transplant and renal units, oncology, the palliative care hospice, cardiology and the infectious diseases unit. Within each of these specialties, I shadowed another pharmacist — usually a senior pharmacist — and participated in activities such as ward rounds, drug chart checking and patient counselling. On rotations where I spent a few weeks on the same ward I had my own group of patients to follow through, which I found particularly rewarding.

Medicines information

One non-ward based rotation I was involved in was in the medicines information department. This was one of the most interesting four week periods of my placement and one in which I learnt a lot. Dealing with queries from all over the hospital and some other health organisations was a challenge and I was able to investigate information in some depth.

When I was not on the wards or in medicines information, I was based in the dispensary which works in a very similar way to community pharmacy dispensaries. There are three levels of patients — in-patients, those who are being discharged soon, and those who have come for out-patient clinics. Being able to recognise which patients are priorities is important and allows you to cover some of the professional competencies.

I was able to get involved in some of the clinics run at the hospitals, even if they weren't pharmacist run and this gave me a good insight into the responsibilities of other health care professionals.

At one point I decided it would be useful for me to see how an operating theatre worked, so the pharmacist in charge of ophthalmology arranged for me to go and spend a day in the eye theatres watching operations such as cataract removals. This was an invaluable experience from which I learnt a lot, especially how hard theatre floors are and the workings of the accident and emergency department. This was because I fainted about 25 minutes into the operation and landed on my head!

Staff

The staff structure at Oxford consisted of the chief pharmacist, deputy chief pharmacists, senior clinical pharmacists, directorate pharmacists, heads of department, clinical pharmacists, resident pharmacists, preregistration trainees, senior technicians (who were qualified to check prescriptions), technicians and pharmacy assistants.

I worked closely with the resident pharmacists — they were working towards their clinical diplomas and ran the on-call service, which was great as I learnt a lot from them directly and they were a very sociable bunch! In Oxford the clinical diploma is usually completed over three years, and the resident pharmacists work on a rotation of about three or four months per ward which gives them a good grounding in the clinical aspects of that ward.

The fact that the resident pharmacists were training and there were student technicians too meant it was a beneficial environment to be in and one which provided many people who were very good at teaching and supporting those in training.

One thing I think hospital pharmacy has to offer over community is that you are working in a multidisciplinary team, rather than with technical staff alone, which allows you to pick up skills and good practice from other health care professionals. There were regular lunchtime meetings within the department and also weekly after-work meetings usually with a speaker from another department of the hospital, and although these were not compulsory, they were excellent resources for learning.

While working in Oxford I lived in hospital accommodation, which was very reasonably priced, on the same site as the main hospital and very close to the town centre. It was not that luxurious, but living with many other people also on placements made the social life good!

And finally…

If you are planning to do your preregistration year in hospital, particularly in a busy teaching hospital, remember it can be quite easy to get lost. So it is important that you keep a clear idea of why you're there, how your training is going and which direction you want to move in. If any of these things start to slip, remember it is you who is responsible for making sure you are satisfied with what you are doing. This may be difficult for some people but it is an essential part of the preregistration experience – you are no longer spoon fed.

Overall, I thoroughly enjoyed my time as a pre-registration trainee in hospital, so much so that I have chosen to do my second six month placement in another busy teaching hospital!