Background

The UK pharmacy regulator, General Pharmaceutical Council (GPhC), sets Standards for all UK Pharmacy Schools. The Standards stipulate that the undergraduate programme (MPharm) must provide students with practical experience in working with patients, carers and other healthcare professionals. This has led to a need to expand experiential learning within the pharmacy curriculum across the nation.

However, the GPhC does not provide specific guidance on how to achieve experiential learning so pharmacy schools are left to arrange practical experience and plan their own learning outcomes.

Placements bridge the gap between theory and practice. They allow students to learn and practise various clinical and communication skills integral to being a competent pharmacist in dealing with patients in real-world situations. Previously, the typical MPharm curriculum traditionally included off-site short placements, where the pharmacist in charge was responsible for supervising the students. The placement itself was not required to be structured in a particular way though guidance was often issued by the pharmacy schools to the placement provider as to certain learning outcomes that schools were looking to achieve. Students were often issued with a workbook with tasks they could complete during their placements. Under the circumstances, it was difficult to ensure that the placement provider would deliver the learning outcomes as designed or to provide all students with equal learning opportunities. Some studies have indicated that students regarded such placement arrangements as more like a day out than a vocational experience. ^1-4

When we revised the MPharm curriculum at University of Reading to meet the new University Curriculum Framework and the GPhC Standards, we needed to expand experiential learning in our programme. Previously, students in Year 3 had been given the option to carry out a week’s placement in a hospital. Not all students opted to take the opportunity. Those who did were given a workbook detailing expectations and tasks to carry out whilst on the placement. The learning experience was variable even among those who undertook the placement, as it relied heavily on the willingness and capability of the pharmacists as well as the students. Furthermore, the students did not always feel they could put theory into practice.

Developing the best placement programme collaboratively

We believe that real-life patient contact and workplace experience is irreplaceable. Therefore, we set out to develop an extensive programme to give every student a structured placement experience. The programme would cover the main sectors of pharmacy practice in the first 3 years of the course. The aims were:

To provide students with first-hand workplace experience and field-specific knowledge and skills that increase their employability
To provide a spiral structured learning experience, starting from “knowing how” to engage with patients and progressing to finally participating in all aspects of patient care.
To implement an inclusive placement programme where all students achieve the same learning outcomes and are well-supported by placement staff in managing complex and difficult situations.
We have set up a Pharmacy Placement Team to design and develop a new inclusive placement programme, working collaboratively with various departments and teams across the university to engage external partners. The team is led by me (Pharmacy Placement Lead), and consists of Mr Dan Grant (Pharmacy Programme Director), Mrs Sue Slade (Hospital Lead), Mrs Caroline Parkhurst (Community Lead), as well as members of the Careers & Employability team, Student Applicant Services, Legal Services Department, and the University of Reading Medical Practice. We have also enjoyed the support of a number of NHS trusts across England and various local community pharmacies as external partners.

Team member	Roles and responsibilities
Dr Wing Man Lau	Oversee the whole placement programme; student facing role; student support; programme design; student workbooks design; student application and allocation.
Mr Dan Grant	Strategic role; student application and allocation
Mrs Sue Slade	Internally supervise placement programme (ISP) Hospital Lead; supervise and run all ISP visits
Mrs Caroline Parkhurst	ISP Community Lead
Careers & Employability team	General administration support; external liaison; student queries; contracts
Student Applicant Services	Student support with DBS and health declaration submission; student queries related to submission
University of Reading Medical Practice	Occupational health support for students

The new pharmacy placement programme

We have now introduced compulsory experiential learning into all years of the MPharm programme at University of Reading. For placement learning, students experience both community and hospital pharmacies very early on in the course. The program has been designed in helping our students develop professional attitudes and competencies by exposing them to real situations that demand satisfactory clinical, professional and communication skills that are essential to effective professional practice in any general pharmacy setting.

Credit hours	Internally supervised placement	Externally supervised placement
1^st year	4 (community and hospital)	–
2^nd year	8 (hospital)	8 (community)
3^rd year	8 (hospital)	37.5 (hospital or community)

Internally supervised placement programme (ISP)

Our ISP spans years 1–3 of the MPharm programme and addresses specific, achievable learning objectives that spiral throughout the 3 years. It has been designed according to Miller’s triangle of competence and Kolb’s experiential learning theory. The hospital training is based in a local NHS hospital and is run in-house by our Hospital Lead, Mrs Sue Slade, and two Placement Tutors who all have dedicated placement roles on my MPharm programme. The staff-student ratio averages 1:4. This ensures a high quality learning experience because the tutors can build rapport with the students, evidence the students’ improvement individually, and tailor the teaching to suit the students’ needs.

The 1^st year community training is based in a local community pharmacy and run in-house by our Community Lead, Mrs Caroline Parthurst. Students learn about the community pharmacist’s roles and the specialist services available in this sector. They are given the opportunities to reflect and compare how the roles differ between hospital and community pharmacy settings.

As students progress through the programme, they continually practise new-found professional skills under supervision and apply them in real-world situations – on real patients. Such skills include patient counselling, taking a medication history and performing medicines optimisation. Students are required to complete a workbook and write a reflection on each visit, which are summatively assessed in Year 3 as part of their personal development portfolio. Transferable skills are formatively assessed on three of the five placements and summatively assessed through OSCE exams in Year 3 and Year 4.

Externally supervised placement programme (ESP)

Building on from their first year community pharmacy experience, year 2 students go to a different local community pharmacy, unaccompanied by university staff or peers, for a whole day. The students are given a detailed workbook and an introductory lecture to guide their learning. Students are reminded closer to the placement through email detailing expectations and tasks to be completed during the visit.

In Year 3, the ESP placement lasts for a week and students choose between a hospital placement or a community placement based on their own interest. The hospital option is usually overwhelmingly popular, so despite being able to offer a large number of these placements, we simply cannot accommodate the demand for it. Therefore, we have put in place an application process, whereby the students are required to submit an application form indicating what attracts them to the hospital placement and why they should be selected. They are also asked to support their application with a reflection on previous placements to identify exactly what further skills they aim to gain. This process is similar to job applications in the real world (for example, the application for pre-registration pharmacist positions), so the students are able to practise this aspect of job seeking and familiarise themselves with the job application process throughout the MPharm programme.

Again, a workbook detailing tasks that build on from previous placements is provided for the students. The pharmacists in charge at the respective pharmacies supervise our students on these visits. We brief the supervisors prior to the placement with details of the placement objectives, learning outcomes with a copy of the student workbook to standardise the student learning experience. The supervisors provide written feedback to the students on each visit to allow them to reflect from their learning.

Benefits and Outlook

To our knowledge, our structured, integrated and inclusive placement programme is unique among pharmacy schools in the UK. The placement programme has been time-consuming to set up and run, and has required careful organisation and planning for each visit to be successful and valuable. Preliminary evaluation suggests all students have found the placement experience positive and valued the structured and inclusive placement format as it helps develop their sector knowledge and skills in real-life situations.

Close collaboration with various University departments and external partners has been crucial to the running of the placement programme. We are committed to continued collaboration as a team, comprising diverse roles, in supporting our students to become competent and highly employable graduates by developing their professional, clinical and communication skills.

A full evaluation of our placement programme is under way. We will update you shortly.

¹ Sosabowski M. (2008) Pharmacy Education in the United Kingdom. American Journal of Pharmaceutical Education. 72(6):130.

² Talyor K and Harding G (2007) The pharmacy degree: The student experience of professional training. Pharmacy Education. 7(1): 83–88

³ Nation L and Rutter P (2011) Short communication piece on experiences of final year pharmacy students to clinical placements. Journal of Health and Social Care Improvement. 2:1-6

⁴ Diack L et.al (2014) Experiences of Supervision at Practice Placement Sites. Education Research International. 2014:6