A Framework for Assessing Canadian Pharmacists' Competencies at Entry-to-Practice Through Structured Practical Training Programs

Introduction

In early 1998, NAPRA's National Licensing Standards Committee (NLSC) identified 19 of the 37 Competency Elements as being optimally assessed through a structured practical training program. It was recommended that these particular competencies require observation of performance to determine the ability of the student or candidate and that further, the observations should occur over a period of time to ensure that performance can be sustained. The NLSC was comprised of individuals appointed by pharmacy regulatory authorities, the Canadian Society of Hospital Pharmacists, the Association of Faculties of Pharmacy of Canada, the Pharmacy Examining Board of Canada, the Association of Deans of Pharmacy of Canada, the Canadian Council for Accreditation of Pharmacy Programs, and the Canadian Pharmacists Association.

Building on this base, representatives from all provincial pharmacy regulatory authorities and the Canadian Council for Accreditation of Pharmacy Programs developed a structured practical training framework, as presented in this Report. The working group acknowledges that some of the identified competencies may be further tested when candidates take the required licensure examinations, and that deficiencies in the national competencies not specifically identified for inclusion in this program may become apparent through the course of the structured practical training experience.

The primary intent of this Report is to provide definition to pharmacy students, licensure candidates, regulators and administrators of structured practical experience programs across Canada.

This project was partially subsidized by Human Resources Development Canada, because of its relevance to the development of a Mutual Recognition Agreement for the profession.

Competency Elements for Assessment through a Structured Practical Training Program (Taken from "Professional Competencies for Canadian Pharmacists at Entry-to-Practice")

Pharmacists:

1.1 Develop a covenantal relationship with the patient or the patient's care provider.

1. establish and maintain rapport by using effective communication skills to initiate dialogue through:
   1. listening, verbal and written skills
   2. sensitivity to nonverbal forms of communication
   3. sensitivity to problems with English or French fluency
   4. sensitivity to diversity in the client population
2. demonstrate a caring, empathetic, and professional attitude
3. elicit the patient's needs, values and desired level of care and outcomes regarding drug therapy
4. discuss with the patient the responsibilities of the pharmacist and patient, outlining the benefits of acceptance of these responsibilities and the consequences of not accepting these responsibilities

1.2 Gather patient information and assess its relevance

1. develop a professional relationship with the patient's other health care providers
2. determine the patient's needs, values, and desired level of care and outcomes
3. actively listen and interpret the information provided
4. identify and use relevant sources of information

1.4 Identify the patient's desired therapeutic outcomes

1. enable the patient to make choices.

1.8 Develop and implement plans to monitor the patient's progress and assess therapeutic outcomes

1. encourage patient involvement in the implementation and maintenance of the plan
2. discuss the ongoing responsibilities of the pharmacist, patient and other health care providers with the patient or caregiver.

1.9 Monitor and evaluate the therapeutic effectiveness of a drug intervention

1. elicit and interpret patient and healthcare provider feedback

2.1 Apply legal requirements and ethical principles to practice

1. consider special patient-related needs
2. consider the social issues which impact on the patient

2.2 Meet the requirements of federal, provincial and territorial legislation regarding the practice of pharmacy.

2.3 Operate within provincial and territorial regulatory authority policies, by-laws and standards.

2.4 Uphold and act on the ethical principle that a pharmacist's primary accountability is to the patient

1. ensure patient confidentiality
2. advocate on behalf of the patient
3. involve the patient in decision-making
4. respect the right of the patient to make their own choices

2.5 Advocate on behalf of groups of patients to ensure appropriate access to products and services

1. assist patients in the identification of their needs
2. in consultation with patients, develop an action plan considering outcomes, risks and costs.
3. prepare rationale to support actions to meet needs
4. present information in an appropriate written or verbal format

2.6 Demonstrate personal and professional integrity

1. accept responsibility for actions and decisions
2. show respect for the dignity of the patient
3. maintain appropriate professional boundaries

4.1 Demonstrate effective and appropriate communication skills in diverse settings or situations

1. display clear, effective writing skills
2. demonstrate appropriate verbal, non-verbal and listening skills
3. show respect for cultural, ethnic, gender, and educational variables.

4.2 Select appropriate communication techniques for use with patients and other health care providers

4.3 Demonstrate sensitivity, respect and empathy when communicating with others

4.4 Demonstrate effective interview techniques

4.5 Demonstrate comprehension and proficiency in written and verbal English or French

5.2 Demonstrate ability to supervise drug distribution

1. maintain safe and effective systems of drug distribution
2. adhere to distribution policies and procedures
3. demonstrate ability to supervise support staff

5.3 Recognize patterns of inappropriate use of drugs

1. recognize the drugs with addiction potential
2. recognize and resolve patterns of inappropriate use
3. identify and document inappropriate order quantities
4. report findings using appropriate mechanisms

5. detect and respond appropriately to drug diversion

6.1 Supervise personnel such that delegated functions are carried out to meet accepted standards

1. apply management principles and skills relevant to human and physical resources
2. define accepted standards, policies and procedures
3. demonstrate the principles of effective inter-professional and intra-professional working relationships

General Principles of a Structured Practical Training Program

Expectations at the point of licensure should be the same for in-province, domestic and foreign applicants.

Terminology
For the purposes of this document:

1. 'clerkship' refers to a period of practical experience, supervised under the auspices of the Faculty, and completed prior to graduation.
   
   

2. 'internship' refers to a period of practical experience, supervised under the auspices of a recognized Provincial or Territorial Regulatory Authority preceptor, that is obtained after a degree has been completed but prior to the granting of a licence to practise Pharmacy in a Canadian Province or Territory.
   
   

3. "studentship" refers to a period of practical experience supervised under the supervision of the Provincial or Territorial Regulatory Authority and the Faculty, completed prior to licensure.

Program materials

Structured practical training program manuals designed for both students and their preceptors, are to be provided by the Provincial Pharmacy Regulatory Authority and/or Faculty. In November 1998 Council approved a recommendation that NAPRA develop a model internship manual for interns and preceptors, as a resource for the Regulatory Authorities. This project is now underway under the auspices of the National Advisory Committee on Licensing).

Educational modules approved by the Provincial or Territorial Regulatory Authority are to be made available. In November 1998 Council directed that an assessment of foreign-trained applicants be conducted to identify any needs for special educational modules, and that NAPRA facilitate module development. This project is underway, under the auspices of the National Advisory Committee on Licensing.

Timeframe for Structured Practical Training

The structured practical training experience and assessment should ideally be incorporated into the undergraduate academic program. However, it is acknowledged that the Canadian Council for Accreditation of Pharmacy Programs' current minimum criterion of 16 weeks practical training experience may not provide sufficient time to assess all the required competencies. In such cases, an internship program administered and supervised by the Provincial Regulatory Authority would be required. The total practical training experience with assessment could be carried out through a partnership arrangement between the Provincial Regulatory Authority and the Faculty, determined on a province-by-province basis.

Programs should be focused on measuring or assessing the actual attainment of competencies, which is not directly related to time spent. Therefore, the Group's further suggestion that the total time required for completion of a structured practical training program prior to licensure be not less than 24 weeks (840 hours) is offered as an example. Using this example, the following schedule of clerkship and internship training is offered as a possible option to consider for candidates enrolled in accredited in-province and domestic pharmacy programs.

The candidate might complete 280 hours of practical experience over eight or more weeks during the first three years of enrollment, as follows:

Practical experience obtained over an extended period of time allows for integration with the didactic program and can result in an optimal learning opportunity. In Year 4 the period of structured practical training might be 560 hours over sixteen weeks, scheduled in blocks of at least 140 hours/four weeks duration and involve sites that offer different types of experiences. An example of a practical training program in Year 4 could be 140 hours over 4 weeks at site A followed by another 140 hours over 4 weeks at site B.

This would then require the candidate to complete 280 hours (over 8 weeks) of an internship program, under the auspices of the provincial regulatory authority prior to licensure.

Foreign candidates will be required to complete a pre-evaluation to determine that the standard of knowledge of pharmacy is adequate. Foreign candidates must also complete a structured practical training program, such as may be designed by the Provincial and Territorial Regulatory Authorities through NAPRA and administered provincially. The time required will be governed by each candidate's ability to demonstrate achievement of the stated competencies. A minimum of 140 hours over at least four weeks is a basic requirement, with a suggested guideline of up to 24 weeks for candidates who may require additional time to demonstrate proficiency.

Assessment Procedures

Assessment procedures for structured practical training are based on the premise that each student or candidate is supervised and assessed by a recognized preceptor.

"Recognized" Preceptor

To be recognized as a preceptor, the pharmacist must:

• be a member in good standing of a Provincial or Territorial Regulatory Authority
• have at least 12 months experience as a licensed pharmacist
• hold a "practising" or "active" licence and be practising in a patient care setting with direct patient interaction.
• have undertaken a preceptor training program offered by an accredited university or the Regulatory Authority