possible career structure for mi consultant dr catherine duggan associate director of clinical...

Possible career structure for MI consultant

Dr Catherine Duggan

Associate Director of Clinical Pharmacy London, South East and Eastern and Senior Clinical Lecturer, School of Pharmacy, University of London

Chair of United Kingdom Clinical Pharmacy Association

Content

– Drivers for change– The competency agenda– Pharmacist development strategy– General level practice– Development of higher level practice– Consultant Pharmacist- MI

Drivers for change

Self-care Disease management Patient safety Access to medicines

Policy trends…

Dislocation between education & practice Non-competency based approaches No clear practitioner development Recruitment and retention Fitness for purpose

Competency → Competence →

Performance → Fit to practise?

= safe, health improvement

The real issue…patient outcome

The Words

Competency Single item of knowledge, skill or professional value

Competence Full repertoire of competencies

Performance Reference to observable behaviour What an individual actually does, as

opposed to what they can do

Effectiveness Effect of performance on a recipient

Miller’s pyramid

Does

Shows how

Knows how

Knows

performance assessment in vivo

performance assessment in vitro

clinical context assessment

factual assessment

From UG to post-registration development

Why competency-based approach?

–National health policies– Governance; Patient safety; service quality

–Evidence– Accelerated and sustained performance– Operationalise “science into practice”

–Sustainability– defines and makes explicit development needs

Pharmacist development strategy – principles:

•Recognise different level of practitioner•Embraces all facets and sectors of practice •Linked to two recognised competency frameworks to link to KSF

•Educational quality assurance structures to provide rigour

10%

20%

30%

40%

50%

60%

70%

1996/97 1997/98 1998/99 2001/02

Pharm Care Competencies(OSCE)

60%

30%

Graduation

One year later

McRobbie et al

Pharmacist Development Strategy

PharmacistPre-

registration

Pharmacist Registered

PharmacistSpecialist

PharmacistAdvanced

ConsultantPharmacist

Qualified Practitioner

Senior or Specialist

Practitioner

AdvancedPractitioner

ConsultantPractitioner

Healthcare ScientistsMaking the Change

Consultant

Advanced Practitioner

Specialist Practitioner

Practitioner

Allied Health ProfessionsMeeting the Challenge PAM(PTA)2/2001

Competency Framework

General Level

Competency Framework

Advanced Level

Competency…a complex construct

Skills

Behaviours

Knowledge

Valuesattitudes

Competency

Skills

Behaviours

Knowledge

Valuesattitudes

Competency

Skills

Behaviours

Knowledge

Valuesattitudes

Competency

Skills

Behaviours

Knowledge

Valuesattitudes

Competency

Competencies have their critics…

“Expert practice is beyond competency”– not a tenable stance post-Bristol

Reflective practice (Schön 1983)

– necessary quality of expertise - but cause or effect?– not a sufficient characteristic

Novice-to-expert progression (Dreyfus & Dreyfus 1986)

– no mechanism to identify ‘expert’– insufficient account of competence

General Level Practice

Higher Level Development Phase

General Level

Development Phase

Undergraduate & Pre-registration Phases

General Level Practitioner

Advanced Practitioner& PhwSI

Higher Level Development Phase 2

1Consultant Practitioner

General Level

Framework

Higher Level Framework: Advanced & Consultant

Pharmacist development strategy

Competency Matrix

PERSONAL PROBLEM MANAGEMENT

DELI VERYOF

PATI ENTCARE

Organisation, Team working,Communication,Professionalism

Drug use

process

Gathers informationKnowledge

Analyses I nformationProvides information

Follows up and reflects

PunctualityI nitiative

Confidentiality

Drug history takingI nteraction identification

Patient counselling

Assesses informationAccurate providesRelevant, Timely

McRobbie, Webb, Bates, Davies, Wright 2001Whiddett and Hollyforde 1999

LogrankP = 0.0048

Intervention = GLFn = 30 hospitals

Time - months

14121086420-2

Pro

bab

ilit

y.7

.6

.5

.4

.3

.2

.1

0.0

-.1

InterventionIntervention

Controlled trial GLF in junior pharmacists

Non-interventionNon-intervention

Reasons to be cheerful…

1. It is straightforward and practitioners understand it

2. It manages performance independent of sector 3. It makes “CPD” a realistic and useful activity !

– It is being used by employers because it works

NHSSpecialist ServicesSpecialist groupsSenior Managers

Service Perspective

HE UniversitiesLondon BrightonKings Medway Portsmouth UEAReading Kingston

Educational Quality

Collaborativeprogrammes

PG Diploma in General Pharmacy Practice

Statement of Completion General Training

JOINT PROGRAMME BOARD (London, East and South East England)

– Government funding – national model ?

– PG Diploma in General Pharmacy Practice

-Core - MI, Technical, Patient & Clinical Services

Common Validation by HEIs in collaborative

Currently 350 junior practitioner-students School PharmacyUniv BrightonUniv East AngliaUniv Portsmouth

Medway SchoolKing’s LondonUniv ReadingKingston Univ

NHS

Early implementation – Joint Programme BoardGeneralist Training (3 years)

Defined Area of Practice I (20 Credits)

Summed credits (60) = PG Cert GPP

Summed credits (120) = PG Dip GPP

6 months

12 months

6 months

6 months

Defined Area of Practice III (20 Credits) 6 months

Assessment 2 (20 credits)



Portfolio review – AfC gateway


Defined Area of Practice II (20 Credits)

Module 1 (M1) (60 Credits)Principles of Practice

Technical / MI / Pt Services/Clinical

The bigger picture…

–Growing higher level practice–Recognising advanced to consultant practitioners–…an evidence-based approach

In other words, a practitioner development strategy from junior to Consultant

Higher level practice


General Level

Development Phase






General Level

Framework



Attributes of higher level practice?

–Expert in clinical practice–Able to work in multidisciplinary teams–Dissemination and contribution to evidence–Training, support and mentorship of staff–Managing a team and a caseload–Leadership skills

Expert professional practice Expert skills and knowledgePatient care responsibilities

Reasoning and judgementProfessional autonomy

Building working relationships CommunicationTeamwork and consultation

Leadership Vision, motivation, governanceStrategy, innovationService development

Management Planning, performance, changePriorities, resources, standards, risk

Education, training, development

Mentorship role model delivery

CPD

Research and evaluation Practice linkage, policyCritical evaluation, protocol

review Evidence creation, development

Supervision, partnerships

ADVANCED LEVEL

Applying ACLF to different practice

groups

– Self assessment of practice level

–specialist-in-training

–experienced practitioner

–leading-edge practitioner

– Evidence

–to substantiate assessment

– Sample (n=390)Cancer 69Mental health 69Critical care 36Primary care 84Paediatrics 53MI 43Other 36

Cluster Foundation F-E Excellence E-M Mastery

Expert Practice

Building Relationships

Leadership

Management

E&T and Development

Research and Evaluation

5.1

2.3

10.3

17.7

20.4

36.6

3.1

4.4

10.6

11.7

43.4

42.1

52.0

62.0

53.5

39.8

16.3

20.8

6.5

5.4

32.1

30.4

20.6

13.1

9.0

8.5

Percentage of respondents located per cluster

N=390

8.9

6.0

43.4

16.3

32.1

42.1

20.8

30.4

10.6

52.0

7.7 52.6

11.7

53.5

36.6

20.8

28.2

-2 -1 0 1 2-2

0

2

4

6

F

E M

F

E

M

F

E

MF

E

M

F

E

M

Expert PP

Leadership

Management

E & T

R & E

Practice level

HOMALS Quantification

Specialist in training

Experienced practitioner

Leading-edgepractitioner

Advanced level practitioners

n = 390

Current level of practice

0.0

0.5

1.0

1.5

2.0

2.5

3.0

Mean

clu

ster

score

Expert Practice

Working relationships

Leadership

Management

E&T and Development

Research & Evaluation

Specialists intraining

Experiencedpractitioners

Leading-edgepractitioners

Competency profiles

–Consultant profile– EPP, BR and Leadership at

Mastery– Management, ETD and RE at

Excellence

–Advanced level profile– 5 clusters at Excellence– RE at Foundation

–Applying consultant profile to sample

– 50 pharmacists satisfy competency criteria (12.8%)

– 21 (+/- 7) years post qualification (mean +/- SD)

– 34% diploma, 40% MSc, 18% PhD

Consultant Pharmacist- MI

3 clusters at Mastery3 clusters at Excellence

Expert professional practice Expert skills and knowledgePatient care responsibilities


Building working relationships CommunicationTeamwork and consultation





CPD




ADVANCED LEVEL

Knowledge and Skills

Personal attributes

Management skills

Technical skills

Interpretiveskills

Conceptualskills

Interpersonalskills

Pragmatic, ownership, individual workingHumility, initiative, communication

Confidence, flexibility, iterationPro-activity, concentration

Managing people, team working, influencing othersMotivational skills, organisational skills, time management

Organisational skills, task prioritisationWriting, meetings, identifying knowledge gaps

Literature searching, presentation skills, protocol writing, administrative skillsWriting, form filling, computer literacy, scientific language, obtaining funds,

Data collection, data management, audit and research

Charting progress, task prioritisation, writing (iteration),Critical appraisal, identifying knowledge gaps

Reading literature, selection of research methods, statistics and interpreting data: analysis, credibility issues

Big picture: concepts into practice, identifying research questionsThinking: critical, conceptual, teaching

Selecting approach, implementation of research in practice

Mentoring, Role model, teachingCommunication, negotiation, team working

Cluster Foundation F-E Excellence E-M Mastery

Expert Practice

Building Relationships

Leadership

Management

E&T and Development

Research and Evaluation

ACLF

Second cycle Third cycle

MSc(Adv) DClinSci/PhD/MRes

Expert professional practice

Expert skills and knowledgePatient care responsibilities


Building working relationships

CommunicationTeamwork and consultation





CPD




ACLF


General Level

Development Phase






General Level

Framework



Not just clinicalAspirational for all specialties

Leadership and Mentors essentialHigher levels – M and D programmes

We need to think big

Awarded Master in Adv Practice(University / JPB accredited- RC recognised ?)

PG DipGPPAward (or equivalent)

New D Clin Sci[or mod map to professional D]

(Specialism)& critical adjacencies

MSc Adv Pract

EPP / BWR

Statement of completion of Practice (University / JPB accredited- RC recognised ?)

L / M / E&D / R&E

Challenges…?

–Equivalence between specialist and generalist–Practicalities of rotations & placements–Maintenance of the service–Curriculum & assessments–Supply and demand

EPP / BWR

L & M

Assessment?Eg: Experience, Portfolios, learning

Evidence

E&D

R&E

Learning setsAll linked to the assignments &

learning outcomes- academically robust

Syllabus & curriculum determined by and

set by expert practitioners-Recognised (accredited)

training centres

Assessment?Eg: Change management assignment

Assessment?Eg: Teaching portfolio

Assessment?Eg: Ethics submission/ audit work

Awarded Master in Adv Practice(University / JPB accredited- RC recognised ?)

Statement of completion of Practice Element (University / JPB accredited- RC recognised ?)

“Royal College”All sectors

specialism specialismspecialism

JPBs (locality based)Accreditation infrastructure, assessment, QA, evidence

Practitionerswho need registering at Foundation, Advanced, PwSI

Practitioner in training

Key skills & KnowledgeCognitive skills

Consultation skillsProblem solvingProfessionalism

CompetenceMedicines expert

Intellectualpractitioner

Decision maker

CONTEXT

Practitioner Skills

Applied Pharmaceutical Sciences

Applied Therapeutics

Clinical Governance

& Risk

JPB and CoDEG websites

www.postgraduatepharmacy.org

www.codeg.org

Where to find information

Possible career structure for MI consultant

Dr Catherine Duggan

Associate Director of Clinical Pharmacy London, South East and Eastern and Senior Clinical Lecturer, School of Pharmacy, University of London

Chair of United Kingdom Clinical Pharmacy Association

possible career structure for mi consultant dr catherine duggan associate director of clinical...

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