The development and validation of a global advanced development framework for the pharmacy workforce: a four-stage multi-methods approach

BACKGROUND

Studies have indicated that a generalisable and translatable global framework is a useful tool for supporting career progression and recognising advanced practice.

AIM

To develop and validate a global advanced competency development framework as a tool to advance the pharmacy profession globally.

METHOD

A four-stage multi-methods approach was adopted. In sequence, this comprised an assessment of initial content and a cultural validation of the advanced level framework. Following this, we conducted a transnational modified Delphi followed by an online survey sampling the global pharmacy leadership community. Finally, a series of case studies was constructed exemplifying the framework implementation.

RESULTS

Initial validation resulted in a modified draft competency framework comprising 34 developmental competencies across six clusters. Each competency has three phases of advancement to support practitioner progression. The modified Delphi stage provided feedback on framework modifications related to cultural issues, including missing competencies and framework comprehensiveness. External engagement and case study stages provided further validity on the framework implementation and dissemination.

CONCLUSION

The four-staged approach demonstrated transnational validation of a global advanced competency framework as a mapping and development tool for the pharmacy professions. Further study is needed to develop a global glossary of terminologies on advanced and specialist practice. Also, developing an accompanying professional recognition system and education and training programmes to support framework implementation is recommended.

Competency-Based Education: Developing an Advanced Competency Framework for Indonesian Pharmacists

Introduction: Pharmacists need to be adaptable, flexible, and capable of advancing their practice to adapt to rapidly changing population health needs. We describe an educational approach to pharmacy workforce transformation in Indonesia through an advanced practice competency framework development using an “adopt and adapt” methodology.

Methods: The competency framework development process comprised a translation phase, an adopt and adapt phase, validation through a nationwide mapping survey, and a completion phase through leadership consensus panels. We conducted a forward-backwards translation of a previously validated Advanced to Consultancy Level Framework (ACLF) to yield the Indonesian Advanced Development Framework (IADF) draft. The subsequent adoption and adaptation process was conducted through a series of consensus panels. We validated the IADF through a nationwide workforce survey. The final phase included leadership consensus panels with the professional leadership body in Indonesia. We analyzed the qualitative data thematically and the quantitative data using a Multiple Correspondence Analysis (MCA) technique.

Results: We identified conceptual challenges in adopting and adapting the existing ACLF, which were addressed by providing a national glossary and concrete examples. A total of 6,212 pharmacists participated in the national workforce survey, of which 43% had <2 years of post-license (post-registration) experience. The MCA results showed that practitioner self-assessment to the IADF could discriminate their career development stages. The results also indicated a four-stage career model (including early years career training). Embedding this model in a structured national training program will enhance the professional workforce development through a more structured career journey.

Conclusions: We describe the first validation of an advanced competency development framework for the pharmacy workforce in a non-Anglophone country, showing the possibility of transnational applicability of this framework. We argue that this methodology can be used in Low and Middle-income countries (LMICs) for the more rapid advancement of pharmaceutical care practice.

The development, validity and applicability to practice of pharmacy-related competency frameworks: A systematic review

BACKGROUND

Global reforms in the education of health workers has culminated in the implementation of competency-based education and training (CBET). In line with the CBET model, competency frameworks are now commonplace in the health professions. In pharmacy, these frameworks are used to regulate career entry, benchmark standards of practice and facilitate expertise development.

OBJECTIVE

This systematic review assessed the development, validity and applicability to practice of pharmacy-related competency frameworks.

METHOD

PubMed/Medline, CINAHL, Embase, ERIC, Scopus, ProQuest and PsycINFO electronic databases were searched to identify relevant literature. Additional searching included Google Scholar, electronic sources of grey literature, and the Member Organisation websites of the International Pharmaceutical Federation (FIP). The findings of this review were synthesised and reported narratively. The review protocol is registered on PROSPERO with reference number CRD42018096580.

RESULTS

In total, 53 pharmacy-related frameworks were identified. The majority (n = 38, 72%) were from high income countries in Europe and the Western Pacific region, with only three each from countries in South East Asia (SEA) and Africa. The identified frameworks were developed through a variety of methods that included expert group consultation used alone, or in combination with a literature review, job/role evaluation, or needs assessment. Profession wide surveys and consensus via a nominal group, Delphi, or modified Delphi technique were the primary methods used in framework validation. The competencies in the respective frameworks were generally ranked relevant to practice, thereby confirming validity and applicability. However, variations in competency-related terminologies and descriptors were observed. Disparities on perception of relevance also existed in relation to area of practice, length of experience, and level of competence. For example, pharmaceutical care competencies were typically ranked high in relevance in the frameworks, compared to others such as the research-related competencies.

CONCLUSION

The validity and applicability to practice of pharmacy-related frameworks highlights their importance in competency-based education and training (CBET). However, the observed disparities in framework terminologies and development methods suggest the need for harmonisation.

Development of nurse practitioner metaspecialty clinical practice standards: A national sequential mixed methods study

AIM

To achieve profession-wide consensus on clinical practice standards for six broad Australian nurse practitioner specialty areas (termed metaspecialties).

DESIGN

Sequential mixed methods with initial interpretive study (Interpretive Phase) followed by modified three-round Delphi study (Survey Phase).

METHODS

Participants from all Australian jurisdictions were recruited. Main eligibility criterion was current endorsement as a nurse practitioner for 12 or more months. Interpretive Phase comprised in-depth interviews of purposeful sample of nurse practitioners to identify clinical care activities and practice processes. Six sets of draft clinical practice standards relevant to six previously identified metaspecialties were developed. Outcome informed Round 1 of Survey Phase (six nested web-based Delphi surveys), with draft standards reviewed profession-wide. Responses comprised scoring using Likert scales to calculate content validity indexes for individual standards with qualitative responses supporting decision-making. For Rounds 2 and 3, participants rated relevancy of original or revised standards after consideration of individual and group feedback. The study was conducted 2014-2017.

RESULTS

Interpretive Phase: Analysis of interview data with 16 nurse practitioners provided 75 draft standards. Survey Phase: 221 nurse practitioners completed Round 1 (20% of then eligible Australian nurse practitioners). Weighted respondent retention was 92%. Seventy-three standards were validated, with final content validity indices of 92-100%. Scale-level indices were 98%, strongly validating metaspecialty taxonomy.

CONCLUSION

A research-derived, professionally endorsed suite of nurse practitioner clinical practice standards was developed. This provides a broad clinical learning structure with metaspecialties guiding nurse practitioner student clinical education.

IMPACT

The clinical practice standards and metaspecialty taxonomy strengthen nurse practitioner clinical education and professional development nationally and internationally. These novel study methods and findings are applicable to advanced specialty roles in other health professions.

Preparing lifelong learners for delivering pharmaceutical care in an ever-changing world: a study of pharmacy students

BACKGROUND

Continuing professional development (CPD) continues to gain acceptance as a model for health care professionals to engage in lifelong learning (LLL). Many pharmacy schools have not adopted yet specific programs targeting the development of LLL skills, though LLL is widely accepted as an essential competence. This paper examines the effectiveness and utility of a longitudinal CPD training program.

METHODS

A CPD simulation course was introduced to a cohort of fifth year students in Northern Cyprus in the 2018-2019 academic year. The program was delivered as an interactive orientation course in one semester; meanwhile, in the second semester, the students applied the CPD cycle and completed their portfolios during their final experiential practice. A mixed-methods approach was used to evaluate the outcomes of the intervention using students' preparedness for lifelong learning (SPLLL) self-administered questionnaire delivered pre-post program, focus group sessions for students to reflect on the course experience, and instructors' evaluations of portfolios.

RESULTS

Following the implementation of the course, students' assessment scores were significantly higher overall and for all scale domains, including "knowledge, skills, attitude and practice", compared to the baseline assessment. Additionally, compared to fifth year students who responded to the second SPLLL questionnaire, the intervention group students' assessment was significantly higher in knowledge, skills, and practice. The qualitative analysis reported high student satisfaction and achievement of the course objectives. Nineteen of the students scored high on their portfolios.

CONCLUSION

The CPD simulation course provided students with opportunities to practice and develop self-assessment and self-management skills that are all desirable for lifelong learning and prepared them for CPD.

Development of a Postgraduate Community Pharmacist Specialization Program Using CanMEDS Competencies, and Entrustable Professional Activities

Objectives. To develop and implement a postgraduate, workplace-based curriculum for community pharmacy specialists in the Netherlands, conduct a thorough evaluation of the program, and revise any deficiencies found. Methods. The experiences of the Dutch Advisory Board for Postgraduate Curriculum Development for Medical Specialists were used as a guideline for the development of a competency-based postgraduate education program for community pharmacists. To ensure that community pharmacists achieved competence in 10 task areas and seven roles defined by the Canadian Medical Education Directions for Specialists (CanMEDS), a two-year workplace-based curriculum was built. A development path along four milestones was constructed using 40 entrustable professional activities (EPAs). The assessment program consisted of 155 workplace-based assessments, with the supervisor serving as the main assessor. Also, 360-degree feedback and 22 days of classroom courses were included in the curriculum. In 2014, the curriculum was evaluated by two focus groups and a review committee. Results. Eighty-two first-year trainees enrolled in the community pharmacy specialist program in 2012. That number increased to 130 trainees by 2016 (a 59% increase). In 2015, based on feedback from pharmacy supervisors, trainees, and other stakeholders, 22.5% of the EPAs were changed and the number of workplace-based assessments was reduced by 48.5%. Conclusion. Using design approaches from the medical field in the development of postgraduate workplace-based pharmacy education programs proved to be feasible and successful. How to address the concerns and challenges encountered in developing and maintaining competency-based postgraduate pharmacy education programs merits further research.

The development of a foundation-level pharmacy competency framework: An analysis of country-level applicability of the Global Competency Framework

BACKGROUND

The importance and usefulness of competency frameworks (CFs) in pharmacy professional development is recognised globally. However, there is no national CF for pharmacists in Japan yet.

OBJECTIVE

This study was conducted to measure the level of relevance of behavioural statements of the International Pharmaceutical Federation (FIP) Global Competency Framework (GbCF) to Japanese foundation-level pharmacy practice, aiming for developing a national framework for foundation-level pharmacists in Japan.

METHODS

A cross-sectional, anonymous, online self-completed survey was conducted during June and July 2018 in Japan. The questionnaire was adopted from the GbCF, translated into Japanese. A snowballing sampling approach was used. The relevance levels of the GbCF items were assessed by using 4-point Likert scales, and analysed by descriptive and inferential methods.

RESULTS

A total 604 useable responses were included in analyses. High levels of relevance levels were found in two clusters ('pharmaceutical public health' and 'pharmaceutical care'), while the other two clusters ('organisation and management' and 'professional/personal') showed significantly low relevance (relevance = 89.6%, 82.5%, 59.6%, and 67.9%, respectively). The study found little engagement of the academic sector with framework, while the industry sector showed relevance to all clusters evenly. Regarding years working in sectors, there was no progression of relevance in 'organisation and management' and 'professional/personal' competencies during foundation years as well as very little professional/personal development.

CONCLUSIONS

The study revealed specific competencies and behaviours which require modifications to adapt the GbCF into the Japanese pharmacy practice environment. This is a key step towards the development of a national framework, illustrating current Japanese foundation-level pharmacy practice compared with global standards. The findings will be used as a base for developing a framework for foundation-level pharmacists in Japan and address concerns such as pharmacist preparedness to advance in management roles and limited personal and professional development.

Educating for health service reform: clinical learning, governance and capability - a case study protocol

Background

The nurse practitioner is a growing clinical role in Australia and internationally, with an expanded scope of practice including prescribing, referring and diagnosing. However, key gaps exist in nurse practitioner education regarding governance of specialty clinical learning and teaching. Specifically, there is no internationally accepted framework against which to measure the quality of clinical learning and teaching for advanced specialty practice.

Methods

A case study design will be used to investigate educational governance and capability theory in nurse practitioner education. Nurse practitioner students, their clinical mentors and university academic staff, from an Australian university that offers an accredited nurse practitioner Master’s degree, will be invited to participate in the study.

Semi-structured interviews will be conducted with students and their respective clinical mentors and university academic staff to investigate learning objectives related to educational governance and attributes of capability learning. Limited demographic data on age, gender, specialty, education level and nature of the clinical healthcare learning site will also be collected. Episodes of nurse practitioner student specialty clinical learning will be observed and documentation from the students’ healthcare learning sites will be collected.

Descriptive statistics will be used to report age groups, areas of specialty and types of facilities where clinical learning and teaching is observed. Qualitative data from interviews, observations and student documents will be coded, aggregated and explored to inform a framework of educational governance, to confirm the existing capability framework and describe any additional characteristics of capability and capability learning.

Discussion

This research has widespread significance and will contribute to ongoing development of the Australian health workforce. Stakeholders from industry and academic bodies will be involved in shaping the framework that guides the quality and governance of clinical learning and teaching in specialty nurse practitioner practice. Through developing standards for advanced clinical learning and teaching, and furthering understanding of capability theory for advanced healthcare practitioners, this research will contribute to evidence-based models of advanced specialty postgraduate education.

An Advanced Pharmacy Practice Framework for Australia

The need to develop An Advanced Pharmacy Practice Framework for Australia (the “APPF”) was identified during the 2010 review of the competency standards for Australian pharmacists. The Advanced Pharmacy Practice Framework Steering Committee, a collaborative profession-wide committee comprised of representatives of ten pharmacy organisations, examined and adapted existing advanced practice frameworks, all of which were found to have been based on the Competency Development and Evaluation Group (CoDEG) Advanced and Consultant Level Framework (the “CoDEG Framework”) from the United Kingdom. Its competency standards were also found to align well with the Domains of the National Competency Standards Framework for Pharmacists in Australia (the “National Framework”). Adaptation of the CoDEG Framework created an APPF that is complementary to the National Framework, sufficiently flexible to customise for recognising advanced practice in any area of professional practice and has been approved by the boards/councils of all participating organisations. The primary purpose of the APPF is to assist the development of the profession to meet the changing health care needs of the community. However, it is also a valuable tool for assuring members of the public of the competence of an advanced practice pharmacist and the quality and safety of the services they deliver.

What does advanced practice mean to Australian paediatric pharmacists? A focus group study

Objectives

The aim of this study was to explore perceptions and attitudes of Australian paediatric pharmacists about advanced pharmacy practice and to identify suitable methods of assessment for this level of practice.

Methods

Four focus groups (with 31 participants) were held in 2012 with Australian hospital pharmacists who work with children. Written notes and audio recordings were used to produce verbatim transcriptions and extract themes.

Key findings

There was consensus across groups that formal recognition of advanced pharmacy practice was valuable to the profession and to individuals. Elements should include a strong grounding in clinical practice, commitment to education, research and service improvement outside the department and institution. A framework for career development should be used to describe the levels of practice leading to advanced practice. Assessment should involve multiple separate criteria, and incorporate direct observation, peer review and a professional portfolio. Postgraduate qualifications are desirable but not considered essential. Different knowledge and skills are required in paediatrics; however, the definition of advanced practice remains the same.

Conclusions

Recognition of advanced practice is valuable for the profession and for individuals. Multiple methods of assessment should be used. Specialty areas such as paediatrics can be defined and assessed similar to other specialties, with acknowledgement of the specific paediatric knowledge and skills required.

Clinical networks influencing policy and practice: the establishment of advanced practice pharmacist roles for specialist palliative care services in South Australia

Objectives To operationalise the concept of ‘advanced practice roles’ in pharmacy within the new integrated regionalised palliative care service model outlined in the Palliative Care Services Plan 2009–2016, SA Health. Methods A working group was established under the auspices of the Palliative Care Clinical Network to progress the development of advanced practice pharmacist roles for regionalised palliative care services. A pharmacy stakeholder forum was conducted in December 2010 to provide further guidance on the advanced practice pharmacist roles in the following domains: education; network links and partnerships; quality and safety; and research. Results Advanced practice pharmacist positions were created for each of the three regionalised palliative care services in South Australia (SA). Funding was obtained for a Statewide Palliative Care Pharmacy Network project, to build a sustainable community-based palliative care pharmacy network. Advanced practice pharmacists commenced in the regionalised palliative care services of SA on 4 October 2011. Conclusions The Statewide Palliative Care Clinical Network and the SA Palliative Care Plan provided a policy framework that supported involvement and advocacy in the planning of the advanced practice pharmacist roles. Collaboration between leaders in workforce reform, service planners, specialist palliative care providers and the pharmacy sector was a key enabler for developing the advanced practice pharmacist positions for regionalised palliative care services. What is known about the topic? The advanced practice palliative care pharmacist role reflects a new direction for the discipline of pharmacy and has been embraced at a time when a nationally endorsed Advanced Pharmacy Practice Framework has been published, while recognising that registration for pharmacists in Australia currently does not have specific endorsement for advanced practice. What does this paper add? This paper outlines the value of collaboration across settings and sectors. There is an opportunity for these roles to align with the new nationally endorsed framework for advanced practice in pharmacy. What are the implications for practitioners? These new positions strengthen the links between the hospital and community pharmacy sectors to enhance a quality use of medicines approach with improved access to end-of-life medicines for home-based palliative care clients, which actively facilitates a home death for those who choose it.

Preparing hospital pharmacists to prescribe: stakeholders' views of postgraduate courses

OBJECTIVES

To explore pharmacy stakeholders' views on developing a postgraduate course to prepare hospital pharmacists for collaborative prescribing in Australia.

METHODS

Semi-structured interviews were conducted with pharmacy stakeholders from universities, hospitals and professional organisations (n = 25) to gather views on the content, structure and delivery methods of a possible postgraduate prescribing course for pharmacists. Transcripts were analysed thematically and coded using NVivo software.

KEY FINDINGS

There was strong support for collaborative prescribing as an appropriate role for advanced pharmacist practitioners and acknowledgement that further training is needed to implement this new role. It was proposed that postgraduate training for hospital pharmacists should be based on a national prescribing competency framework and participants highlighted key aspects of the prescribing process in which pharmacists need particular up-skilling: diagnosis, physical assessments, clinical decision-making and consultations. The training model used in the UK was favoured, where candidates undertake university-based study combined with collaborative training with a doctor and a practical assessment of competency.

CONCLUSIONS

The findings from this study have provided valuable information which can provide a pathway for the development of a postgraduate course to prepare Australian hospital pharmacists for prescribing. Future research should focus on uncovering the perceptions of Australian doctors, nurses and policy makers on the training requirements needed for pharmacist prescribing in the hospital setting. Stakeholders' views on pharmacist prescribing training in the community setting could also be explored.