Embedding Pharmacist Prescribing into Undergraduate Pharmacist Education: A Qualitative Analysis of Student and Stakeholder Perspectives
Authors: Parejo L , Jones T 
Published: November 2023

Abstract

Introduction
From 2026 onwards, upon passing the registration exam, all pharmacy students will become independent prescribers (IP), with the aim of maximising the diagnostic and therapeutic skillset of all pharmacist graduates. As a result of this, pharmacy undergraduate education requires a shift in curriculum design to align with the change in direction the profession demands. Research is required to ascertain the needs of the local workforce to identify how the Master of Pharmacy (MPharm) course needs to change to future proof the pharmacy workforce and prepare them to independently prescribe. The GPhC new standards for pharmacist prescribing act as a scaffold for the structure of the course, but individual institutions have a level of freedom in curriculum design.

Aim
To identify the skills, knowledge and best pedagogical approaches required by key stakeholders in the local workforce, to develop an undergraduate prescribing programme for pharmacy students in a North-East England University Pharmacy School.

Methods
Two focus groups were conducted, one with key educational stakeholders in the North-East of England (Hospital, Primary Care and Academic Leaders in Pharmacy) and one with current MPharm students attending Newcastle University. Participants were selected via convenience sampling. Each group had n=5 participants. Data were recorded and transcribed, then analysed using thematic analysis in NVivo 12 to draw out key themes to consider when redesigning the MPharm curriculum. The project was granted ethical approval by Newcastle University’s Ethics Committee on 27/09/22, Reference 25121/2022.

Results
Five key themes were derived, with several overlapping across both groups. Themes identified: course content, teaching methods, assessment methods, current level of practice, and barriers to implementation. Within these themes, the key areas where stakeholders and students felt more training was required were identified as; diagnostic skills, mental health, dealing with patients with comprehension difficulties and dealing with complex decisions. The ways in which best to deliver this content were found to be through placement and seminars, also with students notably enjoying problem-based learning (PBL). Issues with hospitals having the capacity to provide adequate placement time for all students was a key concern amongst the stakeholders and was recognised as a key barrier to implementation of enhanced education in the future.
Regarding digitalisation of teaching, students expressed a dislike for online delivery of content, but could see the benefits in teaching of emerging technology. However, it was ultimately felt that technology could not replace real-life experience. OSCEs (Objective Structured Clinical Examinations) were recognised as the best way to assess prescribing ability, however further modifications could be made to make them more specific to independent prescribing.

Discussion/Conclusion
Stakeholders and students felt the current programme should place greater emphasis on diagnostic skills and complex patient scenarios, with specific focus on people with additional needs such as autism. Additional awareness of the diversity of patients and how this affects prescribing decisions also was raised as a pertinent consideration. Limitations of this research include the small sample size of participants, which limits generalisability of opinions contributed. This was due to lack of recruitment time as a result of project time constraints.

References
1. Stewart DC, George J, Bond CM, Diack HL, McCaig DJ, Cunningham S. Views of pharmacist prescribers, doctors and patients on pharmacist prescribing implementation. International Journal of Pharmacy Practice. 2009;17(2):89-94.
2. Health Education England. Initial Education and Training of Pharmacists - Reform Programme [Internet]. 2022 [cited 2022 Nov 28]. Available from: https://www.hee.nhs.uk/our-work/pharmacy/transforming-pharmacy-education-training/initial-education-training-pharmacists-reform-programme.
3. (GPhC) General Pharmaceutical Council. Standards for the initial education and training of pharmacists. 2021 January 2021.