In the UK there is a network of around 200 local MI centres based in the pharmacy departments of NHS hospitals and mental health trusts. These centres are staffed mainly by pharmacists and pharmacy technicians who have clinical expertise and skills in locating, assessing and interpreting information about medicines. There are also fifteen regional centres in England, Scotland and Northern Ireland, and one national centre in Wales, and these collaborate to provide strategic direction to the service via an organisation known as UK Medicines Information (UKMi).
Given the rapid development of new medicines, no individual practitioner can hope to know everything, and so all pharmacists must be skilled in the retrieval and interpretation of data about medicines. Not surprisingly, a recent UK survey has shown that the provision of information and advice to patients and professionals is one of the most common tasks undertaken by pharmacy staff 2. Yet in order to advise about the care of patients, simple information retrieval is not enough – it has to be set in the context of clinical practice and the needs of individual patients.
Various policy objectives to expand the role of pharmacy in supporting medicines optimisation in England will increase the pharmacist’s advisory roles across all healthcare settings.3,4 Hence, the skills that MI pharmacists both possess and can teach continue to be essential.
Over the past 30 years, a system of education and training resources has evolved in the UK to support the development of what might be called MI skills or clinical problem solving skills, and we aim to review these here.
The regulator for pharmacists and pharmacy technicians in the UK is the General Pharmaceutical Council (GPhC). Its educational standards for pharmacists in their pre-registration year make it clear that pharmacists must know how to provide evidence-based medicines information.5 For example, they should be able to “Access and critically evaluate evidence to support safe, rational and cost-effective use of medicines” and “Optimise treatment for individual patient needs in collaboration with the prescriber”. These standards are helpful in outlining the kinds of MI-related skills required by pharmacy professionals.
The Royal Pharmaceutical Society (RPS) is the professional membership body for pharmacists and pharmacy in Great Britain. It has produced frameworks for assessment of professional practice at foundation and advanced levels.6 These identify many of the MI skills required during training. UKMi also provides service standards for MI Centres that help to set the practical tone for the training that is required.7
It is also notable that training on MI skills is included in many postgraduate clinical pharmacy diplomas aimed at foundation level pharmacists working across all healthcare sectors.
A survey in 2015 indicated that around half of the current UK undergraduate pharmacy degree programmes have input from practising MI pharmacists.8 The input varies between universities, with teaching in year 4 being the most common. Tuition is delivered via a range of formats including large group lectures, small group teaching, project support and supervision, and work-based experience. Only a minority of courses included formal student MI assessment.
An exemplar approach at the King’s College School of Pharmacy, London has been developed with MI staff working at Guy’s and St Thomas’ NHS Foundation Trust8. MI staff deliver teaching sessions to pharmacy students throughout the undergraduate degree course and also at postgraduate level. This teaching sits under the programme banner ‘Clinical reasoning and influences to prescribing’, and over the four years develops the themes of problem solving, robust literature searching, and critical appraisal. A combination of didactic teaching, case-based learning and assessed presentations are the teaching methods used.
The bulk of MI skills training in the UK is delivered to pre-registration and foundation level pharmacists in hospitals via one-to-one tuition as part of employment. A typical pattern is for pre-registration pharmacists to receive about four weeks’ training from an experienced MI pharmacist, and for a newly-qualified pharmacist to receive two to three months. During this time, these pharmacists take advantage of resources such as the Medicines Learning Portal and MiCAL (see below), and are exposed to real clinical enquiries under supervision. Their draft responses to enquiries are checked by their MI tutor at which stage corrections and learning points are identified. At the end of the period of training a formal assessment is given, which may be considered as evidence towards the GPhC standards or RPS foundation framework as described above.
Medicines learning portal
The Medicines Learning Portal is an open access website that teaches clinical problem solving skills to pharmacists working in a range of environments such as in clinical pharmacy, MI centres, and in the dispensary (www.medicineslearningportal.org). It is aimed at pre-registration and newly-qualified pharmacists in hospitals during their first one thousand days. The site was developed by a wide variety of pharmacists from around the UK, and has content and support from many national pharmacy groups including RPS and clinical pharmacy specialists.
Amongst other content, the site addresses basic principles of medicines safety for key clinical topics, shows the right questions to ask when problem-solving, guides pharmacists on how to apply their professional judgement, and advises on communication techniques for delivering expert advice. The Medicines Learning Portal also includes interactive quizzes and scenarios, as well as links to online material provided and endorsed by the site’s many partner organisations (including MiCAL, below). It also tackles professional skills such as decision-making in difficult clinical situations, and the concept of managing medicines at a level beyond that of the individual patient.
This is a web-based computer-assisted learning platform available via annual subscription (www.midatabank.com/mical). It was developed by MI pharmacists at Northwick Park Hospital, in conjunction with a commercial IT partner, CoAcS. It is aimed at pharmacy staff wishing to gain (or improve) the skills necessary to reduce the risk to enquirers from the provision of inappropriate advice relating to medicines. Updated annually, it provides training on using the enquiry recording database MiDatabank through example enquiries.
There are 20 interactive example scenarios around various clinical topics which help to teach documentation of formal medicines related questions in an MI centre. There are pre- and post-learning tests and MCQs which can be undertaken by the learner and seen by their supervisor, as well as guidance on how to research answers, the importance of seeking background information, and the use of information resources. MiCAL also delivers training on advanced skills such as critical appraisal skills for randomised controlled trials, calculations commonly encountered in pharmacy practice, and patient safety.
Training course and seminar
UKMi organises a National MI Training Course (NMITC) every nine months. It is an intensive three-day residential course designed for UK pharmacy practitioners working as new specialists in MI services. The NMITC equips participants with the knowledge and skills required to provide and develop their service, and is a suitable resource for staff who have completed (or are near completion) of their early, or foundation years, of career development. The course involves lectures, workshops, demonstrations and practical exercises, and provides an opportunity for 30–40 participants to network with MI colleagues.
The annual UKMi professional development seminar is open to MI pharmacists around the world and is a valuable opportunity to learn about new developments, share best practice, and network. A small number of overseas trainees also attend. The current programme is available online: www.ukmi.nhs.uk.
The UKMi Accredited MI Technicians Training Scheme is aimed at Pharmacy Technicians who wish to become specialised in MI. The programme provides information on the organisational issues and responsibilities that must be clarified in order to assure safe operation. There is a taught component, and a period of experience, evidence collection, and assessment.
Primary care training
UKMi and the Centre for Pharmacy Postgraduate Education has developed a web-based, interactive, self-directed programme for pharmacy staff working in primary care settings (www.cppe.ac.uk/programmes/l/amrqp-p-01/). It focuses on delivering high quality responses to questions about medicines. The package covers how to gather information and formulate an evidence-based answer that is relevant to the enquirer and focused on improving patient outcomes.
Clinical pharmacist training
Many MI centres offer training to established clinical pharmacists who may feel that their MI skills are not up-to-date. For example, a short, self-directed PowerPoint presentation was developed by MI and clinical pharmacists in the south west of England in order to address the need for clinical pharmacists to be updated on how to access and use common, standard sources of information on medicines.9 This can be completed in less than an hour with the intention that clinical pharmacists use it to update themselves every year or so.
All healthcare services change and evolve, and pharmacists in the UK have been successful in maintaining a coordinated national approach to teaching MI skills for three decades. An important balance must continue to be struck between educating pharmacy generalists and those who wish to pursue MI as a specialist career: for example, MI pharmacists may need specialist training to perform functions such as managing a hospital formulary.
However, financial pressures also mean that it is now more important than ever to demonstrate the value of training and to deliver it in a cost-effective manner. The Medicines Learning Portal has recently brought together a large number of pharmacy groups to deliver training via what is effectively a crowdsourcing method. It means that all the groups contribute to the delivery of relevant training via a single open access website. Duplication is avoided, and this seems a robust future model. However, more work is needed to ensure that this platform and other MI training initiatives meet the needs of learners. A survey of users of the Medicines Learning Portal is scheduled for later in 2016.
In the UK, individual hospitals are beginning to coalesce to form larger organisations. In this situation, the resulting organisations usually only host one MI centre. Some hospitals are also beginning to outsource their MI service to a neighbouring provider. These developments mean that the number of MI centres is likely to decline, so there may not be a specialist available to teach MI skills on site.
The Medicines Learning Portal and MiCAL have anticipated this change and offer a means to continue to deliver MI training even if an individual pharmacist works in a hospital that does not have an MI centre.
- The clinical problem solving skills that MI pharmacists traditionally teach are career skills that all pharmacists need to optimise patient care.
- The UK has a coordinated approach to teaching this subject across the whole country.
- Partnerships make it easier to deliver a robust training portfolio, reduce duplication, and enable linkage between training resources.
- MI staff currently work with specialist clinicians, schools of pharmacy, educationalists, the private sector, and the professional body for pharmacy and this works well.
- No single training resource meets the need of every learner group and a range of approaches is needed; what is now in place provides a blended range of options.