Publication Date 01/07/2014         Volume. 6 No. 6   
Information to Pharmacists


From the desk of the editor

Welcome to the July 2014 homepage edition of i2P (Information to Pharmacists) E-Magazine.
At the commencement of 2014 i2P focused on the need for the entire profession of pharmacy and its associated industry supports to undergo a renewal and regeneration.
We are now half-way through this year and it is quite apparent that pharmacy leaders do not yet have a cohesive and clear sense of direction.
Maybe the new initiative by Woolworths to deliver clinical service through young pharmacists and nurses may sharpen their focus.
If not, community pharmacy can look forward to losing a substantial and profitable market share of the clinical services market.
Who would you blame when that happens?
But I have to admit there is some effort, even though the results are but meagre.
In this edition of i2P we focus on the need for research about community pharmacy, the lack of activity from practicing pharmacists and when some research is delivered, a disconnect appears in its interpretation and implementation.

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How to measure competence?

Dr Linda Bryant (PGDipPharm, MPharm, DPharm(Auck), FACPP, FNZCP, FPSNZ, MCAPA)

articles by this author...

Linda is a New Zealand Clinical Advisory Pharmacist working as part of a team with GP's and nurses, in a medication advisory role. New Zealand clinical pharmacists get some encouragement to work independently in a variety of settings not necessarily tied to a community pharmacy. Through her company, Comprehensive Pharmaceutical Solutions, she contracts to Primary Health Organisations, lecturing postgraduate students in Clinical Pharmacy and undertaking evaluations of services. Linda's PhD thesis involved investigation into the barriers of implementing Comprehensive Pharmaceutical Care (clinical medication reviews) in primary care.

The concept of ensuring that our workforce is competent is an excellent idea. At a time of rapidly changing clinical information, our undergraduate degree of 30 years ago (now doesn’t that make you feel old!!) is simply inadequate. For those of us that went to University we learned Knowledge, Understanding, Thinking and problem solving. The rest of us were taught on the job. Our work experience, built on this foundation, helped make us competent. The problem is – measuring that competence over time.

In New Zealand we have had a competence-based system that has involved a practice review, identifying gaps, ‘filling’ those gaps and then reflecting on the ‘learning’, and applying our new knowledge to our practice. On the face of it this concept appeared suitable, but we have now moved on and are looking to revamp this system. Unfortunately there appears to be a paucity of systems or methods that fulfil the requirements. It is difficult to identify any other health professionals who have an ideal system – or even close to it. What are the difficulties?

• All the profession cannot be lumped in together – we take on different roles and so require different levels of competency. What is important for me in my work is not the same as a pharmacist in another environment or geographical location

• Clinical competency is very difficult to monitor easily simply because of the nature of clinical work. We may know the guidelines for treatment, but clinical competence is about understanding the information behind the guideline and hence knowing when not to apply it for an individual. Tick boxes for knowledge doesn’t cut it clinically.

• We need a range of clinical competencies depending on the level at which different pharmacists work – but how can we measure this other than through an examination?

• In line with this, application of a learning may be broader than just for an individual patient (e.g. teaching sessions to other health care providers) – this needs acknowledgement as a competency measure

• The system should not be overly burdensome, and needs to be part of our everyday practice. We need acknowledgement of what we do as well as how we extend ourselves.

• As well as not overly burdensome time-wise, it must also not be costly, and hence needs to involve relatively straight forward assessment processes.

The general practitioners have a system where they are required to do a set amount of continuing medical education (not having to show a reflection on this or application of it in practice), a clinical audit every three years and attend peer review. Reviews are undertaken if there is a complaint. Nurses maintain a portfolio. Both groups see the need to change their system.

One area of debate is that of postgraduate qualifications. While it is accepted that possessing postgraduate qualifications do not mean that a person is competent, the debate rages around whether there is a need for postgraduate qualifications to enable a pharmacist to be competent at a particular clinical level – or does osmosis and ‘apprenticeship’ over time mean that the person can achieve clinical competence without the formal postgraduate education. Extending this argument, could enable the pharmacy technician to become a competent pharmacist through working for a prolonged time in a pharmacy and doing some extra reading at home.

Formal clinical postgraduate qualifications are a concise and standardised way of determining a pharmacist’s base knowledge and understanding. On top of that there is an expectation to demonstrate competence by applying this understanding to an individual patient. Without the extensive formal assessment through universities, how could we know the knowledge and understanding base from which a pharmacist is working? Is it enough to recognise that pharmacists have been practicing long term and read a lot? One of the crucial courses for postgraduate clinical pharmacy qualifications is the ‘next level’ of literature searching, critical appraisal and clinical skills. This is a foundation on which we can critically review new information and systems. From ‘experience’, it is a very necessary step in postgraduate study, which is not necessarily present or able to be tested for in those who believe that experience alone can make you competent.

It is a combination of formal study and experience that enables people to be competent at whichever level they chose. The problem of course – is how do you measure the level of competence?

Dr Linda Bryant

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