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How can pharmacy tackle education inequalities?

What steps can be taken to improve black-African registration exam performance?

What part does ethnicity play in students’ registration exam performance? And what can be done to ensure a level playing field for all? These were the questions the General Pharmaceutical Council (GPhC) attempted to tackle last week, when it invited diversity experts and pharmacy education leaders to a central London seminar to debate the issues.

It’s not the first time the GPhC has probed the issue of education inequalities. In July, the regulator published research it commissioned in 2015 into the factors that contribute to the poor performance of black-African students in registration exams compared to other ethnic groups – a trend it has noticed since 2013.

The report showed that the pass rate for black-African candidates sitting the exam for the first time in 2013 was 54%, compared with 93% for white-British students. This pattern persisted in 2014, and in 2015 – when the black-African registration exam pass rate returned to 54%, compared to 88% for white-British students.

The report identified a number of factors (see What did the GPhC’s report find? below), ranging from the difficulties experienced by what were often mature students, to the implicit and explicit bias some students faced during their training.

Armed with the results of the research, GPhC chairman Nigel Clarke kicked off the proceedings by pledging that the day’s discussions would influence the regulator’s standards for pharmacy education and training – due to be published later this year.

“I’m looking forward to some thought-provoking presentations and discussion… to identify what actions we can all take to address some of those challenges and barriers students and trainees may experience,” he said.

Did the GPhC deliver on this promise? Here are the top five things C+D took away from the seminar.

1. A little less conversation and a little more action

The sector should “get on and act” to address the issue, instead of concentrating on statistics, Uduak Archibong, the seminar’s keynote speaker and professor of diversity at the University of Bradford, told delegates.

Professor Archibong – whose daughter is a pharmacist – said now is the time for action, rather than endlessly analysing the data gathered so far. This approach has traditionally prevented organisations from “moving forward” on diversity issues.

“We need to stop the numbers game [and] start asking people… to find out exactly what the problem is,” she stressed.

However, other delegates had different views on the need for more research (see point 4).

2. It’s up to everyone to make a change

During her speech, Professor Archibong advocated a sector-wide approach to tackling education inequalities.

She encouraged setting “achievable targets”, such as introducing diversity “sponsors” across the GPhC and schools of pharmacy to champion inclusivity at every level of their organisations. Making sure that pharmacy education is inclusive should be part of the sector’s “day-to-day practices”, and diversity should be in the “fabric of what we stand for”, she said.

It is the whole sector’s responsibility to take research on diversity seriously, Professor Archibong stressed. “Let’s work together to achieve success for everybody.”

Addressing a delegate’s question on how the focus on underperformance could impact the self-identity of black-African students, Professor Archibong highlighted the need for an “inclusive culture”, which would allow students to see the positivity of such initiatives.

This attitude would also prevent “closing down” students, who may already feel insecure about the expectations and preconceptions of how trainees from their ethnic group generally perform in the registration exam, she said.

“You must have a culture where people feel like critical conversations around this subject are what we need,” she said. The challenge to community pharmacy is to foster the kind of culture that makes this possible, she added.

3. Role models can be a crucial source of support

Professor Archibong closed her speech with a personal story about her daughter and her experiences with a “stupid placement” in a community pharmacy. She said her child “nearly didn’t make it” in the profession, but for the intervention of a delegate at the seminar. This individual became a role model for her daughter – who has now been a pharmacist for many years.

The importance of mentors for black-African students was also highlighted by Dr Helen Brown, one of the researchers who worked on the GPhC report into ethnic minority candidate performance. She pointed out that students who took part in the qualitative study talked about the “all important” benefits of having a role model.

4. More research may be needed…

When the GPhC published its research in July, chief executive Duncan Rudkin said that a “complex interplay of factors” had resulted in the poor exam performance by black-African candidates.

In response to a delegate’s question about whether the research could help to pinpoint exactly what the problem was, Dr Brown said current research is not detailed enough and would need to be updated, as it had only been a “small, exploratory study”.

“These findings were indicative. If you feel they don't have relevance, then you can let them go,” she added.

5. …And there’s more work to be done

Following on from her talk, an audience member asked Dr Brown the question on everyone’s mind: are there plans to expand the study that had only “scratched the surface” of the issues faced by black-African students?

In response Mr Clarke said that this was a question the regulator needed to “take away” from the event.

After the seminar, C+D pressed the GPhC on what its next steps would be to tackle diversity in pharmacy education.

The regulator will be issuing a report of the event to education and training providers, and those who have a “direct influence” on trainees, a GPhC spokesperson said.

A “key message” it took away from the event was that organisations – including itself, schools of pharmacy and training providers – all play a “crucial role” in the experiences of ethnic minority students.

The regulator says it will also consider commissioning further research on the issue, “to build a greater understand of the issues being explored”.

As the seminar raised more questions than it answered, this would seem like a good next step to understand a complex issue affecting the next generation of community pharmacists.

What did the GPhC’s report find?

Different expectations

Some training providers had “lower expectations” of black-African students, making it harder for them to “reach their full potential”. There were particular problems with community pharmacy pre-registration placements, with a small number of those interviewed feeling they could result in bias against their appearance or accent.

Overseas students at a disadvantage

Some students who had studied overseas during their secondary education struggled with adapting to new teaching and exam styles in the UK.

Financial or family pressures

A high proportion of black-African candidates who failed their first registration exam were mature students, which meant they were more likely to face family or financial – alongside academic – pressures.

Being left out

Some students said they felt “isolated and excluded” from their peers, which made it hard to form study groups or support networks.

What else could the GPhC do to improve education equality?

Yemisi Usher, Other healthcare profession

I'd be interested to know:

1) how many white students there are to BME students 

2) are white students more likely to be taken at pre registration placements with better training i.e. Hospital placements and big chains such as Boots and Lloyds? 

Yesterday I saw a very well known hospital pharmacist refer to BME pre registration students as 'poor trainees'. It just made me wonder whether statements like this could also be having detrimental effects. Being constantly told you are not a bright or competent as your white peers. Just a thought

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