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‘Why the pre-reg exam had to be deferred during the COVID-19 outbreak’

“Assessments work if everyone sits them the same time under the same conditions”

Deferring the June and September pharmacy pre-registration exams was the only viable option for candidates during the COVID-19 pandemic, says Khalid Khan

The General Pharmaceutical Council (GPhC) announced last month (March 26) that it’s postponing the June and September sittings of the pre-registration assessment , due to the COVID-19 pandemic.

This understandably sent shockwaves through the cohort of approximately 3,000 trainees. Could the GPhC have done anything else? What might happen next?

When I was asked to write a piece about this, my first thought was there aren’t many answers out there. Lots of speculation, plenty of suggestions, but nothing concrete. It’s almost impossible to plan and predict for anything in the current climate. One of the original assessment venues, ExCel London, is now a makeshift hospital, set up to help cope with the pandemic.

However, there is some value and comfort to be gained in exploring some of the rationale behind the decisions made, as well as highlighting the obstacles to various proposed solutions.

Why can’t pre-regs join the register now?

On the face of it, this is a perfectly reasonable suggestion. Pre-registration trainees have completed four years of MPharm and are eight months into their training year. Surely they have proven their competency and their tutors can sign them off?

Unfortunately, the comparison with student nurses and doctors isn’t a fair one. Both these courses are high in experiential learning from very early on.

Throughout their learning, medicine students are a part of the university, and their placement tutors undergo a much more rigorous process than those in pharmacy to be qualified to supervise and sign off a trainee.

By contrast, pharmacy students spend the majority of their degree in lectures, labs and workshops. Workplace-based placements are limited, and the hands-on learning during those placements is equally limited.

In most cases, when the pre-reg undertakes their training year they are no longer a part of the university and will be in various settings, from NHS trusts to privately-owned community pharmacies.

The criteria to be a pre-reg tutor is based upon a few years of practice and good behaviour, with no mandatory training or assessment. This results in huge inconsistencies in supervision and quality of sign-off when compared to our medical counterparts.

Why can’t we sit an online assessment?

This is another sensible suggestion, but an unworkable one. Assessments work if everyone sits them the same time under the same exam conditions, which eliminates the possibility of trainees having an unfair advantage or cheating.

There are venues that could accommodate this under normal circumstances, but when social distancing is key to saving lives, this is impractical.

A solution proposed by some trainees is having the tutor invigilate the trainee sitting the online assessment at the tutor’s training site. This would not be fair.

Some students will be able to sit at a computer in a large, comfortable office with excellent internet connection and a leather swivel chair. Other trainees would be crammed into the corner of a dispensary or a tiny consultation room with terrible internet connection, surrounded by the chaotic sounds of a busy dispensary.

Also, how many tutors have the time or willingness to do this during a pandemic? What if the tutor calls in sick, and a replacement can’t be found?

Moving forward

There is talk of a provisional register that trainees could join after completing their 52 weeks training, before they sit the assessment.

However, even this would need careful planning. How would their insurance work? What would the trainees be allowed to do supervised and unsupervised? Clinical checks? Final checks? Who will pay them?

What if some can secure work and some can’t? Is it fair that some could continue practising up until their assessment, while some would be sat at home and out of practise for up to six months before their exam?

This idea is out of the hands of the GPhC and would require NHS funding. If funding can be secured for all trainees to carry on working, then this puzzle would be much easier to solve.

Like many of my colleagues, I have a great deal of sympathy for the predicament trainees are in and I don’t pretend to understand how they are feeling. Some have extra financial responsibilities and need to work, while others have immigration issues with visas expiring before the end of the year.

The GPhC wants them to join the register as soon as is safely possible. It isn’t in the interests of the regulator to delay this unnecessarily and there is nothing to gain. In fact, quite the opposite; it’s creating a lot of extra work, difficult conversations and logistical planning.

The GPhC has a lot to factor in and will be wary of unintended consequences. I am aware they have consulted a wide range of stakeholders ranging from student bodies, professional bodies, training providers, employers and many more.

Recently in our workplaces, we have all made decisions we’ve never had to make before. We’ve used our professional judgement and only time will tell if we did the right thing. The GPhC is in the same position with this, and I for one don’t envy the decisions they’re going to have to make.

In the meantime, I humbly implore pre-regs to carry on being an integral part of your pharmacy teams and use this as an opportunity to show leadership and resilience. It won’t go unnoticed.

The prime minister, who most of us took for granted would swiftly recover from COVID-19, spent time in intensive care last week due to the virus. That encapsulates the unpredictable nature of this unprecedented situation.

Khalid Khan is head of training at Imaan Healthcare

3 Comments

Greatly Pedantic and Highly Clueless, Senior Management

"Unfortunately, the comparison with student nurses and doctors isn’t a fair one. Both these courses are high in experiential learning from very early on."

Perhaps it might be time to completely review how pharmacists are trained. Although when your Head of Education at the GPhC has a background in music I'm not expecting any worth while changes. 

Joan Richardson, Locum pharmacist

I am pleased to see the mention of huge variations in supervision and quality of sign off from tutors.  It takes some kind of formal final assessment to ensure that standards are met by every pre-registration student.  There are no easy answers in the current situation but patient safety has to be paramount.

Isabel F, Pre-reg Pharmacist

This article is very clear and comprehensive but unfortunately once again doesn’t take into account the unique situation in which the few pre-registration overseas pharmacists find themselves in.

I understand the need for overseas pharmacist to take some sort of an equivalency programme but the fact that the finalisation of this whole process has been postponed for at least 9 months if not a full year, thus resulting in almost a 3-year process is frankly frustrating and inconsiderate.

I can't comprehend how after a B.Pharm, 5 years of practice in Canada where pharmacy practice is highly advanced and clinically oriented, an OSPAP accredited by the GPhC, a Master in Pharmacy Practice and 8 months as a pre-reg trainee at a world-renowned London NHS Trust where my tutor verbally expressed they felt safe for me to practice and felt confident to sign me off already 3 weeks ago, I still am not able to be registered and have to wait for potentially another year. By the end of this process, it will have taken me more than half the time to be registered in the UK than the time it took me to be fully licensed in Canada, which is unreasonable.

Like a few of my peers, my background is NOT the same as the one of a regular pre-reg and is similar to the one of a European pharmacist who doesn’t even need to go through a tenth of everything we’ve been through. For all these reasons, I truly believe the decision to fully register us at this point should be made on a case by case basis considering the current pandemic.

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