I am the fourth son of parents born in Salford in 1937; I was brought up with three elder brothers in a working class suburb of Wigan. I was the first member of my extended family to enter a caring or medical profession.
My interest in pharmacy stemmed from wanting to enter a ‘caring’ profession but not wanting ‘poke around in people’s guts’ like a doctor. My earliest healthcare experiences related to a volunteer role in the Liverpool pilgrimage to Lourdes. I thoroughly enjoyed the social and interactive aspects of personally caring for vulnerable, elderly and sick people. This helped to hone my communication skills with patient and also to work as part of a wider healthcare team involving doctors, nurses and other inexperienced volunteers such as myself.
During my formative years as a student and pre-registration pharmacist I started to notice that pharmacists often were not integrated into ward-based teams. On reflection this was
probably a combination of personality characteristics and the overarching culture on different wards. In one memorable lecture at University I remember being horrified that most
pharmacists preferred the theorist and reflector learning styles articulated by Honey and Mumford (163); I certainly fitted better into the activist and pragmatist styles of the same model. This is probably the first time I realised that I displayed traits which Austin and colleagues would refer to as atypical of a pharmacist (164 167).
Later in my training it became clearly evident that amongst my fellow cohort of student pharmacists I was one of the more confident and articulate students; confident enough to deliver presentations on behalf of colleagues and unafraid of giving the wrong answer. Throughout my pre-registration year I was inculcated with the behaviours and communication skills expected of a pharmacist: concentrate on medication, try to keep things short and polite, be sure of what you want to happen before discussing problems with medics. I was frequently
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told to leave other questions and issues to nurses, don’t answer the phones on the ward. I was actively living out what Suzanne Gordon would later describe as ‘parallel play with intimate strangers at the patient’s bedside.’
After qualifying as a pharmacist I went to work in what I still consider to be the best job I have had in my career, at Wrightington Hospital in Lancashire. There was great camaraderie between myself, the junior doctors, nurses and allied health professionals. Interprofessional ward rounds took place at least twice a week, input was sought from all members of the team. Over confident young pharmacists were supported rather than blamed when they missed important interactions a key aspect of Mendenhall’s highly effective teams) (168); and there was also enough cross monitoring for young pharmacist to learn that DMARDs were an unsuitable treatment for ankylosing spondylitis from a physiotherapist although I didn’t realise it at the time this was a paradigm experience (97).
Unfortunately the time came for me to move on in my rotation and I quickly tired of the politics and restrictions of hospital pharmacy. I found myself subverting some of the unnecessary rules and regulations because I liked to think about what I was doing. Soon a team of six band 6 pharmacists became 1 and the resultant workload became untenable and frankly unsafe. A job offer from community pharmacy came my way and I gladly took the way out.
Community pharmacy was a revelation in terms of independence and autonomy, although it produced another set of challenges. Primary care meant the contact I previously enjoyed with doctors became less frequent and often facilitated by telephone calls. I struck up a good working relationship with a local physiotherapist where we cross referred patients with musculoskeletal problems and sports injuries to each other. Again I was very interested in his knowledge of anatomy and how he diagnosed patients via physical manipulations.
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Having had the idea as a young pharmacist that I wanted to be a teacher-practitioner and getting a little bored in the world of community pharmacy I applied for a job at Keele
University. Fairly early on in this position I noticed I tended to teach in a different manner to my colleagues, focusing on active and pragmatic theories of teaching I often brought props into my teaching session and compared difficult physiological and pharmacological problems to everyday occurrences. This ‘difference’ to the norm often led me to question my chosen career; if the pharmacy profession did not value my skill set, was I really doing the right thing? This manifested itself in numerous ways with thoughts of retraining as a doctor and a
physiotherapist sitting uncomfortably alongside a broadening of my horizons beyond teaching pharmacy students alone.
With very little knowledge of the unpinning theory of IPE one of my first teaching ventures with colleagues from outside the School of Pharmacy was a session entitled “Physio-Pharmacy IPE . Based on my experiences of working with physiotherapy colleagues in practice, I co- designed my first IPE event with my good friend Anne O’Brien from the School of
Physiotherapy. I felt that final year undergraduates in both disciplines had much to learn from one another, and a case based PBL session based on musculoskeletal medicine was designed which encouraged students to develop shared care plans for their patients. The initial feedback included quotes such as: “This is the best IPE I have ever done.” Almost ten years later, I still learn something new in each iteration of this session. This practical approach to IPE, showing one group the value of the other; and allowing each group to teach the other both has collaborative and affirmatory outcomes. Student knowledge of others’ values and working practises increases alongside student confidence in one’s own practise. This reinforced my belief in the necessity of IPE.
Following completion of my PG Certificate in Higher Education, I accepted a full-time position at University on the proviso that I would complete a PhD. I chose a PhD as opposed to a
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professional doctorate because I wanted a qualification which would transcend my own profession. Being the atypical pharmacist I am I wanted to conduct my study in an area which would expand my horizons rather than limit them. Interprofessional education seemed like the perfect opportunity to do this. Professional bodies in 2012 were becoming more forceful with their endorsements of IPE; alongside this interest in IPE research was expanding. At the same time I became faculty lead for the IPE2 programme; a one month IPE module delivered to second year students from nursing, midwifery, medicine, pharmacy and physiotherapy. Student evaluation of this programme was somewhat mixed; I thought at the time this was due to the absence of explicit learning objectives asking students to teach each other skills. Seven years’ experience has taught me this is not the case; the actual truth is much more complex, but is rooted in the scepticism of classroom based learning from nursing students and the lack of clinical knowledge associated with second year study amongst medical and pharmacy students.
Wanting to solve the age-old difficulty in timetabling shared learning experiences; I identified that the virtual patient technology already in use in the Keele School of Pharmacy had potential to be delivered on a mobile platform. Simulated educational experiences were becoming commonplace in the schools of nursing and medicine and I believed this method of learning could be adapted for pharmacy students. My experience in teaching IPE allowed me to see that pharmacy students suffered from their lack of clinical experience in their
undergraduate study.
As I enjoyed solving practical challenges as opposed to pure research I threw myself into the design and evaluation of a virtual patient simulation which could be used to deliver IPE experiences. With the power of seven years of hindsight I now realise this was somewhat overambitious, and probably beyond the remit of one PhD thesis. Taking into account Anthony H. Wilson’s definition of praxis ‘as doing things and then learning why you did them
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later’ I can now say I have some expertise in IPE, clinical simulation, virtual patients and behavioural psychology. Certainly I think I avoided my worst fear when starting the PhD: that I would know more and more about less and less.
Thus my interest in this particular research project stems from my general dissatisfaction with the cultural norms passed down to me by hospital and community pharmacy. The satisfying part of my previous career had always taken place in the company of other healthcare professionals rather than with pharmacists alone. My paradigm experiences of learning from other professions and my realisation that we all have something to teach each other; turned me into an advocate and a champion for IPE. An honest acknowledgment of the difficulties in scheduling IPE, led me to believe that mobile technology may hold a solution which negated these difficulties. Observation of undergraduate pharmacy students In IPE events;
demonstrated that they were hampered by their lack of exposure to experiential learning. Simulation would provide an opportunity for them to increase their clinical knowledge and competency.
An experienced professor in pharmacy education once told me that the best ideas often come from speaking to others, and adapting their methods. With this in mind I decided to combine the fields of mobile technology and simulated virtual patients to deliver an IPE intervention. At the time my passion for the subject matter exceeded my competency; the project threw up many challenges which I did not envisage. Perhaps now having made many mistakes in the field, I can claim to be competent in the design and delivery of interprofessional clinical simulation.
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