4. A NÁLISIS DINÁMICO DEL SECTOR DE NEGOCIOS
4.4. La etapa del ciclo de vida del negocio
Discussion points specific to this stakeholder group are presented here. More general discussion points between stakeholder groups are described in Chapter Six.
This element of the study explored the perceptions of hospital and
community employers in relation to how graduates are currently prepared for the pre-registration year. The methodology employed allowed participants to speak at length about the issues of most importance to them, informed by their background and other factors. Interviews were conducted across a wide time frame, allowing the researcher to undertake significant reflection and iterations to the topic guide. The researcher also learnt the importance of employing the “pregnant pause” in interview scenarios whereby a question was posed, followed by a period of silence, prompting the interviewee to fill the silence and expand on various issues. Snowball sampling (discussed further in Chapter Two) was employed in recruitment for this study and gatekeepers were used, in the form of teacher practitioners, to recruit participants. This was particularly useful in identifying those individuals who had roles in the education and training of pre-registration pharmacists. Social media was also useful in advertising the study and this allowed an
independent pharmacist at a distant geographical location (hence with experience of supervising graduates from other universities) to be recruited. A separate participant commented before an interview that they did not usually partake in such research, although they had often been asked, and that something about the way in which the advertisement was written
appealed to them, giving the researcher confidence in the recruitment materials being used.
Interviewing participants from a range of geographical areas across Wales and England provided an interesting insight into perceived differences between graduates of different schools.
Participants worked in pharmacies in both deprived and more affluent areas. A mixture of independent pharmacies, small chain and larger multiple
pharmacies were also included. Anonymous destination of leavers’
information was utilised in order to select hospital employers whom recruited more than one Cardiff graduate in the past three years to invite for interview. This information allowed the researcher to select potential participants over a wide geographical area, who had experience with Cardiff graduates and where public transportation links were suitable in order for the researcher to reach the participant for interviews. Unfortunately not all of the sites
approached were able to be included in the study due to reasons described in section 4.2.
Employers of pre-registration pharmacists encounter a diverse range of issues when supervising pre-registration pharmacists. Pre-registration students come from different social, cultural and educational backgrounds. Employers often had experience of many pre-registration trainee
pharmacists particularly the more experienced interviewees, and unsurprisingly were unable to isolate the most important factor that
influences graduate preparedness for their pre-registration year. An interplay of factors were deemed to contribute to preparedness for pre-registration training. These may include but are not limited to the graduates’ school of pharmacy, background and culture, personality and prior work experiences.
CP2 perceived a pre-registration trainee’s calculation skills to be good, while HP1 took an opposing view when recalling the calculation skills of a pre-
registration trainee under her supervision. Whether this was due to the school of pharmacy or a difference between the two individuals was deliberated. There was no consensus regarding whether a school of
pharmacy is responsible for differences between graduate preparedness in terms of calculation skills. This was true for preparedness for pre-registration training in general, unlike the findings of Van Hamel and Jenner (2015), which found that preparedness of medics for practice is dependent on school attended.
Graduate culture and background were identified as potential contributory factors to preparedness for pre-registration training, as discussed in section 4.4.2.3. This is supported by a report, which highlighted that Black-African candidates perform less well at the GPhC exam in comparison with other groups (Johnston et al, 2016). It was concluded that a complex interplay of factors influence the experiences of Black-African students throughout their pharmacy education, including the fact that many are mature students with financial and other family commitments and are oversees students. Some Black-African students have also experienced prejudice throughout their training and a lack of Black-African role models to guide them through their studies (Johnston et al, 2016). Schools should consider how student culture and background may affect their preparedness for the pre-registration year.
Exposure of students to the practice environment through work experience was also highlighted as a contributory factor to graduate preparedness for pre-registration training (4.4.2.4). CP1 noted that a student (who held a pharmacy Saturday job) was a particularly strong candidate owing to her ability to apply her knowledge whereas HP1 had an opposing view and stressed that application of knowledge could be improved. However, HP1 had not supervised a graduate with these experiences. Having such exposure to practice allows learning to be applied and is important. This corroborates with the findings of Sealy et al (2013) and the theory of situated cognition (Vygotsky, 1978) and is explored further in Chapter Six.
Independent community pharmacy participants in particular were keen to provide opportunities for students to gain exposure to the workplace
environment. However, whilst hospital employers recognised the benefits of students gaining workplace exposure they made less reference to wanting to take students through their undergraduate training. This may potentially be attributed to the differences in the way in which community and hospital pharmacy is funded, the “business” element of community pharmacy and recent funding cuts. A community based interviewee highlighted that where staffing is limited students may be utilised in the day-to-day tasks of running the community pharmacy. In hospital practice students may potentially be viewed as requiring more supervision and input from pharmacist staff.
Participant perceptions that learning in the workplace is more effective than other mechanisms of learning is aligned with the views of others (4.4.3.4). “Clinical teaching” (teaching directly involving patients) has been extensively used in medical education at an undergraduate level, with institutions striving to provide greater exposure and introduce this as early as possible in
programmes (Spencer, 2003). Its many strengths are well documented including providing an opportunity for students to develop their behaviours, attitudes and ability to think professionally, in addition to expanding their knowledge, in line with the teachers that they shadow (Spencer, 2003). However clinical teaching is not without its challenges, including competing demands on resource, its often opportunistic nature, fewer patients being available for involvement (through ill health, lack of consent, shorter hospital stays for example), the clinical environment not being “teaching friendly”, rewards and recognition for teaching being poor, time pressures, increasing numbers of students and under-resourcing (Spencer, 2003). The latter three issues were highlighted as barriers by the participants in this study.
Common problems with clinical teaching include a focus on factual recall rather than problem solving, teaching pitched at an incorrect level, passive observation by students, inadequate supervision, little opportunity for
reflection, “teaching by humiliation” (whereby students are put on the spot and may not know the answers), informed consent not sought from patients, lack of respect for patients dignity and privacy, lack of clear objectives and expectations and lack of congruence or continuity with the rest of the curriculum (Spencer, 2003). While some of these issues may be specific to medical education, the latter two were both concerns raised by participants in this study. Their enthusiasm to increase student learning through exposure to practice environments were clear, as was their desire to ensure this is designed as an integral part of the pharmacy curricula, with planned aims and objectives to achieve learning in specific clinical areas. Doing so would ensure that students are drawing on existing knowledge and skills, relative to the learning environment (Parsell and Bligh, 2001).
Clinical teaching allows students to learn through experience, which is said to give “life, texture and subjective personal meaning to abstract concepts” (Kolb, 1984). Kolb’s cycle forms the basis of experiential learning, and includes four fundamental principles.