You will feel a certain amount of trepidation when you start your first rotation, whichever area you may have been allocated to. You have just joined a new organisation and are still getting to grips with how things work and who all these people are. You are also unclear about other people’s expectations of you as a pre-reg because you have never been in this position before. Your first rotation shows you very clearly how far you are from being a pharmacist, and this difference is uppermost in your supervisors’ minds, as they probably have just had pre-regs who were at the end of their pre-reg training year and have now qualified. You should bear in mind that, for some supervisors, it can be very frustrating to train pre-regs from knowing nothing to practising competently, only for them to leave and the next lot of pre-regs to start from ‘zero’ again. This could mean that you are on the receiving end of some frustration from your supervisors, although it is not directed at you as an individual.
‘I felt like we were thrown into the deep end. It was a steep learning curve.
We did everything from first week. We were given a ward and had to do the ward ourselves. We dispensed from the satellite pharmacy, did stock top-ups, and did MI (medicines information) enquiries. In the first 2 weeks it was lots of pressure. It was hard but good. We had a taster of everything. I would wonder if other people cope under this pressure. We learnt so much in 6 weeks.’
‘The majority of our work focused on technical aspects initially. Initially clinical knowledge was not being developed because we were taking lots time to do things. After a while the clinical side starts to develop as technical skills develop. It is good to acknowledge the technical side of the work to appreciate this. In terms of support from technicians and pharmacists, they expect a lot from you right from the beginning. Maybe they should have
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You may start your pre-reg training year with some degree of previ-ous experience, which in some circumstances can put you at a slight advantage. But, whatever experiences you have had, you will still feel that you are starting from the beginning because each hospital has its own systems and standards. Even if you have done a summer placement at the hospital where you are now a pre-reg, you will feel that everyone’s expec-tations of your work performance are different from those of a summer student.
Whatever rotation you start with, you will find that your supervisors assess your individual knowledge and skills before they are confident about letting you do anything unsupervised. At the start of your pre-registration training year, this undoubtedly happens every time that you work with a different pharmacist or technician. This could be very frustrating, especially when you are in a rotation, and your supervising pharmacists are themselves rotating so that, halfway through your rotation, you are working with an entirely new team of people who have not worked with you before, do not know what you are capable of and reassess you, making you feel as if you have to prove yourself again. Please tolerate this, because you must appreci-ate that your supervisors have to take responsibility for what you are doing under their supervision; in addition, be aware that, if anything goes wrong, you may also be liable.
lower expectations if pre-regs are going there for their first rotation and provide orientation in the first week, with no unsupervised working in the first part of rotation.’
‘My first rotation was on the wards, and I loved it – can’t wait to go back.
It’s what I did my degree for, patient interaction – drug histories, coun-selling, picking up problems and making patients’ lives better. At first I was apprehensive, thinking about how I am going to cope with it all.
There was one patient with whom I found a problem and spoke to the doctor who changed the prescription. I knew that what I was saying was right but what is the boundary? I always would have passed it up because I am not a pharmacist yet. I thought that I must have done something wrong.’
‘I’ve been in the dispensary for my first rotation and there are lots of processes to bring together. There are STILL lots of things to do. Initially, I felt like I was under people’s feet. Felt like I was really helping in outpatients but in inpatients I felt like I needed a bit more reliance on other people in doing my job properly. It felt like a pressure cooker. . ..’
Later in your pre-reg year, you will probably be ‘tested’ less, which means that people have certain expectations of your ability to do certain things. At this point, it is up to you to be honest with yourself, and with everyone else, about what you are, and are not, capable of.
It is useful to write some records of evidence from the beginning. This is a good way of recording your progression, and you’ll be writing about very different issues throughout your training period. One way of looking at records of evidence is as a record of your CPD (continuing professional development), tracking your own learning and development, and reflecting on your own progress.
Another issue is how you show your supervisors, and ultimately your pre-reg tutor, that you are competent. In a community pharmacy, it is likely that you will work very closely with your pre-reg tutor, often side by side on a daily basis. This means that the community pharmacy tutor can directly observe what the pre-registration pharmacist is doing. In hospital pharmacy, your tutor probably won’t work with you on a daily basis, because you are rotating around many different rotations, but you need to prove your com-petence to your tutor. This means that you must have some written evidence to prove that you have done the things that you say you have done. Your tutor will also rely on your supervisors’ feedback and assessment in your different rotations, so you may well have appraisal meetings with each rotation to record what you have learned. In this way, your tutor can build up a picture of your developing practice and be sure that he or she is signing you off appropriately.
‘In my first rotation, I felt like people belittled the pre-regs. They stripped me down and made me humble. Initially nobody really cared. But after one rotation, I can already see a change in myself; I’m a lot calmer. If a situation arises, I think things through before doing. I used to just act on natural instincts and just go. I also used to be affected by others. But I have realised that this is not safe, so now I don’t allow certain factors to get to me.’
‘The first rotation was interesting and quiet. I learnt a lot of stuff. It was a good base to start from. It was really the first time that I had met “real”
pharmacists. I could see that their priority was their work, and that was interesting to see.’
‘In my first rotation I went mad on the first day! I was given a folder and told to read. It was a hard day. It was only in the third week that I was able to process anything from beginning to end. When you don’t understand the process you don’t know when to ask for help.’
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T O P T I P S
* Do not be scared if you have never been exposed to a particular rotation
* Be prepared to start from a zero baseline
* Learn the systems of work as soon as you can
* Be prepared to make mistakes
* If in doubt, ask
* Start writing good quality records of evidence