Teoría responsiva aplicada a la desinformación

More research has been conducted in medical graduates’ preparedness to practice than pharmacy graduates. While differences in their initial education must be borne in mind, some parallels can be drawn. Relevant literature in this group is therefore presented here. When surveyed, consultants and registrars identified that junior doctors are not as prepared for starting work as they could be (Matheson and Matheson, 2009; Tallentire et al, 2011; Van Hamel and Jenner, 2015). Graduates were found to lack confidence but positive comments were made regarding their enthusiasm and reliability

(Tallentire, 2011). Having familiarity with the ward environment was emphasised as being of importance in student transition to F1 (Tallentire, 2011). Studies with F1 supervisors also found that preparedness is dependent on medical school attended (Van Hamel and Jenner, 2015).

This chapter aimed to explore employer perceptions of the preparedness of UK pharmacy graduates for pre-registration training.

The objectives were to:

• Determine the perceived knowledge, skills, attitudes and values important for a pre-registration trainee pharmacist

• Explore employer feelings on how graduates are prepared for the pre- registration training year

• Explore employers’ opinions on the factors that influence the preparedness of individual pre-registration trainee pharmacists for their pre-registration training year

• Gather and explore employers perspectives on improvements that could be made to undergraduate programmes to better prepare students for the pre-registration training year

4.2 Ethical approval

Ethical approval was sought from CSPPS Research Ethics Committee (REC).A favorable response for interviewing community pharmacist

employers was obtained 16th March 2015on the condition that consent forms were updated to include the supervisors contact details and the participant information sheet was amended to include details of anonymised quotes. A separate application to interview hospital pharmacist employers was made. A favorable response was obtained on 20th November 2015 upon addition of a complaints procedure to the participant information sheet, clarification of study inclusion criteria, addition of a statement relating to confidentiality in a potential group interview situation and clarification that data would be stored

for twelve months after publication of the last research output or for three years (whichever is longer).

After liaising with Health and Care Research Wales an R&D application was made through the Integrated Research Approval System (IRAS) in order to interview hospital pharmacists. All seven Health Boards in Wales were approached in addition to fifteen NHS Trusts in England. Approvals were granted by all seven Welsh Health Boards and seven English NHS Trusts in spring 2016.Reasons for non-inclusion of the remaining NHS trusts included research and development departments workload and inability to respond in time. One NHS Trust required applications to be made through a separate new HRA system while others did not respond to telephone calls or e-mails.

In order to obtain NHS approvals the researcher became Good Clinical Practice (GCP) certified. Research passports for each site were applied for and granted, Cardiff University Sponsorship was obtained and Site Specific Information (SSI) forms for each site were completed.

4.3 Method

Qualitative methods (described in Chapter Two) were employed for this part of the study.

4.3.1 Topic guide design and refinement

The basic topic guide (Appendix 2.1) was developed for approval by CSPPS Research Ethics Committee, with the specific research questions (including wording) being developed later. Topic guide design was influenced by a previous topic guide that was used to interview CSPPS staff (Chapter Three).

Questions were written according to the aims and objectives of the study and were informed by educational literature. In particular the terms knowledge, skills, attitudes and values were frequently used as this is in line with the terminology employed by the GPhC. Interview questions were written and reflected upon within the research team before being refined. In line with an

iterative process the topic guide was slightly modified in order to generate the highest possible quality data.

For example during interviews with hospital employers the wording of one of the questions was slightly amended by the addition of “briefly”, in order to stress to the participant that this was a relatively small aspect of the interview.

“I’d like to briefly explore your opinion on the desired characteristics of

a pre-reg pharmacist…”

This was in response to the first interviewee, who spent a long time defining what characteristics were most important. While interesting, it reduced the time to discuss other vital areas of the topic guide.

In order to explore employer perceptions around stakeholder engagement and collaboration with pharmacy schools a question was added to the hospital pharmacist topic guide. Initially the following wording was used:

“Something that’s particularly important to the school is

communicating with those individuals involved in the training of our graduates, such as yourself. Is there anything that the School can do to facilitate communication with you, including feedback, to help us better prepare those who undertake their pre-reg with you?”

The question was used with the first two participants however it was clear that it was not working as well as it could have. Participants appeared confused by what was being asked and requested clarification. The

researcher re-listened to audio data in light of this and refined the question, making it shorter and less ambiguous.

“My supervisors have told me that the next question is really

important. Is there anything that the School can do to allow collaborative working to improve the preparedness of our graduates who come to you for pre-reg?”

Stating that the next question is important drew in the participants’ focus and interest. They listened intently and considered their response before

answering. Participants no longer required clarification of what was being asked and were forthcoming with suggestions on how schools (including CSPPS) can better collaborate with employers. While no longer specifically asked in the question, participant answers focused on aspects of

communication between schools and employers, its importance and how it can be improved.

Similarly refinements were made through an iterative process to the topic guide used in interviews with community employers. Examples include removing a question asking which services the community pharmacy offers in order to save time for more vital questions (this information was required for contextualisation purposes only and was gathered by the researcher prior to the interview for example through the pharmacy’s website). More

questions were also added to the initial section of the topic guide to establish the employers experience in supervising pre-registration students (such as whether or not they were a tutor, for how long they had been a tutor if so, when was the last time they’d supervised a pre-registration trainee and do they have contact with one or more pre-registration trainees currently). The focus of the final section of the topic guide was refined with emphasis switched from exploring what pre-registration trainees do well and less well to what schools do well and less well in preparing graduates for pre-

registration training. In doing so repetition was avoided.

4.3.2 Recruitment and sampling

A number of non-probability sampling methods were used to recruit a range of participants (n=25) including convenience, purposive and snowball

sampling. Potential interviewees were identified as individuals known to the researcher and supervisory team. In addition to the methods in Table 4.1 a Facebook advertisement post (Appendix 2.2) to the Welsh School of

Pharmacy Past Students Association page was also made but attracted no interest from potential participants (Table 4.2). Advertisement leaflets (Appendix 2.3) were also handed out at a Royal Pharmaceutical Society Local Practice Forum event but attracted no interest from potential participants. Methods of recruitment and participants recruited by each method are outlined in Table 4.1 and Table 4.2.

Interviews were conducted with pharmacists with a range of backgrounds and experiences including pre-registration tutors, non-tutors involved in the supervision of pre-registration pharmacists, pharmacy managers, education and training specialists, pharmacy owners, those employed by independent pharmacies, individuals employed in a multiple, with varying degrees of experience and seniority within their respective organisations.

Table 4.1- Method of recruitment and uptake for interviews with hospital pharmacist employers

Recruitment method Number of participants recruited

Direct e-mail 6

Snowball Sampling 4

Table 4.2- Method of recruitment and uptake for interviews with community pharmacist employers

Recruitment method Number of participants recruited Direct e-mail/e-mail to pharmacy

recruitment leads

9

Facebook advertisement 1

Twitter advertisement 1

Royal Pharmaceutical Society online boards

3

4.3.3 Research diary

A research diary was kept throughout the study. The researcher recorded post interview reflections for the purpose of documenting any thoughts or feelings on the interview, suggestions for the next interview or emerging themes (diary excerpt in Appendix 3.1 as an example).

4.3.4 Analysis

Verbatim transcription and inductive thematic analysis were undertaken according to the method outlined in Chapter Two (section 2.8).

4.3.5 The interviews

Interviews (n=25) were conducted between 04/08/2015 and 08/09/2016 in accordance with the method outlined in Chapter Two (section 2.5.1). No participant withdrew consent. Interviews were conducted in two separate timeframes. This was to enable the lengthy NHS REC application process to be undertaken alongside data generation with community pharmacists.

Interviews with community pharmacists were conducted before interviews with hospital pharmacists after obtaining a grant from The Harold and Marjorie Moss fund. Monies received were used in order to travel to

hospital pharmacists were conducted soon after. All interviews were conducted face-to-face in geographical locations outlined in table 4.3.

Potential participants were e-mailed (Appendix 2.4) the participant

information sheet (Appendix 2.5) and consent form (Appendix 2.6) at the same time as their e-mail invitation to participate and were asked to read and consider before agreeing to take part. A mutually convenient interview time, date and location was agreed in advance. Interviews were conducted in a range of locations across England and Wales including meeting rooms at hospital pharmacy departments (n=6), community pharmacy consultation rooms (n=7), consultation rooms at CSPPS (n=9), a participants office at another school of pharmacy (n=1), a café near the participants place of work (n=1) and one interview was conducted in the participants home.

At the start of the interview, participants were handed a printed copy of the information sheet and consent form. They were asked to read the information sheet and were given the opportunity to ask any questions, before

completing the consent form. Consent forms were then checked for

completeness before interviews began. Participants were thanked for giving up their time to take part and were given a brief reminder of the purpose of the interview. After general housekeeping points were provided (anticipated length of the interview, reassurance that confidentiality would be maintained and that the researcher may make some written notes as well as making an audio recording of the interview) participants were asked if they had any questions. Interviews were conducted within the hours of the normal working day and so participants had to return to work at a set time meaning interview durations were limited. There was little time for conversation beforehand and the researcher commenced the interview as soon as possible in each case.

As described in Chapter Two (section 2.5.1) the structure of the topic guide was described to each participant so that they could feel the progression of the interview and could anticipate where certain topics were to be discussed.

The Philips Voice Tracer DVT5500 device was used for this part of the study and was placed in the centre of the table. While audio data was being

captured the researcher made notes of non-verbal cues and mental prompts of things to follow up and probe more deeply during the interview.

A topic guide (Appendix 2.1) was employed during interviews, with each section being explored in turn. Questions were asked in the same general order though not consistently as some questions that were already

inadvertently answered by the participant beforehand. In these instances the questions were not repeated. As described in Chapter Two, open questions were used initially followed by a series of closed questions to further probe or clarify a response. Meaning was clarified by asking:

“Can I just check that I have understood you correctly…”

The content of the topic guide allowed the participant to express the knowledge, skills, attitudes and values they believed were required in pre- registration pharmacists, how pre-registration trainee pharmacists were currently performing in practice and their suggestions for future

improvements. This is in line with the aims and objectives of this element of the study.

4.3.6 Interviewee characteristics

Table 4.3 details the key characteristics of the participants (n=25) including their area of practice, gender, current status as a tutor or otherwise,

geographical and specific location of interview and the interview duration. Interviews lasted between 19 and 51 minutes with a mean of 32 minutes. In addition to the characteristics described in the table below interviewees held a range of backgrounds and experiences. These details have been omitted from the table in order to protect participant anonymity.

4.4 Results

Themes and subthemes were derived from the data and are presented in figure 4.1, with themes and blue and corresponding subthemes underneath in white. The results section will explore each of these in turn.

        Fi g ur e 4 .1 : S u m m a ry o f e m p lo ye r th e m e s a n d su b th e m e s

4.4.1 Skills, knowledge, attitudes and values required of a pre-