AFPC Conference
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Presentation Abstracts

Breakout Sessions

Plenary #1
Monday June 27 Opening Keynote Presentation: Continuous Professional Development – Where are we today, where are we going to be tomorrow?
Mike Rouse
, Assistant Executive Director, International and Professional Affairs, Accreditation Council for Pharmacy Education, Chicago, USA

Pharmacy practice, regulation and education are undergoing unprecedented change. Societal needs and expectations are major drivers of this change. JCPP, a forum of pharmacy practitioner organizations in the USA, recently published a vision statement for the future of pharmacy practice: “Pharmacists will be the health care professionals responsible for providing patient care that ensures optimal medication therapy outcomes.” Can this be achieved if our objective is only to assure that all pharmacists remain minimally competent throughout their careers? Who is responsible and accountable for the professional practice of pharmacists?

Pre-service education of pharmacists is evolving to reflect – and drive – the expanded role of pharmacists in delivering patient-centered care, where the pharmacist’s role is transitioning from “passive” through “re-active” to “pro-active.” Changes in pre-service education are, however, not only curricular in nature. They signify a paradigm shift in educational philosophy and methodology, as well as the range of competencies - both pharmacy specific and more “generic” – that are essential for effective delivery of patient-centered care and optimal medication therapy outcomes. Furthermore, education must utilize appropriate strategies and tools to ensure that students and pharmacists have the right knowledge, skills and attitudes to assume responsibility for their own learning and professional development and become self-directed, independent learners.

For pre-service education, the value of a strong science and competency-based foundation, the need to incorporate new technologies and methodologies to enhance learning and achievement of desired outcomes, and the need for quality assurance are well recognized. The same, however, does not yet apply globally throughout the continuum of education. Achieving effective and meaningful learning for busy, pressured pharmacists is a major challenge - and exciting opportunity - for the pharmacy profession. New strategies and models are emerging to meet this challenge, and to more effectively support pharmacists to maintain and develop the competencies they will need in order to achieve the vision described above. Better understanding how adults learn, adopting new technologies and methodologies, and learning from the experiences of others are crucial to success in this area.

The term continuing or continuous professional development (CPD) is now widely used to describe new approaches to lifelong learning and personal development for healthcare and other professionals. Likely it means different things to different people. Certainly, there is not only one “CPD model.” However interpreted, CPD signals the start of a paradigm shift in approaches to lifelong learning. This keynote will discuss where CPD is today – and where it is likely to evolve in the future. The presentation will introduce the three key conference themes: how lifelong learning occurs; how technology can be used to enable it, and how collaboration between academia, practice, industry, and government – both nationally and internationally - can be developed to foster it.

Plenary #2
Monday June 27 Theme Presentation: How Does Lifelong Learning Occur?
Ian Bates
, Head of Educational Development, School of Pharmacy, University of London, London, UK

The ways in which working professionals continue to learn over a lifetime of practice are complex and multi-dimensional, but of central importance to educators. Traditional models of adult learning may not be entirely relevant or applicable to busy, working professionals who must balance practice responsibilities and personal lives with the need for continuous professional development. The theme for Day 1 of the conference will focus on application of theoretical models of lifelong learning within health professions specifically. The psychology of learning in adult professionals will be discussed, and successes – and failures – in application of theory to design of programs will be described. How professionals learn and develop today – and how this may change in the future – will be discussed, with an emphasis on the ways in which practice, academia and industry can collaborate to optimize CPD.

Plenary #3
Tuesday June 28 Theme Presentation: Technology and life long learning – building bridges to continuous professional development
Terri Schindel
, Director of Outreach Education, Faculty of Pharmacy & Pharmaceutical Sciences, University of Alberta, Edmonton, Canada

Technology has been utilized for several decades in a variety of educational settings. At this session, participants will learn about how technology has been used as a tool to support various elements of continuing professional development including self assessment, learning plans, learning activities, reflection and evaluation. From experiences developing continuing professional education at the University of Alberta, and work with programs for COMPRIS and PHARMALearn, the presenter will share insights gained from integrating technology in learning programs and a continuing professional development process for pharmacists. Opportunities and challenges in technologically-supported continuing professional development will be described and discussed.

Plenary #4
Wednesday June 29 Theme Presentation: How Can Collaboration Foster Lifelong Learning?
Abilio Neto, National Prescribing Service, Australia.

Collaboration among educators has the potential to create results bigger and better than what we can achieve on our own. Yet, many educators tend to work in isolation from their international colleagues and are not able to learn from success and failure of those involved in similar activities. In this talk, Dr Abilio Neto will provide a theoretical framework for collaboration addressing the factors that may facilitate or be barriers to achieving true collaboration. He will then provide an example of successful collaboration in action describing the Quality Use of Medicines Movement in Australia as a framework, which has formed the basis for collaboration between consumers, health professionals, academia, industry, and government and also for inter-disciplinary collaboration.

Plenary #5
Wednesday June 29 Summary, Evaluation, Future Planning

Speaker to be confirmed

Workshop #1
‘Learning to Ride’ – Models for Encouraging Engagement in Reflective Practice
Nicola Arnold
, Specialist CPD Facilitator; Helen Middleton CPD Manager & Training Specialist; London Pharmacy Education & Training, London, England

Reflective practice is a fundamental part of CPD. It enables us to identify our learning needs and further develop our skills and knowledge, thus ensuring that we carry out our roles more effectively and continue to provide a high standard of patient care. Not everybody finds CPD and reflective practice easy and facilitation has been shown to be beneficial in helping individuals to engage in the process.

‘Learning to Ride’ uses the analogy of riding a bicycle. Before you can get on the bike you need to learn how to ride, similarly before you enter the CPD cycle (Reflection, Planning, Action & Evaluation) you need to be able to understand how to reflect.

Nicola developed ‘Learning to Ride’ as a result of feedback from CPD Facilitators who reported that they found it difficult to encourage their staff to reflect. Many people were bewildered by the concepts of reflective practice and how to express their feelings and emotions and some staff saw CPD as a negative approach towards assessing skills and knowledge.
• How do you encourage someone who doesn’t think they need to do CPD?
• How can you make reflective practice non-threatening?
• What if individuals don’t understand how to identify their learning and development needs?

‘Learning to Ride’ introduces 3 very different models, which can be used to encourage learners to reflect on their current practice and help them to identify their own learning and development needs. As a participant you will have the opportunity to try the models out for yourself during the workshop session. Enjoy the ride!

Workshop #2
Should Advanced and Specialist Pharmacy Practitioners be Regulated?
Peter Wilson, Head of Post Registration Division, Royal Pharmaceutical Society, London, UK

The practice of pharmacy in Great Britain has developed from a supply-led service 25 years ago into more patient focussed practice. Many pharmacists now work as specialists and/or advanced practitioners. This has been happening principally in hospital pharmacy and pharmacists who work in hospitals generally undertake a programme of formal postgraduate study as part of their in-service training. This has been largely employer led. In community pharmacy, the development of specialist and advanced practice is less widespread. A recent and significant review of the contract with the NHS, however, will lead to the development of advanced and enhanced patient services in community pharmacies. The Department of Health has announced that community pharmacists who provide the new services will be subject to a process of accreditation.

The Royal Pharmaceutical Society has not become actively involved in post registration education and training, to date, and has concentrated on the undergraduate education and pre-registration training of pharmacists. However, increased scrutiny on the competence of health practitioners and the role of professional bodies in assuring the competence of their members raises questions about the regulation of advanced and specialist practice in pharmacy.

This workshop will explore the implications of professional regulation of advanced and specialist pharmacy practice, why it should or should not be introduced, the practicalities of doing it and some of the difficulties.

Workshop #3
Development of A Web-Based Approach To Learning to Fulfil Continuing Education Needs of Pharmacists.
Sue Jones
, Clinical Pharmacy Practice Lecturer; Pat Reynolds, Deputy Director for Education in Distance Learning; King’s College London, UK.

With the changing demands on pharmacist’s time and the growing need for easily accessible continuing education (CE) to meet varying continuing professional development (CPD) requirements, then the development of web-based learning environments provide another option for pharmacists. Time is an issue for pharmacists around the world and the internet gives the flexibility to allow pharmacists to access their learning anytime of the day or night depending on their working pattern. Also, the use of the internet facilitates the diversity of topics and areas that could be chosen with potential international transferability which could lead to a global CPD network.

Internet or web-based environments may be developed using a variety of technology or media and can be very simple in style and content. Each of these techniques adopt a different approach to development and with any potential topics for CE using a web-based methodology, care should be used to select the most optimum medium.

This presentation will commence with an overview of a project that was funded by the European Union Social Fund and entitled ‘Delivery of Continuing Professional Development in the Workplace to Pharmacists and Dentists’. The practicalities and options for pharmacists to access and use the internet to provide CE/CPD in their workplace will be considered. Whilst undertaking the project, a website was developed and a number of developmental stages ensued in order to arrive at the finished product. A number of CE packages were developed as part of the remit of the project and used a range of methods.

Workshop #4
The Use of Technology to Support Learning, Individuals Development and the Management of Change
Jennifer Archer
, Assistant Director; Paul Gray, Head of Technology; Centre for Pharmacy Postgraduate Education, University of Manchester, UK

The Centre for Pharmacy Postgraduate Education (CPPE) is a UK - England organization based at The University of Manchester. It is responsible for the development and implementation of learning activities to support all pharmacists providing NHS services. Our organization utilizes technology to support the learner e.g. on-line discussion groups, access to resources and references as well as on-line capability for assessments and production of records of achievement. During this workshop we will share with you some of the ways in which we do this and highlight advantages and lessons we have learned both in terms of development and delivery. A recent project development has enabled us to use interactive technology in face-to face sessions and also to provide immediate feedback to participants on-line. CPPE, as a learning organization, provides different learning media to meet individuals’ learning needs and styles. We use technology not only to help pharmacists to learn new knowledge, skills and behaviours, but also to enable them to keep up to date and support the management of change. Demonstrations and activities during this workshop will be varied and participants, whether new to the use of technology in learning or building on their own experience in this area, will have the opportunity to use some of the programmes we have developed. This will be ‘hands-on’ and it will enable people to see how the technology is used to engage large numbers of clients in learning activities and manage the associated administration processes. These will include booking systems, various types of assessment, recording achievements, discussion groups, searching for resources, web portals and our new CPD CD-Rom.

In summary, this session will provide information on how the IT needs have been identified, the implementation process and some of the evaluation findings. It will provide an opportunity for active participation or passive observation.

Workshop #5
A CPD Journey across the Pacific – Outcomes Assessment in BC & NZ
Bronwyn Clark, Registrar, Pharmacy Council of New Zealand, Wellington, New Zealand;
Doreen Leong, Director, Assessment Programs, College of Pharmacists of British Columbia,
Vancouver, Canada; Sandy Bhawan, Competence Policy Advisor, Pharmacy Council of New Zealand; Susan Simosko, International Consultant in competence-based assessment, Susan Simosko Associates, Inc, Sidney, Canada

Pharmacist regulatory bodies around the world are requiring practising pharmacists to participate in processes for recertification. This is being driven both internally by the profession and externally by legislation in each country. Different regulatory bodies have taken different approaches to setting up recertification processes for their pharmacists. Many are choosing CPD-based recertification or their recertification processes incorporate participation in CPD as a component of that process.

One of the most challenging hurdles with using CPD as a recertification pathway for practising pharmacists is setting the criteria against which a pharmacist’s CPD is “measured” and determining “how much” CPD is enough. Traditionally, participation in CPD and CE has been measured by a point or credit system related to attendance at accredited courses and conferences or unstructured, unaccredited activities such as reading and workplace learning.

The purpose of this workshop is to provide an overview of the approaches taken by the College of Pharmacists in British Columbia, Canada and the Pharmacy Council of New Zealand in developing recertification processes based on participation in CPD. The CPD program in New Zealand and the Learning and Practice Portfolio (LPP) option of the Professional Development and Assessment Program (PDAP) in British Columbia are both based on patient outcomes, which require pharmacists to demonstrate and provide evidence that they have applied what they learnt to their practice to benefit their patients.

Both jurisdictions have been assessing pharmacists CPD records for a number of years and between them have probably the most pharmacist experience internationally in this area. From their previous programs and pilots (RxCARE in British Columbia and ENHANCE in New Zealand) new systems for assessment of pharmacists’ CPD have been developed. Whilst the philosophy is the same, the approaches taken are quite different, reflecting the different “cultures” of the profession in each country.

The challenges faced by both regulatory bodies will be discussed including:
• the difficulties with moving pharmacists towards systems that require the documentation of practice-outcomes,
• motivating pharmacists to use a systematic process of planning, implementing and evaluating their CPD on an on-going basis,
• developing criteria against which CPD can be assessed, and
• developing a credit system that ‘rewards’ application of learning in practice in both the direct and indirect patient settings.

Workshop #6
The Route to Much Success: A Multidisciplinary Approach to Evaluation
Nadine Wentzell
, Adult Education Consultant, Halifax, Canada

The workshop will unfold in three stages: a brief background summary of the needs assessment process which culminated in this initiative; facilitation of a multi-disciplinary workshop on evaluation; and, a brief summary of the feedback obtained from the participants of the original workshop.

The workshop will follow a program model, developed and facilitated as a component of an interdisciplinary workshop on preceptor development, focusing on evaluation. Program design and delivery will follow a participatory adult education model with an underlying theme of needs assessment.

Program elements will cover the following areas: needs assessment; personal learning experiences; orienting learners to the learning experience; roles and strategies for effective feedback; formative evaluation, assessment, and feedback; sources for feedback; promoting learner feedback; summative evaluation of performance; and, tips from students. Each element requires audience participation and will be covered in detail relevant to the focus of the workshop.

Participants of this workshop will gain first-hand experience of a method of participatory learning based on the principles of adult learning. Those who have attended the presentations on the findings of my research will have the opportunity to observe theory applied to practice. Participants will be asked to: reflect on personal learning from previous experiences; consider the needs of the individuals involved in a learning environment; recognize the benefits of a multidisciplinary approach to learning in this environment; consider the benefits of teamwork and collaboration, workplace learning, and outcomes evaluation.

A learning cycle of Experience-Reflection-Generalization-Application-Evaluation (ERGA-E) will be introduced to support and enhance learning during the workshop (the second level of evaluation) and transfer of learning (the third level of evaluation) to the workplace or practice site. These levels of evaluation go beyond the traditional reaction (first level of evaluation) measurement.

Summary highlights will cover reaction evaluation results from participants of the original workshop.

Breakout #1
The Calgary-Cambridge model: A Model for the Enhancement of Communication Skills Teaching and Learning in Pharmacy?
Brian Addison
, Lecturer in Pharmacy Practice; Denise Hansford, Senior Lecturer in Pharmaceutics; School of Pharmacy, The Robert Gordon University, Aberdeen, UK

The Calgary-Cambridge model of consultation is one of many which have been developed within the medical profession and has formed the basis for the consultation skills training component of the pharmacist supplementary prescribing course delivered by this UK School of Pharmacy. The model was developed to address a perception within medical education that learners and teachers experienced problems integrating effective communication skills with other clinical skills. The model improves the way communication skills are introduced and places them within a comprehensive clinical model.

Supplementary prescribing for pharmacists introduces a more formalized consultation process than previously experienced by pharmacists. Therefore training in consultation skills is integral to the supplementary prescribing course which is a distance learning, modular course, with a compulsory week long residential program at the School of Pharmacy. Prior to attending the residential program, students must complete a module that focuses on the underpinning theory to consultation skills and prompts them to reflect on their current practice. During the residential program the underpinning theory is further explored by group-work and participation in role-play scenarios. The role-play scenarios utilize descriptive feedback to provide a safe and supportive environment for the rehearsal of the skills required to conduct a patient centered consultation.

The residential program has been delivered on five occasions from September 2003 to October 2004. Evaluation by the students of the consultation skills training components has been generally positive and well received. Many students have commented that the sessions have increased their awareness of their communication skills generally and, more specifically, how useful they have found the model in learning how to conduct a patient centred consultation. The experiences gained from using this model are now informing the development of communication skills teaching in the undergraduate Master of Pharmacy course at this UK School of Pharmacy.

Breakout #2
Where Effective Education Begins: The Integral Role of Needs Assessment
Nadine Wentzell
, Adult Education Consultant, Halifax, Canada

This presentation summarizes the findings of a research project addressing the role of pharmacists’ learning needs, in a continuing professional education (CPE) program for pharmacy preceptors, in their positions as clinicians with practicum students in a problem-based learning environment. The presentation will discuss a post-workshop evaluation study conducted 2 years after the workshop. The purpose, format and methodology, prevalent themes from the qualitative investigation of participants’ learning, conclusions, and recommendations that arose from the findings of the study will be discussed. The primary focus of the presentation deals with needs assessment and aspects of facilitation that supported those needs.

The areas of transfer and impact of learning are frequently overlooked in the evaluation of a program or educational event. Most CPE events, traditionally delivered in a didactic format, do not address learners’ needs or application to the practice environment. As the health professional field moves to a more competency-based focus for today’s practitioners we have a professional responsibility to consider and emphasize the outcomes of educational events. True effectiveness of education is measured by what happens after the learning event—“after the applause.” From a review of the literature I will make connections between theory and practice, and highlight the methods employed to address learner needs, with the goal of facilitating transfer and impact of learning.

The second component of the research evaluated the effectiveness of facilitation skills and ability to model an ongoing needs assessment process in the workshop format, which was intended to serve as a guide for pharmacists in their interactions with students. Although contents of the workshop covered many areas the central theme focused on the importance of ongoing needs assessment; in essence, the medium was the message.

The findings of this research have substantial implications for education across all health professional disciplines.

Breakout #3
Developing Pharmacy Practitioners of Tomorrow Using Inter-professional and Reflective Learning Skills
Denise Taylor
, Senior Teaching Fellow, Department of Pharmacy & Pharmacology, University of Bath, Bath, UK; Lyn Hanning, Senior Pharmacist, Education and Training, South West Medicines Information & Training, Bristol, UK

The aim of this session is to share experiences of how to incorporate reflective learning skills and inter-professional education programmes at undergraduate level to help develop our undergraduates as forefront practitioners of tomorrow.

Inter-professional learning has been defined as professionals learning with, from, and about, each other. The development of an inter-professional programme, bringing together undergraduate medical, nursing and pharmacy students was seen to be highly desirable in order to deliver pharmacy graduands who had lifelong skills in terms of working within a team and being able to communicate effectively in any healthcare decision-making process.

The collaborative development group had the following aims for the inter-professional learning experience:
• To learn about each others roles and responsibilities in relation to prescribing and medicines administration
• To develop the ability to share knowledge and skills in clinical problem-solving, and
• To understand the significance of inter-professional work and its contribution to patient care.

In these inter-professional learning sessions the students are loosely facilitated such that only clinical information is commented on where appropriate to ensure that the students learn from with and about each other and not just from regurgitating the knowledge of the clinical facilitators.

The ethos of reflective practice and reflective learning within the UK pharmacy profession has been supported by the Royal Pharmaceutical Society of Great Britain’s CPD accreditation process Plan and Record. This ethos has been incorporated into our undergraduate education programmes to ensure that pharmacy students are capable of critical reflection, to enable them to reach the very pinnacle of their personal and professional growth. By integrating the reflective learning process by the use of a reflective learning diary or reflective commentary dialogues in experiential-based learning programmes during the undergraduates clinical training, we seek to develop lifelong transferable learning skills for pharmacy practitioners of the future.

Breakout #4
CPD Enables and Enhances the Learning Process
Jennifer Archer
, University of Manchester, Manchester, UK

Continuing Professional Development is now a key feature in day to day practice of many professions. For some, it is a way of assuring quality and providing evidence to minimise the possibility of litigation. For others, it is to help people develop and learn in a way that meets their individual learning needs and style. During this workshop, it will be demonstrated how the CPD process is an enabler of learning, continuous improvement and life long learning rather than a system or a requirement that has to be completed. This will be done using the experience we have gained at the Centre for Pharmacy Postgraduate Education in England (CPPE), during the development and implementation of several learning activities on the topics of Clinical Pharmacy, Practice Management, Medicines Management, Minor Ailments, Public Health and Risk Management for pharmacists. Also, our involvement and working in partnership with the Royal Pharmaceutical Society of Great Britain in implementing the CPD process for pharmacy in the UK. Information will be shared on the various findings and outcomes from project development to feedback from participants. The feedback from participants is taken from information collated by external consultants to ensure that there is no bias. In the conference group work, practical activities will facilitate the sharing of CPPE’s experiences, both successful and the not so successful. The activities will also enable the sharing of experiences of workshop participants to further develop everyone’s CPD, therefore demonstrating CPD as a support mechanism for enabling and enhancing the learning process.

Breakout #5
Piloting Peer Mentoring to Support Professional Development
Kim Brackley
, Principal Pharmacist Education & Training, Auckland District Health Board, Auckland, NZ

This session will describe a model of peer mentoring and the experiences to date of its use with pharmacists at Auckland District Health Board. It will provide participants with an opportunity to reflect on their current experiences of peer support and mentoring and consider how peer mentoring could be integrated with their existing CPD practices.

The model of peer mentoring is based on the work of John Heron and provides a possible mechanism to assist pharmacists to support each other, to learn and develop from their own and others experience, and to develop their reflective skills.

According to this model, after training, groups of 4-6 people meet for 1-1.5 hours on a regular (usually monthly) basis and use a structured process to raise issues of current concern or interest to themselves. The model is flexible in that it can be used to discuss any kind of issue e.g. clinical, managerial and interpersonal for staff at any level of experience. There are a range of processes which provide structure, and allow the group to self facilitate in a safe environment. The meeting are time and resource efficient as, following training, no external facilitation is required.

From the published literature this is appears to be the first time this model has been used with pharmacists and this presentation will report the benefits and constraints experienced with the model to date.

Breakout #6
The Development of an Evidence-Based Competency Framework for Pharmacy Practitioners in the UK
Denise Farmer
, Associate Director of Clinical Pharmacy Services (East), Cambridgeshire; Elizabeth Mills, Research Pharmacist, University of London, London; UK

Key Messages:
- This framework is relevant for all sectors of the pharmacy profession
- This framework is evidence based
- The framework is being evaluated as a measurable mechanism to support the CPD of pharmacists
Background: Recent research by our group in hospital pharmacy, has described the design and evaluation of a general level competency framework to facilitate the development of pharmacy practitioners at a general level. An improvement in individual performance was seen where the framework was applied, which was sustained over a 12 month period. The benefits were related directly to the framework’s explicit and structured description of the key required competencies, and the assessment ratings allowing the pharmacist to compare their performance against a standard.

There are a number of different approaches to competency specification and assessment within the pharmacy profession in the UK. There is a danger that a lack of a unified approach will fail to provide a clear and logical career pathway for practitioners. An evidence based approach is to utilise an existing framework validated for pharmacists in secondary care and develop it to capture the activities undertaken in other areas of the profession, rather than designing a new framework for each discipline. This will allow the framework to address the broader needs of the profession. This presentation describes the first stage of a two part project to develop the General Level Framework to support primary care and community pharmacist, and to evaluate this framework as a measurable mechanism to support the CPD of these pharmacists.

Breakout #7
Tutors’ Professional Development – Challenges and Opportunities
Darja Frankic
, Slovenian Chamber of Pharmacy, Slovenia

The pharmacy service has a relatively long tradition in the territory today known as Slovenia. The first community pharmacies date back to the 15th and 16th centuries. Together with the emergence of pharmacy practice, the mentorship of new pharmacists began to develop. Tutors have always been those involved in passing on to trainees their complete theoretical and practical knowledge. With the development of scientific and professional disciplines, theory – and partly also practice – began to move into educational institutions. Yet up until today certain practical competences and skills could only be acquired in-service.

As a rule, tutors have always been pharmacists with several years of experience, with more expert knowledge than their fellow colleagues and with an enthusiasm for teaching.

In order to ensure high-quality pre-registration training to all future pharmacists, systematic regulation in the field of mentorship was undertaken in Slovenia some 15 years ago. Pre-registration training standards were gradually introduced into pharmacies in areas such as personnel, spacing, equipment, and documentation. The Slovenian Chamber of Pharmacy formulated criteria for the appointment of tutors to supervise pharmacy graduates. To be appointed a tutor, a pharmacist must have at least three years' experience in the pharmacy service and must participate in tutors' training organised by the Chamber of Pharmacy on an annual basis. Tutor training is permanent, ongoing, and takes place in the form of lectures and workshops. Participants' knowledge is evaluated in tests before and after the training course. The objective of such training is to acquire new information and competences related to pharmacy, as well as the competences and skills needed for the management of change in the various phases of supervising a pharmacy graduate (immobilisation/living, denial/research, frustration/thinking, development/skills, application/integration and finishing/completion) on their way to developing into an autonomous and responsible pharmacist. For any tutor the process of mentoring a pharmacy graduate is therefore both a challenge and an opportunity for personal growth.

Breakout #8
Implementation Issues/Strategies in Developing a Pilot CPD Program
Alan L. Hanson
, Professor; Ruth H. Bruskiewitz, Clinical Assistant Professor; University of Wisconsin-Madison School of Pharmacy, Madison, USA

Continuing Professional Development (CPD) has been implemented in selected countries as a model for continuing education/lifelong learning for pharmacists. CPD has been proposed as a potential model for pharmacists in the United States; however, it has yet to progress beyond the discussion phase. Perceived implementation challenges in the US are a consideration. These would include, but are not limited to: lack of legislative or regulatory force driving the concept; little or no external funding support for planning and/or implementation; mindset of accumulating CE hours (in the US mandatory CE Model) as a goal rather than outcomes; and vast numbers of pharmacists with varied educational backgrounds based on entry-level degrees earned. This presentation will review the global literature of CPD and related learning models in the health professions to identify the skills/attributes of both learners and providers that are deemed essential to operationalize a CPD model, and to identify strategies for introducing skills/attributes to the profession of pharmacy. Utilizing the information acquired from this global review, the presentation will then report on the development of a strategy to design a model at the University of Wisconsin School of Pharmacy for a pilot program to introduce/implement CPD at a grassroots level in the State of Wisconsin. This strategy will address: (1) identification of CPD concepts/skills and subsequent introduction to students in the undergraduate professional program; and (2) concurrent training of pharmacist-preceptors (who have mentoring roles for students’ clinical training) to reinforce/enhance these CPD concepts/skills.

Breakout #9
Learning: The Bridge to Cross the Quality Chasm
Peter Noyce,
University of Manchester, Manchester, UK

This presentation explores the context and requirements of pharmacy post-foundation learning today. The Institute of Medicine in US, in its report “Crossing the Quality Chasm” outlined the priorities in securing quality in healthcare, and noted the essential ingredient of ensuring a competent professional workforce. In the UK, both the absence of processes to demonstrate competence, and the lack of robustness of governance arrangements are being called into question, following two critical enquiries on the regulation of health professions. The diverse demands for learning - and particular assessment - for levels of practice in pharmacy beyond primary qualification, will be considered.

Breakout #10
Assessing Pharmacist’s Learning Needs – A Model for Practice
Lyn Hanning
, Senior Pharmacist, Education and Training, United Bristol NHS Healthcare Trust, Bristol; Andrea Taylor, Learning & Teaching Research & Evaluation Officer, University of Bath, School for Health, Claverton Down; UK.

This session describes the Learning Needs Analysis (LNA) and Personal Development Planning (PDP) processes introduced in a CPD Masters programme and explore the impact this has had on the learning experiences and CPD of participants.
This session will review the use of a learning development tool in practice in the UK and examine how session participants can apply the principles to their practice.

We have designed a new modular, flexible postgraduate Masters course, based on active learning and reflective practice, which takes into account the diversity of learners on the programme. An innovative tool to evaluate learning and development needs of these participants will be described. The decision to design a new tool for supporting students in evaluating their own personal development reflects the changing role of postgraduate pharmacy education in the UK.

The principles of the LNA and PDP process will be described, addressing both the educational theory in which this is grounded and how such theory can be applied to postgraduate pharmacy education. A range of LNA tools will be demonstrated including those from other professions and the group will have an opportunity to critically review the differences between these.

The model that has been used will be described, including:
- Consideration of the needs of our programme when designing the tool
- The LNA and PDP process adopted and the reasons behind this
- How the programme has used LNAs to map student development
- The role of the work based mentor in supporting the process
- Impact of the process on the students’ progress.
- Comparison of the differing approaches used in our diverse group of learners.

There will be an opportunity for participants to share experiences and discuss how models such as this may be incorporated into their own practice.

Breakout #11
Conceptualizing Professional Competence: A complex view
Amanda Torr
, New Zealand

This presentation summarizes the findings of Amanda Torr’s PhD studies. Her thesis responds to the issues raised by the emerging emphasis on audit and competence assurance resulting from the introduction of the Health Practitioners Competence Assurance Act 2003 in New Zealand. It investigates the concept of professional competence as exhibited by experienced practising pharmacists, how it is defined, and how it evolves through on-going practice. The research also identifies behaviours that differentiate expert, competent and not competent performance.

In her research model, the ability to perform professional tasks competently is called the domain of technical competence and is only one component of professional competence. The other components are contained in four other domains of competence – cognitive, legal/ethical, organizational, and inter/intra-personal. The “competent” pharmacist is able to integrate these domains when performing their professional roles.

“Not competent” performance is characterized by a lack of ability to fully integrate the five domains of competence. This is often exhibited in a lack of ability to integrate one of the domains, for example, not applying legal or ethical judgments to decisions made or not communicating clearly in English. “Expert” performers on the other hand are able to integrate the skills and knowledge within each of the domains across a wider range of practice situations more consistently than competent performers. In doing so experts are less reliant on standard professional and process knowledge, and instead use personal knowledge and experience to underpin their practice and act in more intuitive and creative ways. The model also provides a means of differentiating between “specialist” and “expert” performers.

In merging the domains together, the competent professional will exhibit patterns of behaviour appropriate to their situational context and judgments of competence can be made based on such behaviours. Competence assurance is, therefore, viewed as situational and evaluation methods are required that take this into account.

Amanda proposes that the methods used for competence assurance of health professionals should take a complex view of professional competence, and focus on the integrated behaviours that differentiate performance. She also proposes that her model of professional competence can have profound impacts on curriculum development for initial pharmacist education and continuing professional development activities.

Breakout #12
Cultural Factors Affecting Learning in Overseas Students Taking MSc Pharmacy Programmes
Yi-Chun Chen, Assistant Clinical Research Associate, Roche Taiwan; Soraya Dhillo, Professor; Andrzej Kostrzewski, Academic Manager in Clinical Pharmacy; The School of Pharmacy, , University of Hertfordshire

Overseas students undertaking postgraduate programmes in the UK will encounter challenges from different learning environments. To explore cultural factors influencing international students studying MSc programmes at The School of Pharmacy, University of London, a new Learning Needs Assessment Questionnaire (LNAQ) was designed, and the Approaches and Study Skills Inventory for Students questionnaire (ASSIST -Newble and Entwistle, 1986) was used to identify students learning approaches.

International students of three MSc programmes: i)Clinical Pharmacy, ii)Drug Delivery and iii)Drug Discovery from 2001 to 2004 at The School of Pharmacy, were recruited. All students in year 2003/2004 were administered the LNAQ and ASSIST questionnaire. All past students in 2001/2002 and 2002/2003 were sent the LNAQ only.

A total of 72 LANQ and 46 ASSIST questionnaires were distributed.
a) ASSIST: Students demonstrated high strategic and deep approaches. b) LNAQ: Students reported to gain more experience in role play, brain storming, web-based teaching, workshop, self-study, presentation, and tutorial discussion at The School of Pharmacy compared to their home country. Some students perceived the assessment methods at The School of Pharmacy are ‘more varied’(23.3), ‘more challenging’(3.3%), ‘better’(6.7%), and ‘new’ (16.7%) while others reported ‘no difference’ (20%) and ‘not fair and difficult’(6.7%).

Factors helping students learning included the unlimited availability of learning resources, course design and teachers support. Students voiced their concerns about the school facilities, communication and workload. Barriers such as loss of family support, weather and financial difficulties were identified.

This study has provided an in-depth insight into cultural needs of international students and recommendations for future international students attending The School of Pharmacy.

Breakout #13
Evaluating the Impact of Competency Assessment
Nora MacLeod-Glover
, Manager, Continuing Competency Programs, Ontario College of Pharmacists, Toronto; Anthony Marini, Education Consultant, Martek Assessment Ltd., Calgary; Canada

With the introduction of the Regulated Health Professions Act (RHPA) in 1993, the Ontario College of Pharmacists (OCP) began developing a Quality Assurance Program, which is designed to help assure the Ontario public of the competency of its members. Launched in 1997, the Quality Assurance Program for Ontario pharmacists consists of: a Self Assessment Survey, a Learning Portfolio, Practice Review and Practice Enhancement and Support.

In 2002, with five years’ experience with the Quality Assurance Program, OCP undertook to evaluate the effectiveness of its competency assessment program. The evaluation was designed to examine the impact of the PR on; 1) knowledge acquisition approaches of pharmacists, on 2) attitude of pharmacists towards patients, on 3) the practice of pharmacists and on 4) Quality Assurance as a whole.

The evaluation began with focus groups and interviews with pharmacists who had experienced one or more component of the Quality Assurance Program. Based on the input from the focus groups and interviews in-depth surveys were created. These surveys included: telephone surveys of 136 pharmacists who completed the Practice Review (PR) in 2002 and 67 who completed the PR in 1997/98 and a print survey of 322 pharmacists who completed the Self Assessment (SA) in 2002 but did not complete the PR. In the research design, the SA group serves as a comparison group to the to PR groups. The choice of the 97/98 PR group allowed us to look at impacts after 5 years and the PR 2002 group allowed us to see recent impacts. The results show that the Quality Assurance Program in general and the Practice Review in particular are having a positive impact.

Breakout #14
E-Learning: A Process with Multiple Outcomes
Kirsten Holme Christensen
, Project Coordinator; Tina Schilling Hansen, Head of Department of Education of Pharmaconomists, Pharmakon, Hillerød, Denmark

Pharmakon is the educational institution for pharmacy assistants (pharmaconomists) in Denmark. The education is a three-year curriculum where theoretical courses alternate with practical apprenticeships at the pharmacy.

We found that, in order to optimise the apprenticeship, we might benefit from the advantages of e-learning. We implemented e-learning through homepages, chat groups, tests, web based training programmes and more information to the students.

We set five main objectives, which were evaluated after tree years and five trial classes:

  1. Save resources in the pharmacies: Some pharmacies have indicated that they expect to save resources in the future, due to students' use of e-learning instead of face to face teaching.
  2. Establish closer contact between the students, and between the pharmacies and Pharmakon: Students are now in contact with each other in their apprenticeship through chat groups, and Pharmakon has closer contact with the students and their supervisors at the pharmacies due to more feedback between students and us.
  3. Ensure that the education remains attractive and in demand by young people: E-learning might be a contributing factor to the fact that Pharmakon does not have problems attracting students despite the fact that Denmark is currently experiencing small year groups.
  4. Support the Danish Pharmaceutical Association in its wish to implement greater use of computers: Seeing the students make use of the computer increases interest among the pharmacy staff in the possibilities with computers.
  5. Secure a higher quality of the education: We have gained better insight in how students work and what they actually do in their apprenticeship. This provides us with useful information to ensure a high quality of the education.

In addition to these main objectives, we have also gained experience in other areas, which we discuss more at the session and show examples on e-learning.

Breakout #15
Web-based continuing pharmacy education modules - a bridge linking undergraduate pharmacy experience to CPD
Cheryl Wiens, Clinical Assistant Professor, Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, Canada

Background: The primary objective of this project was to evaluate students’ perceptions and the implementation process of a web-based module in an undergraduate course.

Methods: A web-based module originally developed for practicing pharmacists, PHARMALearn Cholesterol, was introduced to the undergraduate pharmacy therapeutics course in fall 2000. The module was used for 4 years. The evaluation method was a web-based questionnaire, before and after completing the module, consisting of closed-ended questions using a five-point Likert scale and open-ended questions. Data was analyzed using SPSS for the quantitative data and NVivo for the qualitative data.

Results: Each year there were between 99-112 students enrolled in the course. The mean age of the students ranged between 24.9 – 26.7 years, with =65% of the class being female every year. The overall impression of the program was consistently positive. Sixty-three percent of students reported an improvement in their attitude toward web-based learning, while 4% reported a decline. Students from all years (total 69.4%) reported an increase in confidence in making drug therapy decisions. Themes arising from the qualitative data analysis revealed that students felt a lack of interaction with the instructor, expressed a desire for printed materials, and a perception that they did not get value for their tuition because they did not receive a lecture on the topic.

Conclusions: This evaluation study indicates that a web-based module can be successfully incorporated into an undergraduate pharmacy course. Overall students appear to view the technology in a positive way, with the majority of students feeling more confident in their knowledge and skills. However, students appear to view web-based learning as a complement, versus a replacement for, traditional lectures with a professor. Additional challenges for faculty members include the cost of developing and maintaining an up to date and interactive program.

Breakout #16
Bridging Education for Internationally Educated Pharmacists in Canada
Marie Rocchi Dean
, Program Manager, International Pharmacy Graduate Program; Dr. Zubin Austin, Assistant Professor; Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada

Main Objective(s): Upon completion of this session, participants will be able to:
-describe barriers faced by internationally educated pharmacists seeking
licensure in Canada
-compare and contrast models of bridging education for pharmacists
-describe the role of standards-based, outcomes-oriented curriculum and
assessment in bridging education
-discuss implications of bridging education in the context of professional
practice, education, and geographic mobility
-contemplate the logistics, challenges, opportunities and implications of offering bridging education

This presentation will be of interest to an international audience of regulators, educators, employers, government/policy professionals and pharmacists.

Summary: The province of Ontario (Canada) demonstrates an unusually high reliance on
internationally educated pharmacists - each year, close to 40% of all newly registered pharmacists in the province come from outside Canada or the United States, and more than 25% of all pharmacists in Ontario are internationally educated. Needs assessment research has indicated that
these individuals may be at higher-than-average risk of not meeting standards of professional practice both at entry-to-practice certification and in quality assurance/peer review once in practice. Given the significant numbers of individuals involved, and their important
contribution to the pharmacy workforce in the province, a clear need was identified for "bridging education" to facilitate professional enculturation for internationally educated pharmacists. Since 2000, the International Pharmacy Graduate (IPG) program at the University of Toronto has offered a program involving prior learning assessment, academic coursework, mentorship, and distance learning opportunities assessment benchmarked to undergraduate standards, to internationally educated pharmacists seeking licensure in Canada. In this presentation, we will review the structure, process, and outcomes of this bridging education model, and discuss implications for pharmacy practice and education in an environment of enhanced geographic mobility for pharmacists.

Breakout #17
Truth or Consequence – Reactions to the Introduction of Mandatory CPD in Great Britain
Peter Wilson, Head of Post Registration Division; Fred Ayling, CPD Manager; Royal Pharmaceutical Society of Great Britain, London UK.

The introduction of CPD to pharmacy in Great Britain was triggered by a consultation exercise in Pharmacy in 1996. The majority of respondents were in favour of introducing a formal system of CPD and agreed that it should be mandatory for the whole profession. This was the stimulus for the Royal Pharmaceutical Society of Great Britain (RPSGB) to begin the process of devising a CPD framework, which would be appropriate for pharmacists working in all branches of the profession, including the pharmaceutical industry, academia, government, and patient care. The introduction of CPD to the profession in Great Britain was completed in October 2004 and formal implementation, including restructuring of the professional register into practising and non-practising categories was introduced from January 2005.

Reactions to the reality of a mandatory CPD framework can be grouped into three categories.

• A number of pharmacists have expressed concern that their CPD practice will not meet the requirements of the Society and that they will face disciplinary action as a consequence.

• A second group have been concerned that there should be adequate provision to regulate what has previously been ‘free movement’ into and out of practice and also between sectors of professional practice.

• A third group have demonstrated determined opposition to CPD and the intention to continue in the role they currently have as a pharmacist.

The Society has needed to develop specific responses to each of these.

The session will outline the CPD framework adopted by the RPSGB and discuss the rationale and implications of the restructuring of the professional register. The emphasis of the presentation and the balance of presentation and dialogue will respond to the expressed needs and interest of the audience.

Breakout #18
A Training Workshop to Support Pharmacists’ Integration in Family Medicine
Elaine Lau, Zubin Austin for the IMPACT team: McMaster University, University of Toronto, and the University of Ottawa, Canada

This session will focus on the training needs, challenges, opportunities, and approaches for pharmacists integrating into family physicians’ offices. The experience of the IMPACT (Integrating family Medicine and Pharmacy to Advance primary Care Therapeutics) will be discussed, and used as a case study to describe educational needs assessment methods, and the ways in which curricula and assessment can be developed to meet pharmacists’ needs for additional training. A unique educational intervention that has been developed for the IMPACT project is the Family Practice Simulator (FPS), a multi-professional simulation of a typical day within a busy physician-group practice. As part of this simulation, real pharmacists, physicians, and other health care professionals interact with simulated patients and charts through a day-long series of interviews, presentations, and meetings, as a way of developing the collaborative practice skills necessary to support pharmacists’ integration. Results from the use of the FPS will be described and discussed. The IMPACT mentoring program will also be described, A mix of small and large group discussion will be employed to allow participants to share and discuss areas for additional training and mentoring , methods for evaluation, and enhancement of additional training supports for pharmacists working in family physicians’ office practices.

Breakout #19
Methods for Identifying Pharmacists’ Learning Needs
Lizzie Mills
, Research Pharmacist; Raisa Laaksonen, Research Pharmacist; School of Pharmacy, University of London, London, UK

Background: Participation in continuing professional development (CPD) is to become mandatory for pharmacists in the UK during 2005 to ensure competence. The CPD system introduced by the Royal Pharmaceutical Society of Great Britain requires pharmacists to assess their individual learning needs, and acquire skills and knowledge for maintaining and attaining competence. Furthermore, a new contract for community pharmacy will be implemented in the UK in 2005; pharmacists will have to prove their competence to provide certain services, for example medication reviews. It is envisaged that pharmacists may need some facilitation in this process.

Overview: A competency framework has been developed to assist hospital pharmacists’ professional development1,2 and further modified for self-assessment of competence in community pharmacy. The framework will be introduced to the participants and they will be asked to self-assess their own competence and potential learning needs in delivery of patient care. The participants will be engaged in a discussion regarding their own self-assessed patient care competence and asked if the results would stimulate them to undertake learning in this area. In addition, two other methods to assess competence and learning needs related to patient care, competency based case studies and performance assessment of medication reviews, will be introduced and discussed. Findings from studies using these methods for competency assessment in the UK will be presented. The participants will be asked to share their experiences of competence and learning needs assessment, and accreditation for service provision in their countries.

Breakout #20
Pharmacist Professional Development at Work: The Employer’s Role in Continuing Education
Rosemarie Patodia
, Manager, Community Professional Programs, Shoppers Drug Mart, Canada

As the role of the community-based pharmacist evolves to one with higher professional expectations, it is becoming increasingly important for pharmacists to have access to continuing education tools. This session will review considerations for employers in providing professional development opportunities for pharmacists. The discussion will focus on employer needs (including translation of education into activities at the pharmacy level, desire to elevate the profession of pharmacy, and build pharmacist-patient relationships) and pharmacist needs (such as licensing requirements, keeping up-to-date with current practice guidelines, professional satisfaction). The session will highlight some of the challenges of instituting mandatory pharmacist continuing education programs in a large pharmacy chain. The speaker will discuss the benefits of employer collaboration with the pharmaceutical industry and other healthcare providers in providing continuing education programs for pharmacists.

Breakout #21
Technology as an Integral Component of the Working Professional Pharm.D. Program: Past, Present, and Future
Sven Normann
, Assistant Dean for Distance, Continuing & Executive Education; Andrew Kellenberger, Coordinator of Educational Media; Diane Beck, Director of Educational Initiatives; University of Florida, College of Pharmacy, USA.

In the United States, the Doctor of Pharmacy (Pharm.D.) degree is now the sole degree that is offered by pharmacy schools. Over the last 15 years, changes in the profession have led many pharmacy practitioners with a B.S. Pharmacy degree to seek a program that enables attainment of this degree which focuses more on patient-centered care and still maintain their position as a full-time pharmacist. The University of Florida Working Professional Pharm.D. (WPPD) program has met this need by offering a blended-learning curriculum in which technology is an integral component. Since inception of the program, the use of technology has changed from site video-conferencing to web-based learning. The program is now implementing use of electronic learning portfolios to enhance learning, document achievement of outcomes, and serve as a means for graduates to pursue Continuous Professional Development (CPD)/lifelong learning throughout their career. During this session, the presenters will share why the current model has been successful, interventions used to facilitate the learner’s readiness to use technology during the program, and how these achievements to date have positioned the WPPD program to move forward with implementing electronic learning portfolios. The presenters will then engage the audience in discussing the following controversial issues related to implementing e-portfolios that facilitate (CPD)/Lifelong Learning: 1) use of generic tools versus customized systems (e.g. commercially available e-portfolio software) for building an e-portfolio system, 2) e-portfolios as a means for formative versus high-stakes performance decisions, 3) issues related to security and privacy, 4) intellectual property and digital rights, 4) issues of interoperability (ability to work with other software systems), and 5) acceptance by administrators, faculty, and students. Participants will receive a document that includes web-based and electronic resources that will further facilitate successful resolution of these issues at their individual institution when they return home.

Breakout #22
How to Engage Students in On-Line Discussion and Interactive Learning
David J. Woods
, University of Otago, Dunedin, NZ

- To describe techniques and methods that can be used to engage students in on-line discussion forums.
- To describe research findings resulting from five years’ experience of delivering a postgraduate medicines information paper.
- To discuss these findings and a synthesis of the international literature.
- To discuss how discussion forums can be used as part of student assessment.
- To briefly describe other interactive techniques that can be incorporated into web based delivery.

Discussion forums are a feature of most delivery platforms but they are often under utilised or used for simple message exchange rather than for interactive learning or formal assessment.
This session will help to provide guidance and instruction to participants who wish to introduce on-line discussion and simple interactive techniques to their on-line courses.

Breakout #23
Self-Assessment – A Prescription for Continuing Professional Development?
Roberta Stasyk
, Competence Director, Alberta College of Pharmacists, Edmonton, Canada

Continuing competence of health professions is of utmost importance to many stakeholders – the practitioners, other health care providers, government, regulatory authorities, educators, and especially the public. Continuing professional development is the cornerstone of continuing competence as these programs assist pharmacists in maintaining and improving their competence. But how do stakeholders and individual professionals ensure that continuing professional development addresses individual learning needs and thereby affects competence?

The continuing competence program of the Alberta College of Pharmacists—the RxCEL Competence Program—is a well-established continuing competence program that includes two main components – continuing professional development and competence assessment. The most recent component added to the program is the self-assessment. The Alberta College of Pharmacists began development of the RxCEL self-assessment program in fall 2003 based on the Competency Profile for Alberta Pharmacists. Through the self-assessment process pharmacists consider their own competencies within their practice and identify areas that they would like to work on in the future. While self-assessments are often used in CPD, the RxCEL self-assessment is exceptional in its scope. The self-assessment is modeled on The Competency Profile for Alberta Pharmacists, which includes description of eighty-five different competency areas.

After describing the self-assessment program, the presentation will go on to discuss the formative evaluation of the program, including focus groups and a year-long pilot. Discussion of pharmacists’ experiences with the self-assessment process will include benefits, disadvantages, and challenges, as well as their tips for completing a self-assessment. Of particular interest will be the pharmacists’ reception to such a detailed assessment.

Breakout #24
CPD with a Difference
Carmen Oltmann
, Billy Futter; Faculty of Pharmacy, Rhodes University, Grahamstown, South Africa

The South African Government has taken steps to create a comprehensive program to manage the HIV and AIDS crisis. This includes the rollout of the Antiretroviral (ARV) drugs and the training of health care workers. All nine provinces in South Africa have been mandated to collaborate with tertiary academic institutions to create Regional Training Centres (RTC) in order to fast track plans and programs, as well as to provide training, monitoring and evaluation. Members of the Pharmacy Faculty at Rhodes University are involved in helping the RTC to achieve its goals. One unit of the RTC is the Eastern Cape Pharmacy Task Team, which consists of 20 members, mainly pharmacists. The task team consists of a breadth of experience and expertise. We argue that the interaction of diverse opinions and professional perspectives provides a unique experience for personal and professional growth.

In South Africa, Continuing Professional Development (CPD) is defined as: “the process by which natural persons registered with [the South African Pharmacy] Council continuously enhance their knowledge, skills and personal qualities throughout their professional careers, and encompasses a range of activities including continuing education and supplementary training”1. This does not limit pharmacists to Continuing Education.
Our involvement as members of the Eastern Cape Pharmacy Task Team has been incredibly challenging and rewarding. It has provided us with a unique opportunity to train, and coach; do research; write Standard Operating Procedures (SOPs) and guidelines; advise the Provincial Department of Pharmaceutical Services; solve problems; network; and plan. It has impacted on our practice.

Being part of the task team provides action, interpersonal engagement, and we are definitely using our knowledge and skills.

Breakout #25
Continuous Professional Development in Pharmacy – Too Little, Too Late?
Marcus Droege
, Assistant Professor, College of Pharmacy, Nova Southeastern University, Ft. Lauderdale, USA

A notable shift in focus has occurred in pharmacy over the last three decades. Pharmacists, once sole dispensers of medicines, now provide a multitude of patient-oriented services. Commodified, technical knowledge, however, has increasingly presented a danger to the idea of professionalism in pharmacy. Although the role of pharmacists takes different forms in different practice settings and parts of the world, key drivers of change have been commercial pressures, government policy, and therapeutic advances – rarely, patient need. As a result, curricular outcomes and professional mandates have been restructured to impel this major paradigm shift from the product to the patient.

Albeit curricular outcomes have evolved, it is not clear if practitioner attitudes and skills have changed accordingly. Judging from the literature and practice observations, there is reason to believe that pharmacy educators have not been successful in instilling confidence in practitioners to accept new roles in patient care. Disenchantment and negativism of practitioners regarding their new responsibilities is common, an outcome in stark contrast to the intent of educators and the objectives of continuing professional development programs in pharmacy.

It is the aim of this breakout session to review the evidence related to a perceived lack of autonomy and professional service orientation in pharmacy, gain insights into the role of pharmaceutical care practice for professional legitimacy, and discuss the role of continuing professional education in this context.

The presentation will propose possible solutions and attempt to integrate current trends in continuing professional development such as the use of technology, the need for collaboration among health professions, and societal changes as they pertain to our knowledge about how people learn.

Breakout #26
Research To Learning To Research To Learning: Who Learns?
Charles Morecroft
and Jennifer Archer, Centre for Pharmacy Postgraduate Education, School of Pharmacy and Pharmaceutical Sciences, The University of Manchester, Manchester, UK

Learning can be dynamic, innovative and formative as well as making a difference to all those who engage in or with it, similarly the same can be said of research. For research is not just about collecting and analyzing data to decide if the null hypothesis is possible or to explore a particular phenomenon, other forms of learning both by the researcher, participant and a wider audience can take place. In our experience, the majority of research, particularly practice based research, is only seen as obtaining data to answer a specific research question. This is then disseminated in academic journals and conference presentations only to be read by the ‘great and good’ and those already recognizing research in this way. Very little is utilized to inform Health Services Practice, the practice of research or the learning and teaching of future pharmacists and other healthcare professionals

However, other forms of learning can also take place. First, existing skills such as interaction with others are built on, sharpened and refined, the ability to listen to others beliefs and opinions, talk with and not at people becomes second nature. Associated with this is the realization that the researcher may need to learn new skills to enhance their abilities when talking with patients about their experiences, this could identify areas of clinical practice that they are unfamiliar with. Secondly, the outcome of researcher’s learning can also inform further research questions that need asking. Thirdly, participants are able to reflect (CPD) on their experiences during the course of the research leaving the study with new knowledge. Fourthly, patients could indicate what specific areas of the study were important to their learning and what skills and competencies the researcher possessed that they considered would enhance this learning process. Finally, learning could lead to determining what skills and competencies other healthcare professionals would require if particular research findings were incorporated into practice.

This session will demonstrate how a number of learning opportunities exist within a research project and how the can be maximized to benefit learning. The benefits are not just to the lead researcher it includes other researchers, delivers of learning and the participants as well.

Breakout #27
Partnering Academia, Professionals and Business to Deliver CPD: Insights and Lessons
Neil Cohen
, Director of Technical Operations, Medisca Network Inc., Montreal, Canada

This workshop will offer participants the opportunity to explore the insights, lessons and benefits gained from a strategic alliance partnering academia, practicing professionals and private business to deliver CPD. It will revisit elements of program Development, Design and Delivery, in an interactive format.

Workshop participants will be invited to roll up their sleeves and adopt a take charge attitude that explores the following set of questions:

  • How do you appropriately select the CPD experiences needed such as readings, case work, practical exercises, decision-making and personal reflection that results in the pharmacist-participant advancing and accelerating their learning?
  • How do you ensure that all CPD programs are designed to equip pharmacists with appropriate decision-making processes in order to recommend justifiable and defensible pharmacotherapeutic regimens to medical practitioners whenever and where ever necessary?
  • How do you broaden your awareness of the benefits of needs-based training for today's pharmacist?
  • How do you ensure that all CPD programs employ interactive evidence-based and problem-based concepts that mirror design elements ranked excellent by professors and practicing pharmacists?
  • Can you list advantages of building bridges between academia, professionals and business when developing, designing and delivering CPD programs?

Be ready to affirm your commitment to the building of bridges between Academia, Professionals and Business. A professional challenge awaits you!!!

Breakout #28
‘Two Heads – Are They Really Better Than One?’ Optimizing Hypertension Treatment – The Team Approach
Donna Galvin
, CPS Consultants Corp, Okotoks; Charlotte Jones, University of Calgary, Calgary; Canada

Hypertension (HTN) is the number two risk factor for death in North America. 22% of Canadians are hypertensive with almost half of those patients unaware of their diagnosis and only 16% of those diagnosed treated to recommended target blood pressure levels. It is estimated that reduction in hypertension would save between $433.78 million and $1.301 billion in the management of stroke, myocardial infarction and renal dialysis.

Pharmacists are highly accessible, community-based, primary care providers who are underutilized and are often the patient’s first contact with the healthcare system. There is robust proof that pharmacist-initiated programs work.

The award-winning Calgary Fire Department Blood Pressure Program promotes awareness, detection and monitoring of hypertension, and assessment training for allied health providers. Calgary fire halls performed more than 11,000 blood pressure assessments in 2002 and have achieved great acceptance by the general public and local physicians.

There is an urgent need for innovative, community based, multidisciplinary chronic disease treatment programs that link acute care, the community and non-healthcare sectors.

Breakout #29
Fostering Inter-professional Collaboration in Continuing Education
Dimitra V. Travlos
, Director, Continuing Education Provider Accreditation Program
Accreditation Council for Pharmacy Education, Chicago, USA

In the United States, the Institute of Medicine stresses the need for interdisciplinary collaboration to improve our healthcare system. ACPE has taken initial steps to uphold both these philosophies by collaborating with its counterparts in medicine and nursing and to try with academicians to enhance scholarship in continuing education.

Two unique collaborative efforts to enhance the quality of continuing education will be presented. The first collaborative activity includes a project among accreditors and the second endeavor is collaboration between an academic association and an accreditation agency.

Accreditation is a process that requires organizations to expend both human and financial resources. Organizations that maintain multiple accreditations could benefit from a process that allows them to produce only one application. This process could result in saving organizations both time and money and to facilitate collaboration in future endeavors. In addition, a combined application could allow an organization to see a more complete picture of its continuing education programs. The Accreditation Council for Continuing Medical Education (ACCME), American Nurses Credentialing Center (ANCC) and the Accreditation Council for Pharmacy Education (ACPE) worked together to simplify the processes involved when an organization needs to seek accreditation from all three groups.

The American Association of Colleges of Pharmacy (AACP) and ACPE Scholar-In-Residence Program is a unique opportunity for pharmacy educators to work with ACPE staff and resources in addressing issues that ACPE and continuing education providers face in the development and delivery of pharmacy continuing education. The goals of the program include providing an opportunity to increase scholarship of individual continuing education administrators and assist ACPE in addressing their goals. During the residency, the participant researches and addresses issues of importance to the AACP CPE Section and ACPE as defined within ACPE’s strategic plan.

Breakout #30
What Should New Doctors Know about Pharmacy? A Delphi Study.
Alan R. Denison
, Clinical Teaching Fellow,, School of Medical Sciences, University of Aberdeen, Aberdeen, UK; Lesley Diack, Lecturer in E-learning, School of Pharmacy, The Robert Gordon University, Aberdeen, UK

There is evidence that newly qualified doctors have “Prescription Illiteracy”. Although a lack of theoretical knowledge can contribute to error, there is little data on other contributing factors such as poor communication skills and ignorance of the role of Pharmacists as an integrated member of a multidisciplinary team.

This study developed expert comment and feedback on an undergraduate medical curriculum. The main objective was to establish what Pharmacy-related core competencies a new doctor should have, using a three-stage Delphi technique.

Initially, a draft questionnaire was developed in discussion with an independent focus group. The study group consisted of 31 Clinical Pharmacists at a University teaching hospital, all of whom had regular contact with junior doctors. Initially, the pharmacists in the study group were recruited at an introductory meeting with a follow-up individual invitation sent by email. The pharmacists proposed over 200 separate competencies for newly qualified doctors in the first two rounds of the study. The research team organized these competencies into three themes and in the third and final stage, the pharmacists rated each competency item on a five point Likert scale. At each stage of the study the response rate was over 60%.
The main themes identified were
1. The Training, Role and Responsibilities of the Pharmacist
2. Doctor and Pharmacist interaction
3. Prescribing issues

Each theme had further sub groups to aid in the analysis of the competencies. The pharmacists identified twenty-seven competencies that they universally felt a newly qualified doctor should have, sixteen of which related to prescribing issues. The study highlighted the importance of communication skills and the need to increase awareness of the knowledge and expertise of pharmacists. The two most important issues for the pharmacists were that the doctors should learn the skill of legible handwriting and be able to complete a drug prescription chart.

Breakout #31
Inter-professional Continuing Education for Collaborative Client Centred Care (ICEC)
Karen Barber, Program Director, Continuing Physical Therapy Education; Shannan Neubauer, Assistant Professor of Pharmacy, College of Pharmacy and Nutrition; University of Saskatchewan, Saskatoon, Canada

Heath care is becoming increasingly collaborative. The Action Plan for Saskatchewan Health Care, states that “our health plan will coordinate and expand primary health care services and improve patient care. We will begin by organizing front-line health providers into teams so that patients have better access to the most suitable health care provider.” Although there are exceptions, education of health professionals, both when they are students and once they are practicing, is generally offered in a discipline specific manner.

In order to address this gap, the University of Saskatchewan Health Sciences Deans Committee established four subcommittees examining and making recommendations regarding inter-professional education. One of these committees is the Inter-professional Continuing Education for Collaborative Client Centered Care Subcommittee (ICEC4), an inter-professional committee composed of individuals with an interest in continuing education of health professionals. The mandate of the committee includes development of interdisciplinary, collaborative continuing education programs to support health professionals in the development and implementation of primary health care practices. By developing and offering inter-professional continuing education, the partnership will support practicing health professionals in the development of essential knowledge, skills and attitudes for initiating and implementing interdisciplinary collaborative approaches to health services provision.

Our program goal is to identify the learning needs of health care professionals related to collaborative client-centered care in urban under-serviced community settings, and to identify and develop relevant and accessible educational programming to address the identified needs.

By developing and offering inter-professional continuing education, the partnership will support practicing health professionals in the development of essential knowledge, skills and attitudes for initiating and implementing interdisciplinary collaborative approaches to health services provision.

Breakout #32
Advancing Pharmacy Education through International Collaboration and Information Exchange
Mike Rouse
, Assistant Executive Director; Accreditation Council for Pharmacy Education, Chicago, USA

The International Forum for Quality Assurance of Pharmacy Education (the “Forum”) was established in 2001 to facilitate information exchange, collaboration and cooperation in the area of quality assurance of pharmacy education, and ultimately to promote quality in pharmacy education worldwide. . The Forum has close to 200 members from over 50 countries, regional and international pharmacy organizations. It operates under the auspices of the International Pharmaceutical Federation (FIP). Members are drawn from all sectors of the profession, including education, practice, regulation and administration.

Pharmacy practice, pharmacy education and quality assurance systems for education differ from country to country. While developments in practice and education are likely to reduce this diversity over time, current differences (on a global scale) are still considered to be fairly significant. In many countries, quality assurance systems for pharmacy education are well developed; in other countries, they are still emerging. All countries, regardless of their level of development, can learn from the experiences of others and benefit from information exchange. The rapidly evolving concept of CPD is a prime example. By providing information about the work and objectives of the Forum, the presentation will aim to stimulate participants to become more interested and active in multilateral collaborative activities – at the individual, institutional and national levels.

The presentation will provide an overview of the establishment, objectives and activities of the Forum, and will provide selected examples of the outcomes of regional and international collaboration and initiatives in the area of pharmacy education – both professional (pre-service) and lifelong learning/CPD. The presentation will also provide details of the main current project of the Forum – the development of a globally-applicable framework for quality assurance of pharmacy education.

Breakout #33
Inter-professional Training of CPD Facilitators – Pharmacy & Dietetics
Helen Middleton, CPD Manager & Training Specialist, London Pharmacy Education & Training (LPE&T)

What is inter-professional learning? This session will explore the differences between inter-professional, multi-professional and uni-professional learning, using a case study and through sharing of participants’ experiences of learning with other professionals.

London Pharmacy Education & Training (LPE&T) will share their experiences (case study) in developing, delivering and evaluating a workshop “New CPD Facilitators’” for qualified pharmacy and dietetics staff, including challenges, how challenges were overcome and factors contributing to the success of the workshop.

LPE&T have provided CPD Facilitator workshops for pharmacy staff since 1999. Dietetics staff had no previous access to these workshops. The London Dietetic Practice Education Lead had been scoping potential partnerships. In a pilot (2003), dietetics staff joined 1½-day “New CPD Facilitators’” workshops (designed for pharmacy staff). Despite positive feedback (from three cohorts) on the content, dietetics staff felt more partnership working was needed. Feedback informed the second phase of the project.

The workshops were reviewed in partnership to ensure the content met the needs of both professions. Three cohorts (pharmacy and dietetics staff) attended, reviewed, and revised 2-day “New CPD Facilitators’” workshops in 2004. Feedback was collected using evaluation forms which focussed on

  • the relevance of the workshops
  • feelings about learning with another profession at these workshops
  • feelings about inter-professional learning overall

Feedback highlighted that participants valued learning with another profession:

Breakout #34
Developing Pharmacist Pioneers – How Collaborative Multi-Disciplinary Partnerships Have Supported the Development of a Successful Supplementary Prescribing Programme for Pharmacists
Denise Taylor
, Senior Teaching Fellow, Department of Pharmacy & Pharmacology; Andrea Taylor, Learning & Teaching Research & Evaluation Officer School for Health; University of Bath, Bath, UK

The aim of this session is to share experiences of the Supplementary Prescribing Programme (SPP) team to demonstrate how collaborative multidisciplinary partnerships can be successfully used to support the professional development needs of pharmacists in new professional roles.

A SPP was designed and developed to support pioneer practitioner pharmacists who were working full-time in their work-place. The programme therefore needed to be flexible, distance learning-based and yet encompass relevant and appropriate work-based tasks to achieve the programme assessment outcomes. These outcomes were mainly focused on successful completion of consultation OSCEs and a practice-based learning portfolio designed to achieve the indicators outlined in the National Prescribing Centre (NPC) Competency Framework.
The use of OSCE assessments is well known within the medical undergraduate and postgraduate profession. Over the last ten years it has also become a means of assessing clinical competence and professionalism of pharmacists at undergraduate and postgraduate level. However, there are no formal guidelines available to ensure consistency of OSCE assessment in pharmacy practice at a national level. Nor is there cross-discipline organization of practice to assess skills historically associated with the medical profession.

To ensure clinical competence, safety and professionalism were appropriately assessed; OSCEs were developed in collaboration with a multidisciplinary team. Members included: General Practitioner trainers (expertise in communication and consultation skills); consultant nurses in prescribing; educationalists; academic pharmacist (skilled in assessment of communication skills in prescriber consultations), secondary and primary care pharmacists; academic medical clinicians and a general practitioner clinical assistant.

The NPC competency framework was designed such that successful attainment of each indicator (83 in all) would ensure that the supplementary prescriber was competent, safe and effective as a prescriber. The programme was designed to enable the student to attain each competence via work-based learning activities, which linked with experiential learning in the prescribing-practice environment.

Breakout #35
Problems Solved Through CPD and a Unique Collaboration.
Lindsay Taylor
, Head of Pharmacy CPD and Distance Learning; Suki Tattar, Postgraduate Pharmacy Tutor; De Montfort University, Leicester, UK

The overall aim of the session will be to describe an innovative approach to CPD that arose as the result of a unique collaboration set up to address problems arising from imminent changes to practice.

Changes in the delivery of health care delivered through the National Health Service (NHS) mean that all pharmacists will very soon need to demonstrate that they undertake CPD in order to remain on the active register of the professional society. As might be expected, the changes present many challenges for community pharmacy practice, including the need to understand the quality assurance process known as clinical governance. Consequently educational and training needs were for a short “fit for purpose” course, which was met by a unique collaboration between the Local Pharmaceutical Committee (LPC), De Montfort University and the local NHS organizations. Several important support mechanisms were included in order to ensure that students completed the course:
• The activities were all based on practice based problems
• An experienced community pharmacist was available at certain times to explain the course.
• Three course commitments had to be completed to provide evidence of progress; there was no other formal or summative assessment of the students.
• Students were paired with an unknown, ‘buddy.’
• A series of compulsory evening events were held, of which students had to attend one, in order to consolidate their learning, provide vital feedback, and receive their certificate of completion

The feedback from the 46 students who completed the course was evaluated and deemed to meet the learning outcomes; consequently an updated course was delivered to a further 50 community pharmacists.

Research #1
Early Professional Exposure to Patient Care Responsibilities – Start of the Lifelong Learning Journey
Margaret Ackman
, Clinical Practice Leader, Capital Health, Edmonton, Canada

The role of the clinical pharmacist intern (CPI) was developed in response to a need for students to gain clinical experience and exposure to the clinical role of the hospital pharmacist. In the summer of 2004, five third-year pharmacy students were hired by Capital Health to be part of the pharmacy patient care team.

A structured training module was developed to support skill development of pre-determined tasks, such as patient counselling. The evaluation of the program consisted of midpoint and final surveys, and exit interviews of both the pharmacists involved in the program and the CPIs.
Overall, the program was extremely successful. Evaluation results confirmed that the structured training and support from the preceptors was felt to be adequate. Despite the structured training, the CPIs needed a role model to observe and be observed by. From a communication perspective, the CPIs felt that it was important to have a primary preceptor. Ratings by both CPIs and pharmacists regarding their level of comfort with the role of the CPI and the competence of the CPIs were very high. When a specific task was examined, such as patient counselling, both the CPIs and the pharmacists were confident in the ability of the CPIs to provide this aspect of patient care and the 5 CPIs spent almost one-fifth of their time counselling patients.

In conclusion, the most rewarding aspect of the CPI role for the students was making a meaningful contribution to patient care and gaining clinical skills and experience that would be of professional value. Both the CPIs and the pharmacists felt that the CPIs made an important contribution to patient care.

Research #2
Students’ Views on Records of Evidence in Pre-registration Training
Jeremy Liew, Royal Brompton and Harefield NHS Trust, London, UK

Research developments in reflective learning within the Healthcare context have invoked discussions concerning challenges of promoting the harvester of knowledge and practice in adult learners, drawing attention to the framework of work-based learning, the use of learning journals and examining the relationship between reflection and professional development.
The paper will report on work-in progress, the purpose of which is to investigate pharmacy students’ views on the use of records of evidence and the examination of these viewpoints. Records of evidence are equivalent to learning journals in other disciplines; these records are used for formative assessment during the pre-registration year. 151 pre-registration pharmacists in England were recruited in the study (response rate = 46%) through the use of a structured self-completed questionnaire. More than 70% of those who responded expressed that they used record of evidence to reflect on mistakes and identify weaknesses in their professional role. 47.7% (n= 72) of those who responded agreed that the use of records of evidence offered a positive learning experience and 49% (n=74) disagreed, of which 12.6% (n=19) strongly disagreed. 54.3% (n=83) disagreed that records of evidence as a good method of assessment, of which 18.5% strongly disagreed.
The research identified that half of the participants had concerns with the employment of record of evidence as an assessment tool; major areas of concern include time-consuming nature of the activity, the lack of guidance to complete written evidences and the diversity of tutor expectations. Participants communicated unease regarding the lack of tutor standardisation with regards to the formative assessment of these records.
It is anticipated that results will contribute to the development of further guidance for pre-registration trainees to complete records of evidence. This study will also add to the construction of further research strategy to develop a formative assessment framework for records of evidence.

Research #3
The Influence of Clinical Training on the Self-Perceived Competence of Community Pharmacists
Raisa Laaksonen
, Elizabeth Mills, Research Pharmacist, School of Pharmacy, University of London, London, UK

Background: A new contract for community pharmacy will be introduced in the UK in April 2005. Pharmacists will have to undertake a competency based assessment to become accredited to provide certain services. Pharmacists are encouraged to undertake training to update their skills before undertaking the assessment. A group of community pharmacists in the UK has been specially trained to provide medication review services, using a certificate level distance learning course in therapeutics. This study aims to investigate the effect of this training on the self-perceived competence.

Methods: A competency framework has been developed to facilitate the development of pharmacy practitioners in hospital pharmacy1;2. This framework has been adapted for community pharmacy to encompass the competencies required to meet the service specifications for the services requiring accreditation in the new contract. This framework was formatted as a questionnaire3. Pharmacists were asked to state how often they felt they showed the behaviour in the statement; the response categories were ‘always’, ‘usually’, ‘sometimes’ and ‘never’.

The questionnaire was distributed to all (n=179) community pharmacists in four areas of London. Thirty-six of these pharmacists had completed the training to provide medication review services (intervention group), the rest of the pharmacists had not received any such training (non-intervention group).

Results: The response rate was 50%. Interestingly, the mean scores for each competency cluster were lower for the intervention group compared with the non-intervention group; however, the difference was not statistically significant.

Conclusions: Clinical training did not seem to influence the self-perceived competence of the pharmacists in the intervention group. This suggests that pharmacists need support putting their learning into practice. There is no system of mentorship to provide feedback on performance; community pharmacists work in isolation. If pharmacists are to provide high quality services, this need for support must be addressed.

Research #4
Needs, Opinions & Suggestions of Community Pharmacists on Continuing Education in Belgium
Annelies Driesen
, Leemans L., Laekeman G., Faculty of Pharmacy, K.U.Leuven, Belgium.

Background: In January 2002, all main Flemish CE institutes joined forces and founded IPSA (Flemish Institute for CE for pharmacists). As a newborn institute IPSA struggled with fundamental questions: What do pharmacists expect from CE courses and CE institutes like IPSA? What are their needs, opinions and suggestions? These questions had to be answered before determining strategies for the further organization of CE activities. Therefore we started with the needs assessment project.

We applied a multi-method design, including a survey inquiry and focus groups in order to triangulate the results. The key questions were on optimizing the current courses, the need of distance learning facilities, and the implementation of an ideal accreditation system. From the results of the survey we determined pharmacists’ profiles with respect to their CE needs by means of cluster analysis. These profiles are based on their preference for different CE formats: distance learning, interactive training and lectures. All these projects fit within the greater unit of the needs assessment project.

Cluster analysis revealed three clusters of pharmacists. Pharmacists in cluster one are likely to be men who don’t go to CE courses because they experience great intrinsic resistance, don’t like to make the trip and have a lot of other (more interesting) things to do. Pharmacists in cluster two are likely to be strongly motivated pharmacists who like social contact with colleagues and active participation during CE courses and who like to be rewarded for their efforts. Pharmacists in the cluster three are likely to be women who are moderately motivated, who don’t make much of social contact and active participation, in conclusion, who go with the flow and who don’t want any changes.

In the future we will develop CE activities in accordance with the findings of the survey and the focus groups. Do we also need to tune CE activities to the different clusters of pharmacists?
From this research we know that pharmacists are not very much in favor of mandatory CE. We will however start to develop an accreditation system. How can we sell this to our pharmacists?

We used a multi-method design for the needs assessment project. What is the value of triangulation in qualitative research?

Research #5
Continuing Professional Development – The Portuguese Experience
Fernando Ramos
, Vice-President; José Aranda da Silva, President; Tania Saraiva, Professional Secretary of the National Board; Ivana Silva, Professional Secretary of the National Board; Portuguese Pharmaceutical Society Lisboa, Portugal

Maintaining competence throughout a career, during which new and challenging professional responsibilities will be encountered, is a fundamental ethical requirement for pharmacists, whose professional responsibilities include seeking to ensure that people derive maximum therapeutic benefit from their treatments with medicines.

To this end the PPS has established a mandatory renewal of the professional license made on a five years basis, subject to a pre-defined number of credit units obtainable through CPD activities.

In building up its accreditation standards for continuing professional development activities, the PPS has included four levels of evaluation. Concerning continuing education and post-graduation programs, of the more than 300 programs submitted, since September 2003, only one clearly fulfilled these four evaluation requirements.

Discussion sessions on the revalidation model were organized all over the country. An evaluation questionnaire was distributed in order to investigate pharmacists’ reaction to the proposed model for license revalidation. Results from 2002 show that, regarding a first reaction to the proposed model, 49,5% were open to the process, 26,6% were worried and expectant about the process, 13,9% were willing to embrace the process, 3,9% were confident and positively in favour of the process and 4,0% were frightened by the process.

In addition, a nationwide survey on CPD activities was carried out in September 2003 in order to identify existing continuous education habits and investigate specific education and training needs per field of activity, country region, and age. Time and financial resources to be allocated for CPD activities were also assessed. Main results reveal that:

  • Areas of interest for continuing education: Specific areas (related to the field of activity/practice): Pharmaceutical Care (22,2%); Paediatric Pharmacy (20,7%); Geriatric Pharmacy (18,1%); Pharmacotherapy (17,3%); General areas: Business and Administration (29,7%); Good Pharmacy Practice (22,2%); Communication and Information Technologies (17,8%); Legal and ethical aspects of pharmacy practice (17,6%);

Research #6
What are the Issues Surrounding Continuing Professional Development for Pharmacists in the UK?

Sue C Jones,Clinical Pharmacy Practice Lecturer; Pat Reynolds, Deputy Director for Education in Distance Learning; King’s College London, UK.

Toward the latter part of this year, continuing professional development (CPD) is expected to become mandatory for all qualified pharmacists and records of CPD will need to be kept to show participation. The move from obligatory to mandatory CPD has sparked lively debate and discussion amongst members of the profession and many ideas have been muted to pharmacists by the Royal Pharmaceutical Society of Great Britain (RPSGB). The public assume a consistent and high level of service from a person wearing the badge of a ‘pharmacist’, regardless of when and where they qualified. That means a pharmacist who qualified 30 years ago should have the same up-to-date knowledge as someone who qualified a couple of years ago. Without CPD, this would not be possible.

The research presented at this conference will comprise of a number of questionnaire studies that have been undertaken by the researcher. The presentation will consider the various groups of pharmacists that are employed in community pharmacy. It will examine how these pharmacists are reacting to the proposed changes. Pharmacists’ opinion on the semantics of CPD and continuing education (CE); do pharmacists know the difference? With regard to record keeping, data on what pharmacists currently do with their records will be considered together with their plans for the future. Areas for development and perceived needs of pharmacists for CPD will be analysed and discussed in the presentation.

The main objective of the presentation would be to discuss ongoing research that I am working on looking at issues surrounding continuing professional development for pharmacists. Although my research is based in the UK, the issues raised will be very generic. The presentation will consider what the issues are surrounding CPD and pharmacists in the UK and to debate the generic nature of the issues with the audience.

Research #7
Kiwis Switching Hats – Teaching the Preceptor to Assess
Trish Vorstermans
, Pharmaceutical Society of New Zealand, Wellington, NZ

Registration as a pharmacist in New Zealand requires B.Pharm graduates to complete a year-long internship programme, called the Preregistration Programme, run by the Pharmaceutical Society of New Zealand. The “intern” practises under the supervision of a “preceptor” pharmacist, who is responsible for both training and assessment of the intern. We have defined assessment as “A structured process for gathering evidence and making judgments on an individual’s performance in relation to set standards.”

The Pharmacy profession in New Zealand has identified seven key Competence Standards against which pharmacy interns are assessed. The programme uses workplace-based assessment as one method of gathering evidence of competence to register as a pharmacist, along with assignments, a learning portfolio, an OSCE and an interview. Research shows that workplace assessment provides direct and indirect evidence of the intern’s ability to transfer and apply the skills and knowledge gained at university to a variety of situations in the workplace to a predetermined standard.

To assess the intern against these competence standards the preceptor uses a variety of tools, including appraisal, workplace-based assignments and assessment of evidence records. While it is imperative that these assessment tools are well designed, how do we ensure they are being used correctly and appropriately? In other words, how do we know the assessment carried out by the preceptor is reliable? The preceptor role is principally that of the teacher. How do we prepare preceptors to switch from this role to the role of the assessor, and back again?

To ensure consistency of assessment, the Pharmaceutical Society of NZ has developed a programme to train pharmacists in Workplace Assessment. The course was originally developed by a tertiary provider, and is a national qualification on the National Qualification Framework, known as unit standard 4098. It is now provided by the Pharmacy Industry Training Organisation (PITO) and is a one-day face-to-face workshop delivered by suitably trained pharmacists for pharmacists.

All preceptors must be currently accredited in unit standard 4098. For first-time preceptors, courses are run in several centres at the beginning of the programme year to ensure that preceptors have received the appropriate training in workplace assessment as soon as possible after the intern commences their employment.

The course is a one-day workshop, and covers the principles of competence assessment, the assessment process, and the skills required to carry out assessment. Preceptors are taught how to collect evidence of competence, and how to evaluate this evidence. The decision making process and giving feedback is also examined. The course gives participants opportunities to apply their learning during the day by carrying out practical assessment exercises in groups. Feedback from participants is extremely positive, as it gives them an opportunity to “put the theory into practice”. The training day also provides valuable peer support, particularly for first-time preceptors, who benefit from working alongside experienced preceptors attending their refresher course.

Legislation recently passed in NZ requires that pharmacists will have to demonstrate competence in order to hold an Annual Practising Certificate. It is yet to be determined fully how that competence will be assessed. Having a growing number of practising pharmacists trained and qualified in workplace-based competence assessment of interns offers the profession the potential opportunity to expand their role to include workplace and peer assessment of other pharmacists.

Research #8
The Effect of a Pharmacy CE Program for Preceptors on Learning Outcomes
Nancy Fjortoft
, Midwestern University, Chicago, USA

The objective of this study was to conduct a long-term evaluation of cognitive gains from a pharmacy CE program and determine if there are any subsequent behavioral changes. An interactive, curriculum-based 3-month long pharmacy CE program was developed and offered to preceptors. The goals of the program were: 1) provide current preceptors with the knowledge and skills needed for the Colleges’ advanced rotations, and 2) attract pharmacists to serve as preceptors. The program focused on cognitive skills related to specific disease states. Ninety-seven pharmacists attended and completed the program. They were given a pre/post test at each of the three workshops. A one-year follow-up survey was mailed to participants, with a small monetary incentive. A reminder mailing was sent two-weeks later. Given that the first survey was lengthy and may have been a deterrent to responding, an abbreviated survey was sent on the second mailing. The response rate to the first mailing was 30% (N=29). The response rate after the second mailing was 49% (N=48). Repeated measure ANOVA is the preferred statistical test for comparing data over three points in time for dependent groups. However, given that only 29 completed the entire survey, two paired t-tests were conducted. The first paired t-test on the pre/post workshop assessments (time 1 and time 2) indicated successful learning had occurred on each of the specific topics (t=-9.97, p=.000, t=-8.93, p=.000, t=-5.73, p=.000). The second paired t test (time 2 and time 3) indicated a statistically significant decline in average scores for all three content areas. Four pharmacists have since volunteered to serve as preceptor. These data suggest that there are short-term cognitive gains after a CE program, but those gains do not persist over time.

Research #9
Competency Frameworks for Advanced Level Practice: Towards Consultant Pharmacists
David Webb
, University of London, London; J.G. Davies, University of Brighton, Brighton; UK
(presented by Ian Bates)

Research #10
How Accurate is Self Assessment of Competence?
Lizzie Mills
, Research Pharmacist, University of London, London; Denise Farmer, Associate Director of Clinical Pharmacy Services (East), Cambridgeshire; UK

Background: The Royal Pharmaceutical Society of Great Britain advocates continuous professional development (CPD) as a means of assuring the competence of its members such that by mid 2005 all pharmacists on the practising register will have to undertake mandatory CPD. In order to be effective CPD relies on self identification of learning needs. Many community pharmacists in the UK work in isolation and are not subject to regular performance appraisal. This can be a barrier to accurate needs assessment and therefore CPD will not improve competence where it is needed. There is a need to determine the accuracy of self assessment of competence.

This study aims to compare the self assessed competence of a group of community pharmacists in the competencies required for the delivery of patient care, with an objective assessment of their competence in this area.

Methods: A competency framework has been designed for community pharmacists. This framework has been used to develop a questionnaire to determine pharmacists’ self perceived competence. The questionnaire contains a list of behavioural statements and pharmacists are asked to state how often they feel they show the behaviour in the statement. The response categories are ‘always’, ‘usually’, ‘sometimes’ and ‘never’.

Five case scenarios were written by academics to reflect the delivery of patient care competencies. Marking criteria for each case study were developed. The competencies achieved if the criteria were met in an answer were agreed in an expert panel. Case studies were double marked and responses to the case scenarios converted in to a percentage score for each behavioural statement. Scores corresponded to the percentages assigned to the response categories in the questionnaire (always, usually, sometimes and never). Percentage scores from were compared between the case studies and the responses to the questionnaire.

Ninety-five pharmacists (community and those providing medication reviews in GP surgeries) from 6 regions in the UK completed the case scenarios and questionnaire.

Results will be presented

Research #11
Training Community Pharmacists for a New Medication Review Service in England
Diane Harris
, Community Pharmacy Advisor, Amber Valley Primary Care Trust, Belper; Julia Lacey, Pharmacist Teacher/Practitioner, Pharmacy Academic Practice Unit, University of Derby; UK

It was aimed to provide a pharmaceutical care domiciliary visiting and medication review service, by trained community pharmacists. It was necessary to provide training in order to allow the pharmacists to carry out this new clinical role effectively and communicate confidently with a wide range of professionals.

Method: Twenty community pharmacists completed extensive training which included:
• Three CPPE workshops, or open learning on the pharmaceutical care of older people and mental health
• An MSc module on Therapeutics for Older People, equivalent to 150 hours of student effort (1).
Evaluation forms were sent to all referrers, 4 months after the pharmacist’s visit.

Results: This has proved to be a busy service with 600 referrals in the first year. 23% of patients had their number of medicines reduced and 18% of patients had doses or frequencies of medication changed. Many safety issues with medication were discovered by the pharmacists.

A total of 130 evaluation forms were returned (response rate 77%). It has benefited 95% of patients/carers, 87% of patients were no longer having problems taking their medication and 73% patients/carers were better at remembering to take their medicines. The referrers have valued and supported this service.
The pharmacists appreciated the MSc module training, particularly the group clinical sessions with the tutor. This has also provided the impetus for some pharmacists to augment their CPD further by completing additional modules or a full clinical diploma.

Conclusions: This busy service is highly valued and appreciated by the various professionals, involving a group of very highly trained community pharmacists. The training was valued by the pharmacists and considered to be useful preparation for this new clinical role. It enhanced their confidence, CPD and encouraged life long learning. All five Primary Care Trusts have now provided funding for a long term service.

Research #12
Portfolio-Based Learning and Assessment in Non-Doctor Prescriber Training
Alison Eggleton
, Principal Pharmacist for Education and Training, Cambridge University Hospitals NHS Foundation Trust, Cambridge; Soraya Dhillon, Head, School of Pharmac,y University of Hertfordshire, Hatfield; UK

Background: Pharmacists and nurses in the UK who have undertaken additional training can register as prescribers. A practice portfolio is a compulsory assessment element within the prescribing course. This quantitative study explored the use of a portfolio as a student-centred learning tool and in the assessment of prescribers.

Method: Course documentation from higher education institutions (HEIs) offering nurse prescriber training was reviewed to compare commonalities and differences in portfolio use. A questionnaire sought opinions of course organisers (COs) on the value of the portfolio as a learning and assessment tool and how students and assessors were briefed.
Summary of Key Results: Of 36 HEIs approached, 21 COs supplied documentation and responded to the questionnaire. All documentation suggested a standard format for the portfolio. The portfolio encouraged student-centred learning through student self-assessment and formative tutor-led review. Reflection on practice was compulsory but there was no indication of how reflection would be evaluated.
From the questionnaire, staff training in portfolio assessment appeared variable but student training in portfolio development was more consistent. Eighty-percent of respondents considered the portfolio an aid to student learning. Controversial areas included whether portfolios demonstrated:
• learning from mistakes
• how well activities were performed
• patient-centred learning

Problems with reliability of assessment were reported. Some COs disagreed that assessment standards were uniformly applied or weak candidates identified. Some disagreed that success in portfolio assessment guaranteed competent performance of the role. Some considered that students found reflective writing difficult and that assessment of reflective writing was problematic.

Conclusion: The portfolio was used to enhance learning and assess achievement of learning outcomes. Some problems of reliability, practicability and validity remained to be solved. There was lack of clarity about what constitutes reflection.

Research #13
Perceptions of CPE Providers on Their Role in Pharmacist CPD
Virginia (Ginger) G. Scott
, Director of Continuing Education, West Virginia University, Morgantown, USA

Background: Continuing Professional Development (CPD) is an approach to lifelong learning currently used in the United Kingdom, Canada, Australia, and New Zealand. This approach is being studied as a model for pharmacists in the United States (US). National pharmacy organizations in the US support the approach but the role of continuing pharmacy education (CPE) providers has not been defined

Objective: To identify how CPE providers envision their role in pharmacist CPD.

Methods: A convenience sample (443) from the Accreditation Council for Pharmacy Education list-serve of CE Providers was used. A web-based instrument consisting of three sections — demographics, current programming, and perceptions of CPD was developed. Data was collected via Survey Monkey on the Internet.

Results: A usable response rate of 45.1% (199) was received. One-fourth of the responders were from colleges/schools of pharmacy. Approximately 70% of respondents indicated their knowledge of CPD ranged from fair to excellent and CPD enhanced the current approach to lifelong learning. Their philosophical view of opportunities for CPE providers in CPD ranged from supporting the concept to leaving the process as status quo. Respondents identified a range of specific activities for CE providers to perform within the CPD five-staged cycle. Notable challenges were buy-in of the approach, resources, time, development of individualized material, competency measures, record keeping, and quality assurance. Active learning activities (e.g. demonstrations and role-playing) were mentioned most often to include in the CPD approach. Respondents were unsure of the validation process but felt it should be consistent across the country.

Conclusion: CPE providers believe their role would expand in the CPD approach but there is no consensus on their specific role and activities to include or how to assure quality or validation of CPD. Additional research is needed to determine the best approach to CPD implementation in the US.

Research #14
Fostering Personal Learning: A Qualitative Study in Evaluation
Nadine Wentzell
, Adult Education Consultant, Halifax, Canada

This presentation summarizes the findings of a research project which addresses the role of pharmacists’ personal learning, in a continuing professional education (CPE) program for pharmacy preceptors, related to their positions as clinicians with practicum students in a problem-based learning environment. The presentation will discuss a post-workshop evaluation study conducted 2 years after the workshop with a focus on reflective practice, an ongoing process of learning and discovery, and the aspects of facilitation supporting personal learning. The purpose, format and methodology, prevalent themes that arose from the qualitative investigation of participants’ learning, conclusions, and recommendations that arose from the findings of the study will be discussed.

An overview of the considerations in designing specific qualitative methodology will highlight the process followed to encourage pharmacists to incorporate critical reflective practices of their personal learning, their subsequent employment of these practices in their interactions with students, and the implications for professional practice in general. Discussion will also address the aspects of this learning related to behavioural changes at participants’ practice sites and the impact of those changes.

We all strive to facilitate effective learning, directly applicable to practice, where learned knowledge, skills, and values are immediately incorporated into each learner’s daily practice. However, higher-level evaluation areas of transfer and impact of learning are frequently overlooked when considering the evaluation of an educational event. From a review of the literature connections will be made between theory and practice, and the methods that were employed to facilitate transfer and impact of personal learning.

The outcomes of this study support participatory learning and adherence to the principles of adult learning as integral elements in personal learning. The findings will deepen participants’ understanding of the opportunity for accountability to enhance health professional educational programs by linking practice standards and professional competence.

Research #15
A General Level Competency Framework: Final Results of the South of England Trial
Ian Bates
, University of London, London; David Webb, Northwick Park Hospital, Harrow; UK

Research #16
Continuing Education via Videoconference and Webcast Video: A Best Practice Comparison
Heather Scarlett-Ferguson
, Clinical Pharmacist, Alberta Hospital Ponoka, Ponoka, Canada

The need for ongoing professional skill and knowledge enhancement, coupled with a shortage of healthcare workers, creates a need for easily accessible, effective, and timely continuing professional education. This study explores issues concerning the most effective and efficient ways of employing technologies in the delivery of continuing education of mental health workers. A survey questionnaire was developed to systematically gather the opinions of mental health professionals participating in a smoking cessation education module. This survey gathered both quantitative and qualitative data. One group participated via synchronous videoconference and the other via asynchronous Webcast video. Their preferences regarding interactivity, accessibility, convenience, relative advantage, and satisfaction were similar. Follow-up qualitative data gathered via telephone interview showed similarities in both groups with respect to convenience, accessibility, and time and cost savings. They differed somewhat in their opinions about the importance of realtime interactivity with other learners, with the Webcast video group finding it less important. Resulting recommendations for best practice in videoconferencing within this population include ensuring personal comfort and security of participants, providing the ability to ask questions of the presenter, access to written information to accompany the presentation, and minimizing technological difficulties. For Webcast video participants, a design utilizing a segmented program that can be paused or replayed if desired and the ability to e-mail questions to the presenter were considered most important. This preliminary study demonstrated that while overall satisfaction with both formats is similar, the perception of a positive learning experience can be enhanced by these suggestions for best practice. Recommendations for further study include methodological suggestions, changes to content or technology, pedagogical concepts, and cost effectiveness analysis.

Research #17
Supporting the Pioneers – How Student Pharmacist Supplementary Prescribers use Electronic Discussion Boards to Support their CPD.
Andrea Taylor
, Learning & Teaching Research & Evaluation Officer, School for Health; Denise Taylor, Senior Teaching Fellow, Department of Pharmacy & Pharmacology, University of Bath, Bath, UK

This research evaluates the use made of a virtual learning environment (VLE) based discussion board by the first group of pharmacist supplementary prescribers on a newly commissioned supplementary prescribing CPD programme in the UK.

The University of Bath Supplementary Prescribing Programme is distance learning, delivered via the internet, with web based ‘Study Guides’ and support for learners via a VLE, which contains a Discussion Board component. The programme leads to the award of ‘Practice Certificate in Supplementary Prescribing’ and a change in the status of the pharmacist to that of ‘Registered Supplementary Prescriber’.

The use of discussion boards to support learners in disparate environments is well known and can require careful planning and management to maximise participation, typically through including ‘e-tivities’ (Salmon, 2000, 2002). However, observation of discussion board use indicated that these learners were making exceptional use of discussion without the use of e-tivities.

A retrospective qualitative/semantic review of the nature and frequency of use of the discussion board has been undertaken to determine the characteristics of the ‘virtual conversations’. This review has been supplemented by qualitative data on individuals’ perceptions of the use of the VLE during the programme (n=11), collected via questionnaires and semi-structured interviews.

This depth study yielded qualitative information about user preferences which differentiates the experiences of this group from other student groups reported elsewhere. It suggests that the disparate nature of the student group geographically and professionally, the novelty of being the first ‘pharmacist supplementary prescribers’, the innovative programme content and delivery, and returning to learning after a significant period in practice, all contributed to a high level of perceived need for support. The way the discussion board was used to share examples of practice between different practice bases was exemplar and should be adopted more widely for disseminating practice amongst professionals.

Research #18
Pharmacist Intervention in Risk Reduction – A Comparative Trial of In-Depth Versus Conventional CPE
Marci Quesnel, Semchuk, William1, PharmD, Deschamps, Michelle2, MSc, Taylor, Jeff2, PhD, Sulz, Linda1, PharmD, Tsuyuki, Ross3, PharmD, MSc (1Regina Health District, Regina, SK , 2University of Saskatchewan, Saskatoon, SK, 3University of Alberta, Edmonton, SK)

Purpose: To assess the effect of in-depth training versus conventional training on pharmacist-suggested implementation of risk reduction efforts in community practice.

Methods: Sixty-one volunteer pharmacists from 40 pharmacies were randomized to one of two educational groups: six hours of in-depth training (Group I) in cardiac risk reduction (case-based tools, standardized patient actors, multiple follow-ups) OR two hours of conventional CE training (Group C). Patients at high risk for CAD events were identified and approached to participate by study pharmacists. After interviewing the patient, pharmacists completed a physician referral form, containing information on CAD risk factors, medication history and any recommendations to maximize cardiovascular risk reduction. Patients then made an appointment with his/her primary care physician for further assessment if warranted. Follow-up occurred at 4, 16, and 24 weeks to determine if any pharmacist-suggested risk reduction measures had been implemented. Pharmacists were reimbursed $30 per patient accrued.

Results: 217 patients were enrolled in the study with 216 patients having follow-up data available. A significantly higher proportion of patients in the in-depth group had a new risk reduction therapy instituted or a dose enhancement of an existing therapy compared to the conventionally trained group (76/119 vs 49/97, p = 0.04). No significant differences were observed between Groups I versus C with respect to mean number of patients enrolled per pharmacist (4.3 vs 2.7), proportion of pharmacists completing at least one patient (17/27 vs 14/34) or recommendation acceptance rate (35.3% vs 26.1%). Feedback from pharmacists on program delivery showed no significant differences in satisfaction with the training provided.

Conclusions: In-depth continuing education for pharmacist was more likely to result in improvements in cardiovascular risk reduction therapy than conventional training.

This study was funded by an unrestricted research grant from Aventis Pharma and the Canadian Foundation for Pharmacy.

Poster #1
The CPD Process - Integrating it into the Undergraduate Pharmacy Curriculum at the University of Manchester
Jennifer Archer
, Judy Rees, University of Manchester, Manchester, UK

Continuing professional development (CPD) has been around for well over twenty years and is being used by a variety of professionals, practitioners and individuals as a way of progressing, updating and recording their learning. Therefore, it is not a new concept for many, but for pharmacists in the United Kingdom it is becoming a requirement to be ‘fit for practice’ and legislation is being put in place to make it mandatory. Whilst CPD was seen as preferable and desirable, it has to date been on a ‘voluntary’ basis. A structured approach to learning was supported by pharmacists when the Royal Pharmaceutical Society of GB sought their views in a consultation document Pharmacy in the Future1 in 1996. Since then the Government has taken the view that CPD should be mandatory, following recommendations in the Kennedy report2 and others.

In 2002 the University of Manchester School of Pharmacy and Pharmaceutical Sciences introduced the process of reflection 3,4 as part of an existing 2nd year ‘self directed recognized’ assignment. Appropriate learning and support materials were prepared and implemented and an evaluation undertaken in two consecutive years. Undergraduates recognized the benefits but were reluctant to write down and keep records. When it became apparent that CPD was going to be so important for the pharmacy profession, the School took the very positive approach of integrating the CPD process into parts of the undergraduate curriculum to ensure its graduates will be prepared for their future day-to-day practice.

Currently we are in the third year of the scheme. Feedback from the undergraduates is ongoing and evaluation tools for skills development have been developed. Feedback from academics will be introduced since this approach to teaching may present challenges as undergraduates commence modules with their individual learning needs already identified.

Poster #2
Integrated Pharmaceutics Education with Integral Development Of Life-Long Learning Skills.
Denise Hansford
, Senior Lecturer in Pharmaceutics, School of Pharmacy, the Robert Gordon University, Aberdeen, UK

Background: In this UK School of Pharmacy there was concern that students’ perceptions seemed to be that pharmaceutics was only of interest or relevance to those, very few, planning an industrial career. Similarly they did not seem to make a clear correlation between extemporaneous dispensing of medicines and pharmaceutical formulation. Audit demonstrated that many did not undertake directed study tasks which were advised. However pharmacy graduates will require life-long learning skills which should be instilled at undergraduate level.

Key Components of new program: Major revision of modules to show relevance to practice, vertical integration between Pharmaceutics modules, and horizontal integration with Pharmacy Practice modules has been undertaken. An example of vertical integration is the production and characterization of granulations by a student group in one module and the subsequent use of those powders by the group to make tablets and test them for quality within a second module. An example of horizontal integration would be the student being given a prescription, for a product normally compounded, to identify legal and practical requirements for dispensing within a Pharmacy Practice module. The prescription would then be transferred to the concurrent Pharmaceutics module for the manufacture and final dispensing of the product. Formulation and extemporaneous dispensing have been incorporated into a double module with integral directed study required to be undertaken and checked before each coursework session.

Evaluation: The results of two questionnaires will be presented. One will investigate the perceptions of the new integrated modules held by 2nd year students and their understanding of the relevance of module contents to their practice and on their development as life-long learners. The results will be compared with those from a similar questionnaire study of the views and perceptions of 3rd year students who have experienced the previous non-integrated approach.

Poster #3
Developing a Training Program for Preceptors
Guylaine Bertrand
, Marie-France Beauchesne, Marie-Claude Binette, Marie Dubois, Gilles Leclerc, Louise Mallet, professor, Claude Mailhot, Faculty of Pharmacy, Université de Montréal, Québec, Canada

Objective: To develop solid teaching partnership with community and hospital pharmacists through education support program.

Summary: In 1996, two 7 week clerkships became mandatory in our undergraduate program : one in the community setting and one in the hospital setting. In addition to supervision responsibilities, evaluation was delegated to preceptors. This led to the establishment of a preceptorship training program. Our training program based on self-learning and active pedagogy principles allows preceptors to understand all aspects needed for efficient student supervision and evaluation during clerkships. The program includes core courses and re-certification courses and is mandatory to obtain the faculty title: “Clinical Associates”. Core courses include the following topics: 1) pharmaceutical care process; 2) clerkship evaluation and feedback; 3) communication skills and difficult situations resolution. Re-certification program includes 1) Literature search; 2) Literature critical analysis; 3) Documenting the interventions. These courses are part of a 30 credits graduate program entitled: “pharmacien maître de stage”. A variety of adult learning techniques are being used: lectures, interactive workshops and e-education.

Since 1996, we have trained 626 preceptors: 232 from community and 394 from hospital setting. Courses have been evaluated regularly and it provided us feedback from our preceptors. Globally, our training program has been highly appreciated by preceptors. It specifically gave them a better understanding of pharmaceutical care practical applications, evaluation tools and student feedback. Preceptors felt more comfortable in their role after completing these courses. Our program has constantly evolved to better meet their needs.

Poster #4
Educational Theory Applied to Documentation of Observation of Students during Rotations
Andrea Cameron
, SPEP Coordinator – Appraisal and Quality Assurance; Lesley Lavack, Assistant Dean Undergraduate Affairs; Annie Lee, SPEP Coordinator; Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada.

Educational principles, theory and research are examined to support a direct observation, feedback and documentation tool used in experiential final year, baccalaureate pharmacy rotations. The tool effectively captures feedback and areas for improvement in practice based learners. The types and relative frequency of comments are summarized and reviewed.

The tool (Observation Record (OBS)) facilitates daily feedback to students from preceptors. These pocket-sized records assist in developing an evidence-based bi-weekly assessment and final evaluation.

Documented observations, rather than memory, enhance accuracy; a structured form supports consistent and balanced feedback. Beck (1995) confirms the rationale for records. Miller’s (1990) ‘framework for clinical assessment’ suggests rotations need assessment methods that can infer whether the student ‘does’ and can ‘show how’. Observation-based ratings are used to capture what the student ‘does’.

Using a coding system adapted from Salerno (J Gen Intern Med 2003), types and frequency of comments were examined from a random sample of 24 sets of OBS from community I and institutional (I) sites. Most of the 742 comments were specific (84% in C, and 86% in I) and positive (64% in both). Formative feedback related to skills (67% C, 60% I), knowledge (25% C, 30% I), and attitudes (6% C, 10% I). Average OBS ratings (scale 1 to 7) were 5.1 for C and 5.3 for I rotations.

The OBS has enabled consistent formative evaluation across practice settings. Learners can expect balanced feedback based on observed behaviours, leading to specific suggestions for improvement and positive reinforcement. The preceptor has documentation to justify subsequent evaluations. This practical technique can be applied to uni – and inter-professional practice settings.The OBS, an efficient means of providing guidance to junior colleagues and students, consistent with educational principles relevant to practice – based learning, can be used as a component in life long learning endeavors.

Poster #5
A Regional Approach to CPD Facilitation in NHS Hospitals (UK)
Lyn Hanning
, Senior Pharmacist, Education and Training; Adele Jones, Former regional CPD pharmacist; South West Medicines Information and Training, Bristol, UK

This poster describes a regional approach to CPD facilitation in the South West of the UK. A baseline mapping exercise was conducted to examine CPD practice by hospital pharmacy staff in 19 Trusts in 2002.This survey showed a variation in uptake of CPD practices across the region. Responders felt that there were many barriers to successful implementation which included time, motivation and understanding. It was suggested that regional support, protected time and effective facilitation would be beneficial.

Following this initial scoping exercise a number of measures were implemented. A working group was formed and funding secured to make a regional appointment to support CPD. A project plan was developed:
• Appointment of regional CPD pharmacist supported by the working group
• Development of regional resources (including a website and discussion board)
• Identification and regular training of CPD facilitators
• Development of the local CPD facilitator role
• Formation of local review groups supported by the regional CPD pharmacist

Two years after the initiation of the project an evaluation was conducted. The key findings are summarised:

• All Trusts had a trained CPD facilitator (with 10 having more than one).
• 45% of all the pharmacists in the region had made at least one CPD entry on-line.
• 71% of Pre-registration tutors in the region had submitted records for review.
• All responders wished to see regional CPD support continue.

This regional approach has allowed pharmacy staff in the NHS hospital Trusts in the South West region of the UK to develop their understanding of the CPD process. Significant numbers of pharmacists and associated staff have engaged in the process and continue to do so.

Poster #6
CPD – A Coordinated Approach to Supporting Community Pharmacists
Adele Jones
, CPPE Tutor for Gloucestershire, UK.

The Royal Pharmaceutical Society of Great Britain (RPSGB) will make the recording of CPD mandatory for pharmacists from July 2005. Pharmacists in the UK are used to undertaking CPD, but not to recording it. A new recording tool (Plan &Record) has already been rolled out across the country. In some hospitals and large multiple community chains, facilitators have been introduced to help colleagues understand the CPD cycle and record their CPD appropriately. Community pharmacists who work in small outlets or on their own find this support is not readily available.

The Centre for Pharmacy Postgraduate Education (CPPE) is a UK organisation employing 97 tutors to deliver postgraduate workshops to pharmacists .The tutors are also charged with arranging appropriate support for community pharmacists undertaking and recording CPD.
The poster will describe how CPPE used a coordinated centralised approach to identify those pharmacists wanting extra support. It also describes how tutors successfully used a variety of approaches to help pharmacists.

When each pharmacist in the UK received their copy of the Plan&Record documentation they also received a card addressed to the main CPPE office. This card requested help from their CPPE tutor. Tutors were informed of the pharmacists in their area who wanted extra support. It was then up to the tutor to decide on the best way to facilitate.

The poster will describe the variety of learning approaches used by the tutors and how they were evaluated by the participants. It will be of interest to anybody planning to support pharmacists undertaking CPD and shows how a coordinated centralised approach does not necessarily mean choice of learning approach is limited.

Poster #7
Continuing Professional Development Portfolios and Reflective Practice in Health Professionals.
Andrzej Kostrzewski
, Guy’s & St.Thomas’ Hospital NHS Trust; Soraya Dhillon, School of Pharmacy, University of Hertfordshire; Goodsman D., Royal College of Surgeons(England); UK

Introduction: The National Health Service has adopted the use of a portfolio as a record of professional practice within the context of Continuing Professional Development (CPD). Portfolios are used to enhance and foster (Wade RC and Yarbrough DB, 1996) reflection. Little information is available on the long term influences of portfolios on professional practice and there is no data in pharmacy. Reflection is a key element in practice but again there is no data in pharmacy practice.

Aim and Objectives: To investigate how the use of CPD portfolios affect and influence practice.
• Explore NHS health professionals views of using a portfolio.
• Examine the meanings and roles of reflective practice within the context of CPD.

Methodology and Methods: A qualitative survey methodology was adopted. A comprehensive literature review combined with face-to-face semi-structured interviews was conducted. A purposive sample was chosen using Allied Health Profession’s, nurses, doctors and pharmacists in one acute teaching hospital Trust. All interviews were tapped. Ethical approval and participant consent were obtained.

Results: 23 intervews were undertaken, transcribed and thematically aanalysed. Respondents aged from 22 to 56 years, mean of 33(+ 8.4) years.

Conclusion: A technical rationalist approach to recording practice was found. Practitioners found it difficult to verbalise what effect keeping a portfolio had on practice.

Poster #8
Seeking Solutions from Manitoba Pharmacists on a Learning Portfolio System
Susan Lessard-Friesen
, Assistant Registrar, The Manitoba Pharmaceutical Association; Shawn Bugden, Executive Director, Prescription Information Services of Manitoba; Penny Murray, Manager Long Term Care Pharmacy Program, Personal Care Home Program, Winnipeg Regional Health Authority; The MPhA Professional Development Committee; Winnipeg, Canada

Introduced in April of 2002, the MPhA Learning Portfolio System was developed in response to the Professional Development Committee’s (PDC’s) desire to find an effective tool to assist pharmacists to plan, document and reflect on learning activities. Early in 2004, a petition was received by the MPhA, which called for a provincial meeting where a majority of pharmacists present were in support of discontinuing the system. The MPhA Council considered these results, the use of learning portfolios in other jurisdictions and professions, and the literature in support of these systems prior to reaching a decision to direct the PDC to seek input from the membership for revision to the system.

Through this poster, the PDC will present strategies employed to gain pharmacists’ feedback, issues affecting the acceptance of a learning portfolio system and various communication vehicles used to facilitate the introduction of a new system. A consultant was employed to guide the process of identifying and addressing issues. At the Annual Conference (April 2004), a “ PD Issues Forum” was held to gather input, opinion and advice. Issues brought forward formed the basis of a membership survey (n = 1084) in June 2004. A total of 261 completed survey responses were received. Issues and areas of concern identified included:
• Documentation;
• Learning projects;
• Guidelines and requirements (clarity, transparency, minimum requirements);
• The peer review process (require standardization).

Based on survey results, the PDC undertook a facilitated session to identify solutions. The following recommendations for communication and revision were adopted in November 2004:
• Communication on rationale of legislated PD requirements;
• Documentation simplified through revision of forms and by making learning projects optional;
• Requirements standardized (mandatory 25 hours each year of which 15 hours are accredited);
• Random review conducted by administration;
• Enhanced communication of revisions.

Poster #9
Should Individuals be Accredited as a Means of Demonstrating Competence?
Laura O’Loan
, Annual Programme Manager & Training Specialist, London Pharmacy Education & Training, London, England

Introduction: Since the introduction of clinical governance in the UK in 1998, healthcare professionals are increasingly required to demonstrate that they are competent in their area of practice. In the pharmacy profession, a popular method of assessing competence is by accrediting individuals to enable them to undertake certain activities.

Aim: To elicit the views of Chief Pharmacists in NHS organizations in a geographical area of England (London, Hertfordshire and Essex) on accrediting individuals to undertake certain activities as a means of demonstrating competence.

Method: Self-completion questionnaires were given out at the 2003 Annual Chief Pharmacists’ Meeting (attended by 69% of Chief Pharmacists in London, Hertfordshire and Essex). Those present were asked if they would be prepared to explore the issues further by face to face interview at a later date.

Results: Seventy nine of the 81 Chief Pharmacists (98%) completed their questionnaires (representing 68% of Chief Pharmacists in London, Hertfordshire and Essex).
Thirty four (43%) volunteered to be interviewed, and four were selected based on their place of work and geographical location. In addition to the four interviews, comments were received by email from six of the remaining 30 volunteers who were not interviewed.
Respondents supported accrediting individuals, particularly in high risk areas and extended roles. There was no consensus on which staff groups should be accredited. Respondents expressed concern about how to balance what was idealistic with what was realistic in practice. Some indicated they would like to explore other methods of assessing competence.
Conclusion: Further consideration needs to be given to appropriate methods of assessing competence in practice.

Poster #10
Understanding Mandatory CPD in the UK
Kanta Patel
, Morden, UK

Poster #11
The Portuguese Pharmacy Degrees Accreditation Process
Fernando Ramos
, Vice-President; José Aranda da Silva, President; Tania Saraiva, Professional Secretary of the National Board; Ivana Silva, Professional Secretary of the National Board; Portuguese Pharmaceutical Society Lisboa, Portugal

The new statute of the Portuguese Pharmaceutical Society (PPS), officially approved by Decree-Law 288/2001 (November 2001), has established a mandatory registration examination to become a licensed pharmacist. It also establishes a professional accreditation process of university degrees in Pharmaceutical Sciences, performed by the PPS according to criteria specified in its Admission Internal Rules. Students graduating from an accredited degree will be exempt from the registration examination.

Hence, faced by an explosion of new pharmacy degrees and consequently a potential for a range of heterogeneous curricula, the PPS decided to implement a new admissions process in order to:
• Establish a comparable baseline for all its future members;
• Promote collaboration among academics, students and professionals in developing a dynamic, challenging and comprehensive curriculum for the future pharmacists.

Despite some constraints throughout the discussions, a consensus was reached, with schools of pharmacy being not only compliant with the professional accreditation process carried out by the PPS, but also committed to initiate it in May 2003. In accordance with this the process was initiated in the academic year 2003/04 and five faculties (out of seven) have applied for accreditation of their study programmes. Accreditation guidelines were distributed in the end of May 2003, self-evaluation studies were submitted in October 2003, on site visits were carried out in March 2004 and accreditation results became public in July 2004.

In June 2005, one of the two faculties that could not apply for accreditation in 2003 will be completing its process.

The accreditation will be periodical, once every six years, on a voluntary basis, and based on a self-evaluation report.

Poster #12
A Review of an Accredited Checking Technician (ACT) Scheme within NHS Organizations
Diane Blunden
, Pharmacy Technician Training Manager, London, England.

The ACT Scheme commenced in 1997 and has only undergone minor revisions. Changes within the NHS Pharmacy meant a complete review was necessary. There are current National Guidelines for the ACT Scheme and all revisions must adhere to these. This ensures that the ACT Scheme maintains strict controls whilst still continuing to meet the growing needs of the workplace.

A review group was convened and this consisted of senior pharmacy staff and ACT Facilitators. The ACT Scheme was completely reviewed and the guidelines were amended. All amendments were presented to a meeting of Chief Pharmacists and all were approved.

The result of the review gave the opportunity to produce all the documentation into one professionally printed booklet. A complete mailing ensured that the ACT Candidates and the ACT Facilitators would all be aware of the amendments and the new recording paperwork to be used (copies were also sent to all Dispensary Managers and Chief Pharmacists for information). A change over period was allocated to ensure that all staff had a chance to read the new ACT Booklet before implementing the changes and paperwork within their department. The ACT Booklet also contained all the templates of the recording checking logs and nomination forms. New suggested progress paperwork encouraging regular meetings between Candidate and Facilitator was introduced. This is to promote and encourage reflection in Continuing Professional Development.

Discussions from senior and other pharmacy staff have praised the new ACT Booklet by consolidating all the paperwork to complete the ACT Scheme into one booklet and to ensure that the ACT Scheme continued to meet the need of the workplace.

Poster #13
Retrospective Methods Of Measuring Practice Change of Pharmacists in Continuing Education
Certina Ho,
Drug Information Pharmacist Sandra Winkelbauer, Director of Education; Drug Information and Research Centre, Ontario Pharmacists’ Association, Don Mills, Canada

The three-day Patient Care Certificate Programs organized by the Ontario Pharmacists’ Association (OPA) are highly recognized in the pharmacy profession, particularly for the depth and extent of information covered and knowledge transferred to actual practice. The current structure of these programs employs a multifaceted approach in providing Continuing Professional Development (CPD) to practicing pharmacists. Teaching and learning strategies that may lead to a potential outcome of increasing competence and clinical performance of participating pharmacists are incorporated. Consequently, it is worthwhile to explore the effect of these programs on practice changes of the participants. Since learning and change may depend on available resources and enabling factors, which include individual differences in learning progress, identification of barriers to change, and readiness to change, it is important to examine the rationale for change or lack of changes so that future programs can be better prepared based on these results.

In order to examine pharmacists’ learning and behavioural change in CPD, we conducted a follow-up mailed survey to study the degree and nature of practice changes of participants of selected OPA Patient Care Certificate Programs and the reasons for self-reported changes or lack of changes. Since we did not collect any data prior to the program, the only way to measure change is to use a retrospective recall approach.

As the use of retrospective methods is becoming more popular in the evaluation field due to their high practicality and advantage of avoiding biases introduced by pretests, the effectiveness of two retrospective self-reporting methods, the perceived change and post + retrospective pretest methods, was compared in this study. Literature on the evaluation of continuing education for pharmacists is very limited. Findings from this study should encourage future evaluative studies in the field of CPD and contribute to the literature on retrospective methods of measuring change.

Poster #14
Interactive Tutorial To Help Pharmacists Better Utilize Drug Information Resources On The Internet
Certina Ho
, Drug Information Pharmacist; Sandra Winkelbauer, Director of Education; Drug Information and Research Centre, Ontario Pharmacists’ Association, Don Mills, Canada

The Drug Information and Research Centre (DIRC) receives over 70,000 drug information (DI) requests annually. It has a wide range of resources to support its services, of which, Internet references play a significant role. As more pharmacies become equipped with Internet access, pharmacists have the potential to better utilize Internet resources for patient care in their clinical practice.

The Ontario Pharmacists’ Association (OPA), in collaboration with DIRC, has developed a continuing education (CE) program for pharmacists on utilizing Internet DI resources. The program consists of four key components – the basics of using and searching the Internet; web sites pertaining to pharmacy practice; criteria for evaluating web sites; and techniques to answer DI requests using Internet resources.

The two-hour OPA Internet Drug Information CE program is composed of a 75-minute didactic lecture, followed by 45 minutes of practice exercises, either with live online demonstration by the presenters, or hands-on activities by the participants, depending on the facilities available. It has been delivered to over 300 pharmacists across Ontario. Of the 278 evaluations received, 97% of the participants either strongly agreed or agreed that the content was appropriate and easy to understand; 95% found that the length and format of the program were appropriate; and 99% highly rated the visual aids and handouts.

The statistical summary of highly rated evaluations collected from participants has demonstrated the relevance and recognition of this program to continuing professional development (CPD) for pharmacists. In essence, the program provides tools to enhance pharmacy practice and patient care by increasing awareness and utilization of appropriate worldwide Internet resources. Since this interactive CE program was well received, such an approach may be applicable to similar educational events for CPD in Canada and other countries.

Poster #15
Development of Print-Based Home Study Program on the Cold Chain Management of Vaccines
Janice Moshenko
, Sheryl Peterson; Continuing Pharmacy Professional Development, University of British Columbia, Vancouver, Canada

Background: It has been generally accepted that there is a learning gap among health care professionals who manage and administer refrigerated vaccines. A lack of adherence of the cold chain may result in potential lack of effectiveness of the vaccine, undue vaccine failures and an increase rate of local reactions. To ensure that pharmacists better protect and preserve the “cold chain” and contribute to improved efficacy and fewer adverse outcomes within vaccination programs, a home study program was developed to enhance pharmacists’ knowledge, awareness and understanding of the importance of the cold chain management of vaccines.

Description of the home study program: This lesson will review the importance of vaccines, current practices, measures and interventions to preserving the cold chain, packaging and shipping of vaccines, and how pharmacists can apply these strategies, safeguarding these most fragile and valuable products. A case study is available to illustrate how cold chain maintenance can be integrated into the pharmaceutical care approach towards optimizing clients’ goals and outcomes.

Assessment and Evaluation: The program includes a series of multiple-choice questions for formal assessment of knowledge acquisition. A separate evaluation form will allow for participant feedback on content and format of the program. The program was submitted to CCCEP for accreditation.

Impact: Cold chain maintenance is a continuous and cohesive practice of preserving vaccines to maintain their effectiveness and ensure their availability. This program will serve to educate pharmacists about the multi-factorial influences on the cold chain concept and, in turn, their influence on the health outcomes of vaccination programs.

Poster #16
Streaming Media Delivery of CPD Presentations via the Internet
Janice Moshenko
, Sheryl Peterson; Continuing Pharmacy Professional Development, University of British Columbia, Vancouver, Canada

The geography of British Columbia poses a challenge to the delivery of continuing professional development (CPD) programs to all BC pharmacists. To address the need for professional educational programs in several smaller BC communities, program providers must maximize their use of limited resources.
To achieve this goal, three UBC Continuing Pharmacy Professional Development conferences were designed, developed and delivered “live” in the Vancouver, BC location. Although successful, each conference reached an audience of less than 180 pharmacists. In order to reach a larger audience outside the Greater Vancouver area, each of the conferences’ multimedia presentations were digitally recorded in “real time” and later converted into viewer-friendly, streaming web lectures using innovative technology.

These presentations, which may be accessed on the UBC Continuing Pharmacy Professional Development website, are now available to BC pharmacists as a pilot project, with the objective of determining the level of interest in, and the perceived value to, this form of distance learning.

Based on the feedback received to date, this learning format has been very well received.

Poster #17
E-Learning: Finding Its Way Through
Tina Schilling Hansen
, Head of The Department of Education of Pharmaconomists; Kirsten Holme Christensen, Project Coordinator; Danish College of Pharmacy Practice, Hillerød, Denmark

The poster will describe the progress of e-learning at Pharmakon in terms of activities, purpose, pedagogics and organisation. It will describe the progress right from the limited, rather coincidental, start until now, where the provision of e-learning activities has grown in kind and numbers, adapted to the participants and to pharmacy practice, implemented, evaluated, widely used and seen as an integral concept.

The e-learning activities, all developed at Pharmakon, covered in the poster are
• Homepage for pharmaconomist students with access to distance learning materials in the practice periods (exercises: quizzes, chat/discussion etc.), e-learning programmes (texts, cases with feedback, videos, exercises: quizzes with feedback), project forum, mail, educational materials etc.
• E-learning programmes (web-based training), primarily for pharmaconomists, used as on-the-job training or as part of a continuing education course
• Read-train-learn programmes: online material for individual training or presentations for the pharmacy staff (e-learning programmes (quizzes and cases with feedback) combined with PowerPoint presentations with presenters’ notes and specification of relevant literature and links)
• Postgraduate course in case based pharmacotherapy.

After studying the poster, you will be inspired to find your own way of e-learning:
• the importance of a purpose that considers several – if not all – interests among students, supervisors at the pharmacy, teachers at the school etc.
• the must of a pedagogics that relates to e-learning
• the necessity of e-learning being supported by it strategies in the pharmacy sector
• the importance of interdisciplinary teamwork in a comparatively small organisation working with e-learning
• the fact that e-learning does not have to encounter large numbers of participants to be successful
• the way in which e-learning can be integrated in both basic and continuing education and be perceived as a supplement to other activities.

Poster #18
Developing Educational Materials To Support Accreditation In Paediatric Pharmaceutical Care
Arlene Brailey,
Anne Watson, Ailsa Power, Rose Marie Parr, Assistant Director of Pharmacy, NHS Education for Scotland (NES), Glasgow, UK

Work produced in collaboration with the Scottish Neonatal and Paediatric Pharmacists (SNAPP) Group

The pharmaceutical care of children presents a number of challenges. Children are not “little adults” and should not be treated as such. Their bodies handle medicines differently to adults and the response of young children differs from older ones. In addition, many of the medicines that are given to children are unlicensed for this use or are used outside their license (off label use). The evidence suggests that medication safety needs to be improved, particularly in babies and young children. For this reason, the introduction of an accreditation scheme for all pharmacists working with paediatric patients in Scotland is now one of the goals of ‘The Right Medicine: A Strategy for Pharmaceutical Care in Scotland’ (2002).

This poster aims to outline the development process of the distance learning package designed to provide the underpinning knowledge base to fulfill such an accreditation scheme. This course simultaneously aims to meet the education and training needs of all pharmacists who deliver services to children and their parents/carers, as well as other health professionals who require to have a broad knowledge of the use of medicines in children.

What makes this package unique, is that it is the product of collaborative work between NES Pharmacy, the national provider of post qualification education and training in Scotland, and paediatric pharmacists not just in Scotland but throughout Great Britain.

The package contains a number of novel features. A separate printed workbook repeats the exercises and case studies, provides space for the learner to write responses and contains model answers.

A CD-ROM is also enclosed which contains an electronic copy of the workbook ( to allow online submission for accreditation at a later stage), incorporates pdfs of documents and links to quoted websites.

Poster #19
End-of-life Care and Palliative Care Team – A Quantitative and Qualitative Evaluation
Karen Barber, Program Director, Continuing Physical Therapy Education; Shannan Neubauer, Assistant Professor of Pharmacy, College of Pharmacy and Nutrition; University of Saskatchewan, Saskatoon, Canada

Background: Parkridge Centre is a long-term care facility based in Saskatoon, SK which provides care to adults and children requiring residential level 3 & 4 care. In addition to the general nursing staff, a variety of health care team members work at Parkridge, many of whom form the Centre’s Palliative Care Team. This group of professions is an on-site resource to staff who care for residents nearing end-of-life. The philosophy of the Palliative Care Team is that this team extends to include all professional and non-professional staff who care for the residents, however, few of the non-professional staff have had the opportunity to attend palliative care educational programs. “Caring for dying persons requires skill in interpersonal aspects of care, which may be difficult to teach using conventional educational methods”1. The Pulitzer Prize-winning play Wit will be used as part of an on-site workshop to facilitate discussion around the team approach to care.

Methods: Participants: Parkridge administration will encourage the participation of nursing staff (RN, RPN, LPN, and resident attendants) from each Parkridge neighbourhood to attend the workshop. In addition, the therapies staff, housekeeping and food services staff as well as interprofessional education students from Parkridge will attend. Workshop: A one-day workshop, including keynote speaker, a panel presentation, viewing the film version of Wit and facilitated discussion regarding the benefits of a team approach to client-centred care will be held in March 2005. Assessment / Evaluation: Evaluation of the workshop will include a questionnaire (quantitative) as well as an exploration of important themes derived from the discussion groups (qualitative). Discussion groups will be audiotaped.
Analysis of the data will occur in March-April 2005 and will be available for report at the LLL Conference in June.