Guest blog written by Rajkaran Singh Dhaliwal
My first day as a pre-reg was one that helped to establish the tone for the rest of the year. Although the year has been incredibly tough in terms of balancing full time work, studying and having a social life, it has also been an incredibly rewarding experience. In this article, I recall some of the most important aspects of my pre-registration year and how they made an impact on my personal and professional development.
My first few weeks as a pre-reg were spent getting to grips with dispensary processes, as well as learning about the unusual quirks of the pharmacy’s PMR system. Although these may have seemed like basic tasks at the time, spending the time to fully understand the dispensary and its processes in the early weeks was invaluable when I took on more responsibility later on in the year, as I was able to efficiently resolve queries. In terms of revision outside of work, I took the time to thoroughly prepare for my study days through the completion of workbooks and starting a medicines counter assistant course to refresh my OTC knowledge. Due to the fact that I was still in the early stages of the pre-registration year, I made sure that I found a balance between avoiding burning myself out when it comes to full-on revision in the run-up to the registration exam, but also doing enough so that I got used to studying in the evenings after work. I found this approach useful, especially from April onwards as I was no longer fazed about having to revise after a full day of work since I had practised this from the outset.
In my first few weeks, I was also given a list of patients for whom I would be assembling medicines compliance aids (or ‘dossette’ boxes). For all of these patients, it was my responsibility to order their prescriptions in a timely manner, calling them to see if there have been any changes to their medication and dispensing the prescriptions when they arrived. This experience was incredibly beneficial as I was given full responsibility to resolve any queries for these patients and to make sure that their boxes were available in a timely manner. This was a great opportunity to demonstrate some of the 76 performance standards that pre-regs need to achieve during their pre-registration year. Furthermore, it allowed me to develop relationships with my dossette patients as I was regularly in contact with them, which helped me to deliver patient-centred care.
Face-to-Face Patient Contact
During the initial stages of my pre-registration training, I realised that one of the best ways to prepare for the registration assessment is by taking the opportunities to talk to patients. At the start of the year, I was apprehensive about talking to patients since my knowledge was not yet at the level they may expect. I was afraid I may say the wrong thing, or that the patient may think that I was not knowledgeable, which would be embarrassing. However, such encounters helped to increase my own knowledge throughout the year. Even though I may not have known the answer, offering to look it up was not only helpful but also helped me to identify new areas which I could look further into later on. Throughout the year, I also found that talking to patients about their medicines helped me to apply and revise the knowledge I had gained through private study and study days. One particular example is when a patient came in, asking for advice about some spots on their head. They had been prescribed some diclofenac gel for this, but wanted more advice about their condition. Since I didn’t know the answer, I offered to research the answer while the patient waited in the pharmacy. I found out that diclofenac gel was used for solar keratosis using the BNF. I then used NHS choices to briefly read about the condition, allowing me to respond to the query. Although I didn’t know the answer, the patient was happy that I offered to research it for them.
I was encouraged by my tutor to apply for cross-sector experience in the local hospitals. This is a two-week placement designed to give pre-regs from different sectors a taste of hospital pharmacy. I found this incredibly useful since it allowed me to network with other community pre-regs and hospital pre-regs. It also gave me an insight into how varied pharmacy practice can be, as the role of a hospital pharmacist is incredibly different to that of a community pharmacy. Throughout the two weeks, myself and another community pre-reg spent the two weeks rotating through different wards across two hospitals in Leicester. This was an incredible experience since we got to see a wide range of clinical areas and experience the role of a hospital pharmacist, ranging from cancer to the paediatric intensive care unit (which was my favourite by the way!). Furthermore, throughout the two-week placement, I had gained some invaluable clinical knowledge which was highly relevant to the pre-registration assessment, as all the hospital pharmacists were helpful and were always asking questions to help develop our clinical knowledge.
Revision for pre-reg exam
After Christmas, I stepped up my revision, focusing on the BNF, MEP and OTC medicines. I also made sure other areas of the registration assessment framework published by the GPhC were covered in good time, including low priority areas. I made sure that I wasn’t over-reliant on the BNF for my clinical knowledge, since my tutor and recently qualified pharmacists advised me that the exam is about application of knowledge. Therefore, I tried to incorporate this into my pre-registration year by taking the opportunity to answer clinical questions from patients. My clinical knowledge was further supplemented through the attendance of seminars and meetings that were held in the evenings throughout the pre-registration year. Even though these events were tailored towards doctors and qualified pharmacists, I found that I retained a lot more information from these events than from just sitting in my room revising notes over and over again. One particular event I had attended was based on the treatment of atrial fibrillation (AF) and heart failure patients held just 3 weeks before the registration assessment. Since these were clinical areas that I had struggled with, I chose to accompany my tutor to this event. At the end of it, I had felt like I had a very thorough understanding about the treatment of AF and heart failure, especially with regards to doses and treatment considerations of the newer anticoagulants. Experiential learning in this manner throughout the year helped me to understand the clinical aspect of the registration assessment in a much deeper way, compared to just rewriting notes over and over again.
Reflecting on the past year, I feel grateful for the wide variety of people that I have come across and helped me to get through the year. Firstly, my tutor was incredibly supportive and was willing to listen to any concerns and questions I had. Also, he had arranged for me to sit in with local GPs in order to allow me to appreciate the holistic care that patients with complex conditions require. Meeting a lot of different pharmacists has allowed me to ask questions about their experiences, and each one has helped me along the way, whether it be words of encouragement or even sharing anecdotes from their vast experience. Furthermore, other staff members such as counter assistants and dispensers have helped me to develop my professional skills, as each member has a different skill set, and so have all contributed to my development in various ways. Learning from a wide variety of individuals throughout the pre-registration year has expanded my skill-set in ways I never thought imaginable, and I wish to thank everyone for their contribution. Meeting a lot of new people has also helped me to develop my people skills, illustrating that the pre-registration year is not only about professional development, but also personal development.