Self-assessment tools have been explored as a vehicle to compare how an individual practitioner compares to accepted professional standards as well as exploring how practitioner knowledge is applied, compared to their peers. The literature suggests that such tools have not been reliably validated in areas of practice where their use has been reported. Analysis of variance in this study for self-assessment scores did not find any association with the participating pharmacists’ assessment of their own performance. However, the nature of a CPD cycle with an emphasis on reflection does require pharmacists to determine what their needs are ― an interesting proposition if some of the literature is reporting that they may not be good judges of what areas they should update on to improve their own practice. The question is, do pharmacists decide on their CPD needs purely on the basis of a perceived deficit of knowledge rather than improving their ability to apply knowledge and clinical interpretation along with a quality use of medicines perspective. How do they know what they don’t know? A more pragmatic conclusion would be that pharmacists consider cost, time and ease of access to education as well as what is on offer by educational providers such as PSA and SHPA to be the drivers in their decision-making for their professional education.
Self-assessment tools need to be used in association with other CPD activities e.g. case history discussion, self-audit, peer collaboration and discussion as well as the traditional lectures and multiple- choice assessments. In this context, pharmacists need to be aware of what a self-assessment will provide for them in CPD and what their limitations are. The self-assessment tools in this study were not used to the full extent that they were designed for. The amount of time taken by participants to complete these
understand how they can be used, provided they are validated first. Pharmacists need to understand that self-assessments are a dimension of self-reflection but not an endpoint of competency to practise. Registering bodies need to recognise that there may be a difference between a pharmacists’ choice of CPD and that it may not always be the area that needs to be addressed to improve their competency in all areas.
Over the timeframe of this work pharmacists have accepted that the approach to pharmacy practice assessment needs to change, as evidenced by the feedback from the participating pharmacists in this study. Self-assessment and reflection on practice is only a recent activity that has gained a wider acceptance with the introduction of the CPD approach, competency audits by the Pharmacy Board of Tasmania and the introduction and implementation of the CPD and PI Program by the PSA. Efforts to develop a competency assessment tool and a self-assessment tool have demonstrated that the intent of the instruments and their validity is a more complex process than using a small sample of pharmacists to trial a sample assessment. The second competency assessment model with knowledge and practice approach questions is one that could be explored further. However, the content of this type of model needs better scoping to provide a greater depth of material.
The final self-assessment model was well received by participating pharmacists, but needs greater clarity of purpose for wider implementation. Based on published literature, models of self-assessment need to be part of a wider set of evaluation instruments to give pharmacists feedback for practice validation. Ideally, self-assessment tools could be used in the intermediate steps of a learning process in a CPD activity. When complete, the self-assessment tool could be directly compared to the work undertaken in the discussion/workshop. This would use a self-assessment tool as a repeatable activity along the course of the CPD activity, informing progress.
The assessment of competency needs to be further defined and its elements de-constructed to explore how it can be measured. Self-assessment tools are likely to be most effectively used as part of a
Based on the experience gained in this research I would make the following recommendations:
1. A cycle of competency should be nominated for each pharmacist over a five-year period that covers every aspect of their practice in both therapeutic and practice topics using a competency matrix to guide their CPD selection.
2. The delivery of education to pharmacists needs to be de-constructed. Clearly the literature indicates that using one mode of educational CPD will not be sufficient for competency based learning to be successful. There should be clear guidance for pharmacists that all formats of CPD delivery should be undertaken. Methods of assessment like OSCEs and the delivery of CPD in the format of Patient Oriented Evidence that Matters (POEMS) should be blended into CPD delivery where possible.
3. A greater emphasis on learning using personal practice should be promoted with more emphasis on the analysis of outcomes of personal practice. This could be explored using electronic recording systems such as the one developed in the Pharmacy Recording of Medication and Incidents and Services (PROMISe) research (106).
4. The validation instruments developed by Azzopardi (52) should be explored and developed for the Australian setting to support the process of competency.
5. Pharmacists need to be trained to understand that using surrogate instruments to measure their competencies need to be balanced against measurable outcomes of their practice.
6. The re-registration process for pharmacists should consider two categories of pharmacists’ registration – clinical and non-clinical registration as illustrated in the Ontario model in Canada.