overview of Non-medical Prescribing Practice Assessment Document video transcript

Hello. Welcome to part two of the update.

This session is going to discuss the practice assessment process and in particular the Pebble Pad that we use. In order to do that, you can think of the practice assessment as a series of pieces of evidence that aim to build a picture of competence that the student has the competencies to do with prescribing by the end of the program. 

That was originally done through the use of a PDF practice assessment document.

But during COVID, we found that it was difficult for people to meet face to face sometimes, and so we moved over to Pebble Pad, whereby you as an assessor, are given an account with Pebble Pad and you are the student shares their pebble pad with you online. We will have a quick look at the PDF version of it just so you can see what it looks like. And because there are some pieces within that that you might end up needing to use, we do want you to log on to Pebble Pad.

The process is that we send you an invite to Pebble Pad. We manually upload all of the DPPs onto the student's site once we receive your emails through the admissions process and you just need your email address and you can reset your password any time. And then the student shares their pebble pad with you and that will be through an email that you should hang on to because that will take you directly to their pebble pad every time. In the meantime, you can use the odd page from the from the hard copy, but it is quite onerous as a marker and for the students to upload the pages one at a time. Both the PDF document as well as the online document starts primarily with a series of pages that give you an explanatory note. Provide guidance as to how practices assessed.

We won't read those now, but I will show you one item from the PDF that isn't actually on the online version. The practice communication flowchart that is online, but if there are any concerns. So for example, the DPP goes off sick and or is not available anymore and there needs to be a change of DPP, there is a form at the end of this document that covers that.

Similarly, if anything is concern is raised by you, the supervisor, the DPP, or the practice assessor, anybody at all, then there is a concerns form raising concerns form again at the end of this document and the process is outlined here and it's outlined on the Pebble pad. So we'll just quickly go to that page so you can see what I'm talking about.

So this is appendix to practice concerns, alert form. Hopefully nothing will happen, but it's just in case. And there is also an evaluation page. And as mentioned, just like the pre-admission application, there is a form to complete if the DPP changes partway through the course. We're going to leave the practice assessment document there and look at the online pebble pad.

So the Pebble pad, as mentioned, is shared with you by the student and this is the student view. So what I would do as soon as I opened it up and started the Pebble pad, I would click to share it with my DPP. Now only they can't enrol you onto the system. Only we can do that. So the email address has to be identical to the one that you use regularly and that they put on their application form.

So occasionally if they've handwritten the application form, we might have had a typo in the email address. So once they find it, they then select to share it with you and your sense that by an email and you should hang on to that email because it takes you back to their pebble pad every time you click on the link.

The set up is that the first few pages are information and then afterwards each of these tabs up across the top have got documents that get filled in. If you want to see an overview of where to find things, this overview. This tab here on the far left will help you with that. The overview has got the information, introduction and guidance and then the report pages.

That's where the Practice learning agreement, initial interview and all the reports that need to be completed are found. And then there's a separate set of pages that are reserved for the practice-based competencies and practice space. For example, record of practice hours, clinical skills, case-based discussions, clinical observation records, etc. The idea is to build up the picture of the evidence to show that they've met the competencies. Or conversely, there's a lot of different parts also because some students may show their competence in different ways than others.

So sometimes critical reflection might be the best way, and other times it could be an observed consultation, or it could be a case based discussion. So there are different ways for them to meet the learning outcomes and competencies, and there's a variety of opportunities for them to do that. We'll just go through it one step at a time. And there is obviously I'm not going to read everything, so it is important that you read through the document when you first have it shared with you.

One of the things to say is that it is a professional program and the Nursing and Midwifery Council, the General Pharmaceutical Council and the Health and Care Professions Council are very clear that if there's any sorts of major failures within the program that reflects poor practice, that that's a cause for concern and that it can result in overall failure of the program 

So even though it's an assessment we do have, we are cognisant of professional behaviours need to be adhere to human rights laws, equality, diversity, inclusion and basically the professional codes need to be followed throughout the course. And if there's any issues with that, we need to know the assessment is undertaken in various stages. So what the task is at the initial stages is to meet with the student, the student and the DPP or practice assessor and to outline when and where meetings are going to be taking place and the first few stages of the documentation completed. So, for example, the assessor details the practice learning agreement, which we'll look at in a minute and the initial interview Clinical Skills Action Plan and the plan for meeting the competencies of which are 76 at the intermediate stage 

That's about halfway through the course. It ends up at about 13 weeks out of the 26 weeks. And what we want to see at that point is the intermediate report, the intermediate professional values assessment, the Clinical Skills Assessment and Action plan. And there should be a minimum of 30 hours achieved at that point as well. One of the three case-based discussions and one of the three personal formulary entries with a mock prescription. And then after this is signed off by you, it's reviewed by their personal academic tutor at the university, and we check to see if there's any issues that need following up in any action plans.

If you're wondering what the entirety is of what the student needs to achieve, this is the list here of the pieces that are put together to show that they've met the competence. And that's all expected at the final stage or by the final stage. So the clinical skills assessment is then signed off. There's an expert by experience testimony from a person that the student is caring for and signed off by yourselves.

The case-based discussion reports there should be three. And if the student's designated prescribing practitioner is not a GMC registrant, so they're an A non-medical prescriber, then at least one of the three case-based discussions need to be undertaken by a GMC registrant. So similarly for the clinical observation records, the student completes three personal formulary entries and we assess their mock prescriptions.

So even though we would hope that you are modelling best practice in relation to their prescriptions, we will be assessing the mock prescriptions in the pad as, as a summative assignment of the record of practice experience is to show the 90 hours of practice. This that has been achieved across the six months and it should be evenly spaced across those six months.

A minimum of 30 hours or four of the 12 days should be with the DPP and the rest of the time can be spent with other supervisors. Although most people who are signing the student off spend most of the time assessing them or if they if they if there is a range of good supervisors available, then there's other forms of evidence that you can use to build that picture of competence and be able to sign off.

So that's why we say a minimum of 30 hours. The final professional values not to perform final competency report, final interview. And then there's a separate declaration of suitability to say that all of these things have been achieved. There's a little bit of information about navigating the pad. And as I've mentioned, you can use this dropdown menu if you ever are wondering about where things have gone and not able to find them like I just did then.

Okay, so that's navigation and a list of a list of the items that are required and where you can find them. These are optional forms over here. They don't have to complete any of these. But for example, some students might be better at reflecting on practice rather than completing these forms. So, if it's suitable for their knowledge, needs to show that they've met a competency through critical reflection or some additional forms, they're all contained in the optional forms dropdown menu.

The second part here is further guidance, and this is some more general guidance.

Again, it replicates the PDF document, so you should read through that. Just a reminder that it is 12 days, 90 hours. There's a guide that's available. There is a video, just a five minute introduction for the students about how to complete this. There is some information about the various roles. As mentioned, the DPP or practice assessor is the one who's taking accountability for signing them off. But the practice assessor contributes to that and contributes to the evidence.

The student themselves should be identifying some of their learning needs and taking responsibility to make sure that all of the forms have been completed correctly. And the academic successor or the personal academic tutor is the the university lecturer who signs it all off because we are the ones that are uploading the qualification to the professional bodies. There's some more information about the details of the assessment that you can read through and we encourage you to do so.

And again, these pages are replicated here from the PDF document and they talk about the stages as they go through the program. This is the concerns flow chart, and this is the sort of a summary of everything that is due in the graphic form. We recommend that the 12 supervised days across the 26 weeks are spread evenly. We don't want to see a practice document where there's a lot of practice at the start before they've had a chance to absorb the theory or conversely, it's all stuck at the end. It should be evenly spread throughout, and it is a 26-week course, a six month course, so they can't be signed off.

The final sign off the declaration of suitability must be two weeks. No, no earlier than two weeks before the end of the course. There’re various ways in which students can be supervised and assessed. You are permitted to or a form of evidence is actually direct observation because some of the competencies you don't necessarily have to write or they don't necessarily have to write. Maybe a piece of reflection isn't suitable or of a form. That's a case based discussion isn't necessary. So you can directly observe the student and say they have met that competency.

There's direct and indirect supervision. So when the student observes you or when you observe the student, oh, so indirect is when they're with a colleague. And whether that's documented, it might help you. If you're not aware of the colleague's area of expertise, it might help you for them to have done a testimony or a case based discussion, some form of evidence. But if you work with them, it doesn't necessarily require a report for you to be satisfied that it meets the learning needs of the student.

There's other ways in which students can learn while on the course, so such as in site visits, study days, that sort of thing. So that can count in their hours. They can also undertake what's called independent practice, and that doesn't count as the hours with you. So part of that 30 hours minimum. But it does count in the hours as long as you approve it as the DPP.

So, for example, if it was a wound care nurse, a nurse who cares for people with wound care needs, they could be running a clinic for 2 hours that day. They would lock it in the learning log, the record of practice hours as 2 hours and give some details about the nature of the clinic, but only if they then spend some time with you. So say half an hour of a debrief and going through some of the clinical decisions and assessments that were made that day. So they would count the 2 hours as independent practice and then 30 minutes if you spent 30 minutes with them debriefing. So in relation to how things are assessed these are the forms of evidence. So direct observation we've talked about before observer reports or statements, case-based discussion reports, standardised assessment forms such as the consultation observation record, which they need to do, three of those other sorts of observation tools that you can use, such as the cane tool, etc., question and answers, and you can ask them to do a reflection as part of the evidence that's built up.

There's one expert by experience testimony. There can be more if that's appropriate. There's some further guidance about the clinical skills assessment, but that continues here. Guidance part two. So we will get to that when we get to it. So looking at the various forms now, this is the first thing that needs to be completed and this is one that I've completed earlier saying that this course is starting September 6th at this point and finishes or the document should be handed in six months later, which is approximately March 1st. So the student completes that.

The student also completes who it is that's assessing them and they can add to this throughout. It doesn't have it's not a static thing. They can also identify other people that are helping them as as the course goes on. We do want to know who the DPP is and we do want to know if it changes.

So partway through, let's say they've had to change duties and then they make a note and upload the form corresponding form for that. So the that's how that is, is completed. Now the role of the DPP is the one who is taking responsibility for the assessments. So they need to complete you need to complete this section where you're identifying the student's area of future prescribing practice. So for example, if it was a pharmacist in primary care, you could say primary care, general practice, pharmacy or general practice, if they're focusing on hypertension, general practice, hypertension.

Similarly, for a community matron, it might be general practice, long term conditions. So whatever it is that they have, you have agreed as their area of expertise while they're on the program that needs to be entered by you. I can't do that because I'm not in I'm in student mode. But as a DPP, you can type into this and then this is your practice agreement where you're agreeing to these items to oversee their practice, to conduct interviews and reviews, etc.

So you take that to say you agree. And of course the student takes their area to say that they agree this is for the student to complete when the initial interview would be and it would be really good to also identify the dates for the intermediate report and the final interview. It's good to get them in your calendar ahead of time, and then it's optional for the student to complete further notes. And then when the university lecturers look at this in the intermediate stage, we sign it off down here to confirm that the practice agreement's been signed.

Student area students area of clinical practice has been noted and if there has been a DPP change, it's been noted as well. The only other thing to say is with as with most of the pages, there is the option for the student to upload a PDF version of this. If it is the case, something's untoward and you're unable to access this online. So that's the initial interview. Sorry, that's the practice learning agreement. The initial interview is quite broad. It's for the student to outline their priorities while on the course. If you think about the fact that there's 76 competencies, they don't need to go into detail here. They just need to broadly talk about their areas of priority for learning and an action plan. And then you just tick to see that that you agree with that. This is the much more detailed competency framework for all prescribers. Like I said, it has all of those, it has ten broad categories, but then within that it has 76 competencies, some in each category. So this is one that I did earlier as an example.

The expectation is that the student looks at the competency framework. They think about the competency and they. Suggest how they believe that they will meet it. So this first section is assess the patient. So most of that is likely to be through a observation of a consultation. It might be direct observation or it could be a clinical observation report for the evidence. You can also link to items. So, for example, in this case we thought actually maybe an observed consultation is more difficult for this outcome relating to potential vulnerabilities. So instead I've done a case based discussion and the student can link to these. They don't have to, but it's just an option. So this goes on for all of those competencies, just a reminder that there is a competency about prescribing, but we understand that they cannot prescribe until they're legally able to prescribe, which is after they've passed the course.

But it's just the way the competency framework is. So there's ten broad competencies and then you at the end us as the DPP agreed the students plan how of how they're going to achieve the competencies. And the next one is these two are the what's expected at the intermediate stage. So again, approximately 12 to 13 weeks into the program, we have a form called the Professional Values and Attitudes Form. And the reason why this is here is because a student might be competent, but you might have some concerns about their attitude and behaviours. And this is the way to spark a conversation about that. If you're concerned whether they need to do some work on their attitude or on their personal values.

Now first and foremost, you are confirming to say that they have met their basic professional code of conduct requirements. So that is, that's a simple yes or no. And then for the rest of it, there are a series of topic areas in which you say whether you agree that the student is, for example, self-aware, motivated, evidence based and so on, and the student self-assesses. Now what we would hope is that these matched that you feel the same way that the student feels that they're at the same place that you think they are, where they don't match. So for example, let's say that I'm one of those students that is overly confident. I've been a practitioner for years and years. I know my stuff.

I've done renal transplants for forever, so I know exactly the drugs that need to be prescribed. But actually I'm a little bit poor on self-awareness and think I'm great, but I'm not self-aware that there are other things that I haven't yet encountered that you know about. So you might actually mark that down as a disagree about the self-awareness. And the idea behind that is that it's then triggering a discussion that you have with the student about perhaps maybe some more of their learning needs, etc. So that's at the intermediate stage and there's another one at the final stage as well.

The student completes most of the intermediate report. However, we do have the ten broad competencies from the competency framework for you to assess on a grid whether they've passed them or not passed them at this point. And it's really important that you keep in mind that when you we are expecting them to pass at this point, but that's not saying that they have fully met all of those competencies. What that is saying is that they have achieved enough progression that you can see that by the end they are likely to pass them. So it's not saying they are competent. No, in relation to all of those 76 competencies, but that they are progressing sufficiently. So we would expect a two or three rather than a zero or a one at this stage. And it is just simply that the core topic areas that you're that you're signing off at this point, if they do achieve a clear fail or fail at this stage, we would expect to see a action plan as to how they're going to turn it around in time for the next, you know, over the next three months.

By the end of the course, the learning log hours. At that point, we would hope that they have at least 30 and at least 15 with you as the DPP. Their clinical Skills Action plan, which is under this tab, should have been completed and the professional values form as well as one case piece discussion. This is an area where the pharmacists differ slightly. The case-based discussion that we expect pharmacists to have completed by this point is actually an audio case based discussion. So they're asked to record a case based discussion with their DPP and upload that by the intermediate stage and we provide them with feedback on that audio.

A case-based discussion. This is for the student to do and then this is for you as the practice assessor to take to see all the learning log. The learning log hours are accurate. Clinical Skills Assessment Action Plan has been completed and so on. And then as mentioned in other places, you can upload a PDF or the student can upload a PDF if necessary, and then we review this one. You and the practice assessors can't access these. This is for the university team to do so. That's one of the main report pages. There's a final report and that's where you sign off the competencies.

And just a reminder, it's not one at a time, but it's they're all listed there if you've forgotten what the competencies are, but you sign them off at this stage, at the final stage is pass or fail. For all of those professional competencies, there's a final professional values and attitudes form just like the intermediate one, and then there's a service user testimony. So this has to be completed by a person in their care. Obviously, the person in their care can't access this pedal pad, so we would expect it to be uploaded and the student to scan it in and upload it. Otherwise, the student can actually type feedback. If they want, they can type the feedback. And in any case, whether it's a PDF or whether they've typed the feedback you need to sign to see that they it is actually the student that has done it. I confirm this testimony is from someone in the student's care.

So that's the verification and you can write it on behalf of an individual in their care because we do like to maintain confidentiality. We don't penalise the students. If the if the person in their care has insisted on signing it, even though we want confidentiality at all times. They should probably block it out but if the if the person in their care has decided to sign it, we're not going to penalise the student for that. There's a final interview. This one is just free text on behalf of the student and yourselves to just make some notes.

So that is the main report pages. Aside from the declaration of suitability and the next set of items is the clinical skills and learning logs. So the record of practice hours, the student completes this. They put detail about how they're spending their time, who they're spending the time with, and how much time. There's a variety of ways to do this. Some students do quite a lengthy notation of how they've spent their time, and some of them actually put the links to the competencies. They feel that that learning has achieved. Other students are more brief about it. It's up to the DPP to decide how much detail they want, but certainly we look at this as well and we expect a certain amount of detail. So this is quite brief, but it might do for, for example, for just the student if they're just jotting it down quickly and then expanding on it later. But it's basically showing how they've spent their 90 hours or 12 days and how what they have done in that time to meet the competencies.

So when you sign it off, you're signing to say that the prescribing student has done at least 90 hours of the 90 hours, you've supervised them for at least 30 hours. And then if it if it's the case that the DPP isn't a doctor, isn't a GMC registrant, that they have spent enough time with a doctor or a GMC registrant, that they have undertaken a case-based discussion and an observed consultation. So those are the two requirements for a GMC registrant. And then again, just like with all the other pages, they can upload a PDF if necessary, but it's definitely better for them to do it on here. And that's just lecturers looking at that.

There's a second set of guidance and it's basically to just talk about the assessment grid that we use and to talk about the clinical Skills action plan as well as what a case-based discussion is and an observed consultation. So I'm not going to read through that. The clinical skills assessment is divided into two parts. There's essential clinical skills that we expect every student to be able to do. Expected essential skills. And then there's also relevant skills. So it's something that not all students need to do. But for example, if it was a student who was working in respiratory, it would be relevant for them to do our one for chest auscultation or two for saturation monitors and possibly peak flow and spirometry. So even though they're not relevant for every student, the relevant for those students.

And so they need to be measured against that. So for these essential ones, what the student is expected to do is to self-assess whether they are already they already have significant current knowledge and skills in these areas. So, for example, consultation, communication skills, history taking, mental health assessment, blood pressure and so on. So for the pharmacists, for example, some of the pharmacists they put all these is low because they don't have as much experience of doing manual blood pressure. Some of them do, but some of them don't. A lot of people put low for the mental health assessment. And really, we're talking about that in the context of their role. So it might just be that they need to be able to assess consent capacity for consent. However, it could be that if they are dealing with long term conditions, they should be able to, for example, ask the basic Woolley questions to find out if somebody has signs of depression.

So it depends on their role, but they might self-assess themselves as low. Current knowledge and experience because these ones are essential skills for any of the items that are low, it then becomes a high priority for further development. So in this case, just E5 and then as the example of also put specific and broad review of blood test is low and a high priority for development, but then being a wound care nurse also need API or Doppler assessment, but already have as a self-assessment significant knowledge and experience in that. So that's a low priority for development. So in the end, all I need an action plan for is this one which is EE five and not this one that I've typed in, but the review of blood tests. So these are the two action plans and then when you sign them off as the DPP, this is for you to sign off at the end, you must sign off all of the essential ones and then any of the relevant ones that required an action plan or that were considered to be relevant.

And then there's space for you to write notes as well. And then we sign it off. So that's the clinical skills assessment. The case-based discussions are reasonably straightforward. The student completes some details about an individual in their care and a decision that they've made along the lines of these categories. So the bio psychosocial rapport investigations, diagnosis and the decision that they've made and how they've come to make that. So the student records thought is notes, and then you have a discussion about it with them. And whilst you're doing this discussion, you assess these features. So have they communicated effectively both with the person in their care but also with you? Have they outlined the key features, etc.? Clinical assessments and best investigations, examinations. And so those are the categories that you're scoring them on. It's really helpful if you do a summary of the positives for them as well as areas for improvement.

So as you can see, because that's for you, the student can type in there, you can upload a file or the student can upload a file. So there's three of these. At least one of them needs to be with a GMC registrant. At least one of them needs to be with the DPP, and that can be the same person. So that's three. And then we have a look at it at the end. Very similar for the observed consultation, but this one's live for the case-based discussion. You don't need to be there for the consultation, but for the observed consultation. As the DPP, you must observe the student, at least on one occasion directly Having a consultation with an individual in their care can be a remote consultation.

You can listen to telephone calls with them. It doesn't have to be face to face, but it needs to be a live consultation. And again, at least one of these need to be by a GMC registrant. And these are the types of things that you're assessing whilst you're observing the consultation and you're scoring it. They should really all be applicable. But there might be the odd thing that isn't applicable, but it's either a clear fail, a fail, a pass or a clear pass. So as mentioned, there's three of those and then again three opportunities to upload one the student as a personal formulary, whether you can look at this as evidence as well. And it's them mainly talking about the drug, not necessarily talking about the person that they're prescribing it for, but certainly getting to know that particular product, the drug class, the indications, pharmacology, pharmacodynamics side effects, interactions, that sort of thing. So, the student completes this. And then they are also expected to upload a mock prescription for each of these. And when they upload the mock prescription, we assess this. We assess it formatively at the intermediate stage and summatively at the end.

So that's for us to do the mock prescription. You can do mock prescriptions for them as well, if you'd like. Now, for nurses and allied health professionals, they have to do a clinical management plan and that's in the paddock as well. And you can help them with that. So that is because they are legally annotated on the register as independent and supplementary prescribers and as supplementary prescribers, they need to know how to write a legal document. It is to be noted that legally a non-medical prescriber can't authorise a clinical management plan, it must be a GMC registrant or a dentist, so a doctor or dentist.

So if the DPP who's signing this off is not a GMC registrant, then they just need to take to say that they understand that legally they in practice they wouldn't be able to sign off a clinical management plan. So that's the clinical management plan. And again, we assess this when they hand in their full pedal pad summative and every submission if they need it, there's at least one reflection that they need to do. For the pharmacists, it's slightly different because there's some key learning outcomes specific for the pharmacists that they have to include in their reflective piece. And then that's it. Those are all the forms. The last thing you do is you sign them off as safe and effective.

You've confirmed that they've achieved their 90 hours, confirm that you've signed off everything as they've gone through, and that they have successfully achieved all the prescribing competencies in the RPA competency framework. And so that is the end of the session. I hope you have found this useful and would like to thank you once again for agreeing to support a student and enable them to achieve the competencies as a prescriber.

Thank you very much.