Abstract
Based on a ‘traditional’ pharmacist education pathway of four years undergraduate study, followed by a one-year internship, stakeholders often expect undergraduate learning outcomes to be predictive of practice outcomes for future registration. Not only are traditional undergraduate assessment outcomes (grades) different, and distanced, from postgraduate outcomes (competence), but research suggests interns may be experiencing different learning and competence outcomes according to the sector they work within. The extent and implications when assessment pathways do not align, and when workplace sector outcomes are not equitable, has wide reaching consequences for graduate success, workforce contribution, and preparedness for practice. At the time of initiating this study, New Zealand literature had contributed little to this field of pharmacy educational research.
The first aim of this thesis is to identify, measure, and explain relationships between undergraduate academic performances and subsequent measures of competence at internship and registration assessments. The second aim is to identify educational differences between graduates undertaking their internships in hospital pharmacies compared to community pharmacies.
A multi-phased longitudinal research design was used, that tracked outcomes from six years of cohorts in their undergraduate BPharm programme over their five-year pathway to pharmacist registration. Various relationships between student demographic characteristics, admission performance, and academic progression were examined against outcomes of competence in internship and registration assessments. Additionally, a mixed-method investigation into workplace sector differences for intern outcomes was conducted in three phases. Firstly, performance outcomes were quantified between sectors, secondly, postal surveys gauged intern preparedness, followed lastly by interviews with selective cohort participants. Thematic analysis identified learning experiences that facilitated or obstructed interns’ learning and progression. A total of 563 interns were tracked for undergraduate and internship performance outcomes, with 359 survey responses, and 18 participant interviews analysed.
Performing well in clinical and professional components throughout their undergraduate years was moderately predictive for interns successfully demonstrating competence at critical assessment points by preceptors in the internship and at the OSCE-based registration assessment. Academic underperformance, particularly delayed progression, was identified as contributing to lower odds of gaining competence. The student’s citizenship status significantly contributed to the predictive modelling of competence outcomes.
Hospital interns were more likely to achieve competence as appraised by their preceptors, and on first-attempt sitting the registration examination. Wide sector variability regarding intern training opportunities, experiences and support levels were reported, particularly within the community pharmacy sector.
This thesis informs stakeholders in pharmacy education that academic pathway success within a BPharm undergraduate programme is, in general, predictive for future success in internship competence outcomes, even when the assessment measures are very different. Notable contrasts amongst cohort subgroups were detected that were influential to outcomes of competence, with implications for student admission and support mechanisms. Sector differences between hospital and community pharmacy internships have been identified including competence pass rates, training opportunities, and staff support. With emergent person-centred integrated care curriculum changes, and multi-sector integrated five-year education models being introduced internationally, this study provides an important contribution to inform future practice-ready pathway changes.