Training and Assessment in Workplace-based Community Pharmacy: Creating Foundations and Nurturing Progress

This PhD research focuses on the development, validation, and revision of the postgraduate workplace-based community pharmacy education program in the Netherlands. The aim of the program is to develop pharmacists into competent community pharmacists who can provide effective and safe pharmaceutical care. The research addresses two main questions: how to develop, validate, and revise the education program using design approaches from medical education and context-specific research findings, and how trainees and supervisors perceive learning and assessment in the workplace. The study explores the program's function using Moos’ theory of human environments and self-determination theory to assess the quality of the educational environment, and Kane’s framework for validating measures of performance to evaluate the utility and validity of assessments. The postgraduate curriculum for community pharmacy specialists, developed in 2012 and guided by the Canadian Medical Education Directives for Specialists (CanMEDS) framework, includes Entrustable Professional Activities (EPAs) and workplace-based assessments. The research showed that design approaches from medical education were effective in developing and revising the curriculum. A cross-sectional study was conducted to investigate the quality of the educational environment and its impact on trainees' psychological needs and motivation in training pharmacies. The study used the Scan of Postgraduate Educational Environment Domains (SPEED), the Basic Psychological Need Satisfaction and Frustration Scale for the Work Domain, and the Academic Motivation Scale. The findings revealed that a positive environment enhances satisfaction of basic psychological needs, while a suboptimal environment can lead to frustration. A mixed-method approach was applied to examine the tension between measuring performance and giving feedback in progress evaluations. The validity of performance evaluation scores from 342 trainees was analysed using repeated measures ANOVA. Semi-structured interviews with 15 supervisors explored their response processes, the utility of progress evaluations, and the influence of supervisor-trainee relationships. Intermediate progress evaluations in training pharmacies were found to be useful for structuring learning and providing feedback. However, summative evaluations by supervisors were found to be unreliable for decision-making. Establishing a clinical competency committee can help distinguish between formative feedback and summative decision-making. Supervisors face role conflicts, preferring to focus on competency development rather than assessment. Positive supervisor-trainee relationships are crucial for effective feedback, with supervisors acting as educators, mentors, and coaches. The curriculum was revised in 2022 based on feedback and research findings. The updated curriculum includes a revised competency framework, EPAs, assessment program, classroom-based learning program, and workplace support. Increased workplace support can enhance workplace-based education and strengthen the relationship between pharmacies and the educational institute. The thesis concludes that the curriculum and workplace are interconnected, and changes should align with the basic psychological needs of both trainees and supervisors. This research contributes to the foundational development and ongoing progress of training and assessment in workplace-based community pharmacy in the Netherlands.