The Pharmacy Student’s Survival Guide to Placements

You’re reading this the night before your placement, aren’t you?

We’ve all been there. We’ve either winged it or prepared like crazy for no reason. And what’s the point? It’s just a placement, right?

All you need to do is show up, take some notes, smile and nod at what the pharmacist is saying, and head on home.

Wrong.

Well, you could do that, but then you’re not really making the most of your time. Your time as a student is as valuable as a working professional’s.

While you won’t have the same pressures on you as your supervising pharmacist, your placement will give you a taste of what life is like as a pharmacist.

It’s a good idea to do a little bit of prep work beforehand, even if that means a quick Google or a flick through this guide. After going through this guide, you’ll hopefully understand what to expect on placement, and won’t be completely blindsided by the day-to-day activities.

Benefits of placements

If your university course doesn’t offer you enough clinical exposure, you might consider applying for external placements at various NHS organisations. If you’ve already got some experience under your belt it’s a good idea to get a couple of weeks or even a few days in a different sector.

Not only is this beneficial for you, but potential employers will see this as a positive too.

But what are the other benefits of placements? Here’s a few:

• They help you understand the world of pharmacy work
• Your experience in different sectors will show you the similarities and differences of these sectors
• You’ll develop your employable skills e.g. time management, teamwork, communication and pharmacy specific skills, like patient counselling.
• You’ll gain an appreciation of working life in general, from commuting to longer working hours (and probably make you want to be a student for longer!)

The patient journey should be a cohesive experience, but in reality is disjointed. It helps to understand work so you can anticipate any problems down the pipeline.

So now you know why you should try to get at least one or two placements, but what do they even involve?

Types of clinical placements

In most cases, you’ve either got a placement through your university or you’ve applied for an external placement yourself. Both follow a similar format of work covered.

The most common places you’ll be placed are in the following areas:

Let’s have a look at these in more detail.

Community

You’ll generally work in one store of a community pharmacy as part of a larger chain or an independent pharmacy. The team will be small and close-knit, so you’ll have to learn to get on with others in close proximity and work well together.

As a student, you’ll either be in the dispensary helping to dispense prescriptions or out behind the counter where you’ll assist customers with queries and the counter staff with their stock.

This will be quite a hands-on role as community pharmacies need all the help they can get.

Hospital

This is normally split between shadowing a pharmacist on their wards or clinics and helping out in dispensary. Hospitals can be a little more strict on their staff with regards to dispensing, so you might not be just as ‘hands on’ as a community placement would allow you.

Still, there’s plenty to learn by way of high-risk medication and interesting clinical conditions.

General Practice

If you’re lucky enough to get a placement in GP land, you’ll notice a huge difference from the previous two… no dispensary!

While that might feel appealing to you, most GP pharmacists have a good understanding of what happens in a community pharmacy dispensary. They have to liaise with pharmacies to sort out prescription queries, so knowing how a dispensary operates is crucial to creating a smooth prescription management service (GPs don’t always have this knowledge).

In this role, you’ll most likely be shadowing and observing the practice pharmacist in repeat prescription authorisation, long term condition clinics, or sitting in with other practice staff.

How to prepare for your placement

You don’t need to be super-prepared for a placement, but it helps to know what to expect. That way you can make the most of the actual learning experience, rather than playing catch up with the basics.

Here are some essential tips (essential meaning you might regret it later on if you haven’t done this):

• Dress professionally but comfortably. Wards can be hot and you’ll likely be moving around a lot, too.
• A smart but comfy pair of shoes is non-negotiable. Your feet WILL thank me later.
• If on the wards, it’s handy to have a small shoulder bag with you so you’re not carrying everything in your hands
• Commute: find out your route to the placement beforehand e.g. where to park/what public transport to take. If it’s in a larger building like a hospital, you can use the site map on their website to plan where you need to go.
• Note-taking: An A5 notebook is perfect to keep on you, not too small that you can’t write in it practically but not too large that you’ll regret bringing it along.
• Wards can be hot so take a small water bottle (the water dispenser might not always be working)

Now, if you do want to be super-prepared, there are a few things you can do to make the most of your placement:

• Make a list of three things you want to gain out of this placement (it’ll be good practice for when you need to do CPD)
• Divide your notebook into different sections by what you might learn, e.g. new drugs and new diseases
• Read up on patient counselling as there might be a chance to speak to patients about their medications. Revise your WWHAM or ASMETHOD mnemonics if they help.

What to expect on placement

Despite reading this guide, nothing replaces the actual experience of a real working environment. If you’ve never worked in a pharmacy, your first couple of days or even week will likely be getting used to the pace of work and routine of the day (and also when the tea breaks are!).

In general, all placement environments are likely to be fast-paced and busy with periods of calm scattered around. Patients can be incredibly sick (in hospital) or be vulnerable people, so this will develop your sensitivity to these kinds of situations.

Let’s have a look at what activities and roles to expect in each sector:

Community

Activities include:

• Daily prescriptions to endorse and dispense
• Shadowing the pharmacist to clinically screen and check scripts
• Ordering stock (important in understanding the drug tariff)
• Answering over the counter queries from patients
• Communicating with GP practices regarding prescriptions
• Dispensing multi-dose compartment/dosette prescriptions

What is prescription endorsement? Prescription endorsement is a precise process to ensure pharmacies get the right payment for each prescription. In addition to a dispensing fee, pharmacies can claim specific fees around various items. While prescriptions are moving towards a fully electronic service (and therefore endorsements will be electronic), it’s useful to have an understanding of how this is done manually.

Bonus activities you might observe (if the pharmacy has them) could be flu clinics, community anticoagulation clinics, and supervised methadone administration.

Roles you’ll come across:

• Accuracy Checking Technicians (ACTs). These pharmacy technicians are qualified to check prescriptions that have been clinically screened by a pharmacist
• Dispensers. Very knowledgeable and helpful, the dispensers will become your guide to the pharmacy.
• Pre-reg pharmacists. Depending on what part of the year you’ve met them in, pre-regs will either be super stressed out (exam season!) or incredibly helpful.
• Counter assistants. Reliable counter staff are an incredible asset to any pharmacy. They know the patients inside out and are brilliant at handling what might be difficult interactions. Observe how they do it and implement it into your own practice!

You’ll also come across GPs, GP receptionists and GP pharmacists, though this will most likely be over the phone. Each one has a different role, but if you find yourself speaking to any of them, remember to explain your query clearly and concisely.

Hospital

Ward activities:

• Shadowing the pharmacist and multi-disciplinary team (MDT) on their ward rounds
• Understand how patients are managed in hospital and how discharge is facilitated
• Observe the pharmacist screen drug charts and process medication orders
• Taking a drug history for an inpatient
• Medicines reconciliation (where the pharmacist compares the drug history to the prescribed medication and annotates the drug chart to reflect any changes)
• Observe specialist pharmacist-led clinics

Dispensary activities:

(Note: as said before, hospitals are stricter with what activities they allow students to do. You might be asked to complete dispensing logs before you’re able to do anything independently, or you may simply be asked to observe)

• Become familiar with hospital dispensing system & stock levels
• Liaising with ward pharmacists from the dispensary if items are unavailable
• Observe controlled drug dispensing
• Observe clinical trials dispensing

Roles you’ll come across:

• Medicines Management Team which includes MMT technicians.
• ACT technicians
• Dispensers
• Pre-reg pharmacists
• Pharmacy Stores team. As a hospital is a much larger place to manage, there will be a dedicated team that organises and orders pharmacy stock as well as replenishing ward stock items when needed.

What is the Medicines Management Team? The MMT ensures the management of inpatient medication on specific clinical specialities (e.g. an acute MMT, liver MMT, respiratory MMT). The technicians ensure a smooth-running service by performing drug histories and ordering clinically screened medications requested by the wards.

You’ll also meet a whole range of staff in the MDT including: junior doctors, nurses, occupational therapists, physiotherapists, midwives, dieticians, consultants and many many more!

General practice

Activities include:

• Prescription reauthorisation (is a prescription still clinically indicated for a patient, are blood tests up to date etc) and repeat prescription management
• Observe pharmacist-led clinics e.g. medication reviews or long term condition clinics
• Observe the MDT discussing complex cases
• Understand the referral system from primary to secondary care (again, it’s important to have an appreciation of the different interfaces of care)
• Understand how patient care plans are structured

The roles you’ll come across will include the GP pharmacist (likely to be an independent prescriber), primary care network (PCN) pharmacist, pre-reg pharmacist, GPs, practice nurses, prescription clerks, receptionists, social prescribers, physician associates.

How can you help the team?

As tempting as it can be to stay on the sidelines and just observe, for the duration of your placement you are a part of the pharmacy team. It’s good practice to immerse yourself in the day-to-day activities and show that you are a willing participant. Get stuck in!

Some tips to remember:

• Introduce yourself to everyone you meet so that they’re aware you’re a university student (and not a pre-reg, they might mistake you easily and get you to do something you’re not ready for!)
• Ask questions as most people are more than happy to answer. If they know you’re a student, they know why you’re asking.
• Use your initiative where you can. By showing you’re an observant and proactive student, you’ll easily impress your colleagues with your professionalism.
• Be on time! And if you’re running late, try to call ahead to let your supervisor know so that they’re not waiting around for you.

Don’t worry about ‘getting in the way’. Your colleagues were students at one point, so they will know how it feels to be completely swamped with new information.

While it’s important to get involved as much as you can, you might be limited as a student as to what you will be allowed to do. This will differ from employer to employer. You should respect the boundaries they have put in place as this will be for patients and your own safety.

BUT! If you find yourself given the opportunity to do something rather than just observe, take it! Experiencing something firsthand, like patient counselling, is a much more effective way of learning rather than simply observing.

Final advice

The most important thing to remember is: enjoy your placement! It’s a good break away from the uni library and the copious hours of revising (well, for some of us).

Placements are generally unpaid, so take your breaks when they come. Don’t worry about getting in the way or not knowing ‘enough’ about pharmacy. That’s what you’re there for, to learn.

I’ll end here by repeating the most crucial piece of advice…

GET A DAMN GOOD PAIR OF SHOES!

Originally published at https://madeehahreza.com on August 4, 2021.