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Abbreviation |
Term |
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APC |
Australian Pharmacy Council |
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EPA |
Entrustable Professional Activity |
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ITA |
In Training Assessment Activity |
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ITP |
Intern Training Program |
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QUM |
Quality Use of Medicines |
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SPO |
Short Practice Observation |
This guide is to be used by pharmacist interns, preceptors, supervising pharmacists and Intern Training Program (ITP) providers.
This guide outlines the Entrustable Professional Activity – Providing counselling developed by the Australian Pharmacy Council (APC), to assist with the assessment of an intern’s achievement of one or more of the performance outcomes required to be demonstrated at the point of general registration as a pharmacist.
Interns will use the associated forms and templates for seeking feedback on their performance when counselling patients and/or carers about their medications and creating a development plan to enhance performance.
Preceptors and supervising pharmacists (collectively referred to as Supervisors) will use the associated forms and templates to document observations of intern performance, provide feedback, assess intern performance and jointly formulate the intern’s development plan.
Intern Training Program providers will incorporate the EPA into the Intern Portfolio, which is the compiled record of the intern’s achievements during the intern year, and which is used as the basis for determining whether the intern has achieved the relevant performance outcomes.
Familiarity with the following documents is recommended and they should be read in conjunction with this User Guide.
This Entrustable Professional Activity (EPA) should be understood and undertaken within the overarching principles of Quality Use of Medicines (QUM) and person-centred care. In the context of this EPA, providing counselling is applicable to counselling as part of dispensing prescription medications, and supplying non-prescription medications. It may be appropriate to carry out an assessment of EPA 1 Dispensing medicines or EPA 2 Compounding pharmaceutical products together with EPA 3 as patient counselling often follows dispensing or compounding of medicines The assessments can also be carried out independently.
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Title |
Providing counselling |
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Specifications and limitations |
Outcome: Patients, carers, and other customers are provided with, and are able to understand accurate, relevant, contemporary, and tailored advice and education on the use of their medicines and on non-pharmacological and lifestyle measures designed to improve and maintain their health; adherence and quality use of medicines are promoted. Specifications: Patient privacy and confidentiality are respected and maintained. Counselling is carried out in a culturally safe manner. Communication content and style are appropriate for the person’s health literacy and communication needs. Information provided is specific and relevant to the patient. Language appropriate to the situation and participants is used. Appropriate tone, volume and pace are used. Communication failures/barriers/difficulties are identified and addressed. Written or other additional sources of information are used appropriately to support verbal communication. Patient/carer questions are solicited and answered appropriately. Patient/carer understanding is assessed. Limitations: None |
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Potential risks in case of failure |
Inappropriate, inaccurate and/or incomplete counselling may lead to individual patient harm and/or harm to the health and safety of the public. |
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Most relevant performance outcomes |
3.17: providing appropriate tailored counselling, information, and education to enable safe and effective medication, disease state and lifestyle management. 4.2: identifying and acknowledging professional limitations and seeking appropriate support where necessary, including additional professional education and/or referral of patients to other health care professionals. 5.3: recognising and responding to the inherent complexity, ambiguity, and uncertainty of contemporary and future professional practice. |
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Required knowledge, skills, attitudes, and experiences (A RICH) |
Knowledge of pharmacology, medical chemistry, pharmacotherapeutics, pharmacodynamics, pharmacokinetics, formulations (C) Knowledge of non-pharmacological and lifestyle interventions (C) Knowledge of privacy and confidentiality requirements (C) Communication skills (C) Interpersonal skills including empathy (I) Cultural respect and responsiveness (I) Person-centred approach (I) Awareness of personal limitations (H) Willingness to seek assistance (H) |
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Information sources to assess progress and ground a summative entrustment decision |
Short practice observations (SPO) – template provided Patient/carer feedback – template provided Reflection on performance by intern – written or oral1 Entrustment discussions – guidance and template provided |
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Entrustment/supervision level expected at which stage of training |
Level 2 or 3 on entry to intern year Level 4 by end of intern year; may be entrusted earlier |
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Time period to expiration if not practiced |
Not applicable to intern year |
1The template provided as part of the ITA – Reflection is a useful resource for this reflection by the intern
A short practice observation (SPO) would generally involve a supervising pharmacist observing the intern while counselling a patient and/or carer.
This guidance does not set a minimum number of SPOs required to adequately observe and assess intern performance because not all interns will be identical and progression towards the required level of proficiency will differ. Competency to perform counselling safely and appropriately will be deemed to have been achieved when the Intern can be entrusted at Level 4.
While interns are observed regularly while counselling, it is important to clarify that an SPO marks a formal evaluation point. Thus Interns should be provided opportunity for this formal evaluation, aligned with individual growth in competence.
SPOs should cover a range of scenarios from simple counselling where few barriers are present, through to more complex situations requiring the intern to be critically aware of and responsive to cultural or other diversity, or where the scenario is more complex as a result of polypharmacy, co-morbidities and other factors. Ideally, SPOs should be spaced throughout the period of supervised practice to allow for observation of improvements in performance. It is not intended that SPOs be carried out in clusters or close together in time, but regularly spaced and scheduled at times when an intern is considered to have improved since a previous SPO.
After the SPO, an entrustment discussion (see below) should occur between the intern and the observer(s).
Following the entrustment discussion and entrustment decision (see below), the intern creates a development plan to address any areas where improvements could be made. This development plan can be used as the basis for selecting the next opportunity for an SPO, and as the basis for evaluating progress during the intern year.
All aspects for observation by the supervisor should be addressed for initial patient counselling SPOs, however as interns gain more experience and expertise, the focus should be on changes since the last SPO, and all aspects may not need to be answered in detail.
As key stakeholders, and integral participants in the counselling process, feedback on their experience should be sought from patients and carers and used to assist the intern in developing skills and confidence. The patient/carer should be asked in advance for consent to provide feedback. The feedback received should be recorded; a template is provided for this purpose.
Seeking feedback from the patient or carer may be more appropriately carried out by a third party such as the supervisor. The template is adaptable and can accommodate additional questions or comments as needed based on the course of discussion. The template can be completed by the patient/carer, or by the supervisor engaging in conversation with the patient/carer. Where the feedback is collected though a discussion between the patient/carer and supervisor (or other staff member), the questions which are asked do not need to correspond to the questions on the form but can be chosen according to the particular situation. What is important it to capture the patient/carer experience as clearly as possible.
The entrustment discussion focuses on more than simply providing feedback about the intern’s performance of the EPA. The supervisor also seeks to understand the intern’s ability to perform in future scenarios when the context, patient and parameters may be different to what has been observed. It is not feasible to observe every possible scenario and context during the supervised practice period.
An entrustment discussion does not have to occur immediately after the SPO but should be scheduled within a reasonable time period to maximise opportunity for learning and development. These discussions provide additional evidence to support (or not) a decision that an intern can be entrusted to perform the EPA with a lower level of supervision (i.e., to progress from one level of supervision to the next). Using the four-step framework, the preceptor should require the intern to:
Supervisor feedback following these discussions should be recorded in the Assessment of EPA- 3 Form. Feedback should be simple and concise and can be documented using the KEEP, START, STOP approach to feedback. This is a useful framework for receiving and delivering feedback in three sections. Supervisors may find it beneficial to approach feedback by responding to the following three questions:
Entrustment decisions are NOT a rating of the intern’s performance. Entrustment involves making a holistic decision about the level of supervision the intern will need to continue to practice based on triangulation of all the information gathered about the intern’s capability to safely and effectively counsel patients. This information is based on the supervisor’s professional judgement on the SPO(s), intern reflection, patient feedback and the entrustment discussion. Simply put, an entrustment decision answers the question “What level of supervision will this intern require going forward, based on what I have gathered about their performance and abilities?”
An ad hoc entrustment decision can form part of any SPO, and the outcomes should be recorded in the EPA-3 Short Practice Observation (SPO) and assessment of EPA form. The aim of an ad hoc entrustment decision should be to provide the intern a clear understanding of where performance has been strong and areas where further improvement is necessary. Ad hoc entrustment decisions should form part of the overall evidence on which a summative entrustment decision is based.
When either the intern or preceptor considers that the intern may be ready for the next level of supervision, a summative entrustment discussion may be held. During this discussion, prior evidence from activities, feedback and previous discussions should be reviewed. The supervisor should also pose additional questions until such time as a decision in favour (or not) of entrusting the intern to perform the activity with increased autonomy (resulting in decreased supervision) can be reached.
For level 4 entrustment, following a summative entrustment discussion, and based on available evidence, the preceptor will need to answer the questions:
Do I trust this intern to counsel patients and carers as safely and appropriately as a fully registered pharmacist?
Do I trust this intern to adapt counselling style and content appropriately to different patients and situations?
If the answers to both questions are YES, a level 4 entrustment decision may be appropriate. It is important to note, however, that even when an intern has been entrusted at level 4, the Pharmacy Board requirements for supervision while the intern is provisionally registered still apply. Supervisors will need to balance the level of supervision that is required by the intern with the professional responsibility of the supervisor to ensure accountability and patient safety.
