Trainee pharmacists in their Foundation Training Year face a myriad of competing priorities. For most people it will be their first full-time job, they’ll be integrating into well-established teams made up of people they’ve likely never met before, there’s a range of technical and clinical skills to develop, an exam to prepare for and a portfolio of evidence to compile. All while trying to maintain some sort of work-life balance.
During such a challenging year anything that can save time and avoid duplication is likely to be useful, which is why I’ve got some advice on how trainee pharmacists can start producing study notes while writing up their portfolio of evidence against the GPhC learning outcomes.
While supervised learning events and feedback forms make up a well-rounded portfolio, the majority of your portfolio is likely to consist of portfolio entries. Reflective entries can take a while to write up, at least 40 minutes or more for good examples which can demonstrate several learning outcomes, which can eat into your valuable study time and personal life.
To make best use of this time spent writing reflections, I recommend that trainees try to simultaneously write up their reflections while consciously learning or preparing study notes along the way. By providing more detail in your reflective entries which clearly explains your thought process, not just the event that happened, you’ll make a more compelling case for your designated supervisor to sign-off learning outcomes with less reflective entries overall (quality over quantity).
To help you understand how this works in practice I’ve provided an example portfolio entry below:
Title of reflection
Pain relief for a patient with multiple co-morbidities
What happened?
A man around 45 years old wanted to speak to the pharmacist regarding appropriate pain relief as he’d been experiencing headaches but was already taking prescription medications for other conditions which he was worried might interact. I asked the patient if they were happy to speak to myself as the trainee pharmacist and he was happy for me to do this.
I asked open and closed questions to carefully explore relevant background information including:
· Symptoms and duration: bilateral headache described as a tight band around the head that had lasted on and off for three days — the patient did not mention any visual disturbances or other symptoms which might suggest a migraine or cluster headache
· Medical history: diabetes, NSTEMI and asthma
· Current medication: metformin, linagliptin, ramipril, bisoprolol, atorvastatin, aspirin, clopidogrel, Symbicort and salbutamol
· Severity: pain usually 3–4/10 but not made worse by daily activities
· Lifestyle — uses computer all day as working from home and drinks several pints of beer on Friday nights
During the consultation I wasn’t sure what the red flags were for headaches, so I explained this to the patient and quickly looked these up on the NICE CKS website.
The red flags for headaches are:
· New severe or unexpected headaches
· Progressive or persistent headache, or headache that has changed dramatically
· Associated features such as fever, confusion, neck stiffness/pain, papilloedema, new-onset neurological deficit, change in behaviour, atypical aura, dizziness
· Visual disturbance, aura or vomiting — migraine
· Headaches which worsen when standing or lying down
· Head trauma
· Contacts with similar symptoms — could suggest carbon monoxide poisoning
I asked the patient if they had any other symptoms associated with their headaches and confirmed there were no red flags.
I also discussed whether they were sensitive/allergic to ibuprofen as I know some patients with asthma can react to ibuprofen and aspirin — the patient said they’d taken ibuprofen previously without any problems and were currently taking aspirin without any issues.
I know that the different treatment options for tension-type headaches include paracetamol, ibuprofen, and aspirin while opioids should be avoided because they’re less well tolerated (constipation, dizziness and drowsiness) and have a higher risk of causing medication overuse headache. I didn’t recommend aspirin as the patient was already taking low-dose aspirin on prescription.
I therefore recommended paracetamol and ibuprofen to the patient.
At this stage in the consultation my designated supervisor stepped in to help. She mentioned that these were appropriate choices, but it might be better to try paracetamol first when required, then use regular dosing if needed. Because of the risks associated with ibuprofen (renal impairment, GI haemorrhage — particularly in patients already taking aspirin or drinking alcohol, cardiovascular events — generally at high doses of 2.4 grams daily) this should be considered as an option if paracetamol alone didn’t work. A stepwise approach to managing pain means not overtreating patients with multiple types of analgesia, minimising side effects.
The patient was happy with this, and I counselled him on the maximum dose and frequency of paracetamol then provided safety-netting advice.
What did you learn and what would you do differently in future
During this consultation I think I did well to double check about red flags for headaches which I will continue to routinely ask about in future.
I will make sure to consider all the patients’ co-morbidities, current medications and lifestyle factors when selecting appropriate analgesia.
What future learning needs do you have and how will you address them
I need to learn to recognise the common interactions, cautions and contraindications for NSAIDs which I will learn by reading the BNF treatment summary before applying this in practice: Non-steroidal anti-inflammatory drugs | Treatment summaries | BNF | NICE
End of example portfolio entry
There are several reasons this detailed approach to writing portfolio entries works well:
Efficiency — anything highlighted bold in the portfolio entry above can be copied and pasted directly into a separate document containing your study notes
Active recall — the process of actively recalling information strengthens memory and improves long-term retention compared with simply copying or re-reading notes. By recalling information about the common treatment options, cautions associated with ibuprofen and why opioids should be avoided, you’re getting extra practise in for the exam while demonstrating the knowledge to your DS, getting more learning outcomes signed off as a result.
Active learning — this is an educational approach that involves students actively engaging with the learning process and research has shown that active learning can lead to improved retention, comprehension and application of information. By looking up information in the workplace, in this case relating to red flags, and applying it to the patient you’re more likely to remember and apply it correctly in the exam.
One final piece of advice is that I would never expect a trainee to do this for every reflective entry as it would be too time consuming. But for high-weighted topics (in this case CNS) which you know you need to brush up on this is a great way to study and write reflections at the same time. For the example above, any future entries could expand on cautions, contraindications, referral criteria, common interactions and safety-netting — all key information the GPhC expects you to know.
I've been incredibly impressed by the articles you've written for trainee pharmacists. Your insights have been incredibly useful and have helped me navigate some challenging aspects of pharmacy training.