Work Stream 2 Project 1 - Final Report

*Donyai, et al.
2010****************************************************
The CPD for Revalidation in

Pharmacy Study
CPD records for revalidation:

assessing fitness-to-practise
using revalidation standards
and an Outcomes Framework
Principal Investigator:
Dr Parastou Donyai BPharm PGDPRM(Open) PGCertLTHE PGCertEBP
MRPharmS
Co-investigators:
Dr Angela M Alexander BPharm MSc FRPharmS FCPP MBE
Dr Pamela M Denicolo AFBPsS CPsychol FHEA (Hon)MRPharmS
Research Assistant:
Rebecca Z Herbert BA MSc
September 2010
University of Reading 2010
Wednesday 15 December 2010
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Donyai, et al. 2010
The CPD for Revalidation in Pharmacy Study
Abstract
Background
Currently, all pharmacists and technicians registered with the Royal Pharmaceutical Society
of Great Britain must complete a minimum of nine Continuing Professional Development
(CPD) record (entries) each year. From September 2010 a new regulatory body, the General
Pharmaceutical Council, will oversee the regulation (including revalidation) of all pharmacy
registrants in Great Britain. CPD may provide part of the supporting evidence that a
practitioner submits to the regulator as part of the revalidation process. Gaps in knowledge
necessitated further research to examine the usefulness of CPD in a pharmacy revalidation
model in Great Britain.
Project aims
The overall aims of this project were to summarise pharmacy professionals past involvement
in CPD, examine the usability of current CPD entries for the purpose of revalidation, and to
examine the impact of revalidation standards and a bespoke Outcomes Framework on the
conduct and construction of CPD entries for future revalidation of pharmacy professionals.
We completed a comprehensive review of the literature, devised, validated and tested the
impact of a new CPD Outcomes Framework and related training material in an empirical
investigation involving volunteer pharmacy professionals and also spoke with our
participants to bring meaning and understanding to the process of CPD conduct and
recording and to gain feedback on the study itself.
Key findings
The comprehensive literature review identified perceived barriers to CPD and resulted in
recommendations that could potentially rectify pharmacy professionals perceptions and
facilitate participation in CPD.
The CPD Outcomes Framework can be used to score CPD entries
Compared to a control (CPD and revalidation standards only), we found that training
participants to apply the CPD Outcomes Framework resulted in entries that scored
significantly higher in the context of a quantitative method of CPD assessment.
Feedback from participants who had received the CPD Outcomes Framework was positive
and a number of useful suggestions were made about improvements to the Framework
and related training.
Entries scored higher because participants had consciously applied concepts linked to the
CPD Outcomes Framework whereas entries scored low where participants had been
unable to apply the concepts of the Framework for a variety of reasons including
limitations posed by the Plan & Record template.
Feedback about the nature of the revalidation standards and their application to CPD was
not positive and participants had not in the main sought to apply the standards to their
CPD entries but those in the intervention group were more likely to have referred to the
revalidation standards for their CPD. As assessors, we too found the process of selecting
and assigning revalidation standards to individual CPD entries burdensome and
somewhat unspecific.
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Donyai, et al. 2010
We believe that addressing the perceived barriers and drawing on the facilitators will help
deal with the apparent lack of engagement with the revalidation standards and have been
able to make a set of relevant recommendations.
We devised a model to explain and tell the story of CPD behaviour. Based on the concepts
of purpose, action and results, the model centres on explaining two types of CPD
behaviour, one following the traditional CE pathway and the other a more genuine CPD
pathway.
Entries which scored higher when we applied the CPD Outcomes Framework were more
likely to follow the CPD pathway in the model above. Significant to our finding is that
while participants following both models of practice took part in this study, the CPD
Outcomes Framework was able to change peoples CPD behaviour to make it more inline
with the CPD pathway.
The CPD Outcomes Framework in defining the CPD criteria, the training pack in teaching
the basis and use of the Framework and the process of assessment in using the CPD
Outcomes Framework, would have interacted to improve participants CPD through a
collective process.
Participants were keen to receive a curriculum against which certainly CE-type activities
could be conducted and another important observation relates to whether CE has any role
to play in pharmacy professionals revalidation.
We would recommend that the CPD Outcomes Framework is used in the revalidation of
pharmacy professionals in the future provided the requirement to submit 9 CPD entries
per annum is re-examined and expressed more clearly in relation to what specifically
participants are being asked to submit i.e. the ratio of CE to CPD entries.
We can foresee a benefit in setting more regular intervals which would act as deadlines
for CPD submission in the future.
On the whole, there is value in using CPD for the purpose of pharmacy professionals
revalidation in the future.
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Donyai, et al. 2010
Acknowledgements
This study was supported by the RPSGB with Department of Health funding. We thank Dr
Candice Stockton at the University of Reading for her assistance during the initial process of
grant application. We would like to thank the RPSGB research steering committee, including
Dr Andreas Hasman and of course all current members including Beth Allen, Janet Flint and
Sadia Khan and in particular Professor Christine Bond and Dr Peter Wilson for supporting the
fruition of our initial proposal. We extend a special thanks to a number of CPPE staff
including its Director, Dr Chris Cutts, office manager Julie Kennedy and a host of CPPE tutors
for sanctioning the recruitment of study participants from a variety of venues hosting joint
CPPE-RPSGB CPD workshops during July and September 2009. We are of course grateful for
the contribution and input of all participants in this study, regardless of the degree of their
involvement. A special thanks to all colleagues in the Pharmacy Practice Department at
Reading School of Pharmacy for their unfailing support.
The Principal Investigator would also like to extend a special thanks to Dr Paul Weeks for
facilitating time management.
There are things we can measure, like time, but yet our minds do not grasp their meaning. There
are things we cannot measure, like happiness or pain, and yet their meaning is perfectly clear to
us. Robert M MacIver.
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Donyai, et al. 2010
Contents
Abstract .................................................................................................................................................... ii
Acknowledgements .................................................................................................................................. iv
Contents ................................................................................................................................................... v
Chapter 1: Introduction ............................................................................................................................. 1
Chapter 2: Literature review ...................................................................................................................... 6
Chapter 3: Design and methodology ........................................................................................................ 17
Chapter 4: Results ................................................................................................................................... 21
Chapter 5: Discussion ............................................................................................................................. 26
Chapter 6: Summary, main conclusions, and recommendations ............................................................... 33
References .............................................................................................................................................. 35
Appendix 1 ............................................................................................................................................. 38
Annex C: The GPhC Standards of proficiency for pharmacy professionals .......................................... 38
Appendix 2 ............................................................................................................................................. 52
Annex E1: GPhC Continuing Professional Development Standards and Framework ............................ 52
Appendix 3 ............................................................................................................................................. 60
Tables, figure and box relating to the literature review ......................................................................... 60
Appendix 4 ............................................................................................................................................. 84
Planned interventions .......................................................................................................................... 84
Flow of participants ............................................................................................................................ 85
Appendix 5 ............................................................................................................................................. 86
Ethical application .............................................................................................................................. 86
Appendix 6 ............................................................................................................................................. 89
Letter to Director of CPPE .................................................................................................................. 89
Appendix 7 ............................................................................................................................................. 92
Recruitment documentation ................................................................................................................. 92
Appendix 8 ........................................................................................................................................... 100
Seeking initial opinions on the face-validity, clarity/complexity, user-friendliness of the CPD Outcomes
Framework........................................................................................................................................ 100
Appendix 9 ........................................................................................................................................... 116
Seeking to verify the content of the CPD Outcomes Framework using the Content Validity Index ..... 116
Appendix 10 ......................................................................................................................................... 118
Quality assuring the training material: internal reviewer feedback form ............................................. 118
Appendix 11 ......................................................................................................................................... 124
Instructions for submission of CPD records ....................................................................................... 124
Appendix 12 ......................................................................................................................................... 128
The printed material sent to the intervention group.......................................................................... 128
Appendix 13 ......................................................................................................................................... 192
The printed material sent to the control group ................................................................................. 192
Appendix 14 ......................................................................................................................................... 198
Template used for scoring the CPD entries ........................................................................................ 198
Blank template for assessment of CPD cases ..................................................................................... 199
Appendix 15 ......................................................................................................................................... 200
Scoring by two pharmacist raters ....................................................................................................... 200
Appendix 16 ......................................................................................................................................... 202
Information relating to the focus group interviews ............................................................................. 202
Appendix 17 ......................................................................................................................................... 208
Information relating to the telephone interviews ................................................................................ 208
Appendix 18 ......................................................................................................................................... 212
Exploring the data using quantitative analyses ................................................................................... 212
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Donyai, et al. 2010
Appendix 19 ......................................................................................................................................... 218

Quantitative analyses: confirming the experimental effect ................................................................. 218
Appendix 20 ......................................................................................................................................... 225
Qualitative analyses: generating a new model of CPD behaviour ....................................................... 225
Appendix 21 ......................................................................................................................................... 233
Qualitative analyses: Feedback about the CPD Outcomes Framework and participants experience with
the study ........................................................................................................................................... 233
Appendix 22 ......................................................................................................................................... 238
Interpretation and explanation of quality scoring of CPD entries ........................................................ 238
Appendix 23 ......................................................................................................................................... 241
Interpretation and experience of Revalidation Standards in CPD........................................................ 241
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Donyai, et al. 2010
Chapter 1: Introduction
Background
Continuing Professional Development (CPD) in broad terms refers to the idea that learning
continues throughout ones professional career, through educational courses, work
experience and practice.1, 2 CPD is not the same as continuing education (CE) alonewhich is
the more traditional approach to learning via structured educational activities such as
lectures, workshops, and distance-learning courses.3 Underlining CPD in pharmacy is the
notion that professionals can take responsibility for their own learning, behaviour and career
development.4 As a process, CPD centres on experiential learning, which Kolbs model
simplifies into a cycle of reflection, planning, action, (recording) and evaluation. 5
Documentation is an integral part of CPD and a personal portfolio can be used for this
purpose.6 For pharmacists in Great Britain (GB), a CPD template supported online by a
bespoke website Plan & Record (and also available in print) is recommended by the Royal
Pharmaceutical Society of Great Britain (RPSGB) at the present time (September 2010).7
A consultation with GB pharmacists in 1996 identified potential for CPD to be introduced and
made mandatory for all those registered with the RPSGB.8 CPD was piloted in 1999 and
together with an approved recording format CPD was introduced to the pharmacy profession
during 20022004.9 Subsequently, amendments to the Pharmacy Code of Ethics replaced a
previous requirement to undertake 30 hours of CE with a CPD requirement and since January
2005 all pharmacists and pharmacy technicians registered with the RPSGB have given an
annual undertaking to comply with CPD requirements.10 Currently, all GB-registered
pharmacists and technicians must complete a minimum of 9 CPD record (entries) each year.11
Internationally too, there has been a shift towards CPD from traditional models of CE.12 The
International Pharmaceutical Federation (FIP) adopted the concept of CPD in 2002 describing
it as the responsibility of individual pharmacists for systematic maintenance, development and
broadening of knowledge, skills and attitudes, to ensure competence as a professional, throughout their
careers.13 One of the reasons for the shift towards CPD is the limited evidence of effect of
formal CE activities on the behaviour of the practitioner.14 But CPD could also be useful in
helping to assess pharmacy professionals fitness-to-practise.
While the RPSGB has traditionally acted in both a professional and a regulatory capacity,
from the end of September 2010 a new regulatory body, the General Pharmaceutical Council
(the GPhC), will oversee the regulation of all pharmacy registrants (pharmacists and
registered pharmacy technicians) in GB. The GPhC will become responsible for supporting
CPD, which will become a statutory requirement for pharmacy registrants 15, but the GPhC
will also gain responsibility for the revalidation of pharmacists and technicians. Revalidation
of statutorily-regulated health professionals in GB relates to arrangements that will enable
them to periodically demonstrate their continued fitness-to-practise. To prepare for
revalidation, the RPSGB in 2009, guided by the recommendations of the Department of
Health Non-Medical Revalidation Working Group and its own Revalidation Advisory Group
(RAG) report, agreed to a set of ten principles to underpin revalidation design and delivery in
pharmacy.16 Among the principles were the requirements that the process of revalidation
should be effective and cost-effective, evidence-based and standards-based and be consistent
across the country. The recommendation to Ministers from the Non-Medical Revalidation
Working Group stipulated that CPD may provide part of the supporting evidence that a
practitioner submits to the regulator as part of the revalidation process.
This
recommendation was reflected within the RPSGBs submission to the Department of Health
in February 2009. Within the principles for implementation of revalidation in pharmacy the
RPSGB argued that:
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Donyai, et al. 2010
*w+here appropriate, effective connections should be made between existing evidence

and the revalidation process. Existing evidence can take the form of records of Continuing
Professional Development *CPD+, or other sources of evaluative information on professionals
performance and practice.
Although CPD has potential to form the basis of revalidation and has been used in the New
Zealand model of pharmacy recertification 17 the RAG report also concluded that gaps in
current knowledge necessitated further research to examine the usefulness of CPD in a GBbased pharmacy revalidation model. In addition, despite the gradual introduction of CPD to
pharmacy in GB, and a professional requirement to comply, there is evidence to suggest that
pharmacy professionals in GB are yet to engage fully with CPD.18 What is more, recent
research has brought into questions the contribution that CPD can make to pharmacists
practice 19 with some suggesting practice is best monitored using peer assessment instead. 20
However, new guidance issued in the Pharmacy Code of Ethics brings this line of argument
(that CPD may not contribute to pharmacy professionals practice) into question and renders
it somewhat redundant. The guidance states that in order to adhere to the principle develop
your professional knowledge and competence pharmacists must do so in a way that is
relevant to their field of practice and they must also record how their CPD has contributed to the
quality or development of their practice using the Societys CPD framework.11 Thus whether CPD per
se can contribute to a pharmacists practice is no longer a matter for discussion because this
new concept implies it is not CPD until and unless it has been shown to contribute to the
pharmacists practice, in a relevant manner. The new guidance presents a clear shift in
paradigm, placing an expectation on pharmacy professionals to demonstrate CPD outcomes
to substantiate the validity of their CPD, where CPD outcomes can be conceptualised as CPD
relevance and CPD effectiveness.
The pertinent question now relates to whether pharmacy professionals can be guided to
conduct CPD that is relevant and effective, using the RPSGB CPD framework of Plan &
Record. And whether pharmacy professionals can construct their CPD records in a manner
that allows the entries to be assessed for their relevance and effectiveness. While CPD
records normally capture an individuals process of professional development, for
revalidation to be successful individuals must also demonstrate evidence of their continuing
fitness-to-practise through tangible outcomes. In this regard, the record itself becomes an
output and a proxy measure of outcomes. CPD records must therefore provide evidence of
the impact of CPD on the individual, their actions and ultimately if possible patient care
through the recording of relevant outcomes. If the CPD record is considered an output of the
process of CPD, the authors believed that an Outcomes Framework could be used to guide
individuals to bridge the gap between the process of their CPD (resulting in the output) and
the actual outcome in practice. What ultimately is required from a CPD record is for it to
demonstrate that patient care has benefitted in some way in the context of safety, quality
and efficacy in terms of tangible outcomes. An Outcomes Framework has in fact been
implemented by the Pharmacy Council of New Zealand, where pharmacists are expected to
use an Outcome Credit Scale as a measure of the benefit to patients and/or improvement in
patient safety as a result of CPD undertaken as part of recertification.17 Similarly, the
General Dental Council in the UK has implemented a points system for dentists CPD
records for revalidation, which enables these practitioners to pass against various
practice/risk-dependent thresholds.21
At the outset of this project, the RPSGB began developing and consulting on new
revalidation standards for future use in CPD on the premise that a set of practice standards
would be necessary to enable revalidation judgements on fitness to practise. It must be
emphasised that these revalidation standards were in draft format at the time. A new set of
CPD standards were also devised. At the time of commissioning, these draft standards were
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Donyai, et al. 2010
awaiting preparation and in fact were launched at BPC in Sept 2009 and then online in Oct
2009. See Appendix 1 for the version of the revalidation standards (also referred to in this
study as proficiency standards) and Appendix 2 for the version of CPD standards available at
the start of the study and again used throughout. A distinct feature of the current project
was the requirement to explore the applicability and sustainability of the use of these
revalidation standards within the RPSGB CPD framework (Plan & Record). The RPSGB was
awarded a grant by the Department of Health to investigate evidence for revalidation, and we
were subsequently commissioned by the RPSGB to explore the value of CPD for revalidation
of pharmacy professionals in GB. Based on the New Zealand model, we proposed to develop
a bespoke CPD Outcomes Framework to guide participants in the completion of their CPD
against the RPSGB revalidation standards. In this way we set out to help pharmacy
professionals conduct and demonstrate the practical application of their CPD in terms of
safety, quality and effectiveness where possible in relation to patient care, or as stated above
through the concepts of relevance and effectiveness.
Aims and objectives

Specific objectives included:
Identifying areas or groups of registrants in which implementation of the RPSGB
CPD framework is most and least advanced
Our objective was to address this point via a thorough and directed search of existing
research, to result in the synthesis of a considered critique of the findings in the context of
this question.
Identifying if current barriers to CPD uptake would jeopardise the use of CPD in
revalidation
Our objective was to address this point via consideration of the evidence gathered as part
of the literature search and careful analysis of the findings in relation to this question.
Explore the applicability and sustainability of the use of revalidation standards
within the CPD framework
Our objective was to address this point via empirical research that would examine the
applicability of the revalidation standards to the conduct and construction of new CPD
records. The team proposed to produce and test an Outcomes Framework to guide
participants through the process of completing CPD using the revalidation standards.
The above objective was also to be addressed through in-depth analysis of transcripts of
focus-group interviews with the study participants.
Review the current content of CPD portfolios to assess the overall strength and
quality of existing information, and information gaps for the purposes of
revalidation
Our objective was to address this point via empirical research that would examine the
discourse of current CPD entries in relation to the new revalidation standards with a
specific aim of identifying any information gaps.
Produce recommendations, based on evidence garnered and analysed, on the
appropriateness of existing CPD frameworks as the basis of revalidation or as
support documentation for the revalidation process.
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Donyai, et al. 2010
Our objective was to address this point via the collation and analysis of the literature and
empirical evidence gathered through the course of the research to form a concrete set of
recommendations about the appropriateness of the existing CPD frameworks as part of
revalidation.
Summary of chapters
Summary of Chapter 2: Literature review
This chapter outlines a comprehensive review of the published literature to chart the
participation and beliefs of pharmacy professionals in GB in relation to CPD in a decade
(2000-2009) that had seen a formal transition from CE to CPD requirements. The
implications of the findings, which primarily concern the decade in question, are related to
regulatory, professional, work-related and ultimately personal responsibilities, resulting in a
set of recommendations for each.
Summary of Chapter 3: Design and methodology
We set out to conduct the practical element of this work with volunteer pharmacy
professionals who would join as study participants. We proposed to develop a CPD Outcomes
Framework accompanied by training material to guide participants in the completion of their
CPD against the revalidation standards. To fulfil the objectives of this study, we wanted
participants to submit CPD entries before and after receipt of the Outcomes Framework (or
CPD and revalidation standards only) to enable assessment of the impact of the standards on
both the conduct and the writing of CPD records. Participants would also be invited to
attend focus group interviews in order to discuss their experience of participating in the
study and their understanding of CPD in light of the new revalidation standards. This
chapter explains the methods used with cross reference to the appropriate Appendices.
Summary of Chapter 4: Results
Having outlined the manner in which the study was conducted, the results were presented
under two distinct headings relating to the quantitative analyses of the entries as well as the
qualitative interpretative analyses conducted with the entries and the interview transcripts.
A separate section examines the usability of the revalidation standards. We examined the
impact of the CPD and revalidation standards (with and without the training related to the
CPD Outcomes Framework) on both the conduct and the writing of CPD records in this
parallel-group before and after experiment. It must be emphasised that these revalidation
standards were in draft format at the time. The primary outcome measure for the
quantitative analyses was the CPD score obtained by averaging the ratings assigned by the
two investigators. We also wanted to identify gaps in relation to revalidation. We used
grounded theory analysis to examine the CPD entries, and thematic analysis to examine the
transcripts of the focus group interviews and the transcripts of the phone interviews to
devise and further validate a model to explain CPD behaviour. In relation to the revalidation
standards, we looked both at the use of these standards by the participants as well as
participants feedback about the standards. This chapter outlines the results with cross
reference to the appropriate Appendices.
Summary of Chapter 5: Discussion
We completed a comprehensive literature review of the literature, devised, validated and
tested the impact of a new CPD Outcomes Framework and related training material in an
empirical investigation involving volunteer pharmacy professionals and also spoke with our
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Donyai, et al. 2010
recording and to gain feedback on the study itself. This chapter outlines our commentary
and interpretation of those results with final recommendations according to the initial aims.
Summary of Chapter 6: Summary, main conclusions, and recommendations
Based on the findings of this study and our interpretations we made a series of conclusions
and recommendations against the original objectives of this research. This chapter outlines
those conclusions.
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Donyai, et al. 2010
Chapter 2: Literature review

We wanted to investigate how pharmacy professionals had engaged with and received CPD
across the pharmacy sectors in the past decade, in order to identify existing barriers that
could hinder the use of CPD in revalidation.
The first objective of this project was to identify areas or groups of registrants in which
implementation of the RPSGB CPD framework has been found to be most and least advanced.
Pharmacists in the GB have been encouraged to participate in CPD activities for at least a
decade and there is a body of literature in the public domain (as well as smaller unpublished
studies) that has attempted to deal with levels of participation in CPD within the profession.
We proposed to conduct a full and thorough search of the literature, including the grey and
unpublished literature, to identify relevant studies for inclusion in a literature review. Our
objective was to pool together the findings from these studies into an informed review article
that maps patterns of CPD participation in the period before and since the introduction of
the RPSGBs CPD framework. The second objective of this project was to identify if current
barriers to CPD uptake would have the potential to jeopardise the use of CPD in revalidation.
We proposed to collate existing information on patterns of pharmacy professionals CPD
behaviour, to include studies that have identified current barriers to CPD. We set out to
critically examine the barriers in relation to their hypothesised removal and the potential
impact that might have on CPD behaviour.
The work outlined above was written as a manuscript of a comprehensive literature review
for submission to a peer-reviewed journal. Accordingly, the contents of this chapter have
been presented in the style of this manuscript as: aim of the review, methods, results,
discussion and conclusions.
Aim of the review
The aim of this review was to comprehensively examine the published literature to chart the
participation and beliefs of pharmacy professionals in GB in relation to CPD in a decade
(2000-2009) that had seen a formal transition from CE to CPD requirements. Three specific
questions guided our review:
1. What has been the range of views expressed by pharmacy professionals in relation to
CPD?
2. What has been the uptake of CPD in pharmacy?
3. In what way could the potential barriers to CPD uptake jeopardise the use of CPD in
revalidation?
Methods
A comprehensive search of the published literature was conducted to identify all studies that
had examined the uptake of or attitudes towards the CPD process across the different sectors
of the pharmacy profession in GB from 2000-2009, to cover the decade during which CPD
was formally introduced and integrated into pharmacy. Separately, letters sent to the
Pharmaceutical Journal were analysed to identify any additional themes.
Information sources and searches

During September to December 2009 (with an additional search in August
following academic databases were searched for articles published between 2000
Medline, Cochrane Library, Cumulative Index to Nursing and Allied Health
(CINAHL) and International Bibliography of the Social Sciences, Zetoc, British
2010) the
and 2009:
Literature
Education
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Donyai, et al. 2010
Index (BEI), Educational Resources Information Centre (ERIC), and Australian Education Index
(AUEI). An extensive search of the pharmacy specific literature was also conducted by
searching the following journals: Pharmacy Practice, the Pharmaceutical Journal (PJ) and
Pharmacy Education, to include where possible conference proceedings from Health Service
Research and Pharmacy Practice (HSRPP), British Pharmaceutical Conference (BPC), and
International Social Pharmacy Workshop (ISPW).
In addition, the search engine
GoogleScholar as well as the database of the National Electronic Library for Medicine
(NELM) were used in an attempt to capture studies published online not at first identified by
the more traditional means. The reference lists of all the critical articles were scanned to
check for other important studies that may have been missed via the database searches.
A variety of search terms was constructed for use within the databases including pharmacy,
pharmacist, education professional retraining, continuing pharmacy education, professional
development, learning, reflect, continuing education, CPD, continuing professional
development, professional portfolio pharmacy, work based learning, continuous professional
development and combined suitably according to the database used.
Study selection
The titles and abstracts of all articles and conference presentations were scanned and studies
of any design that had examined either the attitude of pharmacists to CPD or the uptake of
CPD in pharmacy in GB published from 2000 to 2009, inclusive, were included for initial
review by a research assistant under the guidance of the lead author (PD). Studies that were
identified as potentially relevant were initially screened (1329) after duplicates were
removed. A total of 54 articles, abstracts and research papers were selected for full-text
assessment from which 22 were included in this review after screening by two reviewers (a
research assistant and the lead author, PD) (see, Appendix 3, Figure 1 for a flow diagram
outlining the steps). The selected articles met at least one of the main criteria for this review
by presenting data on barriers or facilitators and attitudes in relation to pharmacy
professionals participation in CPD and/or mapping engagement with and uptake of CPD in
pharmacy in GB.
The methodology that had been adopted in the papers included quantitative research using
postal/emailed questionnaire surveys and qualitative research using mainly semi-structured
interview techniques. We chose to include papers with differing epistemology because we
wanted to capture the breadth of themes relating to CPD barriers rather than to measure and
quantify them. Some of the papers were investigating attitudes to CPD as part of a related
learning intervention. The majority of studies focused on pharmacists (rather than
technicians) and their engagement with and perceptions of CPD. Community pharmacy was
the main area of focus but some studies had examined other sectors or compared CPD
between sectors. Until recently pharmacy technicians have not been the subject of much
focus but two studies did examine this cohort.
A comprehensive search of PJ returned a variety of letters of communication and
commentaries sent to the journal, which were examined separately in this review for
identification of additional relevant themes.
Exclusion criteria
In relation to research papers, studies were excluded if the focus was on a different group of
health professionals with no orientation towards pharmacy. Papers were excluded if the
focus was simply on CE or professionalism per se or if the focus was only on the pharmacy
student cohort. Studies were also excluded if the country of focus was outside of GB; i.e.
studies conducted in Northern Ireland were excluded. In addition, papers were excluded if
the focus was purely on sub-sets of skills usually associated with CPD, such as reflective
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Donyai, et al. 2010
learning by itself, or on actual content relating to CPD, for example learning clinical
pharmacy. We did not include in the review a study examining feedback on CPD provided by
RPSGB because this very specific study did not investigate general attitudes to CPD but was
instead a form of satisfaction with feedback study. We did nonetheless acknowledge the
contribution of this study to the field in the discussion section of this paper. We did not
include any studies published or relating to the period before 2000 but viewed them as
providing context ahead of the launch of CPD. This review forms part of a bigger
investigation into CPD and while some studies were excluded from this review, they were
retained for use in the overall project.
Data abstraction and synthesis

A grid was created to record the summaries of the articles for further literature
synchronisation and later construction of the literature review. This initial tabulation
presented information on study characteristics as the year study was conducted; main study
design and method of data collection; sector of pharmacy; geographical location of the study;
the sample size; and a brief summary of the aims. It was not possible to use the PICOS
(participants, interventions, comparisons, outcomes, and study design) categorisation 22
because the studies were not necessarily interventional in nature. Instead quality scoring of
the articles was attempted in accordance to the recommendations of the Qualitative
Assessment Review Instrument (QARI) 23 (suggested by the Cochrane Collaboration). The
QARI criteria concerned: (1) congruity between the stated philosophical perspective and the
research methodology, (2) between the research methodology and the research question or
objectives, (3) between the research methodology and the methods used to collect data, (4)
between the research methodology and the representation and analysis of data, (5) between
the research methodology and the interpretation of results; (6) whether there was a
statement locating the researcher culturally or theoretically; (7) whether the influence of the
researcher on the research, and vice-versa, was addressed; (8) adequate representation of
participants and their voices; (9) whether the research was ethical according to current
criteria or, for recent studies, evidence of ethical approval by an appropriate body; (10)
conclusions drawn in the research report appearing to flow from the analysis, or
interpretation, of the data. The number of QARI criteria met by each study was highlighted
within the results section (See Appendix 3, Table 1).
For the main analysis, data from papers included in the review and relating to facilitators and
barriers to CPD were grouped into eight broad categories and presented in eight separate
tables.
Data relating to pharmacy professionals activities or use of resources for
participating in CPD were also tabulated. In the last table, data relating to actual
participation in CE or CPD were shown for the different sectors of practice.
The letters from the Pharmaceutical Journal were examined in detail for new themes that
had not appeared in the formal literature. The results were presented narratively.
Results
Twenty two studies met the criteria for inclusion in this review and were therefore selected
for analysis (see Appendix 3 Table 1). No systematic reviews were identified. This section
summarises the results of the 22 core studies, which used both qualitative and quantitative
methodology to investigate the views and/or participation of pharmacy professionals in CPD
in GB within a ten-year period (2000-2009). Letters and commentaries from PJ were analysed
separately for identification of new additional themes.
Thirteen research papers met the inclusion criteria; seven of which drew on the idiographic
approach to knowledge construction, using qualitative interview and focus-group methods
or an analysis of answers to open questions 19, 24-29 while six of the thirteen studies followed a
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Donyai, et al. 2010
nomothetic approach using the quantitative survey method.18, 30-34 However, only three of
the thirteen research papers had been published in an indexed journal. 18, 31, 33 Six conference
abstracts or papers were identified, with four having used a qualitative approach 35-38 and two
a quantitative approach39, 40 to the research. In total six of the studies included in this review
(i.e. from the 13 papers and 6 conference abstracts mentioned above) evaluated CPD as part
of another programme or intervention related to CPD and learning.26, 27, 38, 40 Two news items
reporting the outcome of RPSGB surveys were also included in this review 41, 42 as was the
report of a relatively recent RPSGB-commissioned study by the PARN (Professional
Associations Research Network) consultancy firm (which compared data with other
professionals surveyed at the same time).43 None of the 22 studies that had met the inclusion
criteria were excluded on the basis of quality alone, but quality was expressed as the number
of QARI criteria met by each study and also considered in the discussion of our findings.
The facilitators and barriers to CPD were grouped into eight broad categories of time,
financial costs and resource issues, understanding of CPD, facilitation and support for CPD,
motivation and interest in CPD, attitudes towards compulsory CPD, system constraints, and
technical problems as described below.
Time as a facilitator or barrier to CPD

Time is a very strong and constant theme that appears throughout the decade in most of the
studies examined (see Appendix 3 Table 2). The main concern expressed by pharmacists is
that CPD takes time to conduct and document and that in the absence of protected CPD-time
at work, time itself becomes a barrier to CPD.28 This is especially in the context of people
whose personal lives take a higher priority over CPD, or whose high workload simply means
learning outside of work hours (e.g. in the evening) becomes unfeasible. 28, 35 Time as a
barrier also featured in the two studies focussed on examining technician views. 29, 40 A lower
proportion of pharmacy professionals who responded to the PARN survey conducted CPD at
work compared to other professionals surveyed, with a higher proportion of the pharmacy
respondents conducting CPD in personal time.43
Financial costs and resources as facilitators or barriers to CPD

Lack of financial support, for example to enable the employment of a locum to cover for time
taken out of work for CPD, was also seen as a barrier to participation in CPD (see Appendix 3
Table 3) and in one study there was a suggestion that part-time workers25 and in two studies
that locums themselves particularly lost out on employer help in this way. 25, 35 This was
juxtaposed with a minority view expressed in one study that development should take place
in ones own time.25 According to the PARN report a lower percentage of pharmacy
professionals claimed their employer pays for their CPD compared to other professionals,
with a greater percentage of pharmacy professionals (compared to other professionals)
conducting CPD that was free of charge.43 Where CPD was paid for by the employer, in
pharmacy it seemed employers were more accepting in terms of the content and cost of the
CPD.
Understanding CPD as a facilitator or barrier to CPD

In terms of understanding CPD, a range of issues were outlined early in the decade including
the distinction between CE and CPD and generally lack of information about CPD, what it
entails, how to record it and how much to record (see Appendix 3 Table 4). There were also
concerns and difficulties expressed in relation to distinct stages of CPD such as assessing own
learning needs, as well as problems identifying resources to meet the learning needs,
reflection, and evaluating ones learning. Feedback from participants about one protected
time scheme indicated it increased participants understanding of CPD. 37 In a study
conducted around the middle of the decade, pharmacists in Scotland reported feeling
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Donyai, et al. 2010
comfortable with identification of learning needs and assessing the value of what they had
learnt and with applying it to practice18, and a study conducted in 2006/2007 reported the
main benefit of the CPD process related to pharmacists increased understanding and use of
reflection, compared to CE.24 However, studies conducted as late as 2007 and 2008 still
reported confusion over what to record, how to record it, difficulty with choosing
competencies (to relate to ones CPD) and what counted as CPD. Pharmacy technicians were
also reported to have faced uncertainly about how to record CPD.40
Facilitation and support for CPD as a facilitator or barrier to CPD

Early in the decade, pharmacists expressed a consistent need for training and facilitation (see
Appendix 3 Table 5). One study providing participants the opportunity to interact with a
facilitator reported it was useful in overcoming the initial CPD inertia 37 and another
examining a CPD development toolkit recommended example documentation of CPD
activities to be made available as a future resource.38 The role of the departmental head in
introducing and supporting CPD was deemed vital in one study conducted in the middle of
the decade,26 when along similar lines another study found pharmacists relied on one
another for guidance with CPD.25 Respondents in a Scottish study conducted around
2005/2006 also needed more support for CPD18 and a paper examining pharmacy technicians
views around the same time discovered technicians did not seem to have received any
training on how to undertake CPD within the formal technician-training courses.29
Motivation and interest in CPD as a facilitator or barrier to CPD

Motivation (lack of) was a barrier to undertaking CPD (see Appendix 3 Table 6). In the first
half of the decade some pharmacists were apathetic towards CPD, some even viewed CPD as
a waste of time, while others sought external motivation from employers and some felt
mandatory CPD would act as the catalyst towards their engagement in CPD. 28 Some
pharmacists queried the relevance of CPD once their career had reached a plateau. 28 A range
of positive benefits were also identified including the CPD as a record of achievements and a
tool for use in interviews and for negotiating performance-related pay, with community
pharmacists mentioning better job satisfaction.28 Other factors investigated related to
personal development, improved knowledge, competence and career progression, better
outcomes for patients and work and the enhancement of the status of the profession.32 In
one study, most of those who saw no benefit to CPD were not undertaking any CE or CPD.33
Researchers investigating the association of personality types with portfolio keeping found a
statistically significant association with the personality traits conscientiousness,
agreeableness and emotional stability (measuring low on the neuroticism scale).31 The
same research group also reported an inability to link CPD with enhancing practice in
hospital pharmacy had caused disillusionment with the CPD process.19 The second half of
the decade saw a general trend towards accepting CPD. In one study the recently qualified
were more comfortable with reflective practice, and while some found portfolios a threat,
others found them motivational.26 Some pharmacists had used CPD to support movement
between sectors.25 In the main primary care pharmacists had the most confidence, ability
and resource to participate in CPD, followed by hospital and then community pharmacists.18
All the technicians interviewed in one study, despite lack of initial training, had learnt about
and were recording CPD.29 One study reported predominantly positive views about CPD but
this did not necessarily correlate with CPD recording as a behaviour. 24 Respondents to the
PARN report were mainly positive towards CPD; the main motivations for participating in
CPD were reported as professional/regulatory requirement, professional duty, improvements
to current performance and development as a person. The majority agreed CPD had been
important to the development of their career.44
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Donyai, et al. 2010
Attitudes towards compulsory CPD as a facilitator or barrier to CPD

Attitudes to mandatory CPD were investigated from the beginning of the decade (see
Appendix 3 Table 7). There was general consensus that, even if not necessarily made
mandatory, pharmacists should be engaging in CPD28 , certainly those whose job is only
satisfied by the employment of a pharmacist.42 A variety of reasons have been cited24 and in
one study compulsory CPD was deemed more important for the profession as a whole and for
personal development than for career progression and general departmental/business
objectives.32 One study found participants unhappy with mandatory CPD and the concept of
non-practitioners assessing records, preferring peer-review or assessment with a local mentor
instead.35 Not many pharmacists agreed that the performance of CPD should be assessed
independently and less than half disagreed pharmacists can remain professionally competent
without any CPD.30 In one study around one-tenth of the respondents thought CPD should
apply to inactive pharmacists.42
Concerns were expressed in numerous early studies about the practicalities of operating a
system of mandatory CPD and fears that it would create an exodus from the profession or
become a form filling exercise.31, 32 In one study pharmacists expressed disdain at the
introduction of mandatory CPD citing a feeling of intimidation and a compulsion to leave the
profession27 and in another a minority found the process of recording CPD patronising and
the intimation of not practising CPD principles in the absence of recording as insulting, with
some (mainly those near retirement) wanting to cease practice and some to focus on
practising in just one of the pharmacy sectors.25 A study in 2008 identified that the concept
of a review by another person was a barrier to CPD.36 In fact in one study conducted after the
introduction of mandatory CPD a minority of participants believed the obligation of CPD in
itself was acting as a barrier to their participation in learning.24
Researchers also investigated opinions about sanctions against those neglecting to meet CPD
requirements.33 While in one study one-fifth of respondents (most of whom were locums or
proprietor pharmacists) stated no action should be taken, with less than 2% suggesting
removal from the register 33, in another study one-tenth of the pharmacists surveyed agreed
failure to complete 30 hours of CPD should lead to removal from the register.30 In the latter
study, only a little over half the respondents actually agreed to the (perceived) 30 hour-CPD
requirement [which should have been correctly defined as a 30-hour CE requirement] then in
operation, with part-time pharmacists, the self-employed, increasing length of registration
and those employed in independent pharmacies found more likely to disagree. In the 2008
PARN survey only 7% of respondents thought CPD should not be enforced by the RPSGB.44
System constraints as a barrier to CPD

Pharmacy professionals perception of system constraints has also appeared as a theme in
numerous studies investigating CPD in pharmacy (see Appendix 3 Table 8). In one early study
pharmacists thought the proposed system was restrictive and should instead permit the
employment of the learning activity the pharmacist chooses to pursue.27 From 2005
onwards, more practical constraints included difficulties with the online system and a
leaning towards written recordsone participant intimating the template in general made
the fabrication of entries feasible.25 More insightful comments concerned the inherent
limitations of the online system of Plan & Record in capturing real-practice situations, its
cumbersome and onerous nature, and an interesting view that the template had been
designed with assessment in mind rather than learning.24 A small survey of branch members
in 2007 reported Plan & Record was easy-to-use for those engaging with CPD.41 However,
those responding to the PARN survey seemed overall unenthusiastic about online tools for
the various stages of CPD with a higher percentage of negative comments than positive
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Donyai, et al. 2010
views.44 Nearly one half of respondents thought changing Plan & Record to a more
accessible format would encourage them to record CPD.
Technical problems as barriers to CPD

Technical issues have also acted as a barrier to CPD (see Appendix 3 Table 9). Pharmacists in
one study in 2001 reported access to the internet at work was crucial to mandatory CPD28
and in another study in 2005 women of all ages indicated not recording CPD online was due
to a lack of IT knowledge with some stating they did not have internet at work or home, and
when present there were competing demands on access to a computer (e.g. because of
dispensing).25 Access to the internet as a barrier to CPD has been mentioned in other studies
too24, 26 including one conducted with technicians in 2008.40
Pharmacy professionals activities or use of resources for participating in CPD

Pharmacists have engaged in a variety of activities for their CPD (see Appendix 3 Table 10).
Studies conducted at the beginning of the decade, around 2001 and 2002 when CE
requirements were still in place, showed pharmacists used reading as a main method of
learning with some attending CPPE courses and accessing distance-learning material as well
as work-shadowing and talking to experts.28 Other studies also investigated use of a variety
of other means such as postgraduate diploma courses, branch meetings, manufacturer
information/training, educational material from the National Pharmaceutical Association, the
internet and computer-aided learning 28, 33 with one study indicating hospital pharmacists
(compared to community pharmacist) undertook more direct learning (e.g. workshops rather
than reading).30 Hospital pharmacists and female pharmacists were also more likely to
undertake a training needs analysis.30 Writing papers and meetings were also mentioned in
another study in 2002, where only hospital pharmacists mentioned teaching as a method of
CPD and in comparison fewer community pharmacists mentioned in-house training or a
preference for small-group discussions.32 Teaching was also mentioned in a study conducted
in the middle of the decade.18 Pharmacists interviewed in 2005 also mentioned presenting
information at in-service sessions, which resulted from reflection and reading, as viable
CPD.26 The PARN survey presents the most recent research into pharmacists CPD practices,
and while informal/self-directed reading still occupy prime position, face-to-face learning,
work-based experiential learning, conferences, seminars, workshops also feature
favourably.44
Pharmacy professionals participation in CPD

Pharmacists engagement in CE activities at the beginning of the decade was generally below
the 30-hour requirement30, 33 with one study indicating female pharmacists, full-time
workers, hospital pharmacists and community pharmacists working for large multiples
conducted more CE hours30 and another finding hospital pharmacists conducted more CE
compared to their community counterparts.32 In a 2004 study only two-thirds of the
participants stated they kept a portfolio 31 and another study in 2005 found a not insignificant
minority of interviewees were not recording CPD despite reporting learning activities.25 In
one study, the recently-qualified and also those with responsibility for training others kept a
portfolio.26 Another study conducted mid-decade also found hospital pharmacists reporting
more CPD hours per annum compared to community pharmacists but in fact primary care
pharmacists conducted slightly more CPD hours than their counterparts working in
hospitals.18 A small-scale survey of branch members in 2007 indicated two-thirds had
engaged with CPD41, and respondents to the PARN survey mostly (84%) reported keeping a
CPD record with around a third indicating they kept 10 or more entries. 44 All 9 technicians
in a study in 200632 were recording CPD but acknowledged some pharmacy technicians
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Donyai, et al. 2010
might find CPD challenging and 70% of technicians evaluated after a CPPE workshop
indicated they had used their learning to create a CPD entry.40
However, a recently published questionnaire study conducted in Wales found 50% of
respondents (n = 473) stated they did not have up-to-date CPD records with 255 not having
recorded any CPD in that 6-month period only one-third had up-to-date CPD records39.
Letters from the Pharmaceutical Journal

For the purpose of analysis in this review, letters and comments were retrieved from the
column of letters or broad spectrum/features in the PJ; where pharmacy professionals
have a wide-reaching forum to express their personal views and commentaries on specific
topics relating to the profession. While only one letter was found for 2000 and eight in 2001,
the number of letters peaked in 2002 (40) with slightly less in 2003 (30) dropping in 2004 (14)
and 2005 (23) before settling again (3 in 2006; 3 in 2007; 7 in 2008 and 8 in 2009). Three
broad spectrum articles were also analysed. We deemed these letters and commentaries
valuable grey literature in particular because the PJ is also one of the major resources that
pharmacy professionals receive in relation to CPD. Thematic analysis was used to examine
the text of the letters and the results are presented here according to the themes identified.
Reflecting the formal literature
The topics of letters retrieved from the PJ reflect the findings of the current literature review
in terms of pharmacy professionals perceptions of and engagement in CPD in the last
decade. In particular, there was evidence of confusion in terms of the difference between
CPD and CE with some contributors stating they were more than happy to accept and
undertake CE but not CPD. Some would need guidance on documenting CPD records as well
as supportive feedback. Lack of time, technical problems, and lack of financial resources
were also expressed in the letters, including inflexibility of the CPD model, mirroring the
formal literature. However, new themes also emerged from examining the contributions and
comments in the PJ.
Minority members
Some minority groups have been identified and investigated in the formal literature such as
part-time pharmacists and those approaching retirement. However, in the letters some other
minority groups had found voice, for example, preregistration trainees and overseas
registrants of the RPSGB, who required guidance regarding CPD and better access to
resources that are available to the mainstream sectors (e.g. limited access to the Plan &
Record website). Academic and industrial pharmacists who have been largely neglected by
the formal literature were also able to express their views in the letters column. These
groups found it hard to document their CPD as most of their exercises were education-based
or did not fit the CPD model provided by the Society.
Looking forward
Recent contributions appear to be looking to the future. For instance, some were curious
about the capabilities of would-be CPD evaluators and qualification of their position was
requested. Interests were also shown in terms of the storage of members CPD files and in
terms of CPD as a major part of revalidation of pharmacy professionals. Resembling the
formal literature, technical problems were raised and assistance sought. However, recently
some pharmacists seem to be embracing new technologies, suggesting a variety of potential
technologies for CPD implementation (podcast) and documentation (email, and mobile phone
internet access).
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Donyai, et al. 2010
Discussion
This is the first comprehensive literature review to examine barriers to pharmacy
professionals participation in CPD in GB during the past decade (2000-2009). The barriers
have been categorised as time, financial costs and resource issues, understanding of CPD,
facilitation and support for CPD, motivation and interest in CPD, attitudes towards
compulsory CPD, system constraints, and technical problems. An absolute summary of the
findings is presented Appendix 3 in Box 1. It must be emphasised that this literature review
primarily concerns the decade investigated (2000-2009). While pharmacists on the whole
might agree with the principle of engaging with CPD there is little evidence in the literature
to suggest widespread and wholehearted acceptance and uptake of CPD, which would be
necessary before CPD could be reasonably expected to contribute to the universal
revalidation of pharmacy professionals in GB. However, we note with interest the following
extract from personal correspondence with an officer from the Regulation Directorate of the
RPSGB, which might indicate the beginnings of a shift in behaviour since the introduction of
call and review45:
There is anecdotal evidence of a change in attitude towards CPD since the RPSGB started calling
in and reviewing CPD records in July, 2009. During the first 6 months of the call and review
process, when just under 2,500 CPD records had been reviewed, the referral rate for noncompliance was just 1.5%. Furthermore, 80.3% of those who have had their records reviewed
achieved an overall assessment of excellent, meaning that for the entries reviewed they had
met 75% or more of the total assessable review criteria. A further 17.8% achieved an overall
assessment of good (between 50 and 74% of total assessable criteria met). This suggests that
the vast majority of the profession are now engaging with CPD and, when required to do so, are
comfortably meeting regulatory requirements.
The principal investigator (PD) has argued previously that it is peoples internal motivations
(identities and beliefs) that drive participation in developmental programmes.46 While a
number of pharmacists expressed negative personal attitudes towards CPD, the majority of
the research participants within the various studies seemed beset by the compound
interaction of barriers apparently outside of their control, such as time and resource issues.
A number of theories have been developed to examine the process by which people attribute
behaviour (including their own) to internal or external causes and there is now a large body
of evidence showing that peoples judgements about the causes of behaviour are not
completely rational but biased.47 A common observation is that people attribute successes
internally, as within their control, whereas failures are attributed externally to others or to
the circumstances, a concept captured by the term self-serving attribution bias.48 A selfserving bias is therefore said to exist where an individual's assignment of responsibility
affects his or her beliefs in an optimistic waya way that makes things appear better than
they are from the individual's point of view. We believe there may be an element of selfserving attribution bias at play in terms of pharmacy professionals stated barriers to CPD.
This importance of external influences would seem to indicate that making CPD a statutory
requirement would compel pharmacy professionals to engage with the process at some level.
Nonetheless, if CPD is to be truly successful, it seems that peoples beliefs and attitudes must
be addressed through the modification of the various other external barriers perceived to be
impacting on CPD behaviour.
The implications of the current findings can be considered as follows. If CPD is to succeed,
peoples beliefs and attitudes must be addressed by recognising and modifying barriers
through a combination of four main categories of regulatory, professional, work-related and
personal channels (see Appendix 3 Figure 2). We believe it is possible to draw on the current
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Donyai, et al. 2010
findings to suggest a number of remedial steps in relation to these categories so as to

ultimately impact on pharmacy professionals personal motivations and therefore
participation in CPD. In light of consistent and continuing difficulties with the CPD
recording template, anxieties expressed in relation to the process of review and the
difficulties with conceptualising possible consequences of non-conformance, we believe there
are three clear areas that must be addressed by the new regulatory body for pharmacy,
namely modifying the process of recording, explaining the process of record reviews and
clarifying the outcome of these reviews.
In addition and again grounded in the current research, there are three distinct implications
for the new professional body for pharmacy. In light of the perceived difficulties with
understanding the concept, conduct and application of CPD, firstly we believe there is scope
for further improvements to be made to the process of CPD facilitation. At the time of
writing this review very little information was available about RPSGB CPD facilitators other
than their potential availability as a last resort.49 We believe the new professional body for
pharmacy should offer appropriate CPD facilitation to help improve pharmacy professionals
understanding, conduct and application of CPD at an early stage. In addition, we believe
there must be scope for improving the current guidance documents and example cases as
well as explanatory courses. Interestingly, a study investigating satisfaction with RPSGB
feedback on CPD submitted by a specific group of pharmacy participants found the feedback
report had met or exceeded the expectations of 86% of respondents and 86% stated that they
felt fully or mostly able to complete CPD records in the future as a result of receiving
feedback50.
But these cannot be expected to be delivered in the absence of change at the regulatory level
so the direction of flow must be considered. Similarly, work-related aspects can only be
addressed following the suggested development of both regulatory and professional support
for CPD. Considering the issues related to time, resources and other key factors expressed in
the studies examined, we believe a top-down and universal change in ethos is required
throughout the pharmacy work environment. The change must look to ways that pharmacy
professionals can be supported in their CPD at work by means of protected CPD-time, such
that perhaps in due course CPD-time will be considered in the same vein as other essential
breaks from formal work. The second work-related proposal relates to employer support for
educational courses, either in-house or sponsored external training. The third and most
pertinent area related to work is of course the opportunity for application of CPD and its
integration in the workplace. Only then can pharmacy professionals be completely free of
the barriers that have hitherto hindered progress and impeded the universal uptake of a
programme designed for the continuous improvement of professional pharmacy practice.
Based on previous evidence, the benefits of direct experience of effective CPD are
hypothesised to impact on personal development, career development and of course on
others, for example patients and work colleagues, thus strengthening personal beliefs in the
value of CPD.
Weaknesses and limitations

Acknowledging the tendency for some pharmacy practice research to be published in the
grey literature, every effort was made to retrieve relevant studies but the authors
acknowledge the possibility of having failed to identify a less accessible paper. Also, the 22
studies that were identified and included in this review were of varied quality with only
three of the 13 full research papers having been published in an indexed journal, and six
conference papers/abstracts and two survey results expressed as news items in the PJ being
included in the review. Additionally, while the qualitative methodology would have
unearthed a variety of themes and topics for inclusion in this study, those papers would not
have provided sufficient evidence to confirm any empirical relationships. Similarly, while a
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Donyai, et al. 2010
number of studies using quantitative methodology would have demonstrated clear

relationships between the variable examined, these papers may not have captured all that
held meaning to the participants in situ by merely failing to ask all relevant questions.
Thus it was not possible to attach any meaningful weighting to quantify the relative
importance of the studies. An attempt was made to use the QARI tool to assess the quality of
the studies but none matched all of the quality criteria and in the absence of any one
benchmark paper the authors chose not to exclude any paper on the basis of quality alone
and indeed considered this was imperative in order to capture all possible themes relating to
perceived barriers to CPD. This approach was in line with the authors epistemological
position, which aimed to create meaning and understanding through an examination of a
breadth of knowledge conveyed in the literature. So instead the authors used the collective
knowledge to make sense and create an understanding of CPD attitudes and uptake for
derivation of the recommendations above.
Conclusion
A comprehensive review of the literature was conducted, which together with an
examination of the grey literature resulted in the categorisation of themes to portray
attitudes towards and uptake of CPD in pharmacy in GB from 2000-2009. The implications of
these findings can be related to regulatory, professional, work-related and ultimately
personal responsibilities. If CPD is to have any practical application in the process of
pharmacy professionals revalidation, there need to be coherent changes to current practice,
consistent with the evidence-based recommendations in this paper.
Additional closing remarks
In addition to the low uptake of CPD and the various barriers expressed by pharmacy
professionals, we have argued that the manner in which CPD is conducted and recorded is
also likely to be of paramount importance in the process of revalidation. For this reason, and
based on our next set of objectives, we set out to develop, validate and test a CPD Outcomes
Framework and a related teaching tool to guide pharmacy professionals in the conduct and
recording of their CPD.
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Donyai, et al. 2010
Chapter 3: Design and methodology

Foreword
While CPD records normally capture an individuals process of professional development,
for revalidation to be successful individuals must demonstrate evidence of their continuing
fitness-to-practise. We set out to conduct the practical element of this work with volunteer
pharmacy professionals who would join as study participants. We proposed to develop an
Outcomes Framework accompanied by training material to guide participants in the
completion of their CPD against the revalidation standards. In this way we hoped we would
help participants demonstrate the practical application of their CPD on patient care or
related outcomes in terms of safety, quality and effectiveness of practice. A decision was
made to also create a control group who would receive the CPD and revalidation standards
only. To fulfil the objectives of this study, we wanted participants to submit CPD entries
before and after receipt of the Outcomes Framework (and/or CPD and revalidation
standards) to enable assessment of the impact of the standards (with or without our CPD
Outcomes Framework and training) on both the conduct and the writing of CPD records.
Participants would also be invited to attend focus group interviews in order to discuss their
experience of participating in the study and their understanding of CPD in light of the new
revalidation standards.
Main Research questions and hypotheses

The aim of this element of the research was to investigate pharmacy professionals ability to
conduct and record their CPD in a manner that enables the CPD records to be used as part of
professional revalidation. We wanted to devise an Outcomes Framework and a bespoke
educational intervention to train pharmacy professionals to construct and conduct their CPD,
based on the new revalidation standards, in a manner that might prove meaningful and
quantifiable. We suspected CPD records submitted before the provision (or in the absence) of
the bespoke training would demonstrate greater gaps in terms of information required for
the process of revalidation. Our hypothesis was that after training pharmacy professionals
on how to use the new revalidation standards, specifically with the aid of an Outcomes
Framework, new CPD records would be constructed and recorded in a manner that would
demonstrate greater value for revalidation. In order to make this assessment, we had to
investigate the means by which revalidation through CPD could be measured and quantified.
We also hypothesised that participants experience of using the new revalidation standards
would be positive and that those exposed to the bespoke CPD Outcomes Framework would
be supportive of its use in CPD in the future. Specific objectives included:
Gaining ethical approval for the research from the University of Reading.
Developing a generic Outcomes Framework for use with the revalidation standards
during the conduct and reporting of pharmacists CPD which would also enable the
quantitative measurement of the value of CPD records.
Recruiting volunteer pharmacist and pharmacy technician participants through formal
CPD events
Collating volunteer CPD records to later examine against the revalidation standards as
well as the Outcomes Framework devised.
Training volunteer participants to complete CPD records using the revalidation standards
as well as the Outcomes Framework devised through distance-learning material, against a
defined control group who would receive the revalidation standards only.
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Donyai, et al. 2010
Collating the new CPD records and examining both before and after records against the
revalidation standards as well as the Outcomes Framework devised.
Holding focus group interviews with study participants.
Analysing the data using qualitative interpretive methods as well as quantitative scoring
against the Outcomes Framework.
Project plan
A description of planned interventions and a depiction of the flow of participants are shown
in Appendix 4.
Ethical considerations
An ethical application (see Appendix 5) was made to the Chair of the School of Chemistry,
Food Bioscience and Pharmacy ethics committee on 2 July 2009 and appropriate University of
Reading ethical exemption was granted on 15 July 2009.
Participants
Volunteer participants attending joint RPSGB-CPPE (Centre for Pharmacy Postgraduate
Education) CPD training workshops in Reading, Banbury, Southampton, Kingston-uponThames and Guildford were recruited to the study in July and September 2009. The
agreement of the Director of CPPE, Dr Chris Cutts was sought on 14 July 2009 and granted on
17 July 2009 (see Appendix 6 for copy of letter to Dr Cutts).
Workshop participants received information about the intended recruitment activity in
advance of the sessions, where one of the researchers (PD or AMA) was at hand to provide
information about the study. An information letter and a statement of frequently-asked
questions formed the basis of discussions and willing participants were recruited to the study
after completion of a consent form and demographics questionnaire (see Appendix 7 for
material relating to the recruitment process).
A total of 83 participants were recruited to the project (exceeding a recruitment target of 72).
Our aim was to retain at least 60 participants for the final analysis. A total of 61 participants
submitted their initial CPD records to the study team and 48 (25 control and 23
intervention) remained in the study to the end.
Research Instruments
We developed and validated a grid to enable quantitative scoring of the records against
revalidation standards and named it the CPD Outcomes Framework. One purpose of the
Outcomes Framework was to guide participants in the intervention group through the
process of completing CPD records, to test the frameworks impact as an intervention
compared to a control group (who received the CPD and revalidation standards only).
The Outcomes Framework was based on a theoretical construct relating to CPD relevance and
CPD impact and specifically Standard 4 of the GPhCs CPD framework: include in your record
CPD that is relevant to safe and effective practice and the Standards of Conduct, Ethics and Performance of
the profession and Standard 5: record how your CPD has contributed to the quality or development of
your practice and has benefited patients and the public as well as the Proficiency Standards (i.e. the
revalidation standards). The Outcomes Framework was developed as a means of both
helping participants with the conduct and construction of CPD records for revalidation as
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well as helping assessors to rate CPD records for revalidation. The Outcomes Framework was
tested for face and content validity, as explained below.
The face-validity, clarity/complexity, user-friendliness of the Outcomes Framework was
established by obtaining feedback from five volunteer academic pharmacist practitioners
who were presented with the documentation detailed in Appendix 8. The documentation
explained the conceptual basis of the Outcomes Framework and sought detailed comments
from the expert practitioners. Where possible, the suggestions received were incorporated
into the Outcomes Framework as part of its development.
The content validity of the Outcomes Framework was established using the Content Validity
Index (see Appendix 9 for rationale and results). Later, the CPD Outcomes Framework
training material (see below) was passed on to two independent internal reviewers for their
assessment and quality assurance (see Appendix 10 for the reviewer information).
Training material
Based on the initial framework we produced a comprehensive training package for the
intervention group, which used as its basis the Outcomes Framework together with 11 new
CPD case scenarios. This training was reviewed by two internal reviewers from within the
University, in line with other course-related QA practices. The aim of the training package
was to encourage learning via the application of knowledge (active learning). To this end, we
asked participants to read through a minimum number of case studies before assessing the
example cases using the Outcomes Framework. We also provided answers to these 11 case
studies. We presented the training package as an Adobe Acrobat file (.pdf with embedded
links), a series of PowerPoint Presentations (.ppt) including presentations with narration (i.e.
as video files .avi) as well as a full-colour print version.
Research procedures
Upon recruitment, participants deemed experienced at recording CPD were asked to submit
copies of 3 existing records. Those considered CPD beginners submitted one record, which
they were permitted to construct following the CPD workshop if none existed beforehand.
All initial entries were submitted by the end of October 2009. See Appendix 11 for
instructions for submission of CPD records, as sent to the study participants. The
participants were subsequently assigned to either a control group or an intervention group
using stratified random sampling
Stratified sampling took account of professional grouping (pharmacist vs. pharmacy
technician), experience of CPD recording (practised vs. beginner) and sector of practice
(community, hospital, other). We randomised 61 study participants to one of two groups of
control (31) vs. intervention (30).
All participants received either the control (CPD and revalidation standards) or an
educational training intervention (CPD and revalidation standards plus training related to
the CPD Outcomes Framework) at the end of December 2009. See Appendix 12 for a copy of
the letters and printed material sent to the participants in the intervention group and
Appendix 13 for a copy of the letters sent to the participants in the control group [both
Appendices are minus the revalidation standards and CPD Standards (which are already
presented in Appendix 1 and Appendix 2 of this report)].
The training package was posted to all participants in the intervention group in December by
recorded delivery. Participants in the control group also received their material by recorded
delivery in December. All participants were asked to work through the revalidation-related
material during January and February with the target of returning two new CPD records by
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28 February 2010. The participants were also asked to sign and return a statement of
learning related to their packs before or at the same time as submitting their new records.
Participants were asked to refrain from discussing the detail of their packs with others.
Participants then submitted two further CPD records by the end of February 2010. One of
the new CPD entries involved participants in rewriting an already-submitted record and the
other in conducting a CPD activity afresh using their knowledge of the CPD and revalidation
standards, with or without the related training.
Assessing the CPD entries via quantitative means
All CPD records were anonymised, pooled and assessed independently by two of the
pharmacist investigators (PD and AMA) blinded to the study stage and intervention type (i.e.
no obvious information to relate entries to each other or to stage of study remained on the
copies assessed). The raters independently scored the entries against the CPD Outcomes
Framework (see Appendix 14 for a copy of the assessment template used in order to grade
the entries). The detail of the scoring is included in Appendix 8 and further explained as part
of the text in Appendix 15. In summary, values for each of the variables consequence (C)
and likelihood (L), were assigned using the CPD Outcomes Framework to produce the
relevance (R) score (R = C x L), and also values were assigned for quality and benefit (Qb)
and strength of evidence (E) to produce the impact (I) score (I = Qb + E) for each entry. The
product of R and I scores (R x I) resulted in the CPD score. The investigators also sought to
assign one or more revalidation standards to the entries to test the possibility of relating the
entries to these standards.
Initially, the ratings of 56 of the records (selected at random) were entered onto the software
package SPSS and explored for a number of relationships detailed in Appendix 15. From
these analyses it was possible to demonstrate that in fact consensus agreement was equal to
averaging the scores assigned by each of the two pharmacist raters. Based on these analyses,
a decision was made to calculate an average CPD score (by taking the mean of PD and AMA
ratings for each record) for all of the CPD entries scored (226) and to use this average score
for all further analyses.
Data for 96 CPD entries written before and rewritten after the educational intervention were
transferred to SPSS and explored then subjected to tests for analyses of differences in CPD
scores (see Appendix 18 and Appendix 19). Further analyses involved exploring the data
relating to all of the CPD entries (226) submitted by the study participants both before and
after the intervention. More detail is provided in the results section. In addition to the
above, we examined the detail of 96 entries submitted at the after stage of the study
(rewritten and new) to quantify the number that explicitly referenced the revalidation
standards.
Assessing CPD entries, focus groups and interviews via interpretative methods
The CPD entries were analysed using interpretative methods and together with data from the
focus group interviews and the telephone interviews were used to devise a model to explain
CPD behaviour. We invited and recruited a total of 12 participants to two separate focus
group interviews (6 control and 6 intervention) lasting half a day each. See Appendix 16 for a
copy of the documentation relating to the focus groups. The transcripts of both focus groups
were analysed using thematic analysis and used in the formation of a model that explains
CPD behaviour. The template used for the focus group interviews was further developed into
an interview schedule for phone interviews with the participants. In total, 34 of the 48
participants who completed the study were interviewed over the phone in 20-30 minute
conversations, which also acted as feedback and debriefing sessions. See Appendix 17 for
copy of documentation relating to the phone interviews. More detail is provided in the
results section.
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Chapter 4: Results
Foreword
Having outlined the manner in which the study was conducted, the results are presented
here under two distinct headings relating to the quantitative analyses of the entries as well as
the qualitative interpretative analyses of both the text of CPD entries and the focus group
and interview transcripts. A separate section examines the usability of the revalidation
standards. It must be emphasised that these revalidation standards were in draft format at
the time. We examined the impact of the CPD and revalidation standards (with and
without the training related to the CPD Outcomes Framework) on both the conduct and the
writing of CPD records in this parallel-group before and after experiment. The primary
outcome measure for the quantitative analyses was the CPD score obtained by averaging the
ratings assigned by the two investigators. We also wanted to identify gaps in relation to
revalidation. We used grounded theory analysis to examine the CPD entries, and thematic
analysis to examine the transcripts of the focus group interviews and the transcripts of the
phone interviews to devise and further validate a model to explain CPD behaviour. We also
used the interview transcripts to gain a better understanding of why some CPD entries had
scores high and some low.
Quantitative analyses of CPD scores

Rewritten entries
Data (CPD scores) for 96 CPD entries written before and rewritten after the educational
intervention were transferred to SPSS. For the purpose of the analyses, the independent
variable educational intervention had two conditions, either control (CPD and Revalidation
Standards) or the active intervention (CPD and Revalidation Standards plus the CPD
Outcomes Framework training). The dependent variable was the final CPD score (an average
of CPD scores assigned by PD and AMA). Data were initially subjected to a series of
exploratory analyses including non-parametric tests (see Appendix 18).
For the definitive analyses and in consultation with a statistical expert, a linear model (linear
regression model) was used to compare the intervention groups adjusting for work setting
and a linear effect of baseline (CPD scores before the educational intervention). See
Appendix 19 for the detail of the analyses. Adjusting for baseline and work setting, the
intervention effect was estimated to be a mean difference of 17.3 (95% CI = 5.6 to 28.9). This
effect is statistically significant (p-value = 0.0048).
All submitted entries
A further analysis was carried out on all of the CPD entries (226) submitted by the 48 study
participants both before and after the intervention. The dependent variable was the final
CPD score. The independent factor was educational intervention (control vs. intervention)
with stage of study (before vs. after) used initially as in independent factor after which
before scores were used as a covariate in a linear model.
As above, a series of exploratory analyses including non-parametric tests were applied (see
Appendix 18). For the definitive analyses the mean of CPD scores before and after the
educational intervention were calculated for each participant and used in a linear regression
model.
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The linear model (linear regression model) was used to compare the intervention groups
adjusting for work setting, a linear effect of baseline (CPD scores before the educational
intervention) as well as an interaction between work setting and baseline scores (work
setting * mean CPD score at baseline). See Appendix 19 for the detail of the analyses.
Adjusting for baseline, work setting and an interaction between work setting and baseline
scores, the intervention effect was estimated to be a mean difference of 9.864 (95% CI = 0.418
to 19.310). This effect is statistically significant (p-value = 0.041).
Qualitative analyses of CPD scores

The CPD entries were analysed using interpretative methods and together with data from the
focus group interviews and the telephone interviews were used to devise a model to explain
CPD behaviour. The interview data also provided useful information in relation to
participants views about the CPD Outcomes Framework and its related training, about using
revalidation standards for CPD completion, their experience of the study and other
comments relating to CPD and revalidation. The main data are presented in a series of
Appendices as indicated and summarised narratively here.
The Purpose-Action-Results as a behavioural model (PARable): telling the story of continuing
professional development in pharmacy professionals
Full data are presented in Appendix 20. We first examined the 162 CPD entries submitted at
the outset of the study and attempted to present data relating to these entries using
descriptive statistics. We found the majority of the entries started from the point of
reflection with one fifth starting from action. The most regularly-used methods for
identifying learning objectives were stated as personal interests, talking with colleagues and
reading journals. Similarly, more CPD entries were driven by the participants themselves
compared to a need to fulfil the needs of users or services/products and indeed the pattern of
impact seemed more focussed on the individual rather than the organisation. Most entries
had taken less than 3 months to complete, with 14% completed on the same day as the CPD
entry was initiated. The most popular activities appeared to be CE-related such as computeraided learning, short courses and workshops.
After further careful reading and using a grounded theory approach, we set about defining
the pattern of CPD activities resulting in the CPD Purpose-Action-Results as a behavioural
model (PARable), which tells the story of continuing professional development in pharmacy
as follows.
Two general types of behaviour can be associated with CPD. The first, represents the more
traditional approach to learning more in line with CE. Here, the drive for CPD is driven
externally by a variety of factors that include in essence a need to fulfil a personal desire for
knowledge acquisition. A number of external drivers are associated with this need,
including, in community pharmacy for example a fear of being asked questions that cannot
be answered and thus a need to maintain a basic level of knowledge in a breadth of subjects.
Although related to personal knowledge acquisition, the motivation for this type of learning
is mainly externally driven, a result of perceived expectations of others and related to
assumptions about potential problems that might arise at work. This type of perception
leads to the undertaking of stand-alone, mainly CE type activities which ultimately have the
greatest impact on the individual themselves rather than on other people. The outcome of
this type of entry is written as hypothesised impact on oneself promised through language
used, such as will have and is going to, I will be able to. This person-centred,
approach is not instantly relevant to practice and is more likely to take place as a result of
perceived needs rather than an immediate precondition and well-thought-out plan.
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The second type of behaviour is captured in the upper part of the model and represents a
genuine connection with Kolbs model of experiential learning. Here, although an
immediate and necessary external condition will appear to be driving the CPD, for example,
a problem at work or a new role, it is the persons internal developmental motivations that
will drive the CPD. So while the need may exist externally, the individuals involvement in
the CPD will be driven internally, via an existing understanding of what it means to practise
continuing professional development. Although the activity may involve this type of pharmacy
professional in some element of learning, it is the integration of the learning with the work
setting that is at the crux of this behaviour. The impact is demonstrated through use of
language such as I have done. or I have been able to. This type of CPD is also accompanied
by some level of documentation that would demonstrate its application or at least reference
to feedback from patients and colleagues. This type of CPD invariably impacts the greatest
on practice and that in turn can be related back to the individuals own development, as
indicated by the top arrow in the diagram shown in Appendix 20.
Thematic analysis of the focus group and interview transcripts
Once the model above had been developed, we sought to conduct focus group interviews
with the participants as a first step towards verifying the model and its application to
participants own expressed understanding of their CPD. The interview guide for use during
the focus group discussions is presented in Appendix 16 and was based on the emerging
themes that informed the model, as highlighted in the left-hand column of the interview
schedules entitled theory. We categorised the transcripts according to the themes identified
in the model and looked for additional themes. In fact, while a number of interesting and
additional features were obtained, the model itself remained unchanged and it was possible
to categorise participants approach to CPD using either the CE or CPD pathways. The
additional supporting themes are described in Appendix 20. In summary, they related to
Time spent on CPD and the Plan & Record CPD template and Understanding of current
assessment of CPD. With the former concept, it meant that those following the CE
pathways are more likely to view CPD as something that can be easily conducted and
recorded to result in the completion of an entry but those following the CPE pathway
appreciated that time, perhaps their own, would need to be invested before truly worthwhile
CPD could come into fruition and be recorded as complete.
Some also expressed a level of anxiety in relation to the current assessment of CPD and its
robustness.
As well as obtaining opinions about participants understanding of CPD, the focus groups and
telephone interviews were used as an opportunity to gain participants opinion of the CPD
Outcomes Framework to enable its further development. The participants were also asked
about their general experiences with the study. While the main concepts are presented in
Appendix 21, a summary is provided below.
Feedback about the CPD Outcomes Framework
Although some found the framework difficult to grasp at first and sought clarification of
some of the descriptors, on the whole, the CPD Outcomes Framework appeared to have
caused a paradigm-shift with participants reporting it had directed their thoughts and
focussed their CPD activities for the better. A number also commented that it would be
difficult to conduct CPD to this level 9 times a year. Some specifically useful feedback
provided by the participants related to the perception that more experienced professionals
practice would be deemed less risky and therefore naturally return a lower relevance score.
And also ideas around risk and shared responsibility for risk, making it difficult to
conceptualise anyones individual practice as having the potential to impact on overall
organisational risk to any great extent. Overall, participants found the quantification of CPD
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helpful, the electronic storage of entries useful and the framework applicable to practice.
One participant expressed anxiety about other pharmacy professionals ability to grasp the
concept.
Other comments related to perceptions that the framework made CE-type learning invalid,
did not value potential benefit in the absence of proof and interestingly that the CPD
Outcomes Framework could not feasibly be used if out of work (non-practising). Participants
also picked up that the framework would direct a portfolio-based approach to CPD.
Participants feedback about the study itself and further suggestions
Feedback about the study was very positive overall. The most relevant feedback related to
perceptions about the incompatibility of the current CPD template of Plan & Record and
what the CPD Outcomes Framework was attempting to achieve. Similar to views expressed
in the focus groups, there was a perception again that the current assessment of entries
lacked tangible criteria. Some interesting views were also expressed about a need for a direct
and focussed curriculum that would enable more focussed CE type learning and a view that
CPD could be presented to assessors as structured case scenarios to convey the information
more than can be achieved with the current Plan & Record template.
A number of direct quotes about participants positive perceptions of the CPD Outcomes
Framework are included in Appendix 21.
Participants own perceptions of high- and low-scoring CPD entries
In addition to the quantitative assessment of the CPD entries, we wanted to assess particular
features of entries that scored high or those that did not. We did this by examining the
content of the entries and the feedback that participants themselves gave about these entries.
Interestingly, one participant who used case scenarios to construct their after entries scored
high in these. We chose to examine information from the interviews because we wanted to
bring participants own understanding to the analyses. The findings are presented in
Appendix 22. In summary entries scored high because participants could relate these to risk,
relevance and actual practice, participants understood the CPD Outcomes Framework and
made a conscious decision to comply, or entries were chosen for which good evidence
existed. CPD entries scored low if there was insufficient evidence of impact at the time of
writing/completion, if participants had not understood the requirements because of a lack of
information and feedback, if Plan & Record hindered appropriate expression of CPD or if
participants were unable to apply their learning to practice because they were out of work.
Examining the usability of the Revalidation Standards

Feedback about the Revalidation Standards
We had also hypothesised that participants experience of using the new revalidation
standards would be positive and that those exposed to the bespoke CPD Outcomes
Framework would be supportive of its use in CPD in the future. On the whole, feedback
about the Revalidation Standards was not encouraging (see Appendix 23). Some found these
vague, some overwhelming and others found them superfluous in light of other competing
standards and competencies. Some thought the Standards would be appreciated more by
junior pharmacists while others thought the large choice made it impossible to select any
one standard in any meaningful way. As assessors, we too found the process of selecting and
assigning revalidation standards to individual CPD entries burdensome and somewhat
unspecific. We also found that participants themselves had not in the main sought to list the
Revalidation Standards in their CPD entries regardless of their group (control or
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intervention). However, see below for a quantitative comparison that did demonstrate a
small difference in approach.
We used NVivo 8 (qualitative data analysis software) to examine the interview data from the
34 participants using thematic analysis. This resulted in the identification of a number of
themes. First-order coding resulted in a number of descriptive labels, which were then
grouped under five main categories during second-order coding, resulting finally in the
identification of two dominant themes during third-order coding. The two dominant themes
of Working with the Standards of Proficiency and Yet to accept the Standards of
Proficiency and the respective second-order and first-order codes are shown in a schematic
in Appendix 23.
Because a number of themes have been identified in relation to both working with and
yet to accept the revalidation standards, we take the view that addressing the perceived
barriers and also drawing on the facilitators will help deal with the apparent lack of
engagement with the Proficiency Standards. We provide our recommendations on how CPD
can be linked to proficiency standards in the discussion section.
The use of Revalidation Standards in CPD
Under closer scrutiny, we were able to quantify the use of the Revalidation Standards in
participants CPD entries. We examined the detail of 96 entries submitted at the after stage
of the study (rewritten and new) to quantify the number that had drawn on the Revalidation
(Proficiency) Standards. The data were cross-tabulated and examined in relation to the
number that had used the Revalidation Standards in each of the intervention arms; control
vs. active intervention groups. We found that participants had not in the main sought to list
the revalidation standards in their CPD entries. A similar number of rewritten entries (9)
and new entries (7) had referred to the Proficiency Standards. However, a higher number of
entries from those in the active intervention group (i.e. from participants who had received
the CPD Outcomes Framework) compared to those in the control group (i.e. from participants
who had received the Revalidation and CPD Standards only) had referred to the Proficiency
Standards in their re-written or new CPD entries (p = 0.005) submitted at the after stage of
the study.
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Donyai, et al. 2010
Chapter 5: Discussion
We completed a comprehensive review of the literature, devised, validated and tested the
impact of a new CPD Outcomes Framework and related training material in an empirical
investigation involving volunteer pharmacy professionals and also spoke with our
recording and to gain feedback on the study itself.
The comprehensive literature review identified a collection of perceived barriers to CPD and
resulted in a set of recommendations that could potentially remedy pharmacy professionals
perceptions and participation in CPD. These recommendations included a need to reexamine the process of CPD recording and related training. The CPD Outcomes Framework
has proved an important step in this direction. Not only were we able to use the Outcomes
Framework as a tool for the scoring of CPD entries, but compared to a control (CPD and
revalidation standards only), we found that training participants to apply the CPD Outcomes
Framework resulted in entries that scored higher (statistically significant). Feedback from
participants who had received the CPD Outcomes Framework was on the whole positive and
a number of useful suggestions were made about improvements to the Outcomes Framework
and related training material. What is more, speaking with participants also revealed that
for entries that scored high, participants had consciously applied concepts linked to the
Outcomes Framework and for those that scored low, they had been unable to apply the
concepts of the Outcomes Framework for a variety of reasons including limitations posed by
the Plan & Record template. In contrast, feedback about the nature of the revalidation
standards and their application to CPD was not on the whole positive. In fact, although
participants had not in the main sought to apply the standards to their CPD entries, we did
find a higher number of entries from those in the active intervention group compared to
those in the control group had referred to the revalidation standards in their re-written or
new CPD entries submitted at the after stage of the study. As assessors, we too found the
process of selecting and assigning revalidation standards to individual CPD entries
burdensome and somewhat unspecific. However, on analysing the interview data we were
able to order participants views about the revalidation standards into two broad categories of
barriers and facilitators that could help with recommendations to address the apparent lack
of engagement with the revalidation standards.
The application of interpretative methods proved very useful in brining meaning and
understanding to pharmacy professionals CPD practices and using this approach we were
also able to devise a model (CPD PARable) to explain and tell the story of CPD behaviour.
Based on the concepts of purpose, action and results, the model centres on explaining two
types of CPD behaviour, one following the traditional CE pathway and the other a more
genuine CPD pathway. While the first is associated with a person-centred need to
accumulate knowledge through numerous, quick, mainly passive learning activities with no
prolonged or direct application to practice, the second is associated with a more considered
approach that involves a motivated individual in recognising their ability to make an impact
at working and bringing this about through their CPD, which is invariably more practical.
We also believe that entries which scored higher when we applied the CPD Outcomes
Framework were more likely to follow the CPD pathway in the model above, which is of
course intuitive. However, the significance of our finding is that while participants following
both models of practice took part in this study, the CPD Outcomes Framework was able to
change peoples CPD behaviour to make it more inline with the CPD pathway.
There were some other interesting and useful discussions with the participants about CPD in
general and CPD for revalidation, some of which reflected the perceptions already identified
in the comprehensive literature review. One important discussion related to the assessment
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of entries for revalidation. As well as expressing a liking for the quantitative criteria
presented in the CPD Outcomes Framework, participants expressed anxieties about the
system currently used to assess CPD records submitted for review. In fact, some participants
in this study had had direct involvement with the RPSGB call & review process and reported a
view that current assessment of entries lacked tangible criteria, which brought the meaning
of the exercise into question. Of course, this general concept is familiar to those working in
educational settings where constructive alignment is used as a good basis for ensuring that
learning, teaching and assessment support each other51. In essence, constructive alignment
is a design for teaching calculated to encourage deep engagement and uses as its basis clear,
specific criteria for attainment, complementary teaching methods and directly related
assessment tasks to address those criteria, which will enable clear and transparent
judgement of whether or not the objectives have been. It would be our interpretation that in
fact the CPD Outcomes Framework in defining the CPD criteria, the training pack in teaching
the basis and use of the Outcomes Framework, and the process of assessment in using the
CPD Outcomes Framework, would have interacted to improve participants CPD through a
process similar to constructive alignment. Interestingly, the participants were also keen to
receive a curriculum against which certainly CE-type activities could be conducted.
In fact, another important observation and interpretation of the findings relates to the role of
CE in pharmacy professionals revalidation. While it was not the scope of this research to
examine the specific contribution that CE could make as part of revalidation, it has become
apparent during the course of this research that pharmacy professionals engage in and
understand CE to a greater extent than CPD. We do not believe that this practice is a simple
legacy of previous CE requirements because so many pharmacists expressed a genuine need
to follow the CE pathway (as described in the PARable model) for their own feelings of
confidence and competence. So while, CPD has been shown to provide direct evidence of
application to work, CE is contributing indirectly to pharmacy professionals sense of self and
personal esteem. In fact, since CPD that follows the recommendations of the Outcomes
Framework is a more involved exercise, and based on our own and the participants
feedback, we would recommend that the requirement to submit 9 CPD entries per annum is
re-examined and expressed more clearly in relation to what specifically participants are
being asked to submit i.e. how many CE and how many CPD entries. During the course of
this research, we also personally came across a number of pharmacists whose records had
been called in for review. Interestingly, as we had predicted, the call & review process acted
as a great influence on those peoples engagement in the CPD process resulting in significant
and systematic attempts to ensure CPD completion and submission. We would not
recommend that more than 2 CPD entries (constructed according to the CPD Outcomes
Framework) are submitted each year the remainder could perhaps demonstrate CE type
learning. However, we can foresee a benefit in setting more regular intervals which would
act as deadlines for CPD submission (of either type) in the future.
Based on the findings of this study and our interpretations we are able to make the following
recommendations against the original objectives of this research
Identifying areas or groups of registrants in which implementation of the RPSGB CPD
framework is most and least advanced
At the outset of the project, we used a comprehensive review of the existing literature in an
attempt to address this point. The literature identified a number of groups of registrants
with more positive views and better levels of engagement in CPD compared to others. For
example, there is some evidence that hospital pharmacists are better engaged than
community pharmacists and there may also be a trend towards increased CPD recording in
more recent years. However, conflicting findings of the research make it difficult to define
any one area or group of registrants in which implementation of the RPSGB CPD framework
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is most and least advanced and indeed we would question the value of such an exercise.
Because, in fact, as noted in correspondence with an officer from the Regulations Directorate
of the RPSGB, the call and review process itself appears to have acted as a real catalyst in
terms of enhancing pharmacy professionals engagement with CPD, seemingly across the
board. More fundamentally, in relation to this study objective, we are now in a position to
argue that categorising people according to their occupational or other demographic
characteristics is not as helpful as representing engagement in CPD via the behavioural
model devised through this study. Our conclusion is that there are pharmacy professionals,
regardless of their sector of practice, who are more at ease with the CE model of learning and
there are those who understand and embrace genuine CPD. What is significant is that we
have proven through empirical investigation that peoples CPD output can be impacted on by
teaching and assessing their entries using the CPD Outcomes Framework devised and
validated in this study.
revalidation
After careful analysis of the data unearthed by the comprehensive literature review we
derived a set of recommendations for moving towards improving participation in CPD using
regulatory, professional, work-related and personal channels.
Through these
recommendations, we believe that current barriers to CPD uptake can be addressed to
minimise risk in relation to the use of CPD in revalidation. It is likely that making CPD a
statutory requirement will in itself compel pharmacy professionals to better engage with the
process and indeed as stated above, it appears that the call and review process is already
acting as a catalyst in that way. Nonetheless, if CPD is to succeed, our recommendation is
that peoples beliefs and attitudes must be addressed by recognising and modifying barriers
through a combination of four main categories of regulatory, professional, work-related and
personal channels, as outlined below.
In light of consistent and continuing difficulties with the CPD recording template, anxieties
expressed in relation to the process of review and the difficulties with conceptualising
possible consequences of non-conformance, we believe there are three clear areas that must
be addressed by the new regulatory body for pharmacy (GPhC), namely modifying the
process of recording, explaining the process of record reviews and clarifying the outcome of
these reviews. There are also three distinct implications for the new professional body for
pharmacy. In light of the perceived difficulties with understanding the concept, conduct and
application of CPD, firstly we believe there is scope for further improvements to be made to
the process of CPD facilitation. Secondly, we believe there must be scope for improving the
current guidance documents and example cases as well as, thirdly, explanatory courses
provided by the new professional body for pharmacy. Pharmacy professionals should also be
supported in their CPD at work by means of protected CPD-time, such that perhaps in due
course CPD-time will be considered in the same vein as other essential breaks from formal
work. A second work-related proposal relates to employer support for educational courses,
either in-house or sponsored external training. The third and most pertinent area related to
work is the opportunity for application of CPD and its integration in the workplace. Based
on previous evidence, the benefits of direct experience of effective CPD are hypothesised to
impact on personal development, career development and of course on others, for example
patients and work colleagues, thus strengthening personal beliefs in the value of CPD.
Our study in fact tested some of the recommendations relating to both the regulatory
(assessment) and professional (teaching and support) elements. Through the CPD Outcomes
Framework we believe it is possible to align peoples understanding of CPD and its
assessment in such as way as to enhance meaningful engagement in quantifiable CPD.
Combined with the significant influence that call & review would generate in itself, we
Page 28
Donyai, et al. 2010
believe the CPD Outcomes Framework could be reasonably expected to facilitate the
submission of meaningful CPD for use in revalidation.
Explore the applicability and sustainability of the use of revalidation standards within
the CPD framework
We devised the CPD Outcomes Framework based on the revalidation standards and the CPD
Standards and gave these standards alone to a control group of participants, with the active
group receiving the CPD Outcomes Framework as well as the standards. It must be
highlighted that the revalidation standards used as part of this research were in draft format
at the time and were not subsequently adopted by the GPhC. The majority of the
participants in both intervention and control groups failed to engage with the revalidation
standards in any meaningful way within their CPD entries. That is, we found that
participants had not in the main sought to list the revalidation standards in their CPD
entries. However, a higher number of entries from those in the active intervention group
(i.e. from participants who had received the CPD Outcomes Framework) compared to those in
the control group (i.e. from participants who had received the revalidation and CPD
Standards only) had referred to the revalidation standards in their re-written or new CPD
entries submitted at the after stage of the study. Thus it seems that the CPD Outcomes
Framework did also encourage the use of the revalidation standards within the CPD entries.
However, of grave importance is the fact that currently the Plan & Record template does not
facilitate the integration of revalidation standards within CPD entries. In fact, some of the
participants in the active intervention group, who had referred to the revalidation standards
for the purpose of their CPD did so using the CPD Outcomes Framework Blank template for
assessment of CPD cases, which invites participants to record the GPhC standards of
proficiency to which each CPD record relates (see Appendix 14).
On speaking with the participants we found that a large number in fact expressed very
negative views about the use of revalidation standards in CPD and revalidation. While it was
possible for the CPD assessors (two of the investigators) to assign specific revalidation
standards to the CPD entries, this process proved onerous and did not add to the weight of
the assessment. Certainly at times the investigators found the use of revalidation standards
for the assessment of CPD burdensome to purpose of assessment using the CPD Outcomes
Framework. This was partly because of the large number of revalidation standards available
for application to each CPD. However, the most useful analysis of perceptions relating to
revalidation standards came from a thematic analysis of interview data from the research
participants. The two dominant themes of Working with the Standards of Proficiency and
Yet to accept the Standards of Proficiency were derived with their respective second-order
and first-order codes. We take the view that addressing the perceived barriers and also
drawing on the facilitators will help deal with the apparent lack of engagement with the
revalidation standards.
Those yet to accept the revalidation standards viewed these with scepticism, had expected
something new or were simply rebelling against them. Under the first heading, participants
found there were simply too many revalidation standards, they were too detailed, did not
relate to any specific area of practice or knowledge-base, and participants also needed
clarification and instructions on how the standards would relate to CPD. Under the second
heading, participants had expected something different to the existing code of conduct and
viewed the standards as already part of everyday thinking and practice. There was resilience
to the standards under the third heading. A number of participants took a more positive
approach, indicating a desire to work with the standards, either trying to understand their
application to CPD or simply viewing them helpful to the construction of better CPD. These
findings indicate that is it in theory possible to move towards refining the revalidation
standards and the accompanying literature by addressing the main points of concern.
Page 29
Donyai, et al. 2010
Therefore, we would recommend firstly that the number of revalidation standards is

reduced, and that the standards are simplified and related more closely to pharmacy practice
or to the knowledge-base required for practice. Secondly, we would recommend a revision of
the accompanying literature to situate the standards in relation to any existing code of
conduct, to better specify the purpose of the standards and to instruct pharmacy
professionals on the manner in which the standards are to be used in relation to CPD. For
the latter, because of our findings, we would advocate that the revalidation standards are
recommended to be used in the context of the CPD Outcomes Framework.
Review the current content of CPD portfolios to assess the overall strength and quality
of existing information, and information gaps for the purposes of revalidation
The aim was to examine current usability of CPD entries and in order to do this we
developed the CPD Outcomes Framework based on a theoretical construct relating to CPD
relevance and CPD impact and specifically Standard 4 of the GPhCs CPD framework: include
in your record CPD that is relevant to safe and effective practice and the Standards of Conduct, Ethics and
Performance of the profession and Standard 5: record how your CPD has contributed to the quality or
development of your practice and has benefited patients and the public as well as the Proficiency
Standards (i.e. the revalidation standards). The Outcomes Framework was developed as a
means of both helping participants with the conduct and construction of CPD records for
revalidation as well as helping assessors to rate CPD records for revalidation. We were able
to use the CPD Outcomes Framework to assess the overall strength and quality of CPD entries
and found that participants who followed a genuine CPD pathway (as defined in our newlydevised CPD model of behaviour) scored higher than those who followed the CE pathway.
For those following the CE pathway the drive for CPD is driven externally by a variety of
factors that include in essence a need to fulfil a personal desire for knowledge acquisition. A
number of external drivers are associated with this need, including, in community pharmacy
for example a fear of being asked questions that cannot be answered and thus a need to
maintain a basic level of knowledge in a breadth of subjects. Although related to personal
knowledge acquisition, the motivation for this type of learning is mainly externally driven, a
result of perceived expectations of others and related to assumptions about potential
problems that might arise at work. This type of perception leads to the undertaking of standalone, mainly CE type activities which ultimately have the greatest impact on the individual
themselves rather than on other people. The outcome of this type of entry is written as
hypothesised impact on oneself promised through language used, such as will have and is
going to, I will be able to. This person-centred, approach is not instantly relevant to
practice and is more likely to take place as a result of perceived needs rather than an
immediate precondition and well-thought-out plan. Thus in terms of the current content of
CPD portfolios, entries that follow the CE pathway present the biggest gap or problem for the
purposes of revalidation, because of a lack of relevance and evidence of outcome.
In contrast, the better entries follow the CPD pathway and demonstrate relevance to practice
and impact on practice as assessed by the Outcomes Framework. These entries represent a
Page 30
Donyai, et al. 2010
on practice and that in turn can be related back to the individuals own development. In
terms of the current content of CPD portfolios, entries that follow the CPD pathway possess
the largest strength and quality of existing information for the purpose of revalidation. In
fact, participants own interpretation of their CPD brings additional insight into the
application of the right concepts to the conduct and construction of better quality CPD. The
participants who produced better CPD entries related them to risk, relevance to practice,
integrated the CPD with practice and selected entries for which there was evidence of
impact. While participants following both models of practice took part in this study, the
CPD Outcomes Framework was able to change peoples CPD behaviour to make it more
inline with the CPD pathway. Therefore, although the content of CPD entries may present
gaps for the purpose of revalidation, we have proven scientifically that training people to use
the CPD Outcomes Framework will result in better CPD for revalidation.
appropriateness of existing CPD frameworks as the basis of revalidation or as support
documentation for the revalidation process.
We believe that it is possible to use CPD for revalidation, provided the CPD Outcomes
Framework features as a strong component of the learning, teaching and assessment of the
entries. The current CPD framework of Plan & Record is not necessarily facilitating the
process of CPD conduct and construction and we would recommend that the CPD Outcomes
Framework is incorporated into the current CPD framework to ensure alignment of peoples
activities with assessment of outcomes. We make the following overall recommendations:
1. In order for CPD to succeed as part of pharmacy professionals revalidation in the
future, our first recommendation is that peoples beliefs and attitudes towards CPD in
pharmacy be addressed by recognising and modifying expressed barriers to CPD in
general through a combination of four main categories of regulatory, professional,
work-related and personal channels, as outlined below:
a. In light of consistent and continuing difficulties with the CPD recording
template, anxieties expressed in relation to the process of review and the
difficulties with conceptualising possible consequences of non-conformance,
we believe there are three clear areas that should be addressed by the new
regulatory body for pharmacy (GPhC), namely modifying the process of
recording, explaining the process of record reviews and clarifying the outcome
of these reviews.
b. There are also three distinct implications for the new professional body for
pharmacy. In light of the perceived difficulties with understanding the
concept, conduct and application of CPD, firstly we believe there is scope for
further improvements to be made to the process of CPD facilitation. Secondly,
we believe there must be scope for improving the current guidance documents
and example cases as well as, thirdly, explanatory courses provided by the new
professional body for pharmacy.
c. Pharmacy professionals should also be supported in their CPD at work by
means of protected CPD-time, such that perhaps in due course CPD-time will
be considered in the same vein as other essential breaks from formal work. A
second work-related proposal relates to employer support for educational
courses, either in-house or sponsored external training. The third and most
pertinent area related to work is the opportunity for application of CPD and its
integration in the workplace.
d. Based on previous evidence, the benefits of direct experience of effective CPD
are hypothesised to impact on personal development, career development and
of course on others, for example patients and work colleagues, thus
Page 31
Donyai, et al. 2010
strengthening personal beliefs in the value of CPD and working in an iterative

manner to promote CPD in pharmacy.
2. We attempted to address some of the above recommendations (1) by devising the CPD
Outcomes Framework and testing its impact in an empirical experiment. When we
examined CPD entries, we found that training participants to apply the CPD
Outcomes Framework resulted in CPD entries that scored higher (statistically
significant) than entries submitted by a control group (no training received). We
attribute the success of the CPD Outcomes Framework to the manner in which it
constructively aligned the learning, teaching and assessment of CPD entries. If CPD
for revalidation is to succeed, our second recommendation is that the CPD Outcomes
framework (or a similar concept) is used as an integral part of the learning, teaching
and assessment of CPD entries.
3. The role of revalidation standards as part of pharmacy professionals revalidation via
CPD must also be addressed. Our third set of recommendations relate to the
revalidation standards:
a. We would recommend firstly that the number of revalidation standards is
reduced, and that the standards are simplified and related more closely to
pharmacy practice or to the knowledge-base required for practice.
b. Secondly, we would recommend a revision of the accompanying literature to
situate the standards in relation to any existing code of conduct, to better
specify the purpose of the standards and to instruct pharmacy professionals on
the manner in which the standards are to be used in relation to CPD.
c. For the latter, because of our findings, we would advocate that the revalidation
standards are recommended to be used in the context of the CPD Outcomes
Framework.
4. The requirement to submit 9 CPD entries per annum should be re-examined and
expressed more clearly in relation to what specifically participants are being asked to
submit i.e. how many CE and how many CPD entries. We would recommend no
more than 2 full CPD entries (i.e. constructed according to the CPD Outcomes
Framework and following the CPD pathway) are submitted each year, with additional
entries following the CE pathway.
5. The call & review process acts as a great influence on peoples engagement in the CPD
process resulting in significant and systematic attempts to ensure CPD completion
and submission. We can foresee a benefit in setting more regular intervals for
submission of CPD entries which would act as deadlines for CPD submission in the
future.
Based on the findings of this study and our interpretations we have made a series of
recommendations against the original objectives of this research. Our conclusions are
presented in the next chapter, which brings our study to a close.
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Donyai, et al. 2010
Chapter 6: Summary, main conclusions, and

recommendations
Specific objectives have been met as follows:
Identifying areas or groups of registrants in which implementation of the RPSGB
CPD framework is most and least advanced
At the outset of the project, we used a comprehensive review of the existing literature to
address this point. While the literature identified a number of groups of registrants with
more positive views and better levels of engagement in CPD compared to others, we
believe categorising people according to their occupational or other demographic
characteristics is not as helpful as representing engagement in CPD via the behavioural
model devised through this study.
Our conclusion is that there are pharmacy
professionals who are more at ease with the CE model of learning and there are those who
understand and embrace genuine CPD. What is significant is that we have proven
through empirical investigation that peoples CPD output can be impacted on by teaching
and assessing their entries using the CPD Outcomes Framework devised and validated in
this study.
revalidation
After careful analysis of the results of the comprehensive literature review we derived a
set of recommendations to help improve participation in CPD using regulatory,
professional, work-related and personal channels. Our study in fact tested some of the
recommendations relating to both the regulatory (assessment) and professional (teaching
and support) elements. Through the CPD Outcomes Framework we believe it is possible to
align peoples understanding of CPD and its assessment in such as way as to enhance
meaningful engagement in quantifiable CPD. Combined with the significant influence
that call & review would generate in itself, we believe the CPD Outcomes Framework
could be reasonably expected to facilitate the submission of meaningful CPD for use in
revalidation.
Explore the applicability and sustainability of the use of revalidation standards
within the CPD framework
We devised the CPD Outcomes Framework based on the revalidation standards and the
CPD Standards and gave these standards alone to a control group of participants. The
majority of the participants in both intervention and control groups failed to engage with
the revalidation standards in any meaningful way within their CPD entries and in fact
expressed very negative views about their use in CPD and revalidation. However, those in
the intervention group were more likely to use the revalidation standards as part of their
CPD. While it was possible for the CPD assessors (two of the investigators) to assign
specific revalidation standards to the CPD entries, this process proved onerous and did
not appear to add to the weight of the assessment. The most useful analysis of
perceptions relating to revalidation standards came from a thematic analysis of interview
data from the research participants. Two dominant themes of Working with the
Standards of Proficiency and Yet to accept the Standards of Proficiency were derived
and we believe that addressing the perceived barriers and drawing on the facilitators will
help deal with the apparent lack of engagement with the revalidation standards.
Page 33
Donyai, et al. 2010
Review the current content of CPD portfolios to assess the overall strength and
quality of existing information, and information gaps for the purposes of
revalidation
The aim was to examine current usability of CPD entries. We were able to use the CPD
Outcomes Framework to assess the overall strength and quality of CPD entries and found
that participants who followed a genuine CPD pathway (as defined in the CPD model of
behaviour) scored higher than those who followed the CE pathway. The better entries
demonstrated relevance to practice and impact on practice as assessed by the Outcomes
Framework of course but it was the participants own interpretation of their CPD that
brought insight into the application of the right concepts to the conduct and construction
of better quality CPD. The participants who produced better CPD entries related them to
risk, relevance to practice, integrated the CPD with practice and selected entries for which
there was evidence of impact. While the content of CPD entries may present gaps for the
purpose of revalidation, we have proven scientifically that training people to use the CPD
Outcomes Framework will result in better CPD for revalidation.
appropriateness of existing CPD frameworks as the basis of revalidation or as
support documentation for the revalidation process.
We believe that it is possible to use CPD for revalidation, provided the CPD Outcomes
Framework features as a strong component of the learning, teaching and assessment of
the entries. The current CPD framework of Plan & Record is not necessarily facilitating
the process of CPD conduct and construction and we would recommend that the CPD
Outcomes Framework is incorporated into the current CPD framework to ensure
alignment of peoples activities with assessment of outcomes. Our recommendations are
grouped according to five themes; addressing general attitudes to CPD, the constructive
alignment of the learning/teaching/assessment of CPD for revalidation, addressing
attitudes to revalidation standards, clarifying the ratio of CE vs. CPD entries for
submission, intervals for submission of CPD entries.
Page 34
Donyai, et al. 2010
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Appendix 1
Annex C: The GPhC Standards of proficiency for pharmacy
professionals
Page 38
Annex C
The General Pharmaceutical Council Regulatory
Standards Development Programme
Standards of proficiency for pharmacy professionals
Introduction
This document sets out the standards of proficiency for pharmacy professionals.
These are the standards necessary for the safe and effective practice of pharmacists
and pharmacy technicians and they are based on the abilities and scope of practice
of pharmacy professionals described in the Pharmacy Practice Framework, RPSGB
2009 and the Standards of Conduct, Ethics and Performance. They are the minimum
standards necessary to protect members of the public. You must meet all of these
standards when you first become registered. After that, you must continue to meet
the standards of proficiency that apply to your scope of practice.
Scope of practice
Your scope of practice may be different to that of a newly registered pharmacy
professional. Your scope of practice will be the area(s) of the profession in which you
have the knowledge, skills and experience to practise lawfully, safely and effectively,
in a way that meets the standards and does not pose any danger to patients and the
public or to yourself.
Your scope of practice will change over time and your practice may become more
focused and specialised than that of a new registrant. This might be because you
have specialised in a certain clinical area or with a particular client group, or moved
into a role in management, education or research. Your particular scope of practice
may mean that you are unable to demonstrate that you meet all of the standards that
apply for the whole of the profession.
As long as you make sure that you are practising safely and effectively within your
given scope of practice and do not practise in the areas where you are not proficient
to do so, this will not be a problem. If you want to move outside of your scope of
practice you should be certain that you are capable of working lawfully, safely and
effectively. This means that you need to exercise personal judgement by undertaking
any necessary training and experience.
The care of patients is at the centre of everyday professional practice. They must be
your primary and continuing concern when practising, irrespective of your field of
work. Even if you do not have direct contact with patients your actions or behaviour
can still impact on their care or safety. For this reason, Section 1 of the proficiency
standards - the expectations of a pharmacy professional - applies to you, regardless
of your scope of practice.
1
Page 39
Standards of proficiency for pharmacy professionals

1. Expectations of a pharmacy professional (pharmacists and pharmacy
technicians)
1.1 Makes patients and the public their first concern
1.1.1 Ensures that the interests of patients and the public are not compromised by
personal or organisational interests, incentives, targets or similar measures.
1.1.2 Takes appropriate action to safeguard the well being of patients and the public,
particularly those who are vulnerable.
1.1.3 Ensures that the services they provide are based on appropriate up-to-date
information.
1.1.4 Satisfies themselves about the quality and appropriateness of the services they
provide or are responsible for.
1.1.5 Conducts research and development with integrity and in accordance with
relevant regulatory provisions.
1.1.6 Regularly reviews the work they undertake and services they provide or are
responsible for to improve quality and minimise risks to patient and public
safety.
1.1.7 Raises concerns promptly with appropriate persons or authorities if they
believe policies, systems or working conditions could compromise patient care or
public safety.
1.1.8 Ensures that all professional activities they undertake are covered by adequate
professional indemnity arrangements.
1.2 Respects the dignity, rights and beliefs of patients, the public and others
1.2.1 Treats patients, the public and others politely and considerately, respecting
their cultural differences, values and beliefs.
1.2.2 Ensures their views about a persons lifestyle, beliefs, race, gender, age,
sexuality, disability, or other perceived status do not prejudice the services they
receive.
1.2.3 Informs relevant persons or authorities if their personal beliefs prevent them
from providing a particular professional service and ensures patients and the public
are referred to alternative providers of the service they require.
1.2.4 Takes reasonable steps to ensure appropriate levels of privacy for patient
consultations.
1.2.5 Maintains proper professional boundaries in the relationships they have with
the patients and other individuals that they come into contact with during the course
of their professional practice.
1.3 Keeps their professional knowledge and skills up-to-date
1.3.1 Keeps their knowledge and skills up-to-date and relevant.
1.3.2 Ensures they are capable of working safely and effectively in their area of
practice.
1.3.3 Understands the laws, regulations and recognised best practice relevant to
their work.
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1.4 Recognises and works within the limits of their professional competence
1.4.1 Practises only in areas in which they have the necessary education, training,
and skills.
1.4.2 Refers to others if a task is beyond their professional competence.
1.4.3 Responds constructively to performance assessments, appraisals and reviews
and undertakes further training where necessary.
1.5 Listens to patients and the public and respects their choices
1.5.1 Recognises and supports the right of patients and the public to be involved in
decisions about them if they wish.
1.5.2 Listens to patients and the public and responds constructively to their concerns
or preferences.
1.5.3 Respects a persons right to refuse professional services.
1.6 Gains consent for the professional services they provide
1.6.1 Explains the options open to patients and the public, including the risks and
benefits, to help them make informed decisions.
1.6.2 Gives information on the service they are planning to provide and gets consent
before commencing it.
1.6.3 Ensures that if a person is not legally competent, any services they provide to
them are in accordance with relevant legal requirements.
1.7 Communicates effectively
1.7.1 Communicates properly and effectively with patients, the public and others and
ensures they have sufficient language competence to do so.
1.7.2 Provides information that patients, the public and others want or need in a way
they can understand.
1.7.3 Takes reasonable steps to meet the particular communication needs of
individuals whenever possible.
1.8 Works with others in the interests of patients and the public
1.8.1 Works co-operatively with people from their own and other professions, sharing
information appropriately and utilising the knowledge, skills and expertise of others.
1.8.2 Shares their skills, knowledge and experience and contributes to the
development and training of others.
1.8.3 Treats those they work with fairly and ensures their actions do not prevent
others complying with their legal or professional obligations.
1.8.4 Ensures that, when working in a team, it is clear who is responsible for
providing particular services.
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1.8.5 Challenges the judgement of others if they believe that a decision could
compromise the safety or care of patients and the public.
1.9 Respects and protects confidential information
1.9.1 Uses information obtained in the course of their professional practice only for
the purpose it was provided for.
1.9.2 Does not disclose confidential information without consent, apart from when
lawfully permitted.
1.9.3 Takes reasonable steps to prevent accidental disclosure or unauthorised
access to confidential information.
1.10 Keeps clear and accurate records
1.10.1 Maintains timely, accurate and adequate records for the professional services
they provide.
1.10.2 Records all relevant information in a clear and legible form.
1.10.3 Records any significant incidents or interventions they make during the
course of their professional practice.
1.11 Ensures their working environment enables them to provide professional
services safely and effectively
1.11.1 Makes sure their working environment enables them to provide professional
services safely and effectively.
1.11.2 Provides a professional service only if the working environment enables them
to do so safely and effectively.
1.11.3 Ensures they have access to the necessary facilities, equipment and
resources.
1.11.4 Ensures the facilities and equipment they use are fit for purpose.
1.12 Delegates effectively
1.12.1 Takes responsibility for their decisions to delegate tasks to others.
1.12.2 Establishes that anyone they delegate a task to has the knowledge and skills
to carry out the task safely and effectively.
1.12.3 Does not ask others to do a task that they are not competent to perform.
1.12.4 Takes appropriate oversight of and provides suitable support to those they
delegate tasks to.
1.13 Behaves with honesty and integrity
1.13.1 Is honest and trustworthy and behaves in a way that maintains public
confidence in them and their profession.
1.13.2 Declares any professional or personal interests to those who may be affected.
1.13.3 Never asks for, or accepts any inducement, gift, hospitality or referral that
may affect, or be seen to affect, their professional judgement.
1.13.4 Provides or publishes accurate and impartial information and ensures they do
not mislead or make claims that cannot be justified.
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1.14 Acts promptly to protect patients and the public from risk if they are
concerned that they or someone else may be not be fit to practise
1.14.1 Takes action if they are concerned that their health, behaviour or professional
competence, or that of another person, may place patients and the public at risk.
1.14.2 Practises only if they are fit and competent to do so.
1.14.3 Promptly informs the General Pharmaceutical Council (GPhC), their employer
and other relevant authorities of any circumstances that may affect their fitness to
practise, including ill health, criminal convictions and findings by other regulatory
bodies or organisations.
1.14.4 Co-operates with any investigation or formal inquiry into their or another
persons fitness to practise.
1.15 Responds constructively to feedback, complaints or criticism
1.15.1 Informs patients and members of the public and others who wish to complain,
feed back comments or make suggestions for improvement, how to do so.
1.15.2 Deals with complaints or criticism promptly, openly and sensitively. Follows
established complaints procedures, documenting the complaint and the action they
have taken.
1.15.3 Ensures a persons feedback, complaint or criticism does not prejudice the
service provided for them.
1.15.4 Learns from and reviews their working practices in the light of feedback,
complaints or criticism.
2. The skills of pharmacy practice
Pharmacists at first registration must be able to apply the skills of critical evaluation
and a detailed knowledge of the concepts and principles of clinical and
pharmaceutical science gained from the MPharm degree and pre-registration
training to meet all the following standards. Pharmacy technicians at first registration
must be able to apply a general knowledge of clinical and pharmaceutical science
gained from an approved qualification and an approved or accredited underpinning
knowledge programme to meet those standards identified as applying to them when
working under the supervision, direction or guidance of a pharmacist.
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2.1 Implementing health policy
Pharmacy
technician
2.1.1 Secures, whenever responsible, the safe, rational, effective

and cost-effective use of medicines:
maintains access to and applies critically an appropriate
scientific evidence base relating to the safe, rational and
cost-effective use of medicines
applies, with others as relevant and appropriate, the
evidence base to the development of medicines use
policies.
2.1.2 Advocates and supports policies and strategies that
promote improved health:
applies knowledge of pharmacy policy, direction and
decisions to improve health
plays an active role with public and professional groups
to promote improved health
collaborates with health care professionals and others
in their efforts to improve health.
2.2 Validates therapeutic approaches and supplies prescribed
and over the counter medicines
Pharmacy
technician
2.2.1 Assesses prescriptions:

validates prescriptions
clarifies medication orders.
2.2.2 Evaluates and advises on prescribed medicines:
appraises prescribed medicines
identifies clinical and pharmaceutical problems
resolves problems with prescribers and patients.
2.2.3 Supplies medicines:
applies a systematic, legal and professional approach
to dispensing, checking and supply of dispensed
medicines (and the supply of over the counter medicines)
maintains appropriate records.
2.2.4 Supports and monitors the patients progress with the care
plan:
assists patient understanding and enhances
concordance
provides information appropriate to the patient and their
need to make decisions about their care.
2.2.5 Records and documents findings, follow-ups
recommendations, information provided and patient
outcomes:
identifies information that should be documented
maintains and stores information.
Page 44
2.3 Ensures safe and effective systems are in place to manage risk
inherent in the practice of pharmacy and the delivery of
pharmaceutical services
Pharmacy
technician
2.3.1 Acts as the responsible pharmacist:

takes responsibility for the safe and effective running of
the pharmacy
ensures that appropriate pharmacy procedures are
maintained, reviewed and implemented
ensures that staff are competent to fulfil their
responsibilities and work within their level of responsibility
maintains records in accordance with professional
standards and legislation
limits their absences to the duration and purposes
allowed by legislation.
2.3.2 Develops and maintains quality systems:
ensures standard operating procedures are in place and
followed
ensures that staff are aware of their roles and adhere to
the standard operating procedures
identifies and manages risks in the delivery of
professional services and patient care
ensures that appropriate records are maintained and are
accessible.
2.3.3 Produces drug preparations and products:

prepares pharmaceutical products accurately and safely
packages pharmaceutical products to protect the integrity
of the product and safety of the user.
2.3.4 Obtains and stores drug preparations and products:

selects medicines and materials which are fit for purpose
ensures appropriate levels of stock and equipment are
maintained
maintains an adequate storage environment and systems.
2.3.5 Distributes drug preparations and products:
maintains security and integrity and timeliness during the
distribution process
maintains records of distribution.
Page 45
2.3.6 Disposes of drug preparations and products:

identifies products requiring disposal
stores products requiring disposal securely and
removes from pharmacy (or other premises)
disposes of products legally and safely.
2.3.7 Maintains, to limits of responsibility, a productive, healthy

and safe working environment:
assists in the maintenance of the physical environment
takes personal (professional) responsibility for health
and safety.
2.3.8 Engages with the management of staff and other

resources within the workplace.
contributes to team management
develops individuals and teams
supervises staff.
2.3.9 Plays an appropriate role in systems to oversee the supply

of medicines and to provide products and high quality
services:
takes responsibility, as appropriate, for the
management and maintenance of stock and equipment
creates, maintains and improves information,
knowledge and resources
seeks continuous improvement.
2.3.10 Minimises practice errors and omissions, unsafe practices
and professional misconduct:
identifies and prevents practice errors/omissions,
unsafe practices and professional misconduct
minimises, manages and reports errors and omissions
responds to and resolves unsafe practices and
professional misconduct.
2.4 Working with patients and the public
Pharmacy
technician
2.4.1 Promotes, evaluates and improves the health of

individuals:
understands their role in encouraging health and wellbeing of patients and the public
supports access to and understanding of health
information
identifies problems and solutions to improve the health
of individuals
provides education to patients and public.
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2.4.2 Engages with patients to establish health status and needs:

establishes and maintains a relationship with the patient
determines the patients desired health outcomes and
priorities
obtains information about the patient, their health and
concurrent treatment.
2.4.3 Agrees the appropriate course of action with the patient:
formulates treatment or care options seeking input from
other members of the healthcare team as needed
makes recommendations to meet the patients needs
refers the patient to other health care professionals if
appropriate
supplies non-prescription medicines or prescription only
medicines under a patient group direction
identifies needs for ongoing monitoring and follow up and
puts arrangements in place.
2.4.4 Records and documents findings, follow-ups,
recommendations, information provided and patient outcomes.
documents information
applies a legal and professional framework to the storage
of information.
2.5 Maintain and improve professional performance
Pharmacy
technician
2.5.1 Plans and implements personal development strategies to

improve current and future performance:
uses reflective practice and appraisal to create and
maintain a professional development plan to improve
current & future performance
monitors and evaluates development achievements
uses learning skills to comply with practice requirements
and to pursue professional progression
keeps records of continuing professional development
that meet professional standards.
2.5.2 Understands the need to play an active role in the pharmacy-

based and multi-disciplinary systematic monitoring and review
of the quality of service provision and the implementation of
service improvement measures:
takes part in regular and systematic audit as part of the
continuing process of quality improvement
plays a full part in local arrangements for clinical
governance or equivalent provision.
Page 47
2.5.3 Engages with the education, training and mentoring of

students, colleagues and healthcare professionals:
contributes to improving quality and relevance of
education and training.
2.5.4 Creates, maintains and enhances working relationships with

others in relation to the science of medicines and their use,
the practice of pharmacy and the provision of health care:
creates, maintains and enhances effective working
relationships
exchanges information and advice with others
uses pharmaceutical knowledge to contribute effectively
to meeting the goals of multi-disciplinary teams.
3. Being a Pharmacy Professional

3.1 Pharmacy is a science-based clinical profession. To be safe and effective, the
practice of pharmacy must be underpinned by relevant science.
Pharmacists must be able to:
apply biomedical and pharmaceutical science principles, method and
knowledge to safe and effective pharmacy practice. Sound science is the
basis of effective pharmacy
apply psychological and social principles, method and knowledge to
pharmacy practice (e.g. concepts of ill health, illness and disease and aspects
of behavioural change and treatment compliance)
apply population and improvement science principles, method and
knowledge to pharmacy practice (e.g. discuss basic principles of health
improvement and risks, methods for measuring improvements in clinical
effectiveness/delivery of care)
interpret and apply the standards of conduct, ethics and performance, the
law relating to pharmacy and principles of quality management to assure
provision of safe and effective pharmaceutical services.
Pharmacy technicians must be able to:
apply a general knowledge of the science of pharmacy, pharmacy practice
and the law relating to pharmacy to complete tasks and solve problems that
are well defined but may be complex and non-routine
identify, select and use appropriate skills and procedures to deliver
pharmacy services, including selection, preparation and supply of medicines
and the ability to communicate appropriately with patients and the public,
clients and colleagues
take responsibility for the carrying out of a range of activities in the pharmacy
under non-directive supervision, where the overall goal is clear;
take supervisory responsibility for the work of others and lead established
teams in the implementation of routine work.
In order to demonstrate that they meet the proficiency standards for the
profession and register with the General Pharmaceutical Council, pharmacists
have to complete the initial education and training for the profession and show
that they
10
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have achieved the learning outcomes described in the initial education and
training standards. Pharmacy technicians have to demonstrate that they have
achieved the learning outcomes contained in the Requirements for Pharmacy
Technician Qualifications and Programmes.
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Page 49
Workshop Members
Chairs
Sue Ambler MPI, Pharmacy Regulation, DH (Secondee)
Peter Wilson MPI, Pharmacy Regulation, DH (Secondee)
Department of Health
Diana Kenworthy MPI Pharmacy Regulation
Anne Spence MPI Pharmacy Regulation
Royal Pharmaceutical Society of Great Britain
Christine Gray Head of Corporate Governance (interim), GPhC
Stuart Heaney Senior Administrator, Support Staff Regulation
Janet Flint Head of Support Staff Regulation
Carol Evans Head of Professional Development Scotland
Damian Day Head of Education and Quality Assurance
Other organisations
Elizabeth Baker Medicines and Healthcare products Regulatory Agency
Melanie Boughen West Suffolk Hospitals NHS Trust
Liz Caines Chair of the Merritt Medical Centre Patient Participation Group
(Patient and Public Representative)
Christopher Cutts Centre for Pharmacy Postgraduate Education
Tess Fenn Association of Pharmacy Technicians United Kingdom
Nick Goss Patient and Public Representative
Emma Grace Boots the Chemists Ltd
Gareth Jones National Pharmacy Association
Amanda Kemp Leicester School of Pharmacy
Clive Jackson National Prescribing Centre
Jayne Lawrence RPSGB/Kings College, University of London
Diane Leakey Medicines and Healthcare products Regulatory Agency
Emma Lewis Boots the Chemists Ltd
Alison Littlewood University of Manchester
12
Page 50
Rachel Marchant Pharmacist

Kay Marshall Bradford School of Pharmacy
Helen Middleton NHS Education and Development
Ian Millar Strathclyde Institute of Pharmacy and Biomedical Sciences
Siu Ping Lam Medicines and Healthcare products Regulatory Agency
Raminder Sihota Boots the Chemists Ltd
Alison Simpson NHS North West
Lisa Smith Pharmaceutical Society of Northern Ireland
David Webb London and SE NHS specialist pharmacy services
Barbara Wensworth Bradford Hospital NHS Trust
James Johnson University of Strathclyde
Clive Moss-Barclay NHS North West
Kuljit Thiaray Bradford School of Pharmacy
Maria Christou NHS Pharmacy Practice Unit, East of England
13
Page 51
Donyai, et al. 2010
Appendix 2
Annex E1: GPhC Continuing Professional Development
Standards and Framework
Page 52
Annex E1
The General Pharmaceutical Council Regulatory
Standards Development Programme
Continuing Professional Development Standards and Framework
Introduction
The draft Pharmacy Order requires the General Pharmaceutical Council (GPhC) to
establish a framework for Continuing Professional Development (CPD) that specifies
the following:
(a)
the amount and type of continuing professional development that a registrant

is required to undertake
(b)
the information to be provided by a registrant about the continuing

professional development that the registrant has undertaken and the form and
manner in which that information is provided
(c)
the times at which information about the continuing professional development

that a registrant has undertaken is to be provided (including any continuing
professional development that relates to a particular specialisation or
annotation that is to be recorded in the Register)
(d)
the keeping of records about the continuing professional development

undertaken by registrants
The framework adopted by the GPhC must ensure that any continuing professional
development that is undertaken by a registrant demonstrates a relevance to:
(e)
the safe and effective practice of pharmacy; and
(f)
a learning need for the individual registrant that is relevant to the current
scope of practice including any specialisation of that individual registrant and
the environment in which they practise.
This document sets out the CPD standards that must be met by all registrants and the
GPhCs framework for undertaking and recording CPD.
1
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Standards and Framework for CPD

Standard 1
Keep a record of your CPD that covers the full period between reviews by the
GPhC and meets the requirements of the CPD framework.
The GPhC will call in registrants CPD records for review to confirm that they meet the
CPD standards. Initially, this will include CPD entries made in 2009. You can keep
your record in any way you choose providing you meet the requirements of the CPD
framework and can provide the information required by the GPhC in the correct
format. If you keep your record in an unapproved format you will have to copy it into
the correct format before submission.
Standard 2
Maintain a CPD record that is up-to-date and reflects continuous learning
The record of your CPD must be continuous and up-to-date and gaps between entries
should not normally exceed three months. This means that you must add to your
record regularly and not have long gaps between entries. Your CPD must be recorded
at the time or soon after it has taken place.
Some formal education programmes last for significant lengths of time. They provide
the opportunity to make a number of CPD entries based on large and small units of
learning and/or experience. It is better to record several CPD entries from a long
programme rather than one entry based on the whole programme. If you record
entries from a long programme, you should also record some entries that relate to
your daily practice.
You must ensure that your CPD record reflects a number of different types of learning.
Individual preferences for types of learning can vary widely so you can choose the
learning types that suit you best.
Standard 3
Make the minimum number of CPD entries in your record required by the GPhC
each year which reflect the context and full scope of your practice as a
pharmacist or pharmacy technician
You must make the minimum number of CPD entries required by the GPhC in your
record each year. You are likely to complete more CPD than you require to make the
minimum number of entries in a year. Making more entries than the minimum will
enable you to choose which entries to submit when the GPhC asks to see your record.
The GPhC does not require you to spend a certain amount of time on your CPD
because what people need to learn and the time needed for learning varies between
individuals. It is the practice outcomes of CPD that are important, not how long the
CPD takes.
If you work part-time, only occasionally or in a sector of practice without patient
contact, you may feel that this CPD standard should not apply to you in the same way
as it does to other registrants. All registrants must be able to demonstrate that they
keep up-to-date and maintain their competence in their scope of practice. This
standard is not dependent on where you work or how much work you do but on
developments in the profession and your scope of practice. For this reason, all
registrants have to meet this and the other CPD standards. If you work part-time or on
a limited basis you may have limited opportunities to record CPD based on practice
experience. If this is the case, it would be appropriate to make a higher proportion of
CPD entries based on learning and applying
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Page 54
new knowledge or developing your skills, although you should aim to include learning
from practice whenever possible.
The CPD you record must be relevant to your scope of practice as a pharmacy
professional including responsibilities such as superintendent or pre-registration tutor
and register annotations such as pharmacist prescriber. If you record CPD that arises
from experience at work, this is almost certain to be the case although you may wish
to include some continuing education relevant to your practice as well. If your scope of
practice is changing, you must reflect this in your CPD record.
Standard 4
Include in your record CPD that is relevant to safe and effective practice and the
Standards of Conduct, Ethics and Performance of the profession
You should review the proficiency standards for the profession at least once per year
and any other competence or standards frameworks that apply to your scope of
practice and identify any standards where you need to update your capability. While
your scope of practice may have developed to the point where you cannot meet all of
the Standards of Proficiency, you must be able to demonstrate that you meet all the
standards in Section 1, The Expectations of a Pharmacy Professional (based on the
Standards of Conduct, Ethics and Performance) and your CPD record should reflect
this.
This does not mean that you need to retain an up-to-date knowledge of medicines and
their uses if you do not use this knowledge in practice. You should, however, be able
to provide sound advice and/or appropriate referral to another professional if you are
consulted as a pharmacy professional by a patient in a formal or informal setting.
You should aim to think about your practice at least once per month and make some
entries that arise from this and some that arise from events in practice.
You should aim for your CPD to improve your practice as a pharmacy professional.
CPD that arises from critical incidents such as errors will be relevant to safe and
effective practice. Other forms of CPD may not appear to be directly relevant but CPD
that improves your confidence or improves the efficiency of your service can also have
an impact on safe and effective practice.
Standard 5
Record how your CPD has contributed to the quality or development of your
practice and has benefited patients and the public
This CPD standard is based on the principle that the outcomes of learning should be
beneficial to service quality and improvement. The outcomes of CPD are, therefore,
the most important part of a CPD record. Some CPD activities have very clear
beneficial outcomes such as the introduction of a new service. You do not, however,
always have to demonstrate significant benefits from CPD. Maintaining your
professional competence in a profession that is constantly changing and showing that
your skills and knowledge are improving can be evidence of beneficial outcomes.
Standard 6
Submit your CPD record to the GPhC on request so it can be reviewed
The GPhC will review the CPD records of every registrant every five years and for some
registrants, more often than this. When the GPhC asks to see your record you will be
3
provided with details of how to submit it and a clear deadline for submission. The CPD
record that you submit to the GPhC must be legible and in a format and medium
Page 55
specified and approved by the GPhC. A copy of an approved recording format is

available from the GPhC but other organisations may also provide a compatible
recording system for their members. If you keep a record of your CPD for other
organisations or employers in addition to the GPhC, this can be used to keep your
CPD details for the GPhC, providing you record all the information required. When the
GPhC asks to see your record, you will have to transfer the information into an
approved format before submission.
If your record does not meet these standards, for example if there are gaps in your
record because you have been unwell or caring for a relative, you should explain that
in your submission.
The CPD Framework
This framework together with the CPD standards comprise the CPD requirements for
registrants of the GPhC. The framework outlines how to make a CPD record that
meets the CPD standards.
CPD is a process that all pharmacy professionals are engaged in throughout their
professional life to maintain their competence. A CPD framework for the analysis and
recording of CPD, based on the CPD cycle of reflection, planning, action and
evaluation has been established in pharmacy since 2005. It requires registrants to
think about their practice and record what they learn and implement in practice. This
can be as simple as learning about a new medicine or CPD to support a more
substantial change such as a new service or procedure. Sometimes learning occurs
unexpectedly through experience and this can be recorded as CPD as well.
How people learn is a matter for individual preference and judgement although
everyone learns in more than one way. Your CPD record must demonstrate that you
have used a mixture of types of learning, normally at least three types of learning over
a five year period. Records of both formal continuing education and experiential
learning can contribute equally to the requirements of the CPD framework.
The CPD framework sets out the requirements for recording CPD based on the CPD
cycle. It sets out how much of the CPD you complete in a year should be included in
your record and the types of learning that you should undertake and record.
In compiling a CPD record for the GPhC, you must:
record details of your scope of practice
ensure that any changes in your practice, such as a specialist annotation of
your register entry, change of practice sector or scope of practice are
recorded and show that these changes have been supported with CPD
activities
record details of your CPD electronically or as hardcopy on paper, structured
according to the CPD cycle of reflection, planning, action and evaluation, in a
format published or approved by the GPhC
record CPD entries that meet the criteria for good recording practice
published by the GPhC including some entries that start at reflection
include a minimum of nine completed entries in your CPD record for each
year which reflect the scope and context of your practice as a pharmacist or
pharmacy technician, including practice responsibilities or specialties.
make some CPD entries that are relevant to changes or developments in
4
your scope of practice
Page 56
make a record which demonstrates CPD that utilises at least three types of
learning activity in a five year period.
CPD Review
In order to ensure that registrants meet the CPD requirements, the GPhC, in common
with other regulators, will need to call in registrants CPD records for review and
confirmation that they comply with the requirements of the CPD framework and
standards. The GPhC plans to review the CPD record of every registrant every five
years although some registrants may be asked to submit their CPD records more
frequently than this.
When you are asked to submit your CPD record for review, you will be given details of
how to do this and how long you have to respond. If you are keeping your CPD record
in an unapproved format, you will have to copy it to an approved format before you
submit it for review. Submission in an electronic form is preferable but you can also
submit it on paper providing it is legible.
If you do not submit your CPD record when asked, it may be necessary to cancel your
registration. If you tell the GPhC that your CPD record does not comply with the
standards, you may be given a formal warning, which will remain on your record for
five years. You will also be given a timescale to improve your record and submit it for
review.
When your CPD record is received, it will be reviewed by a trained CPD reviewer
against the requirements of the CPD standards and framework.
You will be informed if your CPD record meets the CPD requirements. If your record
does not meet the CPD standards or is not fully compliant with the CPD requirement,
you will be asked to improve your record within a set timescale. If your record
demonstrates significant non-compliance with the CPD requirement or if you fail to
improve it when asked, it may be necessary to cancel your registration.
If there are grounds for thinking that your CPD record is fraudulent or contains false or
misleading information, this will be dealt with under the GPhCs fitness to practise
procedures.
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Page 57
Workshop Members
Chairs
Sue Ambler MPI, Pharmacy Regulation, DH (Secondee)
Peter Wilson MPI, Pharmacy Regulation, DH (Secondee)
Department of Health
Diana Kenworthy MPI Pharmacy Regulation
Anne Spence MPI Pharmacy Regulation
Royal Pharmaceutical Society of Great Britain
Stuart Heaney Senior Administrator, Support Staff Regulation
Janet Flint Head of Support Staff Regulation
Carol Evans Head of Professional Development Scotland
Damian Day Head of Education and Quality Assurance
Other organisations
Christine Gray Head of Corporate Governance (interim), GPhC
Elizabeth Baker Medicines and Healthcare products Regulatory Agency
Melanie Boughen West Suffolk Hospitals NHS Trust
Liz Caines Chair of the Merritt Medical Centre Patient Participation Group (Patient
and Public Representative)
Christopher Cutts Centre for Pharmacy Postgraduate Education
Tess Fenn Association of Pharmacy Technicians United Kingdom
Nick Goss Patient and Public Representative
Emma Grace Boots the Chemists Ltd
Gareth Jones National Pharmacy Association
Amanda Kemp Leicester School of Pharmacy
Clive Jackson National Prescribing Centre
Jayne Lawrence RPSGB/Kings College, University of London
Diane Leakey Medicines and Healthcare products Regulatory Agency
Emma Lewis Boots the Chemists Ltd
Alison Littlewood University of Manchester
Kay Marshall Bradford School of Pharmacy
Page 58
Helen Middleton NHS Education and Development

Ian Millar Strathclyde Institute of Pharmacy and Biomedical Sciences
Siu Ping Lam Medicines and Healthcare products Regulatory Agency
Raminder Sihota Boots the Chemists Ltd
Alison Simpson NHS North West
Lisa Smith Pharmaceutical Society of Northern Ireland
David Webb London and SE NHS specialist pharmacy services
Barbara Wensworth Bradford Hospital NHS Trust
James Johnson University of Strathclyde
Clive Moss-Barclay NHS North West
Kuljit Thiaray Bradford School of Pharmacy
Maria Christou NHS Pharmacy Practice Unit, East of England
Page 59
Donyai, et al. 2010
Appendix 3
Tables, figure and box relating to the literature review
Table 1 The list of studies included in this review in chronological order from the start of the decade (2000-2009) There were 13 full research papers
(only 3 of which were published in indexed journals), six conference abstracts/papers, two news reports of RPSGB survey outcomes and one RPSGBcommissioned report published by the PARN consultancy firm. The number of QARI criteria met is also indicated.
Study
Type of
publication
Year study
conducted
Method of data
collection
Sector(s) of
pharmacy
Study location
Sample size
Brief description of study aims
Attewell 28
QARI = 4 / 10
Paper published
in non-indexed
professional
journal
Paper published
in non-indexed
education
journal
2001
Semi-structured
interviews
Community
pharmacists
Nottingham,
England
21 community
pharmacists
2001
Community
pharmacists
Brighton,
England
14 community
pharmacists
Conference
abstract in
journal
supplement
Paper in nonindexed
professional
journal
Paper in nonindexed
professional
journal
Circa 2001
Focus group
interviews as part
of a CPD skills
assessment
programme
Focus group
interviews as part
of a study piloting
a CPD toolkit
Questionnaire sent
by internal mail or
e-mail with open
questions
Postal
questionnaire
Investigated community
pharmacists perceptions and ideas
about CPD as well as involvement
in CPD.
Identified training issues and
attitudes towards CPD.
Pharmacists
Wales
14 pharmacists
Examined pharmacists needs in

relation to CPD and the toolkit
tested as part of the study
Hospital and
community
pharmacists
Leeds/Bradford,
England
88 (response rate
40%)
Pharmacists
Liverpool and
Wirral, England
291 analysable
questionnaires
(38.8% response
rate)
Paper in nonindexed
education
journal
Conference
abstract in
journal suppl.
2002
Pre-piloted postal
questionnaire
Community
pharmacists
Hampshire and
the Isle of Wight,
England
Circa 2003/4
Focus group
interviews
Locum
community
pharmacists
England
312 (response rate

55%, usable
response rate 47%
271)
6 locum
community
pharmacists
Investigated current CPD practice

and pharmacists views about the
help that they will need in the
future.
Evaluated pharmacists
engagement in CE and explored
their perceptions and attitudes
towards future developments in
CPD.
Investigated community
pharmacists attitudes and
approaches to CE and CPD.
James 34
QARI = 7 / 10
Thompson 38
QARI = 3 / 10
Swainson and
Silcock 32
QARI = 5 / 10
Mottram 30
QARI = 6 /10
Hull 33
QARI = 5 / 10
Miller 35
QARI = 5 / 10
2002
2002
Page 60
Explored locum pharmacists

understanding of and views about
CPD
Donyai, et al. 2010
Table 1 continued. The list of studies included in this review.

Study
Type of
publication
Year study
conducted
Method of data
collection
Sector(s) of
pharmacy
Study location
Sample size
Anon. 42
QARI = 2 / 10
Survey outcome
published in
non-indexed
professional
journal
Conference
abstract
published in
journal
supplement
Paper published
in non-indexed
professional
journal
2003
Survey
questionnaire
distributed to all
RPSGB registrants
All RPSGB
registrants
Across GB
1,000 analysed
Investigated views about

mandatory CPD prior to its launch.
Circa 2003
Feedback as part of
CPD facilitation
scheme
Community
pharmacists
Wales
40 participants
Collected feedback relating to a

protected time CPD facilitation
scheme.
2002 and
2004
Face-to-face
interviews and
telephone
interviews
Community
pharmacists
London , England
Explored perceived motivations

and barriers to engaging in CPD in
community pharmacists trained
and non-trained in a medication
review service
Paper published
in indexed
pharmacy
journal
Paper published
in indexed
pharmacy
journal
Paper published
in non-indexed
education
journal
Paper published
in non-indexed
education
journal
2004
Questionnaire
study examining
CPD engaging
behaviour
Face-to-face semistructured
interviews
Hospital
pharmacists
London
43trained
pharmacists and
14 non-trained in
2002; 33 trained
pharmacist and 5
non-trained in
2004
132 completed
questionnaires
Hospital
pharmacists
London
9 pharmacists (4
male)
Explored attitudes towards CPD

and its contribution to practice
2005
interviews
Female
community
pharmacists
North West of
England
Examined the usage and

understanding of CPD using
qualitative methods of analysis.
Circa 2005
interviews as part
of pilot of portfolio
system
Pharmacists
Durham and Tees

Valley, England
30 female
community
pharmacists over
the age of 30
9 pharmacists
Lau 37
QARI = 2 / 10
Laaksonen 27
QARI = 7 / 10
Kostrzewski 31
QARI = 8 / 10
Kostrzewski 19
QARI = 6 / 10
Gidman 25
QARI = 6 / 10
Swallow 26
QARI = 8 / 10
2004-2005
Page 61
Explored the relationship between

personality characteristics and
attitude and CPD engagement
Examined pharmacists use and

attitudes towards a portfolio
system.
Donyai, et al. 2010
Table 1 continued. The list of studies included in this review.

Study
Type of
publication
Year study
conducted
Method of data
collection
Sector(s) of
pharmacy
Study location
Sample size
Power 18
QARI = 5 / 10
Paper published
in indexed
pharmacy
journal
Paper published
in non-indexed
professional
journal
Conference
paper published
online
Circa
2005/2006
Postal
questionnaire
Pharmacists
across the
sectors
Scotland
543 (response rate

22.4%)
Summarised Scottish pharmacists

views and attitudes towards CPD.
Spring 2006
Semi-structured
interviews
Pharmacy
technicians
London region
9 (all females)
Explored pharmacy technicians

perceptions of registration and
professionalism including CPD.
2006-2007
Semi-structured
interviews and
focus-group
Pharmacists
from a variety
of backgrounds
Nottinghamshire,
England
Explored pharmacists attitudes to

CPD identifying four key themes
Briefly reported
in non-indexed
professional
journal
Conference
abstract
published in
journal
supplement
Commissioned
report
published
online
Conference
abstract
published in
journal
supplement
Conference
abstract in
journal
supplement
2007
Survey
Pharmacist
RPSGB branch
members
Sunderland
Branch, England
23 pharmacists
interviewed with 6
attending focus
groups
46 pharmacists
2008
interviews
Community
pharmacists
Manchester,
England
18 pharmacists
Explored the views of community

pharmacists on the barriers to
CPD.
Circa 2008
Online
questionnaire
RPSGB
registrants
UK
1945 respondents
Investigated RPSGB registrants

views using a CPD-focussed
questionnaire.
July 2008
Postal
questionnaire as
part of evaluation
of a CPPE
workshop
Postal
questionnaire
Pharmacy
technicians
England
146 (67.6%
response rate)
Explored pharmacy technicians

uptake of CPD and impact of
learning on working practice.
Middleton 29
QARI = 1 / 10
Gifford 24
QARI = 8 / 10
Anon. 41
QARI = 0 / 10
Coglan 36
QARI = 5 / 10
PARN 44
QARI = 2 / 10
Schafheutle 40
QARI = 1 /10
Coulman39
QARI = 6 / 10
February
2009
Practising
pharmacists
Wales
939 (46% response

rate)
Page 62
Explored engagement of
Sunderland branch members with
CPD
Explored whether CPD being

recorded and what format used for
recording
Donyai, et al. 2010
Table 2 Pharmacy professionals perception of time as a facilitator or barrier to participation in CPD

Study
Year study
conducted
Study participants
Outcomes in relation to barriers and facilitators
Attewell 28
2001
21 community pharmacist interviewed in Nottingham,

England
James 34
2001
Mottram 30
2002
Swainson and
Silcock 32
2002
Miller35
Circa 2003/4
Lau 37
2003
Laaksonen 27
2002 and
2004
Swallow 26
Circa 2005
Gidman 25
2005
14 community pharmacists in Brighton interviewed as

part of a CPD skills assessment programme.
291 pharmacists in Liverpool and Wirral who answered
postal questionnaire on engagement in CE and attitudes
to CPD
44 community and 44 hospital pharmacists in Leeds and
Bradford who answered CPD practice questionnaire using
open text
Six locum community pharmacists interviewed during
focus groups
40 community pharmacist providing feedback as part of a
CPD facilitation under a protected time scheme in Wales
43 London pharmacists trained in a medication review
service and 14 non-trained in 2002; 33 trained
pharmacist and 5 non-trained in 2004 interviewed faceto-face or over the phone
9 pharmacists in Durham and Tees Valley interviewed as
part of study piloting portfolio system
30 female community pharmacists in North West of
England interviewed
The main response to the question about barriers to CPD or CE was lack of time.
Of those undertaking CPD most acknowledged that some of the learning took
place during work time rather than completely in their own time. One
pharmacist thought that protected time was essential to support portfolio
development. Related to time were issues around family commitments, lack of
locally available courses, and difficulty undertaking CE after a full days work.
One of the themes identified as a barrier to undertaking CPD was time to both
undertake and document CPD activities.
231 (79.4%) of the respondents identified lack of time as an obstacle to CPD; 179
(61.5%) identified workload as an obstacle.
Time was cited as a concern about CPD by 33 (75%) of hospital and 25 (55%) of
community pharmacists. A common request was for protected time to complete
CPD and relevant documentation.
All participants at the focus group acknowledged they were poor at documenting
their CPD and resented the extra time they would need to spend doing so.
Feedback from participants about a protected time scheme was very positive and
motivated pharmacists to overcome the initial inertia associated with CPD.
Perceived barriers preventing engagement in CPD included the themes limited
time for CPD. high workload, and frame of mind (not being able to learn
anything after a long days work) as well as family and social commitments
(other commitments more important than CPD) and leisure time.
Whilst participants were willing to invest personal time in CPD they also wanted
a proportion of work time reserved for CPD activity.
The majority reported it difficult to find time to complete CPD, especially those
with dependent children and evening training was unpopular with most. Time
also appeared within the theme remuneration for completing CPD and training
for the new contract with a minority of stating CPD should be completed in
personal time but most demanding set CPD time.
Page 63
Donyai, et al. 2010
Table 2 continued. Pharmacy professionals perception of time as a facilitator or barrier to participation in CPD.
Study
Year study
conducted
Study participants
Power 18
Middleton 29
Circa
2005/2006
Spring 2006
543 Scottish pharmacists who answered a questionnaire

about attitudes to CPD
9 female pharmacy technicians interviewed in London
Anon. 41
2007
Coglan 36
2008
PARN 44
Circa 2008
46 pharmacists answering a survey for Sunderland branch

of RPSGB
18 community pharmacists interviewed in Manchester,
England
1945 RPSGB registrants who answered an online
questionnaire compared data to respondents from other
professions.
A total of 76% of the respondents agreed with the statement I do not have
sufficient time to achieve my CPD goals
Time was identified in relation to challenges to becoming a registered
professional, particularly for part-time workers with children.
One of the main concerns was time.
Schafheutle 40
July 2008
146 pharmacy technicians who had attended a CPPE

workshop and completed an evaluation afterwards
One of four themes in relation to barriers to CPD was time: lack of time to write
up CPD, especially at work.
A total of 68% of the respondents participated in CPD at work during work hours
(compared to 80% in other professions); 87% in personal time (compared to 68% in
other professions); 49% at an external venue during work hours (compared to
72% in other professions).
From 43 participants who had not created a CPD entry following workshop
learning, a total of 20 identified lack of time as the reason with two specifying
lack of work-time learning.
Page 64
Donyai, et al. 2010
Table 3 Pharmacy professionals perception of financial costs and resource issues as facilitators or barriers to participation in CPD
Study
Year study
conducted
Study participants
Attewell 28
2001
James 34
2001

England
Mottram 30
2002

to CPD
Laaksonen 27
2002 and
2004
Miller35
Circa 2003/4

focus groups
One barrier to CPD or CE was identified as cost of locum cover to enable

attendance at daytime courses.
One of the themes identified as a barrier to undertaking CPD was incentives and
financial rewards for participating. The authors of the report noted lack of
locum support had even hindered participants involvement in the research.
41 (14.1%) of the respondents identified lack of financial resource as an obstacle
to CPD. The majority of respondents (51.2%) disagreed with the statement CPD
should be undertaken without additional payment (20.6% agreed and 28.2% were
neutral).
Perceived barriers preventing engagement in CPD included the theme cluster
lack of resources which included problems with recruiting locums,
participation in CPD incurs costs, lack of remuneration for CPD and services.
Gidman 25
2005
30 female community pharmacists in North West of

England interviewed
Swallow 26
Circa 2005
PARN 44
Circa 2008

professions.
Available resources were limited and poor and many seemed to be targeted
towards pharmacists permanently based somewhere.
Payment for CPD was unusual and locum pharmacists CPD activities were
thought to be generally unrecognised even if leading to financial gain for
employer.
A minority felt that professionals had a responsibility to complete additional
training in own time but more commonly interviewees felt they should get paid
time to complete training. There was a suggestion that locum and part-time
pharmacists felt they lost out on employer help.
Issues related to infrastructure support from the employer and opportunities to
attend CPD events at work.
A total of 44% of respondents stated their employer pays for their CPD (compared
to 67% in other professions); 72% stated the CPD they did was free (compared to
30% in other professions); 42% paid for their own CPD (compared to 53% in other
professions).
Where CPD was funded fully or partly by the employer, 35% stated the CPD must
meet their employers needs for it to be funded (compared to 56% in other
professions); 20% stated they were permitted to do any CPD according to their
need (compared to 29% in other professions); 25% stated the cost of the CPD was
a determining factor for employer funded CPD (compared to 43% in other
professions).
Page 65
Donyai, et al. 2010
Table 4 Pharmacy professionals understanding of CPD as a facilitator or barrier to participation in CPD

Study
Year study
conducted
Study participants
Attewell 28
2001

England
James 34
2001
Thompson 38
Circa 2001

14 pharmacists in Wales interviewed as part of a study
piloting a CPD toolkit
Swainson and
Silcock 32
2002
Few pharmacists understood and practised the CPD principles and there was
confusion about the difference between CPD and CE. Few had received any
training in relation to CPD. Pharmacists found it hard to describe how they
assessed own learning needs and many were unsure how to evaluate own
learning.
One of the themes identified as a barrier to undertaking CPD was general
understanding of CPD process with the reflection a particular barrier.
Although not strictly a lack of understanding of CPD, participants identified
learning needs analysis as the component of the CPD process most difficult and
some had problems identifying resources to meet learning needs.
When asked to define CPD responses tended to focus on action rather than other
stages and definitions that involved some aspect of planning were least common.
Mottram 30
2002
Hull 33
2002
Lau 37
2003
Laaksonen 27
2002 and
2004
Miller 35
Circa 2003/4
Gidman 25
2005
Power 18
Circa
2005/2006

open text
to CPD
271 community pharmacists in Hampshire and the Isle of
Wight who responded to a postal questionnaire.
focus groups
30 female community pharmacists over the age of 30
interviewed in the North West of England.

178 (61.2%) of the respondents answered they had understood the distinction
between CPD and CE before reading the questionnaire, with a slightly higher
proportion being from hospital vs. community pharmacy.
While 166 (61%) of respondents had a clear understanding of CE and 25 (9%)
none, only 58 (21%) had a clear understanding of CPD with 113 (42%) none.
Others were confused or had partial understanding.
Feedback from participants about a protected time scheme was very positive
with comments indicating understanding of CPD had been improved/gained.
One barrier to engagement in CPD was identified as lack of information about
CPD and what exactly it entails.
One pharmacist was not clear on difference between CPD and CE and none made
reference to the CPD cycle.
The majority found the principles of CPD confusing; some were uncertain about
how much CPD they were required to complete and what constituted CPD. Most
interviewees were uncertain whether they were complying with CPD principles
and meeting legislative requirements. Some were unsure how to record CPD.
Pharmacists felt most comfortable with identification of learning needs and were
also confident in assessing the value of what they had learnt and applying it to
practice.
Page 66
Donyai, et al. 2010
Table 4 continued. Pharmacy professionals understanding of CPD as a facilitator or barrier to participation in CPD
Study
Year study
conducted
Study participants
Gifford 24
2006-2007
23 pharmacists interviewed in Nottinghamshire, England
Anon. 41
2007
Coglan 36
2008
Schafheutle 40
July 2008

of RPSGB
England
The main benefit of the CPD process related to pharmacists increased

understanding and use of reflection, compared to CE.
One of the main concerns was what to record and most thought they would
benefit from further guidance on what CPD to report and how to report it.
One of four themes in relation to barriers to CPD was that of process with
difficulty choosing competencies and confusion over what counted as CPD.
learning, a total of 9 felt they were unsure about how to record CPD.
Page 67
Donyai, et al. 2010
Table 5 Pharmacy professionals perception of facilitation and support for CPD as facilitators or barriers to participation in CPD
Study
Year study
conducted
Study participants
Attewell 28
2001

England
James 34
2001

Thompson 38
Circa 2001
14 pharmacists in Wales interviewed as part of a study

piloting a CPD toolkit
Swainson and
Silcock 32
2002
Lau 37
2003

open text
Swallow 26
Circa 2005

Gidman 25
2005
Power 18
Circa
2005/2006

Middleton 29
Spring 2006
Few pharmacists had received training on CPD. When asked what support was
needed for developing CPD, participants stated opportunity to meet with other
pharmacists, MCQs to help identify learning needs, guidance on how to develop
personal objectives, and easier access to information.
One of the themes identified as a barrier to undertaking CPD was availability of
appropriate facilitation and training and participants emphasised the need for
support and ongoing facilitation.
A CPD development portfolio toolkit was found to be a valuable resource and the
author suggested a key element of facilitation in future would be the availability
of example documentation of CPD activities as a resource.
9% of hospital and 9% of community pharmacists selected support as a concern
about CPD. Both groups agreed managers should facilitate CPD via different
means.
The author reported the opportunity to interact with a facilitator who provided
support and motivation increased pharmacists self- and social awareness to
overcome the inertia.
Issues related to infrastructure included facilitation/nurturing and mentorship, it
was felt appraisal could be timed with CPD planning and achievement with some
needing mentorship or training for CPD. The role of the department head in
introducing continuing professional education was deemed vital.
Pharmacists relied on one another for guidance with CPD but training others
acted to increase the workload of some pharmacists.
A total of 65% of respondents disagreed with the statement I have support in my
workplace to carry out my CPD plans. More support was perceived to be needed
for pharmacists CPD.
The authors identified that pharmacy technicians do not seem to receive training
about how to undertake CPD in formal technician training courses.
Page 68
Donyai, et al. 2010
Table 6 Pharmacy professionals motivation and interest in CPD as facilitators or barriers to participation in CPD
Study
Year study
conducted
Study participants
Attewell 28
2001

England
James 34
2001
Mottram 30
2002
Swainson and
Silcock 32
2002

291 pharmacists in Liverpool and Wirral answered postal
questionnaire on engaging in CE and attitudes to CPD
Bradford who answered CPD practice questionnaire
Hull 33
2002

Laaksonen 27
2002 and
2004

Kostrzewski 31
2004
132 questionnaires completed by hospital pharmacists in

London.
A recurring theme among pharmacists was querying the relevance of CPD once
their career had progressed to the desired (or achievable) level believed, when
they were in maintenance mode. One pharmacist thought it the responsibility
of the national and small chains to convince their employees to participate in
CPD. Some participants felt keeping a CPD portfolio helped them remember
their accomplishments, others felt it important for future interviews and one felt
it correlated with receiving a company bonus. Some thought mandatory CPD
would motivate them to complete it.
One of the themes identified as a barrier to undertaking CPD was general
motivation and support.
31 (10.7%) of respondents stated apathy to the subject as a specific obstacle to
CPD.
A range of benefits of CPD were described by hospital and community
pharmacists including personal development (20% v 25%), improved knowledge
(0% v 43%), skills or competence (36% v 27%), public/self-confidence (11% v 27%)
and outcome for patients (43% v 23%). In relation to impact on working life, only
community pharmacists mentioned better job satisfaction.
222 (81.5%) thought CPD would improve their ability to perform their role, 161
(59.4%) and 132 (48.7%) thought CPD would enhance the status of the profession
among professionals or the public, respectively. Only 66 (24.4%) thought CPD
would enhance their career prospects and 29 (10.7%) saw no benefit from CPD
27 of the latter did not undertake any CE/CPD.
A barrier to engagement in CPD was lack of motivation with participants not
being motivated to participate or viewing participation as a waste of time. A
number of motivational factors influencing engagement in CPD included
purpose of CPD, influences of CPD on working life, benefit of CPD for work,
incentives for CPD, feeling of being compelled to engage in CPD.
The personality traits conscientiousness, agreeableness and emotional
stability were associated with keeping a portfolio.
Page 69
Donyai, et al. 2010
Table 6 continued. Pharmacy professionals motivation and interest in CPD as facilitators or barriers to participation in CPD
Study
Year study
conducted
Study participants
Kostrzewski 19
2004-2005
9 London hospital pharmacists interviewed.
Swallow 26
Circa 2005

Gidman 25
2005
Power 18
Circa
2005/2006

Middleton 29
Spring 2006
Gifford 24
2006-2007
Coglan 36
2008

England
The authors concluded the contribution of CPD recording to enhancing practice

in hospital pharmacists was difficult to demonstrate, linking this with
pharmacists disillusionment with the CPD process. Mentality as a
characteristic way of thinking was used by participants to describe how
recording influenced the way they structured their thinking working as a
trigger for learning and as a change in their way of thinking.
The authors sensed respondents would appreciate an incentive for maintaining
their CPD. Regardless of career stage, the majority emphasised the importance
of learning continuously at work but the recently qualified were more
comfortable with reflective practice. Some found portfolios motivational while
others were threatened.
A significant minority of interviewees who devoted considerable amounts of
time to training did so to move sector most commonly to Primary Care Trusts.
Hospital pharmacists were motivated towards CPD with primary care
pharmacists the most motivated group with the most confidence, ability and
resource to participate in CPD. The authors suggested community pharmacists
require the most support both for motivation and confidence and ability in
participating in CPD.
Technicians interviewed had undertaken considerable learning and development
since qualifying and were all recording CPD. Some had learnt about CPD by
attending courses and some by self-directed learning.
The majority of pharmacist viewed the concept of CPD positively, understood its
purpose and were in agreement with its but an understanding did not mean they
were actually recording their CPD. The pharmacists admitted to lacking in
motivation to actually act. In some instances pharmacists admitted that having
to record their CPD had discouraged them from undertaking a learning activity.
The majority of pharmacists thought that updating knowledge was necessary.
Page 70
Donyai, et al. 2010
Table 6 continued. Pharmacy professionals motivation and interest in CPD as facilitators or barriers to participation in CPD
Study
Year study
conducted
Study participants
PARN 44
Circa 2008

professions.
When asked about overall attitude to CPD 63% were positive, 22% neutral and
11% negative. A number of drivers or motivations for participating in CPD were
rated very important, important, neutral, unimportant or very unimportant.
Responses are presented here by grouping the first and the last two categories to
produce scores relating to important (i), neutral (n) and unimportant (u):
My professional/regulatory body requires me to do it (82% i, 12% n, 7% u)
My employer requires me to do it (49% i, 32% n, 18% u)
It is explicitly included in my regular appraisal process (39% i, 37% n, 23% u)
I feel it is my duty as a professional to do it (89% i, 8% n, 2% u)
I do it to improve performance in my current role (84% i, 10% n, 5% u)
I do it to further my position with my current employer (32% i, 39% n, 27% u)
I do it to further my career in general (52% i, 28% n, 21% u)
I do it because I want to change career (12% i, 35% n, 52% u)
I do it to develop as a person (71% i, 18% n, 11% u)
When asked how important taking part in CPD had been to development of their
career 79% said important, 17% were neutral, 14% said unimportant.
Page 71
Donyai, et al. 2010
Table 7 Pharmacy professionals attitude towards compulsory CPD as facilitator or barrier to participation in CPD
Study
Year study
conducted
Study participants
Attewell 28
2001

England
Hull 33
2002

Mottram 30
2002

20 of the 21 pharmacists agreed CPD should be mandatory. Reasons included to

improve standards in community practice and improve patient and other
professionals perception of community pharmacy.
Questions were raised about practicality and attainability of mandatory CPD
some thought proposals had not been well thought through and others thoughts
they were not practical. Other concerns were about how the system would
work, what would be expected, how much paper work would be required, how
the scheme would be managed effectively, what support would be available, and
how time-consuming mandatory CPD would be.
One thought mandatory CPD would create exodus from profession.
Some thought mandatory CPD questioned their professionalism.
When asked about sanctions that should be applied to those pharmacists who
fail to meet RPSGB criteria for CPD when it becomes mandatory, 32.3% said
competence reassessment, 24.7% said counselling, 19.8% said no action taken,
17.1% said remedial training, 2.3% said reprimand, 1.9% said removal from
register. A significant proportion of respondents who suggested no action were
locum or proprietor pharmacists.
In relation to CPD:
81.8% agreed all pharmacists should engage in CPD
19.9% agreed the performance of all pharmacists CPD should be assessed by an
independent body (40.5% disagreed and 39.5% were neutral)
52.6% agreed pharmacists should spend at least 30 hours per annum on CPD
(16.5% disagreed and 30.9% were neutral) part-time pharmacists disagreed with
the statement more and disagreement increased with length of registration.
Community pharmacists in independent pharmacies disagreed more than their
counterparts in small or large multiple and more self-employed disagreed than
managers and locums.
10.7% agreed pharmacists not completing 30 hours of CPD should be removed
from the register (71.5% disagreed and 17.9% were neutral) expressions of
disagreement were higher in males and for community pharmacists
Continued overleaf
Page 72
Donyai, et al. 2010
Table 7 continued. Pharmacy professionals attitude towards compulsory CPD as facilitator or barrier to participation in CPD.
Study
Year study
conducted
Mottram 30 continued
2002
Swainson and
Silcock 32
2002

open text
Laaksonen 27
2002 and
2004

Anon. 42
2003
1,000 RPSGB registrants answering a GB-wide survey
Study participants

29.6% agreed pharmacists can remain professionally competent without
undertaking CPD (43% disagreed and 27.5% were neutral) fewer hospital
pharmacists agreed.
20.6% agreed CPD should be undertaken without additional payment (51.2%
disagreed and 28.2% were neutral) a higher proportion of community
pharmacists disagreed with hospital pharmacists neutral.
In relation to impact on working life, themes common to both sectors included
more structured learning and the need to document activities. Concerns about
compulsory CPD covered 6 themes including concerns about procedures for
assessing and monitoring CPD (expressed by community pharmacists) with some
concerns about fundamental concept of CPD as a form filling exercise.
The perceived importance of compulsory CPD was also captured:
93% of hospital and 93% community pharmacists agreed compulsory CPD is
important to the future of the profession
important for my personal development
important for my career progression
needed for our departmental/business to meet its objective
Some pharmacists disapproved of the introduction of mandatory CPD and six
considered quitting and others felt intimidated. Older pharmacists perceived
they were experienced enough not to participate in CPD and younger ones
thought they were still developing their competence.
Some thought engaging in CPD was an obligation.
When asked to whom should mandatory CPD apply 93.3% thought a
pharmacist in a job normally undertaken by a pharmacist but only 59.5% thought
it should apply to a pharmacist in a job for which they do not have to be a
pharmacist and 11.5% thought a retired/career break/inactive pharmacist. There
were concerns that transfer from non-patient to patient care area should require
a test of competence and conduct of regular CPD. In response to minimum
requirements in relation to CPD records 54.7% agreed CPD should relate to
pharmacy in general; 67.4% to the pharmacists sector of practice and 67.4% to
the pharmacists job
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Donyai, et al. 2010
Table 7 continued. Pharmacy professionals attitude towards compulsory CPD as facilitator or barrier to participation in CPD.
Study
Year study
conducted
Study participants
Gidman 25
2005

Swallow 26
Circa 2005

Gifford 24
2006-2007
Coglan 36
2008
PARN 44
Circa 2008

England
professions.
The majority were in agreement with mandatory CPD in principle but a minority
found the process of recording CPD patronising and were insulted by the
intimation that they did not routinely practice CPD principles.
A minority reported they would cease to practice as a consequence of CPD
commonly they were near retirement age. One hospital pharmacist stated they
would cease to practice in community pharmacy on Saturdays.
There was a level of confusion about how information recorded in portfolios
would inform mandatory requirements and an anxiety that in fact dual effort
was likely to be invested in ensuring mandatory requirements were met.
Respondents tended to describe retaining evidence of attendance at CE events
particularly to meet mandatory requirements rather than evidence of
competence.
Some of the focus group participants in particular commented the move towards
a mandatory requirement to undertake and record CPD was acting as a negative
influence on their motivation and decreasing their willingness to undertake
learning activities. The majority though viewed the concept of CPD positively
and felt it was needed in the current healthcare climate, for assessing
competence, maintaining registration, lifelong learning, ensuring public
confidence and providing evidence of ability to work in employment situations.
One of four themes in relation to barriers to CPD was review: unwillingness to
have CPD reviewed (I dont like the idea of being able to be checked up on).
Only 7% of respondents said CPD should be initiated by the individual and not
enforced by the RPSGB.
When asked what single change to CPD recording would encourage members to
keep a CPD record, 2% wrote something in the theme make it mandatory, 10%
wrote replace CPD with regular professional testing, 6% wrote accept all types
of recording.
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Donyai, et al. 2010
Table 8 Pharmacy professionals perception of system constraints as facilitator or barrier to participation in CPD
Study
Year study
conducted
Study participants
Laaksonen 27
2002 and
2004
Gidman 25
2005

Gifford 24
2006-2007
Anon. 41
2007
PARN 44
Circa 2008

of RPSGB
professions.
The proposed CPD system was thought to be restrictive pharmacists thought

they should not be required to employ all different learning activities but be
allowed to continue with the one they felt comfortable with and which
facilitated their studies.
One interviewee said the system was flawed as CPD could be fabricated.
A minority reported that recording CPD online posed a few problems.
Commonly interviewees didnt record CPD online but kept written records.
A number found the website difficult to use.
Pharmacists expressed very negative views about Plan & Record, the RPSGBs
CPD recording process, described as cumbersome and onerous. The online
system was thought to have inherent limitations to capture situations in practice
and the forms the subject of much comment. There was a perceived lack of
flexibility in the recording process. There was lack of clarity about who could
access electronically-stored records and for what purpose. There were concerns
the forms had been designed to allow easy computer assessment rather than to
optimise learning.
All 64% stated they had engaged with the concept of CPD with all those recording
online stating the RPSGB Plan & Record was easy-to-use.
When asked about online tools for planning, recording and reflecting on CPD,
31% did not use online tools to plan CPD and had no desire to, 14% felt the same
about online tools for recording CPD and 21% for reflecting on CPD. 18% used but
did not value online tools for planning, 28% felt the same about online tools for
recording and 29% for reflecting on CPD. 20% used and valued online tools for
planning CPD, 38% felt that way about online tools for recording and 27% for
reflecting on CPD.
The following responses were received about the RPSGB Plan & Record:
The online framework is not user-friendly 25%
The framework is complex and time-consuming 18%
It is useful and easy to use 15%
It does not reflect all pharmacists competencies 14%
The method of CPD recording is problematic 9%
When asked what single change to CPD recording would encourage members to
keep a CPD record, 46% wrote something in the theme make online recording
more user-friendly by simplifying it, for example changing comment boxes to
tick boxed, 23% make recording more relevant to pharmacists competencies.
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Donyai, et al. 2010
Table 9 Pharmacy professionals perception and experiences of technical problems as facilitators or barriers to participation in CPD
Study
Year study
conducted
Study participants
Attewell 28
2001
Access to the internet at work was considered crucial to mandatory CPD.
Gidman 25
2005

England
Swallow 26
Circa 2005

Gifford 24
Schafheutle 40
2006-2007
Women of all ages indicated their not recording of CPD online related to lack of
IT knowledge. In other cases interviewees did not have internet access at work
or at home. Those with internet access at work did not have time to record CPD
online due to competing demands for access to computer e.g. because
dispensing.
Respondents described a variety of factors influencing access to CPD including IT
resources such as access to a computer at work to keep an ongoing record of
CPD.
Many pharmacies were said not to have internet connections.
July 2008

learning, a total of 3 mentioned IT problems accessing the online record.
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Donyai, et al. 2010
Table 10 Pharmacy professionals activities or use of resources for participating in CPD

Study
Year study
conducted
Study participants
Attewell 28
2001

England
Hull 33
2002

Mottram 30
2002

Swainson and
Silcock 32
2002

open text
When asked about the CE conducted the most common type was reading
professional journals particularly the PJ and Chemist and Druggist. All read PJ
occasionally to weekly, most picking out important articles to read at a later date
due to ease of accessibility. Some also attended workshops by the Centre for
Pharmacy Postgraduate Education (CPPE) and completion of its distance-learning
packs. Activities also included postgraduate diploma courses. Work-shadowing
and talking to an expert were also mentioned.
The following sources were used for CE/CPD activities: The PJ (93%), CPPE
distance learning (76%), CPPE workshops (73%), textbooks (60%), Chemist &
Druggist (53%), RPSGB branch meetings (47%), manufacturers literature and/or
training (45%), educational material from National Pharmaceutical Association
(33%), in-house company information (31%), internet (28%), computer-aided
learning (11%), other professional journals (6%), RPSGB video-loan service (4%).
The mean number of hours for each type of CE was reported as 16.2 for
attending workshops, 9.1 for reading journal articles, 8.2 for distance learning
courses, 0.8 for computer assisted learning. A comparison of the difference in
participating in direct (workshops) vs. indirect activities (reading/distance
learning/computer assisted learning) by sub-group of respondents showed all
except for hospital pharmacist undertook more indirect than direct learning.
Most of the learning by the pharmacists working in large multiples was via
indirect learning.
41.2% stated they regularly undertook training needs identification and this was
more likely for female pharmacists than male and also more likely for hospital
vs. community pharmacists.
When asked about activities considered to be CPD a wide variety of responses
included private study (including internet-based literature searching), external
training, writing papers and meetings. Fewer community pharmacists
mentioned in-house training (e.g. audits and queries) and only hospital
respondents mentioned teaching. More community pharmacists mentioned
external training which included CPPE workshops or work associated with postgraduate diplomas. Few community pharmacists preferred small-group
discussions.
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Donyai, et al. 2010
Table 10 continued. Pharmacy professionals activities or use of resources for participating in CPD
Study
Year study
conducted
Study participants
Swallow 26
Circa 2005

Power 18
Circa
2005/2006

PARN 44
Circa 2008

professions.
The respondents described a wide and varied range of involvement with CE and
CPD activities including attending lectures and study days, also identifying as
CPD under-taking post-graduate diploma courses and masters programmes and
learning achieved through presenting information at in-service sessions which
resulted from reflection and reading.
The uptake of various CPD activities expressed as median % CPD time spent on
activity were reported as 10% for NHS Education for Scotland conferences, 0%
for RPSGB branch meetings, 0% for in-service meetings, 10% for distancelearning courses, 10% directed reading in the workplace, 10% learning from
colleagues (mentoring/shadowing/discussion), 15% personal study/non-directed
reading, 5% teaching or enquiry and 0% on-line courses.
When asked about different modes of CPD delivery in past 12 months 92% had
participated in informal/self-directed reading and research, 68% face-to-face, 76%
work-based, experience on the job, 68% online, 53% text-based distance learning,
28% use of corporate intranet for learning.
Type of CPD undertaken in the last 12 months were reading (96%), attending
conferences/seminars/workshops (82%), internet or library search (83%), informal
discussion with colleagues (80%), university courses/modules (16%),
modules/courses as part of professional qualification (21%).
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Donyai, et al. 2010
Table 11 Pharmacy professionals participation in CPD

Study
Year study
conducted
Study participants
Attewell 28
2001
Six had a CPD portfolio.
Hull 33
2002

England
Mottram 30
2002

Swainson and
Silcock 32
2002

open text
Kostrzewski 31
2004
Gidman 25
2005
Swallow 26
Circa 2005
132 questionnaires completed by hospital pharmacists in

London.
The numbers of hours of CPD in past 12 months were reported: 13.3% said 1-9
hours, 17% said 10-19 hours, 15.1% said 20-29 hours, 32.5% said 30 or more hours.
The most likely profile to meet the RPSGB 30+ hours of CE was female employee
pharmacists registered between 11-20 years. Locum and proprietor pharmacists
were most likely not to conduct CE/CPD.
When asked if participants had undertaken any CE within the previous 12
months, 90.4% responded yes. The mean number of hours estimated to have
been undertaken in the past 12 months was 37.8 and the median was 30.
49.6% estimated they had completed the 30 hours or more CE in the previous 12
months. Pharmacist sub-groups undertaking significantly more CE were female
(median 30 hours), full-time workers (median 30 hours), those employed in
hospital (median 40 hours), or if in community working for a large multiple
(median 30 hours).
A total of 28.5% stated they maintained a CPD portfolio there were no patterns
associated with the different sub-groups.
The mean reported CPD hours in the past month for community pharmacists
was 6.9 hours with a median of 5 hours. For hospital pharmacists the mean was
14.5 hours with a median of 12.75 hours. The difference between the sectors was
statistically significant. In the past year, 50% of hospital pharmacists reported
completing more than 50 hours of CPD activity.
61% stated they kept a portfolio.
A significant minority of interviewees were not recording CPD despite reporting
learning activities.
The few respondents who had previously used a portfolio included those who
had qualified within the last few years, those responsible for creating a Trustbased educational infrastructure for pharmacists, those with responsibility for
developing a climate to allow appropriate training and supervision for preregistration pharmacists. Length of time appeared to be an influencing factor in
respondents perception of both CPD and portfolio development the recently
qualified were more comfortable with the concept of reflective practice and had
experience of a portfolio.
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Donyai, et al. 2010
Table 11 continued. Pharmacy professionals participation in CPD

Study
Year study
conducted
Study participants
Power 18
Circa
2005/2006

Middleton 29
Spring 2006
Gifford 24
2006-2007
Anon. 41
2007
PARN 44
Circa 2008

of RPSGB
professions.
Schafheutle 40
July 2008
Respondents reported spending a median of 40 hours per annum on CPD with

the range being 0 hours to 720 hours with one outlier reporting all their
professional work was CPD (1920 hours per annum).
Hospital pharmacists reporting more hours (66.3 hours) CPD per annum
compared to community pharmacists (44.9 hours), which was statistically
significant as was the difference reported by primary care pharmacists (67.5
hours).
No statistically significant gender difference was found in relation to CPD hours.
All technicians in the study were recording CPD but acknowledged some
pharmacy technicians might find this challenging.
Several of the pharmacists were apologetic for their lack of engagement in CPD
process.
64% stated they had engaged with the concept of CPD making 2 to 15 entries in
the previous year.
2% had not undertaken any CPD in the past 12 months, 11% said they had
undertaken 1-10 hours, 19% said 11-20 hours, 17% said 21-30 hours, 19% said 3140 hours, 8% said 41-50 hours, and 21% said 41-50 hours.
When asked if kept a record of CPD, 15% replied no and 84% replied yes. 23%
kept 0-3 CPD entries, 20% kept 4-6, 16% kept 7-9, 26% kept 10-12, 12% kept >13.
70.3% had used their workshop learning to create a CPD record.
Coulman39
Feb 2009

939 practising pharmacists registereted in Wales who had
returned a CPD questionnaire.
50% stated they did not have up-to-date records for the preceding 6 months and
255 had not recorded anything in that period
Only one-third reported having up-to-date records for preceding 6 months
Most recorded CPD online (58%), 25% used paper and 14% used both with others
using a desktop system.
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Donyai, et al. 2010
Box 1 Summary of the findings from this review

Time is seen as a strong barrier to pharmacy professionals participation in CPD.
The financial cost of participating in CPD is important to pharmacy professionals involvement in CPD.
Understanding fundamental aspects of the CPD process appears to remain an issue in pharmacy.
The provision of CPD facilitation has been helpful in pharmacy.
There appears to be a trend towards accepting the idea of CPD in pharmacy.
There appears to be a trend towards accepting the idea of compulsory CPD in pharmacy.
Perceptions towards Plan & Record are not on the whole encouraging.
Some pharmacy professionals appear to have experienced problems with online access to Plan & Record.
Pharmacy professionals understanding of the scope and application of CPD could be enhanced.
The uptake of CPD could be enhanced.
The CPD needs of pre-registration trainees, overseas registrants, and academic and industrial pharmacists may
need to be examined separately.
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Donyai, et al. 2010
Records
identified
through database
searching British
Education Index
(BEI), Educational
Resources
Information
Centre (ERIC),
and Australian
Education Index
(AUEI).
(n = 355)
Records
identified
through database
searching
Medline
(n = 395)
Screening
Identification
Figure 1 Flow diagram demonstrating identification, screening, eligibility and inclusion steps
Records
identified
through database
searching Zetoc
(n = 213)
Records
identified
through database
searching the
International
Journal of
Pharmacy
Practice
(n = 82)
Records after duplicates removed

(n = 1329)
Eligibility
Included
Records
identified
through database
searching
Cochrane library
(n = 63)
Studies / reports identified

by hand searching The
Pharmaceutical Journal,
Pharmacy Education, the
Internet
(n = 11)
Records screened
(n = 1329)
Records excluded
(n = 1275)
Full-text articles
assessed for
eligibility
(n = 54)
Full-text articles excluded,

due to setting, date or focus
(n = 43)
Studies included in
main qualitative
synthesis
(n = 22)
Page 82
Records identified
through database
searching
Cumulative Index to
Nursing and Allied
Health Literature
(CINAHL) and
International
Bibliography of the
Social Sciences
(n = 343)
Donyai, et al. 2010
Figure 2 Supporting pharmacy towards CPD engagement.
If CPD is to succeed, peoples beliefs and attitudes must be addressed by recognising and modifying perceived barriers through a combination of regulatory, professional, work-related
and personal channels.
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Donyai, et al. 2010
Appendix 4
Planned interventions
Procedures
Total no.
per
participant
Average
Description of intervention/procedure
time per
intervention/
procedure
Face-to-face meeting and informed
About 15
minutes or
more if
needed.
10 minutes
3 hours
>1 hour
10 minutes
Optional focus groups with participants
50 minutes
End of study debriefing
About 15
minutes (more
if needed)
consent and completion of demographics

and contacts questionnaire
Submission of 3 CPD records from the past
for those in the practised category and 1
CPD record for those in the novice
category
Learning about the revalidation standards
with or without the Outcomes Framework
through distance learning material
Completion of new CPD entries using the
revalidation standards
Submission of 2 new CPD records from the

past
Participants will be recruited from CPD training events. Before participants enrol they will discuss with a
researcher their suitability for the study, and details of the study, as described in the information sheet.
Participants will then sign the consent form before completing a short demographics and contacts
questionnaire. The exchange will take place at each site. Each participant receives a unique study number.
Each participant will be requested to submit CPD records they have already prepared as part of their practice
or further to the CPD workshops. The records will be photocopied and/or printed and anonymised by using
the participants study number plus a code to indicate study stage. Paper records will be returned to the
participants. This work will be carried out either electronically (e-copies) or via the postal service, after
recruitment to the study.
After stratification according to pre-determined criteria, the Contractor will arrange to deliver either the
revalidation standards alone (control group) or training material to include the revalidation standards and
the Outcomes Framework and related training (intervention group). Participants in the intervention group
will receive a workbook that forms the basis of the training as well as a PowerPoint presentation (delivered
via e-mail) which will include an audio pod-cast. .
Participants will complete 2 new CPD records after receiving the revalidation standards (control group) and
completing that tasks within the revalidation standards training material (intervention group). Each entry is
likely to take 1 hour or longer depending on the nature of the activity and the manner in which it is recorded.
One will involve users in rewriting an existing CPD and the other in a new CPD activity altogether.
Each participant will be requested to submit 2 of the new CPD records they have prepared after learning
about the revalidation standards through the distance-learning material. The records will be photocopied
and/or printed and anonymised by using the participants study number plus a code to indicate study stage.
Paper records will be returned to the participants. This work will be carried out either electronically (ecopies) or via the postal service, after receipt of training material.
Willing participants will be interviewed in focus groups comprising 5-7 professionals. The interviews will be
audio-recorded and transcribed for analysis.
Debriefing will takes place when a participant has finished the study. Participants will be allowed to ask
questions of the researchers. This will take place face-to-face for those who attend the focus groups and over
the telephone for others, who will be given the option to attend a face-to-face debriefing if required.
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Donyai, et al. 2010
Flow of participants
Potential participants assessed for eligibility
and recruited into study
Participants asked to submit 3 existing CPD records if deemed practised at CPD

recording and one record if deemed novice novice e.g. planning first CPD after
type 1 events
Stratification (72)
Control group (36) - receives revalidation

standards only
Intervention group (36) - receives revalidation

standards plus outcomes framework and
related training
Receive training material on revalidation standards with or

without the outcomes framework, as workbook, and
PowerPoint presentation (delivered via e-mail) including an
audio pod-cast (see above).
Asked to submit two new CPD records using revalidation

standards one rewritten and one conducted afresh.
Participants invited to attend focus group interviews after

submitting second set of CPD records
Debriefing
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Donyai, et al. 2010
Appendix 5
Ethical application
CPD records for revalidation: assessing fitness-to-practise using revalidation standards and an
Outcomes Framework
Dr Parastou Donyai, Dr Angela Alexander, Professor Pam M Denicolo
All statutorily regulated health professionals will need to periodically demonstrate their
continued fitness to practise through revalidation. From April 2010 a new regulatory body,
the General Pharmaceutical Council (GPhC) will be responsible for the statutory regulation of
pharmacists and pharmacy technicians in Great Britain and this role will include the
revalidation of these professionals. It has been proposed that records of CPD form part of the
supporting evidence submitted by practitioners for revalidation and for that to take place
there is a requirement for new revalidation standards to be developed and tested. While
CPD has been a professional requirement of the Code of Ethics for a number of years, recent
new standards issued by the RPSGB require all practising pharmacists and registered
technicians to make a minimum of nine CPD entries per annum from 1 March 2009 in all
normal circumstances. In addition, pharmacists are now required to demonstrate CPD
outcomes in terms of their relevance and effectiveness.
The aim of this research is to investigate pharmacy professionals ability to conduct and
record their CPD in a manner that enables CPD records to be used as part of professional
revalidation. We will critically examine current literature and well as existing CPD records
after which we will use an educational intervention to train pharmacy professional to
construct and conduct their CPD based on the new revalidation standards. We will devise
and use an Outcomes Framework to help participants complete their new CPD records. We
expect that while existing research shows variability in pharmacy professionals in terms of
their participation in and attitudes towards CPD, the records submitted before training will
demonstrate gaps in terms of the information required for the process of revalidation. All
records will be anonymised by removing individual/personal details and replacing all
identifiable data either with the unique participant study number or by removing it through
erasure. Our hypothesis is that after training pharmacists to use the new revalidation
standards, specifically with the aid of an Outcomes Framework, new CPD records will be
constructed and recorded in a manner that will enable these documents to be used as part of
revalidation.
We also hypothesise that participants experience of using the new
revalidation standards will be positive and that they will be supportive of CPD in the future.
Specific objectives include:
Conducting a full literature review to identify research already undertaken that examines
areas and groups of registrants in which implementation of the RPSGB CPD framework is
most and least advanced. Identifying gaps in research.
Collating information on already-identified barriers to the uptake of CPD and examining
the nature of these barriers in relation to the uptake of future CPD for revalidation.
Developing a generic Outcomes Framework for use with the revalidation standards
during the conduct and reporting of pharmacists CPD.
Recruiting volunteer pharmacist and pharmacy technician participants through formal
CPD events
Collating volunteer CPD records to examine against the revalidation standards as well as
the Outcomes Framework devised.
Training volunteer participants to complete CPD records using the revalidation standards
as well as the Outcomes Framework devised through distance-learning material.
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Donyai, et al. 2010
Collating the new CPD records and examining these against the revalidation standards as
well as the Outcomes Framework devised.
Holding focus group interviews with study participants.
Analysing the data using qualitative interpretive methods as well as quantitative scoring.
Reporting the findings in a timely and considered manner.
Disseminating and publishing the findings via conference presentations and in peerreviewed journals.
Risk
We have considered the risks to which we might be exposing participants in this research.
We do not expect that participants will be exposed to any increased risk, over and above
what they would be expected to encounter in their normal lives. As researchers, however,
we have a responsibility to protect participants from physical and mental harm during the
investigation. There is a potential for participants to feel susceptible about the fact that their
CPD records are being assessed against an Outcomes Framework and Revalidation Standards.
In order to address this issue all CPD records will be anonymised by the Research Assistant on
receipt. This will involve removing individual/personal details and replacing all person
identifiable data either with the unique participant study number or removing it altogether
through erasure. In any case, this is a stand-alone pilot that will not link with actual process
of revalidation of pharmacy professionals, which may or may not use CPD records as part of
the process in due course. On enrolling onto the study, each participant will receive a unique
participant study number, which they will be asked to quote in all future correspondence. A
master copy of the code will be kept by the Research Assistant in hard copy and under locked
storage in a filing cabinet for the duration of the study. After the project this data will be
destroyed by shredding. In addition to the analysis of CPD records, we will be conducting
qualitative focus group interviews with participants. In the event that a distressing situation
arises for a participant during conversations about completion of CPD records, the lead
researcher or a co-investigator will be co-convening all interviews with the Research Assistant
to ensure that due judgement is exercised and that unexpected outcomes are managed
appropriately and sensitively.
Informed consent
We will recruit adult participants only. We will disclose any information that might affect
someones decision to participate or not. As such, we will inform participants as fully as
possible about what the study will involve when recruiting them, so that they can choose
whether or not they wish to participate. We will avoid undue coercion but feel it is
reasonable to propose to reimburse each participant with a 50 book token for their
participant in the study. We also propose to pay for the cost of locum cover for those
attending focus-group interviews at 200/day (which will include the locums travel expenses)
and we will also be providing light refreshments to the value of 3 per head for interview
participants. We will inform all participants of all aspects of the research that might
reasonably be expected to influence willingness to participate. This will include how long the
study will take, what is actually involved, why we are conducting the research, and what
aspect(s) of learning we are investigating.
Right of withdrawal
Right of withdrawal is essentially an extension of informed consent. Participants have the
right to withdraw their consent to participate at any time before, during or after the study.
For example, someone who initially agrees to participate has the right to cancel, to drop out
part way through the study, or to decide afterwards that they wish they hadnt participated
and to withdraw then. If a participant decides after they have completed the study that they
wish to withdraw, we will not use their data unless they give their permission to do so. We
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Donyai, et al. 2010
will inform our participants of their right of withdrawal when we seek their consent, and
remind them of this right during the briefing. We will also inform them that they do not
have to give a reason for withdrawing.
Debriefing of research participants
Debriefing has been built into the study protocol and will take place when participants have
finished the study, and will allow us to bring the study to a close. We will provide the
participants with any necessary information to complete their understanding of the nature of
the research. Where needed, this might include explaining the nature of the phenomenon
under investigation, the method used or further clarifying the purpose of the study.
Debriefing will also allow the participants to ask questions of us as the researchers. This will
take place face-to-face for those who attend the focus groups and over the telephone for
others, who will be given the option to attend a face-to-face debriefing if required.
Confidentiality and anonymity
Participants have the right to expect that information about them, including data collected
during a study, is kept confidential and/or anonymous as appropriate. Participants certainly
have the right to expect that their identity will not be revealed by name or by any other
description and we will ensure that this is the case. We will take measures to protect
participants data in the conduct, storage of data and dissemination of outcomes of this study
as follows. The data collected as part of the CPD reviews will be in the form of electronic or
paper CPD records. We will print a copy of any electronic record and photocopy paper
records before returning the originals to the participants. At the print/photocopy stage, all
records will be anonymised by the Research Assistant. Each record will be assigned the
participant study number by the Research Assistant (and a code to indicate study stage
because this is a before and after study) on receipt. As this is a before and after study, the
study code is needed to help match up the records submitted pre- and post-intervention. In
relation to the focus group interviews, we will tape record the conversations (with
participants consent) to allow accurate notes to be made afterwards. The recording will be
carried out using a digital audio-recorder and the transcripts will be typed using Microsoft
Word. Although we will not be setting out to collect this type of information, any data that
will enable a subject to be identified (e.g. name, address, work-place, job title, date of birth)
will be removed before the data is typed and stored electronically. Data would not be kept
for longer than necessary so after the outcomes have been adequately disseminated this
material would be disposed of. To make sure of the privacy of any electronic data, it will be
stored by the investigators and the Research Assistant on password protected drives. The
paper copies will be kept in a locked cabinet when not in use. Only the persons concerned
(Drs Donyai and Alexander and Professor Denicolo and the Research Assistant) will be
allowed access to the data. In the reporting of the project, no information will be released
which will enable to reader to identify who the respondent was.
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Donyai, et al. 2010
Appendix 6
Letter to Director of CPPE
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Donyai, et al. 2010
Dear Dr Cutts
CPD records for revalidation
Dr Christopher Cutts
Director
Centre for Pharmacy Postgraduate
Education (CPPE)
1st Floor, Stopford Building
University of Manchester
Oxford Road
Manchester
M13 9PT
United Kingdom
14 July 2009
I am writing following the successful award made to the Reading School of Pharmacy by the
Royal Pharmaceutical Society of Great Britain (RPSGB) to investigate the use of Continuing
Professional Development (CPD) records for revalidation of pharmacy professionals.
Our project will involve the recruitment of pharmacists and pharmacy technicians as
volunteer participants in a pilot scheme. We hope to recruit from forthcoming joint RPSGBCPPE interactive CPD workshops and I am writing to seek your formal approval to recruit
from the events. I understand that Dr Angela Alexander brought our bid to your attention at
the application stage in May. I would like to thank you for kindly accepting in principal our
intention to recruit at these events, and agreeing to consider the full detail of our proposal on
attainment of funding. Please find below a description of the recruitment process as relates
to the forthcoming CPD events.
Our aim is to recruit a total of 72 pharmacy professionals during July and September 2009.
With your approval, we intend to recruit from 15 of the forthcoming CPD events in the
South Central region, primarily those being held at the University of Reading. Our plan
would be to write to the local tutors running each session to inform them of our intention to
recruit volunteer pharmacy professionals at the close of each workshop session for
participation in this independent research project examining the appropriateness of CPD
records for revalidation. On the day of the workshops at least one member of our research
team will be present to fully brief potential participants about our study, using information
letters as a basis and collecting participants informed consent prior to enrolment. We
intend to conduct the recruitment away from the main events training rooms and in private
at each training site. The project, in essence, will involve participants submitting a number
of CPD records at future dates for evaluation before and after receiving revalidation-specific
instructions in due course. We are in the latter stages of obtaining ethical approval for this
study from the University of Reading.
Pharmacy is undergoing a period of unprecedented change and I look forward to us working
together to facilitate a project that we believe will provide robust and scientific data in
relation to the role of CPD in pharmacy professionals revalidation. Please do not hesitate to
Page 90
Donyai, et al. 2010
contact me if you need any further information or clarification as relates to the project
recruitment plans or indeed the project itself. I look forward to hearing back from you.
Yours sincerely
Parastou Donyai
Dr Parastou Donyai
Cc. Dr Angela Alexander, Prof. Pam M Denicolo
Page 91
Donyai, et al. 2010
Appendix 7
Recruitment documentation
Information letter
Frequently-asked questions
Consent form
Demographic information
Page 92
University of Reading
Lecturer, Pharmacy Practice

Dr Parastou Donyai
PHD, BPHARM, PGDPRM(OPEN),
PGCERT LTHE, MRPHARMS
+44 ( 0)118 378 4704
The CPDSchool
for Revalidation
in Pharmacy Study
Reading
of Pharmacy
Food Biosciences building
Whiteknights, PO Box 226
Reading RG6 6AP
UK
p.donyai@reading.ac.uk
The Continuing Professional Development for

Revalidation in Pharmacy Study (CPD-RPS)
phone +44 (0)118 378 4637

fax
+44 (0)118 378 4703
email pharmacy@reading.ac.uk
To pharmacist and pharmacy technicians

Saturday/Sunday
July/Sept 2009
Dear Pharmacy Professional

We were recently successful in our bid to the Royal Pharmaceutical Society of Great Britain (RPSGB) for
funding to investigate the use of Continuing Professional Development (CPD) records for revalidation of
pharmacy professionals. Our project is called The CPD for Revalidation in Pharmacy Study (CPD-RPS).
We are asking if you would consider helping us with the CPD-RPS study by enrolling as a participant.
The study can only take place with support from colleagues in the pharmacy profession; both pharmacists
and registered pharmacy technicians.
Participation is on a voluntary basis. You need not take part in the CPD-RPS study, and could leave it at
any time without affecting your relationship with the undersigned, CPPE or the University of Reading in
any way. Should you decide to enrol, the CPD-RPS study in essence will involve you in submitting and
writing a number of CPD records for researchers to evaluate anonymously against Revalidation Standards
before and after receiving revalidation-specific instructions.
We hope the study will help us gain a better understanding of the suitability of CPD records as part of
professional revalidation in pharmacy and would greatly appreciate receiving your support. In addition to
knowing that you have contributed to the development of revalidation procedures, the experience may be
useful to you personally in helping you prepare for the Revalidation process as a future part of your
professional activity.
This project has been subject to ethical review, according to the procedures specified by the University
Research Ethics Committee, and has been allowed to proceed.
Yours sincerely
Dr Parastou Donyai
BPharm PGDPRM(Open)
PGCert LTHE MRPharmS
Dr Angela Alexander
BPharm MSc FRPharmS
MCPP MBE
Prof. Pam M Denicolo

AFBPsS CPsychol FHEA
(Hon)MRPharmS
Page 93
The CPD
for Revalidation in
Pharmacy Study
Contact and demographics questionnaire
Please complete this short questionnaire writing in ink and using clear capitals. All sections should be completed.
Contact information and demographics

CPD-RPS study participant
number:
Date completed:
Title (Mr/Mrs/Miss/Ms/Dr etc.):

Last name:
First name:
Postal address:
Postcode:
Home telephone number:
Work telephone number:
Mobile telephone number:
Email address:
Gender:
Age band:
Professional status:
Male
20
31 - 40
51 - 60
21 - 30
41 - 50
61 - 70
Pharmacist
Year of registration with RPSGB:

Main sector of practice:
Female
Registered technician
Year qualified as technician:
Community
Hospital
Primary care organisation

Other
CPPE CPD workshop type:
Have you 3 CPD records, which
you can submit to the CPD-RPS?
Format normally used (or
planning to use) for recording
CPD:
71 or over
Online
Industry
Please describe:
Type 1
Yes
Academia
Type 2
No
If No, tick the box if you can

submit the 1 CPD record:
Paper
Page 94

Pharmacy Study
Consent Form for participating in The Continuing Professional

Development for Revalidation in Pharmacy Study CPD-RPS
1.
I have read and had explained to me by

the accompanying letter and FAQ sheet relating to the project
on CPD records for revalidation called the CPD-RPS
2.
I have had explained to me the purposes of the project and what will be required of
me, and any questions I have had have been answered to my satisfaction. I agree to
the arrangements described in the FAQ sheet in so far as they relate to my
participation.
3.
I understand that participation is entirely voluntary and that I have the right to
withdraw from the project any time, and that this will be without detriment to any
services I may be receiving or may receive in the future.
4.
This application has been reviewed according to the procedures specified by the
University Research Ethics Committee at the University of Reading, and has been
given a favourable ethical opinion for conduct.
5.
I have received a copy of this Consent Form and of the accompanying letter and FAQ
Sheet.
Name:
Signed:
Date:
(Copy to be retained by the participant)
Page 95
Donyai, et al. 2010

Pharmacy Study
Frequently Asked Questions (FAQs)

Q.1 What is the background to this study?
In the future, all regulated health professionals (including pharmacy professionals) will need to
periodically demonstrate their continued fitness to practise through revalidation. From April 2010 a new
regulatory body, the General Pharmaceutical Council (GPhC) will be responsible for the regulation of
pharmacists and pharmacy technicians in Great Britain and this will include professional revalidation. It
has been proposed that records of CPD form part of the supporting evidence submitted by practitioners for
revalidation but for that to take place we need to see if such records could contribute usefully to the
revalidation process. While CPD has been a professional requirement of the Code of Ethics for a number
of years, recent new standards issued by the RPSGB require all practising pharmacists and registered
technicians to make a minimum of nine CPD entries per annum from 1 March 2009 in all normal
circumstances. The aim of the CPD-RPS study is to investigate the appropriateness of CPD records for use
as part of professional revalidation. We intend to examine CPD records made by study participants before
and after receipt of revalidation-specific instructions, which we will deliver to you as a participant in due
course. It is our hope that the CPD-RPS study will help us gain a better understanding of the suitability of
CPD records as part of revalidation.
Q.2 What in summary does the research involve?
If you wish to participate, we will invite you to sign a consent form in the first instance. There is also a
short demographics and contacts questionnaire for you to complete when joining. We will then contact
you within a week to request that you to submit either one or three CPD record(s) to us in the next month,
depending on your incidence of CPD recording. The records submitted could be already-completed ones
or if you are attending a Type 1 CPPE event, one that you complete following todays CPD workshop.
After submitting the initial record(s), we will provide you with instructions about new Revalidation
Standards new proficiency standards that will be used for revalidation in pharmacy. We will send you
the material through the post and via e-mail. Once we have recruited a sufficient number of participants,
we will allocate you to one of two groups to receive one of two types of instructions. Everyone will
receive the new Revalidation Standards but the format of the instructions will differ between the two
groups. This is because we would like to test out the format we use for training people to see which works
better. After you work through the material, we would ask you to submit two new CPD records to us: one
will involve you in rewriting an already-submitted CPD record and one will be a freshly-conducted CPD.
We hope to be able to examine all the records submitted and evaluate any impact of the Revalidation
Standards instructions. We are also hoping to conduct one or two focus-group interviews towards the end
of the study to help us understand your experience of the project.
Q.3 What are you expected to do as a participant in the CPD-RPS study?
In summary, the study will involve you in:
Enrolling onto the study and signing the consent form
Completing a short demographics and contacts questionnaire on enrolling
Submitting 1 or 3 existing CPD records in the next month (we will contact you separately with
instructions)
Receiving and working through the revalidation-specific instructions that we later send to you
Submitting two new CPD records
Participating in optional focus groups
Debriefing conversation at the close of study
Page 96
Q.4 What are the timelines involved?

The CPD-RPS study will last about 4-5 months depending on your date of enrolment. The following
schedule will more or less need to be adhered to. If you decide to enrol, we would ask you to submit your
initial CPD records(s) within one month of enrolling. We will then deliver the Revalidation Standards
material to you in the latter part of October 2009. We would subsequently ask you to submit two new
CPD records to us by the end of November 2009. The focus-group interviews are optional and will take
place in December 2009. We will sum-up the CPD-RPS study through a debriefing conversation with you
either at the focus-groups close if you attend or on the telephone in December.
July
August
September October
Enrolment
Submission of initial CPD record(s)
Receipt of
revalidationspecific
instructions
November
December
Submission of
two new CPD
records one
rewritten and one
conducted afresh
Optional Focus
group interviews
Debriefing about
the study
CPD-RPS timelines: this table illustrates the main aspects of the study as relates to time
Q.5 What will the Revalidation Standards instructions consist of?

Once you have submitted your initial CPD record(s) we will post you printed material relating to
Revalidation Standards, which will be used in the future by the GPhC for revalidation in pharmacy. We
would also send the material to you via e-mail so that it is available to you electronically. You will receive
one of two sets of instructions, depending on the group you are allocated to. We envisage that working
through the material sent will take up to three hours to complete. We would ask all participants to read the
material sent and complete a short form to indicate they have read and understood the main substance of
the material.
Q.6 Are there any benefit in participating in the CPD-RPS study?
We hope the study will help us gain a better understanding of the suitability of CPD records as part of
professional revalidation in pharmacy and would greatly appreciate receiving your support. In addition to
knowing that you have contributed to the development of revalidation procedures, the experience may be
useful to you personally in helping you prepare for the Revalidation process as a future part of your
professional activity. All CPD-RPS participants will receive the Revalidation Standards instructions. If
we find that one type of training makes a positive impact on CPD recording, then we would make this
material available free-of-charge to anyone who didnt receive it as part of the study but wished to receive
it afterwards.
Q.7 Are there any risks involved in taking part in the CPD-RPS study?
We have not identified any unwanted effects and there is no reason to believe that participants should be at
any risk of adverse effects from taking part in the CPD-RPS study. The CPD-RPS is a stand-alone pilot
that will not link in any way with the actual process of revalidation of pharmacy professionals, which may
or may not use CPD records as part of the process in due course. Although we will use CPD records and
assess these against Revalidation Standards as part of the CPD-RPS study, this is only for the hypothetical
purpose of research and we will use anonymised records only. We invite you to provide your views on the
project as we proceed, we also plan to debrief you about the project at the end and you are able to
withdraw at any time should you wish.
Q.8 How will the data from the CPD-RPS study be used?
The CPD records collected as data as part of this study will be scrutinised and anonymised on receipt so
that all person-identifying information is removed. You will receive a unique study number on enrolment
Page 97
today, which we will ask you to use in all future correspondence. We will analyse the CPD records by
comparing the records before and after the revalidation-specific instructions and we will look specifically
to see if such records could be used in the future as part of revalidation of pharmacy professionals. We
will analyse the focus-group interviews to identify themes in relation to participants understanding and
experience of participating in the CPD-RPS study. We will eventually use the information to produce a
report to communicate our findings to the RPSGB. It is also likely that we will publish journal articles to
disseminate the findings to the wider pharmacy community. Published reports on the results from the
CPD-RPS study will not mention individuals or include any identifying information.
Q.9 How will your information be kept private?
We will take measures to protect your data throughout the conduct, storage and dissemination of this study
as follows. If you decide to take part in this study, you give us permission to use the CPD records you
submit to us as study data. However, this information will be kept anonymous. This means that your
identity will not be revealed by name or by any other description and we will ensure that this is the case.
The data collected as part of the CPD record reviews will be in the form of electronic or paper CPD
records. We will print a copy of any electronic record and photocopy paper records before returning the
originals to you within two weeks of receipt. At the print/photocopy stage, all records will be anonymised
by a member of the research team. Each record will be assigned the appropriate participant study number
on receipt (and a code to indicate study stage because this is a before and after study). Personal
information (such as name and address) about you will be kept confidential at all times. It will be kept in a
secure file.
In relation to the optional focus group interviews, we will tape-record the conversations (with all
participants consent) to allow accurate notes to be made afterwards. The recording will be carried out
using a digital audio-recorder and the transcripts will be typed using Microsoft Word. Although we will
not be setting out to collect this type of information, any data that will enable a subject to be identified will
be removed before the conversations are typed and stored electronically.
Data would not be kept for longer than necessary so after the outcomes have been adequately disseminated
all the material will be disposed of. To make sure of the privacy of any electronic data, it will be stored by
the investigators and a Research Assistant on password protected drives. The paper copies will be kept in
a locked cabinet when not in use. Only the persons concerned (Drs Donyai and Alexander and Professor
Denicolo and a Research Assistant) will be allowed access to the data. In the reporting of the project, no
information will be released which will enable to reader to identify who the respondent was.
Q.10 What if you decide to withdraw from the study?
You have the right to withdraw your consent to participate at any time before, during or after the study.
For example, you have the right to cancel, to drop out part way through the study, or to decide afterwards
that you wish you hadnt participated and to withdraw then. If you decide after you have completed the
study that you wish to withdraw, we will not use your data unless you give your permission for us to do so.
You do not have to give a reason for withdrawing.
Q.11 Will you receive payment for being part of this study?
We feel it is reasonable to reimburse each participant with a 50 book token for participating in the CPDRPS study to the end. We also propose to pay for the cost of locum cover for those attending focus-group
interviews at 200/day.
Q.12 What if theres a problem?

If you have any concern about any aspect of this study, you should ask to speak with me and together with
the CPD-RPS study team we will do our best to answer your questions. If we are unable to resolve your
Page 98
concerns or you wish to contact someone else regarding the study, please do so using the Reading School
of Pharmacy contact information at the head of this letter.
Q.13 Has there been ethical consideration for the project?
This project has been subject to ethical review, according to the procedures specified by the University
Research Ethics Committee, and has been allowed to proceed.
If you have any queries please contact

Dr Parastou Donyai
Reading School of Pharmacy
PO Box 226
Whiteknights
Reading
Berkshire RG6 6AP
Tel: 0118 378 4704
Email: p.donyai@reading.ac.uk
Yours sincerely
Dr Parastou Donyai
BPharm PGDPRM(Open)
Dr Angela Alexander
BPharm MSc FRPharmS
MCPP MBE

(Hon)MRPharmS
Page 99
Appendix 8
Seeking initial opinions on the face-validity,
clarity/complexity, user-friendliness of the CPD Outcomes
Framework
Page 100

Validity of the CPD Outcomes Framework
We are in the process of developing a mechanism (CPD Outcomes Framework) for assessing CPD
activities and outcomes. Eventually, we would like to use this framework to evaluate pharmacists
CPD records. As part of the development process, first we need to check the validity of the
framework i.e. we would like to ask if, the descriptions are assessing the desired qualities and ask
if we have covered all the relevant and important domains (topics).
We are inviting you to consider helping us in your capacity as a pharmacist colleague, on a
voluntary basis. If you agree to help, in your capacity as a pharmacist working in academia, you
would form part of our panel of advisors and we would keep your comments strictly anonymous.
We would like to ask you to treat this document as confidential and refrain from discussing it in
detail with others (i.e. anyone else including colleagues who might be completing the same form).
If you agree, please read the following pages and write down your comments. Return the paperwork
direct to me when complete.
Thank you in advance.
Parastou
19 October 2009
On behalf of the research team:
Dr Parastou Donyai
BPharm
PGDPRM(Open) PGCert
LTHE MRPharmS
Principal Investigator
Dr Angela Alexander
BPharm MSc
FRPharmS MCPP
MBE
Co-investigator

(Hon)MRPharmS
Co-Investigator
Rebecca Z Herbert
BA MSc
Research Assistant
Page 101
Background
The General Pharmaceutical Council (GPhC) has recently launched a consultation as part of its
Regulatory Standards Development Programme. Annex C contains the Standards of proficiency for
pharmacy professionals, considered the minimum necessary to protect members of the public. In
the future, pharmacy professionals (pharmacy technicians and pharmacists) will need to meet all of
the standards upon first registration and thereafter continue to meet the standards that are relevant to
their scope of practice. More specifically, Section 1 of the standards, Expectations of a pharmacy
professional, apply to all pharmacy professionals irrespective of their field of work at first
registration and thereafter. Section 2 of the standards, The skills of pharmacy practice, apply to
pharmacists (and pharmacy technicians, where indicated by a tick) at first registration, and where
relevant thereafter. Section 3 of the standards, Being a pharmacy professional, provides a global
overview of what it means to be a pharmacist or a pharmacy technician. A copy of Annex C is
enclosed for your information.
We were successful in our bid to the Royal Pharmaceutical Society of Great Britain (RPSGB) for
funding to investigate the use of CPD records for revalidation of pharmacy professionals. Our
research will examine the applicability of the above-described Standards of proficiency for
pharmacy professionals (in short, proficiency standards) to the assessment of CPD records. We
propose to do this via a CPD Outcomes Framework. This is a tool that will verify the relevance of
the CPD, and its tangible impact in relation to the proficiency standards.
In constructing the Outcomes Framework, we have also referred to Annex E1 of the GPhC
Regulatory Standards Development Programme, Continuing Professional Development Standards
and Framework. This document states that the (CPD) framework that is adopted by the Council
must ensure that any CPD that is undertaken by a registrant demonstrates a relevance to:
a) the safe and effective practice of pharmacy; and
b) a learning need for the individual registrant that is relevant to their current scope of
practice including any specialisation of that individual registrant and the environment in
which they practise.
There are 6 CPD Standards, two of particular interest, namely Standard 4 Include in your record
CPD that is relevant to safe and effective practice and the Standards of Conduct, Ethics and
Performance of the profession and Standard 5 Record how your CPD has contributed to the quality or
development of your practice and has benefited patients and the public. A copy of Annex E1 is
enclosed for your information.
Page 102
Demonstrating the relevance of CPD

As stated above, our first aim in developing the CPD Outcomes Framework is to enable registrants
to demonstrate the relevance of their CPD. The CPD Standard 4 establishes relevance in relation
to safe and effective practice and the Standards of Conduct, Ethics and Performance of the profession .
We believe this statement can be related to the risk associated with practice and propose to use the
Risk Matrix developed by the National Patient Safety Agency (NPSA). To measure CPD relevance,
the tool has been applied as follows.
The NPSA tool consists of two parts; Table 1 Consequence scores and Table 2 Likelihood scores
are used to return a risk scores for a third table, Table 3 Risk scoring. Because the tool relates to
risk, Table 1 enables a consequence score (C) (severity level) to be determined in relation to
(potential) adverse outcome(s) that might arise from the risk on a scale of 1 to 5. Table 2 enables a
likelihood score (L) to be determined, by assigning a predicted chance of occurrence (of the adverse
outcome) on a scale of 1 to 5.
We believe the NPSAs Risk Matrix can be applied to the assessment of pharmacy registrants CPD
relevance. Firstly, we believe it will be possible to use Table 1 to score the consequence of failing
to complete the CPD activity. Please examine Table 1 below and provide your thoughts on the
applicability of this table to the consequence of failing to complete CPD in pharmacy; please either
write in the box below or on the margins of the Table itself.
Comments on the use of Table 1 Consequence scores in relation to the consequence of failing to
complete the CPD activity
Page 103
Table 1 Consequence scores (C)

To enable you to relate this table to CPD, we have enclosed 11 example CPDs from the RPSGB Plan & Record website (please refer to at least 4
records). To use the table below, choose the most appropriate domain for the potential risk from the left hand side of the table. Then work along the
columns in the same row to assess the severity of the risk on the scale of 1 to 5 to determine the consequence score, which is the number given at the
top of the column.
Consequence score (severity levels) and examples of descriptors
1
Domains
Negligible
Minor
Moderate
Major
Catastrophic
Impact on the safety of patients, staff or public

(physical/psychological harm)
Minimal injury requiring

no/minimal intervention or
treatment.
Minor injury or illness, requiring

minor intervention
Moderate injury requiring

professional intervention
Major injury leading to long-term

incapacity/disability
Incident leading to death
Requiring time off work for >3

days
Requiring time off work for 4-14

days
Requiring time off work for >14

days
Increase in length of hospital

stay by 1-3 days
Increase in length of hospital stay

by 4-15 days
Increase in length of hospital stay

by >15 days
RIDDOR/agency reportable
incident
Mismanagement of patient care

with long-term effects
An event which impacts on a

small number of patients
Treatment or service has
significantly reduced
effectiveness
Non-compliance with national

standards with significant risk to
patients if unresolved
Local resolution
Formal complaint (stage 2)

complaint
Multiple complaints/ independent

review
Single failure to meet internal

standards
Local resolution (with potential to

go to independent review)
Low performance rating
No time off work
Quality/complaints/audit
Peripheral element of
treatment or service
suboptimal
Overall treatment or service

suboptimal
Formal complaint (stage 1)
Informal complaint/inquiry
Multiple permanent injuries or irreversible

health effects
An event which impacts on a large number
of patients
Totally unacceptable level or quality of

treatment/service
Gross failure of patient safety if findings not
acted on
Inquest/ombudsman inquiry
Gross failure to meet national standards
Critical report
Minor implications for patient

safety if unresolved
Repeated failure to meet internal

standards
Reduced performance rating if

unresolved
Major patient safety implications

if findings are not acted on
Page 104
Human resources/ organisational

development/staffing/ competence
Short-term low staffing level

that temporarily reduces
service quality (< 1 day)
Low staffing level that reduces

the service quality
Late delivery of key objective/

service due to lack of staff
Unsafe staffing level or
competence (>1 day)
Uncertain delivery of key

objective/service due to lack of
staff
Unsafe staffing level or
competence (>5 days)
Low staff morale
Non-delivery of key objective/service due

to lack of staff
Ongoing unsafe staffing levels or
competence
Loss of several key staff
Loss of key staff
Statutory duty/ inspections
No or minimal impact or
breech of guidance/
statutory duty
Poor staff attendance for

mandatory/key training
Very low staff morale
No staff attending mandatory training /key

training on an ongoing basis
Breech of statutory legislation
Single breech in statutory duty
No staff attending mandatory/

key training
Enforcement action
Multiple breeches in statutory duty
Reduced performance rating if

unresolved
Challenging external
recommendations/ improvement
notice
Multiple breeches in statutory

duty
Prosecution
Complete systems change required
Improvement notices
Zero performance rating
Low performance rating
Severely critical report
Adverse publicity/ reputation
Rumours
Potential for public concern
Local media coverage

short-term reduction in public
confidence
Local media coverage

long-term reduction in public
confidence
Critical report
National media coverage with <3
days service well below
reasonable public expectation
Elements of public expectation

not being met
Business objectives/ projects
Insignificant cost increase/

schedule slippage
<5 per cent over project budget
National media coverage with >3 days

service well below reasonable public
expectation. MP concerned (questions in
the House)
Total loss of public confidence
510 per cent over project

budget
Schedule slippage
Non-compliance with national

1025 per cent over project
budget
Schedule slippage
Incident leading >25 per cent over project

budget
Schedule slippage
Schedule slippage
Key objectives not met
Finance including claims
Service/business interruption Environmental

impact
Small loss Risk of claim

remote
Loss of 0.10.25 per cent of

budget
Loss of 0.250.5 per cent of

budget
Claim less than 10,000
Claim(s) between 10,000 and

100,000
Loss/interruption of >1 hour
Loss/interruption of >8 hours
Loss/interruption of >1 day
Minimal or no impact on the

environment
Minor impact on environment
Moderate impact on
environment
Page 105
Key objectives not met

Uncertain delivery of key
objective/Loss of 0.51.0 per cent
of budget
Non-delivery of key objective/ Loss of >1

per cent of budget
Failure to meet specification/ slippage
Claim(s) between 100,000 and

1 million
Loss of contract / payment by results
Purchasers failing to pay on time

Loss/interruption of >1 week
Claim(s) >1 million

Permanent loss of service or facility
Major impact on environment
Catastrophic impact on environment
We also believe it will be possible to use Table 2 to score the likelihood of a potential adverse
outcome(s) occurring as a result of failing to complete the CPD activity. Please examine Table 2
below and provide your thoughts on the applicability of this table to CPD for the purpose of
providing evidence for revalidation; please either write in the box below or on the margins of the
Table itself.
Table 2 Likelihood score (L)
Again, please use the example CPDs when considering the applicability of this table. Consider,
what is the likelihood of the consequence (identified above) occurring?
Likelihood score
Descriptor
Rare
Unlikely
Possible
Likely
Almost certain
Frequency
How often might
it/does it happen
This will probably

never happen/recur
Do not expect it to
happen/recur but it is
possible it may do so
Might happen or recur

occasionally
Will probably
not a persisting issue
Will undoubtedly
happen/recur,possibly
frequently
Comments on the use of Table 2 likelihood scores in relation to the likelihood of a potential adverse
outcome(s) occurring as a result of failing to complete the CPD activity.
Please see below for information on Table 3 Risk scoring and Instructions for use as provided by the
NPSA.
Page 106
Table 3 Relevance scoring = consequence x likelihood ( C x L )

Likelihood (L)
Consequence (C)
Rare
Unlikely
Possible
Likely
Almost certain
5 Catastrophic
10
15
20
25
4 Major
12
16
20
3 Moderate
12
15
2 Minor
10
1 Negligible
For grading risk, the scores obtained from the risk (relevance) matrix are assigned grades as follows
15-25
9-12
4-8
1-3
Significant relevance
High relevance
Moderate relevance
Low relevance
Instructions for use

1 Define the consequence score in terms of the adverse consequence(s) that might arise from the risk of not
completing the CPD.
2 Use Table 1 to determine the consequence score(s) (C) for the potential adverse outcome(s) relevant to the risk
being evaluated.
3 Use Table 2 (above) to determine the likelihood score(s) (L) for those adverse outcomes. If possible, score the
likelihood by assigning a predicted frequency of occurrence of the adverse outcome. If this is not possible, assign a
probability to the adverse outcome occurring within a given time frame, such as the lifetime of a project or a
patient care episode. If it is not possible to determine a numerical probability then use the probability descriptions
to determine the most appropriate score.
4 Calculate the relevance score by multiplying the consequence by the likelihood: C (consequence) x L (likelihood) = R
(relevance score)
5 Identify the relevance score and based on the colour banding decide on the priority for addressing via CPD.
Comments on the use of Table 3 Relevance scores in relation to the relevance of a CPD activity.
The idea is that a higher score indicates a more relevant CPD.
Page 107
Demonstrating the impact of CPD

As stated above, our second aim in developing the CPD Outcomes Framework is to enable
registrants to demonstrate the impact of their CPD. The CPD Standard 5 states Record how your
CPD has contributed to the quality or development of your practice and has benefited patients and the
public. We believe this statement relates to the impact associated with practice and propose to use
an Impact Matrix, as follows.
Firstly, we believe it will be possible to use Table 4 Quality and benefit score to score the positive
practical consequence(s) of the CPD since completing the activity. Please examine Table 4 below
and provide your thoughts on the applicability of this table to the consequence(s) of completing
CPD in pharmacy; please either write in the box below or on the margins of the Table itself. Again,
please use the example CPDs when considering the applicability of this table.
Comments on the use of Table 4 to score the positive practical consequence(s) of CPD
To calculate the quality and benefit score, we are proposing that registrants firstly demonstrate the
proficiency standard(s) to which their submitted CPD activity relates. They then work along the
columns to assess the extent to which their CPD, in relation to the states proficiency standard(s), has
since contributed to the quality or development of their practice and has benefited patients and the
public. The quality and benefit score is then read as the number given at the top of the column.
Table 4 Quality and benefit scores (Qb)
Quality and benefit score
-2
-1
Domain
Negligible
Minor
Moderate
Major
Substantial
Standards of proficiency for

pharmacy professionals
No or minimal
impact on quality
of practice
Minor improvement
in quality of
practice.
Moderate
improvement in
quality of practice.
Major improvement
in quality of practice.
Major improvement
No or minimal
direct benefit to
patients and the
public
Minor benefit to
patients and the
public
Moderate benefit to
patients and the
public
Major benefit to
patients and the
public
Major benefit to
patients and the
public
Positive impact has

been on a minimal
number of patients
Positive impact has

been on a minor
number of patients
Positive impact has

been on a moderate
number of patients
Positive impact has

been on a large
number of patients
We also believe it will be possible to use Table 5 to score the strength of evidence relating to the
quality and benefit score. Please examine Table 5 below and provide your thoughts on the
applicability of this table to CPD for the purpose of providing evidence for revalidation; please
Page 108
either write in the box below or on the margins of the Table itself. Again, please use the example
CPDs when considering the applicability of this table.
Page 109
Table 5 Strength of evidence score (E)

To calculate the strength of evidence score, we are proposing that registrants work along the columns to assess the extent to which they can
substantiate the quality and benefit score through the strength of evidence score; read as the number given at the top of the column.
Strength of evidence score
Descriptor and characteristics
-2
-1
Evidence of input
Evidence of reaction
Evidence of learning
Evidence of behaviour change
Evidence of Results
Evidence of having conducted the

learning experience. This is the
least amount of evidence
required. There should be some
form of statement or record
relating to the learning
experience haven taken place.
Reaction evaluation is how the

registrant felt, and their personal
reactions to the training or
learning experience.
For example:
Did the trainees like and enjoy
the training?
Did they consider the training
relevant?
Was it a good use of their time?
Did they like the venue, the
style, timing, domestics, etc?
Level of participation.
Ease and comfort of experience.
Level of effort required to make
the most of the learning.
Perceived practicability and
potential for applying the
learning.
Learning evaluation is the

measurement of the increase in
knowledge or intellectual capability
from before to after the learning
experience, ideally objectively by a
third party:
Did the registrant learn what was
intended to be taught?
Did the registrant experience what
was intended for them to
experience?
What is the extent of advancement
or change in the registrant after the
training, in the direction or area that
was intended?
Methods of assessment need to be
closely related to the aims of the
learning. Reliable, clear scoring and
measurements are ideal as they
minimize risk of inconsistency.
Behaviour evaluation is the extent

to which the registrant applied
the learning and changed their
behaviour, and this can be
immediately and several months
after the training, depending on
the situation:
Did the registrant put their
learning into effect when back
on the job?
Were the relevant skills and
knowledge used?
Was there noticeable and
measurable change in the
activity and performance of the
trainees when back in their
roles?
Was the change in behaviour
and new level of knowledge
sustained?
Would the trainee be able to
transfer their learning to
another person?
Is the trainee aware of their
change in behaviour,
knowledge, skill level?
Results evaluation is the effect

on the practice or environment
resulting from the improved
performance of the trainee - it is
the acid test.
Measures would typically be
practice or organisational key
performance indicators, such as:
Volumes, values, percentages,
timescales, return on
investment, and other
quantifiable aspects of
organisational performance, for
instance; numbers of
complaints, staff turnover,
attrition, failures, wastage,
non-compliance, quality
ratings, achievement of
standards and accreditations,
growth, retention, etc.
Page 110
Examples of tools and methods
Typically certificate of attendance

representing input.
Can include written statements
by the registrant about the
learning that took place and, say,
reference to sources of
information used.
Material acquired from others:
Course attendance certificates
Other evidence of participation
Course programme documents
Learning contracts
Typically satisfaction-withtraining sheets'.

Feedback forms based on
subjective personal reaction to
the training experience.
Post-training surveys or
questionnaires.
Online evaluation or grading by
registrant.
Subsequent verbal or written
reports given by registrant to
managers back at their jobs.
Typically assessments or tests before

and after the training, ideally in a
formal manner. Can include hardcopy, electronic, online or interview
style assessments.
Interview or observation before and
after learning is permissible but is
time-consuming and can be
inconsistent.
Written documents prepared and
approved after the learning as part of
professional work also permissible:
Material gathered:
Evaluation of
courses/conferences attended
Profiles drawn from learning
portfolios
Material produced:
Formal assessment and exam scores
Case studies
Course assignments
Information leaflets
Critical literature reviews
Policy or position statements
Discussion documents
Procedural documents
Protocols
Documents relating to national or
local processes (e.g. schemes for
peer review, mentorship or clinical
supervision)
Reports (e.g. on project work,
clinical audit, reviews of activity)
Business plans
Guidance materials (e.g. for service
users, colleagues or students)
Clinical audit tools
Clinical guidelines
Presentations
Articles produced for publication
Questionnaires
Research papers/proposals/funding
applications/ethical approval
applications
Induction materials for new
members of staff
Contributions to work of a
professional body or a special
interest group
Documented and approved claims
for academic credit for prior or
experiential learning
Page 111
Typically, appraisals are

acceptable. Observation and
interview over time are required
to assess change, relevance of
change, and sustainability of
change.
Arbitrary snapshot assessments
are not reliable because people
change in different ways at
different times.
360-degree feedback is useful
method and need not be used
before training, because
respondents can make a
judgement as to change after
training.
Material acquired from others:
Documentation arising from
appraisal
Documentation arising from
clinical supervision
Job evaluation
Compliance with locallyimplemented competence
frameworks.
Testimonies
Letters from users, carers,
students or colleagues
Patient assessment
Peer assessment
It is possible that many of these

measures are already in place via
normal management systems
and reporting.
The challenge is to identify which
and how relate to the
registrants input and influence.
Failure to link to training input
type and timing will greatly
reduce the ease by which results
can be attributed to the training.
For senior people particularly,
annual appraisals and ongoing
agreement of key business
objectives are integral to
measuring business results
derived from training.
Material acquired from others
Objective statistical
benchmarking
Objective measurement of a
variety of effect and outcomes
Comments on the use of Table 5 to score the strength of evidence of CPD
Please see below for information on Table 6 Impact scoring devised by the CPD-RPS investigators:
Table 6 Impact scoring = quality and benefit + strength of evidence ( Qb + E )
Quality and benefit score
Strength of evidence
score
3 Evidence of results
2 Evidence of
behavior change
1 Evidence of
learning
-1 Evidence of
reaction
-2 Evidence of input
-2
-1
Negligible
Minor
Moderate
Major
Substantial
-1
-3
-2
-4
-3
-1
For grading impact, the scores obtained from the impact matrix can be assigned grades as follows
4-6
1-3
0
-4 - -1
High impact
Moderate impact
Low impact
Negligible impact
Page 112
Comments on the use of Table 6 Impact scores in relation to the impact of a CPD activity.
The CPD Outcomes Framework

As stated above, our aim in developing the CPD Outcomes Framework is to enable the assessment
of CPD records against proficiency standards in a manner that relates to the relevance and impact of
the CPD. Therefore, the final part of the Outcomes Framework involves the interaction of the
relevance and impact scores to derive a CPD score ( = R x I). The possible scores have been graded
as proposed:
50 to 150
8 to 48
-12 to 6
-100 to -15
Exceeds required standard

Achieves required standard
Borderline for acceptable standard
Fails to achieve acceptable standard
Comments on the use of CPD scores in relation to the overall assessment of a CPD activity.
Page 113
Decreasing strength of evidence (E)

Tables relating to column 1 of Impact table (Qb -2) x Relevance scores
5
4
3
2
1
10
8
6
4
2
15
12
9
6
3
20
16
12
8
4
25
20
15
10
5
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
-5
-4
-3
-2
-1
-10
-8
-6
-4
-2
-15
-12
-9
-6
-3
-20
-16
-12
-8
-4
-25
-20
-15
-10
-5
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
-15
-12
-9
-6
-3
-30
-24
-18
-12
-6
-45
-36
-27
-18
-9
-60
-48
-36
-24
-12
-75
-60
-45
-30
-15
-20
-16
-12
-8
-4
-40
-32
-24
-16
-8
-60
-48
-36
-24
-12
-80
-64
-48
-32
-16
-100
-80
-60
-40
-20
Table relating to column 2 of Impact table (Qb -1) x Relevance scores
Increasing Quality and benefit (Qb)
10
8
6
4
2
20
16
12
8
4
30
24
18
12
6
40
32
24
16
8
50
40
30
20
10
5
4
3
2
1
10
8
6
4
2
15
12
9
6
3
20
16
12
8
4
25
20
15
10
5
0
0
0
0
0
0
0
0
0
0
-10
-8
-6
-4
-2
-20
-16
-12
-8
-4
-30
-24
-18
-12
-6
-40
-32
-24
-16
-8
-50
-40
-30
-20
-10
-15
-12
-9
-6
-3
-30
-24
-18
-12
-6
-45
-36
-27
-18
-9
-60
-48
-36
-24
-12
-75
-60
-45
-30
-15
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
-5
-4
-3
-2
-1
-10
-8
-6
-4
-2
-15
-12
-9
-6
-3
-20
-16
-12
-8
-4
-25
-20
-15
-10
-5
15
12
9
6
3
25
16
12
8
4
30
20
15
10
5
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
5
4
3
2
1
10
8
6
4
2
15
12
9
6
3
20
16
12
8
4
25
20
15
10
5
Table relating to column 3 of Impact table (Qb 1) x Relevance scores

20
16
12
8
4
40
32
24
16
8
60
48
36
24
12
80
64
48
32
16
100
80
60
40
20
15
12
9
6
3
30
24
18
12
6
45
36
27
18
9
60
48
36
24
12
75
60
45
30
15
10
8
6
4
2
20
16
12
8
4
30
24
18
12
6
40
32
24
16
8
50
40
30
20
10
30
24
18
12
6
45
36
27
18
9
60
48
36
24
12
75
60
45
30
15
40
32
24
16
8
60
48
36
24
12
80
64
48
32
16

25
20
15
10
5
50
40
30
20
10
75
60
45
30
15
100
80
60
40
20
125
100
75
50
25
20
16
12
8
4
40
32
24
16
8
60
48
36
24
12
80
64
48
32
16
100
80
60
40
20
15
12
9
6
3
5
4
3
2
1
10
8
6
4
2

30
24
18
12
6
60
48
36
24
12
90
72
54
36
18
120
96
72
48
24
150
120
90
60
30
25
20
15
10
5
50
40
30
20
10
75
60
45
30
15
100
80
60
40
20
125
100
75
50
25
20
16
12
8
4
100
80
60
40
20
10
8
6
4
2
Page 114
20
16
12
8
4
30
24
18
12
6
40
32
24
16
8
50
40
30
20
10
Donyai, et al. 2010
Thank you very much for taking the time to complete this form. Please feel free to use the space
below for additional comments.
Parastou
19 October 2009
Dr Parastou Donyai
BPharm
PGDPRM(Open) PGCert
LTHE MRPharmS
Dr Angela Alexander
BPharm MSc
FRPharmS MCPP
MBE
Co-investigator

(Hon)MRPharmS
Co-Investigator
Rebecca Z Herbert
BA MSc
Research Assistant
Additional comments
Page 115
Donyai, et al. 2010
Appendix 9
Seeking to verify the content of the CPD Outcomes
Framework using the Content Validity Index
Page 116
Donyai, et al. 2010
Rationale
The Content Validity Index (CVI) has been advocated as a rigorous approach to evaluating
content validation. A panel of experts is asked to rate each scale item in terms of its
relevance to the underlying construct. Each expert is given an explicit description of each of
the domains and rates the content relevance on a 4-point scale, where 1 indicates totally
irrelevant content and 4 reflects extremely relevant content. Then a CVI is derived for each
item, which is the proportion of judges who rate the item 3 or 4.
A summary
recommendation is that for a scale to be judged as having excellent content validity, it would
be composed of items with CVIs that meet the following criteria:
Individual item CVI = 1.00 with 3 to 5 experts
Individual item CVI = 0.78 with 6 to 10 experts (no more than one should score item <3).
Overall average CVI = 0.90 or higher.52
Participants who attended the focus group interviews were deemed sufficiently expert on
the topic to be invited to rate the content validity of the CPD Outcomes Framework, as
follows:
E-mail sent to participants
I wondered whether you would be able to provide me with some feedback on your views
about the CPD Outcomes Framework by answering the 5 questions below (by return of email). If you would like to help with this, each question should be answered by indicating a
number from 1 to 4 against it as follows: 1 = not relevant, 2 = somewhat relevant, 3 = quite relevant,
4 = highly relevant
1) How would you rate the concept of Consequence (as part of calculating relevance) in
relation to CPD for revalidation?
2) How would you rate the concept of Likelihood (as part of calculating relevance) in
relation to CPD for revalidation?
3) How would you rate the concept of Quality and benefit (as part of calculating impact)
in relation to CPD for revalidation?
4) How would you rate the concept of Strength of evidence (as part of calculating
impact) in relation to CPD for revalidation?
5) How would you rate the CPD Outcomes Framework in general in relation to CPD for
revalidation?
Summary of ratings
Question Rater 1
Rater 2
Rater 3
Rater 4
Rater 5
Rater 6
Rater 7
CVI
Q.1
0.86
Q.2
0.71
Q.3
Q.4
Q.5
Overall average CVI
0.91
Page 117
Donyai, et al. 2010
Appendix 10
Quality assuring the training material: internal reviewer
feedback form
Page 118
Review sheet: CPD for Revalidation Pharmacy Study

Background to the research
This project examines the feasibility of using continuing professional development (CPD)
records as part of pharmacy professionals revalidation. Recent new standards issued by
the Royal Pharmaceutical Society of Great Britain (RPSGB) require all practising
pharmacists and registered pharmacy technicians to make a minimum of nine CPD entries
per annum from 1 March 2009. One of the requirements is for registrants to record how
their CPD has contributed to the quality or development of their practice. But can
pharmacists construct their CPD records in a manner that allows the records to be
assessed for their relevance and effectiveness? And can pharmacists be guided to conduct
CPD that is relevant and effective, using the CPD framework? We believe that an
Outcomes Framework can be used to guide individuals to bridge the gap between the
process of their CPD (resulting in the CPD record as an output) and the ensuing outcome.
We are using an experimental approach, and have recruited volunteer pharmacy
professionals to the study. Their CPD records are examined before and after the
implementation of this training package (provided to an intervention group). It is
designed to train participants on the use of revalidation standards in the conduct and
construction of CPD records. In parallel a control group receive the revalidation standards
but no specific training.
At the before stage, all participants were asked to submit either one or three previouslycompleted CPD records for analysis by the research team; participants unfamiliar with
CPD recording, as identified by initial questions will be asked to submit one CPD record.
At the after stage all participants will be asked to submit two further CPD records; one of
the two CPD records submitted will involve the participants in rewriting an previouslysubmitted record, and the other will involve them in conducting a CPD activity afresh
using their knowledge of the revalidation standards and Outcomes Framework
(intervention group) or revalidation standards only (control group).
This will enable us to examine the impact of the standards (and additional Outcomes
Framework and training) on both the conduct and the writing of CPD records. The
revalidation standards developed by the RPSGB/GPhC * will be used in order to assess the
overall strength and quality of the information within the records. Two of the
investigators will independently evaluate the participants records by comparing the
information against the revalidation standards. A quantitative scoring method, the
Outcomes Framework, will be devised and used to guide this assessment. We will also
identify the information gaps that exist in the records in relation to the revalidation
standards. In addition, we will use the Outcomes Framework to identify remedial action
in relation to the information gaps identified as part of this process. The investigators will
also record qualitative information relating to the strengths and quality of the records and
information gaps and areas for improvement. Participants will be invited to attend focus
group interviews in order to discuss their experience of participating in the study and
their understanding of CPD in light of the new revalidation standards. The focus-group
interviews will be analysed using full thematic analysis.
* The regulatory role of the RPSGB will be carried out by the General Pharmaceutical
Council (GPhC) after April 2010. The shadow GPhC has issued draft standards for
consultation.
Page 119
Aims of the enclosed material:

To guide pharmacists to conduct CPD that is relevant and effective, using the CPD
framework.
Purpose of the review of the enclosed material:
To ensure the educational material is written in a manner that will be understood
To identify any excessive or irrelevant content that can be removed from the
programme
To consider if the learning programme is missing any information relevant to the
programme purpose
To ensure the activities and task are felt to relevant and appropriate to engage the
learner
To suggest any terms you feel would be useful to include in a glossary
Check for typographical errors, poor use of English, or confusing sentences
Items for review
We would like you to review the following items in the folder:
Material in plastic folder
The CPD Outcomes Framework: an overview
The CPD Outcomes Framework: the Tutorial
The CPD Outcomes Framework: suggested case study answers
Presentations on dvd
There are some additional documents included that have not been prepared by the
research team and which do not therefore require review:
Annex C GPhC Standards for proficiency for pharmacy professionals
Annnex E1 GPhC CPD standards and framework
How to structure your comments
Please use the grid provided in this document to structure your feedback. Please circle or
highlight your answer option for each question and use the third column to add further
comments. Feel free to add as many comments and suggestions to the third column as you
wish. Where you feel a change to the content is needed please describe the exact location
of the current text along with your suggestion for the change, for example:
Introduction
Do you think the introduction was

easy to read and understand?
Not at all
1
Spelling mistake: Page 7. Currently

reads: depending on youre learning style
change to depending on your learning style
To a great extent
3
Page 120
Reviewer feedback:
Material in plastic folder
Introductory
Do you think this was easy to read and
letter
understand?
Not at all
How to use
this pack and
what to do
next?
Statement of
learning and
agreement to
confidentialit
y
Additional comments:
To a great extent
1
2
3
4
5
understand?
Not at all
To a great extent
1
2
3
4
5
understand?
Not at all
To a great extent
1
2
3
4
5
What was your overall impression of
this section? How do you think this
section could be improved? Please
provide comments and suggestions as
appropriate.
4 page stapled document

The CPD
Outcomes
understand?
Framework:
an overview
Not at all
To a great extent
1
2
3
4
5
Do you feel the level of information
covered was:
Too basic
Too advanced
1
2
3
4
5
appropriate.
Page 121

The CPD
Outcomes
understand?
Framework:
the Tutorial
Not at all
To a great extent
1
2
3
4
5
covered was:
Too basic
Too advanced
1
2
3
4
5
Do you think the case studies are
effective to help the learner think
about recording relevant and effective
CPD?
Not at all
To a great extent
1
2
3
4
5
appropriate.
The CPD
Outcomes
understand?
Framework:
suggested
Not at all
To a great extent
case study
answers
1
2
3
4
5
covered was:
Too basic
Too advanced
1
2
3
4
5
Do you think the case study answers are
effective to help the learner think about
recording relevant and effective CPD?
Not at all
To a great extent
1
2
3
4
5
What was your overall impression of this
section? How do you think this section
could be improved? Please provide
comments and suggestions as appropriate.
Page 122
The dvd
Video/
Powerpoint
presentation
Do you think this was easy to view and

understand?
Not at all
To a great extent
1
2
3
4
5
covered was:
Too basic
Too advanced
1
2
3
4
5
appropriate.
Page 123
Donyai, et al. 2010
Appendix 11
Instructions for submission of CPD records
Page 124
Donyai, et al. 2010

Pharmacy Study
Instructions for submission of CPD records

Option 1 using the CPD Viewer facility on the RPSGBs CPD Online:
Use this option if:
You keep your CPD records online using the CPD website of the RPSGB
You would be happy to share your records electronically using the Viewer facility
What to do:
1.
Access and work through the online tutorial relating to the CPD Viewer as follows:
a. Go to the CPD website of the RPSGB http://www.uptodate.org.uk/
b. On the Home page, on left hand panel, click on CPD Materials
c. This action opens a new page entitled CPD Materials. On this page under the
heading of Online Tutorials click on Click here to launch the online
tutorials.
d. This action opens a new dialogue box headed Tutorials. Under the subheading
CPD viewers click on Entry properties .
e. This action opens a new page (window) for an animated demonstration showing
how you can authorise someone to view specified parts of your CPD Record.
f. Click on Start Demo at the foot of the page and watch the demonstration by
pressing the green Play button
when you are ready. You may need to make
the screen larger or scroll down to see the Start Demo and Play buttons on each
page. There are 5 steps to watch.
g. Close the Demo page (window) and the Tutorials page when you have finished
watching the 5 steps.
2.
Log in to your CPD Records in the usual way by clicking the button in the top left hand
corner of the main
page:
Log
in to your CPD Record
3.
Go to your CPD Record .
4.
Choose an entry and make it available for viewing by following the instructions provided in
the online tutorial as per Step 1, above. In summary:
a. In the top right hand corner of your chosen record, click on
Properties
b. In this window, click on Add new viewer . This action open a new dialogue box
headed Add/Edit Viewer.
c. Complete each section, noting down the information you type in:
i. For Name of Viewer: type CPD-RPS
ii. For User Name: type your unique participant number provided on
enrolment (care is needed in typing this number) e.g. xyz 98765
iii. For Password: type CPD-RPS
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iv. For Allow Viewer Access: Click on either Always or Between Dates
Specified Below. The second option allows you to limit our access to your
chosen CPD record to a specified time period using the start and end dates.
d. Click on OK when you have completed all the sections above. This action
returns you to the Properties page for that particular CPD record.
e. In the section headed Personal Viewers, the Viewer description column should
now include CPD-RPS. Click the small box in the next column headed Viewer
has access. A small will appear to finalise the process.
5.
Choose 2 further entries and make them available by again accessing the Properties tab in
the right hand corner of those records. CPD-RPS should automatically appear as a Viewer
description for each subsequent record. Again click the small box in the next column headed
Viewer has access to make the chosen records available.
6.
Email me at p.donyai@reading.ac.uk to confirm you have made your 3 records available for
viewing and you have typed the information as per 4c, above, into the relevant Viewer fields.
At that time, please also let me know your RPSGB registration number, which I need to
access the records via CPD Viewer.
7.
On receipt of your e-mail, I will access and print the 3 records and make them anonymous. I
will then write back to you to confirm that I have finished viewing the records.
Option 2 sending printed records from the RPSGBs CPD Online:

Use this option if:
You keep your CPD records online using the CPD website of the RPSGB
You would prefer to print and send paper copies of your CPD records
What to do:
1. E-mail to let me know you will be sending printed records and I will send you a stamped
envelope addressed to me at Dr Parastou Donyai, Food Bioscience Building Room 1.05B,
Reading School of Pharmacy, University of Reading, PO Box 226, Whiteknights, Reading,
Berkshire RG6 6AP.
2. Go to the CPD website of the RPSGB http://www.uptodate.org.uk/
3. Log in to your CPD Records in the usual way by clicking the button in the top left hand corner
of the main page: Log in to your CPD Record
4. Go to your CPD Record .

5. Choose an entry and print it by pressing the
page.
Show Printable Page...
6. Click on
Print..
.
button at the foot of the main entry
and print the record.
7. Choose 2 further entries and repeat the process.

8. Send your 3 entries to me using the stamped-addressed-envelope on receipt or if you choose,
direct to the address above. Dont forget to include your unique participant number with
the entries.
9. On receipt of your printed records through the mail, I will make them anonymous. I will at
the same time write to you to confirm safe receipt of your printed records.
Page 126
Option 3 sending records made on paper or printed from a different

CPD electronic recording facility:
Use this option if:
You keep your CPD records on paper
You keep your CPD records on a different CPD electronic recording facility
What to do:
1. E-mail to let me know you will be sending printed records and I will send you a stamped
envelope addressed to me at Dr Parastou Donyai, Food Bioscience Building Room 1.05B,
Reading School of Pharmacy, University of Reading, PO Box 226, Whiteknights, Reading,
Berkshire RG6 6AP.
2. Send your 3 entries to me using the stamped-addressed-envelope on receipt or if you choose,
direct to the address above. Dont forget to include your unique participant number with
the entries.
3. On receipt of your printed records through the post, I will photocopy each record and make
the copies anonymous. I will at the same time write to you to confirm safe receipt of your
records. For entries made solely on paper, I will return the originals to you through the post.
Page 127
Donyai, et al. 2010
Appendix 12
The printed material sent to the intervention group
Page 128

Dr Parastou Donyai
PGCERT LTHE, MRPHARMS
+44 ( 0)118 378 4704

Reading School of Pharmacy

Reading RG6 6AP
UK
phone +44 (0)118 378 4637
fax
+44 (0)118 378 4703
To pharmacists and pharmacy technicians

10 December 2009
Dear CPD-RPS study participant

We hope this letter finds you well. We received all CPD records from study participants last month and
are now contacting you with further instructions relating to the CPD-RPS project. Please accept my
apologies for contacting you later than scheduled.
We have reached the second phase of the study. This second phase will involve you in:
1. Working through the training pack enclosed a CD-ROM and a folder containing printed
material relating to the CPD Outcomes Framework devised for your use.
2. Submitting 2 further CPD records (1 completely new record and 1 re-written record after
working through the above pack).
Please find enclosed the pack containing the CD-ROM and folder containing printed material relating to
the CPD Outcomes Framework. We envisage that working through this material will take three hours
at a minimum.
The best way to engage with the training is through a mixture of reading the printed material and
accessing the files on the CD-ROM, but it should also be possible to use just the one (either CD-ROM
or folder) depending on your preference for learning.
Along with the training material, we have included an updated schedule for the project, further
information on what you are being asked to do, a statement of learning and agreement to
confidentiality (to be returned in the stamped-addressed envelope). Good luck, thank you and please
dont hesitate to contact me if you have any queries or comments to make about this stage of the study.
We are grateful for your continued support and commitment to the development of CPD for our
profession.
Yours sincerely
Dr Parastou Donyai
Dr Parastou Donyai
BPharm PGDPRM(Open)
Dr Angela Alexander
BPharm MSc
FRPharmS MCPP MBE
Co-investigator

(Hon)MRPharmS
Co-Investigator
Rebecca Z Herbert
BA MSc
Research Assistant
If you have any queries please contact:

Dr Parastou Donyai, Lecturer, Pharmacy Practice, Reading School of Pharmacy, University of Reading, PO Box
226, Whiteknights, Reading, Berkshire RG6 6AP
Tel: 0118 378 4704 Email: p.donyai@reading.ac.uk
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Pharmacy Study
List of materials enclosed in this envelope

We have enclosed a number of documents and a CD-ROM in this envelope, listed below. Please note
that the majority of this material is merely duplicate ways of representing the same concept of the
CPD Outcomes Framework. Therefore, please do not feel that you have to access ALL of the
material enclosed.
Please feel free to use this as a checklist to ensure you have access to all of the enclosed
documents/files:
Cover letter
List of materials enclosed (this list)
Updated schedule for the project
How to use this pack and what to do next
A folder of printed material containing:
1. The CPD Outcomes Framework: the Tutorial
2. The CPD Outcomes Framework: an Overview
3. Blank templates (x 15) for assessment of CPD cases
4. The CPD Outcomes Framework: suggested case study answers
5. The GPhC Standards of Proficiency for Pharmacy Professionals
6. The GPhC Continuing Professional Development Standards and Framework
A CD-ROM containing:
1. Adobe Acrobat files (of the CPD Outcomes Framework Overview and Tutorial)
2. PowerPoint presentations (of the CPD Outcomes Framework Overview and
Tutorial as well as suggested case study answers)
3. Videos (of the CPD Outcomes Framework Overview and Tutorial as well as
suggested case study answers)
Statement of learning and agreement to confidentiality
A stamped-addressed envelope
Page 130

Pharmacy Study
How to use this pack and what to do next?

This is the second phase of the study. We are asking you to kindly:
1. Work through the training material enclosed. The best way to engage with the training is
through a mixture of reading the printed material and accessing the files on the CD-ROM. It
should be possible to use just the one form (either CD-ROM or the printed material) depending
on your preference for learning. PLEASE NOTE THAT ALTHOUGH IT MAY LOOK AS
THOUGH WE HAVE SENT YOU MANY DOCUMENTS, THE MAJORITY OF THE
MATERIAL IS MERELY DUPLICATE WAYS OF REPRESENTING THE SAME
CONCEPT OF THE CPD OUTCOMES FRAMEWORK. Therefore, please do not feel
that you have to access ALL of the material enclosed.
2. Sign and return the statement of learning and agreement to confidentiality to indicate that you
have read and understood the training material enclosed and agree to keeping the information
sent confidential (this will help us with our Quality Assurance processes).
3. Assess your already-submitted CPD record(s) in light of the training provided. Ask yourself
what changes you could make to your record(s) having worked through the training
material?
4. New CPD Record 1: Select one your already-submitted CPD records and write it again using
the CPD Outcomes Framework provided in the training pack so that you match the record to
the CPD Outcomes Framework. You can create a new entry for this purpose. You are in
effect being asked to interpret the CPD Outcomes Framework and see if you can rewrite
one of your CPD records previously submitted to this project, in a way that might better
match the expectations in the Framework. This activity will produce the first of the new
CPD entries we are asking you to submit by the end of February 2010. You can select to
rewrite any one of the following CPD records you have already submitted:
Title of the CPD record you have already submitted*
Date completed
*Please note we were able to accept a maximum of 3 CPD records from each participant, so if you
submitted more than 3 records in phase one of the study, please note that we have accepted only the
first 3 records for inclusion in the study.
5. New CPD Record 2: Record a completely new CPD activity after completing the steps above.
This may involve you in conducting a whole new CPD activity or you may decide to create a
new record based on an activity you have been conducting. Again, this new CPD should be
conducted and recorded using the CPD Outcomes Framework. This will form the second
of the new CPD entries we are asking you to submit by the end of February 2010.
6. Submit the two new CPD records to me by the end of February 2010 using one of the options
previously outlined (postal or electronic as before). If you find it easier, you may wish to print
Page 131
and use the stamped-addressed envelope to send in the records together with your statement of
learning and agreement to confidentiality.
Thank you for your continued support and commitment to the development of CPD for our
profession.
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Pharmacy Study

What are the new timelines involved?
All participants have now enrolled and submitted their initial CPD record (s). We are contacting you
with this letter to enclose a training pack. We would like you to work through this material in the New
Year. Of course, if there is time, you could also choose to read the material in December. We would
like you to return the statement of learning to us in the stamped-addressed envelope once you have
worked through this material. We are then asking you to submit two new CPD records to us by the end
of February 2010. The focus-group interviews are optional and we will plan for these to take place in
March/April 2010. We will sum-up the CPD-RPS study through a debriefing conversation with you
either in private at the end of the focus-groups if you attend or on the phone in March/April depending
on progress. We will be able to provide you with feedback on the records you have submitted at
that final stage.
July
to
November December
Enrolment
Receipt of
instructions
namely, a
detailed training
pack enclosed
with this updated
schedule.
January/February March/April
Working through
the training pack,
and submitting
two new CPD
records one
rewritten and one
conducted afresh.
Returning the
statement of
learning.
Optional focus
group interviews
Debriefing about
the study
including
feedback about
your CPD
records
CPD-RPS timeline: this table illustrates the main aspects of the study as relate to time
What are you expected to do as a participant in the CPD-RPS study?

In summary, we are now asking you:
To work through the training pack.
To write and submit two new CPD records. This will involve you in:
o rewriting one of the CPD records you have already-submitted to us for this project;
o writing a new CPD record;
o submitting both records to me using one of the options (postal or electronic as before)
To return the signed statement of learning in the stamped-addressed envelope.
Please also read the document entitled how to use this pack and what to do next for further details.
We will write to you again in February about the optional focus groups and the debriefing
conversations that are to take place at the close of the study.
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Pharmacy Study
Statement of learning and agreement to

confidentiality
The training pack relating to the CPD Outcomes Framework was sent to you in order that you read and
understand the material before writing your two new CPD records (one rewritten record and one
completely new CPD record).
With this statement, we are asking you to confirm that you have read and understood the training
material before submitting your two new CPD records.
I have read and understood the concept of the CPD Outcomes Framework.
In addition, we would like to ask you to agree to keep the information sent to you with this pack as
Confidential Information. Please do not disclose this Confidential Information to any third party. As
highlighted in the Frequently Asked Questions we provided at the start of the project, we have allocated
you to one of two groups to receive one of two types of instructions relating to revalidation. Although
everyone will receive the new Revalidation Standards the format of the accompanying instructions will
differ between the two groups, as we would like to see which works better. Of course, if we find that
one type of training makes a more positive impact on CPD recording, then we would make this material
available free-of-charge to anyone who didnt receive it as part of the study but wished to receive it
afterwards. In order to help us, please do not disclose the information posted to you in this pack to any
third party.
I have read and understood the statement above and agree to treat the information sent
in this pack as Confidential Information for the duration of the study.
If you have ticked the above boxes, please sign this statement of learning and agreement to
confidentiality and post it back to us in the stamped-addressed envelope provided in the pack.
Thank you. This will help us with our quality assurance processes.
Participant number:
Signed:
Date:
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Pharmacy Study
How to get the best out of this CD-ROM

We have used the CD-ROM to represent the concept of the CPD Outcomes Framework as Adobe
Acrobat files, PowerPoint presentations as well as Video files containing audio recorded
explanations. As long as you develop an understanding of the CPD Outcomes Framework and its
application, you do not have to access ALL of the material enclosed, as the files merely represent the
same concept in duplicate ways. Below is a guide to how you can get the best out of this CD-ROM:
Adobe Acrobat files (of the CPD Outcomes Framework Overview and Tutorial):
1. OutcomesFramework Overview.pdf this is a copy of the printed 4-page overview.
Please access before the tutorial, below.
2. TutorialForCPDOutcomesFramework.pdf this file contains all the case studies, the CPD
Outcomes Framework as well as the case study worked answers. There are active links
and you may wish to click on highlighted text to navigate through the tutorial.
3. GPhC_Annex_E1_CPD_v1.0.pdf this is a copy of the CPD standards
4. GPhC_Annex_C_Proficiency_v1.0.pdf this is a copy of the Proficiency Standards
PowerPoint presentations (of the CPD Outcomes Framework Overview and Tutorial as well as
suggested case study answers)
1. CPD Outcomes Framework Overview.ppt this is a representation of the printed 4-page
overview as a PowerPoint presentation. Please access before the tutorial, below.
2. CPD Outcomes Framework In Detail.ppt this is a representation of the CPD Outcomes
Framework as a PowerPoint presentation.
3. Case studies 1-11 as 11 separate PowerPoint files the cases and the respective answers
as PowerPoint presentations.
Videos (of the CPD Outcomes Framework Overview and Tutorial as well as suggested case study
answers) you will need to have a newer copy of Windows Media Player to access.
1. Duplicate of the above PowerPoint files containing audio recorded explanations.
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Pharmacy Study
The CPD Outcomes Framework: an Overview

The overview is available as this printed document, an Adobe Acrobat file (.pdf), a PowerPoint
presentation (.ppt) and a video file (.avi) that can be played on a newer version of Windows Media
Player.
Introduction
The General Pharmaceutical Council (GPhC) will be responsible for the revalidation of all
pharmacy professionals from April 2010 onwards. Revalidation may involve examining
pharmacy professionals Continuing Professional Development (CPD) records. We have devised a
new framework (the CPD Outcomes Framework) to help you complete CPD records for revalidation.
You are the first group of pharmacy professionals to receive this framework. We hope that you
can work through this overview as an introduction to the CPD Outcomes Framework, before
accessing the Tutorial.
Aim
The aim of this overview is to introduce the CPD Outcomes Framework before you access the CPD
Tutorial that provides more hands-on guidance through specific examples.
Learning outcomes
After reading this overview you should have an understanding of the following components of
the CPD Outcomes Framework:
1. The concept of Relevance in relation to CPD
2. The concept of Impact in relation to CPD
3. The interaction of CPD Relevance with CPD Impact for ultimate grading of a CPD record
These concepts may appear unfamiliar at first. Please persevere and work through the rest of
this document then revisit the learning outcomes to judge your understanding.
1. Relevance in relation to CPD and the practice of pharmacy
The GPhC recently launched a consultation to outline future standards and rules in a number of
areas including CPD. The GPhCs Continuing Professional Development Standards and Framework
outlines 6 CPD Standards. Standard 4 is of particular interest:
Standard 4 states: include in your record CPD that is relevant to safe and effective practice and the
Standards of Conduct, Ethics and Performance of the profession.
Relevance in general is the degree to which something is related or useful to what is happening
or being talked about. In relation to pharmacy and CPD, standard 4 indicates that CPD must be
relevant to ones practice, in particular, safe and effective practice.
Determining the Relevance of CPD to safe practice
Consider the concept of safe practice. We think it is possible to plan and conduct CPD that is
relevant to the safe practice of pharmacy. We believe this can be achieved by thinking about
CPD in a completely new way. Our premise is that the concept of risk can be used to work out
the relevance of a CPD to safe practice. Imagine you are considering whether or not to conduct a
particular CPD or to make a CPD record available for revalidation. Now think about your practice
in the absence of this CPD. What would be the possible risk to your practice if you did not (or
had not) conduct(ed) this CPD? This will start to guide you in constructing and submitting CPD
records that demonstrate relevance to safe practice.
How does risk relate to CPD relevance?
You can rate the relevance of a particular CPD by thinking about the risk posed to your practice
should you decide not to conduct the CPD.
Page 136
How would you assess risk to your practice?

There are two factors involved in calculating risk, namely consequence and likelihood.
Consequence:
One of the ways in which you can think about the risk posed to your practice is to think of the
consequences of not conducting the CPD. Could a (potential) adverse outcome arise if you did
not conduct this CPD? Look at the diagram below. How bad would the possible consequence (of
failing to complete the CPD activity) be on your practice? Would it be negligible, catastrophic or
somewhere in between? This is the concept for now; we will expand on it in the Tutorial:
How does consequence contribute to a risk assessment of your CPD?
You can start to rate a risk posed to your practice by first evaluating the consequence of failing to
complete the CPD activity.
If you didnt conduct this CPD would there be a negative outcome on your practice? How severe would it be?
Increasing seriousness of consequences:
Negligible
Minor
Moderate
Major
Catastrophic
Likelihood:
The other dimension relating to risk is the predicted chance of occurrence, in this case of the
adverse outcome/consequence that you have identified above. This concept is known as
likelihood. What are the chances that the above consequence would occur if you didnt complete
this particular CPD? Look at the diagram below. How likely is it for the consequence to actually
happen if you did not complete this CPD activity? Would it be rare, almost certain or somewhere
in between? This is the concept for now; we will expand on it in the Tutorial:
How does likelihood contribute to a risk assessment of your CPD?
You should then rate the likelihood (of the consequence identified above) actually happening.
If you didnt conduct a particular CPD how likely is it for the predicted negative outcome to actually happen?
Increasing likelihood:
Rare
Unlikely
Possible
Likely
Almost certain
Linking consequence and likelihood to determine risk and therefore relevance of CPD to safe practice:
The dimensions consequence and likelihood are normally used to calculate risk using a table
similar to the one shown below. We think this table can be used to rate the relevance of the
CPD to your safe practice. The idea is that the more serious and likely the consequence of
failing to complete a particular CPD, the more relevant the CPD is to your safe practice.
How do consequence and likelihood contribute to a risk assessment of your CPD?
The point at which consequence and likelihood meet helps gauge relevance of CPD to safe practice
RELEVANCE
Likelihood (L)
Consequence (C)
Rare
Unlikely
Possible
Likely
Catastrophic
Major
Moderate
Minor
Negligible
Increasing relevance
Almost certain
Look at the table below. Where is the point at which the consequence and likelihood grades
meet? Is it an area shaded green or red or somewhere in between? We think that a green square
represents a CPD that is relevant to safe practice, while red represents one that is not. This is the
concept for now; we will expand on it in the Tutorial:
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2. Impact in relation to CPD and the practice of pharmacy

In addition to relevance to safe practice (dealt with above), standard 4 of the GPhCs CPD
Standards and Framework addresses the relevance of your CPD to effective practice; and standard
5 addresses the actual impact of your CPD on your practice. These concepts relate your CPD to
tangible positive effects on your practice.
Standard 4 states: include in your record CPD that is relevant to safe and effective practice and the
Standards of Conduct, Ethics and Performance of the profession.
Standard 5 states: record how your CPD has contributed to the quality or development of your
practice and has benefited patients and the public.
Impact in relation to Standards of Proficiency
To demonstrate the impact of your CPD you will need to link it to genuine effects on your
practice. In other words, you should show that your CPD has resulted in an actual outcome that
is valuable to your specific scope of practice. In addition to the CPD standards, the GPhC has
also set out new Standards of Proficiency for Pharmacy Professionals. These standards are produced for
the safe and effective practice of pharmacists and pharmacy technicians. They are the minimum
standards necessary to protect members of the public. All pharmacy professionals in the future
must meet all of the Standards of Proficiency when first becoming registered. After that, pharmacy
professionals must continue to meet the Standards of Proficiency that apply to their specific scope
of practice. We believe that CPD records can also be used to demonstrate that the Standards of
Proficiency are being met. This is achievable by completing and recording CPD outcomes (impact)
with reference to the new GPhC Standards of Proficiency.
How can you relate Standards of Proficiency to your CPD?
You can start to rate the impact of a particular CPD by thinking about its effect on your scope of
practice and new Standards of Proficiency.
How would you assess the impact of your CPD on your practice?
There are two factors involved in calculating impact, namely quality and benefit brought to your
practice (and in relation to the Standards of Proficiency) and the strength of evidence you have in
order to confirm such an effect.
Quality and Benefit:
When judging the impact that a CPD has exerted on your practice, we are suggesting first that
you identify a Standard of Proficiency to which your CPD activity relates the most. We would then
ask you to rate the extent to which the CPD has contributed to the quality or development of
your practice and has benefited patients and the public in the context of this Standard of Proficiency
in short, you would be rating the quality and benefit of your CPD against Standard of Proficiency.
This will start to guide you in constructing and submitting CPD records that demonstrate real
impact on practice. Look at the diagram below. What impact has your CPD had on your
practice, in relation to a Standard of Proficiency? Is it negligible, substantial, or somewhere in
between? This is the concept for now; we will expand on it in the Tutorial:
Has your CPD contributed to the quality or development of your practice and benefited patients
and the public?
You can start to rate the impact of your CPD by first evaluating its contribution towards quality and
benefit of your practice, against one of the proficiency standards.
Can you assess the degree to which your CPD has contributed to the quality or development of your
practice and benefited patients and the public, against a Standard of Proficiency?
Increasing impact on quality and benefit:
Negligible
Minor
Moderate
Major
Substantial
Page 138
Strength of evidence:
Standard 5 asserts the importance of demonstrating the quality and benefit of your CPD activity
and, above, we have related this concept to the Standards of Proficiency. For the purpose of
revalidation, we believe it is also important and necessary to provide evidence relating to the
impact of your CPD. Look at the diagram below. The evidence providing the lowest strength
relates to input (e.g. course attendance); the next level relates to evidence of your reaction to the
learning (e.g. your reflection); the next level relates to evidence of enhanced learning (e.g. formal
assessment); the next level relates to evidence of behaviour change on your part (e.g. through an
appraisal system); the final level relates to evidence of results (e.g. objectively measured
outcomes such as increased patient satisfaction). What is the extent to which you can
substantiate the impact of your CPD through evidence? Would it be evidence of input, or results
or somewhere in between? This is the concept for now; we will expand on it in the Tutorial:
What is the Strength of Evidence in relation to the impact of your CPD on your practice?
Grade the strength of evidence as the extent to which you can substantiate the quality and benefit
of your CPD through different types of evidence.
What is the extent to which you can substantiate the impact of your CPD through evidence?
Increasing Strength of Evidence:
Evidence of input
Evidence of
reaction
Evidence of
learning
Evidence of
behaviour change
Evidence of
results
Linking quality and benefit and strength of evidence to determine impact of CPD on your practice:
Look at the table below. Where is the point at which the Quality and Benefit and Strength of
Evidence grades meet? Is it an area shaded green or red or somewhere in between? We think
that a green square represents a CPD that is shown to have impacted on safe practice, while red
represents one that is not. This is the concept for now; we will expand on it in the Tutorial:
Strength of
evidence (E)
Results
Benefits to practice (Quality and benefit Score)

Negligible
Minor
Moderate
Major
Substantial
Behavior change
Learning
Reaction
Input
Increasing impact
IMPACT
Increasing impact
3. Using CPD Relevance and CPD Impact for ultimate grading of a CPD record
The aim of this CPD Outcomes Framework is to help you to create CPD records that demonstrate
relevance and positive impact on your practice. The final part of this CPD Outcomes Framework
involves the considering both the relevance and the impact of your CPD to derive an overall CPD
rating. This is the concept for now; we will expand on it in the Tutorial:
What is the overall rating of your CPD?

Consider the relevance of your CPD combined with its impact on practice to judge the overall
rating of the CPD record.
*** This is the end of the overview. You are now advised to access the full Tutorial. ***
Further reading about revalidation in pharmacy and the GPhC:
http://www.pharmacyregulation.org/
http://www.chre.org.uk/consultation/175/
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Donyai,CPD
et al. 2010
The
for Revalidation in
Pharmacy Study
The CPD Outcomes Framework: the Tutorial

The tutorial is available as this printed document, an Adobe Acrobat file (.pdf), a PowerPoint presentation (.ppt)
and a video file (.avi) that can be played on a newer version of Windows Media Player.
Introduction
We introduced the CPD Outcomes Framework in the overview. Please access the overview first, if you have
not already done so, before working through this tutorial. Please now work through this tutorial to gain
a better understanding of how to apply the CPD Outcomes Framework to example CPD activities.
Aim
The aim of this tutorial is to encourage you to apply the CPD Outcomes Framework to specific examples.
Learning outcomes
Part A of this tutorial contains eleven example case studies relating to CPD, which you can assess using
the CPD Outcomes Framework. By working through Part A you should be able to apply the CPD Outcomes
Framework in order to assess:
4. The Relevance of a CPD record
5. The Impact of a CPD record
6. The ultimate grading of a CPD record
The basic concepts of CPD relevance, impact and grading should already be somewhat familiar to you if
you have worked through the overview. Please persevere and work through the rest of this document
then revisit the learning outcomes to judge your new understanding.
In Part B we encourage you to assess one of your own previously-submitted CPD records using your
new knowledge of the CPD Outcomes Framework.
Part A: Example CPD records to be assessed using the CPD Outcomes

Framework
We provide here eleven case studies relating to different aspects of pharmacy practice for you to work
through and assess. You can work through as many of these case studies as you need. Our aim is to
help you gain a good understanding of how to apply the CPD Outcomes Framework to the assessment of
CPD records so that you can apply the concepts to one of your own CPD records in Part B. You may
wish to start with a case study that mimics closely your own practice. We advise that, as well as
selecting a case study relevant to your own field of practice, you work through case studies 5, 7 and 11
as a minimum.
Community pharmacist: Case Study 1
Junior pharmacist: Case Study 2
Hospital pharmacy technician: Case study 3
Production and quality assurance pharmacist: Case Study 4
Pharmacovigilance pharmacist: Case Study 5
Primary care pharmacist: Case Study 6
Education and training pharmacist: Case Study 7
Research pharmacist: Case study 8
Locum pharmacist: Case study 9
Pharmacist living overseas: Case study 10
Community pharmacy technician: Case study 11
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Community Pharmacist: Case Study 1

Simon is a 35-year old pharmacist living in Hampshire. He qualified in 1996 and has
worked for a number of independent community pharmacies before taking up his
current post in a relatively quiet store. Simon is anxious about his CPD and has been
keen to read various articles in the Pharmaceutical Journal to try and maintain his
knowledge and learn about new developments relating to pharmacy. Simon has also
accessed distance learning packages and attended evening tutorials on a number of
occasions in the past. One evening, while looking through the Centre for Pharmacy
Postgraduate Education (CPPE) e-learning packages, Simon comes across a new package
entitled Travel Health. Although Simon has not had any difficulty answering patient
and customer queries relating to travel health in the past, he nonetheless decides to
access the e-learning package and spends the time completing the tutorial online.
Afterwards, he reflects on his experience and considers the learning package was moreor-less useful as it has probably helped him prepare better for questions relating to the
purification of water. The next day, Simon decides to make a CPD entry about his new
learning. Imagine Simon creates a CPD record the next day to document his new
learning.
Now try and rate Simons CPD using the concepts of relevance and impact introduced in
the overview. Access and use the CPD Outcomes Framework (pages 13 17) to rate the value
of recording such a CPD for the purpose of revalidation. Use a blank template for
assessment of CPD cases (page 28 extra copies also provided).
Wednesday, 15 December 2010
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Shelley is a 23-year old pharmacist who completed her pre-registration training with a
large community pharmacy multiple in Devon last year. After passing her registration
exam, Shelley travelled for a few months and then applied for a junior pharmacist post
at her local district general hospital where she is currently based. Shelley started
rotating through Medicines Information (MI) last month, where she will remain for at
least the next six months. She was finding the experience quite a challenge as she felt
she lacked the confidence to deal with some of the enquirers. While on her own in the
MI unit one lunchtime last month, she received a telephone call from a locum doctor
expecting her to outline the hospitals policy for the treatment of multiple sclerosis.
Unable to answer and rather flummoxed, Shelley tried to obtain the callers details but
they hung up before she could do so. Shelley discussed the incident with her manager
who was quite understanding and recommended Shelley reads up about multiple
sclerosis in general and familiarises herself with the hospital formulary for now.
Shelleys partner suggested to her that she might also benefit from attending a course on
confidence building and communication skills to help her cope better with telephone
enquiries. Shelley didnt take kindly to the suggestion made by her partner but decided
she would take up her managers recommendations. To make a start on her learning,
Shelley accessed two articles on Multiple Sclerosis available via the new Clinical Pharmacist
online pages at www.pjonline.com. After she read the articles, Shelley answered the
accompanying multiple-choice questions (MCQs) via the online module. Her answers
were subsequently marked by Clinical Pharmacist and she received a certificate and her
results by email two weeks after the module closed. Shelley obtained a score of 80% in
her online MCQ assessment. This in itself boosted Shelleys confidence and since the
incident last month Shelley now feels she is much better equipped to handle enquirers
in her MI rotation, even when she doesnt have all the answers to hand.
Now try and rate Shelleys CPD using the concepts of relevance and impact introduced in
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Monica is a pharmacy technician who registered with the RPSGB last year. She has been
working in the same hospital pharmacy since she qualified 5 years ago. Monica enjoys
her job but has been asked to take on a new challenge, which she doesnt feel quite
ready to tackle yet. She is to become involved in managing the use of patients own
drugs. As part of this new role, she will need to interact with patients admitted to one of
the general wards to take their drug histories soon after they arrive. Monicas manager
recommends she attends an in-house training session on patient drug history taking run
by one of the clinical pharmacists. Monica also decides to access the CPPE Pharmacy
Technician Learning Programme on Patients, Medicines and the Pharmacy Technician
A Pharmacy Technician Guide to Medication Review which she reads in part without
completing fully. Some weeks later, Monica starts her new role rather reluctantly but
then finds that she is able to apply a lot of her learning to the patient interactions. She
becomes interested in refining her communication skills and later attends a Neurolinguistic Programming (NLP) course at her local Borough. Months later, Monicas
manager praises her improved communication skills during her appraisal and
recommends Monica for a promotion. Monica decides to write her experience up as a
CPD record.
Now try and rate Monicas CPD using the concepts of relevance and impact introduced in
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John is a 43-year old pharmacist who has been working for the same medium-sized
pharmaceutical company for the past 15 years. The company is based in Hull and John
has enjoyed working mainly in production and quality assurance roles. Having
completed a range of training, John became a member of the Chartered Quality Institute
(CQI) a year ago and would now like to work towards becoming a Chartered member. He
knows there is a requirement for Chartered members to plan, undertake and keep
records of CPD so he has been keeping informal records since joining the institute. Six
months ago John was promoted to the position of team leader and as a result took
responsibility for contributing towards managing his units budget which had been
allowed to be exceeded two years running. John decided to enrol on an online elearning course with the CQI to help him contribute towards the improved management
of his unit and perhaps even help cut production costs. The course was called The road
to Lean Six Sigma and covered essentially a set of quality management methods,
including statistical ones, which John has tried to use to improve the quality of his units
outputs by identifying and removing the causes of defects (errors) and minimising
variability in the production processes. John has passed the Six Sigma course and
obtained a completion certificate from the CQI providers. At his appraisal, Johns line
manager commended him on the level of enthusiasm he had shown in his new role and
also praised John for the contribution he had already made to the increased efficiency of
the unit.
Now try and rate Johns CPD using the concepts of relevance and impact introduced in
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Khalid is 32 years old and works as lead pharmacovigilance pharmacist at a NHS trust in
Greater London. His job is varied and interesting and he finds he can work well with the
team of clinical pharmacists with whom he regularly liaises as part of his role. Khalid
was asked by the local School of Pharmacy whether he could accommodate a number of
student projects. Khalid eagerly agreed to take on these projects. He had wanted to
conduct an audit of anticoagulant counselling within the Trust since the release of the
National Patient Safety Agency (NPSA) Patient Safety Alert No. 18 there has been
instances of readmissions to the hospital as a result of potentially preventable warfarinrelated morbidities and Khalid had wondered whether he should investigate the
effectiveness of warfarin counselling at discharge. He used the current opportunity to
liaise with the wider healthcare team and devised a 3-month audit of anticoagulant
counselling in the clinical areas and the outpatient pharmacy prior to patients discharge
from the hospital. The audit revealed a number of problematic areas, which Khalid
noted needed to be rectified with some level of urgency. The students were able to
engage in the audit process and later wrote a number of e-mails expressing their
gratitude to Khalid for his involvement in their learning. In addition, Khalid produced a
concise audit report from the data generated, which he presented to the anticoagulant
committee at their next monthly meeting. The report was well received and a number
of changes were agreed to be put in place. Although Khalid had not become involved in
the activity for CPD purposes, he was encouraged by his colleagues to record the
experience as a CPD record.
Now try and rate Khalids CPD using the concepts of relevance and impact introduced in
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Farzana is 49 years old and relatively new in her role as community pharmacy facilitator
at a Primary care Trust in North Yorkshire. She has been asked to start attending the
PCTs commissioning meetings in order to sell community pharmacy services to the
committee. She is expected to mainly advocate the involvement of pharmacists in the
new vascular risk assessments as this is a key part of the Chief Pharmacists strategy for
community pharmacy in the PCT. Farzana doesnt know how to approach such a duty
and decides to access one of the CPPE online learning courses entitled Vascular risk
focal point. She works through the programme and answers the associated MCQs, for
which she received a relatively high grade of 67%. She feels relatively confident that she
has the knowledge needed to answer any questions on how pharmacists can become
involved in the vascular risk assessments. However, at the meeting she is asked to
provide data relating to the effectiveness of community pharmacy public health services
and specifically impact on patient outcomes. The meeting leaves her feeling defeated
and she hears later that pharmacy services would not be considered in the first round of
commissioning next month. Nonetheless, Farzana records her learning and experience
as a CPD entry.
Now try and rate Farzanas CPD using the concepts of relevance and impact introduced
in the overview. Access and use the CPD Outcomes Framework (pages 13 17) to rate the
value of recording such a CPD for the purpose of revalidation. Use a blank template for
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Costas is 38 years old and works both as clinical lecturer in a new School of Pharmacy
and as pre-registration tutor in a large teaching hospital. Because of a permanent staff
shortage issue, Costas has been asked to become involved in the moderation of the
fourth-year clinical pharmacy exam paper for the MPharm degree at the School of
Pharmacy, a job normally reserved for academic staff. Costas has no prior experience of
either devising or moderating formal University exam papers but is always happy to
accept new challenges so he decides to look into the process involved in more detail.
Costas finds the University guidance on writing exam papers and also attends a one-day
workshop on effective assessment operated by the University library. When the exam
papers are generated Costas is unable to allocate enough time to conduct as thorough a
review as he had hoped so decides to make some general comments about issues relating
to question style instead. Nonetheless, having attended the University workshop on
effective assessment Costas feels justified to write the experience as a CPD entry.
Now try and rate Costass CPD using the concepts of relevance and impact introduced in
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Tailen is a 24-year old postdoctoral research fellow at a prestigious academic institution.
She is also a pharmacist and is keen to complete relevant CPD records for the purpose of
revalidation. Tailen has been working on a funded project for the last two years
examining the formulation of new anticancer drugs via novel drug-delivery methods.
Her contract is coming to a close in a years time and she has been asked by her research
mentor to start thinking about writing some of her results for publication in peerreviewed journals. Tailens project is funded by a start-up pharmaceutical company that
is expecting peer-reviewed publications to arise from the research, having already
secured patents on the main novel elements of the work. Although Tailen has been a
published author in the past, most of the papers were authored by her PhD supervisor so
she has no direct experience of managing the process of writing and submitting
manuscripts for publication. She decides to visit target journal websites and after
reading the instructions to authors, selects one publication to target first. Although she
finds the process difficult to begin with, Tailen perseveres and after 8 months produces a
manuscript she can submit to her target journal. Although the paper is still undergoing
the process of peer-review and is not accepted by the journal, Tailen feel justified in
writing her experience as a CPD entry.
Now try and rate Tailens CPD using the concepts of relevance and impact introduced in
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Jane is a semi-retired pharmacist who now works only occasionally as a locum
community pharmacist. Jane took a break over the summer and returned to locum work
after the implementation of the Responsible Pharmacist regulations. Although Jane had
tried to prepare for the changes by accessing the RPSGB Responsible Pharmacist Toolkit,
she felt ill-equipped to deal with all the new requirements on her first day back,
especially the requirement to check the pharmacy procedures on arrival. Feeling rather
unhappy about this new way of practice Jane wondered whether it would really be
necessary to check all the procedures every time she arrived at a new store. She
consulted with some of her peers who were equally unhappy about the changes at first
but had managed to work these into their routine after a few weeks. Jane decided to
access the CPPE e-learning module on the Responsible Pharmacist and worked through
this over a number of evenings. She couldnt find a means of formally assessing her
learning via that module but did reflect on the usefulness of the course afterwards. Jane
also accessed the website of her professional indemnity insurer and found a number of
useful documents that clarified her understanding of the new regulations. Jane decided
to write a CPD record relating to her increased knowledge and understanding.
Now try and rate Janes CPD using the concepts of relevance and impact introduced in
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Margaret is a young pharmacist who took up a two-year post with Voluntary Service
Overseas (VSO). She was posted to a small town in Tanzania to look after the pharmacy
of the towns only hospital. Margaret was unsure whether she could remain registered
with the GPhC if not practising in the UK but thought to keep her CPD records active for
when she returns. Although she didnt envisage having regular access to the internet,
she had taken paper CPD templates for completion in Tanzania. Margaret also took with
her a copy of the Martindale, a print copy of the British Pharmacopoeia, the British
National Formulary and some clinical books and guidelines relevant to diseases
encountered in Tanzania. However, nothing could have prepared Margaret for some of
the practices she came across on arrival. For example, although some donated stock was
available and being used, the local pharmacy assistant who had been working at the
hospital for over 15 years, had to regularly make injectable products using archaic
processes and equipment in very unhygienic conditions, out of sheer necessity. Margaret
made it her mission to try and tackle the health risks posed by such a practice and spent
one year of her VSO posting trying to collect sufficient funds for new equipment and
consumables. She travelled weekly to and from Dar es Salaam and e-mailed prospective
donors and charities for the funding. She eventually took delivery of a new autoclave
and was also able to buy some infusion bottles and closures as well as the raw
ingredients needed. She was also able to pay for some remedial work to the clean
room, which improved its suitability to some extent. Margaret took photos before and
after the changes and decided to write her experience up as one of her CPD entries.
Now try and rate Margarets CPD using the concepts of relevance and impact introduced
in the overview. Access and use the CPD Outcomes Framework (pages 13 17) to rate the
value of recording such a CPD for the purpose of revalidation. Use a blank template for
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Ben is 48 and works as a pharmacy technician for a busy independent pharmacy. Since
the introduction of the Responsible Pharmacist regulations, he has become more actively
involved in ensuring the safe and effective supply of all pharmacy medicines. Bens line
manager, the owner/pharmacist, recently asked him to also become involved in revising
the standard operating procedure (SOP) for the sale of emergency hormonal
contraception (EHC). The pharmacist is planning a three-week break and would also like
Ben to help make sure that all locum pharmacists providing cover in those weeks are
fully briefed on the pharmacys procedures. Ben accepts the challenge and completes
the first task of revising the SOP on EHC. He decides to record the experience as a new
CPD entry.
Now try and rate Bens CPD using the concepts of relevance and impact introduced in
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The CPD Outcomes Framework

Relevance in relation to CPD and the practice of pharmacy
We introduced the concept of relevance in relation to CPD in the overview document. Standard 4 of
GPhCs Continuing Professional Development Standards and Framework indicates that CPD must be relevant
to practice, in particular, safe and effective practice:
Standard 4 states: include in your record CPD that is relevant to safe and effective practice and
the Standards of Conduct, Ethics and Performance of the profession.
Determining the Relevance of the CPD to the pharmacy professionals safe practice
In relation to the concept of safe practice, we think it is possible for us to plan and conduct CPD that
is relevant to our safe practice of pharmacy. We believe this can be achieved by thinking about CPD in
a completely new way. Our idea is that the concept of risk can be used to work out the relevance of
a CPD to safe practice. Here we have to think about our practice in the absence of this CPD. What
would be the possible risk to our practice if we did not (or had not) conduct(ed) a particular CPD? This
question will start to guide us in constructing and submitting CPD records that demonstrate relevance
to our safe practice.
How does risk relate to CPD relevance?

You can rate the relevance of a particular CPD by thinking about the risk posed to your practice
should you decide not to conduct the CPD.
How would you assess risk to practice?
There are two factors involved in calculating risk, namely consequence and likelihood.
Consequence:
One of the ways in which you can think about the risk posed to a pharmacy professionals practice is
to think of the consequences of them not conducting the CPD. Could a (potential) adverse outcome
arise if they did not conduct this CPD? In relation to your case study, look at the diagram below. How
bad would the possible consequence (of failing to complete the CPD activity) be on the pharmacy
professionals practice? Would it be negligible, catastrophic or somewhere in between?
How does consequence contribute to a risk assessment of CPD?

You can start to rate a risk posed to your practice by first evaluating the consequence of failing
to complete the CPD activity.
If the pharmacy professional in the case scenario didnt conduct this CPD would there be a negative outcome
on their practice? How severe would it be?
Negligible
Minor
Moderate
Major
Catastrophic
STEP 1: Grading the consequence level in relation to the CPD record:

Before deciding on the consequence level (i.e. whether negligible, minor, and so on), you have to
choose one of 8 domains that relate to the possible risk posed (see the bullet points, below). Each
domain is associated with a table providing descriptors for the different levels of consequence for the
domain. You may not be able to decide which of the domains relate best to this case. You can view all
the tables one-by-one and identify the most relevant domain before deciding which consequence level
to choose.
Choose one domain from the 8 domains relating to consequence. Read more about each domain by
visiting the fuller table as indicated:
Domain 1: Impact on the safety of patients, staff or public (physical/psychological harm) (page
18)
Domain 2: Quality/complaints/audit (page 19)
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Domain 3: Human resources/organisational development/staffing/competence (page 20)

Domain 4: Statutory duty/inspections (page 21)
Domain 5: Adverse publicity/reputation (page 22)
Domain 6: Business objectives/ projects (page 23)
Domain 7: Finance including claims (page 24)
Domain 8: Service/business interruption, Environmental impact (page 25)
Once you have selected a consequence domain from the list above move on to STEP 2, below.
STEP 2: Grading the likelihood level in relation to the consequence:
Likelihood:
The other dimension relating to risk is the predicted chance of occurrence of the adverse
outcome/consequence that you have identified above. This concept is known as likelihood. What are
the chances that the above consequence would occur if the pharmacy professional hadnt (didnt)
complete this particular CPD? Look at the diagram below in relation to your case study. In the context
of this case, how likely is it for the consequence you have identified above to actually happen if the
pharmacy professional did not complete this CPD activity? Would the likelihood be rare, almost
certain or somewhere in between?
How does likelihood contribute to a risk assessment of your CPD?

You are looking to rate the likelihood (of the consequence identified above) actually
happening.
If the pharmacy professional in the case scenario didnt conduct this particular CPD how likely is it for the
predicted negative outcome to actually happen?
Descriptor
Rare
Unlikely
Possible
Likely
Almost certain
Frequency
This will
probably never
happen/recur
Do not expect it to
Might happen or
recur occasionally
Will probably
Will undoubtedly
happen/recur, and
possibly frequently
Choose a likelihood level from the chart above.

STEP 3: Linking consequence and likelihood to determine risk thus relevance of CPD to safe practice:
The dimensions consequence and likelihood are normally used to calculate risk using a table similar
to the one shown below. We think this table can be used to rate the relevance of the CPD to the
pharmacy professionals safe practice. The idea is that the more serious and likely the consequence of
failing to complete a particular CPD, the more relevant the CPD is to their safe practice.
How do consequence and likelihood contribute to a risk assessment of your CPD?

The point at which consequence and likelihood meet helps gauge relevance of CPD to safe
practice.
RELEVANCE
Likelihood (L)
Consequence (C)
Rare
Unlikely
Possible
Likely
Catastrophic
Major
Moderate
Minor
Negligible
Almost certain
Look at the table below. Where is the point at which the consequence and likelihood grades meet? Is
it an area shaded green or red or somewhere in between? We think that a green square represents
a CPD that is significantly relevant to safe practice, while red represents one that is of low relevance.
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For grading risk, the colours obtained from the risk (relevance) matrix are assigned grades as follows:
Significant relevance
High relevance
Moderate relevance
Low relevance
Impact in relation to CPD and the practice of pharmacy
In addition to relevance to safe practice (dealt with above), standard 4 of the GPhCs CPD Standards and
Framework addresses the relevance of CPD to effective practice; and standard 5 addresses the actual
impact of a pharmacy professionals CPD on their practice. These concepts relate the CPD to tangible
positive effects on the pharmacy professionals practice.
Standard 4 states: include in your record CPD that is relevant to safe and effective practice
and the Standards of Conduct, Ethics and Performance of the profession.
Standard 5 states: record how your CPD has contributed to the quality or development of
your practice and has benefited patients and the public.
To demonstrate the impact of your CPD you will need to link it to genuine effects on your practice. In
other words, you should show that your CPD has resulted in an actual outcome that is valuable to your
specific scope of practice. In addition to the CPD standards, the GPhC has also set out new Standards
of Proficiency for Pharmacy Professionals. These standards are produced for the safe and effective practice
of pharmacists and pharmacy technicians. They are the minimum standards necessary to protect
members of the public. All pharmacy professionals in the future must meet all of the Standards of
Proficiency when first becoming registered. After that, pharmacy professionals must continue to meet
the Standards of Proficiency that apply to their specific scope of practice. We believe that CPD records
can also be used to demonstrate that the Standards of Proficiency are being met. This is achievable by
completing and recording CPD outcomes (impact) with reference to the new GPhC Standards of
Proficiency.
How can you relate Standards of Proficiency to your CPD?

You can start to rate the impact of a particular CPD by thinking about its effect on your scope
of practice and new Standards of Proficiency.
How would you assess the impact of CPD on practice?
There are two factors involved in calculating impact, namely quality and benefit brought to your
practice (in relation to the Standards of Proficiency) and the strength of evidence you have in order to
confirm such an effect.
STEP 4: Grade quality and benefit of the CPD record.
In relation to the case scenario, when judging the impact that a CPD has exerted on the pharmacy
professionals practice, we are suggesting first that you identify a Standard of Proficiency to which the
CPD activity relates the most. Please access the document entitled Standards of proficiency for
pharmacy professionals. Can you identify one to three Standard of Proficiency to which the CPD
applies? Now rate the extent to which the CPD has contributed to the quality or development of
practice and has benefited patients and the public in the context of your case scenario you would be
rating the quality and benefit of the CPD in real terms. This practice will later start to guide you in
constructing and submitting CPD records that demonstrate real impact on your own practice. Look at
the diagram below in relation to your case scenario. What impact has this CPD had on the pharmacy
professionals practice and in relation to a Standard of Proficiency? Is it negligible, substantial, or
somewhere in between?
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Has your CPD contributed to the quality or development of your practice and benefited
patients and the public?
You can start to rate the impact of your CPD by first evaluating its contribution of towards
quality and benefit of your practice, against one of the Standard of Proficiency.
Can you assess the degree to which the pharmacy professionals CPD has contributed to the quality or
development of their practice and benefited patients and the public, against a Standard of Proficiency?
Negligible
Minor
Moderate
Major
Substantial
Examine the chart below and read the explanations provided under each grade heading. This will
help you decide on the level of impact this CPD has had on the pharmacy professionals practice. You
must do this in relation to a Standard of Proficiency:
Domain
Negligible
Minor
Moderate
Major
Substantial
Standards of proficiency for

pharmacy professionals
No or minimal
impact on quality
of practice
Minor improvement
Moderate
improvement in
Major improvement in
Substantial
improvement in
No or minimal
direct benefit to
patients and the
public
Minor benefit to
patients and the
public
Positive impact has
been on a minimal
number of patients
Moderate benefit to
patients and the
public
Positive impact has
been on a minor
number of patients
Major benefit to
patients and the
public
Substantial benefit to
patients and the
public
Positive impact has

been on a moderate
number of patients
Positive impact has

been on a large
number of patients
STEP 5: Grade the strength of evidence relating to the CPD record.

Standard 5 asserts the importance of demonstrating the quality and benefit of ones CPD activity and,
above, we have related this concept to the Standards of Proficiency. For the purpose of revalidation, we
believe it is also important and necessary to provide evidence relating to any claim made about the
impact of ones CPD. Look at the chart below and access the more detailed chart outlining these levels
of evidence (page 26 27). The evidence providing the lowest strength relates to evidence of input (e.g.
course attendance); the next level relates to evidence of your reaction to the learning (e.g. your
reflection); the next level relates to formal evidence of enhanced learning (e.g. recognized assessment);
the next level relates to evidence of behaviour change (e.g. through an appraisal system); the final level
relates to evidence of results (e.g. objectively measured outcomes such as increased patient
satisfaction). What is the extent to which you can substantiate the impact of your CPD through
evidence? Would it be evidence of input, or results or somewhere in between?
What is the Strength of Evidence in relation to the impact of your CPD on your practice?
Grade the strength of evidence as the extent to which you can substantiate the quality and benefit of your
CPD through different types of evidence.
What is the extent to which you can substantiate the impact of your CPD through evidence?
Evidence of input
Evidence of
reaction
Evidence of
learning
Evidence of
behaviour change
Evidence of results
Access the more detailed table explaining these levels of evidence (pages 26 27).
STEP 6: Interact the quality and benefit and strength of evidence to determine the impact of the CPD on
practice
Look at the table on the next page. Where is the point at which the Quality and Benefit and
Strength of Evidence grades meet? Is it an area shaded green or red or somewhere in between?
We think that a green square represents a CPD that is shown to have impacted on safe practice, while
red represents one that is not.
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Strength of
evidence (E)
Results
Negligible
Minor
Moderate
Major
Substantial
Increasing impact
IMPACT
Behavior change
Learning
Reaction
Input
Increasing impact
For evaluating impact, the grades obtained from the impact matrix are indicated as follows:
High impact
Moderate impact
Low impact
Negligible impact
STEP 7: Use CPD Relevance and CPD Impact to grade the CPD record
The aim of this CPD Outcomes Framework is to help us create CPD records that demonstrate relevance to
and positive impact on our practice for the purpose of revalidation. The final part of this CPD Outcomes
Framework involves the considering both the relevance and the impact of a CPD to derive an overall CPD
rating.
What is the overall rating of your CPD?

Consider the relevance of your CPD combined with its impact on practice to judge the overall
rating of the CPD record.
The final rating of a CPD record is determined by both the relevance and impact grades. We propose
that if both the relevance and impact levels have been graded as green, this is an indication that the
CPD record has met the required standard. Conversely, if both the grades are red, then the record is
likely to fail to meet acceptable standards. In this case, the pharmacy professional would be
encouraged to think about the changes they could make to their CPD in order to enhance its rating
before submitting it as part of the revalidation process. Where a yellow grading is achieved, it is also
likely for the record to have achieved the required standard while an orange grading indicates
borderline acceptable standards. Clearly, there will also be instances where a different shade is
achieved in each of the relevance and impact domains. We recommend pharmacy professionals
attempt to improve their CPDs rating in each of these domains to such an extent that at least one
green or yellow cell is achieved for each of relevance and impact scores and that no red rating is
achieved.
Evaluate the overall CPD rating by considering the predominant colour grade achieved as a result of
combining the relevance and impact grades:
Meets required standard
Likely to meet required standard
Borderline for acceptable standard
Fails to achieve acceptable standard
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Consequence Domain 1: Impact on safety

Examine the table below. You may think that in the absence of this particular CPD there is a
risk to the safety of patients, staff or the public (including physical/psychological harm). Read
the explanations provided under each grade heading. This will help you decide on whether
the impact on safety would be negligible, catastrophic, or somewhere in between.
Once you have decided on a level of consequence go back to STEP 1 (page 13).
Domain 1
Negligible
Minor
Moderate
Major
Catastrophic
Impact on the safety

of patients, staff or
public
(physical/psychological
harm)
Minimal
injury
requiring
no/minimal
intervention
or treatment.
No time off
work
Minor
injury or
illness,
requiring
minor
intervention
Requiring
time off
work for <3
days
Increase in
length of
hospital stay
by 1-3 days
Moderate
injury requiring
professional
intervention
Requiring time
off work for 4-14
days
Increase in
length of
hospital stay by
4-15 days
RIDDOR/agency
reportable
incident
An event
which impacts
on a small
number of
patients
Major injury
leading to longterm
incapacity/disability
Requiring time
off work for >14
days
Increase in length
of hospital stay by
>15 days
Mismanagement
of patient care with
long-term effects
Incident leading
to death
Multiple
permanent
injuries or
irreversible
health effects
An event which
impacts on a
large number of
patients
Page 157
Donyai, et al. 2010
Consequence Domain 2: Quality/complaints/audit

risk in relation to quality, complaint or audit. Read the explanations provided under each
grade heading. This will help you decide on whether the impact on quality/complaints/audit
would be negligible, catastrophic, or somewhere in between.
Domain 2
Negligible
Minor
Moderate
Major
Catastrophic
Quality/complaints/audit
Peripheral
element of
treatment or
service
suboptimal
Informal
complaint/inquiry
Overall
treatment or
service
suboptimal
Formal
complaint
(stage 1)
Local
resolution
Single
failure to
meet internal
standards
Minor
implications
for patient
safety if
unresolved
Reduced
performance
rating if
unresolved
Treatment or
service has
significantly
reduced
effectiveness
Formal
complaint
(stage 2)
Local
resolution
(with potential
to go to
independent
review)
Repeated
failure to meet
internal
standards
Moderate
patient safety
implications if
findings are
not acted on
Noncompliance
with national
standards with
significant risk
to patients if
unresolved
Multiple
complaints/
independent
review
Low
performance
rating
Critical
report
Totally
unacceptable level
or quality of
treatment/service
Gross failure of
patient safety if
findings not acted
on
Inquest/ombuds
man inquiry
Gross failure to
meet national
standards
Page 158
Donyai, et al. 2010
Consequence Domain 3: Human resources/organisational development/staffing/competence

risk in relation to human resources/ organisational development/staffing/ competence. Read
the explanations provided under each grade heading. This will help you decide on whether
the impact on human resources/ organisational development/staffing/competence would be
negligible, catastrophic, or somewhere in between.
Domain 3
Negligible
Minor
Moderate
Major
Catastrophic
Human resources/
organisational
development/staffing/
competence
Short-term
low staffing
level that
temporarily
reduces
service
quality (< 1
day)
Low staffing
level that
reduces the
service quality
Late delivery
of key objective/
service due to
lack of staff
Unsafe staffing
level or
competence (>1
day)
Low staff
morale
Poor staff
attendance for
mandatory/key
training
Uncertain
delivery of key
objective/service
due to lack of
staff
Unsafe staffing
level or
competence (>5
days)
Loss of key
staff
Very low staff
morale
No staff
attending
mandatory/ key
training
Non-delivery of key
objective/service due
to lack of staff
Ongoing unsafe
staffing levels or
competence
Loss of several key
staff
No staff attending
mandatory training
/key training on an
ongoing basis
Page 159
Donyai, et al. 2010
Consequence Domain 4: Statutory duty/ inspections

risk in relation to statutory duty/inspections. Read the explanations provided under each
grade heading. This will help you decide on whether the impact on statutory duty/
inspections would be negligible, catastrophic, or somewhere in between.
Domain 4
Negligible
Minor
Moderate
Major
Catastrophic
Statutory duty/
inspections
No or
minimal
impact or
breach of
guidance/
statutory
duty
Breach of
statutory
legislation
Reduced
performance
rating if
unresolved
Single breach in
statutory duty
Challenging
external
recommendations/
improvement
notice
Enforcement
action
Many
breaches in
statutory duty
Improvement
notices
Low
performance
rating
Critical report
Multiple breaches
in statutory duty
Prosecution
Complete systems
change required
Zero performance
rating
Severely critical
report
Page 160
Donyai, et al. 2010
Consequence Domain 5: Adverse publicity/ reputation

risk in relation to adverse publicity or reputation. Read the explanations provided under each
grade heading. This will help you decide on whether the impact in relation to adverse
publicity or reputation would be negligible, catastrophic, or somewhere in between.
Domain 5
Negligible
Minor
Moderate
Major
Catastrophic
Adverse publicity/
reputation
Rumours
Potential for
public
concern
Local media
coverage
short-term
reduction in
public
confidence
Elements of
public
expectation not
being met
Local media
coverage
long-term
reduction in
public
confidence
National
media coverage
with <3 days
service well
below
reasonable
public
expectation
National media
coverage with >3
days service well
below reasonable
public expectation.
MP concerned
(questions in the
House)
Total loss of public
confidence
Page 161
Donyai, et al. 2010
Consequence Domain 6: Business objectives / projects

risk in relation to business objectives / projects. Read the explanations provided under each
grade heading. This will help you decide on whether the impact on business objective /
projects would be negligible, catastrophic, or somewhere in between.
Domain 6
Negligible
Minor
Moderate
Major
Catastrophic
Business objectives/
projects
Insignificant cost
increase/ schedule
slippage
<5 per cent

over project
budget
Schedule
slippage
510 per
cent over
project budget
Moderate
schedule
slippage
Noncompliance
with national
1025 per cent
over project
budget
Major
schedule
slippage
A number of
key objectives
not met
Incident leading
>25 per cent over
project budget
Schedule slippage
Many key
objectives not met
Page 162
Donyai, et al. 2010
Consequence Domain 7: Finance including claims

risk in relation to finance including claims. Read the explanations provided under each
grade heading. This will help you decide on whether the impact on finance including claims
would be negligible, catastrophic, or somewhere in between.
Domain 7
Negligible
Minor
Moderate
Major
Catastrophic
Finance including
claims
Small loss /
Risk of claim
remote
Loss of 0.1
0.25 per cent of
budget
Claim(s) less
than 10,000
Loss of 0.25
0.5 per cent of
budget
Claim(s)
between
10,000 and
100,000
Uncertain
delivery of key
objective/Loss of
0.51.0 per cent
of budget
Claim(s)
between
100,000 and 1
million
Purchasers
failing to pay on
time
Non-delivery of key
objective/ Loss of
>1.0 per cent of
budget
Failure to meet
specification/
slippage
Loss of contract /
payment by results
Claim(s) >1
million
Page 163
Donyai, et al. 2010
Consequence Domain 8: Service/business interruption & Environmental impact

risk in relation to the service/business interruption or an environmental impact. Read the
explanations provided under each grade heading. This will help you decide on whether the
impact on the service/business interruption or the environmental impact would be negligible,
catastrophic, or somewhere in between.
Domain 8
Negligible
Minor
Moderate
Major
Catastrophic
Service/business
interruption
&Environmental
impact
Loss/interruption
of <8 hours
Minimal or no
impact on the
environment
Loss/interruption
of 8 hours 1 day
Minor impact
on environment
Loss/interruption
of 1 day 1 week
Moderate impact
on environment
Loss/interruption
of >1 week
Major impact on
environment
Permanent
loss of service
or facility
Catastrophic
impact on
environment
Page 164
Donyai, et al. 2010
Impact: Strength of Evidence

Examine the table below, which describes and gives examples of the different strengths of evidence in relation to CPD records. Read
carefully the descriptor and characteristics and decide the level of evidence provided in relation to the impact of the CPD. Also visit the
next page detailing examples of evidence.
Once you have decided on a strength of evidence go back to STEP 5 (page 16).
Descriptors
Evidence of input
Evidence of
behaviour change
Evidence of results
Evidence of having conducted

the learning experience. This is
the least amount of evidence
required. There should be
some form of statement or
record relating to the learning
experience haven taken place.
Reaction evaluation is how the

registrant felt, and their
personal reactions to the
training or learning
experience.
Did the trainee like and
enjoy the training?
Did they consider the
training relevant?
Was it a good use of their
time?
Did they like the venue, the
style, timing, domestics, etc?
Level of participation.
Ease and comfort of
experience.
Level of effort required to
make the most of the learning.
Perceived practicability and
potential for applying the
learning.
Learning evaluation is the measurement

of the increase in knowledge or
intellectual capability from before to
after the learning experience, ideally
objectively by a third party. Evidence of
learning can also include new
documents developed by the learner for
use at work.
Did the registrant learn what was
intended to be taught?
Did the registrant experience what
was intended for them to experience?
What is the extent of advancement or
change in the registrant after the
training, in the direction or area that
was intended?
Behaviour evaluation is the

extent to which the
registrant applied the
learning and changed their
behaviour, which can be
immediately or several
months after the training,
depending on the situation.
Did the registrant put
their learning into effect
when back on the job?
Were the relevant skills
and knowledge used?
Was there noticeable and
measurable change in the
activity and performance of
the trainees when back in
their roles?
Was the change in
behaviour and new level of
knowledge sustained?
Would the trainee be able
to transfer their learning to
another person?
Is the trainee aware of
their change in behaviour,
knowledge, or skill level?
Results evaluation is the effect on

the practice or environment
happening because of the
improved performance of the
learner it is the acid test.
Measures would typically be
practice or organisational key
performance indicators, such as:
Volumes, values, percentages,
timescales, return on investment,
and other quantifiable aspects of
organisational performance, for
instance; numbers of complaints,
staff turnover, attrition, failures,
wastage, non-compliance, quality
ratings, achievement of standards
and accreditations, growth,
retention, etc.
Evidence of
behaviour change
Evidence of results
Impact: Strength of Evidence continued.

Evidence of input
Documents required
to produce
Course attendance certificates

Other evidence of
Evaluation of
Formal assessment and exam scores
courses/conferences attended
Case studies
Wednesday 15 December 2010 Page 165
Documentation arising
from appraisal
Objective statistical
benchmarking
Donyai, et al. 2010

participation
Course programme
documents
Learning contracts

Profiles drawn from learning
Course assignments
portfolios
Information leaflets
Formal reflection on the
Critical literature reviews
course/learning
Policy or position statements
Discussion documents
Procedural documents
Protocols
Reports (e.g. on project work, clinical
audit, reviews of activity)
Business plans
Guidance materials (e.g. for service
users, colleagues or students)
Clinical audit tools
Clinical guidelines
Presentations
Articles produced for publication
Questionnaires
Research papers /proposals/funding
applications/ethical approval
applications
Induction materials for new members
of staff
Contributions to work of a
professional body or a special interest
group
Documented and approved claims for
academic credit for prior or
experiential learning
Page 166
Documentation arising
from clinical supervision
Job evaluation
Compliance with locallyimplemented competence
frameworks.
Testimonies
Letters from users, carers,
students or colleagues
Patient assessment
Peer assessment
Objective measurement of a
variety of effect and outcomes
Donyai, et al. 2010
Blank template for assessment of CPD cases

Notes:
RELEVANCE
Likelihood (L)
Consequence (C)
Rare
Unlikely
Possible
Likely
Almost certain
Catastrophic
Major
Moderate
Minor
Negligible
Linking consequence and likelihood to determine risk and therefore relevance of CPD to safe
practice:
GPhC Standards of Proficiency to which the current record relates:
Linking quality and benefit and strength of evidence to determine impact of CPD on practice:
Strength of
evidence (E)
Results

Negligible
Minor
Moderate
Major
Substantial
Behavior change
Learning
Reaction
Input
Increasing impact
Page 167
Increasing impact
IMPACT
Donyai, et al. 2010
Part B: Assess one of your own previously-submitted CPD

records using your new knowledge of the CPD Outcomes
Framework
7. Assess your already-submitted CPD record(s) in light of the CPD Outcomes Framework.
To help this process, please use a blank template for assessment of CPD cases (page
28 see also extra copies printed as loose sheets). Ask yourself what changes you
could make to your record(s) having worked through this tutorial.
8. New CPD Record 1: Select one your already-submitted CPD records and write it
again so that you match the record to the expectations outlined in the CPD Outcomes
Framework. You could create a new entry for this purpose. You are in effect being
asked to see if you can rewrite one of your CPD records previously submitted
to this project, in a way that might better match the expectations of the CPD
Outcomes Framework. Again, to help this process please use a blank template for
assessment of CPD cases (page 28). This activity will produce the first of the new
CPD entries we are asking you to submit by the end of February 2010. You can
select to rewrite any one of the following CPD records you have already submitted:
Date completed
(See How to use this pack and what to do next)

*Please note we were able to accept a maximum of 3 CPD records from each participant, so if
you submitted more than 3 records in phase one of the study, please note that we have accepted
only the first 3 records for inclusion in the study.
9. New CPD Record 2: Record a completely new CPD record after completing the steps
above. This may involve you in conducting a whole new CPD activity or you may
decide to create a new record based on an activity you have been conducting.
Again, this new CPD record should be matched as much as possible to the CPD
Outcomes Framework. Once more, to help this process please use a blank template
for assessment of CPD cases (page 28). This will form the second of the new CPD
entries we are asking you to submit by the end of February 2010.
10. Submit the two new CPD records to me by the end of February 2010 using one of
the options previously outlined (postal or electronic as before). If you find it easier,
you may wish to print and use the stamped-addressed envelope to send in the
records together with your statement of learning and agreement to confidentiality.
Page 168
The
CPD
for Revalidation in
Donyai,
et al. 2010
Pharmacy Study
The CPD Outcomes Framework: suggested case

study answers
This document is also available as an Adobe Acrobat file (.pdf), a series of 11 PowerPoint
presentations (.ppt) and a series of 11 video files (.avi) that can be played on a newer version of
Windows Media Player. Please work through these suggested answers to gain a better understanding
of how the CPD Outcomes Framework can be applied to example CPD cases.
Contents:
Community pharmacist: Case Study 1 (pages 2 3)
Junior pharmacist: Case Study 2 (pages 4 5)
Hospital pharmacy technician: Case study 3 (pages 6 7)
Production and quality assurance pharmacist: Case Study 4 (pages 8 9)
Pharmacovigilance pharmacist: Case Study 5 (pages 10 11)
Primary care pharmacist: Case Study 6 (pages 12 13)
Education and training pharmacist: Case Study 7 (pages 14 15)
Research pharmacist: Case study 8 (pages 16 17)
Locum pharmacist: Case study 9 (pages 18 19)
Pharmacist living overseas: Case study 10 (pages 20 21)
Community pharmacy technician: Case study 11 (pages 22 23)
Page 169
Donyai, et al. 2010
Community Pharmacist: Case Study 1

Simon is a 35-year old pharmacist living in Hampshire. He qualified in 1996 and has worked for a
number of independent community pharmacies before taking up his current post in a relatively quiet
store. Simon is anxious about his CPD and has been keen to read various articles in the Pharmaceutical
Journal to try and maintain his knowledge and learn about new developments relating to pharmacy.
Simon has also accessed distance learning packages and attended evening tutorials on a number of
occasions in the past. One evening, while looking through the Centre for Pharmacy Postgraduate
Education (CPPE) e-learning packages, Simon comes across a new package entitled Travel Health.
Although Simon has not had any difficulty answering patient and customer queries relating to travel
health in the past, he nonetheless decides to access the e-learning package and spends the time
completing the tutorial online. Afterwards, he reflects on his experience and considers the learning
package was more-or-less useful as it has probably helped him prepare better for questions relating to
the purification of water. The next day, Simon decides to make a CPD entry about his new learning.
Imagine Simon creates a CPD record the next day to document his new learning.

What would be the possible risk to Simons practice if he had not conducted this CPD?
STEP 1: Grading the consequence level in relation to Simons CPD:
Which consequence domain relates best to this CPD? We think that knowing about travel health is
related best to Domain 1: Impact on safety. In the absence of this particular CPD there could be a risk
to the safety of patients, staff or the public. How severe would such a risk be? Simon has not
experienced any difficulty answering queries relating to travel health in the past and later reflects the
CPD has probably helped him prepare better for questions relating to water purification. We think at
most the severity level for the risk posed by Simon not having conducted this CPD is moderate.
Negligible
Minor
Moderate
Major
Catastrophic
STEP 2: Grading the likelihood level in relation to the consequence

But what are the chances that a moderate consequence would occur if Simon hadnt completed this
particular CPD? Based on Simons statement, the likelihood of such an event occurring is quite
unlikely if not rare.
Descriptor
Rare
Unlikely
Possible
Likely
Almost certain
Frequency
This will probably

never happen/recur
Do not expect it to
happen/recur but it
is possible it may
do so
Might happen or
recur occasionally
Will probably
happen/recur but it
is not a persisting
issue
Will undoubtedly
happen/recur, and
possibly frequently
RELEVANCE
Likelihood (L)
Consequence (C)
Rare
Unlikely
Possible
Likely
Catastrophic
Major
Moderate
Minor
Negligible
Almost certain
Where is the point at which the consequence and likelihood grades meet? Is it an area shaded green
or red or somewhere in between? We think that a green square represents a CPD that is
significantly relevant to safe practice, while red represents one that is of low relevance.
Page 170
Donyai, et al. 2010
Case Study 1 continued

Can you identify one or more Standards of Proficiency relating to Simons CPD? We think that Simons
CPD can be related to the following Standards of Proficiency:
1.3 Keeps their professional knowledge and skills up-to-date
2.4.1 Promotes, evaluates and improves the health of individuals
2.5.1 Plans and implements personal development strategies to improve current and future
performance
To what extent has the CPD contributed to the quality or development of Simons practice and has
benefited patients and the public in the context of one of the Standards of Proficiency above? We think
that in the current situation, the learning has had no impact on improving the quality and benefit of
Simons practice. He has after all, prepared this CPD record the day after completing the online
learning package.
Negligible
Minor
Moderate
Major
Substantial

To what extent has Simon substantiated the impact of his CPD through evidence? Simon hasnt
completed the online assessment and doesnt have any formal evidence of his learning. He has
however reflected on the learning package and provided he writes a reflective statement about this
when completing his CPD record, Simon has provided evidence of reaction as his reflection on his
learning.
Evidence of input
Evidence of
reaction
Evidence of
learning
Evidence of
behaviour change
Evidence of results
practice
Where is the point at which the Quality and Benefit and Strength of Evidence grades meet? Is it an
area shaded green or red or somewhere in between? We think that a green square represents a
CPD that is shown to have impacted on safe practice, while red represents one that is not.
Strength of
evidence (E)
Results

Negligible
Minor
Moderate
Major
Substantial
Increasing impact
IMPACT
Behavior change
Learning
Reaction
Input
Increasing impact
Consider both the relevance and the impact of a CPD to derive an overall CPD rating. The final rating of
a CPD record is determined by both the relevance and impact grades. In this instance, there is an
orange grading for relevance and a red grading for impact. We recommend Simon attempts to
improve his CPDs rating in each of these domains to such an extent that at least one green or
yellow cell is achieved for each of relevance and impact scores and that no red rating is achieved. If
this is not achievable, we would advise Simon considers whether this particular CPD record is good
enough for inclusion in his revalidation portfolio.
Page 171
Donyai, et al. 2010

Shelley is a 23-year old pharmacist who completed her pre-registration training with a large
community pharmacy multiple in Devon last year. After passing her registration exam, Shelley
travelled for a few months and then applied for a junior pharmacist post at her local district general
hospital where she is currently based. Shelley started rotating through Medicines Information (MI) last
month, where she will remain for at least the next six months. She was finding the experience quite a
challenge as she felt she lacked the confidence to deal with some of the enquirers. While on her own
in the MI unit one lunchtime last month, she received a telephone call from a locum doctor expecting
her to outline the hospitals policy for the treatment of multiple sclerosis. Unable to answer and
rather flummoxed, Shelley tried to obtain the callers details but they hung up before she could do so.
Shelley discussed the incident with her manager who was quite understanding and recommended
Shelley reads up about multiple sclerosis in general and familiarises herself with the hospital
formulary for now. Shelleys partner suggested to her that she might also benefit from attending a
course on confidence building and communication skills to help her cope better with telephone
enquiries. Shelley didnt take kindly to the suggestion made by her partner but decided she would
take up her managers recommendations. To make a start on her learning, Shelley accessed two
articles on Multiple Sclerosis available via the new Clinical Pharmacist online pages at
www.pjonline.com. After she read the articles, Shelley answered the accompanying multiple-choice
questions (MCQs) via the online module. Her answers were subsequently marked by Clinical Pharmacist
and she received a certificate and her results by email two weeks after the module closed. Shelley
obtained a score of 80% in her online MCQ assessment. This in itself boosted Shelleys confidence and
since the incident last month Shelley now feels she is much better equipped to handle enquirers in her
MI rotation, even when she doesnt have all the answers to hand.

What would be the possible risk to Shelleys practice if she had not conducted this CPD?
STEP 1: Grading the consequence level in relation to Shelleys CPD:
Which consequence domain relates best to this CPD? We think that overall this CPD relates best to
Domain 2: Quality/complaints/audit. In the absence of this particular CPD there could be a risk to the
quality of the service provided. How severe would such a risk be? Shelley has already experienced
difficulty with handling telephone queries and later reflects the CPD has helped her feel more
confident when answering queries. We think that the severity level for the risk posed by Shelley not
having conducted this CPD could be moderate.
Negligible
Minor
Moderate
Major
Catastrophic

But what are the chances that a moderate consequence would occur if Shelley hadnt completed this
CPD? Based on Shelleys statement, the likelihood of such an event could be considered possible.
Descriptor
Rare
Unlikely
Possible
Likely
Almost certain
Frequency
This will probably

never
happen/recur
Do not expect it to
Might happen or
recur occasionally
Will probably
Will undoubtedly
happen/recur, and
possibly frequently
RELEVANCE
Likelihood (L)
Consequence (C)
Rare
Unlikely
Possible
Likely
Catastrophic
Major
Moderate
Minor
Negligible
Almost certain
Page 172
Donyai, et al. 2010

Can you identify one or more Standards of Proficiency relating to Shelleys CPD? We think that Shelleys
1.15.4 Learns from and reviews their working practices in the light of feedback, complaints or criticism.
2.5.1 Plans and implements personal development strategies to improve current and future performance
2.5.4 Creates, maintains and enhances working relationships with others in relation to the science of medicines
and their use, the practice of pharmacy and the provision of health care
To what extent has the CPD contributed to the quality or development of Shelleys practice and has
that in the current situation, the learning has had a moderate level of impact on improving the
quality and benefit of Shelleys practice. She has after all noted an improvement to her practice
through increased confidence.
Negligible
Minor
Moderate
Major
Substantial

To what extent has Shelley substantiated the impact of her CPD through evidence? Shelley doesnt
have any objective evidence of service improvement but she did complete the online test and does
have objective evidence of her learning. Shelley is able to provide evidence of learning as her MCQ
results and certificate.
Evidence of input
Evidence of
reaction
Evidence of
learning
Evidence of
behaviour change
Evidence of results
practice
Strength of
evidence (E)
Results
Behaviour change
Learning

Negligible
Minor
Moderate
Major
Substantial
Increasing impact
IMPACT
Reaction
Input
Increasing impact
a CPD record is determined by both the relevance and impact grades. In this instance, there is a
yellow grading for relevance and a yellow grading for impact. We consider Shelleys CPD rating is
likely to be good enough for the purpose of revalidation and would recommend that she includes this
record as part of her revalidation portfolio.
Page 173
Donyai, et al. 2010

Monica is a pharmacy technician who registered with the RPSGB last year. She has been working in the same
hospital pharmacy since she qualified 5 years ago. Monica enjoys her job but has been asked to take on a new
challenge, which she doesnt feel quite ready to tackle yet. She is to become involved in managing the use of
patients own drugs. As part of this new role, she will need to interact with patients admitted to one of the
general wards to take their drug histories soon after they arrive. Monicas manager recommends she attends an
in-house training session on patient drug history taking run by one of the clinical pharmacists. Monica also
decides to access the CPPE Pharmacy Technician Learning Programme on Patients, Medicines and the
Pharmacy Technician A Pharmacy Technician Guide to Medication Review which she reads in part without
completing fully. Some weeks later, Monica starts her new role rather reluctantly but then finds that she is able
to apply a lot of her learning to the patient interactions. She becomes interested in refining her communication
skills and later attends a Neuro-linguistic Programming (NLP) course at her local Borough. Months later,
Monicas manager praises her improved communication skills during her appraisal and recommends Monica for
a promotion. Monica decides to write her experience up as a CPD record.

What would be the possible risk to Monicas practice if she had not conducted this CPD?
STEP 1: Grading the consequence level in relation to Monicas CPD:
Domain 1: Impact on safety. In the absence of this particular CPD there could be a risk to the safety of
patients. How severe would such a risk be? Monica didnt feel ready to take on a more patient-facing
role and we think that poor communication with patients could have resulted in major consequences
on patient safety. We think that the severity level for the risk posed by Monica not having conducted
this CPD could be major.
Negligible
Minor
Moderate
Major
Catastrophic

But what are the chances that a major consequence would occur if Monica hadnt completed this
particular CPD? Based on Monicas situation, prior to the CPD the likelihood of such an event could
have been considered possible.
Descriptor
Rare
Unlikely
Possible
Likely
Almost certain
Frequency
This will probably

never happen/recur
Do not expect it to
happen/recur but it
is possible it may
do so
Might happen or
recur occasionally
Will probably
happen/recur but it
is not a persisting
issue
Will undoubtedly
happen/recur, and
possibly frequently
RELEVANCE
Likelihood (L)
Consequence (C)
Catastrophic
Rare
Unlikely
Possible
Likely
Major
Moderate
Minor
Negligible
Almost certain
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Donyai, et al. 2010

Can you identify one or more Standards of Proficiency relating to Monicas CPD? We think that Monicas
1.3.2 Ensures they are capable of working safely and effectively in their area of practice.
1.7.1 Communicates properly and effectively with patients, the public and others and ensures they
have sufficient language competence to do so.
performance.
To what extent has the CPD contributed to the quality or development of Monicas practice and has
that in the current situation, the learning has had a moderate level of impact on improving the
quality and benefit of Monicas practice. She has noted an improvement to her practice, which has
even been picked up at appraisal.
Negligible
Minor
Moderate
Major
Substantial

To what extent has Monica substantiated the impact of her CPD through evidence? Monica didnt
complete the CPPE learning but did attend an NLP course and does have evidence of behaviour change,
as documented in her appraisal. Monica is able to provide evidence of behaviour change as
documented in her appraisal.
Evidence of input
Evidence of
reaction
Evidence of
learning
Evidence of
behaviour change
Evidence of results
practice
Strength of
evidence (E)
Results

Negligible
Minor
Moderate
Major
Substantial
Increasing impact
IMPACT
Behaviour change
Learning
Reaction
Input
Increasing impact
yellow grading for relevance and a yellow grading for impact. We consider Monicas CPD rating is
good enough for the purpose of revalidation and would recommend that she includes this record as
part of her revalidation portfolio.
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Donyai, et al. 2010

John is a 43-year old pharmacist who has been working for the same medium-sized pharmaceutical
company for the past 15 years. The company is based in Hull and John has enjoyed working mainly in
production and quality assurance roles. Having completed a range of training, John became a member
of the Chartered Quality Institute (CQI) a year ago and would now like to work towards becoming a
Chartered member. He knows there is a requirement for Chartered members to plan, undertake and
keep records of CPD so he has been keeping informal records since joining the institute. Six months
ago John was promoted to the position of team leader and as a result took responsibility for
contributing towards managing his units budget which had been allowed to be exceeded two years
running. John decided to enrol on an online e-learning course with the CQI to help him contribute
towards the improved management of his unit and perhaps even help cut production costs. The
course was called The road to Lean Six Sigma and covered essentially a set of quality management
methods, including statistical ones, which John has tried to use to improve the quality of his units
outputs by identifying and removing the causes of defects (errors) and minimising variability in the
production processes. John has passed the Six Sigma course and obtained a completion certificate
from the CQI providers. At his appraisal, Johns line manager commended him on the level of
enthusiasm he had shown in his new role and also praised John for the contribution he had already
made to the increased efficiency of the unit.

What would be the possible risk to Johns practice if he had not conducted this CPD?
STEP 1: Grading the consequence level in relation to Johns CPD:
Domain 7: Finance including claims. In the absence of this particular CPD there could be a risk to the
financial situation of his unit. How severe would such a risk be? John doesnt give exact details but we
get the impression from the information provided that the existing problems have at least a
moderate consequences on the units finances. We think that the severity level for the risk posed by
John not having conducted this CPD could be moderate.
Negligible
Minor
Moderate
Major
Catastrophic

But what are the chances that a moderate consequence would occur if John hadnt completed this
particular CPD? Based on Johns description, prior to the CPD the likelihood of such an event could be
considered likely since the unit had already exceeded its budget two years running.
Descriptor
Rare
Unlikely
Possible
Likely
Almost certain
Frequency
This will probably

never happen/recur
Do not expect it to
happen/recur but it
is possible it may
do so
Might happen or
recur occasionally
Will probably
happen/recur but it
is not a persisting
issue
Will undoubtedly
happen/recur, and
possibly frequently
RELEVANCE
Likelihood (L)
Consequence (C)
Rare
Unlikely
Possible
Likely
Catastrophic
Major
Moderate
Minor
Negligible
Almost certain
Page 176
Donyai, et al. 2010

Can you identify one or more Standards of Proficiency relating to Johns CPD? We think that Johns CPD
can be related to the following Standards of Proficiency:
1.1.4 Satisfies themselves about the quality and appropriateness of the services they provide or are
responsible for.
1.3.1 Keeps their knowledge and skills up-to-date and relevant.
2.3.9 Plays an appropriate role in systems to oversee the supply of medicines and to provide products
and high quality services
To what extent has the CPD contributed to the quality or development of Johns practice and has
that in the current situation, the learning has had at least moderate level of impact on improving the
quality and benefit of Johns practice. He has noted an improvement to his practice, which has even
been picked up at appraisal.
Negligible
Minor
Moderate
Major
Substantial

To what extent has John substantiated the impact of his CPD through evidence? John completed the
CQI course and has a completion certificate as evidence of learning. John also has evidence of impact
of his behaviour change, as documented in his appraisal. The highest level of evidence John is able to
provide is evidence of behaviour change as documented in his appraisal.
Evidence of input
Evidence of
reaction
Evidence of
learning
Evidence of
behaviour change
Evidence of results
practice
Strength of
evidence (E)
Results

Negligible
Minor
Moderate
Major
Substantial
Increasing impact
IMPACT
Behaviour change
Learning
Reaction
Input
Increasing impact
yellow grading for relevance and a yellow grading for impact. We consider Johns CPD rating is
good enough for the purpose of revalidation and would recommend that he includes this record as
part of his revalidation portfolio.
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Donyai, et al. 2010

Khalid is 32 years old and works as lead pharmacovigilance pharmacist at a NHS trust in Greater
London. His job is varied and interesting and he finds he can work well with the team of clinical
pharmacists with whom he regularly liaises as part of his role. Khalid was asked by the local School of
Pharmacy whether he could accommodate a number of student projects. Khalid eagerly agreed to take
on these projects. He had wanted to conduct an audit of anticoagulant counselling within the Trust
since the release of the National Patient Safety Agency (NPSA) Patient Safety Alert No. 18 there has
been instances of readmissions to the hospital as a result of potentially preventable warfarin-related
morbidities and Khalid had wondered whether he should investigate the effectiveness of warfarin
counselling at discharge. He used the current opportunity to liaise with the wider healthcare team and
devised a 3-month audit of anticoagulant counselling in the clinical areas and the outpatient pharmacy
prior to patients discharge from the hospital. The audit revealed a number of problematic areas,
which Khalid noted needed to be rectified with some level of urgency. The students were able to
engage in the audit process and later wrote a number of e-mails expressing their gratitude to Khalid
for his involvement in their learning. In addition, Khalid produced a concise audit report from the
data generated, which he presented to the anticoagulant committee at their next monthly meeting.
The report was well received and a number of changes were agreed to be put in place. Although
Khalid had not become involved in the activity for CPD purposes, he was encouraged by his colleagues
to record the experience as a CPD record.

What would be the possible risk to Khalids practice if he had not conducted this CPD?
STEP 1: Grading the consequence level in relation to Khalids CPD:
Domain 1: Impact on safety. In the absence of this particular CPD there could be a risk to the safety of
patients. How severe would such a risk be? Khalid states there have been instances of readmission to
the hospital as a result of potentially preventable warfarin-related morbidities. He also states the audit
revealed a number of problematic areas that needed to be rectified with some level of urgency. The
existing problems seem to indicate at least major consequences on patient safety if not catastrophic.
We think that the severity level for the risk posed by John not having conducted this CPD could be
considered to be major.
Negligible
Minor
Moderate
Major
Catastrophic

But what are the chances that a major consequence would occur if Khalid hadnt completed this
particular CPD? Based on Khalids description, prior to the CPD the likelihood of such an event could
be considered likely since the unit had already experiences a number of warfarin-related
readmissions.
Descriptor
Rare
Unlikely
Possible
Likely
Almost certain
Frequency
This will probably

never happen/recur
Do not expect it to

occasionally
Will probably happen/recur

but it is not a persisting
issue
Will undoubtedly
happen/recur, and
possibly frequently
RELEVANCE
Likelihood (L)
Consequence (C)
Catastrophic
Rare
Unlikely
Possible
Likely
Major
Moderate
Minor
Negligible
Almost certain
Page 178
Donyai, et al. 2010

Can you identify one or more Standards of Proficiency relating to Khalids CPD? We think that Khalids
1.8.2 Shares their skills, knowledge and experience; contributes to the development and training of others.
2.5.2 Understands the need to play an active role in the pharmacy-based and multi-disciplinary systematic
monitoring and review of the quality of service provision and the implementation of service improvement
measures.
2.5.3 Engages with the education, training and mentoring of students, colleagues and healthcare professionals.
To what extent has the CPD contributed to the quality or development of Khalids practice and has
that in the current situation, the learning has had a major level of impact on improving the quality
and benefit of Khalids practice. He has produced a useful audit report that was well received by his
colleagues.
Negligible
Minor
Moderate
Major
Substantial

To what extent has Khalid substantiated the impact of his CPD through evidence? Khalid has received
e-mails of thanks from the students. In addition, Khalid produced an audit report that was well
received by his colleagues. The audit report as an outcome provides evidence at the learning stage.
The highest level of evidence Khalid is able to provide is evidence of behaviour change as
documented in the student e-mails.
Evidence of input
Evidence of
reaction
Evidence of
learning
Evidence of
behaviour change
Evidence of results
practice
Strength of
evidence (E)
Results

Negligible
Minor
Moderate
Major
Substantial
Behaviour change
Learning
Reaction
Input
Increasing impact
IMPACT
Increasing impact
green grading for relevance and a green grading for impact. We consider Khalids CPD rating is
definitely good enough for the purpose of revalidation and would recommend that he includes this
record as part of his revalidation portfolio.
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Donyai, et al. 2010

Farzana is 49 years old and relatively new in her role as community pharmacy facilitator at a Primary
care Trust in North Yorkshire. She has been asked to start attending the PCTs commissioning
meetings in order to sell community pharmacy services to the committee. She is expected to mainly
advocate the involvement of pharmacists in the new vascular risk assessments as this is a key part of
the Chief Pharmacists strategy for community pharmacy in the PCT. Farzana doesnt know how to
approach such a duty and decides to access one of the CPPE online learning courses entitled Vascular
risk focal point. She works through the programme and answers the associated MCQs, for which
she received a relatively high grade of 67%. She feels relatively confident that she has the knowledge
needed to answer any questions on how pharmacists can become involved in the vascular risk
assessments. However, at the meeting she is asked to provide data relating to the effectiveness of
community pharmacy public health services and specifically impact on patient outcomes. The
meeting leaves her feeling defeated and she hears later that pharmacy services would not be
considered in the first round of commissioning next month. Nonetheless, Farzana records her
learning and experience as a CPD entry.

What would be the possible risk to Farzanas practice if she had not conducted this CPD?
STEP 1: Grading the consequence level in relation to Farzanas CPD:
Domain 6: Business objectives / projects. In the absence of this particular CPD there could be a risk to
the Chief pharmacists business objectives in terms of getting community pharmacy recognised as a
viable option for the commissioning of vascular risk services. How severe would such a risk be?
Farzana is clearly unsure about how to approach her new role. The situation, i.e. the apparent key
contribution she will make here, seems to indicate at least major consequences on the business
objectives. We think that the severity level for the risk posed by Farzana not having conducted this
CPD could be considered to be major.
Negligible
Minor
Moderate
Major
Catastrophic

But what are the chances that such a major consequence would occur if Farzana hadnt completed this
particular CPD? Based on Farzanas description, prior to the CPD the likelihood of such an event could
be considered likely since pharmacy had not as yet been commissioned for the vascular risk checks.
Descriptor
Rare
Unlikely
Possible
Likely
Almost certain
Frequency
This will probably

never happen/recur
Do not expect it to

occasionally

issue
Will undoubtedly
happen/recur, and
possibly frequently
RELEVANCE
Likelihood (L)
Consequence (C)
Catastrophic
Rare
Unlikely
Possible
Likely
Major
Moderate
Minor
Negligible
Almost certain
Page 180
Donyai, et al. 2010

Can you identify one or more Standards of Proficiency relating to Farzanas CPD? We think that Farzanas
1.8.1 Works co-operatively with people from their own and other professions, sharing information
appropriately and utilising the knowledge, skills and expertise of others.
2.1.2 Advocates and supports policies and strategies that promote improved health
2.5.4 Creates, maintains and enhances working relationships with others in relation to the science of
medicines and their use, the practice of pharmacy and the provision of health care
To what extent has the CPD contributed to the quality or development of Farzanas practice and has
that in the current situation, the learning has had at most a minor level of impact on improving the
quality and benefit of Farzanas practice. She did build a good level of knowledge to give her
confidence in relation to her role and she has attended one meeting since her learning. However, it is
probably early stages yet in terms of a real impact on her practice.
Negligible
Minor
Moderate
Major
Substantial

To what extent has Farzana substantiated the impact of her CPD through evidence? Farzana did
complete a CPPE programme and does have evidence of learning in the form of an MCQ pass grade.
This is the highest level of evidence that Farzana is currently able to provide since she has not yet
hones her skills in this role.
Evidence of input
Evidence of
reaction
Evidence of
learning
Evidence of
behaviour change
Evidence of results
practice
Strength of
evidence (E)
Results
Behaviour change
Learning

Negligible
Minor
Moderate
Major
Substantial
Reaction
Input
Increasing impact
IMPACT
Increasing impact
green grading for relevance but orange for impact. We consider Farzanas CPD rating is not yet good
enough for the purpose of revalidation and would recommend that she waits longer before including
this CPD record for revalidation.
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Donyai, et al. 2010

Costas is 38 years old and works both as clinical lecturer in a new School of Pharmacy and as pre-registration
tutor in a large teaching hospital. Because of a permanent staff shortage issue, Costas has been asked to
become involved in the moderation of the fourth-year clinical pharmacy exam paper for the MPharm degree at
the School of Pharmacy, a job normally reserved for academic staff. Costas has no prior experience of either
devising or moderating formal University exam papers but is always happy to accept new challenges so he
decides to look into the process involved in more detail. Costas finds the University guidance on writing exam
papers and also attends a one-day workshop on effective assessment operated by the University library. When
the exam papers are generated Costas is unable to allocate enough time to conduct as thorough a review as he
had hoped so decides to make some general comments about issues relating to question style instead.
Nonetheless, having attended the University workshop on effective assessment Costas feels justified to write
the experience as a CPD entry.

What would be the possible risk to Costass practice if he had not conducted this CPD?
STEP 1: Grading the consequence level in relation to Costass CPD:
Which consequence domain relates best to this CPD? We think that overall this CPD relates best to Domain 2:
Quality/complaints/audit. In the absence of this particular CPD there could be a risk to the quality of the
Costass practice. How severe would such a risk be? Costas is clearly unsure about how to approach his new
responsibility. The situation seems to indicate at least minor consequences on the quality of Costas practice.
We think that the severity level for the risk posed by Costas not having conducted this CPD could be considered
to be minor.
Negligible
Minor
Moderate
Major
Catastrophic

But what are the chances that such a minor consequence would occur if Costas hadnt completed this
particular CPD? Based on Costass description, prior to the CPD the likelihood of such an event could
be considered likely since Costas had no prior knowledge of exams moderation and was about to
perform just such a task.
Descriptor
Rare
Unlikely
Possible
Likely
Almost certain
Frequency
This will probably

never happen/recur
Do not expect it to

occasionally

issue
Will undoubtedly
happen/recur, and
possibly frequently
RELEVANCE
Likelihood (L)
Consequence (C)
Rare
Unlikely
Possible
Likely
Catastrophic
Major
Moderate
Minor
Negligible
Almost certain
Page 182
Donyai, et al. 2010

Can you identify one or more Standards of Proficiency relating to Costass CPD? We think that Costass
responsible for.
1.4.1 Practises only in areas in which they have the necessary education, training, and skills.
2.5.3 Engages with the education, training and mentoring of students, colleagues and healthcare
professionals:
To what extent has the CPD contributed to the quality or development of Costass practice and has
quality and benefit of Costass practice. He did attend a one-day workshop and did indeed find some
guidance on writing exam papers but then failed to put the learning into practise due to issues of time
management. Perhaps given time, Costas could develop his learning and apply his new knowledge to
better effect. At the moment, there is no evidence of an increase in the quality of Costass practice
through this CPD.
Negligible
Minor
Moderate
Major
Substantial

To what extent has Costas substantiated the impact of his CPD through evidence? Costas did attend a
one-day workshop so has evidence of input; i.e. evidence of learning. However, there is no evidence of
reflection as yet so if Costas has a record of his course attendance, that is the highest level of evidence
he can currently provide.
Evidence of input
Evidence of
reaction
Evidence of
learning
Evidence of
behaviour change
Evidence of results
practice
Strength of
evidence (E)
Results

Negligible
Minor
Moderate
Major
Substantial
Behaviour change
Learning
Reaction
Input
Increasing impact
IMPACT
Increasing impact
a CPD record is determined by both the relevance and impact grades. In this instance, there is an
orange grading for relevance and a red grading for impact. We consider Costass CPD rating is not
yet good enough for the purpose of revalidation and recommend that he waits longer before including
this CPD record for revalidation.
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Donyai, et al. 2010

Tailen is a 24-year old postdoctoral research fellow at a prestigious academic institution. She is also a
pharmacist and is keen to complete relevant CPD records for the purpose of revalidation. Tailen has
been working on a funded project for the last two years examining the formulation of new anticancer
drugs via novel drug-delivery methods. Her contract is coming to a close in a years time and she has
been asked by her research mentor to start thinking about writing some of her results for publication
in peer-reviewed journals. Tailens project is funded by a start-up pharmaceutical company that is
expecting peer-reviewed publications to arise from the research, having already secured patents on the
main novel elements of the work. Although Tailen has been a published author in the past, most of
the papers were authored by her PhD supervisor so she has no direct experience of managing the
process of writing and submitting manuscripts for publication. She decides to visit target journal
websites and after reading the instructions to authors, selects one publication to target first. Although
she finds the process difficult to begin with, Tailen perseveres and after 8 months produces a
manuscript she can submit to her target journal. Although the paper is still undergoing the process of
peer-review and is not accepted by the journal, Tailen feel justified in writing her experience as a CPD
entry.

What would be the possible risk to Tailens practice if she had not conducted this CPD?
STEP 1: Grading the consequence level in relation to Tailens CPD:
Domain 6: Business objectives / projects. In the absence of this particular CPD there could be a risk to
the projects objectives in terms of meeting the sponsors expectations of published research. How
severe would such a risk be? Tailen is clearly unsure about how to approach the process of writing for
publication. The situation, i.e. the potential failure to prepare and submit relevant publications, seems
to indicate major consequences on the project objectives since key objectives will not be met. We
think that the severity level for the risk posed by Tailen not having conducted this CPD could be
considered to be major.
Negligible
Minor
Moderate
Major
Catastrophic

But what are the chances that such a major consequence would occur if Tailen hadnt completed this
particular CPD? Presumably Tailen is working for a principal investigator, who may have been able to
take on the manuscript preparation if Tailen has failed to take it on herself. Based on Tailens
description, prior to the CPD the likelihood of such an event could be considered possible since none
of the results are yet published.
Descriptor
Rare
Unlikely
Possible
Likely
Almost certain
Frequency
This will probably

never happen/recur
Do not expect it to

occasionally

issue
Will undoubtedly
happen/recur, and
possibly frequently
RELEVANCE
Likelihood (L)
Consequence (C)
Catastrophic
Rare
Unlikely
Possible
Likely
Major
Moderate
Minor
Negligible
Almost certain
Page 184
Donyai, et al. 2010

Can you identify one or more Standards of Proficiency relating to Tailens CPD? We think that Tailens
1.1.5 Conducts research and development with integrity and in accordance with relevant regulatory
provisions.
performance
To what extent has the CPD contributed to the quality or development of Tailens practice and has
that in the current situation, the learning has had a major level of impact on improving the quality
and benefit of Tailens practice. She did persevere and find out how to present her data and has
achieved the task of writing and submitting her manuscript for publication. In the context of Tailens
practice, there has been a real impact.
Negligible
Minor
Moderate
Major
Substantial

To what extent has Tailen substantiated the impact of her CPD through evidence? Tailen did produce
a manuscript and submit it for publication. Therefore, Tailen can be considered to have evidence of
learning.
Evidence of input
Evidence of
reaction
Evidence of
learning
Evidence of
behaviour change
Evidence of results
practice
Strength of
evidence (E)
Results
Behaviour change
Learning

Negligible
Minor
Moderate
Major
Substantial
Reaction
Input
Increasing impact
IMPACT
Increasing impact
yellow grading for relevance and a yellow grading for impact. We consider Tailens CPD rating is
good enough for the purpose of revalidation and would recommend that she includes this record as
part of her revalidation portfolio.
Page 185
Donyai, et al. 2010

Jane is a semi-retired pharmacist who now works only occasionally as a locum community pharmacist.
Jane took a break over the summer and returned to locum work after the implementation of the
Responsible Pharmacist regulations. Although Jane had tried to prepare for the changes by accessing
the RPSGB Responsible Pharmacist Toolkit, she felt ill-equipped to deal with all the new requirements
on her first day back, especially the requirement to check the pharmacy procedures on arrival. Feeling
rather unhappy about this new way of practice Jane wondered whether it would really be necessary to
check all the procedures every time she arrived at a new store. She consulted with some of her peers
who were equally unhappy about the changes at first but had managed to work these into their
routine after a few weeks. Jane decided to access the CPPE e-learning module on the Responsible
Pharmacist and worked through this over a number of evenings. She couldnt find a means of
formally assessing her learning via that module but did reflect on the usefulness of the course
afterwards. Jane also accessed the website of her professional indemnity insurer and found a number
of useful documents that clarified her understanding of the new regulations. Jane decided to write a
CPD record relating to her increased knowledge and understanding.

What would be the possible risk to Janes practice if she had not conducted this CPD?
STEP 1: Grading the consequence level in relation to Janes CPD:
Domain 4: Statutory duty/ inspections. In the absence of this particular CPD there could be a risk of
multiple breaches in statutory duty; since Jane is clearly thinking to forgo the procedural checks. How
severe would such a risk be? We think that the severity level for the risk posed by Jane not having
conducted this CPD could be considered to be major.
Negligible
Minor
Moderate
Major
Catastrophic

But what are the chances that such a major consequence would occur if Jane hadnt completed this
particular CPD? Based on Janes description, prior to the CPD the likelihood of such an event could be
considered likely since Jane is clearly thinking to forgo the legal requirement. .
Descriptor
Rare
Unlikely
Possible
Likely
Almost certain
Frequency
This will probably

never happen/recur
Do not expect it to

occasionally

issue
Will undoubtedly
happen/recur, and
possibly frequently
RELEVANCE
Likelihood (L)
Consequence (C)
Catastrophic
Rare
Unlikely
Possible
Likely
Major
Moderate
Minor
Negligible
Almost certain
Page 186
Donyai, et al. 2010

Can you identify one or more Standards of Proficiency relating to Janes CPD? We think that Janes CPD
responsible for.
1.3.3 Understands the laws, regulations and recognised best practice relevant to their work.
2.3.1 Acts as the responsible pharmacist.
To what extent has the CPD contributed to the quality or development of Janes practice and has
quality and benefit of Janes practice. Jane has tried to build a good level of knowledge in relation to
her learning, however, there is no reference to whether Jane has put her learning into practice as yet.
It is probably early stages yet in terms of a real impact on Janes practice. There is at most minor
impact.
Negligible
Minor
Moderate
Major
Substantial

To what extent has Jane substantiated the impact of her CPD through evidence? Jane did complete a
CPPE programme but does not have evidence of learning in the form of, for example, an MCQ pass
grade. Jane has reflected on the usefulness of the CPPE course so at present the highest level of
evidence that Jane is currently able to provide is that of evidence of reaction (reflection).
Evidence of input
Evidence of
reaction
Evidence of
learning
Evidence of
behaviour change
Evidence of results
practice
Strength of
evidence (E)
Results

Negligible
Minor
Moderate
Major
Substantial
Behaviour change
Learning
Reaction
Input
Increasing impact
IMPACT
Increasing impact
green grading for relevance but a red grading for impact. We consider Janes CPD is not yet ready
for the purpose of revalidation and would recommend that she collects evidence of impact for
revalidation purposes.
Page 187
Donyai, et al. 2010

Margaret is a young pharmacist who took up a two-year post with Voluntary Service Overseas (VSO).
She was posted to a small town in Tanzania to look after the pharmacy of the towns only hospital.
Margaret was unsure whether she could remain registered with the GPhC if not practising in the UK
but thought to keep her CPD records active for when she returns. Although she didnt envisage having
regular access to the internet, she had taken paper CPD templates for completion in Tanzania.
Margaret also took with her a copy of the Martindale, a print copy of the British Pharmacopoeia, the
British National Formulary and some clinical books and guidelines relevant to diseases encountered in
Tanzania. However, nothing could have prepared Margaret for some of the practices she came across
on arrival. For example, although some donated stock was available and being used, the local
pharmacy assistant who had been working at the hospital for over 15 years, had to regularly make
injectable products using archaic processes and equipment in very unhygienic conditions, out of sheer
necessity. Margaret made it her mission to try and tackle the health risks posed by such a practice and
spent one year of her VSO posting trying to collect sufficient funds for new equipment and
consumables. She travelled weekly to and from Dar es Salaam and e-mailed prospective donors and
charities for the funding. She eventually took delivery of a new autoclave and was also able to buy
some infusion bottles and closures as well as the raw ingredients needed. She was also able to pay for
some remedial work to the clean room, which improved its suitability to some extent. Margaret took
photos before and after the changes and decided to write her experience up as one of her CPD entries.

What would be the possible risk to Margarets practice if she had not conducted this CPD?
STEP 1: Grading the consequence level in relation to Janes CPD:
Domain 1: Impact on safety. In the absence of this particular CPD there would be a risk to patient
safety. How severe would such a risk be? Because of the nature of the problem, this risk is likely to be
catastrophic. There is clearly a risk of an incident leading to death, multiple permanent injuries or
irreversible health effects in a large number of patients. We think that the severity level for the risk
posed by Margaret not having conducted this CPD could be considered to be catastrophic.
Negligible
Minor
Moderate
Major
Catastrophic

But what are the chances that such a major consequence would occur if Margaret hadnt completed this
particular CPD? Based on Margarets description, prior to the CPD the likelihood of such an event
could be considered almost certain because of the poor standards of hygiene and equipment.
Descriptor
Rare
Unlikely
Possible
Likely
Almost certain
Frequency
This will probably

never happen/recur
Do not expect it to

occasionally

issue
Will undoubtedly
happen/recur, and
possibly frequently
RELEVANCE
Likelihood (L)
Consequence (C)
Rare
Unlikely
Possible
Likely
Catastrophic
Major
Moderate
Minor
Negligible
Almost certain
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Donyai, et al. 2010

Can you identify one or more Standards of Proficiency relating to Margarets CPD? We think that
Margarets CPD can be related to the following Standards of Proficiency:
1.1.6 Regularly reviews the work they undertake and services they provide or are responsible for to
improve quality and minimise risks to patient and public safety.
2.3.2 Develops and maintains quality systems.
2.3.3 Produces drug preparations and products.
To what extent has the CPD contributed to the quality or development of Margarets practice and has
that in the current situation, the learning has had at least a major level of impact on improving the
quality and benefit of Margarets practice. She has managed to obtain necessary equipment and
supplies and make some improvements to the setting of the clean room.
Negligible
Minor
Moderate
Major
Substantial

To what extent has Margaret substantiated the impact of her CPD through evidence? Margaret did
take photographs of her achievements this is evidence of learning. It is the highest level of
evidence that Margaret is currently able to provide since there is no reference to evidence of impact on
patient outcomes.
Evidence of input
Evidence of
reaction
Evidence of
learning
Evidence of
behaviour change
Evidence of results
practice
Strength of
evidence (E)
Results
Behaviour change
Learning

Negligible
Minor
Moderate
Major
Substantial
Reaction
Input
Increasing impact
IMPACT
Increasing impact
a CPD record is determined by both the relevance and impact grades. In this instance, there is a green
grading for relevance and a yellow grading for impact. We consider Margarets CPD rating is
definitely good enough for the purpose of revalidation and would recommend that she includes this
record as part of her revalidation portfolio when she returns to the UK.
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Donyai, et al. 2010

Ben is 48 and works as a pharmacy technician for a busy independent pharmacy. Since the
introduction of the Responsible Pharmacist regulations, he has become more actively involved in
ensuring the safe and effective supply of all pharmacy medicines. Bens line manager, the
owner/pharmacist, recently asked him to also become involved in revising the standard operating
procedure (SOP) for the sale of emergency hormonal contraception (EHC). The pharmacist is planning
a three-week break and would also like Ben to help make sure that all locum pharmacists providing
cover in those weeks are fully briefed on the pharmacys procedures. Ben accepts the challenge and
completes the first task of revising the SOP on EHC. He decides to record the experience as a new CPD
entry.

What would be the possible risk to Bens practice if he had not conducted this CPD?
STEP 1: Grading the consequence level in relation to Bens CPD:
Domain 4: Statutory duty/ inspections. In the absence of this particular CPD there could be a risk of
breaching statutory legislation in relation to the requirements to produce and maintain up-to-date
SOPs. How severe would such a risk be? Bens manager clearly feels that the SOP on EHC needs to be
updated so it seems that there is a risk in terms of a breach in statutory duty. The situation seems to
indicate moderate consequences in terms of statutory duty. We think that the severity level for the
risk posed by Ben not having conducted this CPD could be considered to be moderate.
Negligible
Minor
Moderate
Major
Catastrophic

But what are the chances that such a moderate consequence would occur if Ben hadnt completed this
particular CPD? Based on Bens description, we could hypothesise that if Ben had not revised the SOP
on EHC, the pharmacist may have done so himself. However, he may not have had time to do this
before his break, leaving the locum pharmacists with out-dated SOPs. Thus we could consider the
likelihood of such an event as possible since there is a possibility it would have occurred under
current circumstances.
Descriptor
Rare
Unlikely
Possible
Likely
Almost certain
Frequency
This will probably

never happen/recur
Do not expect it to
happen/recur but it
is possible it may do
so
Might happen or
recur occasionally
Will probably
happen/recur but it is not
a persisting issue
Will undoubtedly
happen/recur, and possibly
frequently
RELEVANCE
Likelihood (L)
Consequence (C)
Rare
Unlikely
Possible
Likely
Catastrophic
Major
Moderate
Minor
Negligible
Almost certain
Page 190
Donyai, et al. 2010

Can you identify one or more Standards of Proficiency relating to Bens CPD? We think that Bens CPD
2.3.2 Develops and maintains quality systems.
2.3.8 Engages with the management of staff and other resources within the workplace.
2.3.9 Plays an appropriate role in systems to oversee the supply of medicines and to provide products
and high quality services
To what extent has the CPD contributed to the quality or development of Bens practice and has
that in the current situation, the action has had at most a minor level of impact on improving the
quality and benefit of Bens practice. At this stage, Ben has revised just one SOP which has not yet
been shown to impact on the quality of patient care.
Negligible
Minor
Moderate
Major
Substantial

To what extent has Ben substantiated the impact of his CPD through evidence? Bens CPD is the
revision of an SOP therefore having successfully revised this document, Ben has evidence of learning
in the form of the SOP.
Evidence of input
Evidence of
reaction
Evidence of
learning
Evidence of
behaviour change
Evidence of results
practice
Strength of
evidence (E)
Results
Behaviour change
Learning

Negligible
Minor
Moderate
Major
Substantial
Reaction
Input
Increasing impact
IMPACT
Increasing impact
yellow grading for relevance and an orange grading for impact. We consider Bens CPD rating is
unlikely to be sufficient for the purpose of revalidation at this stage and would recommend he waits a
little longer or expands on his learning before include this record as part of his revalidation portfolio.
Page 191
Donyai, et al. 2010
Appendix 13
The printed material sent to the control group
Page 192
Donyai, et al. 2010

Dr Parastou Donyai
PGCERT LTHE, MRP HARMS
+44 ( 0)118 378 4704
The CPD for

Revalidation
in Pharmacy Study
Reading
School
of Pharmacy
Reading RG6 6AP
UK

phone +44 (0)118 378 4637

fax
+44 (0)118 378 4703
To pharmacists and pharmacy technicians

30 November 2009
Dear CPD-RPS study participant

We hope this letter finds you well. We received all CPD records from study participants last month and
are now contacting you with further instructions relating to the CPD-RPS project. Please accept my
apologies for contacting you later than scheduled.
We have reached the second phase of the study. This second phase will involve you in:
1. Reading two new General Pharmaceutical Council standards.
2. Submitting 2 further CPD records (1 completely new record and 1 re-written record after reading
the above pack).
Please find enclosed the pack containing the two new General Pharmaceutical Council standards;
Standards of Proficiency for Pharmacy Professionals and Continuing Professional Development
Standards and Framework. We envisage that reading through this material will take a maximum of three
hours.
As well as the GPhC standards, we have included a list of materials enclosed, an updated schedule for the
project, further information on what you are being asked to do and a statement of learning (to be returned
in the stamped-addressed envelope). Good luck, thank you and please dont hesitate to contact me if you
have any queries or comments to make about this stage of the study.
We are grateful for your continued support and commitment to the development of CPD for our
profession.
Yours sincerely
Dr Parastou Donyai
Dr Parastou Donyai
BPharm PGDPRM(Open)
Dr Angela Alexander
BPharm MSc
FRPharmS MCPP MBE
Co-investigator

(Hon)MRPharmS
Co-Investigator
Rebecca Z Herbert
BA MSc
Research Assistant

Dr Parastou Donyai, Lecturer, Pharmacy Practice, Reading School of Pharmacy, University of Reading, PO Box 226,
Whiteknights, Reading, Berkshire RG6 6AP
Tel: 0118 378 4704
Email: p.donyai@reading.ac.uk
Page 193
Donyai,for
et al.Revalidation
2010
The CPD
in
Pharmacy Study
List of materials enclosed in this envelope

We have enclosed seven documents in this envelope, listed below.
Please feel free to use this as a checklist to ensure you have accessed all the enclosed documents.
Cover letter
List of materials enclosed (this list)
What to do next
The GPhC Standards of Proficiency for Pharmacy Professionals
The GPhC Continuing Professional Development Standards and Framework
Statement of learning (and stamped-addressed envelope)
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Donyai,for
et al.Revalidation
2010
The CPD
in
Pharmacy Study
What to do next?
This is the second phase of the study. We are asking you to kindly:
1. Read the GPhC Standards of Proficiency for Pharmacy Professionals and the GPhC Continuing
Professional Development Standards and Framework enclosed.
2. Sign and return the statement of learning to indicate that you have read and understood the GPhC
standards (this will help us with our Quality Assurance processes).
3. Assess your already-submitted CPD record(s) in light of the two GPhC standards. Ask yourself
what changes you could make to your record(s) having read the new standards.
4. New CPD Record 1: Select one your already-submitted CPD records and write it again so that you
match the record to the two GPhC standards. You could create a new entry for this purpose. You
are in effect being asked to interpret the GPhC standards and see if you can rewrite one of
your CPD records previously submitted to this project, in a way that might better match the
expectations in the new standards. This activity will produce the first of the new CPD entries
we are asking you to submit by the end of February 2010. You can select to rewrite any one of the
following CPD records you have already submitted:
Date completed
*Please note we were able to accept a maximum of 3 CPD records from each participant, so if you
submitted more than 3 records in phase one of the study, please note that we have accepted only the first 3
records for inclusion in the study.
5. New CPD Record 2: Record a completely new CPD record after completing the steps above. This
may involve you in conducting a whole new CPD activity or you may decide to create a new
record based on an activity you have been conducting. Again, this new CPD record should be
matched as much as possible to the new standards. This will form the second of the new CPD
entries we are asking you to submit by the end of February 2010.
6. Submit the two new CPD records to me by the end of February 2010 using one of the options
previously outlined (postal or electronic as before). If you find it easier, you may wish to print and
use the stamped-addressed envelope to send in the records together with your statement of
learning.
Thank you for your continued support and commitment to the development of CPD for our
profession.
Page 195
Donyai,
et al.
2010
The CPD
for
Revalidation
in
Pharmacy Study

What are the new timelines involved?
All participants have now enrolled and submitted their initial CPD record (s). We are contacting you with
this letter to enclose a pack containing two new General Pharmaceutical Council standards. We would like
you to work through this material in the New Year. Of course, if you have the time, you could read the
material in December. We would like you to return the statement of learning to us in the stampedaddressed envelope once you have read the GPhC standards. We are then asking you to submit two new
CPD records to us by the end of February 2010. The focus-group interviews are optional and we will
plan for these to take place in March/April 2010. We will sum-up the CPD-RPS study through a debriefing
conversation with you either in private at the end of the focus-groups if you attend or on the phone in
March/April depending on progress. We will be able to provide you with feedback on the records you
have submitted at that final stage.
July
to
November December
Enrolment
Receipt of
instructions
namely, two new
General
Pharmaceutical
Council
standards
January/February March/April
Reading the GPhC
standards, and
submitting two
new CPD records
one rewritten
and one
conducted afresh.
Returning the
statement of
learning.
Optional focus
group interviews
Debriefing about
the study
including
feedback about
your CPD
records
CPD-RPS timeline: this table illustrates the main aspects of the study as relate to time
What are you expected to do as a participant in the CPD-RPS study?

In summary, we are now asking you:
To read the two new General Pharmaceutical Council standards. These are the GPhC Standards of
Proficiency for Pharmacy Professionals and the GPhC Continuing Professional Development
Standards and Framework; both enclosed with this letter.
To write and submit two new CPD records. This will involve you in:
o rewriting one of the CPD records you have already-submitted to us for this project;
o writing a new CPD record;
o submitting both records to me using one of the options (postal or electronic as before)
To return the signed statement of learning in the stamped-addressed envelope.
Please also read the document entitled What to do next for further details.
We will write to you again in February about the optional focus groups and the debriefing
conversations that are to take place at the close of the study.
Page 196
Donyai, et al. 2010

Pharmacy Study
Statement of learning
The two new General Pharmaceutical Council standards were sent to you in order that you read and
understand these before writing your two new CPD records (1 rewritten record and 1 completely new CPD
record).
With this statement, we are asking you to confirm that you have read and understood these GPhC standards
before submitting your two new CPD records.
I have read and understood GPhC Standards of Proficiency for Pharmacy Professionals
and the GPhC Continuing Professional
Development Standards and Framework.
If you have done the above, please sign this statement of learning and post it back to us in the stampedaddressed envelope provided in the pack.
Thank you. This will help us with our quality assurance processes.
Participant number:
Signed:
Date:
Page 197
Donyai, et al. 2010
Appendix 14
Template used for scoring the CPD entries
Page 198
Donyai, et al. 2010
Blank template for assessment of CPD cases

Notes:
RELEVANCE
Likelihood (L)
Consequence (C)
Rare
(1)
Unlikely
(2)
Possible
(3)
Likely
(4)
Almost certain
(5)
Catastrophic (5)
Major (4)
Moderate (3)
Minor (2)
Negligible (1)
Linking consequence and likelihood to determine risk and therefore relevance of CPD to safe
practice:
GPhC Standards of Proficiency to which the current record relates:
Linking quality and benefit and strength of evidence to determine impact of CPD on practice:
Strength of
evidence (E)
Results

Negligible
Minor
Moderate
Major
Substantial
Behavior change
Learning
Reaction
Input
Increasing impact
Page 199
Increasing impact
IMPACT
Donyai, et al. 2010
Appendix 15
Scoring by two pharmacist raters
All CPD records were anonymised, pooled and assessed independently by two of the
pharmacist investigators (PD and AMA) blinded to the study stage and intervention type (i.e.
no obvious information to relate entries to each other or to stage of study remained on the
copies assessed). The raters independently scored the entries against the CPD Outcomes
Framework (see Appendix 14 for a copy of the assessment template used in order to grade
the entries).
Initially, the two raters (labelled Pharmacist1 and Pharmacist 2 for the sake of the analyses)
independently scored a total of 56 CPD entries using the CPD Outcomes Framework to
generate values for each of the variables consequence (C) and likelihood (L), resulting in
the relevance (R) score (R = C x L), and quality and benefit (Qb) and strength of evidence
(E), resulting in the impact (I) score (I = Qb + E), for each entry. The product of R and I
scores resulted in the CPD score (CPD-S = R x I). The entries included a range of before and
after data from both control and intervention groups, although as explained, at the time of
scoring both raters were blind to this information.
Data were entered onto the software package SPSS and explored for a number of
relationships detailed below. From these analyses it was possible to demonstrate that in fact
consensus agreement was equal to averaging the score assigned by each pharmacist rater.
The final Pharmacist1 CPD scores and the Pharmacist2 CPD scores correlated with each other
(r = 0.563) and this correlation was found to be statistically significant (p<0.005). The exact
nature of the relationship between the Pharmacist1 CPD scores and the Pharmacist2 CPD
scores was demonstrated in the regression equation: Pharmacist1 CPD score = 12.219 +
(Pharmacist2 CPD scores x 0.765).
Although they correlated with each other, there was a statistically significant difference in
Pharmacist1 CPD scores vs. Pharmacist2 CPD scores. Using a paired samples t-test, it was
possible to test for the amount of variation between the Pharmacist1 CPD score and
Pharmacist2 CPD score (i.e. the difference between the means for each condition) compared
with the amount of variation within each condition (i.e. the standard deviation for each
condition). The effect size (d) was calculated using d = (Mean P1 - Mean P2) / Mean SD,
where Mean SD = (SD P1 + SD P2) / 2. This analysis revealed the difference between the
samples to be statistically significant (t(55) = 5.11, p<0.005, d = 0.664). Taken together with
an examination of the descriptive statistics, this analysis showed that Pharmacist1 CPD scores
were generally higher than CPD scores awarded by Pharmacist2.
Prior to the above analyses, the investigators (PD and AMA) met face-to-face to examine each
others ratings for each of the 56 CPD records. Because of apparent differences between the
first and the second pharmacists CPD scores, for the purpose of this study, a set of mutuallyagreed scores were generated in that meeting by a process of negotiation. Therefore, during
that face-to-face meeting each CPD entry and each of its individual ratings were considered
and discussed in detail before consensus was reached between the two pharmacist raters on
the value to be assigned to each of the variables of consequence, likelihood, quality and
benefit and strength of evidence for that entry. The final agreed CPD score was calculated
from the individually-agreed values. All cases were considered and agreement was reached
on all the cases without the need to resort to a third opinion.
From these data it was possible to demonstrate that in fact consensus agreement was equal to
averaging the score assigned by each pharmacist rater, as follows.
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Donyai, et al. 2010
Multiple linear regression was carried out using the Pharmacist1 CPD scores and the
Pharmacist2 CPD scores as independent predictors of the agreed CPD score:
= 0.499;
p<0.005 and
= 0.517; p<0.005; i.e. the correlation of Pharmacist1 CPD scores and
Pharmacist2 CPD scores with the agreed CPD score was also statistically significant to
p<0.005. The regression yielded a correlation coefficient r = 0.899; p<0.005 higher than
either of the Pharmacist scores alone. The regression equation for the agreed CPD scores was
calculated as agreed CPD score = 1.477 + (Pharmacist1 CPD score x 0.469) + (Pharmacist2
CPD score x 0.661).
Then a fourth set of data predicted agreed CPD score was generated using the above
equation. And finally a fifth dataset was generated by simply averaging the final Pharmacist1
and Pharmacist2 CPD scores. A correlation matrix for all the variables was produced.
The simple average score (fifth dataset) correlated highly both with the predicted agreed CPD
score (generated using the equation) (r = 0.996; p<0.005) and the actual agreed CPD score (r =
0.895; p<0.005). In fact, using simple linear regression again to predict the agreed CPD score
using the average CPD score, it was possible to calculate a regression equation as: agreed
CPD score = 0.297 + (1.093 x average score). With a slope of nearly one and an intercept near
to zero, meaning that for any given CPD the average score and the agreed CPD score would
be very similar.
Using a paired samples t-test, it was then possible to test for the amount of variation between
the two conditions average CPD score and the agreed CPD score. This analysis revealed the
difference between the samples to not be statistically significant (t(55) = 0.397, p=0.693, d =
0.026). Thus there was not a significant difference in average CPD scores vs. the agreed CPD
scores. Taken together with an examination of the descriptive statistics generated at the
time and the regression equation above, this analysis showed that the average CPD scores
were generally very similar to the CPD scores awarded by mutual agreement.
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Donyai, et al. 2010
Appendix 16
Information relating to the focus group interviews
Page 202
Donyai, et al. 2010
Programme for morning group: 10am to 1pm

10am to 10:15 pm Welcome and introduction
10:15 am to 11:00 am First discussion: our understanding of CPD
11:00 am to 11:20 pm break
11:20 am to 12:00 noon Second discussion: CPD Outcomes Framework
12:00 noon to 12:10 pm short break
12:10 pm to 12:40 pm Rating of CPD entries and feedback
12:40 pm to 1 pm What we hope to achieve with the study
1 pm Close of session
Programme for afternoon group: 2pm to 5pm

2pm to 2:15 pm Welcome and introduction
2:15 am to 3:00 pm First discussion: our understanding of CPD
3:00 pm to 3:20 pm break
3:20 pm to 3:50 pm Second discussion: experiences with the study
3:50 pm to 4:00 pm short break
4:00 pm to 4:20 pm Introduction of the CPD Outcomes Framework
4:20 pm to 4:40 pm Rating of CPD entries and feedback
4:40 pm to 5 pm What we hope to achieve with the study
5 pm Close of session
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Donyai, et al. 2010

Dr Parastou Donyai
PGCERT LTHE, MRP HARMS
+44 ( 0)118 378 4704
The CPD for

Revalidation
in Pharmacy Study
Reading
School
of Pharmacy
Reading RG6 6AP
UK

phone +44 (0)118 378 4637

fax
+44 (0)118 378 4703
To pharmacist and pharmacy technicians

19th March 2010
Dear colleague
As promised I am writing to confirm arrangements for the focus-group interview taking place on Saturday
27th March 2010 at the University of Reading, to which you have been invited. The meeting will start at
10am and will come to a close by 1pm. It will be attended by around 6 other study participants, myself
and my colleague Rebecca working on the study. We will be providing participants with refreshments and
a light sandwich snack. Please do let me know of any dietary requirements in advance.
The purpose of the meeting is to seek your views about the study, learn more about your experiences of
CPD in general and to discuss the purpose of the study with you in more detail. As part of this work, we
are also hoping to work through a small number of hypothetical CPD cases to gain your views and ratings
of these entries. We will analyse the focus-group interviews to identify themes in relation to participants
understanding and experiences of participating in the CPD-RPS project. We also hope to be able to use
your ratings of the entries to help validate the CPD Outcomes Framework. In addition, we will strive to
provide you with feedback, in confidence, about your own CPD entries as submitted for the purpose of the
study, against the framework devised.
We are providing participants with a 200 fee to cover the cost of locum expenses, etc to facilitate
attendance. We are also able to fund reasonable travel costs to the University of Reading. Both claims can
be made on a claim form that I will supply on the day. However, please note that with the introduction of
new regulations, we are not permitted to process the completed claim forms without making photocopies
of original documents that verify claimants right to work in the UK. The University has a blanket
requirement to fulfil certain duties in respect of monitoring, reporting and record keeping. This means that
in order for me to pass the completed claim forms for processing I must be presented with certain
documents, check them, take copies, sign, date and retain until the claim is processed. I have enclosed the
full guidance with the e-mail accompanying this letter, but in summary the University asks to keep a copy
of claimants passport and NI number from original documents. I apologise for the inconvenience this will
present but am grateful for your understanding.
The meeting will take place in the Pharmacy Practice Laboratory, University of Reading, Whiteknights
Campus, Reading, RG6 6UR. The following URL provides a link to maps and travel directions:
http://www.reading.ac.uk/about/find/about-findmap.aspx
You can enter the Whiteknights Campus by either the Pepper Lane gate or the Shinfield Road gate. Please
do not use the Earley gate entrance. Once on campus you will need to find your way to the Food
Bioscience Building (number 47 on the map). A parking permit will not be required on a Saturday. The
nearest car park is P10. The entrance to the Food Bioscience building (adjacent to the Chemistry &
Pharmacy Building) is down a small flight of steps. Because the meeting is being held at a weekend the
main external door may be locked; if that is the case please wait as we will be periodically allowing access.
Once in the Food Bioscience building, you will then have to walk up a flight of steps - the Pharmacy
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Donyai, et al. 2010
Practice Laboratory is through a set of double doors and on the right. I will make sure I place adequate
signs on various locations in the building on the day to act as a guide.
Yours sincerely
Dr Parastou Donyai, on behalf of the research team:
Dr Parastou Donyai
BPharm PGDPRM(Open)
Dr Angela Alexander
BPharm MSc
FRPharmS MCPP MBE
Co-investigator

(Hon)MRPharmS
Co-Investigator
Rebecca Z Herbert
BA MSc
Research Assistant

Dr Parastou Donyai, Lecturer, Pharmacy Practice, Reading School of Pharmacy, University of Reading, PO Box 226,
Whiteknights, Reading, Berkshire RG6 6AP
Tel: 0118 378 4704 Email: p.donyai@reading.ac.uk
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Donyai, et al. 2010
Focus group interview guidelines for discussion: CPD Outcomes

Framework (intervention)
Theory
Question how to phrase and what is our aim

To gain understanding in relation to peoples own meanings
and interpretation of the events: to find out why
CPD is driven either internally as a
What did you think of the CPD Standards and Framework?
response to own developmental
Do you think its possible to use the CPD Standards and
needs vs. externally as a response to Framework in any useful way?
others requirements/inducement
Did it make you think differently about the type of CPD you
should pursue?
Why?
Could you explain your understanding some more?
CPD is carried out either through
What did you think of the Standards of Proficiency?
continuing education-type activities Did you try to relate your CPD entries to the Standards of
that involve completion of standProficiency?
alone learning or carried out by
How did you find the task of finding GPhC Standards of
integrating learning and practice.
Proficiency to suit your entries?
Did it make you think differently about the type of CPD you
should write up?
Why?
CPD that is carried out as CE
How did you feel about being asked to complete a new
exercise can take any period of time CPD entry this year?
to complete but CPD that involves Do you think it was possible to follow the CPD Standards and
practice cannot be completed in a
Framework completely if you were going to start a new CPD
short period of time.
in January/February?
Why?
CPD can be written as either as a
Were the CPD and Proficiency Standards helpful in re-writing a
hypothesised statement of impact
CPD?
in relation to the future or can be
Could you use the standards to help write a new CPD entry?
written once impact on actual
Did you find it helpful?
practice has been solidly
demonstrated.
CPD can be constructed through
Is it possible to use Plan & Record in conjunction with the
language used in completing the
CPD Standards and Framework?
entries or it can be evidenced
And the Proficiency Standards?
through additional documentation
Did you relate CPD to revalidation on purpose in your second
or it needs both.
set of CPD constructions?
CPD and revalidation
Do you feel that you eventually benefited from taking part
in the study?
Which parts did they understand and agree with?
Which parts did they not understand or disagree with?
What do participants think of the CPD and proficiency
standards as a way of helping prove fitness-to-practise?
Is there difference between your previous understanding and
your present understanding of a good CPD?
Would you use the material again?
Would you recommend them to others?
How do you think other pharmacy professionals might find
the use of these standards?
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Donyai, et al. 2010
Focus group interview guidelines for discussion: our

understanding of CPD (control)
Theory
CPD is driven either internally as a

response to own developmental
needs vs. externally as a response to
others requirements/inducement
CPD is carried out either through

continuing education-type activities
that involve completion of standalone learning or carried out by
integrating learning and practice.
CPD that is carried out as CE

exercise can take any period of time
to complete but CPD that involves
practice cannot be completed in a
short period of time.
CPD can be written as either as a
hypothesised statement of impact
in relation to the future or can be
written once impact on actual
practice has been solidly
demonstrated.
CPD can be valuable either to the

individual or to others.
CPD can be constructed through
language used in completing the
entries or it can be evidenced
through additional documentation
or it needs both.
Question how to phrase and what is our aim

To gain understanding in relation to peoples own meanings
and interpretation of the events: to find out why
If you cast your mind to the various CPD entries you have
completed, could we start off in quite a general way by
talking about why you would have made those entries?
What were your reasons for writing the activity as a CPD
entry?
What prompts you to make a CPD entry?
What makes it to the plan & record website?
What doesnt?
How do you decide on what should become a new CPD
entry? What are your main concerns?
Obviously, we are all involved in busy jobs and various outside
interests, what sorts of things from your life would make it to
(be worthy of!!) a CPD entry?
What sort of things wouldnt make it to the CPD entry?
Why?
Are you satisfied with the approach that you take when
you decide what should become your CPD?
Is there anything you would want to change?
Do you favour CPD activities that can be conducted away
from your everyday practice or do you involve your
practice in your CPD activity?
To what extend does your practice become involved in your
CPD activity when you are conducting it?
Do you think its possible to conduct CPD away from your
practice?
Why?
How long can a CPD take to complete?
What type of CPD takes longer to complete?
What is quicker?
To what extent does CPD feed back into practice before you
write it up as an entry?
Do you wait until you have applied your learning in practice,
before completing a CPD entry or can learning alone be
written as a CPD entry? (i.e. is it valid to assume future
impact?)
Why?
Can you explain your understanding some more?
Who should benefit from your CPD?
Why?
Do you think it is possible to demonstrate your Continuing
Professional Development by completing a standard CPD
entry?
Why?
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Appendix 17
Information relating to the telephone interviews
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Telephone interviews Intervention:

Participant number:
Group: Intervention / Control
Area of practice: Community / Hospital / Other
CPD expertise: Practised / Novice
What did you think of the Relevance scoring?
Do you think its possible to use a risk matrix in this way?
How did you find the task of finding a Domain?
Did it make you think differently about the type of CPD you should
pursue?
Why? Could you explain your understanding some more?
What did you think of the Impact scoring?
Do you think its possible to use a matrix such as this to look at
impact?
How did you find the task of finding GPhC Standards of Proficiency
to suit your entries?
write up?
How did you feel about being asked to complete a new CPD
entry this year?
Do you think it was possible to follow the CPD Outcomes
Framework completely if you were going to start a new CPD in
January/February? HOW DID YOU CHOOSE WHICH TO REWRITE?
HOW DID YOU CHOOSE WHICH NEW ENTRY TO SUBMIT?
Was the CPD Outcomes Framework helpful in re-writing a CPD?
Could you use the CPD Outcomes Framework to help write a new
CPD entry?
Is it possible to use Plan & Record in conjunction with the CPD
Outcomes Framework?
Did you relate CPD to revalidation on purpose in your second set of
CPD construction?
Do you feel that you eventually benefited from taking part in the
study?
What do participants think of the CPD Outcomes Framework as a
way of helping prove fitness-to-practise?
Is there difference between your previous understanding and your
present understanding of a good CPD?
Would you use it again?
Would you recommend it to others?
How do you think other pharmacy professionals might find the CPD
Outcomes Framework?
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Telephone interviews Control:

Participant number:
Group: Intervention / Control
Area of practice: Community / Hospital / Other
CPD expertise: Practised / Novice
What did you think of the CPD Standards and Framework?
Do you think its possible to use the CPD Standards and Framework
in any useful way?
pursue?
Why?Could you explain your understanding some more?
What did you think of the Standards of Proficiency?
Did you try to relate your CPD entries to the Standards of
Proficiency?
How did you find the task of finding GPhC Standards of Proficiency
to suit your entries?
write up?
Why?Could you explain your understanding some more?
How did you feel about being asked to complete a new CPD
entry this year?
Do you think it was possible to follow the CPD Outcomes
Framework completely if you were going to start a new CPD in
January/February? HOW DID YOU CHOOSE WHICH TO REWRITE?
HOW DID YOU CHOOSE WHICH NEW ENTRY TO SUBMIT?
Were the CPD and Proficiency Standards helpful in re-writing a
CPD?
Could you use the standards to help write a new CPD entry?
Is it possible to use Plan & Record in conjunction with the CPD
Standards and Framework?
And the Proficiency Standards?
Did you relate CPD to revalidation on purpose in your second set of
CPD constructions?
Do you feel that you eventually benefited from taking part in the
study?
What do participants think of the CPD and proficiency standards as a
way of helping prove fitness-to-practise?
Is there difference between your previous understanding and your
present understanding of a good CPD?
Would you use the material again?
Would you recommend them to others?
How do you think other pharmacy professionals might find the use of
these standards?
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Grid used for feedback during phone interviews

Before entry
Relevance
Impact
Overall
Before entry
Relevance
Impact
Overall
Before entry rewritten
Relevance
Impact
Overall
Rewritten entry
Relevance
Impact
Overall
New entry
Relevance
Impact
Overall
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Appendix 18
Exploring the data using quantitative analyses
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Checking for normality in the different groups

The final CPD scores for the different groups were subjected to tests for normality using the
Kolmogorov-Smirnov and the Shapiro-Wilk tests. A summary is provided below:
Final CPD
Scores
Zskewness
Zkurtosis
Control
0.693 / 0.224 =
3.09
0.694 / 0.231 =
3.004
0.732 / 0.312 =
2.35
0.654 / 0.246 =
2.66
-0.007 / 0.444 =
0.016
0.235 / 0.459 =
0.51
0.391/ 0.422 =
0.93
0.631 / 0.488 =
1.29
Intervention
Before
After
KolmogorovSmirnov
D(117) = 0.172,
p < 0.0001.
D(109) = 0.162,
p < 0.0001.
D(130) = 0.153,
p < 0.0001.
D(96) = 0.136,
p < 0.0001.
Shapiro-Wilk
W(117) = 0.952,
p < 0.0001.
W(109) = 0.958,
p < 0.005.
W(130) = 0.945,
p < 0.0001.
W(96) = 0.970,
p < 0.05.
Exploring the data using non-parametric analyses

Initially, data for 96 CPD entries written before and rewritten after the educational
intervention were transferred to SPSS and explored using non-parametric tests for analyses of
differences. The educational intervention was either a control (C; Proficiency and CPD
Standards) or the intervention (I; Proficiency and CPD Standards as well as CPD Outcomes
Framework training).
As part of these exploratory analyses, the Wilcoxon signed-rank test was applied. In
summary the results can be reported as follows. For the Intervention group, CPD scores were
significantly higher in the After stage (Mdn = 9.0) than in the Before stage (Mdn = -15.0), z =
-3.979, p<0.0001, r = -0.83. However, for the Control group, there was no statistically
significant difference between CPD scores in the After stage (Mdn = -1.5) than in the Before
stage (Mdn = -4.5), z = -1.339, p=0.181, r = -0.27.
The ranks are illustrated in the table below as the number of negative ranks (number of
people for whom Before results were greater than After results) and the number of positive
ranks (number of people for whom After scores were greater than the Before scores). For
the Control group, for 10 people Before scores were greater than After scores, for 13
people, After scores were greater than Before scores and there were two tied ranks (i.e.
participants who scored the same at Before and After stages). Conversely, for the
Intervention group, for 2 people the Before scores were greater than the After scores, for
20 people, the After scores were greater than the Before scores and that there was one
tied rank (i.e. participant who scored the same at the Before and After stages).
Ranks
N
Mean Rank
Sum of Ranks
AfterControl -
Negative Ranks
10(a)
9.40
94.00
BeforeControl
Positive Ranks
13(b)
14.00
182.00
Ties
2(c)
Total
25
AfterIntervention -
Negative Ranks
2(d)
2.00
4.00
BeforeIntervention
Positive Ranks
20(e)
12.45
249.00
Ties
1(f)
Total
23
a AfterControl < BeforeControl; b AfterControl > BeforeControl; c AfterControl = BeforeControl; d AfterIntervention <
BeforeIntervention; e AfterIntervention > BeforeIntervention; f AfterIntervention = BeforeIntervention
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Donyai, et al. 2010
The table below shows the test statistic based on the negative ranks; for the Control group
the z-score is -1.339 (p=0.181) and for the Intervention group the z-score is -3.979 (p<0.0001).
It can be concluded that with the Intervention group there was a statistically significant
increase in CPD scores from Before to After (z = -3.979, p<0.0001) but that the increase in
the Control group was not statistically significant.
Test Statistics(b,c)
AfterInterventi
on AfterControl -
BeforeInterve
BeforeControl
ntion
Z
Asymp. Sig. (2-tailed)
Monte Carlo Sig. (2-
Sig.
tailed)
99% Confidence
Lower Bound
Interval
Upper Bound
-1.339(a)
-3.979(a)
.181
.000
.194
.000
.184
.000
.205
.000
.098
.000
Monte Carlo Sig. (1-
Sig.
tailed)
99% Confidence
Lower Bound
.090
.000
Interval
Upper Bound
.106
.000
a Based on negative ranks.

b Wilcoxon Signed Ranks Test
c Based on 10000 sampled tables with starting seed 2000000.
The effect sizes for these results can be calculated as follows:

r Control = - 1.339 /
25 = -0.27
rintervention = -3.979 /
23 = -0.83
This represents a large change in CPD scores with the Intervention group (as it is above 0.5, a
benchmark set by Cohen). The effect size with the Control group was not statistically
significant and was small (below 0.3, a benchmark set by Cohen).
A further exploratory analysis was carried out on all of the CPD entries (226) submitted by
the 48 study participants both before and after the intervention. The dependent variable was
the final CPD score (an average of Pharmacist1 and Pharmacist2 CPD scores). The
independent factors were educational intervention (control vs. intervention) and stage of
study (before vs. after). The Kruskal-Wallis test was applied and the following table was
produced to illustrate the ranks:
Ranks
Grouped according to
Intervention and Stage
FinalCPDScore
Mean Rank
ControlBefore
67
114.29
ControlAfter
50
128.94
InterventionBefore
63
84.71
InterventionAfter
46
135.00
Total
226
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Donyai, et al. 2010
The table for the test statistic is shown below. The test statistic, H, for the Krustal-Wallis test
(shown as chi-square) together with its significance are shown. It shows that there is a
statistically significant difference in the groups (but does not show where the difference is).
Test Statistics(b,c)
FinalCPDScore
Chi-Square
20.029
df
Asymp. Sig.
.000
Monte Carlo
Sig.
Sig.
99% Confidence
Lower Bound
.000(a)
.000
Interval
Upper Bound
.000
a Based on 10000 sampled tables with starting seed 1502173562.

b Kruskal Wallis Test
c Grouping Variable: Grouped according to Intervention and Stage
It was then also possible to conduct post-hoc tests to check for differences in the groups. Here
a Bonferroni correction is made post-hoc so that instead of using 0.05 as the critical value for
significance for each test, the critical value of 0.05 divided by the total number of tests is
used instead. In this instance the Mann-Whitney test was used to test for two differences as
follows:
Test 1: Control/before compared to control/after
Test 2: Intervention/before compared to intervention/after
Hence, the critical value was equal to 0.05/2 = 0.025.
For the Control group, the Mann-Whitney test returns the following ranks and statistics:
Ranks
Control
CPDScoreControl
Mean Rank
Sum of Ranks
Before
67
55.32
3706.50
After
50
63.93
3196.50
Total
117
Test Statistics(a)
CPDScoreControl
Mann-Whitney U
1428.500
Wilcoxon W
3706.500
-1.361
.173
a Grouping Variable: Control

Descriptive Statistics
N
CPDScoreControl
Mean
117
-.1111
Std. Deviation
15.46856
Minimum
-28.00
Maximum
42.00
For the Control group, the Kolmogorov-Smirnov test returns the following ranks and
statistics.
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Donyai, et al. 2010
Frequencies
Control
CPDScoreControl
Before
67
After
50
Total
117
Test Statistics(a)
CPDScoreControl
Most Extreme
Absolute
.196
Differences
Positive
.196
Negative
-.060
Kolmogorov-Smirnov Z
1.049
.221
a Grouping Variable: Control
Using the Mann-Whitney U test, the effect size can be calculated as follows: r = -1.361 / 117
= -0.126. The effect size with the Control group was not statistically significant (p=0.173) and
was small (below 0.3, a benchmark set by Cohen). It can be concluded that CPD scores after
the Control educational intervention (Mdn = 0) did not differ significantly from CPD scores
before the control as intervention (Mdn = -4.5) , U = 1428.5, z = -1.361, p = 0.173, r = -0.126.
For the Intervention group, the Mann-Whitney test returns the following ranks and statistics:
Ranks
Intervention
CPDScoreIntervention
Mean Rank
Sum of Ranks
Before
63
45.64
2875.50
After
46
67.82
3119.50
Total
109
Test Statistics(a)
Mann-Whitney U
859.500
Wilcoxon W
2875.500
-3.619
.000
a Grouping Variable: InterventionBandA

Descriptive Statistics
N
Mean
109
-2.4404
Std. Deviation
21.40004
Minimum
-45.50
Maximum
62.00
For the Intervention group, the Kolmogorov-Smirnov test returns the following ranks and
statistics.
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Donyai, et al. 2010
Frequencies
Intervention
Before
N
63
After
46
Total
109
Test Statistics(a)
Most Extreme
Absolute
Differences
Positive
Negative
Kolmogorov-Smirnov Z
.398
.398
.000
2.053
.000
a Grouping Variable: InterventionBandA
Using the Mann-Whitney U test, the effect size can be calculated as follows: r = -3.619 / 109
= -0.347. The effect size with the Intervention group was statistically significant (p<0.0001)
and was medium (between 0.3-0.5, a benchmark set by Cohen). It can be concluded that CPD
scores after the Intervention as educational intervention (Mdn = 0) did differ significantly
from CPD scores before the educational intervention (Mdn = -12), U = 859.5, z = -3.619, p
<0.0001, r = -0.347.
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Appendix 19
Quantitative analyses: confirming the experimental effect
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Donyai, et al. 2010
Quantitative analyses of the CPD scores using linear regression modelling:

Linear regression modelling was used in order to conduct confirmatory analyses of the data.
The Reading Statistical Services Centre was formally consulted and an expert statistician
confirmed the validity of the analyses applied.
PART A: Rewritten entries
A linear model (linear regression model) was used to compare the intervention groups
(control vs. educational intervention) in terms of CPD score adjusting for work setting and a
linear effect of baseline (i.e. inputting before CPD scores as a covariate, and work setting as
an independent variable in an analysis of covariance ANCOVA). SPSS version 17 was used
with the UNIANOVA command. The assumptions the linear models were checked via an
analysis of residuals. No major problems were identified.
Adjusting for baseline and work setting, the intervention effect was estimated to be a mean
difference of 17.3 (95% CI = 5.6 to 28.9). This effect is statistically significant (p-value =
0.0048).
Table showing raw means and adjusted means:
Raw mean
Control
0.2143
Intervention 14.2941
Adjusted mean
-0.460
16.818
The SPSS output is shown below.

Univariate Analysis of Variance SPSS output
Between-Subjects Factors
Value Label
Work setting of pharmacist
'Treatment' group
Community
24
Hospital
14
1.00
Control
21
2.00
Intervention
17
Tests of Between-Subjects Effects

Dependent Variable:After
Source
Type III Sum of

Squares
df
Mean Square
Sig.
1504.461
5.416
.004
3930.084
3930.084
14.147
.001
246.458
246.458
.887
.353
Before
1525.248
1525.248
5.490
.025
Intervention
2528.002
2528.002
9.100
.005
Error
9445.362
34
277.805
Total
15570.750
38
Corrected Total
13958.743
37
Corrected Model
Intercept
WorkSetting
4513.382
a. R Squared = .323 (Adjusted R Squared = .264)

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Donyai, et al. 2010
Parameter Estimates
Parameter
95% Confidence Interval

B
Std. Error
Sig.
Lower Bound
Upper Bound
Intercept
22.996
5.296
4.342
.0001
12.234
33.758
[WorkSetting=1]
-5.751
6.105
-.942
.3529
-18.158
6.657
[WorkSetting=2]
.423
.180
2.343
.0251
.056
.789
[Intervention=1.00]
-17.278
5.728
-3.017
.0048
-28.918
-5.638
[Intervention=2.00]
Before
a. This parameter is set to zero because it is redundant.
Estimated Marginal Means

'Treatment' group
Estimates
'Treatment' group

Mean
Control
-.460
dimensi on1
Intervention
Std. Error
Lower Bound
Upper Bound
3.912
-8.409
7.490
4.124
8.436
25.200
16.818
a. Covariates appearing in the model are evaluated at the following values: Before = 7.8158.
Pairwise Comparisons
(I) 'Treatment' group (J) 'Treatment' group
Mean
95% Confidence Interval for
Difference (I-
Difference
J)
Control
dimensi on2
Intervention
Intervention
dimensi on2
Control
Lower Bound
Upper Bound
5.728
.005
-28.918
-5.638
5.728
.005
5.638
28.918
-17.278
dimensi on1
Sig.a
Std. Error
17.278
Based on estimated marginal means

*. The mean difference is significant at the .05 level.
a. Adjustment for multiple comparisons: Least Significant Difference (equivalent to no adjustments).
Univariate Tests
Sum of Squares
df
Mean Square
Contrast
2528.002
2528.002
Error
9445.362
34
277.805
Sig.
9.100
.005
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Donyai, et al. 2010
Univariate Tests
Sum of Squares
df
Mean Square
Contrast
2528.002
2528.002
Error
9445.362
34
277.805
Sig.
9.100
.005
The F tests the effect of 'Treatment' group. This test is based on the linearly independent
pairwise comparisons among the estimated marginal means.
Boxplot
Case Processing Summary
'Treatment' group
Cases
Valid
N
Before
Missing
Percent
Total
Percent
Percent
Control
21
100.0%
.0%
21
100.0%
Intervention
17
100.0%
.0%
17
100.0%
dimensi on1
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Donyai, et al. 2010
PART B: Rewritten and new entries

A further analysis was carried out on both the rewritten and new CPD entries submitted by
the study participants before and after the intervention. The dependent variable was the
final CPD score. The independent factor was educational intervention (control vs.
intervention) with before scores used as a covariate in a linear model.
The linear model (linear regression model) was used to compare the intervention groups
adjusting for work setting, a linear effect of baseline (CPD scores before the educational
intervention) as well as an interaction between work setting and baseline scores (work
setting * mean CPD score at baseline). SPSS version 17 was used with the UNIANOVA
command. The assumptions the linear models were checked via an analysis of residuals. No
major problems were identified.
Adjusting for baseline, work setting and an interaction between work setting and baseline
scores, the intervention effect was estimated to be a mean difference of 9.864 (95% CI = 0.418
to 19.310). This effect is statistically significant (p-value = 0.041).
Table showing raw means and adjusted means:
Raw mean
Control
1.643
Intervention 7.353
Adjusted mean
2.231
12.095
The SPSS output is shown below.

Univariate Analysis of Variance
Between-Subjects Factors
Value Label
Work setting of pharmacist
'Treatment' group
Community
24
Hospital
14
1.00
Control
21
2.00
Intervention
17
Tests of Between-Subjects Effects

Source
Type III Sum of

Squares
df
Mean Square
Sig.
711.844
4.054
.009
2310.035
2310.035
13.156
.001
WorkSetting
107.312
107.312
.611
.440
Before
690.772
690.772
3.934
.056
WorkSetting * Before
706.972
706.972
4.026
.053
Intervention
792.561
792.561
4.514
.041
Error
5794.392
33
175.588
Total
9311.250
38
Corrected Total
8641.770
37
Corrected Model
Intercept
2847.378
a. R Squared = .329 (Adjusted R Squared = .248)
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Parameter Estimates
Parameter

B
Std. Error
Sig.
Lower Bound
Upper Bound
Intercept
15.785
4.231
3.731
.001
7.177
24.393
[WorkSetting=1]
-3.853
4.929
-.782
.440
-13.881
6.175
[WorkSetting=2]
Before
.006
.278
.020
.984
-.561
.572
[WorkSetting=1] * Before
.727
.362
2.007
.053
-.010
1.465
[WorkSetting=2] * Before
[Intervention=1.00]
-9.864
4.643
-2.125
.041
-19.310
-.418
[Intervention=2.00]
a. This parameter is set to zero because it is redundant.
Estimated Marginal Means

Treatment' group
Estimates
'Treatment' group

Mean
Control
2.231
dimensi on1
Intervention
Std. Error
Lower Bound
Upper Bound
3.145
-4.168
8.630
3.521
4.931
19.260
12.095
a. Covariates appearing in the model are evaluated at the following values: Before = 4.7763.
Pairwise Comparisons
(I) 'Treatment' group (J) 'Treatment' group
Mean
95% Confidence Interval for
Difference (I-
Difference
J)
Control
dimensi on2
Intervention
dimensi on1
Intervention
dimensi on2
Control
Std. Error
Sig.
Lower Bound
Upper Bound
4.643
.041
-19.310
-.418
4.643
.041
.418
19.310
-9.864
9.864
Based on estimated marginal means

*. The mean difference is significant at the .05 level.
a. Adjustment for multiple comparisons: Least Significant Difference (equivalent to no adjustments).
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Donyai, et al. 2010
Univariate Tests
Sum of Squares
Contrast
Error
df
Mean Square
792.561
792.561
5794.392
33
175.588
Sig.
4.514
.041
The F tests the effect of 'Treatment' group. This test is based on the linearly independent
pairwise comparisons among the estimated marginal means.
Case Processing Summary
'Treatment' group
Cases
Valid
N
Before
Missing
Percent
Total
Percent
Percent
Control
21
100.0%
.0%
21
100.0%
Intervention
17
100.0%
.0%
17
100.0%
dimensi on1
Boxplot
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Donyai, et al. 2010
Appendix 20
Qualitative analyses: generating a new model of CPD
behaviour
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Donyai, et al. 2010
The Purpose-Action-Results as a behavioural model (PARable): telling the

story of continuing professional development in pharmacy professionals
A specific aim of this research had been to examine current CPD entries to identify
information gaps in relation to revalidation. We sought to do this mainly through the
application of the CPD Outcomes Framework via an experimental approach. However, to
bring meaning and understanding to the measurements obtained, we also deployed a series
of methods to examine the content of CPD entries, and to analyse the focus group transcripts
as well as the interview transcripts. We believed that a combination of methods would
present a more holistic picture and lead to a deeper understanding of the features of current
practice.
Ultimately, thematic analysis and a grounded theory approach both proved useful in
analysing the CPD entries and focus group and interview transcripts, against themes
identified from a full literature review but also to generate new themes. This led ultimately
to the creation of a new model of CPD behaviour called the Purpose-Action-Results as a
behavioural model (PARable), to bring a rich understanding of the range of CPD behaviours.
Descriptive analysis of CPD entries
A total of 162 CPD entries received at the outset of the study were examined in depth by one
of the researchers not involved in the quantitative scoring of the entries (RZH). While most
of the entries were recorded using the electronic version (131 of 162; 80.9%), a number used
online forms (18; 11.1%) or were written on paper hardcopies (13; 8.0%). The CPD formats
allow an entry to start with reflection, planning, action, or evaluation. The majority of CPD
entries (119 of 162; 73.5%) started from reflection following the experiential learning cycle of
Kolb. One fifth of the entries had action as their starting point for CPD (33 of 162; 20.4%).
Very few records started with planning (9 of 162; 5.06%) and evaluation seemed to the least
favoured starting point with only one record (0.6%).
In terms of identifying the learning needs, the method most regularly used to identify
learning objectives was personal interest. Forty-three records started from non-reflection and
therefore did not contain the section required to explain how the learning need had been
identified. These 43 CPD records taken away, over half of the entries that had this section
complete (62 of 119) stated personal interest as the means of identifying the learning
objective, followed by talking to colleagues (46 of 119; 38.7%), and reading journals (38 of 119;
31.9%). The other ways of identifying learning needs included competences, critical
incidents, feedback from colleagues, and feedback from users of products / services, all of
which were used by one fifth of the entries that had this section completed. The remaining
methods were appraisal, audit, meeting, training, and requirement of work, which were used
occasionally by the participants. The table below provides the detail:
Identifying learning objectives
Methods to identify learning objectives
numbers
Appraisal
Audit
Competences
Critical incidents
Feedback from colleagues
Feedback from users of products/ services
Personal interest
Reading journals
Talking to colleagues
Meeting
Training
Requirement of work
13
9
28
23
22
24
62
38
46
1
2
2
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Donyai, et al. 2010
When looking at who has driven the conduct of CPD, 34 CPD records did not contain any
information in this section (33 CPD records starting with action and one starting with
evaluation). In the remaining 128 copies, 86 left this section blank while only one third of
the entries containing information in this section (42 of 128). Nearly 60% of the participants
(25 of 42) who completed this section ticked only one option for the party driving their CPD
conduct whereas the other 17 participants ticked more than one option (40%). In terms of
who is driving CPD, nearly half of the participants who completed this section stated their
CPD was driven by themselves together with the NHS or other employing or contracting
organization. On the other hand, not many CPD entries showed users of services/ products
and peers as the driving force for the CPD.
Similarly, participants categorisation of the impact of their CPD seemed more focused on
effect on the self, than on users of services and peers as illustrated in the graph below.
Identifying impact of CPD
The entries were also analysed in terms of the period of time apparently taken to complete
each CPD for a total of 116 entries that contained this information. Many CPD entries were
completed between 1 week 1 month (39 of 116; 33.6%) and 2 months (22 of 116, 19%) from
the start point. On one hand there are not many cases when participants completed the CPD
within a week (8 of 116; 6.9%). A total of 18 entries (15.5%) indicated longer than 3 months
had been spent and 7 (6%) between 2 to 3 months. Interestingly, 16 (13.8%) of the entries
appeared to have been completed and finished on the day the entry was made. For 6 entries
(5 reflection entries and 1 planning entry) the entry was made after the actions had taken
place.
In terms of activities undertaken, a table was constructed to displays the type of activities
conducted to complete CPD. The most popular activities were CE type activities. Computer
aided learning, short courses and workshops seemed to have been favoured. Communication
with peers, especially speaking to colleagues, was also embraced by some participants. Only
a small number of CPDs seemed to relate to teaching type activities.
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Donyai, et al. 2010
Activities undertaken to complete CPD

Clusters of activities
Communication with peers
(41)
Continuing education (181)
Instructing (7)
Activities
Brainstorming
Colleagues
Meeting
Projects
Work shadowing
Computer aided learning
Distance learning
Information services
Workshops
Postgraduate certificate
/diploma/degree
Presentation
Short courses
Structured reading
Mentoring
Teaching
Tutoring
3
27
9
1
1
25
9
14
21
12
4
27
69
4
2
1
Grounded theory analysis of the entries

All the 162 CPD entries were read carefully and analysed using a grounded theory approach.
We wanted to examine how people had undertaken their CPD and recorded them. Little on
this topic exists in the literature. Therefore, grounded theory analysis53, more specifically an
inductive analysis method was employed to analyse this set of data seeking to define the
pattern of CPD activities and relationships in terms of undertaking CPD and recording CPD
entries, de novo.
The analysis covered three procedures: open coding, axial coding and selective coding.
Immersed in the discourse of the CPD entries, we allowed categories and subcategories to
emerge when appropriate. During a second reading, we regrouped the categories to a
structure while not forcing the data naturally produced into an artificial framework. After
open coding, we employed axial coding to develop the categories further by specifying the
relationships between each category and its subcategories. Selective coding at the final stage
enabled integration of the categories and formulation of the ground theory from the analysis
exercise. This process led to a model capturing the theory from descriptions of concepts and
themes at the first two stages.
Open coding
As mentioned in descriptive analysis above, most records started with reflection. These
records were the first batch to be analysed in the hope that we would discover current
practices in terms of undertaking and recording CPD under close scrutiny. Starting with
open coding of 50 CPD records, rapidly some categories emerged in terms of why a specific
CPD is undertaken. After several rounds of regrouping, the final categories in relation to
what was driving CPD became as follows: new role, new regulations/requirement,
new/existing problem in practice, critical incident/mistakes at work, new product launching,
requalification/assessment/audit, and pure personal interest. It is worth noting that the
multiple choice options on Plan & Record selected by the participants to indicate the
methods used in order to identify the learning objectives does not necessarily explain the
real motivation or trigger for a CPD. Only reading the descriptive explanation in the entry
reveals the real reason behind a CPD.
After coding the entries in terms of the motivation or trigger for each CPD, the remainder of
each entry was also read in detail. With the development of the motivation categories,
another family of categories gradually emerged indicating how the entries demonstrated the
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Donyai, et al. 2010
relationship of CPD to practice, learning needs, type of action and the evidence of the impact
of CPD. For instance, when the reason for undertaking a CPD is a new role, the participants
tended to be able to put what has been learned into everyday practice, therefore it would be
easy for them to present the impact of CPD, in particular on their practice. Using another
example, when participants conducted a CPD due to new regulations/requirements, they
were more likely to attempt to ensure their learning by merely reading relevant information.
Therefore there was little evidence to collect to effectively evaluate and further justify their
CPD.
Axial coding
Axial coding developed the categories further by specifying the relationships between the
subcategories. In the main, for the first category of trigger (which we have called CPD),
encompassing namely new roles, existing or new problems and critical incidents, as well as
the CPD being highly related to practice, participants in the main conducted the learning
through a practical problem-solving exercise and while CE may have been a part of the
learning, engagement with others also featured as an activity. This category of CPD would
enable demonstration of impact through some form of documentation or feedback, as well as
resulting in an improve self-confidence and self-realisation.
For the second category of trigger, (which we have called CE) encompassing namely new
requirements/regulations, product promotions and new product launches or some form of
assessment of personal knowledge, the CPD had a low level of association and application to
practice and the learning was conducted mainly to fill potential knowledge gaps and to
answer closed questions such as what is or how to.. This category of CPD would be
facilitated mainly by partaking in a CE activity of some sort and would invariably lead on to
some level of enhanced confidence but very little evidence of impact instead focussing on
presumed benefits in the future. The final category related to unsuitable material for CPD.
Category
CPD
CE
Inapt
Trigger of CPD
New role
Existing/new
problem
Critical incident
New
requirement/reg
ulations
Product
promotion/new
product
launching
Requalification/a
ssessment/audit
Anecdotal family,
friends
Relation of
CPD to
practice
Learning needs
CPD action
categories
Highly
associated to
practice
Along with
knowledge gap
and
competences,
there is a priority
on solving
problem in
practice.
Low application
to practice
Mainly
knowledge gap to
answer questions
expecting closeended answer,
such as: what
is, how to do
Continuing
education is still
vital part, but
other activities
are engaged with,
such as
discussing with
colleagues/line
manager,
contacting other
departments/GPs,
work shadowing,
peer consensus
exercise, etc.
Mainly
continuing
education such as
short course,
presentations,
workshop,
constructed
reading, etc.
Impact on practice
(Evidence)
Confidence/compet
ences
Putting what has
been learned into
practice-immediate
positive feedback
from
patients/colleagues
Documentation
(paper, worksheet,
format, etc.)
Confidence/compet
ences
Presumed benefits
Positive feedback
from
patients/colleagues
No impact on practice
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Donyai, et al. 2010
Selective coding
Selective coding enabled integration of the categories and formulation of the grounded
theory from the analysis exercise. In order to capture the theory from descriptions of
concepts and themes and their interrelationships, a simple model was developed. There will
inevitably be variations when applying CPD entries to this model but this model we believe
captures the essence of CPD behaviour in pharmacy.
We have named this the Purpose-Action-Results as a behavioural model, which abbreviates
to PARable it tells the story of continuing professional development in pharmacy as follows.
Purpose-Action-Results as a behavioural model (PARable)
The story of CPD

Two general types of behaviour can be associated with CPD. The first, depicted in the lower
part of the model represents the more traditional approach to learning more in line with CE.
Here, the drive for CPD is driven externally by a variety of factors that include in essence a
need to fulfil a personal desire for knowledge acquisition. A number of external drivers are
associated with this need, including, in community pharmacy for example a fear of being
asked questions that cannot be answered and thus a need to maintain a basic level of
knowledge in a breadth of subjects. Although related to personal knowledge acquisition, the
motivation for this type of learning is mainly externally driven, a result of perceived
expectations of others and related to assumptions about potential problems that might arise
at work. This type of perception leads to the undertaking of stand-alone, mainly CE type
activities which ultimately have the greatest impact on the individual themselves rather than
the significant others. The outcome of this type of entry is written as hypothesised impact
on oneself promised through that language uses such phrases as will have and is going
to, I will be able to. This person-centred, approach is not instantly relevant to practice
and is more likely to take place as a result of perceived needs rather than an immediate and
well-thought-out precondition.
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The second type of behaviour is captured in the upper part of the model and represents a
on practice and that in turn can be related back to the individuals own development, as
indicated by the top arrow in the diagram above.
Thematic analysis of the focus group and interview transcripts
Once the model above had been developed, we sought to conduct focus group interviews
with the participants as a first step towards verifying the model and its application to
participants own expressed understanding of their CPD. The interview guide for use during
the focus group discussions is presented in Appendix 16 and was based on the emerging
themes that informed the model, as highlighted in the left-hand column of the interview
schedules entitled theory. We categorised the transcripts according to the themes identified
in the model and looked for additional themes. In fact, while a number of interesting and
additional features were obtained, the model itself remained unchanged and it was possible
to categorise participants approach to CPD using either the CE or CPD pathways. The
additional supporting themes are described below.
Time spent on CPD and the Plan & Record CPD template
The CE approach was associated with what the participants described as quick and easy CPD.
These participants also saw the concept of longer more complex activities imposing on what
they could reasonably conduct and express as CPD. This was linked with the CPD template
of Plan & Record, which seemed to facilitate the construction of quick entries for this
group. Those favouring the CE approach then seemed to associate CPD with the recording
process itself, which necessitated setting clear specific objectives that could be met with ease
through specific planned activities. This group in particular had difficulty conceptualising an
ongoing relationship with their CPD entry, for example to continue to collect evidence of
impact, instead preferring to adhere to a systems-based approach that relied on form
completion and the filing away of entries as complete at the first opportunity. Starting at
action was deemed perfectly acceptable if not preferable to this group yet the purpose was
not to apply the learning in any in-depth manner but to acquire it instead even with entries
that began at action there was a sense that the learning could be filed for application at a
later date. Or that CPD could be constructed from a pool of actions to fit the CPD template.
In fact, there was evidence that the template led to the selection of activities that would
enable completion of the form in an efficient manner to indicate learning completed even
though participants openly admitted some of the categories on Plan & Record were being
completed for the sake of completion. In addition, the completion of the form itself was
viewed as an activity that detracts from available time. On this basis, the group had no
objection to completing 9 entries per annum. But the group was keen for some form of
protected CPD time and also seemed to favour the association of CPE with specified
minimum hours. The participants in this group also appeared more concerned with CPD as
an activity that had to be completed for mandatory revalidation purposes rather than for
development per se.
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The views expressed by those following the CPD pathway were associated with an
understanding that CPD would invariably involve a deeper relationship with practice and
that the outcomes would take longer to achieve. The participants in this group demonstrated
a desire to conduct CPD in a less ad hoc way and appeared more willing to compromise in
terms of the time (their own) they would give up for CPD. Their CPD was focussed on
meeting work objectives in clear manner and this group appreciated the need for relevance
and impact on others as well as on self. They recognised the transition from CE to CPD. In
particular, this group had a focus on improving their behavioural and communication skills
through practising CPD, again linking their learning with actual application and interaction
with significant others. These participants appreciated that the depth of learning was key
and could perhaps not be achieved sufficiently for 9 entries per annum. They also
appreciated that completion of the CPD template was simply a process of recording and not
the CPD itself.
It was interesting to note that quite a number of participants in the intervention group chose
to submit CPD entries they had been thinking about over a period longer than the assigned 2
months in January and February 2010.
Understanding of current assessment of CPD

In addition to information relating directly to the CPD behavioural model, the participants
were also able to convey their understanding of the current assessment of CPD entries during
the focus groups and interviews. One of the concerns expressed related to the scoring of
entries by non-experts and a requirement to express the CPD in lay language. In addition, a
number of participants expressed anxiety about instructions they had received at CPD
training courses to complete CPD entries to indicate high impact, regardless of actual impact,
to facilitate favourable assessment on submission. This related to a general concern about
the mechanical computer assessment of CPD entries under the current system. A real
concern also related to the current loop-hole that enables people to make up their CPD
entries or to at least commission them especially in light of confusion about requirements
concerning the keeping of physical documentation as proof of CPD (i.e. portfolios). There
was a feeling that language alone could be used to convey CPD. There was also a sense that
CPD entries could be completed in the absence of any practical application of knowledge
e.g. by those out of work. Participants also found the template and the form-filling nature
rather belittling and imagined other health professionals (of a different status) such as
doctors and dentists would resist such demands.
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Appendix 21
Qualitative analyses: Feedback about the CPD Outcomes
Framework and participants experience with the study
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Participants feedback about the CPD Outcomes Framework

telephone interviews were used as an opportunity to gain participants opinion of the CPD
Outcomes Framework to enable its further development. The participants were also asked
about their general experiences with the study. The main concepts are outlined below:
Presentation of the training material

None of the cases started at action
Difficulty obtaining same rating as indicated in the case answers
Complicated and difficult concept to take in at first but able to work out eventually
Training presented in too many formats and some material repetitive
Presentation of cases a good way to convey actual CPD more so than standard Plan
& Record template.
Adobe version same as paper version whereas expecting interactive version online
a step-by-step tool.
The exercises and examples very really very good
Need to cut down on the volume of wording because of pharmacists perception of
limited time
Diagrams nice and clear
Booklet presentation helpful for travel and commutes
Problems accessing the DVD
Needed something more succinct
Pack self-explanatory
The CPD Outcomes Framework itself

Overall concept can help rationalise approach taken.
Concept of risk good way of managing relevance.
Relevance and impact good concepts to use
Others may find difficulty using the Outcomes Framework
Some of the descriptors need to be clarified
Would direct CPD and focus activities cutting down on unnecessary CPD
Would make it difficult to complete 9 entries per annum (to the required standard)
Difficult concept to grasp at first
More experienced pharmacists might have difficulty finding relevant CPD since their
practice would be deemed less prone to risk due to experience
Familiar concept to pharmacy professionals who conduct risk assessments
Difficulty defining CPD in terms of risk and consequences where systems-based
approach means no one individual responsible for preventing risk
Focussed on outcomes rather than potential benefit to self in absence of proof
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Donyai, et al. 2010
Not all identifiable risk can be tackled by a single pharmacy professional

Does not allow CE type learning to be deemed valid
Enables focus on areas of risk and therefore helpful
Beneficial to those changing fields or doing new work
Would need to collect a number of pending CPD that could not be ticked off easily
because evidence would be awaited
Quantification element helpful for revalidation
Applying the CPD Outcomes Framework makes need for Revalidation Standards
redundant.
Some misunderstandings relating to risk scoring and whether linked to past incidents
of errors
The need to keep a separate portfolio communicated better with the CPD Outcomes
Framework
Electronic storage of entries and evidence needs to conform to data protection and
confidentiality rules.
Electronic storage enables safe-keeping for future reference
Difficulty evidencing some things such as medicines information query and
generating other forms of evidence.
Would be challenging to locums on one-day a week.
Compares well with New Zealand model (one participant was familiar with this)
Learning for the sake of learning should still count
Some difficulty knowing how to rewrite the entries
Impossible to use CPD Outcomes Framework if out of practice
Collecting feedback evidence not practical
Outcomes Framework fits with hospital practice which is patient orientated
How to claim benefit as ones own and related to a specific CPD (e.g. good
departmental audit results)
Difficult to establish whether meeting criteria
Just because it is unlikely to happen, if catastrophic still worth learning about - think
of it as pilots and ash clouds.
Participants feedback about the study itself and further suggestions

Benefitted from participating.
Others may find difficulty using the Outcomes Framework i.e. could be simpler for
other people.
Need more guidance about revalidation for others
Could consider mixed model that embraces CE
Consider use of CPD in revalidation and need for efficient processed call in a random
selection, conduct OSCEs.
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Donyai, et al. 2010
Peoples learning styles lean towards didactic teaching and people dont know what
they need to know
A need for a curriculum to address CE needs
The General-Level Framework would be useful to CPD
Link CPD to job descriptions
CPD assessment caused a level of gloom
Specifying a curriculum could be dangerous too because that might limit activity
CPPE courses not relevant to specialist pharmacists
Could consider asking people to write their CPD as case scenarios with specified
headings to convey a story rather than rigid form-filling
Feedback more important than a mere certificate.
A lot of technicians find CPD a chore and need more guidance on type of CPD to do
9 CPDs is a lot to do in a year
Study took longer than first thought participant wanted book token earlier
Plan & Record not compatible with what CPD Outcomes Framework is trying to
achieve.
People should be permitted to submit some entries on a trial basis to get feedback
MCQ self-assessment would help identify learning needs
Would not have enough of the high-scoring entries to submit 9 per annum
Prefer objective criteria to follow
A feeling that currently CPD entries are being passed easily in the absence of
tangible assessment criteria
Difficult to convey competence through text rather than observation
More CPD facilitation courses would be helpful and a chance to interact with others
and compare notes
Some particularly positive comments about the study and specifically the Outcomes
Framework :
Yes I havent written any up for a while but am already thinking I need to do one and whats
relevant! Ive got what I want out of it and I can feed it back to staff. I quite enjoyed doing it
actually because its just as I say it made me think about me CPD it had gotten to be a chore
rather not pleasure but this makes you think about how youre going to do it and plan it
better.
I thought it was very good and its made me think differently when I write up my own CPDs now
about risks involved and also is it really, is it a valid CPD to start off with. Its made me think
more of the content of my CPD. When I first started doing CPDs it was just a matter of ok Ive got
a certificate to say Ive done this CPD or Ive attended a workshop but now its more what Im
actually getting out of writing. Since Ive done this correspondence with you its more like what
Im getting out of the CPD and I can pass on to others as well.
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Donyai, et al. 2010
I do feel it has been of benefit and just like I said, it makes me think more about, its all very well
doing something and saying you've done it. You have to decide as to why you have done it and
what the benefits or indeed was it worth doing it. So it has made me think more about what I am
doing in terms of writing, how I present what I have learned or courses of Ive been on or
information I've researched. And, certainly I have found that using this framework, or reading
about the framework, or trying to use it, then you think more about what I was writing and trying
to get across to the facilitators as to why I was doing something, and what I was getting out of
it.
But you understand what they are actually looking for now. Going on the course that was run
by CPPE was useful, but I have felt that reading this information is more useful in terms of
thinking about why I am actually doing something and how it can, like you said the impact on my
day to day work.
Yeah, it made me focus what I was doing CPD for. Um, yeah, I remember looking at some of my
CPD entries and thinking well, that wasnt really good really. But I think a lot of people just
thought of CPD as recording any old learning and wasnt putting um, any sort of impact of what
it was gonna have on their practice.
Yeah. I quite liked this idea! Yes. Once, Id got my head around it. It was quite difficult to, to
grasp, you know I did need to read it a couple of times. I just think its put me on the right trail
now. Nobody shared their CPD entries so you dont know if youre doing it right or not!
Oh thank you! Oh, Im pleased Im really really pleased. Im delighted because you know at the
back of my mind I panic like everyone else and they are going to ask me for nine entries
tomorrow you know what I mean. And I was delighted to take part in it.
Fair enough. Well I think its been very good. I hope, I hope that it does get published and I
hope that the new body does accept it and put it into place. I hope it becomes a reality and that
we can start teaching our students this as well.
I mean I must admit that when I did open CPD entry in terms of my involvement in the study,
and when we are thinking about advantages and disadvantages, one disadvantage is that I this is
a study, and we dont know what the general pharmaceutical council are going to take part, or
whether the draft standards and information will stay as they are, so I kind of recognised that
limitation, but nevertheless I still think its really really use preparation and Im sure its the
direction of travel and Im sure they will be convinced by your research in this study - and so from
my personal and very selfish perspective, its been a very beneficial thing to have done.
It has been very useful to do it. Thank you. I enjoyed it immensely.
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Donyai, et al. 2010
Appendix 22
Interpretation and explanation of quality scoring of CPD
entries
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Donyai, et al. 2010
Interpretation and explanation of quality scoring of CPD entries

In addition to the quantitative assessment of the CPD entries, we wanted to assess particular
features of entries that scored high or those that did not. We did this by examining the
content of the entries and the feedback that participants themselves gave about these entries.
Interestingly, one participant who used case scenarios to construct their after entries scored
high in these. We chose to include information from both interviews and the paper version
because we wanted to bring participants own understanding to the analyses. The findings
are presented under the headings below:
High-scoring entries
The reasons listed below relate either to participants understanding relevant concepts before
any training, because they were in the Intervention group or because they had made the
correct interpretation from the CPD and Revalidation Standards.
Participants related these to risk.
E.g. I thought we if its going to be dangerous then Im going to have to learn about it.
Participants related these to relevance.
E.g. So that was the easiest one because anything which was new and would affect my practice in
the future. Good entries as well as relevant entries to the current situation.
Participants related these to actual practice.
E.g. And we started running one-to-one weight management clinic as well. So that would have
helped my rewriting the entries. Because I've got more involved in other aspect of the/with regards
to the pharmacy services line. Because I've because I managed to get some funding for it. So
probably, that probably would have helped me to probably increase the level of entry I made.
Consciously altered in light of CPD Outcomes Framework.
E.g. So, from what I got from the pack I could see how I could improve my scoring and I could see
that what I was trying to prove was that my CPD was having an impact on my practice at the
risk.
E.g. Ok, well I mean obviously when a table is written there that this is what we expect this is
how we want you to write the CPD, people will try to find cases that will achieve that element in
such a way there would be more I would say that there would be more improvement in the writeup because what you would need to do is to find material that will fit in the requirements
E.g. And as I was writing that one up I tried to write it reflecting what I had learnt.
Chose entries for which there was evidence.
E.g. I deliberately picked an example where I got a really good strength of evidence because I got a
course certificate.
E.g. I think more from the point of view that I needed to do it, why I needed to do it, and what
were the benefits of doing it. I could apply that more to that particular one than perhaps the other
two.
E.g. Thats fine. I mean, I would sort of rewriting it perhaps to put more emphasis on the impact,
but the actual work hasnt changed. I suppose things might have been put into practice on a few
more occasions.
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Donyai, et al. 2010
Low- and medium-scoring entries

The reasons listed below relate either to participants lack of understanding, because they
were in the Control group or because the entries were submitted before the training.
Insufficient impact and evidence demonstrated at time of writing.
E.g. I have actually I dont know if I wrote it in there but I have had to write up an SOP for
the ---- in case we came across that situation again.
E.g. The problem is that you think about something is and you think I need to improve my
learning and do something about that, and then while youre writing it up you get to the last page
and it says howve you changed your practice and a lot of the time youve writing it up, well, I
write it up quite near the time while its in my head and otherwise I forget. And then I havent
really had any examples really of putting it into practice at that stage
Not understanding requirements fully in the absence of feedback.
E.g. Thats it you just write along but nobody criticises them or comments which is why its
been such a useful exercise.
E.g. I think up until now I have not had any assessment of my work and sometimes you feel like
when you are on the right track but you clearly aren't unless someone [laughter] tells you you're
clearly aren't.
E.g. Yes, definitely, yeah, because I have found that the CPD isnt really, really doing very much.
The way Ive done it its just a quick record of what youve done. And Ive actually had to submit
mine to the Society anyway around 20. I got called in November. Its all excellent. Everything.
And I thought, ah, well, okay, well, thats brilliant. But I just feel it wasnt searching very deeply.
E.g. Ive learnt something Ive documented it its there on the record and if I got a problem
again I know where to find it -- but yes it doesnt say anything about what stage of impact it has to
be, or it has to be for several people.
The Plan & Record template as a barrier.
E.g. I dont actually think the template the RPSGB template lets you expand. They ask a
question and you answer it and so a lot of people they probably wouldnt expand or extend what
they wanted to write and give more examples because its just an end to CPD isnt it? So I dont
yeah I dont particularly like the template much. Would this (study) lead to a change in the
template in the RPSGB website?
Inability to apply to practice situation because out of work.
E.g. But yes, if your, you know, if you are trying to return to work, then it makes it very difficult.
It is like multiplying something by zero.
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Donyai, et al. 2010
Appendix 23
Interpretation and experience of Revalidation Standards in
CPD
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Donyai, et al. 2010
Participants feedback about the Revalidation Standards

telephone interviews were used as an opportunity to gain participants opinion of the
Revalidation Standards to enable their further development for use with CPD. The
participants were asked specifically about the Revalidation Standards (Standards of
Proficiency) through a series of questions outlined in Appendix 17.
The main concepts initially identified are shown below:
The Revalidation Standards

Use of Revalidation Standards not practical or particularly desirable process in light of
other specialist competencies and standards and competing requirements to meet
these instead.
CPD Standards and Revalidation Standards not instructional enough in terms of what
is actually required.
Standards stating do not always have to demonstrate benefit to practice leaves it
open for people to conduct CE type activities only.
Current CPD training undertaken elsewhere has not conveyed the requirements to
ensure relevance and impact (as per the standards).
Revalidation standards may be more useful to junior pharmacists.
Wording too open to interpretation and wishy-washy.
Some participants in the control group had read the Revalidation Standards in detail
and were able to pick up the concepts.
Revalidation Standards unworkable.
Too many competencies mean cannot be selected in meaningful way first one
thought to be relevant selected without further thought
The Revalidation Standards not specifying any actual knowledge that needs to be
acquired
Difficult to understand and apply lacked tables and not easy to work with.
Cumbersome
A lot of work put into their construction
Not focussed sufficiently
Does not add anything to code of ethics
We then used NVivo 8 (qualitative data analysis software) to examine the interview data from
the 34 participants using thematic analysis; a way of organising interview and other written
qualitative material to draw out meanings in the form of themes, where recurrent topics,
ideas and statements that are identified by seeing the patterns in ideas or experiences from
one person or across several people. This resulted in the identification of a number of
themes.
First-order coding resulted in a number of descriptive labels, which were then grouped under
five main categories during second-order coding, resulting finally in the identification of two
dominant themes during third-order coding. The two dominant themes of Working with
the Standards of Proficiency and Yet to accept the Standards of Proficiency and the
respective second-order and first-order codes are shown in the schematic below.
Page 242
lysis of
elation
rds of
cy
Donyai, et al. 2010
Thematic analysis of interviews in relation to the Standards of Proficiency
Working with the

Standards of
Proficiency
Yet to accept the

Standards of
Proficiency
Standards of Proficiency viewed with
scepticism
Trying to understand the

application of the standards to CPD
Can't remember detail of standards

Confusion and ambiguity
Insufficient instructions
Not impressed
Proficiency standards did not relate to
specific area of practice
Proficiency standards don't relate to
actual knowledge needed
Standards easier for younger people to
understand
Too many standards
Too much detail
Unclear how standards relate to

non-patient-facing role
Should CPD be related to
Proficiency Standards?
Standards have to be met
Standards of Proficiency were

viewed positively
CPD standards quite instructional
Proficiency standards quite
thorough
Standards helpful
Standards making CPD more
focussed
Standards viewed as clear
Had expected something new

Already part of everyday thinking
Looking for something new
Proficiency Standards similar to Code of
Conduct
Rebelling against the standards
Did not have time to read
Did not relate CPD to Proficiency Standards
Didn't want to make the effort to change
CPD to fit in with proficiency standards
Need a curriculum to follow instead
The use of Revalidation Standards in CPD

Under closer scrutiny, we were able to quantify the use of the Revalidation Standards within
CPD entries. We examined the detail of 96 entries submitted at the after stage of the study
(rewritten and new) to quantify the number that had drawn on the Revalidation (Proficiency)
Standards. The data were cross-tabulated and examined in relation to the number that had
used the Revalidation Standards in each of the intervention arms; control vs. active
intervention groups. We found that participants had not in the main sought to list the
Revalidation Standards in their CPD entries. A similar number of rewritten entries (9) and
new entries (7) had referred to the Proficiency Standards. However, a higher number of
entries from those in the active intervention group (i.e. from participants who had received
the CPD Outcomes Framework) compared to those in the control group (i.e. from participants
who had received the Revalidation and CPD Standards only) had referred to the Proficiency
Page 243
Donyai, et al. 2010
Standards in their re-written or new CPD entries (p = 0.005) submitted at the after stage of
the study.
Crosstab
ProficiencyStandard
No
Intervention Control
Count
47
% of Total
34.4%
Count
13
83.3%
46
13.5% 47.9%
80
% of Total
50
3.1% 52.1%
33
% of Total
Total
3
49.0%
Intervention Count
Total
Yes
16
96
16.7% 100.0%
Chi-Square Tests
Value
Pearson Chi-Square
Continuity Correction
df
Likelihood Ratio
Exact Sig. (2-
Exact Sig. (1-
sided)
sided)
sided)
.003
7.021
.008
9.034
.003
8.548
b
Asymp. Sig. (2-
Fisher's Exact Test

Linear-by-Linear Association
N of Valid Cases
.005
8.459
.003
.004
96
a. 0 cells (.0%) have expected count less than 5. The minimum expected count is 7.67.
b. Computed only for a 2x2 table
Page 244
Last page (left blank for notes)
Page 245

Work Stream 2 Project 1 - Final Report

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*Donyai, et al.

The CPD for Revalidation in

CPD records for revalidation:

University of Reading 2010

Wednesday 15 December 2010

Donyai, et al. 2010

The CPD for Revalidation in Pharmacy Study

University of Reading 2010

Wednesday 15 December 2010

Donyai, et al. 2010

The CPD for Revalidation in Pharmacy Study

University of Reading 2010

Wednesday 15 December 2010

Donyai, et al. 2010

The CPD for Revalidation in Pharmacy Study

Wednesday 15 December 2010

Donyai, et al. 2010

The CPD for Revalidation in Pharmacy Study

University of Reading 2010

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Donyai, et al. 2010

The CPD for Revalidation in Pharmacy Study

Appendix 19 ......................................................................................................................................... 218

University of Reading 2010

Wednesday 15 December 2010

Donyai, et al. 2010

The CPD for Revalidation in Pharmacy Study

Wednesday 15 December 2010

Donyai, et al. 2010

The CPD for Revalidation in Pharmacy Study

*w+here appropriate, effective connections should be made between existing evidence

University of Reading 2010

Wednesday 15 December 2010

Donyai, et al. 2010

The CPD for Revalidation in Pharmacy Study

Aims and objectives

University of Reading 2010

Wednesday 15 December 2010

Donyai, et al. 2010

The CPD for Revalidation in Pharmacy Study

University of Reading 2010

Wednesday 15 December 2010

Donyai, et al. 2010

The CPD for Revalidation in Pharmacy Study

University of Reading 2010

Wednesday 15 December 2010

Donyai, et al. 2010

The CPD for Revalidation in Pharmacy Study

Chapter 2: Literature review

Information sources and searches

Wednesday 15 December 2010

Donyai, et al. 2010

The CPD for Revalidation in Pharmacy Study

University of Reading 2010

Wednesday 15 December 2010

Donyai, et al. 2010

The CPD for Revalidation in Pharmacy Study

Data abstraction and synthesis

Wednesday 15 December 2010

Donyai, et al. 2010

The CPD for Revalidation in Pharmacy Study

Time as a facilitator or barrier to CPD

Financial costs and resources as facilitators or barriers to CPD

Understanding CPD as a facilitator or barrier to CPD