Lessons from community pre-registration training

There is a consensus that, between hospital and community pharmacy, there is much more clinical knowledge to learn from doing pre-registration training in the former.

When you have consistent exposure to medical notes and drug charts, handle ward patients with complex care needs and work with a multidisciplinary healthcare team, there is no end to the amount of knowledge you can amass.

On the other hand, the chief objective of community pharmacy is to ensure that patients get their medications in a timely manner, NOT to review or optimise their medication regimens.

Yes, community pharmacists still have to check the appropriateness of prescriptions (e.g. dosage, quantity, legal conformity etc.) and not hand them out blindly. But we can’t afford to dig deep and discuss about medicines in detail, especially in busy pharmacies.

We have to deliver a certain standard of service excellence, and having thorough conversations with patients about their medicines will result in unacceptably long waiting times.

Besides, do patients really want you to “meddle” by asking questions about their repeat medicines? There is a high chance that they know what they are taking, and their only intent is to collect their medicines and get out ASAP.

The primary focus in community pharmacy is truly to dispense as many prescriptions as possible. And for the pre-registration trainee, it takes precedence over learning or applying clinical knowledge—the core pharmacist knowledge—at work.

No wonder why the majority of pharmacy graduates would rather do their pre-registration training in hospital.

Nevertheless, instead of complaining, I rather share two of the most important—and unexpected—lessons I took away from my training which, in turn, helped me to manage my expectations at the workplace.

Store management is the main job responsibility

Yes, it really is. In fact, 70% of the knowledge and skills I gain from my training come from store management.

Let’s face it, most of the work tasks pre-registration trainees do in community pharmacy are the same as dispensers. Picking medicines from shelves, ordering stock, scheduling medication deliveries to patients and claiming reimbursements for prescriptions are all dull tasks; and you barely need your pharmacist knowledge to do them.

However, if you focus on trying to be an efficient store manager, you won’t feel like another dispenser. That’s because dispensers generally do not see running the pharmacy smoothly as part of their job responsibility. In fact, they can be quite reliant on the pharmacist to allocate tasks for them.

If there are no prescriptions to dispense or stock to put away, the dispensers may assume that there is nothing else of importance. Sometimes, they really are unaware. But more often than not, they are just not going to take the initiative to do them.

I find that having good awareness at the workplace is indispensable for effective store management. During busy periods, there are too many things going on at once in the pharmacy. It is impossible to pay attention to everything.

If you struggle to stay focused among all the incoming information and distractions from multiple sources, you will quickly fall behind. You will probably even forget to do your routine daily tasks amid the chaos.

On the other hand, if you can filter out distractions and not be flustered by other less relevant issues in the pharmacy, you will stay in control.

What about times when the pharmacy is less busy? You then need to use your foresight to anticipate what issues could occur if you don’t do certain tasks now. One major task that you should do when the pharmacy is less busy is stock inventory management. Quiet times are the best times to look around the dispensary and top up the commonly used stock.

One stock-related task that is most commonly forgotten about, and results in a lot of angry patients, is ordering outstanding items to fulfill prescriptions. Admittedly, it is easy to put this aside and forget about it entirely, but you can’t fault the patient for being angry if you fail to follow through your promise on ordering their medicines.

Store management is not an intellectual concept. There are technical aspects to it, but having a proactive attitude and good awareness of what you need to do every day will suffice.

Lastly, don’t underrate the skill set of managing the day-to-day operations of a store. It is highly valuable and sought after.

Trust is difficult to establish

No matter how good your knowledge or conversation skills are, there will always be a significant number of people that rather not take advice from you simply because you are a pre-registration trainee.

There were a number of occasions when patients completely ignore me when I serve them, and head straight for the pharmacist instead. Even if you give them coherent advice, they may still force their way into talking to the pharmacist because they want complete reassurance.

In some cases, these patients are regular customers of the pharmacy and would rather talk to people they have a good rapport with. But in most cases, customers trust the pharmacist much more than the unproven pre-registration trainee.

I suppose, for these people, ignoring me seems like the most appropriate way to maintain politeness. Some customers use more deplorable tactics. I have encountered a few elderly patients repeatedly whining that they couldn’t hear or understand a word I said no matter how hard I tried. I could tell that they just wanted to talk to someone else because their “hearing impairment” magically disappears the moment the pharmacist entertains them.

Moving away from customers, it’s also not easy to establish full trust with the pharmacy team either. While it is important to work well with the dispensers, dispensers still trust the word and authority of the pharmacist more than of the trainee.

Effective store management requires you to take charge and allocate tasks to the dispensers, and that isn’t straightforward for a pre-registration trainee. Telling dispensers what to do or pointing out errors in their work, even in a non-confrontational way, don’t always go down well with them.

They may not say anything upfront, but it’s not hard to sense annoyance from their facial expressions. Older and experienced dispensers are more likely to feel that they don’t need to be told what to do, and I won’t be surprised if they think that you are just imposing authority over them.

As a trainee, I just accept that this is the reality. I don’t take it personally and I am not resentful about this because it’s a waste of mental energy. I rather put my focus on doing my job properly.

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