Abstract
Ensuring the competence of healthcare professionals’ is core to undergraduate and post-graduate education. Undergraduate pharmacy students and pre-registration graduates are required to demonstrate competence at dispensing and accuracy checking medicines. However, competence differs from understanding. This study determined the competence and understanding of undergraduate students and pharmacists at accuracy checking dispensed medicines. Third year undergraduate pharmacy students and first year post-graduate diploma pharmacists participated in the study, which involved an accuracy checking task and concept mapping exercise. Participants accuracy checked eight medicines which contained 13 dispensing errors and then constructed a concept map illustrating their understanding of the accuracy checking process. The error detection rates and types of dispensing errors detected by undergraduates and pharmacists were compared using Mann–Whitney and chi-square, respectively. Statistical significance was p ≤ 0.05. Concept maps were qualitatively analysed to identify structural typologies. Forty-one undergraduates and 78 pharmacists participated in the study. Pharmacists detected significantly more dispensing errors (85%) compared to the undergraduates (77%, p ≤ 0.001). Only one undergraduate and seven pharmacists detected all dispensing errors. The majority of concept maps were chains (undergraduates = 46%, n = 19; pharmacists = 45%, n = 35) and spokes (undergraduates = 54%, n = 22; pharmacists = 54%, n = 42) indicating surface learning. One pharmacist, who detected all dispensing errors in the accuracy checking exercise, created a networked map characteristic of deep learning. Undergraduate students and pharmacists demonstrated a degree of operational competence at detecting dispensing errors without fully understanding the accuracy checking process. Accuracy checking training should be improved at undergraduate and post-graduate level so that pharmacists are equipped with the knowledge and understanding to accurately check medicines and detect dispensing errors, thereby safeguarding patient safety.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Alexander, A. (2000). Check mate: An internet-based qualitative study of the processes involved in error checking. International Journal of Pharmacy Practice, 265, R70.
Barnett, R. (1994). The limits of competence: Knowledge, higher education and society. Buckingham: Society for Research into Higher Education & Open University.
Dieckmann, P., Reddersen, S., Wehner, T., & Rall, M. (2006). Prospective memory failures as an unexplored threat to patient safety: Results from a pilot study using patient stimulators to investigate the missed execution of intention. Ergonomics, 49, 526–543.
Fyrenius, A., Wirell, S., & Silen, C. (2007). Student approaches to achieving understanding–approaches to learning revisited. Studies in Higher Education, 32, 146–165.
GMC (2003). Tomorrow’s doctors. Recommendations on undergraduate medical education. http://www.gmc-uk.org/education/undergraduate/undergraduate_policy/tomorrows_doctors.asp. Accessed November 2009.
Hay, D. B. (2007). Using concept maps to measure deep, surface and non-learning outcomes. Studies in Higher Education, 32, 39–57.
Hay, D. B., & Kinchin, I. M. (2006). Using concept maps to reveal conceptual typologies. Education & Training, 48, 127–142.
Hay, D. B., & Kinchin, I. M. (2009). Pedagogy of higher education—a concept mapping lesson [CD ROM].
James, K. L. (2009). Dispensing errors in hospital pharmacy. Incidence, causes and impact of automation. PhD Thesis, King’s College London, London.
James, K. L., Barlow, D., McArtney, R., Hiom, S., Roberts, D., & Whittlesea, C. (2009). Incidence, types and causes of dispensing errors: A review of the literature. International Journal of Pharmacy Practice, 17, 9–30.
Kinchin, I. M., Baysan, A., & Cabot, L. B. (2008a). Towards a pedagogy for clinical education: Beyond individual learning differences. Journal of Further & Higher Education, 32, 373–387.
Kinchin, I. M., Cabot, L. B., & Hay, D. B. (2008b). Using concept mapping to locate the tacit dimension of clinical expertise: Towards a theoretical framework to support critical reflection on teaching. Learning in Health & Social Care, 7, 93–104.
Kinchin, I. M., & Cabot, L. B. (2009). An introduction to concept mapping in dental education: The case of partial denture design. European Journal of Dental Education, 13, 20–27.
Kinchin, I. M., Hay, D. B., & Adams, A. (2000). How a qualitative approach to concept map analysis can be used to aid learning by illustrating patterns of conceptual development. Educational Research, 42, 43–57.
Leung, W.-C. (2002). Competency based medical training: Review. British Medical Journal, 325, 693–695.
Miller, G. E. (1990). The assessment of clinical skills/competence/performance. Academic Medicine, 65, S63–S67.
Novak, J. D. (1998). Learning, creating and using knowledge: Concept maps as facilitative tools in schools and corporations. Mahwah: Lawrence Erlbaum.
Novak, J. D., & Canas, A. J. (2008). The theory underlying concept maps and how to construct and use them. Technical report IHMC CmapTools 2006–01 Rev 01–2008. Florida: Institute for Human and Machine Cognition.
NPSA. (2004). Seven steps to patient safety. London: NPSA.
NPSA. (2007). Design for patient safety. A guide to the design of the dispensing environment. London: NPSA.
Plasschaert, A. J., Holbrook, W. P., Delap, E., Martinez, C., & Walmsley, A. D. (2004). Association for dental education in Europes/DentEd III thematic framework project. Profiles and Competencies for the European Dentist. http://adee.dental.tcd.ie/ec/repository/EJDEProfilefinalformattedforweb.pdf. Accessed October 2009.
Ramsden, P. (2003). Learning to teach in higher education. Oxon: Routledge Falmer.
Rethans, J.-J., Norcini, J. J., Baron-Maldonado, M., Blackmore, D., Jolly, B. C., LaDuca, T., et al. (2002). The relationship between competence and performance: Implications for assessing practice performance. Medical Education, 36, 901–909.
RPSGB. (2002). Teaching pharmacy to undergraduates. London: RPSGB.
RPSGB. (2006). Medicines, ethics and practice. A guide for pharmacists. London: RPSGB.
RPSGB. (2009). Pre-registration Training Manual. London: RPSGB.
Savage, I., Bissenden, B., & Martin, C. (2006). Learning to teach the final check. London: School of Pharmacy. Unpublished research.
Smith, F. (2002). Research methods in pharmacy practice. London: Pharmaceutical Press.
Talbot, M. (2004). Monkey see, monkey do: A critique of the competency model in graduate medical education. Medical Education, 38, 587–592.
Toft, B., & Mascie-Taylor, H. (2005). Involuntary automaticity: A work-system induced risk to safe health care. Health Services Management Research, 18, 211–216.
WCPPE. (2004). The welsh pharmacy technician. Accredited checking training scheme. Cardiff: WCPPE.
Yin, R. K. (2003). Case study research: Design and methods. London: Sage.
Acknowledgments
The authors would like to thank the students that participated in the study, Berko Anto for assisting in the data collection process, Gillian Cavell (Consultant Pharmacist in Medication Safety, King’s College Hospital) for validating the classification of patient harm and the staff at the Department of Pharmacy King’s College London and Joint Programmes Board for supporting this research.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
James, K.L., Davies, J.G., Kinchin, I. et al. Understanding vs. competency: the case of accuracy checking dispensed medicines in pharmacy. Adv in Health Sci Educ 15, 735–747 (2010). https://doi.org/10.1007/s10459-010-9234-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10459-010-9234-7