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Background: Following the MPharm degree, the pre-registration training year is a critical time where the values, attitudes and behaviours of qualified pharmacists are inculcated. Given the paucity of research, a programme of work was undertaken to explore the process of professional socialisation and development of professionalism in trainees during the pre-registration year. Method: The programme of work, the first of its kind in pharmacy, explored the process of professional socialisation and development of professionalism in trainees prospectively during the 2011/12 pre-registration year. A purposive sample of 20 pre-registration trainee-tutor pairs - 14 from community and 6 from hospital pharmacy – were recruited across North West England. Semi-structured interviews and behavioural professionalism questionnaires were used longitudinally in four rounds of data collection during the training year and with newly qualified pharmacists (NQPs; formerly trainees). A cross-sectional survey was administered to 1706 trainees towards the end of the training year to examine areas explored in the longitudinal study, including behavioural professionalism, supervision and ‘patient mattering’. Interviews were analysed thematically using template and framework analyses, and the critical incident technique. Quantitative data was analysed using descriptive and multivariate analyses. Results: Findings demonstrated that many of trainees’ attitudes and values appeared to be fostered during their upbringing and were further shaped by the MPharm degree, laying out professional expectations for pharmacists. At the beginning of training, sector differences were apparent with more formalised inductions in place in hospital than community pharmacies, particularly independents. Previous pharmacy work experience, which all 20 trainees had undertaken during MPharm studies, facilitated the transition into training. Early on in the year, as trainees familiarised themselves with the organisation and working processes they were often supported by pharmacy technicians and other support staff and trainees worked effectively and in a professional manner with them throughout training. The application of clinical knowledge acquired from the MPharm degree was challenging, as recognised by trainees and tutors. With continued practice experience and increased responsibility and patient contact, abilities in applying clinical knowledge and communicating with patients improved, as did trainees’ confidence. Longitudinal ratings of behavioural professionalism increased significantly during training, as assessed by trainees and their tutors, and this was confirmed in the analysis of a representative sample of 347 trainees that were surveyed (response rate = 24.2%). Survey findings showed how elements of behavioural professionalism such as communication skills were more prone to development compared to, for example, appearance and interpersonal skills. Perceptions of supervision received during the training year were generally positive. The pre-registration tutor was a key source of support, as well as role model, throughout the year, particularly in community pharmacy. Hospital tutors had a more distant relationship with their trainees and relied on other pharmacists to supervise their trainees. Tutors were often considered to have the largest impact on the development of professionalism in trainees, particularly in community. When considering aspects of their supervision, hospital trainees rated their tutors significantly higher than those in community in ‘articulation’ and ‘exploration’, relating to asking trainees for rationale of actions and encouraging them to pursue learning goals, respectively. Differences between training sites, such as the pharmacy services being delivered and patient mix, were found as were trainees’ beliefs that they mattered to patients: community trainees believed they mattered more (e.g. were more helpful) to their patients than hospital trainees. Conclusions: The multiple methods employed in this programme of work revealed experiences trainees faced and contributing factors associated with their professional socialisation and development of professionalism. The findings led to recommendations for pharmacy education and training including: integrating university-based and work-based learning more closely, ensuring consistency in training experiences in different settings and sectors, improving training and support for staff involved in training and setting explicit standards relating to elements of professionalism. These are considered in the context of anticipated changes to the MPharm into a more integrated 5-year degree programme.

Healthcare education is continually evolving to reflect therapeutic advances in patient management. Society demands assurances regarding the ongoing competence of HCPs including pharmacists. The use of OSCEs to evaluate competence of medical staff as well as nurses is well documented in the literature however evidence of its use with undergraduate pharmacy students is still sparse.

This thesis explores the notion of professionalism in pharmacy from a pharmacy education viewpoint, specifically the process of becoming a ‘professional’ as experienced by pharmacy students as they undertake the educational programme required for registration as a pharmacist. Registration as a pharmacist is commonly understood as an end-point in becoming a professional, portraying the educational programme as an acquisitional endeavour where upon completion, an individual has become a professional. Such understandings are problematic as they disguise the complex, uncertain and individual journeys that students experience as they undertake an educational programme that portrays becoming a professional as a static, linear process rather than an on-going negotiation and emergence of professional selves. This study adopts a social constructionist framework to explore the experiences of pharmacy students at one Higher Education Institution (HEI) in the United Kingdom. Rejecting positivistic notions of control, prediction and generalisability this study uses an interpretive approach to the generation and analysis of interview data to gain understandings of the individual and local experiences of pharmacy students at this particular HEI. Interviews were conducted with nineteen students who prepared a repertory grid to describe their own constructions of an ‘ideal’ pharmacist and the grids were used as a catalyst for discussion in individual participant interviews. Using the repertory grid approach afforded an insight into pharmacy students’ experiences of ‘becoming’ a pharmacist, revealing themes and patterns emerging from analysis of student narratives. Drawing on Actor Network Theory (ANT) as a theoretical lens to explore these themes and patterns from a socio-material perspective, the micro-interactions and exchanges that emerged from these networks exposed the innumerable realisations of ‘becoming’ a pharmacist. Tracing some of these networks in this thesis revealed a number of powerful actors in these micro-interactions and exchanges. When considered individually these actors appear inconsequential, however, collectively these micro-interactions and exchanges reveal the highly individualised, complex and uncertain experience of ‘becoming’ a pharmacist. In coming together these non-human and human actors emerge as a driving force in the emergence of student identities as a pharmacist. This study makes an original contribution to pharmacy education by revealing the uncertainty that pharmacy students experience in ‘becoming’ a pharmacist. It identifies that this experience is highly individualised and personal to each student and argues for embracing uncertainty as a helpful and essential experience of ‘becoming’ a pharmacist.

The need to incorporate interprofessional education (IPE) as part of any healthcare profession curricula is growing in an approach to prepare a collaborative practice-ready workforce. Pharmacy students should be equipped with the necessary competencies and skills needed for them to practise interprofessionally, commensurate with the expanding and evolving role of the pharmacist. Thus, the Qatar University College of Pharmacy has decided to incorporate IPE initiatives formally into the pharmacy curriculum in collaboration with other healthcare institutions in Qatar to meet the accreditation standards set by the Canadian Council for Accreditation of Pharmacy Programs (CCAPP) and fulfil the recommendations set in the World Health Organization (WHO) framework. To implement effective IPE strategies, it is important to consider the prior attitudes and expectations of various stakeholders in the process -- particularly students, faculty, and practising pharmacists. The overall aim of this PhD research is to explore the pharmacy perspectives of IPE and collaborative practice from a Middle Eastern context. The research started with a comprehensive systematic review of the literature focusing on the perspectives of pharmacy students, pharmacy faculty, and practising pharmacists on IPE and collaborative practice. Five themes have been identified from the systematic review: inconsistency in reporting IPE research, professional image of the pharmacist, lack of longitudinal follow-up, lack of IPE research on faculty, and lack of mixed method studies. This was followed by three sequential explanatory mixed method designs, to explore the perception of faculty, students, and practising pharmacists, individually. This was undertaken to gain an in depth understanding of the strengths and challenges of each group that can affect the implementation and perspectives toward IPE and collaborative practice. Two data collection methods were used: quantitative surveys and qualitative focus groups. Quantitative data were imported into SPSS® version 22 and analysed using both descriptive and inferential statistics. Qualitative data from the focus groups were analysed using thematic analysis. For the quantitative surveys, the overall response rate was 117 out of 334 (35%) for pharmacy faculty in the Middle East, 102/132 (77%) for pharmacy students in Qatar and 178/285 (63%) for practising pharmacists in Qatar. This was followed by seven focus groups with a total of 51 participants. Findings, from both the survey and focus groups, support that students, faculty and practising pharmacists are ready to engage in IPE and collaborative practice. The findings further identified positive attitudes that reinforce the need to incorporate IPE into healthcare curricula. They perceive anticipated benefits to them as professionals and to the patients. However, a large number of challenges have been highlighted, including the existence of a hierarchical culture, pharmacists’ role and image, a weak sense of professional identity among pharmacists, their marginalised contribution, resistance from the healthcare teams to the evolving role of the pharmacists, and the heterogeneous background of healthcare professionals. Promisingly, the education and healthcare system in Qatar is undergoing significant changes with some positive influences noted within education and practice settings. This is the first study investigating pharmacy perspectives of IPE in Qatar, the Middle East, and worldwide. The findings from this research generated a body of knowledge regarding the pharmacy perspectives of IPE and provided a better understanding of what shapes this perspective from a Middle Eastern context. The research presents a new model based on collective input, efforts, and readiness in five key stages: academic institution, faculty, student, practice, and environment. The model moves beyond focusing on the individual stages separately and expands to consider the complexity of linking and aligning the stages together. Coordinated efforts, between the stages, focused on a more comprehensive and holistic implementation, is essential for successful implementation of IPE and collaborative practice.