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Dropping the pre-reg exam – an overview of arguments

Greg Lawton


A rundown of some of the arguments advanced for dropping the pre-reg exam. In no particular order.


1. In employment law, you’re a pharmacist if you’ve worked as one.


Answer: In employment law, if you’ve had certain arrangements for a period of time, you can acquire the status of ’employee’ or ‘worker’. It doesn’t change your profession and has nothing to do with regulation.


2. There’s a global pandemic.


Answer: This is unrelated to the need for an exam. Other professions are not campaigning for their exams to be scrapped. They have sat them and understand why they’re needed.


3. Provregs will have practised for months, so surely it would be safe.


Answer: Absence of evidence of risk is not evidence of absence of risk. You’d have also been practising to be a pharmacist for 12 months as a pre-reg, but still some 25% fail the exam.


4. Provregs will have practised for months so surely they’d be competent.


Answer: In that case, the exam shouldn’t be a problem, and if they completed it, it would give the public the assurance that it deserves.


5. It’s been really challenging during Covid.


Answer: Everyone understands that, and they sympathise and empathise. But it’s not about you, it’s about patients and the public. The public.


6. The exam is just parroting the BNF, so it’s not required.


Answer: The content of the exam is a separate discussion. But if it was really just parroting the BNF, it shouldn’t be a problem as all you have to do is demonstrate that you can use the reference source.


7. Pharmacists are saying “we had to do an exam, so should you.”


Answer: Have any really said that, or is that what you think they think? If they have, they’re missing the point. It’s about the public, not what they had to do.


8. Pharmacists won’t treat us the same if we don’t sit the exam.


Answer: See the last sentence in no. 7.


9. There are pharmacists on the register who didn’t sit an exam.


Answer: Practice evolves. Before 1868, people didn’t need to be pharmacists or have a degree to sell dangerous drugs. So by extension of your logic – if it was once okay then it must be now – we could do away with the degree and the profession too.


10. I’m busy, I don’t have time to sit it.


Answer: Working life do be like that, but it’s not about you. It’s about the public. The public. The people you’re joining a profession to care for and protect.


11. They shouldn’t have put us on the register in the first place if they were going to insist on an exam!


Answer: Necessary or not, it was always provisional, a balance of risks in a global pandemic. You accepted this, along with other conditions, when you voluntarily applied to join the register, and have been paid for your role.


12. There haven’t been any FtP issues to date, so what’s the problem?


Answer: Evidence of this? FtP cases can take two years to progress. Also, it’s not about immediate FtP issues being apparent, but risk.


13. Employers would support this too! They’d sign off the provregs!


Answer: I’m sure they would, they’d have a vested interest in it.


14. Provregs have done a stellar job during the pandemic.


A: Notwithstanding their commendable efforts during the pandemic, this is unrelated to the need for an exam.


15. I’ve worked in hospital, I’m confident I’ll pass.


Answer: Think beyond yourself. The discussion is about the entire cohort.


16. I’ve had pharmacists telling me I’m right. In fact, they’ve even liked and retweeted what I said!


Answer: Welcome to pharmacy Twitter, where some people’s self-interest, self-promotion and narcissism know no bounds!


The points from 17 onwards were added on 28.9.2020 in response to the counterpoints made by Jonny Blatchford in a letter to the editor that you can access here. 


17. The exam is just about memorizing information.


Answer: The exam is partly about memory. The same is true of your Uni exams, A-Levels etc., but that doesn’t devalue them. More significantly, the exam also tests your ability to use reference sources, understand scenarios and apply knowledge. It’s part of assessing whether you’ve met the learning outcomes for pharmacists’ initial education and training.


18. Memorizing information doesn’t reflect practice.


Answer: Clearly, memory plays an important part in practice. It is by no means the only important facet for pharmacists, but knowledge without needing to refer to reference sources on every occasion is important.


19. It is inaccurate to say that other professions have sat exams.


Answer. My understanding of the regulatory requirements for the UK and overseas doctors, dentists, nurses, solicitors and barristers is that the usual exams will remain a requirement before full or permanent registration.


20. The exam should be scrapped but we will prove competence in a different way.


Answer. How? It seems that a signoff of competencies wouldn’t be appropriate as this has already been done – 25% fail AFTER this signoff has been made. The tutor’s friend in the same business or organisation may be influenced to sign you off such assessments are subjective in any event. Not all pre-regs receive the same experience, training and opportunities, so the exam provides a fundamental baseline to ensure all candidates meet core criteria at the point of registration.


21. People could cheat if it was done online!


Answer: Online proctoring may be an appropriate solution. You use your webcam to show your ID and demonstrate that the room is empty, and are observed throughout. The exam can be done in a controlled software environment which prevents other applications from running at the same time. I understand that some providers can proctor large numbers of students (e.g. 2000) simultaneously, but due diligence would be needed on the provider. It may be that the exam needs be done in person when safe to do so, and socially distanced (c.f. the approach being taken in schools) with PPE as necessary.


22. If I sat the exam, I’d have to sit with 1000s of students during the Covid crisis!


Answer: Is it done surrounded by thousands of people, normally?


23. I have anecdotes from lecturers who recall that they sometimes worry about the ones who pass.


Answer: The system may let some people through who have FtP issues. This doesn’t mean that the exam (and, by extension of your logic) the pre-reg and the degree should all be scrapped.


24. Practice has evolved so maybe we shouldn’t have to sit it.


Answer: The reason you didn’t sit is Covid. Practice has not evolved so substantially since August (the date of provisional registration) that the exam is now no longer necessary for your cohort all of your training up to this point was tailored and geared towards an endpoint, on the understanding it would be supplemented by a pre-reg exam at the end – and you can’t change your earlier training retrospectively.


Greg Lawton is a pharmacist specialising in patient and medicines safety, staffing, data protection, privacy and healthcare policy. This piece is short and concise because it originally appeared on Twitter as a thread and has been reproduced with permission. You can find Greg on Twitter here. 



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