Advanced Clinical Practitioner Research Articles

Experiences of learning disability nurses within community nursing teams, working in collaboration with primary care

Background: The approach and understanding of healthcare systems and societies regarding people who have a diagnosis of learning disability (LD) varies across countries; however, it is widely reported that those with LDs report feeling disempowerment and devalued by those working in healthcare. When an individual is devalued, they are more likely to have poorer health outcomes. International human rights laws, such as the Convention on the Rights of Persons with Disabilities, set out an international responsibility to address LD-related inequalities and mistreatment. In England, LD nurses predominantly work within community teams to improve patients living with LDs' holistic access to healthcare and reduce the health inequalities they experience. Exploration of the literature failed to identify any relevant research on the specific role and experiences of the LD nurse within a community team. Aim: This study aimed to explore the lived experiences of a LD nurse working with LD patients within a community setting. The research was conducted by an advanced clinical practitioner (ACP). Method: Semi-structured interviews were used to gather data from four participants. These interviews were recorded and analysed for themes and repeat experiences. Data were analysed using Braun and Clark's (2006) six step model. Findings: LD nurses reported that their patients benefited when they worked collaboratively with primary care. Discussion: The LD nurse was shown to improve access to healthcare for people living with a formal diagnosis of LD or intellectual disability. However, the LD community nurse role is not well known or understood. The LD nurse, when working collaboratively with primary care, often becomes a ‘token’ role that is not utilised. Investment in the role is required to ensure it reaches its full potential. The ACP is best placed to lead on these recommendations and contribute to building the research base in this area of expertise. The role is essential in reducing health inequalities and improving holistic healthcare outcomes for adults with a LD living within the community in the UK. Recommendations: It is recommended that a LD nurse, primary care pathway and an outcome measure tool for workforce planning are implemented within the LD nurse community setting. Future research within and outside the UK is needed to explore the experiences of LD nurses in other geographical locations.

Examining advanced clinical practice from the perspective of a trainee advanced clinical practitioner

This article discusses advanced clinical practice from the perspective of a trainee advanced clinical practitioner (ACP). The commentary explores the four pillars of advanced practice with respect to the frailty specialty, taking both the author and a trainee ACP into account. The evaluation analyses the historical development of advanced clinical practice and the knowledge, skills and competencies expected at the advanced level. It highlights how support, colleague networking and supervision remain vital to the journey of trainee ACP, and influences the overall wellbeing of, and care given to, the patient.

Exploring advanced clinical practitioner perspectives on training, role identity and competence: a qualitative study

BackgroundAdvanced Clinical Practitioners (ACPs) are a new role that have been established to address gaps and support the existing medical workforce in an effort to help reduce increasing pressures on NHS services. ACPs have the potential to practice at a similar level to mid-grade medical staff, for example independently undertaking assessments, requesting and interpreting investigations, and diagnosing and discharging patients. These roles have been shown to improve both service outcomes and quality of patient care. However, there is currently no widespread formalised standard of training within the UK resulting in variations in the training experiences and clinical capabilities of ACPs. We sought to explore the training experiences of ACPs as well as their views on role identity and future development of the role.MethodsFive online focus groups were conducted between March and May 2021 with trainee and qualified advanced clinical practitioners working in a range of healthcare settings, in the North of England. The focus groups aimed to explore the experiences of undertaking ACP training including supervision, gaining competence, role identity and career progression. Thematic analysis of the focus group transcripts was performed, informed by grounded theory principles.ResultsFourteen advanced clinical practitioners participated. Analysis revealed that training was influenced by internal and external perceptions of the role, often acting as barriers, with structural aspects being significant contributory factors. Key themes identified (1) clinical training lacked structure and support, negatively impacting progress, (2) existing knowledge and experience acted as both an enabler and inhibitor, with implications for confidence, (3) the role and responsibilities are poorly understood by both advanced clinical practitioners and the wider medical profession and (4) advanced clinical practitioners recognised the value and importance of the role but felt changes were necessary, to provide security and sustainability.ConclusionsAppropriate structure and support are crucial throughout the training process to enable staff to have a smooth transition to advanced level, ensuring they obtain the necessary confidence and competence. Structural changes and knowledge brokering are essential, particularly in relation to role clarity and its responsibilities, sufficient allocated time to learn and practice, role accreditation and continuous appropriate supervision.

Use of a handheld real-time ultrasound unit in post-prostatectomy incontinence rehabilitation

Following surgery for prostate cancer, a 56-year- old man self-referred to a specialist pelvic health physiotherapist working in private practice. An assessment was performed, and a holistic treatment programme was implemented. The patient was an advanced clinical practitioner who concurrently employed real-time ultrasound as a biofeedback tool. This was part of a wider, physiotherapist-supervised programme of pelvic floor muscle training and overall rehabilitation. An early return to continence was achieved. While recognizing the limitations of the unique circumstances described, this case report discusses the possibilities that it raises with regard to: male pelvic health rehabilitation; the use of biofeedback tools; and access to information or adjuncts that might be usefully employed by physiotherapists working in this field.

Diagnosis and management of atrial fibrillation in primary care: a case study

This critically reflective case study will look at a 65-year-old male presenting with dyspnoea and an incidental diagnosis of atrial fibrillation (AF) in a primary care setting. The article critically analyses the diagnosis and management of the patient, considers potential differential diagnoses, current guidelines, and areas for service improvement. The author, a trainee advanced clinical practitioner (ACP) prescriber with a paramedic background, discusses the complexity of managing AF and the need for collaboration with a general practitioner. AF is a common cardiac arrhythmia associated with a significantly increased risk of stroke. The primary focus of AF management is stroke prevention. This article delves into the pathophysiology of AF, discussing its various causes and classifications, emphasising the role of left atrial appendage (LAA) in stroke risk. The limitations of AF screening methods, especially for paroxysmal AF, are also discussed. Recent advancements in opportunistic screening, including the use of artificial intelligence (AI) and smartwatches, show promise but require further research and validation. This article explores stroke risk assessment tools like CHA2DS2VASc and ATRIA, bleeding risk assessment using HAS-BLED and ORBIT scores, as well as rhythm control in newly diagnosed AF cases. Finally, the importance of lifestyle modifications and regular patient follow-up are underscored. AF diagnosis and management are multifaceted, involving stroke prevention, rate or rhythm control, and lifestyle modifications. Technological advancements hold promise in improving early AF detection. Collaborative efforts between healthcare providers and adherence to current guidelines are crucial in achieving optimal patient outcomes, while future practice may benefit from enhanced diagnostic screening and treatment options as further research unfolds.

Working in primary care: an advanced clinical practitioner's perspective.

Working in primary care: an advanced clinical practitioner's perspective.

Enhancing quality in same-day emergency care: a service improvement perspective

Background: Same-day emergency care (SDEC) units were introduced in the UK in response to growing numbers of emergency department visits. Key quality indicators for their performance include timely assessment, diagnosis and treatment to reduce delays and optimise care delivery. Aims: This article presents the findings from a multi-cycle service improvement project undertaken at a regional SDEC unit from the perspective of the advanced clinical practitioner (ACP). Methods: The SI project adopted an array of SI methodologies, including the Plan, Do, Study, Act model, process mapping and audit data analytics to identify and reduce variance in patient care. Results: The project identified the importance of adopting a whole-system approach to clinical leadership to improve the care experience of patients and staff. Success is highly dependent on the availability of a confident and skilled workforce to provide high-quality patient care. Conclusions: As demands on emergency health services continue to grow, the ACP is in an ideal position to adapt to change and generate innovative solutions to address capacity issues.

Improving care for cardiac patients with heart arrhythmias

Sue Armstrong, Advanced Clinical Practitioner, University Hospitals of Leicester NHS Trust ( suzanne.armstrong@uhl-tr.nhs.uk ), won a Bronze Award in the Cardiovascular Nurse of the Year Category in the BJN Awards 2023

From healthcare professional to degree apprentice.

In the UK, new degree apprenticeship opportunities are enabling non-medical practitioners to develop advanced roles. Frameworks to structure and standardise this development are also becoming more common. Knowing that historically healthcare professionals moving into advanced roles have experienced a transition period, we undertook a qualitative study to explore how this role transition - from healthcare professional to Advanced Clinical Practitioner (ACP) - was experienced in a degree apprentice programme. First year ACP degree apprentices were purposively selected from a cohort of 28 enrolled on a 3-year Masters programme at a UK University in 2021/22. Consenting participants took part in in-depth qualitative online semi-structured interviews, which were recorded, transcribed and analysed thematically. The five participants were in their first year of ACP training and represented core professional groups and primary, secondary and tertiary healthcare sectors. Five themes were identified: 1. what ACP apprentices bring; 2. reflections on how they see themselves; 3. how others see them; 4. effects of employing organisation's support; and 5. experience of Masters level learning. ACP apprentices experienced a strong and often difficult transition period at the beginning of their training. The themes identified as influencing this could be used by higher education providers and clinical workplaces to better understand this period in training. Specifically, having a clear transition point to a defined role; a reduced workload during the transition period; and improved information sharing to better prepare workplaces for trainees, could all improve the experience.

HPB P10 The impact of an electronic referral system for tertiary pancreatitis referrals

Abstract Background In the Leeds catchment, pancreatitis referrals were made ad hoc via telephone or email. This was frequently by a junior team member and essential information was frequently absent. Frustratingly the referring teams did not know who to contact and often had to make multiple calls. There was no record of these referrals and the advice provided. As a Quality Improvement we instituted an electronic referral system. Methods An Electronic referral system (Patient Pass, already within the Trust) was utilised. We developed a simple questionnaire for the referrer to complete. This was accessed via a hyperlink on the Leeds Pancreas Unit website. Images could be reviewed using a regional El Xero server without the need for image transfer This was implemented in September 2021. The system is monitored Monday to Friday by either an Advanced Clinical Practitioner or by the senior registrar/fellow. Information and scans are reviewed, and all cases discussed with the on call pancreas consultant. A survey was sent to all users in secondary care. Results 166 referrals in 21 months , Average response time from initial referral was under 3 hours. 46/166 transferred to LTHT. Average number of responses per individual referral. Overall satisfaction was over 80% from secondary care. The Pancreas team has found it easier to provide timely accurate advice on a complete set of data, especially the immediate access to images. Conclusions An electronic referral system has led to increased satisfaction for referrers. The system has led to an open, auditable, visible, referral and advice process. This has allowed patients to remain in the local hospital closer to home and visitors until the time intervention is needed or appropriate.

A virtual heart failure ward in a rural demography

Abstract Background Lincolnshire is a large rural county in the UK with wide economic variation, social deprivation, poor communication infrastructure and no large urban centre of population. As a result of these factors we have a significant incidence of heart failure and a variation in access to services. As part of a county wide initiative to improve the care of patients with heart failure and to reduce acute reduce admissions to hospital we introduced a virtual heart failure ward in January 2022. The ward is overseen by the community cardiology heart failure specialist nurses and led by a cardiology Advanced Clinical Practitioner (ACP) - a multi-professional worker educated to Level 7 with the ability to prescribe and request procedures/ investigations. Governance is from the acute cardiology team via multi-disciplinary meetings. Patients who are decompensating that historically would have required admission can be 'admitted' to the ward and patients who have been admitted to the acute hospital can also be admitted/ stepped down to facilitate discharge. The ward is supported by a 7/7 (expanded from 5/7 to support the project) specialist nursing team, weekly ward rounds, telemedicine (multi-provider app), remote monitoring (oximetry/ weight/ BP), outpatient IV furosemide, specialist heart failure rehabilitation (F2F and remote) and supports a seamless service between primary, community and secondary care. Results In the first 13-months N=213 patients were treated via the virtual ward. N=137 (64%) 'step up, N=75 (35%) step down, N=1 (self-referral), see figure one. N=194 patients were discharged. N=25 (12%) were admitted for escalation of care, see figure two. In the first year, we estimate that the virtual ward released 1,147 acute bed days (1,033 admission prevention and 114 early discharge) and delivered a cost reduction of approximately to £1m. An external audit team has identified a 10% reduction in heart failure admissions to the acute hospital. PROMS (patient recorded outcome measures) show high patient satisfaction and staff have found the enhanced 7/7 service beneficial and rewarding. Discussion Our experience of implementing a virtual heart failure ward in a rural demography has been exceedingly positive. We have observed significant reductions in admissions, facilitated early discharged from hospital with high patient and staff satisfaction. this intervention has also delivered a substantial cost saving to the wider health economy.Step Up/ Step DownDischarge Destinations

A115Developing a simulation course for Advanced Clinical Practice-Challenges of designing for a diverse interprofessional group

There is increased availability and development of the advanced clinical practitioner (ACP) course to upskill allied health professionals in clinical, leadership and supervision areas [1]. Locally, ACPs and ACPs in training have not previously had simulation integrated into their training for this role despite this being considered an effective learning method for communication skills [2]. The simulation department was approached with funding to develop a course to add variation to their development programme and enhance learning in areas better targeted through simulation. A survey was sent to the ACP cohort to ascertain their desired learning objectives from simulation training. Then the team met a focus group of ACP trainees to further explore their varied roles and the expected changes moving to the ACP role. From this research, a 1-day course was developed to include scenarios with themes felt to be widely applicable across the umbrella of ‘advanced clinical practice’. Examples included; managing patient expectations, challenging hierarchy, safeguarding, learning disability, mental capacity assessment, difficult supervision. Two courses have been completed with a mix of ACP roles, and scenarios adapted to apply to the specific participants. The debriefs explored how the scenario theme could be applied cross discipline and gave an opportunity for these senior healthcare professionals to share experiences and their individual management strategies. This was a stimulating but challenging course to develop given the seniority and multidisciplinary background of the target group. This required significant creativity and adaptability from the organizing team and multiple scenarios to be designed for participants. The courses generated valuable discussion and all candidates reported the day to be a useful experience with specific learning and development taken from the day. Limitations included some allocated scenarios were felt to be outside the usual job remit of the allocated participant, which could impact on the authenticity and psychological safety of the scenario for that candidate. Despite this, useful discussion of the intended themes was still possible, and this was reinforced by the experience brought from the candidates present. Even though ACPs may have similar more complex learning needs in line with their required capabilities, this is challenging to translate into a transferable and valuable simulation course when targeting multiple disciplines with varying amounts of senior experience. We reflect on ways to approach this in the future and would be open to opinions from our esteemed education colleagues. Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

Exploring collaboration in the implementation of a national assessment strategy: perspectives of advanced practice educators

Background: Despite an increasingly competitive market, collaboration on course design between higher education institutes (HEIs) is still relatively under-researched, particularly in the UK. With the implementation of advanced clinical practice apprenticeships, this study focused on a series of workshops facilitated by the Association of Advanced Practice Educators UK (AAPEUK). These workshops aimed to ensure that faculty staff of HEIs, who were intending to deliver the advanced clinical practitioner (ACP) apprenticeship end-point assessments (EPAs), were informed and provisions met the requirements of the EPA assessment plan. Method: This study used a mixed methodology to explore perceptions of the UK's collaborative community of practice, which has been developed in relation to a national assessment strategy, the ACP Apprenticeship EPA ( Institute for Apprentices and Technical Education 2018 ). The survey used open and closed questions, and data and results were analysed separately. The participants of this study were all members of the End Point Assessment Organisation Network (EPAO). Results: The study collected both quantitative and qualitative data from 16 participants to understand their experiences in the EPAO Network. The thematic analysis of the data resulted in three key themes: collaboration, support, and quality and consistency. Discussion: The respondents found creating an environment where sharing experiences in an honest, open and generous group, and supporting each other, were valued. Such measures drove professional growth and empowered educators in the implementation of the ACP EPA. Conclusion: The study's findings demonstrated the benefits of learning communities working as a community of practice, and the positive impact that collaboration had on individuals and faculties in higher education settings.

Design and Evaluation of an Intensive Care Unit Dashboard Built in Response to the COVID-19 Pandemic: Semistructured Interview Study.

Dashboards and interactive displays are becoming increasingly prevalent in most health care settings and have the potential to streamline access to information, consolidate disparate data sources and deliver new insights. Our research focuses on intensive care units (ICUs) which are heavily instrumented, critical care environments that generate vast amounts of data and frequently require individualized support for each patient. Consequently, clinicians experience a high cognitive load, which can translate to suboptimal performance. The global COVID-19 pandemic exacerbated this problem by generating a large number of additional hospitalizations, which necessitated a new tool that would help manage ICUs' census. In a previous study, we interviewed clinicians at the University Hospitals Bristol and Weston National Health Service Foundation Trust to capture the requirements for bespoke dashboards that would alleviate this problem. This study aims to design, implement, and evaluate an ICU dashboard to allow for monitoring of the high volume of patients in need of critical care, particularly tailored to high-demand situations, such as those seen during the COVID-19 pandemic. Building upon the previously gathered requirements, we developed a dashboard, integrated it within the ICU of a National Health Service trust, and allowed all staff to access our tool. For evaluation purposes, participants were recruited and interviewed following a 25-day period during which they were able to use the dashboard clinically. The semistructured interviews followed a topic guide aimed at capturing the usability of the dashboard, supplemented with additional questions asked post hoc to probe themes established during the interview. Interview transcripts were analyzed using a thematic analysis framework that combined inductive and deductive approaches and integrated the Technology Acceptance Model. A total of 10 participants with 4 different roles in the ICU (6 consultants, 2 junior doctors, 1 nurse, and 1 advanced clinical practitioner) participated in the interviews. Our analysis generated 4 key topics that prevailed across the data: our dashboard met the usability requirements of the participants and was found useful and intuitive; participants perceived that it impacted their delivery of patient care by improving the access to the information and better equipping them to do their job; the tool was used in a variety of ways and for different reasons and tasks; and there were barriers to integration of our dashboard into practice, including familiarity with existing systems, which stifled the adoption of our tool. Our findings show that the perceived utility of the dashboard had a positive impact on the clinicians' workflows in the ICU. Improving access to information translated into more efficient patient care and transformed some of the existing processes. The introduction of our tool was met with positive reception, but its integration during the COVID-19 pandemic limited its adoption into practice.

Septic pulmonary emboli: a case discussion.

A septic pulmonary embolus occurs from the embolisation of an infected thrombus - typically from an infected source such as an abscess - that enters the venous circulation, implanting in the lungs, which in turn causes a parenchymal infection. This case discussion gives a candid reflection on the treatment and management of a patient who was a known intravenous drug user, with a past history of a deep vein thrombosis and new presentation of a groin abscess. He was initially reviewed by a trainee advanced clinical practitioner, working out of hours in a hospital setting. This article will reflect on the patient presentation, the clinical examinations and investigations undertaken, which finally led to the diagnosis of septic pulmonary emboli. Although this condition is rare, having a high index of suspicion in patients with known risk factors may lead to early diagnosis and successful treatment.

Advanced Clinical Practitioner role for dietitians to act as Second Operators in Percutaneous Endoscopic Gastrostomy Tube placement in a District General Hospital setting

Advanced Clinical Practitioner role for dietitians to act as Second Operators in Percutaneous Endoscopic Gastrostomy Tube placement in a District General Hospital setting

WTP7.3 Advanced Clinical Practitioner (ACP) led Surgical Same Day Emergency Care (SSDEC) has transformed emergency surgical workflow with high levels of satisfaction

Abstract Aims ACPs offer senior assessment to emergency general surgical patients and have changed the face of emergency surgical assessment and care. To demonstrate success of SSDEC through increasing numbers seen though the service, less patients assessed through ED, more timely assessment, and expedited ward discharges within a competent and safe environment. To demonstrate staff (ACP and Consultant) and patient confidence and satisfaction. Methods Data will be collected from service provision dashboards, locally collected data including Incident Reporting and the newly introduced electronic patient record. Surveys are used for patient, consultant and ACP feedback. Results The number of patients seen through SSDEC has increased from an average of 25 per week in 2017 to 125 per week in 2023. Patients dealt with in SSDEC alleviate pressure on ED and the surgical team. Survey results demonstrate that surgical consultants feel that SSDEC has improved their emergency experience, patient experience and there is confidence in the ACPs competence. Surgical ACPs felt clinically supported and had confidence in their own clinical autonomy. 93% of patients were very satisfied or satisfied with their practitioner and experience. Conclusion An ACP led surgical SDEC leads to high levels of patient satisfaction with consultants feeling confident in ACP competence to assess and manage emergency surgical patients. Moreover, the ACPs report feeling autonomous, confident, supported and satisfied in their job.

The 'scan and treat' clinic; early evaluation of an advanced clinical practitioner (ACP) led combined echocardiography and outpatient cardiology clinic

Abstract Funding Acknowledgements Type of funding sources: None. Background There is increasing recognition that traditional models of hospital-based outpatient care in England are inefficient, unsustainable and do meet patient’s needs and preferences (RCP 2018). The National Health Service (NHS) ‘getting it right fist time’ (GIRFT) report for cardiology makes a number of recommendations including; increasing the utilisation non-medical roles such as Advanced Clinical Practitioners (ACPs), reducing face to face appointments, and triaging referrals with tests performed ahead of clinic appointments (NHS, 2021). We developed a novel clinic combining formal echocardiography with clinical assessment by a single British Society of Echocardiography (BSE) accredited ACP at medium sized district general hospital (DGH) in the west Midlands, England. No clinics of this type were identified in the literature, although there are studies demonstrating the efficacy of physiologist led valve clinics (Wasing et al., 2009) and cardiologist led ‘one stop’ clinics (Falces et al., 2008) Purpose To evaluate the case mix and early outcomes of the first 6 months of the scan and treat clinic. Methods Patient demographics, reason for referral and clinic actions were collected prospectively on an excel spreadsheet. A single un-blinded cardiologist reviewed the electronic patient records and echo images of 10 randomly selected patients from the first 3 months to assess the accuracy and appropriateness of documented diagnoses and treatment plans. Results 72 patients were seen over 11 clinics between July and December 2022. There was a low (6%) non-attendance rate, although a further 5 patients (7%) did not require an echo, due to booking errors. The most common reason for referral was suspected heart failure (33%) (table 1). Combined Heart Failure (HFrEF, HFmrEF, HFpEF) was also the most common primary diagnosis in the clinic (32%) (figure 1). There was a low rate of non-cardiac diagnoses (19%) and normal echocardiograms (33%) (figure 1). Clinic actions included prescribing (54%), cardiac monitors (24%), further imaging (15%) and blood tests (11%). The Cardiologist reviewer reported appropriate diagnosis and treatment of 10 radomly selected cases. Of 7 patients followed up in a cardiologist clinic before 10/01/2023, 5 had no significant changes in treatment or diagnosis, 1 patient had a pacemaker for asymptomatic 2nd degree AV block and another had Bisoprolol stopped due to side effects. Conclusion These preliminary results suggest the ‘scan and treat’ clinic is a viable alternative to traditional general cardiology clinic for patients who also require echocardiography. This review has a number of limitations including limited short term follow up, un-blinded cardiologist review and is not generalizable. This kind of initiative may help modernise and improve cardiology outpatient services. Further research is required to assess the efficacy of similar non-cardiologist led ‘one-stop’ clinic designs.Table 1Figure 1

A qualitative interview study applying the COM-B model to explore how hospital-based trainers implement antimicrobial stewardship education and training in UK hospital-based care

BackgroundAntimicrobial resistance (AMR) is a major global health threat caused by the inappropriate use of antimicrobials in healthcare and other settings. Antimicrobial stewardship (AMS) is a broad multi-component health services intervention that promotes and monitors the judicious use of antimicrobials to preserve their future effectiveness. A main component of AMS is education and training (E&T). However, there are often discrepancies in how such interventions are implemented and delivered in hospital-based care. The aim of this study was to explore the factors influencing the implementation of AMS E&T in UK hospitals.MethodsSemi-structured interviews were carried out with AMS E&T trainers in UK hospitals. The interview schedule was developed using the Capability, Opportunity, Motivation = Behaviour (COM-B) model. Participants were identified via professional networks and social media. Interviews were analysed using inductive thematic analysis, followed by deductive analysis using the COM-B model as a framework.ResultsA total of 34 participants (26 antimicrobial pharmacists, 3 nurses, 1 advanced clinical practitioner, 2 infectious disease consultants, 1 microbiologist and 1 clinical scientist). responsible for designing, implementing and evaluating AMS E&T in UK hospitals (five from Northern Ireland, four from Wales, two from Scotland and 23 from England) took part in virtual interviews. Key themes were: (1) The organisational context, including system-level barriers to AMS included competing organisational targets (Reflective motivation and physical opportunity) and the impact of the COVID-19 pandemic on activity (Physical opportunity); (2) Healthcare professionals’ roles and the wider multi-disciplinary team, such that AMS roles were defined and addressed poorly in E&T (Social opportunity); and (3) The individual perception of the need for AMS E&T in hospital-based care, manifest in a perceived lack of conviction of the wider threat of AMR and the resulting need for AMS E&T (Reflective motivation).ConclusionThis study has identified factors influencing implementation of AMS E&T in UK hospitals and further identified where implemented, AMS E&T did not address real-world challenges. Current AMS E&T needs to be optimised to elicit practice change, with recommendations including training and engaging the wider work-force and drawing upon theoretically-informed intervention development frameworks to inform AMS E&T to better target AMS behaviour change.

Pharmacy professionals’ perceptions of educational supervision in primary care through the lens of Proctor’s model

BackgroundEducational supervision plays a vital role in postgraduate medical education and more recently in pharmacy and advanced clinical practitioner training in England. Proctor’s three-function model of clinical supervision (consisting of formative, restorative, and normative functions) is assumed to apply to educational supervision, but this has not been tested empirically. The aim of this study was to establish perceptions of the purpose of educational supervision from the perspective of primary care pharmacy professionals enrolled on a national training pathway in England.MethodsUsing a mixed methods design, data were collected using a validated 25-item online survey and respondents were invited to add comments explaining their responses. The survey was sent to all 902 learners enrolled on a postgraduate training pathway for pharmacy professionals working in primary care. Principal components analysis (PCA) was used to interpret patterns in the survey data, and framework analysis of qualitative free text comments was used to identify themes and aid interpretation of quantitative findings.ResultsOne hundred eighty-seven pharmacy professionals responded (response rate 20.7%). PCA extracted three factors explaining 71.5% of the total variance. Factor 1 corresponded with survey items linked to the formative function of Proctor’s model, while factor 2 corresponded with survey items linked to the restorative function. No items corresponded with the normative function. Framework analysis of qualitative free-text comments identified two themes: learning support, which corresponded with factor 1; and personal support, which corresponded with factor 2.ConclusionsThis study identified that pharmacy professionals perceived educational supervision to perform two functions, formative (educational) and restorative (pastoral), but did not perceive it to perform a normative (surveillance) function. Educational supervision has the potential to support allied health professionals advancing their roles and we suggest the need for more research to develop models of effective educational supervision which can inform practice.