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Advanced and Extended Pharmacy Practice
An environmental snapshot September 2013

Australian Pharmacy Council Ltd Advanced and Extended Pharmacy Practice
ABN: 45 568 153 354
ACN: 126 629 785 An environmental snapshot September 2013
Level 2, Ethos House
28-36 Ainslie Place
Canberra ACT 2601
AUSTRALIA
PO Box 269
Civic Square ACT 2608
Telephone: +61 2 6262 9628
Fax: +61 2 6247 9611
Email: admin@pharmacycouncil.org.au
Website: www.pharmacycouncil.org.au
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Contents
Glossary of Terms......................................................................................................................................................................5
List of Tables...............................................................................................................................................................................7
List of Figures............................................................................................................................................................................7
List of Abbreviations...............................................................................................................................................................8
The Australian Pharmacy Council Ltd (APC) is an independent body engaged, in the public interest, in Preamble................................................................................................................................................................................... 11
the development and assurance of education, training and assessment standards. The APC holds the 1. Introduction.................................................................................................................................................................... 13
assignment for accreditation for pharmacy from the Pharmacy Board of Australia under the National
2. Background..................................................................................................................................................................... 13
Registration and Accreditation Scheme.
3. What is Advanced Practice?.................................................................................................................................... 14
3.1 Advanced Practice in Professions other than Pharmacy.............................................................................. 14
3.1.1 Recognition Process.......................................................................................................................................... 14
Australian Pharmacy Council Advanced and Extended Practice Steering Committee
3.1.2 Recognition Terminology.................................................................................................................................. 15
John Low President, Australian Pharmacy Council 3.1.3 Generalist Practice............................................................................................................................................. 15
Prof Nick Shaw Councillor, Australian Pharmacy Council;
3.1.4 Specialist Practice.............................................................................................................................................. 15
Member, Australian Pharmacy Council Accreditation Committee
3.1.5 Advanced, Extended, Expanded Practice..................................................................................................... 16
Dr Ian Coombes Councillor, Australian Pharmacy Council
3.2 Advanced and Extended Practice in the Pharmacy Context........................................................................ 19
Debra Rowett Councillor, Australian Pharmacy Council;
3.2.1 Pharmacist competence................................................................................................................................... 20
Chair, Australian Pharmacy Council Accreditation Committee
3.2.2 What is Advanced Pharmacy Practice?....................................................................................................... 20
Andrew Matthews Member, Australian Pharmacy Council Accreditation Committee
Dr Mark Rowe Member, Australian Pharmacy Council Examining Committee 3.2.3 What is Extended Pharmacy Practice?........................................................................................................ 21
ADVANCED AND EXTENDED PHARMACY PRACTICE | AN ENVIRONMENTAL SNAPSHOT

Tricia Greenway Councillor, Community Representative, Australian Pharmacy Council 3.2.4 Benefits of Recognising Advanced Practice............................................................................................... 24
Bronwyn Clark Chief Executive Officer, Australian Pharmacy Council 3.2.5 State of Play: Advanced and Extended Pharmacy Practice in Australia........................................... 25
Rachel Adkins Director, Accreditation, Australian Pharmacy Council
3.3 Defining Terminology............................................................................................................................................ 27
The Australian Pharmacy Council wishes to acknowledge the valuable contribution of the following 4. Literature review of accreditation pathways................................................................................................... 28
consultants in the authoring of this document:
4.1 Accreditation pathways – Pharmacy.................................................................................................................. 28
Dr Charles Mitchell
4.1.1 Accreditation in other countries.................................................................................................................... 28
Lynda Cardiff
Karen Bettenay 4.1.2 Australian Pharmacy Council Accreditation processes........................................................................... 34
Elaine Lum 4.2. Accreditation pathways – Other Healthcare Professions............................................................................ 35
4.2.1 Medical profession............................................................................................................................................. 35
4.2.2 Dental practitioners........................................................................................................................................... 39
4.2.3 Nursing profession............................................................................................................................................. 39
4.2.4 Physiotherapy...................................................................................................................................................... 42
© Australian Pharmacy Council, 2013. All rights are reserved. No part of this publication may 4.2.5 Psychology............................................................................................................................................................ 45
be reproduced, stored in a retrieval system or transmitted in any form or by any means,
4.2.6 The Cost Associated with Recognition of Advanced and Extended Practice................................... 49
electronic, mechanical, photocopying, recording or otherwise, without prior permission of the Australian
Pharmacy Council Ltd.
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5. Literature review of assessment technologies and methods.................................................................... 53 Glossary of Terms
5.1 Assessment Methods............................................................................................................................................... 53 Where available definitions from national Australian entities have been used in preference to those of
5.1.1 Multiple Choice Questions.............................................................................................................................. 53 international organisations.
5.1.2 The Objective Structured Clinical Examination........................................................................................ 55

5.1.3 Multi-Source Feedback................................................................................................................................... 56 Accredited (Adj) Used to describe an organisation*, site, or program that meets certain
5.1.4 Portfolio................................................................................................................................................................ 58 established qualifications or standards, as determined through initial and
periodic evaluations, e.g. an accredited program.
5.1.5 Viva Voce.............................................................................................................................................................. 60 Adapted from reference(1)
*Organisation here includes institutions, corporations, universities,
5.1.6 Case-based Discussion.................................................................................................................................... 61
colleges, schools, and health systems.
5.1.7 Direct Observation of Competency.............................................................................................................. 63 Accreditation Accreditation of a program/ course against defined standards to ensure
5.2 Blended models for assessment........................................................................................................................... 64 that the education and training leading to registration as a health
6 References...................................................................................................................................................................... 69 practitioner is rigorous and prepares graduates to practise a health
Adapted from reference(2) profession safely.
7 Appendices..................................................................................................................................................................... 81
Advanced practice(3) Practice that is so significantly different from that achieved at initial
Appendix A: Certification Requirements in the USA............................................................................................... 83 registration that it warrants recognition by professional peers and the
Appendix B: Advanced and Extended Practice in Other Countries: Supporting Organisations............ 89 public of the expertise of the practitioner and the education, training and
experience from which that capability was derived.
Note: This definition comes from the pharmacy profession. Definitions
from other professions (where available) have been included in the report.
Area of practice Refers to the clinical field of practice e.g. renal, paediatrics, cardiology,
oncology.
Certification Certification is a voluntary process by which a non-governmental agency


or an association grants recognition to an individual who has met certain
predetermined qualifications specified by that organisation.
Adapted from reference(1)
This formal recognition is granted to designate to the public that
the individual has attained the requisite level of knowledge, skill,
and experience in a well-defined, often specialised, area of practice.
Certification usually requires initial assessment and periodic
reassessments of the individual’s knowledge, skill, and experience.
Certified (Adj) Used to describe an individual who holds certification.

Credential (noun) Documented evidence of professional qualifications.
Credentials include academic degrees, diplomas, licences, certificates, and
certifications.
Credential (verb) See credentialing.
Credentialing(4) Process by which an authorised organisation/ body reviews and verifies a
practitioner’s qualifications, skills, experience and competencies against
defined standards.
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Endorsement An endorsement of registration recognises that a person has an extended List of Tables
scope of practice in a particular area because they have demonstrated Table 1. Comparison of the use of terminology associated with advanced and
competence and an additional qualification that is approved by the extended practice roles....................................................................................................................................................... 18
National Board.
Entry to Practice Qualifications and experience a practitioner holds at the commencement Table 2. Selected key terms used in other countries............................................................................................... 34
of practice. Includes formal education qualifications and any experience Table 3. Recognition of advanced and extended practice by other healthcare
the practitioner has gained during the process of training. professions in Australia...................................................................................................................................................... 48
Extended Practice An extension of existing scope of practice requiring additional education
and training and a demonstration of competence. Table 4. Costs associated with recognition of advanced practice...................................................................... 51
Note: This definition is in the context of the pharmacy profession.

Definitions from other professions (where available) have been included in
the report. List of Figures
License(1) A credential issued by a state or federal body indicating that the holder is Figure 1. Examples of the use of terminology associated with advanced and
in compliance with the minimum mandatory governmental requirements extended practice.................................................................................................................................................................. 20
necessary to practice in a particular profession or occupation.
Licensure(1) The process of gaining a licence. Figure 2. Health Professionals Prescribing Pathway (April 2013 draft version).......................................... 23
Pharmaceutical review Pharmaceutical review is a minimum standard of systematic appraisal Figure 3. Process for training and recognition of a medical officer as a specialist.................................... 37
of all aspects of patients’ medication management conducted (or
supervised) by a qualified and suitably trained healthcare professional Figure 4. Miller’s pyramid................................................................................................................................................... 55
Adapted from reference(5) (ideally a pharmacist) acting as part of a multidisciplinary team. It
Figure 5. Percentage of each competency domain tested by assessment method
includes objective review of medication prescribing, dispensing,
(adapted from Stern, D: The assessment of global minimum essential requirements in
distribution, administration, monitoring of outcomes and documentation
medical education)................................................................................................................................................................. 66
of medication-related information in order to optimise the quality use of
medicines.

Portfolio Formal documentation of training, achievements and experience.
Prescribing(4) The information gathering, clinical decision making and communication
steps involved in the initiation, continuation or cessation of a medication,
remedy or treatment for a specific patient.
Privileging(1) The process by which a healthcare organisation, having reviewed an
individual healthcare provider’s credentials and performance and found
them satisfactory, authorises that person to perform a specific scope of
patient care services within that organisation.
Registered Means registration to practise with a National Board.
Registration(2) Registration granted to practitioners to practise the profession. In general,
practitioners who hold general registration have graduated from a Board-
approved, accredited program of study in the profession and completed
any required period of supervised practice or internship, or have
demonstrated equivalence of their overseas qualifications.
Scope of practice(6) A time sensitive, dynamic aspect of practice which indicates those
professional activities that a pharmacist is educated, competent and
authorised to perform and for which they are accountable.
Note: This definition is in the context of the pharmacy profession.
Definitions from other professions (where available) have been included in
the report.
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List of Abbreviations GPhC General Pharmaceutical Council
AACP Australian Association of Consultant Pharmacy HPPP Health Professionals Prescribing Pathway
ACCP American College of Clinical Pharmacists HWA Health Workforce Australia
ACLF Advanced to Consultant Level Framework ICN International Council of Nurses
ACN Australian College of Nursing IMG International Medical Graduate
ACP Australian College of Pharmacy JPCT Joint Partners Credentialing Task group
ADC Australian Dental Council MBA Medical Board of Australia
AHPA Allied Health Professions Australia MCQ Multiple Choice Question
AHPRA Australian Health Practitioner Regulation Agency MSF Multi-Source Feedback
AMC Australian Medical Council Mini-PAT Mini Peer Assessment Tool
ANMAC Australian Nursing and Midwifery Accreditation Council Mini-CEX Mini Clinical Evaluation Exercise
ANMC Australian Nursing and Midwifery Council MMR Medication Management Review
APA Australian Physiotherapy Association NAPRA National Association of Pharmacy Regulatory Authorities
APAC Australian Psychology Accreditation Council NAPE National Alliance for Pharmacy Education
APC Australian Pharmacy Council N3ET National Nursing and Nursing Education Taskforce
APPF Advanced Pharmacy Practice Framework NHS National Health Service
APPFSC Advanced Pharmacy Practice Framework Steering Committee NMBA Nursing and Midwifery Board of Australia
APS Australian Psychological Society NMP Non-Medical Prescriber

BPS Board of Pharmacy Specialties NNO National Nursing Organisations
CbD Case-based Discussion NP Nurse Practitioner
CCCF Critical Care Curriculum Framework NZ New Zealand
CCP Council on Credentialing in Pharmacy OSCE Objective Structured Clinical Examination
CoDEG Competency Development and Evaluation Group PBA Pharmacy Board of Australia
CoNNO Coalition of National Nursing Organisations PREP Physician Readiness for Expert Practice
COSP Committees of Specialty Practice PSA Pharmaceutical Society of Australia
CPD Continuing Professional Development PSAB Pharmacy Specialist Accreditation Board
CSP Commonwealth Supported Place PsyBA Psychology Board of Australia
CV Curriculum Vitae QUM Quality Use of Medicines
DBA Dental Board of Australia RACDS Royal Australian College of Dental Surgeons
EN Enrolled Nurse RACP Royal Australasian College of Physicians
GLF General Level Framework RACGP Royal Australian College of General Practitioners
GMC General Medical Council RN Registered Nurse
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RPL Recognition of Prior Learning Preamble
RPS Royal Pharmaceutical Society From a patient’s perspective, the competence of healthcare professionals should be assured, regardless
RTO Registered Training Organisation of whether a recent graduate or mature professional. Delivery of a competent and capable workforce
requires clear articulation of expectations coupled with an effective process for ensuring these are
SHPA Society of Hospital Pharmacists of Australia
consistently met. Expectations should be reflective of current practice, based on accepted standards and
shpaclinCAT Society of Hospital Pharmacists of Australia Clinical Competency Assessment Tool partnered with quality education and training.
SPRAT Sheffield Peer Review Assessment Tool Professional practice is dynamic. Evolution of practice may be influenced by external factors such as
TGA Therapeutic Goods Administration changes in the population to which services are provided, and internal factors specific to the profession,
such as those observed when the profession accepts an additional role or begins to provide existing
UK United Kingdom services in a new and novel way.
UKCPA United Kingdom Clinical Pharmacy Association A fundamental premise of effective healthcare is the provision of services that meet the needs of the
USA United States of America public. When these needs change, appropriate modification to the type and manner in which healthcare
services are delivered is required.
In Australia, the ageing population has impacted on the health related services provided by healthcare
professions. Increasing age brings with it an increase in the number of co-existing disease states, and
a resultant increase in therapeutic intervention and complexity. For pharmacists, these changes provide
both challenges and opportunities for the individual practitioner and the profession.
The practice of pharmacy has also evolved with time. A shift in focus from the supply of medicines to
a greater level of patient-centred input has been observed. Along with this change, pharmacists have
begun to position themselves as experts in medicines.
Recognition of practice improvement, and in particular the achievement of advanced skills and
knowledge, provides the profession with an opportunity to define the specific requirements of advanced
practice and the process for assessment of these requirements. The outcome of this process is

an improved structure within the profession and the provision of clear direction for the individual
practitioner.
Broad competencies attributed to advanced practice are articulated in the Advanced Pharmacy Practice
Framework (APPF). This framework is intended to support the process of professional development by
defining expectations of pharmacists at different levels of practice. The framework recognises that many
characteristics of advanced practice are common across practice areas. It is intended the framework be
flexible and applicable to all sectors of the profession. Individual areas of practice may seek to customise
the framework and articulate the specific skills and knowledge required for competent practice in that
setting. It is essential that modifications are made in accordance with clear standards and processes.
Extended practice presents the pharmacist with opportunities to develop skills and knowledge applicable
to an area of practice not traditionally associated with a pharmacist’s scope (e.g. prescribing) and/ or a
new role for the profession (e.g. Medication Management Reviews). While compounding has been part
of a pharmacist’s scope of practice since its inception, we include it here due to new best practice and
regulatory requirements in this area.
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Articulation of the specific skills, knowledge and attributes required to safely practise in these extended 1. Introduction
roles is clearly important.
The Australian Pharmacy Council commissioned this project to inform the development of a
The broad aims of the project were to:
contemporary and sustainable pathway for recognition of pharmacy practitioners in extended and
I Review the methods employed by healthcare professions to recognise advanced and extended advanced practice roles. This aligns with Domain 2 – Health Workforce Capacity and Skills Development
practice both in Australia and internationally. of the National Health Workforce Innovation and Reform Strategic Framework for Action 2011 – 2015.(7)
II Consider the factors, which may impact on the recognition of advanced and extended pharmacy This report includes the outcome of a desktop literature review. It provides an overview of accreditation
practice in the Australian context. and credentialing pathways in pharmacy and in other healthcare professions both within Australia and
Review of the literature regarding advanced practice identified processes, terminology and assessment internationally. Evidence based assessment methods are also presented.
methods that appear to both resonate with the practice of pharmacy in the Australian context and serve
as a point from which to lever further discussions.
2. Background
Pharmacists currently sit in a place of opportunity. As relative newcomers to the advanced/ extended
practice recognition arena, we have the ability to learn from those who have gone before us. We should Registration of healthcare professionals is intended to provide public assurance regarding the
aim to create a novel approach for the recognition of advanced and extended practice, which will serve practitioner’s ability to perform required tasks. In Australia, the Health Practitioner Regulation
the profession and ultimately the public for years to come. National Law Act 2009 (The National Law)(8) dictates that health practitioner Boards set standards
for registration. These standards are approved by the Ministerial Council and must be met by all
registered healthcare practitioners as a method of ensuring patient safety.(9) Frameworks are available
to support practitioners by articulating practice requirements according to accepted standards.
Professional development, however, continues through all stages of practice as does the need to ensure a
practitioner’s competence.
Post registration, the practice of healthcare professionals is modified according to many factors including
further education, practice experience, interaction with peers and other professions and the specific
needs of the patient mix within which the practitioner works. The ageing population of Australia brings
with it a change in the complexity of disease states requiring therapeutic intervention(10, 11) and an

associated change in required healthcare services. Healthcare professionals must adapt and tailor their
practice to meet the changing needs of the population they serve. Evolution and advancement of skills
and knowledge is a consequence of this adaptation.
Parallel to these population changes, healthcare reform in Australia aims to improve health outcomes
for all Australians and the sustainability of the healthcare system.(12) Pharmacists, along with other
healthcare professionals, play an important role in the delivery of services to manage chronic disease and
implement preventative health strategies.
In relation to health reform, the Allied Health Professions Australia (AHPA), which represents 14 national
allied health professional associations, has indicated that(13):
n ealthcare professionals should be accountable through a clear clinical governance structure;
H
including access to support, supervision, mentoring and professional development.
n ealthcare professionals should have equitable access to incentives and initiatives to provide
H
inter-disciplinary care.
12 13
Recognition of the skills, knowledge and professional attributes of advanced and extended pharmacy and training, evidence of continuing professional development activities and evidence of experience
practice provides a two-fold advantage: in the specialty area. In addition, demonstration of an appropriate level of specific knowledge, as
assessed by examination, may be utilised, as may a process of peer review. Professional organisations
I A structure for professional (and career) growth via a process to afford credit to those who have
supporting the process of advancement within healthcare professions also have common elements. For
strived to improve their practice as a contribution to patient care; and
example, nursing colleges support the professional development of nurses working in specific areas of
II A process by which the profession can progress to a more prominent place as experts in medicines practice; medical colleges provide professional development support and training programs for medical
use, recognised and respected by other health professions and the public. practitioners undergoing training in specific areas of specialist practice; physiotherapists may undertake
Cultivation of advanced skills often requires completion of further studies associated with a specific area additional education and training to become a Fellow of the Australian College of Physiotherapists.
of practice. The provision of appropriately accredited programs of study is therefore a significant factor Achievement of Fellowship in some professions may afford the practitioner eligibility to apply to their
in the development of an advanced workforce. Standards exist for the provision of programs within respective National Board for formal recognition as part of their registration status, e.g. Specialist
the higher education sector; recognition of and adherence to these standards is imperative. Threshold Registration is available to those holding a Fellowship of the Royal Australasian College of Physicians.
Standards associated with the Higher Education Standards Framework are currently under review.(14) For other professions, Fellowship status indicates the practitioner has been recognised by peers within
their respective professional body as a specialist practitioner, e.g. Fellow of the Australian College of
Physiotherapists.
3. What is Advanced Practice?
A clear understanding of the term ‘advanced practice’ is required. Defining this, and associated 3.1.2 Recognition Terminology
terminology, is essential as the profession articulates a vision for recognition of advanced and extended
Variation in the terminology employed to define and describe the process of recognition is apparent.
practice with a level of shared certainty.
Between professions, the use of terms such as advanced practitioner, advanced practice, expert practice,
extended practice, scope of practice, endorsed, specialist, consultant, generalist are often used with
3.1 Advanced Practice in Professions other than Pharmacy
differing implications. For example, The Australian Physiotherapy Association defines scope of practice
An understanding of the processes and terminology employed by other professions to recognise in terms of the boundaries and regulations that encompass the role of an appropriately qualified
advanced practice provides a useful context to begin defining the process for pharmacists. To achieve physiotherapist; nursing organisations recognise both the scope of practice of the profession and that
this, a systematic review of the literature available in this setting was undertaken and revealed both of an individual practitioner. The scope of practice within which an individual nurse practises is dictated
similarities and differences between professions. by their specific educational experience, as well as the tasks for which that individual is competent

Although registration at an entry to practice level remains a common process within healthcare and authorised to perform. Similarly, dental practitioners define scope of practice in terms of both the
professions, the process for recognition of specific additional qualifications, experience and skills beyond profession and the individual.
the registration level differs in terms of both process and terminology. Given the fundamental need to Table 1 highlights differences in the definition of some commonly used terms associated with the
ensure professional competence regardless of the stage of a practitioner’s professional development, a recognition of advanced practice across healthcare professions.
robust and transparent process for the recognition of advanced skills and knowledge appears essential.
3.1.3 Generalist Practice
3.1.1 Recognition Process
The term ‘generalist’ may refer to a practitioner with a broad skill set who has not yet developed skills
The process required to achieve recognition as an advanced level practitioner differs depending on the specific to a subset of practice (e.g. nursing) or it may refer to a practitioner who has developed advanced
profession. Nursing and dental surgery have defined scopes of practice within which practitioners must skills applicable to many areas of practice (e.g. medicine and pharmacy).
work, according to appropriate education and training and evidence of competency. Physiotherapists
and dentists may undertake additional study to be recognised in a specialty area. Registered Nurses
3.1.4 Specialist Practice
may seek endorsement as a Nurse Practitioner or Registered Nurse with endorsement to supply
scheduled medications. Since 1996, Commonwealth legislation has required all newly registered medical The term ‘specialist’ carries similar meaning across most professions as reflected in the definitions used.
practitioners to achieve Fellowship of a recognised medical college as a component of eligibility for a
Medicare provider number.(15) Specialist practice is defined by the Coalition of National Nursing Organisations (CoNNO), formerly known
as National Nursing Organisations,(16) as following and building on a base of generalist practice and
Despite differences in the specific steps required to achieve recognition of advanced skills, many focused on a specific area of nursing. It is directed towards a defined population or a defined activity and
similarities exist. Factors which remain consistent between healthcare professions in relation to is reflective of depth of knowledge and relevant skills.
achieving recognition of advanced or specialised practice include: evidence of additional education
14 15
The term ‘specialist’ when associated with the medical profession appears well understood by the public The practice of physiotherapy defines an ‘Extended Scope of Practice’ in terms of a role that is
to indicate a high level of knowledge and skill relating to a particular area of practice. The Australian considered outside the currently recognised scope of practice. Factors required to practice in such an
Medical Council (AMC) considers the specialist to be a medical practitioner who “develops significant extended role include specific training and experience, development of competency and subsequent
expertise within a specific domain or branch of medical practice and research. These are most commonly credentialing. In addition, legislative change is required. This is distinct from an ‘Advanced Scope of
(but not solely) defined by a bodily system and its pathologies, a group of diseases, and related Practice’ which is a role that is currently considered within the scope of practice for the profession but
interventions or procedures.” The AMC has a broad understanding of the term ‘medical specialty’. The which has been performed by other professions. Advanced practice may also require training, experience
discipline of General Practice, for example, is recognised by the AMC as a distinct medical specialty in and development of competency.(20)
itself.(15)
The National Nursing and Nursing Education Taskforce published a Specialisation and Advanced Practice
In contrast to other healthcare professions, the decision to recognise a medical specialty rests with the Discussion Paper,(19) which reviews and discusses the terminology around specialisation and extended
Commonwealth Minister for Health and Ageing governed by the Health Insurance Act, 1973.(15) An and advanced practice. This report acknowledges the growing use of terminology to define practice
Australasian specialist medical college may advise the Medicare Australia Chief Executive Officer that a considered to be outside of that of a generalist role and highlights the inconsistencies in terminology
medical practitioner satisfies the criteria for specialist registration.(17) between profession organisations and regulatory bodies.
Use of the term ‘specialist’ is currently restricted under The National Law to the dental and medical
professions only.(8) Currently no provision for use of this term applies to pharmacy. Specialty areas are
defined within a number of professions e.g. dentistry, medicine, and physiotherapy (currently no provision Table 1. Comparison of the use of terminology associated with advanced and extended
for specialist registration for physiotherapy). practice roles
A national specialisation framework for nursing and midwifery was established in 2006(18). In defining
Scope of Practice
this framework, it was noted that the development of specialty areas within nursing had developed in an
ad hoc manner, with specialty areas being defined according to a number of systems including: Physiotherapy Definition of the rules, the regulations, and the boundaries within which a fully qualified
practitioner with substantial and appropriate training, knowledge, and experience may
n Body systems (cardiology, respiratory) practise in a specifically defined field. Such practice is also governed by requirements for
n Diseases (dementia, mental health) continuing education and professional accountability.(20)
Nursing and The profession of nursing has a single scope of practice, which encompasses the full
n Service or setting (residential care, operating theatre)
Midwifery range of nursing activities. An individual nurse’s scope of practice refers to the activities
Intervention/ therapy (chemotherapy, incontinence, palliative care)

n which that nurse is educated, authorised and competent to perform.
n Client (women’s health, aged care) The depth and breadth of an individual nurse’s engagement in the profession’s total
n A combination of systems (rural and remote mental health) scope of practice is dependent on their educational preparation, experience, role and
the context of their practice.
In addition, the authors of that framework note that the “absence of a framework for specialties has
important consequences for the quality of future workforce planning and the development of appropriate The national competency standards for registered nurses, enrolled nurses and nurse
educational programs for the workforce. To date, there has been little focus on identifying specific skills practitioners outline the knowledge, skills, judgement, values and attributes required by
required within a given area of (nursing) practice.” the RN, EN or NP on entry to practice.(21, 22)These standards form the minimum core
for nurses’ commencing scopes of practice and are the basis on which nurses build their
A notable advantage pharmacists have in undergoing the important process of defining a pathway for
practice and expand their scopes of practice.
the recognition of advanced and extended scope practice is the ability to learn from other healthcare
Dentistry The Scope of Practice for Dental and Oral Health Therapists encompasses two levels of
professions who are further developed in this process.
interpretation. The profession’s scope of practice encompasses the full range of activi-
ties undertaken by Dental and Oral Health Therapists.(23)
3.1.5 Advanced, Extended, Expanded Practice
An individual’s scope of practice refers to the personal subset of the full scope. This is
Nursing and midwifery regulatory authorities describe expanded roles as an extension of advanced the range of procedures and practice defined by an individual’s educational preparation,
practice and different to specialist practice, with extended practice recognised as that of the nurse competence, experience and acquired skills and practice context, which will differ from
practitioner. The Australian Nursing and Midwifery Council (ANMC) is quoted as defining that advanced individual to individual. A Dental or Oral Health Therapist’s individual scope of practice
practice nurses may work in a specialist or generalist capacity. (19) will establish the patient/client groups to be treated, define the oral health services
they will provide, define the boundaries of their practice and the conditions they will
need to collaborate with or refer to another practitioner in order to ensure appropriate
standards of care.(23)
16 17
Extended Scope of Practice Comments
Physiotherapy Extended Scope of Practice – A role that is outside the currently recognised scope Physiotherapy Scope of practice is dynamic. Some roles currently considered advanced or extended
of practice and one that requires some method of credentialing following additional now may not be in the future. As a consequence, it is inappropriate to publish a list of
training, competency development and significant professional experience, as well as tasks / activities that are considered either within or outside of physiotherapist’s scope
legislative change. of practice. A ‘rigid and narrow definition of scope of practice will restrict opportunity
and innovation for individuals, the profession and the health system by placing fixed
Note: Advanced Scope of Practice - A role that is within the currently recognised
limits on the boundaries of practice which are not sensitive to changes in the health and
scope of practice for that profession, but that through custom and practice has been
social care environment.’(20)
performed by other professions. The advanced role may require additional training as
well as significant professional experience and competency development.(20)
Nursing and Nursing and midwifery regulatory authorities describe expanded roles as an extension of Figure 1. Examples of the use of terminology associated with advanced and extended practice
Midwifery advanced practice and different to specialist practice, with extended practice recognised
as that of the nurse practitioner.(19)
Generalist Example One: The Medical Model
Nursing and Generalist practice refers to a generic nursing or midwifery role distinguished by broad Post registration, medical practitioners enter specific training programs to begin specialist
Midwifery range of knowledge, experience and skills enacted in a wide range of health care settings training in a particular area of practice. Having registered with a college, the trainee undertakes a
and involving a comprehensive spectrum of activities directed towards a diversity of prolonged period of supervised practice in pre-determined areas during which regular workplace
people with different health needs, occurring in a wide range of health care settings.(19) assessment occurs. Summative assessment occurs at several stages and successful completion is
Medicine The generalist in medicine is understood as a doctor whose knowledge and practice required before the trainee is allowed to progress.
of medicine extends across a broad range of medical conditions, bodily organs and
Example Two: Nursing
systems.(15)
Specialty / Specialist The nurse practitioner practices in an extended scope and is expected to provide advanced clinical
Nursing and A specialty/area of nursing practice subscribes to the overall purposes, functions and assessment, to diagnose and /or refer appropriately and to deal with complex tasks in innovative
Midwifery ethical standards of nursing. It requires application of specially focused knowledge ways. The extension of practice lies in the ability to prescribe according to practice standards.
and skills. (Adapted from criteria 1 and 2, ‘Specialty in Nursing’, National Nursing Expanded practice may include the provision of services not previously provided by the profession.

Organisations (NNO), 2004).(16) These may include services provided by other professions. (19)
The International Council of Nurses (ICN) definition is used by the NNO, to define Example Three: Dental Practitioners
specialisation as to ‘... imply a level of knowledge and skill in a particular aspect of
Dental practitioners may elect to undertake additional training in the area of conscious
nursing which is greater than that acquired during basic nursing education’ …. while
sedation. The DBA recognises this additional training and extension of scope by endorsement of
specialist practice is stated to involve knowledge beyond the beginning level, there is a
registration status.
‘becoming’ component of specialisation where a nurse or midwife may work in an area
of specialisation, as opposed to being a specialist. (19)
Dentistry A specialist dentist is one who practices a recognised specialty, possesses a higher
qualification relevant to this area of dentistry, and has fulfilled any other statutory 3.2 Advanced and Extended Practice in the Pharmacy Context
requirements within the State or Territory of practicing and has been so registered. Recognition of work previously undertaken by the profession places a level of context over what is
Specialist registration is available in 13 areas of practice.(24) yet to be completed in this important process. Accepted definitions and an understanding of why the
Medicine The specialist develops significant expertise within a specific domain or branch of recognition process is important to both the profession and the individual practitioner are presented in
medical practice and research. These are most commonly (but not solely) defined by this section.
a bodily system and its pathologies, a group of diseases, and related interventions
or procedures. Such practitioners are typically concerned with diagnosing, treating Similar to other professions, the practice of pharmacy has evolved to meet the changing needs of the
and managing particularly complex or difficult-to-treat conditions falling within their consumer. Specifically, the focus has shifted from providing traditional dispensing and compounding
particular area of expertise. (15) services alone, to a greater involvement in the choice of therapy and an influence on the use of
prescribed therapy through patient counselling and therapeutic monitoring. Consequently, the need for
improved knowledge and skills in relation to the specifics of pharmacotherapy applicable to a particular
18 19
area of practice has emerged. Appropriate recognition of these enhanced skills has been the focus 3.2.3 What is Extended Pharmacy Practice?
of broad discussion. The need to solidify a pathway to facilitate this process is clear. Given the fact
that existing legislation prevents Australian pharmacists from achieving recognition as an advanced The definition of extended practice requires an understanding of the existing scope of practice, which
or extended scope practitioner, a favourable outcome of a pathway to recognition would include for pharmacy represents a broad range of activities. Extended practice in other healthcare professions
amendments to allow this. requires additional education, training and the demonstration of an appropriate level of applicable
competence.
3.2.1 Pharmacist competence Examples of extended pharmacy practice may include, but are not limited to, pharmacist prescribing
and Medication Management Review (MMR). These scopes of practice require additional education and
In order to describe the specific areas of competency within which pharmacists are expected to perform, training and a demonstration of competence.
competency documents such as The National Competency Standards Framework for Pharmacists in
Australia(3) and the Society of Hospital Pharmacists of Australia (SHPA) Clinical Competency Assessment Extended practice presents the pharmacist with opportunities to develop skills and knowledge applicable
Tool for Australian Pharmacists(25) have been produced. These documents are aimed at pharmacists to an area of practice not traditionally associated with a pharmacist’s scope (e.g. prescribing) and/ or a
working at all levels of practice. new role for the profession (e.g. Medication Management Reviews). While compounding has been part
of a pharmacist’s scope of practice since its inception, we include it here due to new best practice and
3.2.2 What is Advanced Pharmacy Practice? regulatory requirements in this area.
The latest version of the National Competency Standards acknowledges the concept of advanced
pharmacy practice and includes a definition that was adapted from the Royal Pharmaceutical Society of Non-Medical Prescribing
Great Britain.
In view of more healthcare professions seeking prescribing rights, the Australian Health Ministers’
Advisory Council, through the National Health Workforce Taskforce, commissioned a report on non-
Practice that is so significantly different from that achieved at initial registration that it warrants medical prescribing which was completed by the National Health Workforce Planning and Research
recognition by professional peers and the public of the expertise of the practitioner and the Collaboration (NHWPRC) in 2010. This report included a literature review of non-medical prescribing,
education, training and experience from which that capability was derived.(3) international models, case for introducing a nationally consistent approach to non-medical prescribing
in Australia, development of a draft framework and implementation challenges.(4) Currently,
non-medical prescribers (NMPs) include dentists, midwives, nurse practitioners, optometrists,
It is important to understand what sets an advanced pharmacy practitioner apart from a pharmacist

paramedics and podiatrists.
with many years’ experience whose practice has evolved and grown with time. Both may perform
their required tasks efficiently and with purpose. Attributes which may be considered components of The release of this report as a consultation paper by Health Workforce Australia in 2012 as part of
advanced practice as distinct from mature practice include: Phase 1 of its Health Professionals Prescribing Pathway (HPPP) Project, revealed broad ranging support
for the development of a nationally consistent approach for non-medical prescribing.(27) The scope
n S pecific and appropriate education and training. Healthcare professions that currently recognise
of the HPPP Project focuses on prescribed scheduled medicines only and limits the non-medical
advanced practice consistently require formal postgraduate qualifications as a component of
health professions to those registered under the National Registration and Accreditation Scheme as
recognition;
at 1 July 2012.
n S ignificant experience in the area of practice with ability to move fluidly between different modes
Respondents felt that:
of clinical reasoning (procedural – problem identification and treatment focussed; interactive – a
perspective which seeks to engage and understand the patient’s point of view; conditional – a “There appeared to be adequate provisions of the National Law and the resources of the
contextualised whole-person approach).(26) While mature practice is clearly associated with a depth National Boards, the Australian Health Practitioner Regulation Agency and accrediting bodies
of experience, the integration of this experience with formal qualifications to guide decision making to support a consistent approach to the endorsement of healthcare professionals to prescribe
may contribute to practice which may be considered ‘advanced’; medicines, noting the need to balance consistency with the diverse needs of different
professions.”(27)
n C ontribution to the profession in the form of creating new knowledge as part of research and
leadership (as recognised in the Australian Advanced Pharmacy Practice Framework(6)). Consultation feedback from stakeholders, clinicians and consumers, while supportive of non-
medical prescribing, highlighted common concerns of ensuring patient safety and avoiding potential
fragmentation of care.(27) An example cited is the need for separation of the function of prescribing,
from that of dispensing and administration of medicines.(27)
20 21
As a result, in Phase 2 of the HPPP Project, core principles guiding the development of the pathway were Compounding Pharmacists
made explicit. These principles centred on patient safety (including safe prescribing practice and safe
prescribing models) and ensuring consistency in enablers such as education, training and assessment The Therapeutic Goods Administration (TGA) is due to commence consultation with professional bodies
standards and delivery, registration, accreditation processes, and maintenance of prescribing competency. in early 2013 regarding extemporaneous compounding. In June 2010, following a 2008 consultation
(27) The draft pathway developed in Phase 2 outlined the steps required by a healthcare professional to paper, the National Coordinating Committee on Therapeutic Goods published proposals on the regulation
be endorsed as a prescriber by their respective National Board. To reflect different contexts and models of compounding pharmacists.(30) A component of this proposal was that pharmacists compounding
of care, graded levels of autonomy in prescribing underpinned by collaboration, were included.(28) or dispensing extemporaneous products should be regulated by means of self assessment or other,
as required by pharmacy regulators or professional associations. In its 2010 Pharmacy Roadmap
Phase 3 will see refinement and testing of the draft pathway at workshops with registered healthcare document,(31) The Pharmacy Guild of Australia recognised that pharmacists providing enhanced
professional groups. Accredited education providers are expected to align existing and future training compounding services must meet specific professional competencies for which additional training
programs with the national competency framework for prescribing.(28, 29) should be available. Professional standards are available in the form of the PSA’s Professional Practice
Pharmacists are able to prescribe in the USA, UK, Canada and New Zealand. It is envisaged that following Standards,(32) but there is currently no accredited process for credentialing compounding pharmacists.
on from the HPPP Project and the availability of the national competency framework for prescribing, The Pharmacy Board of Australia’s (PBA) Compounding Working Party is currently liaising with the TGA,
pharmacists in Australia will soon have access to qualifications that enable endorsement as a non- and it is possible that such credentialing may become compulsory.
medical prescriber. Hence, any pathway for recognition of extended or advanced practice in pharmacy
should make provisions for this development.
Medication Management Review
Figure 2. Health Professionals Prescribing Pathway (April 2013 draft version) Currently, pharmacists seeking credentialing in this area of practice must do so via either SHPA or the
Australian Association of Consultant Pharmacy (AACP). These are the only two entities recognised and
approved by the Department of Health and Ageing (DoHA) and the Department of Veteran Affairs (DVA)
Obtain recognition
Prescribe medicines Maintain & enhance to ‘accredit’ pharmacists to undertake medication management reviews (MMRs).(33)
Steps
Complete education from the National Ensure authorisation

and training Board of competence to prescribe within scope competence
of practice to prescribe
to prescribe SHPA offers members and non-members three pathways to gain credentialing:(34)
I Certification as a Geriatric Pharmacy Specialist by the Commission for Certification in Geriatric
The health professional The health professional The health professional The health professional The health professional
Pharmacy (USA)

completes prescribing seeks and receives ensures they can prescribe prescribes within a safe maintains and continues
education and training that recognition of their
is consistent with their scope competence to prescribe
medicines according to the
legislation in their state or
model of prescribing and
works collaboratively with the
to develop their
competence to prescribe. II Certification as a Pharmacotherapy Specialist by the Board of Pharmaceutical Specialties (USA)
of practice and the models of from their National Board.
prescribing they territory for the prescribing, consumer and the healthcare
are involved in. obtaining, dispensing,
supplying and administering
team for safe and quality
care of the person receiving III Master in Clinical Pharmacy or Master in Pharmacy Practice, plus meeting credentialing criteria from
of medicines. treatment.
a university within the National Alliance for Pharmacy Education (NAPE) group (i.e. the SHPA-NAPE
Safe Practice Standards CPD Standards
pathway).
Safety &
National Prescribing Registration Standards

Quality
National Medicines Policy -

Tools
Competency Framework State & Territory

Legislation
Safe and Quality Use of
Professional Development
Guidelines
Pharmacists undertaking any of these pathways must also satisfy the following criteria:
Accreditation Standards National Board Policy Medicines Electronic
Guideline Information & support systems Self-reflection
n Evidence of current registration as a pharmacist in Australia
Responsibilities
• Prescribers
• Education Providers
• Prescribers
• National Boards
• Prescribers
• Jurisdictions
• Consumers and carers • Prescribers n E vidence of at least two years of experience as a pharmacist (e.g. statement from employer,
• Prescribers • Continuing education
• Accreditation Councils • Australian High
supervisor, or by making a statutory declaration)
Roles &
• Health Services providers

• Consumer Representatives Practitioner Regulation • Employers • Professional Associations
Agency • Regulations • National Boards
• Australian Health • Advisory Bodies • Accreditation Councils
Workforce Ministerial
Council
• Professional Associations • Consumer Representatives n E vidence of current participation in an approved continuing professional development (CPD) program
• Consumer Representatives
(e.g. conducted by SHPA or other professional associations).
‘Re-accreditation’ requires evidence of completing at least 60 CPD credits annually.
AACP offers a two-stage process, where successful completion of the Stage 1 preparatory course is a
pre-requisite for Stage 2. AACP does not run Stage 1 preparatory courses. Instead, several professional
associations, such as the Australian College of Pharmacy, the Pharmacy Guild (Guild Clinical) and the
Pharmaceutical Society of Australia, are approved by AACP to offer these. On completion of Stage 1,
pharmacists can apply for AACP’s Stage 2 ‘Accreditation Assessment’ process.(35)
22 23
In Stage 2, pharmacists submit a ‘portfolio of experience’ – elements of which are defined by AACP, Recognition of advanced practice status would also identify the advanced practice pharmacist as a
and undertake a 50-question clinical MCQ and 4 hypothetical case studies. As part of their ‘portfolio of potential supervisor, mentor or educator, thus consolidating their role within the workplace. It would also
experience’, pharmacists must also successfully complete the MCQ assessment of the Communication facilitate the advanced practice pharmacist’s development as a leader in their field.
Module. ‘Re-accreditation’ requirements include completion of at least 60 CPD credits annually and
completion of a clinical MCQ every three years.(36) Career benefits
Official recognition of advanced practice status would assist pharmacists in their career pathway
3.2.4 Benefits of Recognising Advanced Practice
by providing evidence of competency to prospective employers. It would demonstrate that they
Formal recognition of advanced practice confers many benefits, some of which are outlined below: were working at a pre-designated level and that they had evidence that their skills, knowledge and
professional attitude are at an advanced level.
Patient safety
Formal recognition would also assist the employer in establishing, or recruiting to, positions in specialist
Regulation of healthcare professionals in Australia is undertaken by the Australian Health Practitioner areas, as they can incorporate specific advanced practice requirements into their position statements and
Regulation Agency (AHPRA) and the National Boards. The primary purpose of such regulation is to selection criteria. In time, the career structure of the profession, be it in community, hospital, industry or
protect the public and facilitate access to health services.(37) Where once the public trusted that academia, may adapt to reflect the transition from a general to advanced level practitioner, and advanced
health practitioners were fit to practice, there is now a shift of opinion that requires such trust to be practice status may become a pre-requisite for selected positions.
underpinned by objective assurance.(38)
Growth of the pharmacy profession
In order to provide the highest level of patient care and maximise patient safety, it is necessary to
provide a level of pharmaceutical care that is commensurate with patient care needs. In those cases Having a clear and robust pathway for recognition of advanced and extended practice pharmacists will
where patient care needs are complex, for example patients with a wide range of illnesses and difficult be a major step towards demonstrating to the public and other healthcare professions, the maturation
management challenges, pharmaceutical care should be available from pharmacists working at an of the pharmacy profession in Australia. This becomes increasingly important given the role pharmacists
advanced level. Such pharmacists would have greater expertise within their scope of practice than those play in public health.
working at a general level and have the competence to deal with complex health issues, working to
optimise use of medicines and minimise the risk of patient harm. International drivers
By defining such qualities, assessing capability, and allowing members of the public access to ‘proof’ Many other countries have developed, or are in the process of developing, pathways to recognise
of competency, the patient and carers can feel reassured that they are receiving care from a suitably advanced and extended practice and to formalise practitioner development (Section 4.1 provides

experienced healthcare professional who has qualifications necessary to meet the patient’s needs. The a comprehensive review of these pathways). In order to maintain strategic alignment with progress
patient should be able to relate the advanced practice pharmacist’s expertise to that which they receive overseas it is important that Australia moves forward with the implementation of its own
from experts in other healthcare professions such as the medical consultant or the nurse practitioner. recognition pathway.
There is a history of collaboration between Australia and other countries; particularly with The
Acceptance by clinical colleagues Competency Development and Evaluation Group (CoDEG) in the UK, whose competency assessment tools
Pharmacists in all fields of practice work closely with other healthcare professionals. When working at have been adapted for use in Australia.(25, 39) Such collaboration provides opportunities for countries to
an advanced level, often with colleagues who have expert skills, it would be beneficial to have evidence share expertise in pharmacy practitioner development and work together to facilitate best practice. (40)
of pharmacy expertise in order to maintain credibility as an advanced practitioner. This evidence will also
inform other healthcare professionals that the pharmacist is competent, not only in direct patient care, 3.2.5 State of Play: Advanced and Extended Pharmacy Practice in Australia
but also in the development of patient care services. There is also an expectation that any professional Acknowledging the potential benefits to the profession and the individual, the Australian pharmacy
working at an advanced level can function autonomously in their clinical field and an advanced practice profession has taken initial steps to recognise advanced and extended practice.
status would assist the pharmacist in providing evidence of this ability.
The Advanced Pharmacy Practice Framework Steering Committee
Peer recognition
During a recent review process, the Competency Standards Review Steering Committee expressed the
Experienced pharmacists are often asked for advice by general level pharmacists who may lack need for additional work to take place in the areas of professional competency and advanced practice.
knowledge and skills in a particular area. Gaining formal recognition as an advanced practitioner in an As a result of this recommendation, the Advanced Pharmacy Practice Framework Steering Committee
area of practice would assist the general level pharmacist to identify the most suitable colleague to (APPFSC) was formed in March 2011. The APPFSC is a collaboration of ten pharmacy organisations
consult. Such recognition would also provide reassurance that the advice provided is appropriate. representing community, hospital, consultant and academic pharmacists, whose role is to act as an
advocate for the profession and provide strategic leadership and guidance in agreed projects.(41)
24 25
A number of specialist groups in Australia have produced competency frameworks.(42-45) Development undertaking a process of formal recognition of advanced or extended practice will be small, although
of such frameworks, whilst beneficial in supporting specific clinical areas, has the potential to lead difficult to predict.
to inconsistencies in recognising advanced practice. One of the designated tasks of the APPFSC was,
therefore, to develop an advanced practice framework for the pharmacy profession. 3.3 Defining Terminology
Following a consultative process, An Advanced Pharmacy Practice Framework for Australia (APPF),(6) Accepted and useful terminology will contribute to the profession comfortably using the language
was released in October 2012, and subsequently endorsed by the PBA. In February 2013, the APPFSC associated with the process of recognition with a clear and shared vision. Proposed terminology
announced the next stage of its work (46) to: associated with the process is presented for consideration.
I Develop an implementation plan, including a possible recognition pathway
II Define specific areas of advanced level practice Accreditation and Credentialing – use of terms
III Produce an options paper on possible models for a recognition process In reviewing published literature, the term “accreditation” was not used consistently to mean the same
thing. The term was used to denote approval of a training program, teaching hospital or education
In addition, the APPFSC is seeking input from pharmacists working at or towards an advanced level by
provider as well as applied to individual practitioners deemed suitable for a particular service e.g.
means of a survey which it distributed on 1st March 2013.(47)
accredited as a MMR Pharmacist (Australia). Variations in usage were also found between countries e.g.
Accreditation in the UK is used both to indicate benchmarking of education materials and courses by
Ongoing work by other Australian pharmacy organisations regulators or a quality assurance body, and endorsement from a recognised and respected body of the
Several national pharmacy organisations are working individually to further advanced practice. SHPA has educational materials or courses developed by an education provider. In Singapore, accreditation is a
produced a professional development framework for pharmacists, and proposes that they may utilise the term applied to an individual pharmacist e.g. Accredited as a Specialist Pharmacist.
SHPA Committees of Specialty Practice (COSP) to develop, endorse and publish practice specific advanced The term “credentialing” was more consistently used between countries to mean the process of verifying
frameworks based on the generic APPF.(48) an individual practitioner’s qualifications, skills, experience and competencies against a defined standard.
The Pharmaceutical Society of Australia (PSA) has recently released a framework for pharmacists working In this document, the authors will apply the term “accreditation” to training programs, training facilities,
as partners in mental health care.(49) Whilst the framework is not specifically aimed at pharmacists and education providers as defined in the Glossary of Terms. The term “credentialing” will be used in the
working at an advanced level, it is indicative of work that is being undertaken in specific clinical areas. context of an individual practitioner as defined above.
There is also the potential for additional specialist services to be developed in other clinical areas that
The definition of terms applied to the process of recognition of advanced and extended practice requires

are included in the Pharmacy Practice Incentive Program(50) under the Fifth Community Pharmacy
profession-wide consensus in order to be useful and meaningful. A process of broad consultation is
Agreement.
imperative to achieve this aim.
The Australian Association of Consultant Pharmacy (AACP) describes its primary role as to “define and
The authors make the following assumptions in proposing terminology applicable to the recognition of
develop new consultant services and accredit pharmacists to provide them”.(51) Whilst the AACP already
advanced and extended practice in pharmacy:
offers ‘accreditation’ for registered pharmacists to perform MMRs, it also plans to develop and establish
accreditation procedures for “specific consultant services” in areas such as asthma, diabetes, wound care, n T he recognition of extended and advanced practice is necessary to ensure the provision of safe and
smoking cessation and methadone therapy. effective pharmaceutical care to patients
Advanced and Extended Pharmacy Practice in Australia: Practicalities n T he use of applicable titles describing advanced and extended practice will promote an increased level
of structure within the profession and result in meaningful advantages for the individual practitioner
The development of a pathway for recognition of advanced and extended practice in Australia requires
careful consideration of the context in which the pathway is being implemented. There is a clear need n F ormal recognition of advanced and extended practice will be provided by the Pharmacy Board of
for accessibility to all pharmacists practising in Australia and a need for sufficient resources to make the Australia in the future
process feasible. n S tandards applicable to the setting of advanced and extended practice will be set and applied in the
In March 2013, there were 27,226 pharmacists registered in Australia,(52) a country that covers public interest as part of the recognition process
7,692,000 km² and where distances between practitioners can be thousands of kilometres. Compare this The authors suggest use of the term “Advanced Practice Pharmacist” and “Extended Practice Pharmacist”
with the UK, where in March 2012 there were 45,435(53) registered pharmacists in a country that covers and will use these terms throughout the remainder of the report.
243,610 km².
It is important to acknowledge that not all pharmacists will want to pursue advanced or extended
practice qualifications.(54) It may be anticipated that, at least initially, the numbers of pharmacists
26 27
4. Literature review of accreditation pathways available via residency programs, fellowships, master degrees and doctorate level training. Postgraduate
year one (PGY1) residency programs generally provide experiential learning in a broad range of
Identification of the component processes that comprise pathways used by other countries and other competencies while PGY2 residencies promote skills in specialised settings.(56)
professions provides useful information. The context in which these pathways are utilised is significant
and may include the population of the profession and available infrastructure to support the process. In 2006, the American College of Clinical Pharmacists (ACCP) released a position statement regarding
Information was sourced by undertaking a detailed review of the pathways used for recognition residency programs for pharmacists in the USA.(56) At that time, approximately 20% of US pharmacy
of advanced and extended practice in countries other than Australia and in professions other than graduates entered a residency program and 770 accredited (or pending accreditation) programs were
pharmacy. available to graduates. In its position statement, the ACCP promotes completion of a residency program
as pre-requisite for undertaking any pharmacist role involving direct patient care. Achieving this vision
Searches were carried out using the PubmedR electronic database. Keywords used in searches were: will require an increase in the number of available residency positions and associated resources
advanced pharmacy practice, recognition of pharmacy practice, accreditation of pharmacy practice, and funding.
consultant pharmacist, specialist pharmacist, pharmacist credential, pharmacy education, postgraduate
pharmacy education, professional practice, advanced pharmacy education, pharmacist accreditation, The ACCP strategic plan (2010) highlights advancing clinical pharmacists as a focus for the organisation.
accreditation programs, certification, and endorse. A total of 1309 published articles were found. (57) Increasing the number of recognised specialties and providing advocacy for the appropriate
Eliminating those that did not focus on the topic of advanced pharmacy practice and related issues, 96 credentialing and privileging of clinical pharmacists are included in the organisation’s strategic direction.
articles were reviewed. Certification in clinical specialty areas is available via the Board of Pharmacy Specialties (BPS). The BPS
In addition, reference lists were examined for publications not captured in the original search. This currently offers certification in six specialty areas of pharmacy practice: ambulatory care pharmacy,
revealed a further 38 articles. nuclear pharmacy, nutrition support pharmacy, oncology pharmacy, pharmacotherapy and psychiatric
pharmacy. Board Certification is valid for a period of seven years and a re-certification process is
To identify grey literature, the following key words – advanced pharmacy practice, certification of available. Requirements for recertification depend largely on the specialty but broadly consist of either
advanced pharmacist, pharmacist certification, pharmacy credential, were entered into Google and achievement of a defined continuing education requirement or passing an examination.(58) Refer
Google Scholar. This yielded a further 8 articles. In addition, websites of registration, certification and Appendix A – Certification Requirements in the USA.
professional bodies were also searched.
In addition to that offered by the BPS, certification is available in other specialty areas e.g. Geriatric
Pharmacy, Diabetes Education, Advanced Diabetes Management, Infection Control.(59) Certification is not
4.1 Accreditation pathways – Pharmacy
a requirement for pharmacists working in these specialties and does not necessarily confer additional
remuneration.

4.1.1 Accreditation in other countries
Canada
Globally, the recognition of advanced pharmacy practice has been influenced by many factors. As the role
of the pharmacist has moved from a focus on product provision to that of therapeutic decision-making, Undergraduate education for pharmacists include both bachelor and entry level PharmD programs.
the need to identify pharmacists who possess specific skills and knowledge regarding a particular area of Postgraduate education is available via residencies, fellowships, masters programs and PharmD doctorate
practice has arisen. The articulation of competencies related to an area of practice has become important programs. In addition, non-formal programs include continuing professional development, certification
in the process of recognition as has the availability of appropriate postgraduate education. For some and other workplace training programs.(60)
countries, the process of recognition of advanced practice has been available for many years; for others it A number of certificate programs exist in specialty areas, however certification has no legal standing in
remains in its infancy. any province. Some regulatory authorities recognise non-formal training in the form of legally extended
United States of America (USA) scopes of practice.
The US Council on Credentialing in Pharmacy (CCP) made the following recommendation in its Guiding Significant provincial differences exist in relation to the regulation of pharmacy practice and available
Principles for Post-licensure Credentialing of Pharmacists(55) “Due to the variability in complexity of care scopes of practice.(61)
and increasing differentiation of pharmacy practice, CCP believes that pharmacists—like many other In 2008, a Canadian Task Force released a landmark document entitled ‘Blueprint for Pharmacy: the
patient care providers— should be expected to participate in credentialing and privileging processes to Vision for Pharmacy’. This document details objectives for the pharmacy profession with the aim of
ensure they have attained and maintain competency to provide the scope of services and quality of care aligning the practice of pharmacy with the healthcare needs of Canadians. The following year, the
that are required in their respective practices.” Recognition of all levels of pharmacy practice has been Canadian Pharmacists Association released an implementation plan(60) to achieve the Blueprint vision
embedded in the health system in this country for many years. of “Optimal drug therapy outcomes for Canadians through patient-centred care”. This plan recommends
Undergraduate education for pharmacists in the USA consists of an entry-level doctorate in Pharmacy “the implementation of accessible programs to upgrade knowledge, skills and values to support current
(PharmD). Undergraduates may also elect to complete a dual degree. Post-licensure education is practice and services, the implementation of new professional pharmacy services, specialty practices or
new practice models”.
28 29
Previously in 2002, the National Association of Pharmacy Regulatory Authorities (NAPRA) developed One of the aims of the JPCT project was to inform the development of the Royal Pharmaceutical Society
a framework for Recognizing and Certifying Pharmacy Specialists in Canada.(62) Four specialty areas (RPS) Faculty. The RPS Faculty will launch this year (June 2013) and represents a new professional
were identified as appropriate for further development of a certification process: Anticoagulation recognition program for RPS members. The RPS will adopt the ACLF as the method for identifying and
Management, Asthma Management, Diabetes Management and Advanced Pharmacotherapy recognizing levels of practice. It is anticipated that the ACLF will be used as a basis for a pharmacist’s
Management. The process for certification of pharmacists working in these areas was proposed to professional portfolio. Membership of the Faculty will be tiered with assessment required for each tier.
include knowledge and knowledge-application assessment and a performance based assessment The Faculty aims to provide a range of services in support of professional development.(70)
(portfolio review and onsite practice review).
The Department of Health, London, published Guidelines for the Development of Consultant Pharmacist
Residency programs in Canada involve structured rotations for a period of twelve months with the Posts.(71) Guidelines included a need for the individual to meet an appropriate level of competence,
aim of providing experiential learning with a practitioner role model. In excess of forty accredited which may be demonstrated, in part, by use of the ACLF.
general hospital pharmacy residency programs exist.(63) Recent debate has focused on whether formal
A Postgraduate Diploma or Master of Science in advanced practice is available and includes a pharmacist
credentialing should be developed for pharmacists working in advanced or specialist practice areas.(64)
independent prescribing qualification accredited by the General Pharmaceutical Council (GPhC).(72)
Some advocates consider adoption of the Certification provided by the Board of Pharmacy Specialties in
the USA to be an appropriate step forward while others consider further development of local residency New Zealand
programs a more appropriate way forward for Canadian pharmacists.(65) Pharmacists complete a bachelor degree prior to registration as a pharmacist. Subsequently, an Annual
United Kingdom (UK) Practising Certificate is required. The Health Practitioners Competence Assurance Act 2003 requires
pharmacists to have a mechanism to demonstrate they are competent and fit to practise.(73)
Undergraduate pharmacists in the UK complete a four-year masters degree. Postgraduate education is
available as diploma, masters, fellowship, doctorate and residency programs. The Pharmacy Sector Action Group published a ten year vision for pharmacists in New Zealand (2004
– 2014).(74) This paper identified 24 vision statements in 12 key areas and called for “clearly defined
A Department of Health, London White Paper recommended that a greater understanding of the role
scopes of practice”.
of pharmacists may contribute to the improvement of the health and wellbeing of the public. One
improvement suggested to enhance patient care is “the development of higher-level competencies of The Pharmacy Council of New Zealand has defined the scope of practice for Pharmacist Prescribers and
consultant pharmacists, pharmacists with special interests, independent and supplementary prescribers associated competencies.(75),(76) This new role for pharmacists requires amendment to legislation to
or pharmacists registered as defined specialists on the UK Public Health Register.”(66) enable pharmacists working in collaborative healthcare teams and who have completed the postgraduate
certificate in pharmacist prescribing, to become designated prescribers.(77) Currently as stipulated by
CoDEG have proposed a tiered approach to the recognition of pharmacy practice: Registered pharmacist;
the Pharmacy Council of New Zealand, pre-requisites for entry into pharmacist prescribing postgraduate

General Pharmacist Practitioner; Advanced Pharmacist and Consultant Pharmacist and advocates the
qualification is a Postgraduate Diploma in Clinical Pharmacy or equivalent, and must include at least 600
use of practical, evidence-based frameworks to support practitioner development at each stage of
hours of applied pharmacotherapy. The pharmacist prescribing postgraduate qualification itself will be
professional development. The Advanced to Consultant Level Framework (ACLF) describes common areas
equivalent to 600 hours of study and include a practicum of 300 hours, out of which 150 hours must be
of practice applicable to pharmacists working at an advanced level.(67)
supervised practice under a ‘Designated Medical Practitioner’.(78)
Individual specialty groups have further developed frameworks specific to their area of practice including
Proposed registration requirements include, holding an Annual Practising Certificate in the Pharmacist
the UK Clinical Pharmacy Association (UKCPA) renal pharmacists group and the UKCPA Critical Care
scope of practice, declare that specified competency standards from the Pharmacist scope of practice
Group. Recent evidence published by the UKCPA Critical Care Group described a system to credential and
forms part of their current practice, at least 3 years of recent, appropriate and relevant post registration
recognise expertise in this specialised area of pharmacy practice. The system involved use of a number
experience working in a collaborative healthcare team environment, completed a Council accredited
of accepted professional development tools including multi-source feedback, case based discussions
course of education and training, and evidence to identify and support that their prescribing practice
and the ACLF. A significant emphasis on expert peer review was evident in the process which included
occurs in a collaborative healthcare team environment.(79)
observation of clinical practice, evaluation in relation to clinical cases and assessment of a portfolio of
practice evidence. It is anticipated that this process may be applicable to many other areas of specialty
practice.(68)
The Joint Partners Credentialing Task group (JPCT) recently published evidence-based recommendations
regarding the recognition and credentialing of pharmacists across all areas of practice.(69) Among
its recommendations, the JPCT highlighted a need for the establishment of networks to support the
development of advanced practitioners and the use of established tools to assist with professional
recognition. The use of a professional portfolio (which includes evidence of multiple-source feedback
and practice development such as clinical exercise or case based discussion reports) in conjunction with
a process of peer review was considered a sound strategy.
30 31
Singapore Table 2. Selected key terms used in other countries
Initially, pharmacists complete a 4-year Bachelor of Science (Pharmacy) degree.(80) Postgraduate Accreditation Certification Credentialing
education is available and includes a two year PharmD program, masters and doctorate programs and a USA(1) Accreditation is the Certification is a voluntary Credentialing is:
residency program.(80) The Ministry of Health offers residency scholarships for pharmacists who wish to process by which an process by which a non-
1. the process of
complete a PGY2 residency overseas.(81) association, organisation* or governmental agency or an
granting a credential (a
governmental agency grants association grants recognition
designation that indicates
The Pharmacy Specialists Accreditation Board (PSAB) provides certification for pharmacists with public recognition to an to an individual who has
qualifications in a subject
organisation*, site, or program met certain pre-determined
appropriate qualifications and experience in recognised specialty areas. Registration as a specialist or an area), and
that meets certain established qualifications specified by that
pharmacist requires (i) appropriate postgraduate qualifications and experience in the area of practice, qualifications or standards, as organisation. 2. the process by which an
(ii) certification from the Board of Pharmacy Specialties (USA) in one of the following areas – Oncology, determined through initial and
This formal recognition is
organisation or institution
Advanced Pharmacotherapy (i.e. Cardiology, Infectious Diseases, Psychiatric Pharmacy, or in the case of periodic evaluations. obtains, verifies, and
granted to designate to the
assesses an individual’s
Geriatric Pharmacy, certification from the Commission of Certification in Geriatric Pharmacy (USA), and *Organisation here includes public that the individual has
qualifications to provide
institutions, corporations, attained the requisite level
(iii) completion of a PSAB recognised specialist residency program.(82) patient care services.
universities, colleges, schools, of knowledge, skill, and/
Recognition and registration as a specialist pharmacist is a one-off process. A one-off specialist and health systems. or experience in a well-
defined, often specialised,
registration fee of SGD$500 (approximately AUD$415 – foreign exchange rate as at 15/4/2013) is area of the total discipline.
payable to the Singapore Pharmacy Council, in addition to the 2-yearly fee for renewal of pharmacist Certification usually requires
registration. Renewal of registration to practise as a pharmacist and retention on the specialist register initial assessment and
periodic reassessments of the
is contingent on the pharmacist meeting mandatory continuing professional development requirements.
individual’s knowledge, skill,
Saudi Arabia and/or experience.
UK(69) The term ‘accreditation’ can be A process that evaluates
Currently, students enrol in a 5-year bachelor undergraduate degree.(83) used in two ways: and documents evidence of
professional or educational
Saudi Arabia was the first country outside of the USA to establish a residency program accredited by the 1. Independent kite marking
capabilities and qualifications
American Society of Health-System Pharmacists.(84) This program commenced in 1997 in affiliation with for materials, courses and
(examples may include
education that is recognised by
the St. Louis College of Pharmacy, St. Louis, Missouri and is now accredited locally. both formal and informal
regulators or other QA bodies;
qualifications and capabilities:
In describing the process for establishing a residency program, Al-Qadheeb et al have called for 2. Endorsement from a university degree, diploma,

international accreditation of pharmacy residency programs and highlighted the need for appropriately recognised and respected and certification; quality
body of educational materials assured evidence of capability;
trained preceptors to facilitate programs.(84) or courses developed by professional examinations;
independent providers, to membership criteria
demonstrate to users that it is for learned societies or
of high quality. associations; etc).
Accreditation of the individual Not used – apart from Not used.
Definition of terms was not consistent between countries. Table 2 highlights selected key terms as used pharmacist. recognising certification by
and defined by these countries. Board of Pharmacy Specialties
(USA) or Commission of
Certification in Geriatric
Pharmacy (USA).
Australia Accreditation of a program/ Not used. Process by which an
course against defined authorised organisation/
standards to ensure that the body reviews and verifies a
education and training leading practitioner’s qualifications,
to registration as a health skills, experience and
practitioner is rigorous and competencies against a
prepares graduates to practise defined standard.
a health profession safely.
32 33
4.1.2 Australian Pharmacy Council Accreditation processes 4.2. Accreditation pathways – Other Healthcare Professions
Following the implementation of the National Registration and Accreditation Scheme on 1 July 2010, Grey literature searches were carried out for each health profession included in this section, using the
and under Section 48 of the Health Practitioner Regulation National Law Act 2009 (the National Law), AHPRA website as a starting point and subsequently websites of professional organisations and colleges.
The Australian Pharmacy Council (APC) was designated as the organisation responsible for accrediting
education providers and programs of study for the pharmacy profession in Australia and New Zealand. 4.2.1 Medical profession
Whilst its role is to facilitate accreditation and review processes, it does not develop actual programs or
curricula. Recognition as a specialist medical practitioner is gained through vocational training, usually
APC provides accreditation in the following areas commencing in postgraduate years 2 or 3, and taking between 3 to 7 years to complete. The Medical
Board of Australia (MBA) approves programs of study and authorises the Australian Medical Council
n Pharmacy Degree Programs (AMC) to accredit education providers – broadly defined as organisations that may be accredited
n Intern Training Program Providers to provide education and training for a health profession. Such organisations can encompass
universities, tertiary education institutions, institutions/organisations that provide vocational training,
n Continuing Professional Development (CPD) Accrediting Organisations, which include:
specialist medical colleges or other health profession colleges.(8)
o Pharmaceutical Society Of Australia
Medical practitioners, who have been assessed by an AMC accredited specialist college as eligible for
o Society of Hospital Pharmacists of Australia
college fellowship, can seek specialist registration with the MBA. The Ministerial Council approves the
o Pharmacy Guild of Australia list of specialties, fields of specialty practice and specialist titles.
o Australian College of Pharmacy Education providers are held to standards for assessment and accreditation of programs
The accreditation process is overseen by the APC Accreditation Committee which consists of 14 determined by the Specialist Education Accreditation Committee of the AMC.(91) These standards
members, including pharmacy professionals, pharmacy academics, consumers and student group set out accreditation criteria covering the following aspects: structural (e.g. governance, program
representatives. The committee also includes three members of the APC council; two of whom are management), curriculum, teaching and learning methods, assessment, monitoring and evaluation,
appointed by other pharmacy organisations and the Committee Chair who is appointed by APC. This implementation, retraining, remediation and continuing professional development.(91)
committee is responsible for the development of accreditation guidelines and procedures,(85) as well Accredited education providers (largely medical colleges) for specialist training are responsible for
as standards such as The APC Accreditation Standards for Pharmacy programs in Australia and New approving or accrediting training sites, training programs and defining the number of training places. The

Zealand(86) and the Accreditation Standards for Intern Training Programs in Australia 2010.(87) two-part figure below illustrates the generic process for training and gaining recognition as a medical
In addition to accreditation of Australian pharmacy study programs, the APC developed, and currently specialist.(4)
administers, the Skills Recognition Process: an assessment process for overseas pharmacists wishing As of December 2012, medical practitioners with general and/or specialist registration can apply for
to become registered in Australia. The APC reviews the applicants’ qualifications prior to acceptance endorsement of registration for acupuncture if they hold an approved qualification in acupuncture. For
into the assessment scheme. Eligible candidates are required to participate in one of two examination those without such qualifications, endorsement is still possible if they have been credentialed by the
processes, depending on their country of training and registration. The APC sets and administers both Joint Consultative Committee on Medical Acupuncture for acupuncture prior to 30 June 2012 and have
examination processes (Knowledge Assessment of Pharmaceutical Sciences (KAPS) exam and the complied with CPD requirements for medical acupuncture, or have been practising acupuncture from 1
Competency Assessment of Overseas Pharmacists (CAOP) exam). July 2010 to 30 June 2012 as evidenced by a minimum of 25 relevant Medicare claims in that period.
The APC also developed the intern written examination, which pharmacy interns are required to pass
prior to registration. The APC conducts this examination bi-monthly on behalf of the PBA. The APC also
supplies assessment and examinations to other pharmacy bodies to assist in their recognition processes.
Work relating to skills assessment and examinations is overseen by the APC Examining Committee which
consists of nine members, including representatives of pharmacy professional bodies, pharmacy schools,
the Pharmacy Council of New Zealand, consumers and the community. This committee is responsible
for the development and implementation of examination processes as well as monitoring, reviewing
and evaluating these processes for their quality. Written guidelines such as handbooks(88, 89) and the
written examination guide(90), are produced to assist candidates.
34 35
Figure 3. Process for training and recognition of a medical officer as a specialist
Royal Australasian College of Physicians
Medical Officer - Process for training and accreditation
To embark on a Royal Australasian College of Physicians (RACP) training program, trainees must be
Continued PTO
employed in suitable training positions in accredited hospitals (Australia or New Zealand) throughout
Registrar /
Specialist / their training years. The RACP offers Basic Training Programs in general internal medicine or general
Phase
Medical student International Intern Registered General

Fellowship
paediatrics, comprising 3 to 6 months on rotation, for a total period of 36 months. Basic training is
Medical Graduate Medical Officer Practitioner
(IMG) Trainee (Fellow)
completed under supervision of the Director of Physician Education, in accredited teaching hospitals.
Assessment consists of a written and a clinical exam administered by the college.
Training
College approved
Bachelor of On-the-job 1 year - Clinical 3 years + on-the- training program
Surgery / Medicine experience job training (time and site
specified)
The trainee then proceeds to Advanced Training for the next 3 years (4 years if completing a dual/ joint
- Assessment of overseas equivalence
Advanced Training Program) and is supervised by a college credentialed supervisor. Assessments are
- 3 years +
- English test - Term assessment training
completed every 12 months. Advanced training is available in over 20 subspecialties in Adult Internal
requirement/s
by Supervisor (q6/52) - Examination

- Multi-choice - Pre-employment - No adverse - Supervisor College fellowship
Medicine or Paediatrics & Child Health. Joint Training Programs are available between RACP and the
Gateway
Examination knowledge Structured Clinical “dispatches” (ie Registration Entrance assessed Medical Board
examination Interview adverse supervisor Examination competency Endorsement to
- 16 station OSCE - Workplace reports) - Number registration
assessment using
AMC approved
of required
procedures Australasian Faculty of Rehabilitation Medicine, the Royal College of Pathologists of Australasia, and
Mini-CX completed
the Australasian College for Emergency Medicine. Trainees can choose to undertake specialised training
programs within one or more of the Faculties and Chapters within RACP e.g. Chapter Training Programs
Assessing
Approved post
Agency
State (or national) Specialty College

in addiction medicine, palliative medicine and sexual health medicine; Faculty Training Programs in
Accredited AMC AMC approved graduate medical College approved State (or national)
education training Medical Board training site Medical Board
University training site
site
occupational & environmental medicine, public health medicine and rehabilitation medicine.
Accrediting
Post Graduate
Medical Education
AMC accredited
The trainee is admitted as a Fellow of RACP (± that of another college for those completing joint
Agency
Australian Medical Specialist

Council (AMC) AMC Committee (Quasi Advisory
Non-Government
Organisation
Committees
programs) upon successful completion of training, and is eligible to apply to the Medical Board of
Australia for specialist registration.
Authorisation
AMC legislation AMC legislation State Government State Legislation State Legislation
Royal Australian College of General Practitioners
The Royal Australian College of General Practitioners (RACGP) offers two fellowships – the Fellowship of
Part 2 - Credentialing and Scope of Practice the RACGP and the Fellowship in Advanced Rural General Practice.
END
To be admitted as a Fellow, candidates must pass the 3-part RACGP Fellowship Assessment: an

Specialist /
Credentialised
Specialist with
applied knowledge test (150 questions, MCQ format, available online), key feature problem (MCQ
Specialist /
Phase
General
Practitioner
(Fellow)
General
Practitioner
approved Scope
of Practice and short answer based on 26 cases, available online) test, and an objective structured clinical exam
(Fellow)
(OSCE) consisting of 14 scenarios. The applied knowledge test must be passed before sitting the OSCE
component. Practising general practitioners can elect to sit the Practice Based Assessment to gain
Training
Nil
Nil Nil Fellowship of the RACGP.
Medical practitioners must be on one of 3 pathways in order to be eligible to sit the exams:
requirement/s
+/- Annual
General Practice Experience (Practice Eligible) Pathway
Medical Board Individual Complaints
competency n
Gateway
Endorsed +/- Clinical performance Investigations

+/- Clinical Audit + Audit + against ACSQHC
registration Peer Review Indemnity Cases
+/- Annual Peer Review Standard Civil Cases
+/- CPD +
competency
Facility Service
Capability
Legal reports
n Specialist Pathway Program
n Vocational Training Pathway
Assessing
Agency
Hospital Boards and

Medical Board Professional / Facility Credentialing Government
specialty college Committee Agencies
General Practice Experience Pathway

This pathway recognises work experience and is an option for international medical graduates (IMG)
Accrediting
Agency
Various (eg
AMC ACHS, ISO)
to gain Fellowship without having to do specialist general practice training in Australia. Four years of
full-time equivalent practice in general practice, of which 1 year must be in Australia, is required prior
to enrolment for Fellowship assessments. Candidates’ experience in general practice is assessed by the
Authorisation
Health Practitioner Acts (Registration,

Registration Acts Complaints, CMC,
Civil etc) College Censors through a formal application process. Candidates on this pathway can choose to take
either the RACGP Fellowship exams or the Practice Based Assessment.
36 37
Practice Based Assessment includes 3 components: 4.2.2 Dental practitioners
n Examiner Clinical Visit– direct observation of practice by an examiner All dental practitioners are registered with the Dental Board of Australia (DBA) supported by AHPRA.
According to The National Law, The Australian Dental Council (ADC) is the accreditation authority
n ecorded Video Consultations– candidates submit 90 video recordings of patient consultations.
R
responsible for accrediting education and training programs that lead to registration as a dental
Three examiners will assess 15 of these video consultations for applied knowledge, clinical reasoning,
practitioner. This includes assessment of overseas trained dental practitioners seeking registration with
clinical skills, communication skills and professional attitudes in the context of consultations
the DBA. The ADC accredits postgraduate courses and has also developed “attributes and competency
n iva– an examiner will administer and videotape the viva exam at an agreed scheduled venue. This is
V statements” which describe the professional attributes and competencies of newly qualified dental
an assessment of applied knowledge and skills, clinical decision-making, health promotion, continuity practitioners.(92)
of care, practice management and medical record-keeping.
General registration is subdivided into divisions for Dentists, Dental Hygienists, Dental Prosthetists,
Dental Therapists and Oral Health Therapists. All registrants are required to base their practice on the
Specialist Pathway Program definitions outlined in the DBA Scope of practice registration standard,(93) and are limited to perform
The Specialist Pathway Program provides an avenue for IMGs who do not hold a current Australian procedures for which they have been formally educated and trained in approved programs, and in
medical registration to obtain Fellowship based on assessment of their previous training and experience which they are competent. The DBA also recognises the concept of “development of scope of practice”
in general practice. Once Fellowship is achieved, IMGs can apply for Vocational Registration with the for dental practitioners, and has approved add on programs of study such as local analgesia for dental
MBA, and will be able to work unsupervised as a general practitioner. hygienists.(94)
In addition to development of scope, the DBA allows endorsement of registration in the area of practice
Vocational Training Pathway of conscious sedation. This endorsement recognises additional qualifications and specific expertise, the
This pathway is available to General Practice Registrars. Candidates must complete training in either an standards for which are defined in the Registration standard for endorsement in relation to conscious
Australian General Practice Training program or the Remote Vocational Training Scheme. The Regional sedation.(95)
Training Provider delivers the training program and certifies the completion of training. Candidates For dental practitioners, specialist registration is available to dentists only and is achieved by a three year
must also complete training in the early management of trauma and advanced life support and pass the Doctor of Clinical Dentistry postgraduate qualification, accredited by the ADC.(96) Dentists undertaking
Fellowship exams. this qualification choose to specialise in one of the DBA’s 13 specialities approved by the Ministerial
Royal Australasian College of Surgeons Council(97) (e.g. orthodontics, paediatric dentistry, periodontics). Assessment of subjects within these
courses is by a combination of written exams, oral exams and clinical performance. Once a practitioner

The Royal Australasian College of Surgeons (RACS) is accredited in Australia and New Zealand to train has completed a specialist qualification, and providing they meet the requirements defined in the DBA
surgeons in nine surgical specialties: cardiothoracic surgery, general surgery, neurosurgery, orthopaedic Specialist registration standard(98) (including a minimum of two years general dental practice), they can
surgery, otolaryngology head and neck surgery, paediatric surgery, plastic and reconstructive surgery, apply to the DBA for specialist registration status.
urology, and vascular surgery.
In addition to programs of study approved by the DBA, The Royal Australasian College of Dental Surgeons
The RACS offers the Surgical Education and Training (SET) program where trainees are selected directly (RACDS) is a postgraduate education body which provides a range of CPD activities for both general and
into the specialty in which they will undertake specialist surgical education and training, usually for a specialist dentists. The RACDS provides courses of study and examinations directed at preparing dentists
period of 5 to 6 years. Specialty training boards allocate trainees to accredited training positions for for Membership and Fellowship.
their clinical placements. Trainees work and train under the supervision of experienced surgeons /
supervisors provided by the accredited hospitals. These specialty training boards monitor the quality and 4.2.3 Nursing profession
outcomes of training through regular hospital accreditation and through reviewing trainees’ logbooks. Registration and endorsement
The main components of training include: rotations in hospital positions, college-run short courses on All nurses and midwives are registered with the Nursing and Midwifery Board of Australia (NMBA)
skills and specialty specific courses, at least one research project, work based assessments and college supported by AHPRA. According to The National Law, the Australian Nursing and Midwifery
assessments. Work-based assessments include mid-term and end-of-term reports, Direct Observation of Accreditation Council (ANMAC) is the accreditation authority responsible for accrediting education
Procedural Skills (DOPS) reports, Mini Clinical Evaluation Exercise reports and logbooks. providers and programs of study for the nursing and midwifery profession. In addition ANMAC assesses
the skills of nurses and midwives who wish to migrate to Australia under Australia’s General Skilled
RACS assessments of surgical trainees include: a clinical exam (objective structured clinical exam (OSCE) Migration Program.
format), a generic Surgical and Education Training Surgical Science Exam (100 questions on anatomy –
20 are image based, 60 MCQs on physiology, 60 MCQs on pathology), and a specialty specific exam (120
MCQs determined by the specialty).
38 39
General registration for nurses is gained following completion of a NMBA approved program of study, and relevant State and Territory legislation”. (104) Requirements for this endorsement include 3 years post-
is subdivided into division 1 for registered nurses and division 2 for enrolled nurses. In addition the NMBA registration experience as a midwife and completion of a NMBA approved program of study.
allows the following endorsement for registered nurses:
Colleges
n Registered Nurse-supply scheduled medicines (rural and isolated practice)
There are a number of nursing colleges in Australia that support professional development. The
n Nurse practitioner –includes prescribing scheduled medicines Australian College of Nursing (ACN) was formed on 1 July 2012 by the unification of the pre-existing
Royal College of Nursing, Australia and The College of Nursing, and is a key national organisation. The
Endorsement to supply scheduled medicines (rural and isolated practice) indicates that the “registered
college consists of six faculties and provides a range of Graduate Certificate and continuing professional
nurse is qualified to obtain, supply and administer limited schedule2, 3, 4 or 8 medicines appropriate
development courses. In addition The ACN is a Registered Training Organisation (RTO) and offers a
to the registered nurse’s scope of practice”.(99) To be eligible for endorsement nurses are required to
number of courses including a Diploma in Nursing and Certificate IV in Training and Assessment. As
complete a NMBA approved program of study.
well as providing networking opportunities for members, the ACN liaises with state, territory and federal
A nurse practitioner (who is allowed to prescribe scheduled medicines) is defined as a “registered governments on issues of policy development and reform.
nurse who is educated and endorsed to function autonomously and collaboratively in an advanced and
There are also a number of speciality nursing colleges in Australia. These include, but are not limited to,
extended clinical role”.(100) The NMBA Guidelines on endorsement as a nurse practitioner(101) define
colleges such as the Australian College of Emergency Nursing, Australian College of Nurse Practitioners,
endorsement requirements as:
Australian College of Mental Health Nurses, The Australian College of Children and Young People’s Nurses,
n Current registration as a registered nurse Australian College of Critical Care Nurses. All colleges promote professional development and offer
n T he equivalent of 3 years full-time experience in an advanced practice* nursing role (within the 6 educational services to a varying extent.
years preceding the application for endorsement) Advanced practice nursing
*Advanced practice is further defined as: In 2005 The Australian Government Department of Health and Ageing funded the Australian Nursing
“A level of nursing practice that utilises extended and expanded skills, experience and Federation to review and update the Competency Standards for the Advanced Registered Nurse (the
knowledge in the assessment, planning, implementation, diagnosis and evaluation of original standards being published in 1997). The resulting publication(105) defines competencies around
[nursing] care required. Nurses practising at this level are educationally prepared at three domains and describes the advanced practice nurse as:
postgraduate level and may work in a specialist or generalist capacity. However, the basis n Being prepared for evidence-based practice through post registration qualifications/education
of advanced practice is the high degree of knowledge, skill and experience applied in the
An active member of the nursing profession

n
nurse-patient/client relationship to achieve optimal outcomes through critical analysis,
problem solving and accurate decision-making” n ccepting responsibility for complex situations which may encompass clinical, managerial,
A
educational or research contexts
n C ompletion of approved nurse practitioner program at masters level or equivalent as
determined by the Board n Demonstrating leadership and initiating change
n C ompliance with the national competency standards for the nurse practitioner (standards n Practising comprehensively as an interdependent team member
developed by the Australian Nursing and Midwifery Council (ANMC) in 2006 and approved
n Practising outside of single contexts or episodes of care
by the Board) (100)
n Having particular breadth or depth of experience and knowledge
n Compliance with the Board’s registration standard on continuing professional development
n Focused on outcomes for individuals and groups
There are 2 pathways for submitting an application for endorsement, dependent upon the masters
qualification obtained. Both pathways require submitting a portfolio as evidence to support the In 2006 the Royal College of Nursing revised its position statement on Advanced Practice Nursing,(106)
application; the contents of which are described in two NMBA produced guides.(102, 103) including definitions derived from the International Council of Nurses (the same definition is used by
both the NMBA and the ANMC when defining advanced practice). The position statement made the
Nurses who completed a NMBA approved nurse practitioner program of study at masters level are not
following recommendations:
required to demonstrate compliance with the national competency standards, nurses who completed an
alternative, but equivalent, masters qualification are. This is achieved by additional portfolio requirements n National accreditation standards for educational preparation programs for advanced practice
including self assessment against the national competency standards. n T he use of the Competency standards for the advanced nurse for assessment of competence by
The NMBA general registration for midwives allows endorsement as ‘Eligible Midwife - prescribe advanced practice nurses
scheduled medicine’. This endorsement allows midwives to “prescribe schedule 2, 3, 4 and 8 medicines n That advanced practice nurses have appropriate professional indemnity cover.
required for midwifery practice across pregnancy, labour, birth and post-natal care, in accordance with
40 41
Position statements from the recently formed ACN are currently under review and unavailable to The APA has developed a three tiered career pathway to recognise physiotherapists with advanced
comment upon. expertise and experience.
Credentialing Tier 1
In 2011 The Coalition of National Nursing Organisations (CoNNO) developed a National Nurse A qualified physiotherapist and APA member joins the relevant national group and undertakes
Credentialing Framework, (107)in a project funded by the Australian Government Department of Health appropriate educational and professional development activities.
and Ageing. The framework defines credentialing as “a process of professional validation by which an
Tier 2: Titling
individual nurse may be designated as having met established professional nursing practice standards”
and clearly states that in Australia nurse credentialing is a voluntary process whose undertaking The physiotherapist applies to the relevant APA national group, to be awarded the right to use an APA
is initiated by individuals and should not be linked to employment opportunities or outcomes. The Physiotherapist title. The APA titles that are currently awarded are as follows:
framework lays down principles for credentialing as well as standards and criteria. There is also an n APA Musculoskeletal Physiotherapist
accompanying tool kit which includes templates for implementing the framework.(108)
n APA Sports Physiotherapist
The Australian College of Mental Health Nurses currently provides credentialing of mental health nurses
n APA Animal Physiotherapist
under its Credential for Practice Program. Applicants submit details of registration, qualifications,
employment and nursing experience.(109) In addition they need to submit an Evidence-Based Record n APA Gerontological Physiotherapist
which documents Continuing Professional Education and CPD. The submission is reviewed by a peer
n APA Neurological Physiotherapist
review process and successful applicants receive a credential from the college.
n APA Occupational Health Physiotherapist
4.2.4 Physiotherapy n APA Cardiorespiratory Physiotherapist
All physiotherapists are registered with the Physiotherapy Board of Australia supported by AHPRA. n APA Continence and Women’s Health Physiotherapist
According to The National Law, the Australian Physiotherapy Council is the accreditation authority
n APA Paediatric Physiotherapist.
responsible for accrediting education and training programs that lead to registration as a physiotherapist.
It also assesses qualifications of internationally qualified physiotherapists for registration and migration There are two pathways to achieve titling:
purposes, accredits postgraduate courses, and maintains and reviews the Australian Standards for
Physiotherapy. The first is an academic pathway, open to all titles except Occupational Health Physiotherapist.

Applicants must fulfil the following criteria:
General registration is achieved by studying a Physiotherapy Board of Australia approved program of
study usually at bachelor level (although some courses offer a combined Bachelor of Health Science/ n Successful completion of an APA-approved masters course
Master of Physiotherapy degree). The Physiotherapy Board of Australia plans to allow an endorsement to
general registration for acupuncture.(110) The term acupuncturist is currently limited under the National n t least 2 years’ clinical experience (full-time equivalent) in physiotherapy, with evidence of working
A
Law to registered Chinese medicine practitioners, or practitioners whose registration has been endorsed in the relevant field
as being qualified to practice acupuncture. The standards necessary for holding an endorsement for
acupuncture from the Physiotherapy Board of Australia are not yet available, although the Board is n Current APA membership of relevant national group
currently working on an additional pathway for physiotherapists to legally use this protected title. Until The second pathway is the experiential pathway, where applicants must fulfil the following criteria:
this pathway (which will include grand parenting arrangements for physiotherapists already practising in
Section One:
this area) has been approved, physiotherapists wishing to use this title must be registered by the Chinese
Medicine Board of Australia. n t least 5 years (full-time equivalent) clinical/practical experience, with evidence of a period at least
A
3 years (full-time equivalent) in the relevant discipline area
The Australian Physiotherapy Association
n Current APA membership of relevant National Group
The Australian Physiotherapy Association (APA) is the main national physiotherapy organisation, with
state and national branches and provides CPD, professional development and advocacy services. n E vidence of having engaged in a variety of programs of education to advance their knowledge in
the relevant field of physiotherapy (Applicants need to have accrued 20 Continuing Professional
The APA also contains a number of national speciality groups that facilitate networking, provide CPD
Development (CPD) hours in the relevant disciplinary area in the last year).
activities and represent group members at a national and international level. There are currently 14
national groups which include clinical areas such as musculoskeletal, paediatric and neurology as well as
non-clinical areas such as leadership and management, business and educators).
42 43
Applicants who satisfy these criteria must then successfully complete Section Two of the application 4.2.5 Psychology
process to be awarded the title.
All psychologists are required to be registered with the Psychology Board of Australia (PsyBA) supported
Section Two: by AHPRA. According to The National Law, the Australian Psychology Accreditation Council (APAC) is
the accreditation authority responsible for accrediting education and training programs that lead to
n ritten examination (or portfolio submission for the ‘APA Occupational Health Physiotherapist’ title
W
registration as a psychologist. In addition APAC accredits postgraduate courses, as well as psychology
application)
courses in Hong Kong, Singapore and Malaysia, and provides accreditation assessor training and
n Practical Examination (or viva for the ‘APA Occupational Health Physiotherapist’ title application). certification in Australia and internationally.
Tier 3: Specialisation General registration is achieved by studying a PsyBA approved program of study at bachelor level with a
Specialisation involves the physiotherapist undertaking a 2-year training program which results in subsequent 2 year period of supervised practice. This 2 year period can be achieved by means of a 2 year
admission as a Fellow of the Australian College of Physiotherapists (an educational body within the APA). internship or by completion of an APAC accredited higher degree program such as a masters degree or
Fellowships by Specialisation are awarded in all APA areas of titling apart from animal physiotherapy. doctorate. The PsyBA is currently developing an alternative 5+1 pathway, where the student completes a
fifth year degree, such as a Diploma, followed by a one year internship.
Applicants wishing to commence the course must fulfil a number of prerequisites, as specified in the
candidate manual,(111) and be recommended by an existing Fellow of the College. Applications must be The PsyBA allows for subsequent endorsement of registration in the following areas of practice:
approved by the Board of Censors of the Australian College of Physiotherapists before the physiotherapist n Clinical neuropsychology
can enter the training program, at which point they become an Associate of the College.
n Clinical psychology
Applicants who have completed a postgraduate clinical doctorate, or who consider they have met some
n Community psychology
of the Program requirements, may be given credit for prior learning. Such candidates can apply to the
Board of Censors who will decide if the candidate may omit some, or all, of the program. n Counselling psychology
This training program, which is overseen by the College, consists of a facilitated program of professional n Educational and developmental psychology
development, including regular study groups, formal case presentations, audit reports and trial
n Forensic psychology
examinations. Candidates form specialist study groups and are facilitated throughout the training
period by a Specialist Physiotherapist, who is a Fellow of the College. The training program is conducted n Health psychology
concurrently with the physiotherapist working full-time in their field of speciality for a minimum n Organisational psychology

two-year continuous period (or part-time equivalent).
n Sport and exercise psychology
At the completion of the two-year training program, candidates are required to pass a final clinical and
The PsyBA ‘Area of practice and endorsements registration standards’(113) describes the requirements
two oral examinations. Successful candidates are awarded Fellowship of the College and the title of
for endorsement as:
Specialist Physiotherapist. There is, however, currently no provision for specialist registration with the
Physiotherapy Board of Australia. a) An accredited doctorate in one of the approved areas of practice, and a minimum one year of
approved, supervised, full-time equivalent practice with a Board approved supervisor; or
Fellowship of the College can also be achieved by Original Contribution, which includes submission of a
thesis or original or academic work as follows:(112) b) An accredited Masters in one of the approved areas of practice, and a minimum of two years of
approved, supervised, full-time equivalent practice with a Board approved supervisor; or
I. A collection of research published by the candidate (3-5 substantive papers) where the applicant
is the sole or main author (hereafter called “the collection of published papers”).This must be c) Another qualification that, in the Board’s opinion, is substantially equivalent to (a) or (b).
preceded by an introduction/background chapter and followed by discussion/ conclusion chapter
Note: Option C provides a route for overseas qualifications to be assessed and approved as equivalent.
and other chapters as necessary which together provide a valuable contribution and advancement
of knowledge of a certain area of physiotherapy practice. These papers/articles should be The Australian Psychology Society
independent of work submitted for a higher degree. The Australian Psychology Society (APS) is the largest professional body for psychologists in Australia,
II. A scholarly textbook or monograph (hereafter called “the published textbook”) where the candidate with over 20,000 members.(114) The APS provides educational opportunities as well as representation
is the sole or main author and which demonstrates academic/clinical leadership in a field of for its members. It is also responsible for the assessment of qualifications of overseas trained
physiotherapy practice. Books published during the previous year may be submitted. The work will, psychologist for the purpose of migration or granting student visas.
however, be subjected to the usual review process.
Fellows of the Australian College of Physiotherapists by Original Contribution are not allowed to refer to
themselves as Specialist Physiotherapist.
44 45
There are various levels of memberships available: Table 3. Recognition of advanced and extended practice by other healthcare professions in Australia
n ssociate Membership-open to all psychologists who have completed an
A Medical Practitioners
APAC accredited 4-year sequence of study Registration Medical Board of Australia* (MBA)
n embership-open to psychologists who have completed an APAC accredited 6-year sequence of
M Accreditation Australian Medical Council (AMC)
study in psychology (4 years undergraduate plus 2 years or more postgraduate) Royal - Represents over 21,500 members including more than 19,300 GPs.
Australian
n F ellowship-existing APS members must be nominated by an APA Fellow and have a minimum of 10 - Conjoint Fellowship exams are provided in Malaysia and Hong Kong.
College of
years experience in psychological work or study subsequent to being elected to the grade of Member. - Responsible for maintaining standards for quality clinical practice, education and
General
The candidate must also have made a substantial contribution to the activities of the Society for a Practitioners training, and research in Australian general practice.
minimum of 5 years and have and advanced knowledge of psychology and have made significant
(RACGP) - Provides advocacy in relation to a range of clinical, professional and business issues
contribution to advancement of knowledge, professional practice and education of others
that influence the capacity of GPs to provide patient care.
n In addition there are student and affiliate membership categories
- Membership is available via 3 pathways: practice eligible pathway for practising
Within the APS there are a number of member groups which APS members may join: GPs, the vocational training pathway for GP registrars and the specialist pathway
for international medical graduates (IMGs).
n ranches-provide networking opportunities and professional development at a state and regional
B
levels and are open to any members. - Assessment for Fellowship includes an RACGP Fellowship examination (consists
of 2 written examinations available on-line and an OSCE) or a Practice Based
n Interest groups- facilitate networking between members interested in similar fields, and provide Assessment (PBA) available only to those following the practice eligible pathway.
professional education by means of seminars, courses and conferences. There are 41 interest groups,
Note: Other representative specialist colleges exist representing other areas of medical
which also provide representation for the area of interest at a society level. Interest groups are open
practice
to all members.
Dental Practitioners
n C olleges-there are nine colleges within the APS representing the same specialist areas that are Registration Dental Board of Australia* (DBA)
eligible for registration endorsement. Each college provides educational opportunities by means
of seminars, workshops, courses and conferences. Each college also maintains practice standards - General registration available in 5 areas of practice
and quality assurance for its specialist area and promotes the development of practitioners within - Specialist registration available in 13 specialty areas

the speciality. There are different membership categories according to member qualifications. A full - Limited registration is available for teaching, research, supervisory roles
member must have completed:
Accreditation Australian Dental Council (ADC)
o An accredited doctorate program in the specialist area followed by a minimum one year Royal - Provides CPD opportunities suited to all career paths leading to Fellowship status
full-time equivalent supervised practice; or Australasian (FRACDS)
College
o An accredited masters program in the specialist area, followed by a minimum of two years - Two streams are available to achieve Fellowship:
of Dental
full-time equivalent of supervised practice. (a) General stream – consisting of a primary examination covering 6 main areas
Surgeons
of study; Membership in the general stream (MRACDS) which is available via a 2-3
(RACDS)
year modular, educational learning program based on completion of appropriate CPD
Table 3 summarises recognition of advanced and extended practice by other healthcare professions courses and assessment; the final examination in the general stream is clinically
in Australia. oriented, requires demonstration of a broad experience in general dentistry, mature
clinical judgement and application of knowledge based on current literature.
(b) Special Stream - Membership and Fellowship is available in a number of special
fields. Available to existing Fellows in the general stream and provides an opportunity
to become a member of the college in a specialty area. Examinations include written
and oral assessment and clinical examination. Following the award of Membership,
a specialist must complete a requisite period of specialist practice prior to applying
for assessment of eligibility to present for the final examination for Fellowship in the
Special Field.
- The College also holds the registrable qualification for Oral and Maxillofacial Surgery,
leading to FRACDS (OMS), through a four year training program, following completion
of medicine and dentistry and other requirements as determined by the college.
46 47
Psychology
Registration Psychology Board of Australia (PsyBA)*
- Endorsement to registration available in nine areas of practice
Nursing and Midwifery
Registration Nursing and Midwifery Board of Australia* (NMBA) - Endorsement requires further education in the form of either an accredited
doctorate or masters qualification in addition to a period of supervised practice.
- 2 divisions of registration are available (Registered Nurse and Enrolled Nurse) Accreditation Australian Psychology Accreditation Council (APAC)
- Endorsements to registration available for nurse practitioners, registered nurses
(supply scheduled medicines in rural and isolated practice) and eligible midwife Australian - The largest professional body for psychologists with in excess of 20,000 members
(prescribe scheduled medicines) Psychology
- Provides education and reviews qualifications of overseas trained psychologists
Society (APS)
- Registration endorsement for nurse practitioners requires: current registration, - Membership is available as an Associate (requires completion of an APAC accredited
equivalent of 3 years full-time experience in advanced practice (according to an 4 years of study), Member (requires completion of an APAC accredited 6 years of
accepted definition), completion of an approved program of study at the Masters study, 4 of which may be as an undergraduate) or Fellow (requires nomination by
level, compliance with the Board’s CPD requirements for registration and with an existing APS Fellow, 10 years experience in either work or study subsequent to
national competency standards. Submission of a portfolio to the NMBA is required achieving Membership of the Society. In addition, a substantial contribution to the
for recognition. profession and evidence of advanced knowledge is required).
Accreditation Australian Nursing and Midwifery Accreditation Council (ANMAC) - Provides a number of branches, interest groups and colleges, which represent
Australian - Registered training organisation (RTO) registered and accredited by the Tertiary specialist areas.
College of Education Quality and Standards Agency (TEQSA). Surgery
Nursing
- Provides CPD, graduate certificates and diplomas and competence assessment Registration Medical Board of Australia (MBA)*
(ACN) programs. Accreditation Australian Medical Council (AMC)
Australian - Recognised credentialing body for mental health nurses in Australia Royal - Represents nine regions: all Australian states and territories and New Zealand
College of Australasian
- Represents the profession at all levels of government and across all health service - Provides training for surgeons and maintains standards within Australia and
Mental Health College of
sectors. New Zealand
Nurses Surgeons
- Sets standards for practice - A number of interest groups and sections are available representing
(ACMHN)
- Supports mental health nursing research subspecialty areas.

- Provides professional development activities - The Academy of Surgical Educators (ASE) provides oversight to curricular
development related to generic education needs of surgeon teachers, trainers,
- Provides mentoring via online and 1:1 support
supervisors, assessors and examiners. Membership is available to Fellows,
- The Credential for Practice Program is an initiative of the Australian College of trainees and non surgeons who contribute to surgical education programs and
Mental Health Nurses and has established the only national consistent recognition have an interest in improving their ability to provide surgical education.
for specialist mental health nurses. Credentialing requires submission of registration
- ASE provides graduate programs in surgical education including graduate
details, qualifications, nursing experience and an evidence based record of personal
certificate, graduate diploma and masters level programs as well as seminars
CPD which is subsequently peer reviewed.
and master classes.
Physiotherapy
- Membership of ASE requires submission of a CV, details of 2 referees, RACS
Registration Physiotherapy Board of Australia*
details and a covering letter explaining reasons for applying for membership.
Accreditation Australian Physiotherapy Council
* All Health Practitioner Boards are supported by the Australian Health Practitioners Regulatory Agency
Australian - Represents more than 13,000 members and over 300 members in volunteer (AHPRA)
Physiotherapy positions on committees or working parties.
Association
- The APA is governed by a Board of Directors elected by representatives of all 4.2.6 The Cost Associated with Recognition of Advanced and Extended Practice
(APA)
stakeholder groups within the Association.
At this early stage, the true cost for implementing a pathway for recognition of advanced and extended
- Offers CPD and advanced training and links with 14 specialty groups who deliver practice pharmacists cannot be known, both for stakeholders and individual pharmacists. Awareness
specific CPD to those working or interested in the specialty areas. of what other healthcare professionals pay for gaining recognition as advanced practitioners in their
- The Australian College of Physiotherapists is a body within the APA. The College respective professions may be an indication for the pharmacy profession, at least for the individual
provides a three-tiered model for recognition of different levels of practice from pharmacist. Table 4 shows the costs associated with recognition of advanced practice by other
Graduation to Titled Membership and Fellowship by Specialisation. health professions.
48 49
50
Table 4. Costs associated with recognition of advanced practice
Advanced Cost payable to Costs payable to Cost of associated Cost of College Number of
Qualification National Board Professional Body qualification Membership registered
Profession for registration for recognition of practitioners
amendment advanced practice in Australia1
Medicine Specialist $680 (application fee) See Cost of College See Cost of College $23,108 to achieve 91,745
Registration Membership Membership Fellowship of RACP
(Costs vary for $680 (specialist Out of which
(costs are approximate
each specialty. registration fee) 52,779 hold
and do not include
This example $170 (add specialist late fee, interruption specialist
pertains to registration to general fee, supplementary registration
the Royal registration) fee, chapter training
Australasian fee). Annual fee after
College of obtaining Fellowship =
Physicians) $3,060
Dentist Registration $94 Not applicable Graduate Diploma $8,878.30 to achieve 14,576
Endorsement: in Clinical Dentistry Fellowship of RACDS in
Including
Conscious (Conscious Sedation & general stream
91 with
sedation Pain Control):
$7,285.10 to achieve registration
2
$35,280.00 Fellowship of RACDS in endorsement
Specialist $289 Not applicable Doctorate Clinical the special field stream & 1523 with
Registration Dentistry: specialist
Note: prices are
registration
$105,8403 approximate and do
not include training
modules. It is not
mandatory to be a
FRCADS to achieve
specialist status
Registered Registration $125 Not applicable Master of Advanced College membership 280,219
Nurse Endorsement: Nursing Practice Nurse not related to advanced
Including 788
Nurse Practitioner practice status
registered
practitioner
$32,342 or with a CSP nurse
$11,2964 practitioners
Advanced Cost payable to National Costs payable to Cost of associated Cost of College Number of
Qualification Board for registration Professional Body for qualification Membership registered
Profession amendment recognition of advanced practitioners in
practice Australia1
Physiotherapist APA Title Not applicable Academic pathway: Masters degree: $29,2005 24,304
Application fee$75 Including 1435
APA Titled
APA membership $744
Physiotherapists
annually
and 119
National Group Specialist
membership $96 annually Physiotherapists
Experiential pathway: Not applicable
Application fee:$75
Examination/
Portfolio:$1210
Practical/viva: $1210
APA membership $744
annually
National Group
membership $96 annually
APA Specialist Not applicable $110 application fee Not applicable Supplication for Fellowship
of Specialisation
2 year training course:
$3,300.00
$13,200
(Note: unable to determine
APA membership $744 annual fee from website)
annually
National Group
membership $96 annually
51

5. Literature review of assessment technologies and methods
4. Masters of Nurse Practitioner programs vary in cost and length, depending upon entry level. This estimation is based on the University of Melbourne Master of Advanced Nursing 2 year
registration
Number of
8,441 with
registered
Including
2. Based on indicative fees University of Sydney Graduate Diploma in Clinical Dentistry (Conscious Sedation and Pain Control).(117) No Commonwealth Supported Places (CSP) available.
27, 226
Recognition of advanced and extended practice provides an indication to both peers and the public
29,984
that an individual practitioner conducts their practice at a level considered worthy of additional
acknowledgement. To the public, this implies a stringent process of assessment has been undertaken
and the practitioner has achieved a required standard of practice.
Many methods are available to assess an individual’s professional performance. None, however,
provide a complete picture of practice. To define what constitutes an appropriate assessment model, a
Cost of College
detailed literature review of the assessment methodologies in both the pharmacy and other healthcare
Membership
6. Based on indicative fees Master of Psychology (Counselling) at Monash University.(121) and Doctorate of Psychology (Clinical) Griffith University.(122)
professions was completed.
1. All information obtained from professional board statistics under the AHPRA website(115) and from the National Groups on the APA website(116)
Searches were carried out using the Pubmed® electronic database. Keywords used in searches
were: OSCE/objective structured clinical examination; portfolio, appraisal, employee performance +
questionnaire + feedback; multi-source feedback, mini-PAT; case based discussion; multiple choice
$50,780 or with a CSP:
$46,700, or with a CSP
question/questions/exam/questionnaire, confidence/ cerrtainty based marking; viva voce/viva;

Cost of associated
observation.
Masters degree:
qualification
In areas where searches yielded a large response, these terms were searched in combination with the
Doctorate:
$17,6046
MeSH headings educational measurement/method and/or clinical competence. Eliminating those that
$11,736
3. Based on indicative fees University of Sydney Doctorate of Clinical Dentistry (Orthodontics).(118) No CSP available.
did not focus on the topic of competency assessment tools, a total of 460 published articles were found,
5. Based on indicative fees LaTrobe University Master of Musculoskeletal Physiotherapy.(120) No CSP available
of which 69 were reviewed.

In addition, grey literature searches yielded an additional 13 information sources.
program of study,(119) entry level Bachelor of Nursing. There are limited CSPs available for this course.
advanced practice
for recognition of
Professional Body
Costs payable to
5.1 Assessment Methods

Not applicable
“It is a highly questionable practice to label someone as having achieved a goal when you don’t even

know what you would take as evidence of achievement” Robert F Mager 1962
5.1.1 Multiple Choice Questions

Multiple choice questions (MCQs) have been used extensively as a method of assessment in education.
(123-125) The conventional multiple choice format consists of a stem which poses the question,
Cost payable to
for registration
National Board
followed by several possible answer options. The correct option is called the key, whilst the alternatives
amendment
are called distractors.

Costs currently unknown
Endorsement $215
Advantages
MCQs are useful for assessing the knowledge base of the student. They are easy to use and administer,
in one of
nine areas of
Qualification
and can test a breadth of knowledge in a short period of time.(124, 126) They are also an economical
Advanced
form of assessment, particularly for assessing large number of students.(126)

practice
It is possible to build a bank of MCQ questions for re-use, thus minimising the exam preparation time.
It is important, however, to analyse results relating to previously used questions, as they may require
revision or deletion. Reuse of questions must be done cautiously, as previous students may transmit
questions to subsequent students, and it is necessary to constantly renew the MCQ bank.(124)
Psychologist
Pharmacist
Profession
52 53
Disadvantages To fully assess an individual it is recommended that MCQs are used strategically to test important
content along with other assessments that test practical competence.(124)
It is difficult and time consuming to write unambiguous MCQs.(125) Many considerations need to be
taken into account, including grammar, formatting, number of answer options and their order, as well as
the placement of distractors.(123, 124) As described below, it is important to test MCQs for validity and 5.1.2 The Objective Structured Clinical Examination
reliability prior to administration. Although there are publications regarding the design of MCQs, they are The Objective Structured Clinical Examination (OSCE) was first introduced in the 1970s as a means
mainly opinion or consensus and not based on evidence.(123) of objectively assessing clinical skills in medical students.(131) The OSCE provides the ability to test
Having the correct answer amongst alternative answer options in an assessment may provide the multiple skill sets in a controlled environment.
student with a prompt, the student requiring only recognition rather than recall of details to pick the The original OSCE used a series of paired stations, where the candidate would perform a task at an initial
correct answer. Without this ‘cue’ the student may not have been able to elicit the correct response. This procedural station and then respond to a series of questions about the task in the second associated
is called the ‘cueing effect’, and is particularly evident with true/false MCQs.(124) station. This process limits the ‘cueing effect’, where students are given cues regarding what to look
When faced with a question they do not know the answer to, students may guess an answer, working for or do in the procedural station, based on the questions they have to answer. The candidate may be
on the assumption that they have a specific probability (based on the number of options) of choosing observed at some procedural stations by examiners who use a checklist to capture information. The
the correct response. In the past some organisations have used negative marking to overcome this issue, results from this checklist combined with the number of correct answers in the second station gives
where marks are actually deducted from the total score if an answer is incorrect. More recently certainty a final score. This process is then repeated at additional stations which assess other clinical skills. The
based marking has been employed.(127, 128) As for traditional MCQs, the student is asked to choose the original OSCEs used stations of 5 minute duration and proposed 16 stations as a convenient number.
correct answer, they are then asked to indicate a degree of certainty that the answer will be marked as Since development of the original OSCE, increasing numbers of medical schools across the world have
correct. The marking scheme rewards accurate reporting of certainty and good discrimination between taken to using this method of assessment(132, 133) and its use has spread to nursing and allied health
more and less reliable answers. professions, including pharmacy.(132)
Validity and reliability The original format has been adapted and adjusted over the years (132, 134-137) with common changes
Validity refers to the extent to which the assessment method measures what it is supposed to being a reduction in the number of stations, increased station duration and increased focus on the
measure, and includes content validity and construct validity. Content validity is a measure of whether interaction with the patient/client. The use of a longer station allows for a more complete and holistic
the assessment is relevant, appropriate and representative of the skill being assessed.(123) In MCQ assessment, and facilitates assessment of other professional skills such as communication and behaviour.
assessments this will be dependent upon the questions that are included. It is important that the Advantages

questions are reviewed prior to the assessment by reviewers who have both clinical and tool design
By using standardised patients (either a ‘real patient’ trained to present their condition consistently or
expertise. Construct validity is whether an assessment is actually measuring the skill that it claims to be
an ‘actor’ briefed to present their condition in a standardised way), it is possible to reduce variation in
measuring,(123) and once again should be established prior to the assessment.
the information supplied to the candidate, and the level of co-operation that they may receive from the
Reliability is the degree to which an instrument produces the same results with repeated administration. patient.(131) It is also possible to test multiple clinical tasks in one assessment session.(132)
MCQs have a high level of reliability because they have an objective scoring process.(123)
Assessment by OSCE may be particularly useful for assessing competency in areas that are difficult
Summary to observe but important to practice e.g. prioritisation of tasks. They also provide the opportunity for
MCQs are mainly useful for assessing knowledge base, thus they assess at the “knows” level of Miller’s the student to be assessed in an environment that is not harmful to a patient, and where immediate
pyramid(129) (Figure 4). Whilst this provides evidence of a practitioner’s knowledge, it may not assess feedback can be facilitated.(132, 138) Other benefits include reduced examiner bias, greater objectivity
overall competence or the ability of the practitioner to put theoretical knowledge into practice. Well and an ability to test a broad range of skills. OSCEs are positively viewed by both examiners and students.
constructed MCQs can be used to test higher order cognitive processing such as interpretation, synthesis (132)
and application.(124, 125, 130) Disadvantages
The main disadvantages lie in the time and cost associated with OSCEs, both in preparation and
Figure 4. Miller’s pyramid DOES administration of the assessment.(132, 139) Costs can be minimised by employing lower cost
SHOWS HOW
alternatives such as volunteer standardised patient, re-writing previous scenarios and using an office
based environment rather than a simulation centre.(133) There is evidence that students find OSCE
KNOWS HOW assessment a stressful process although it can be argued that this may actually reflect the ‘real world’
environment.(132)
KNOWS
54 55
There is also some discussion that whilst OSCEs facilitate assessment of individual clinical elements, MSF has been used as a method of assessing postgraduate training and professional development. In
they do not assess the candidate’s ability to view the patient holistically.(132, 139) Actors playing the UK the Sheffield Peer Review Assessment Tool (SPRAT) was developed to assess paediatricians in
standardised patients may also not be able to authentically represent complex patients. Both of training. The tool was subsequently modified to the mini peer assessment tool (mini-PAT), which is used
these issues may suggest that although OSCEs are useful in an undergraduate setting, their use in in postgraduate medical training.(146) In 2011, Patel et al reported on a mini-PAT for pharmacists which
postgraduate students is limited.(135, 139) was used to assess hospital pharmacists enrolled in a postgraduate diploma program.(147) A validated
MSF tool has also been developed for assessment of NHS clinical directors in the UK.(148)
Reliability and validity
Effects on performance are varied and whilst some papers report improvement in motivation and overall
Content validity of OSCEs is considered to be good.(134, 139). Studies reviewing Inter-rater reliability
performance amongst staff undergoing 360-degree reviews, evidence is conflicting and some papers
have been mixed, with many giving very good scores for OSCEs but some showing inconsistent results.
describe decreased performance, discouragement and anger, particularly when negative feedback is
(132, 134) Some authors have suggested that 2 examiners per station would help to resolve this issue,
received.(141)
although due to labour and cost restraints, random quality checks are often employed as an alternative.
(132) The design and choice of the scoring tool is also critical for maximising reliability. Checklists are Advantages
commonly employed in OSCE assessment, often being adapted so that the examiner can make some
Review of MSF provides the opportunity for the assessor to get an overview of how others perceive
assessment of the student’s overall performance.(132)
the student/practitioner at work and how they relate to other professions within the healthcare
Other important aspects of reliability are the extent to which the OSCE scores match the scores achieved environment. It facilitates comparison with other students and offers the opportunity to compare self
by the same candidate in other assessment processes (concurrent validity), and also their ability to perception with peer perception.(141) Review of the assessment can also be used to identify strengths
predict subsequent performance (predictive validity). Findings in both these areas have been conflicting and weaknesses of the individual.
and often show poor reliability.(132, 139) It is, however, argued that such studies are poorly designed,
Students, raters and supervisors generally find the tools easy to use and have a positive attitude to them,
and that it was poor reliability of other assessment methods which lead to the introduction of the OSCE
although interestingly the perceived effectiveness of the tool is low.(149)
in the first place.(132) It appears that reliability of OSCE assessments is improved with a greater number
of stations, (particularly when a diverse range of skills is being tested).(132, 139) Disadvantages
Summary Most MSF tools rely on the student nominating the peer assessor. Although Ramsey et al(142)
demonstrated that peer ratings are not biased substantially by the method of selection of the peers,
OSCEs can be used to test a wide range of clinical, technical and practical skills. They are also useful
or the relationship between the rater and the subject, there is concern that the student may nominate
in the assessment of higher order skills associated with problem solving. The OSCE can also assess
colleagues they believe may provide favourable reviews. This can be overcome to a certain extent by the

behavioural, interpersonal and communication skills.(133) OSCEs may be particularly useful for assessing
supervisor reviewing peer choices and encouraging nomination of a wide group of peer assessors.
competency in areas of extended scope such as prescribing.(140)
Raters base their assessment on their perception of overall student performance. Any views offered
The OSCE has the benefit over other assessment techniques in that candidates can actually demonstrate
are personal views and may be influenced by the experience and standards of the rater. Students often
competence to an examiner; it therefore sits at the “shows how” level of Miller’s pyramid.(132, 134, 136)
express concern that feedback may not be based on direct knowledge. In one study although the majority
It is worth noting, however, that any simulation is not going to achieve the same level of assurance as
of raters stated they based their feedback on direct observation, a large majority said they used indirect
observing actual clinical practice, where the “does” level in Miller’s pyramid can be assessed.
evidence obtained from colleagues. This has the potential to reduce the number of individual views and
increases the risk of biased preconceptions.(149)
5.1.3 Multi-Source Feedback
Providing feedback to the student/practitioner is an essential component of MSF, and it is vital that the
Multi-Source Feedback (MSF) is the process by which an individual receives feedback on their work supervisor providing the feedback is appropriately trained in feedback techniques.(141) This may limit
performance from peers, managers and subordinates. Other descriptors include peer assessment, multi- the application of MSF in organisations that do not have access to such training.
source assessment, 360-degree feedback, 360-degree appraisal, peer review, and peer rating.(141)
Validity and reliability
MSF tools typically collect information in the form of rating scales, but usually allow the rater to add
qualifying statements in the form of text. As MSF tools vary, there is a need to demonstrate validity and reliability for each individual tool, and
some such evaluations have occurred. Reliability has been demonstrated in MSF and peer assessment
Although MSF was originally developed by industrial organisations to improve leadership qualities, its tools used in some medical specialties,(141) as well as the questionnaires used by the GMC for doctor
use is becoming increasingly common at a global level to provide evidence of professional behaviours in revalidation.(145)
healthcare.(141-143) From December 2012, all UK doctors are required to undergo a MSF assessment
every 5 years as one component of their General Medical Council (GMC) revalidation process.(144)
Validated questionnaires assessing both patient and peer assessment of the doctor’s professional
practice have been developed to assist in this process.(145)
56 57
The number of peer assessors required to ensure reliability varies remarkably from study to study Many facilities have developed web based portfolios, which appear to improve flexibility of access to
and tool to tool. Ramsey et al(142) demonstrated that peer ratings from 11 physicians were needed information for both users and assessors, motivate users and encourage reflection.(153) Some web
to provide reliable ratings on a physician assessment tool. Validity and reliability assessment of the based programs facilitate links with online peer evaluation tools and provide the ability to upload, files,
SPRAT tool found that only four raters were sufficient to make a reasonably confident assessment of videos, and PubMed® searches.(151)
competence. (141) Validation of the questionnaires recommended by the GMC, suggest that at least 34
Advantages
patients and 15 colleague questionnaires per doctor are required to achieve acceptable reliability.(145)
There is also evidence from validation of these questionnaires that feedback is biased towards Portfolios can be used to provide evidence of competencies that would otherwise be hard to assess such
the positive. as professional behaviour, practice-based improvements, creative endeavours, research activities and
professional experience. They give a complete picture of a practitioner’s achievements, strengths and
Summary
weaknesses and professional goals and aims.(154)
MSF is a widely used and well accepted assessment process. New tools will need to be validated prior
Portfolios are useful tools for formative assessment,(153) and it has been shown that students favour
to introduction. Due to concerns regarding the objectivity of rater assessment they should not be used
portfolio assessment over traditional testing.(154) The attitude of postgraduate students towards
in isolation to inform decisions about practitioner competence, but can be a useful indicator of
portfolios is generally positive.(153)
professional practice.
Disadvantages
5.1.4 Portfolio Postgraduate students complain that completion of portfolios is time consuming and difficult to fit into
A portfolio is defined as “formal documentation of training, achievements and experience”. their busy schedules,(153) whilst some undergraduate students state that portfolio development keeps
them away from other clinical learning.(152)
Many health professions in varied countries have introduced portfolios as a means of facilitating ongoing
professional development and encouraging self-reflective learning.(150) The ongoing use of portfolios by individual practitioners seems to tail off after a period of time.
Compliance with portfolio development is much greater if they are to be used for a summative
Evidence suggests that portfolios have the following benefits: (151-153) assessment.(153)
n Improved student’s self awareness Reliability and Validity
n Improved self-confidence Whilst there is evidence to support portfolio review as a valid method for assessing competency,(153,
n Assisted identification of individual learning needs 154) some studies have highlighted concerns around the contradiction of encouraging original and

reflective content whilst, trying to ensuring a structure that is valid.(153)
n Augmented ability to learn independently and to integrate theory with practice
Individual portfolio assessors will vary in their experience and skills. Due to the nature of portfolios, the
n Increased awareness of a student’s needs for mentors
content will also vary considerably from practitioner to practitioner. Portfolio development is intended to
n Improved trust between student and tutor. provide evidence over a wide range of competencies and, as such, assessors will require clear and specific
Portfolio contents vary considerably from organisation to organisation but some key components include: evaluation tools in order to make effective and reliable judgements. Training of assessors, increasing the
(102, 151) number of assessors and using evaluation tools have been shown to produce good reliability rates.(153-
155) There is also evidence that portfolio ratings correlate with the overall student achievement,(154)
n Curriculum vitae although other authors argue that portfolio assessment is not reliable enough to be used as a sole
n Qualifications method of assessment, but is useful when combined with other assessment methods.(153, 154)
n Work experience Summary
n Rotation evaluations At an undergraduate, level portfolios are increasingly being used to encourage students to reflect on
their own practice, facilitate learning, and assess progress and competency.(152) Portfolio use is also
n Action plans from direct observations
becoming increasingly popular at postgraduate level, to provide evidence of the scope and depth of
n Evidence of CPD the practitioner’s competence.(154) Portfolios also have the potential to be used as tools to organise
n Teaching presentations workplace learning during postgraduate specialist training.(155) In Australia portfolios are important
tools to assist registered practitioners demonstrate their competence against the standards required
n Critical incidents for licensure.(156) In addition portfolio submission is already being used as an element to achieving
n Quality improvement projects recognition as an advanced practitioner in nursing and physiotherapy (see section 4.2)
n Evidence of research.
58 59
5.1.5 Viva Voce The appearance and attitude of the candidate may also impact on the examiner’s rating of a student,
with gender, social background and ethnicity having been shown to inappropriately influence examiners.
A definition of the viva voce (commonly referred to as the viva) is an “oral examination characterised by (159) Levels of prompting may also vary between examiners, and in addition examiners assessing a
face-to-face interaction between an examinee and one or more examiners”.(157) number of candidates may subconsciously start to rank the candidates or compare one against the other
Whilst the viva was once a common assessment method for undergraduate, postgraduate and in a subjective manner.(158, 159)
professional examinations, its use has declined, and it has been increasingly replaced by other Validity and Reliability
assessment methods.(158, 159)
Any assessment that lacks formal structure will be prone to errors of variability. Validity of the viva
In Australia the viva is used for the Fellowship route into some colleges; for example the RACDS(160) and is difficult to establish, (158) as to some extent validity is dependent on the questions asked by the
the RACGP (via the work based assessment pathway).(161) Other colleges, such as the Royal Australasian examiner. As discussed earlier, these questions may vary from candidate to candidate and examiner to
College of Physicians, use alternative workplace-based assessments such as mini clinical evaluation examiner.
exercises, case-based discussions and direct observation of procedural skills.(162)
The subjective nature of the viva is likely to reduce its reliability. Variations in subject matter, questioning,
Advantages prompting and attitude of the examiner may all lead to differences in the examining standards between
The viva may be useful for the assessment of the following characteristics, some of which are difficult to different candidates and different examiners. Inter-rater reliability of vivas is, therefore, generally poor.
measure via alternative assessment techniques:(157, 159) (159)
Much can be done to improve the traditional viva. Careful selection of examiners and subsequent training,
n Clinical reasoning
use of formal structured questions to cover pre-defined topics and a structured method of rating have
n Decision-making all been employed in an effort to make results more reliable.(158, 159) Analysis of such measures
introduced by the Royal College of General Practitioners in the UK has shown that reliability of vivas can
n Communication skill be achieved.(159)
n Problem solving and reasoning Summary

Vivas generally test the candidate at the “knows how” level of Miller’s pyramid. Whilst vivas may be
n Judgement
unreliable, they remain useful tools for assessing clinical reasoning, problem solving and decision-
n Ethics making functions; skills that may be difficult to test by other assessment methods. This may make them

potentially useful for the assessment of the postgraduate student. (157) By using appropriate examiner
n Ability to think on one’s feet training and assessment technique, some of the issues of reliability may be overcome.
n Clinical competence
5.1.6 Case-based Discussion
n Professionalism A Case-based Discussion (CbD) involves a comprehensive review of a clinical case between a student/
The viva allows the examiner flexibility to move between different subjects, and to tailor the questions to practitioner and an assessor. The student/practitioner will typically prepare and present a case that they
the candidate, thus making the assessment more individualised.(159) have been significantly involved with. Presentation may include presenting complaint, patient history
(including medicines), clinical investigations and findings, management plan and follow up.
Oral examinations are relatively easy to prepare, organise and run, facilitating the assessment of a large
number of candidates in a relatively quick time. Traditionally the CbD has been used as a training tool, and is mainly used in formative assessments.
(163) Depending on the examining body, the student/practitioner may choose the case they wish to
Disadvantages present,(164) or provide the examiner with a number of cases, from which the examiner selects the
case(s) they wish to review. Students may be requested to provide cases that cover a number of learning
Viva examinations are often unstructured, and as such a wide variation may occur in the questioning of
objectives or situations of varied degree of difficulty.(165)
different candidates by different examiners, the examiner may even direct the questioning to areas they
themselves are interested or experienced in.(159) The viva assessment is thus subjective in nature, as Patient cases have been used as a means of teaching in pharmacy for a long time, often by means of
the examiner may, to some extent, choose the topics that are discussed and decide how deeply they will case presentations to peers in continuing education sessions. CbD is a method of formalising this process
probe areas of knowledge with different candidates. to allow assessment of the case and facilitate feedback to the student/practitioner.
In order to standardise assessment and feedback, CbD tools have been developed. One such pharmacy
specific CbD tool has been developed by the Joint Programming Board in the UK and has ratings for
60 61
pharmaceutical needs assessment, treatment recommendation, follow up/monitoring, professionalism 5.1.7 Direct Observation of Competency
and overall clinical judgement.(166)
Direct observation is an important element of both training and assessment of a student/practitioner,
Advantages and involves the assessor observing the student/practitioner in a working environment.
The CbD is designed to assess clinical decision-making, professional judgement, application of knowledge Numerous tools have been developed to facilitate assessment of competency by direct observation,
and professionalism; skills that are often difficult to assess by means of a written exam. It has the including the mini Clinical Evaluation Exercise (mini-CEX), which is widely used in assessment of medical
advantage of demonstrating something that the student/practitioner has been actively involved in, whilst residents in the USA,(172) and also as part of the basic training program for the RACP.(173) The mini-
allowing them to explain why they acted as they did. CEX, as the name would suggest, is a short observational assessment taking approximately 20 minutes,
which allows for numerous formative assessment to be conducted across the year. The mini-CEX has
The CbD is a relatively cheap and easy to administer assessment, requiring little preparation on the part
been adapted for use in assessing pharmacists in the UK.(164)
of the examining body. It is also relatively quick with assessments taking between 20-30 minutes.(164,
165, 167) In Australia, professional competency tools have been implemented to support practitioner development
through a process of direct observation and feedback. Both the Queensland Health General Level
Disadvantages
Framework (GLF)(39) and the shpaclinCAT (25) were adapted from the original CODEG GLF.(174)
In the preparation of the CbD for presentation, the student is able to reflect on their case and research These tools take considerably longer than the mini-CEX to complete, and greater emphasis is placed
and prepare information in anticipation of the questions. Whilst this is a positive outcome in terms of on feedback and the production of an education and training plan for the pharmacist. It should be
training and development, the CbD itself may not truly reflect the student’s knowledge base and clinical emphasised that these tools were designed with professional development and training as their primary
decisions at the time of their involvement with the patient. goal rather than as a summative assessment method.
Some rating scales may ask the assessor to rate against linear gradation scales such as unsatisfactory Advantages
through to superior.(168) Different raters may have different interpretations of these scales dependent
Direct observation provides the opportunity to see the student working first hand in a clinical
on their experience and standards. Raters may also be disinclined to rate in negative sounding categories
environment. Whilst it is possible to assess a student in a controlled environment, competence in such an
such as unsatisfactory or poor.(169) Other scales are designed to assess performance in relation to stage
environment does not predict workplace performance.(169)
of training. For example ratings such as below expectations through to exceed expectations.(166) Raters
may be unsure what is actually expected for a stage of training, and may be hesitant to rate a student as Direct observation facilitates assessment of skills such as interaction with patients and families,
below expectation if they are reaching the end of their training period.(169) compassion and empathy(175) which would be impossible to assess without direct observation. It also
provides the opportunity to observe the practitioner’s interaction with other healthcare professionals and

assess the practitioner’s place in the healthcare team.
There is little published evidence about the reliability of the CbD, though there is data that suggests
Disadvantages
a fore-runner of this assessment method (the chart-stimulated recall) demonstrated good construct
validity as well as good inter-rater reliability.(170) Direct observation generally requires the assessor to complete the observation in the student/
practitioner’s usual workplace. The logistics of organising this may prove difficult, particularly when
Both validity and reliability will be improved by the use of standardised assessment and rating tools,
assessing at an advanced level where the number of suitably trained assessors with appropriate
which ensure the appropriate skills are tested and reduce the risk of inter-rater variation. Instruction
experience may be limited.
sheets for examiners can also be prepared with standardised questions.(171)
An alternative option is to gather multiple candidates in one clinical environment, where there is
Summary
access to appropriate assessors. This is likely to give a misrepresentation of the student/practitioner’s
The CbD generally tests the candidate at the “knows how” level of Miller’s pyramid. It is useful for competency, as they will be practicing in an unfamiliar environment. It will also be difficult to assess
assessing clinical decision making, problem solving skills and application of knowledge. interaction with other healthcare professionals and the way the student/practitioner normally fits into
The CbD is typically employed in training and formative assessment, as it can be used to demonstrate the the healthcare team.
student/practitioner’s input into patient care. Assessors need to be trained in order to perform this role. Assessors who received comprehensive
Validated tools will improve the reliability of the assessment, along with the use of structured questions training on how to conduct a direct observation assessment feel more comfortable about conducting
for the examiner. observations, and rate students/practitioners more stringently than those who do not receive training.
(176)
It is a well recognised effect that once people are aware they are being observed, they intentionally or
unintentionally modify their behaviour. This is called the Hawthorne effect, and means that students/
62 63
practitioners undergoing observation will attempt to perform at their very best rather than practice at Figure 5. Percentage of each competency domain tested by assessment method (adapted from
their normal level.(175) Stern, D: The assessment of global minimum essential requirements in medical education)
The disadvantages of rating scales as discussed relating to clinical-based discussions (section 5.1.6) also
apply to those typically used in direct observation tools.
100
90
There is a considerable body of evidence for the reliability of the mini-CEX form. Inter-rater reliability
varies, although there is evidence that ratings of overall clinical competence are consistent. (170) It has 80
also been shown that the mini-CEX can differentiate between different levels of competency due to
variations in experience and performance, thus exhibiting strong construct validity. 70
Although many tools are available for the direct observation of clinical skills, validity evidence is scarce. 60
(177) Studies have shown that the reliability of direct observation is low.(176) This variability can
50
be improved by the use of specific observation tools to facilitate rating, and appropriate training of
assessors. 40
The GLF has been validated in the UK,(178) Australia(39) and Singapore(179) as a formative tool to 30
facilitate the evaluation of ward-based competencies of junior pharmacists, but has yet to be validated
as a summative assessment tool. There is little published evidence to support the reliability of the GLF. 20
Summary 10
Direct observation is the only method of assessing the “does’’ level of Miller’s pyramid. It can be used 0
Professionalism
Scientific Knowledge
Communication Skills
Population Health
MCQ
Clinical Skills
Information
Management
Critical Thinking
and Reserach
to assess a wide skill set including knowledge, practical skills, communication, judgement, decision
making, professional relationships, workload management and professionalism. It is recommended that a OSCE
validated assessment tool should be used to facilitate direct observation.
Observation/
As mentioned above, direct observation tools for pharmacists have been used for education and
Logbook

professional development processes, and there is no evidence regarding their use as a summative
assessment method.
5.2 Blended models for assessment

Whilst this figure does not include all assessment methods, it illustrates the tools that can be used to
It is clear from the review of assessment methods, that each has its own advantages and disadvantages.
assess various competencies and highlights the requirement of using a variety of tools to establish
Evidence in reviewing the literature has suggested that there is no single method that will give a holistic
competency.
view of the candidate to be assessed. (124, 132, 145, 153, 180-182) It is, therefore, important to use
multiple modes of assessment to ensure that requisite knowledge, skills and attitudes are demonstrated It is, therefore, appropriate to consider using a mixture of assessments to evaluate an advanced
to a pre-defined level. practitioner and this approach has been taken by many professional organisations. Provided below
are examples of how different organisations have used or are considering using blended models for
In 2004, Stern et al published a paper which set out to establish a set of tools that could be used to
assessment.
assess medical competencies.(183). Part of the process was to determine which competencies were
assessed by different assessment tools (Figure 5 on the next page). Medication Management Review credentialing in Australia
Currently within Australia, the credentialing of pharmacists to undertake MMRs by both SHPA and
AACP utilises multiple modes of assessment. Various combinations of the following have been
included:(184),(185) portfolio review, clinical MCQs, completion of case studies, OSCEs, and direct
observation of clinical practice evaluated by a trained assessor using an approved tool (e.g. shpaclinCAT).
In one of the pathways, these assessments are in addition to completing an approved postgraduate
qualification.
64 65
Royal Australasian College of Physicians Fellowship exams:
In order to become a Fellow of the RACP, it is necessary to proceed through ‘Physician Readiness for n pplied Knowledge Test: consists of 150 questions made up of single best answer (MCQs) and
A
Expert Practice (PREP)’ basic and advanced training programs. Assessment of training programs may vary Extended Matching Questions.
slightly with speciality; the information below is based on a trainee in adult medicine. (186-188)
n K ey feature problems: 26 cases where the candidate is required to either type short responses or
Basic PREP program select responses from a list of options
Formative assessment is achieved by means of: n OSCE: a combination of 14 clinical cases of either 8 or 19 minute duration.
n ini-CEX: trainees are required to complete 4 encounters annually on a range of cases with each
M Practice Based Assessment:
focussing on specific aspects of the clinical encounter (e.g. history taking, or physical examination)
n E xaminer Clinical Visit: the examiner visits the candidate’s practice and observes a general practice
n rogress reports: the educational supervisor provides both a mid-year and annual report whilst the
P session with patients
ward/service consultants provide end of rotation reports
n ecorded Video Consultations: three examiners mark 15 recorded video consultations out of the 90
R
n L earning Needs Analysis: trainees are required to create a learning plan using an online learning consultations submitted by a candidate
needs analysis tool. They are subsequently required to complete 2 learning need analyses each year,
n iva: an oral examination comprised of 20, two-part questions formulated by reviewing the
V
preferably at the end of major rotations
candidates practice profile and general practice consulting trends.
n rofessional qualities reflections: trainees are required to submit 2 reflections each year on an event
P
Assessment of Advanced Pharmacy Practitioners in the UK
that had medical or professional significance to them
The Joint Partners Credentialing Task group (JPCT) recently published a report regarding professional
Summative assessment occurs in the third year of training and determines progression to
recognition for pharmacists in the UK on behalf of the Royal Pharmaceutical Society.(69)
advanced training:
Recommendations of the report include the establishment of assessment processes comprised of
n ritten examination- comprises two papers that consist of a combination of MCQs and Extended
W multiple assessment techniques, use of validated tools and the development of an electronic portfolio to
Matching Questions (short questions with common answer options, but different stems) assist with submission of practice evidence and to guide evidence gathering in relation to the Advanced
to Consultant Level Framework (ACLF). Multi-source feedback, portfolio review and expert assessment of
n C linical Examination-comprises two examination cycles taken on the same day (2 long cases of 95
practice were considered important components of the process.
minutes duration, and 4 short cases of 15 minutes duration)

McKenzie et al(68) recently investigated a process for credentialing advanced level pharmacy practice
Advanced Training Program
in the specialty area of critical care. Established tools available to evaluate pharmacists working in this
Advanced trainee curricula and assessment vary with speciality; the information below is based on an area of practice include: the Critical Care Curriculum Framework (CCCF), which describes the specialist
Advanced Trainee in general medicine. knowledge and skills required to work in the area of critical care, a modified version of the ACLF which
Formative assessments: has been refined for pharmacists working in critical care, multi-source feedback, case based discussion,
clinical evaluation exercise and viva voce. In addition, submission of a portfolio, which highlighted the
n Case-based Discussion (one per year)
pharmacist’s CV, current role, self-assessment using the ACLF, previous peer reviews conducted by
n Mini-Clinical Evaluation Exercises (one per year) appropriate evaluators was required.
n Mid-Year Progress Report (one per year) The recognition process involved multiple steps including:
Summative assessments: n Application for assessment
n Final Supervisor’s Report (one per rotation) n Undertake multi-source feedback
n Research project (two in total during Advanced Training). n Submit portfolio of evidence
The Royal Australian College of General Practitioners n Undertake case-based discussion, clinical evaluation exercise and viva voce.
Fellowship of the RACGP can be achieved by the Fellowship Exam route or the Practice-Based The use of multiple sources of practice information was considered essential to achieving the aim of
Assessment route (which is open to International Medical Graduates who have prior experience working ensuring the competence of practitioners and ultimately to improving standards of patient care.
as a GP).(161, 189)
66 67
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7. Appendices
80 81
82
Appendix A: Certification Requirements in the USA
Specialty Area Who Certifies Qualification Achieved Requirements to achieve certification Requirements to achieve recertification Comments Cost
Ambulatory Care Board of BCACP Eligibility n Current licence to practise BPS accredited Certification
Pharmacy Pharmacy by National Application Fee
Specialists n Degree accredited by ACPE Commission
for Certifying $600
(BPS) PLUS
Agencies (NCCA) Recertification
n Current licence to practise
n Pass 100 item MCQ recertification exam Application Fee
Then
OR Certification valid $400
n P
ass Ambulatory Care Specialty Certification for 7 years Certification
Exam n E
arn CPD credit provided by a program Retake Fee
approved by BPS or 100 hours credit provided (within 2 years)
OR by PD programs offered by ACCP and/or joint
program offered by the ASHP and APhA. Max $300
n C
omplete PGY2 Ambulatory Care Pharmacy 50% accepted during the first 3 years of Recertification
Residency at site accredited by ASHP certification cycle. Retake Fee
OR (within 1 year)
$200
n C
omplete PGY1 residency at site accredited
by ASHP /other recognised body PLUS one Annual Fee -
year practice experience with at least 50% $100
time spent in ambulatory care activities
(defined by BPS ambulatory Care Pharmacy
Content Outline)
Cardiology BPS BCPS (pharmaco-therapy Eligibility n Maintenance of BCPS status and BPS accredited Application
specialist) with added resubmission of electronic portfolio yearly. by NCCA for Added
qualifications in cardiology n M
ust be Board Certified Pharmacotherapy Qualification:
Specialist. $100
Certification valid Renewal
Then for 7 years Application
n S
ubmit electronic copy of portfolio which $100 (every 7
justifies the additional credential and defines years)
the distinction between the individual
and other BPCS who do not qualify for the Annual Fee – NIL
additional recognition. Portfolio must contain: Reconfirmation
o Letter from applicant of Added
requesting portfolio review Qualification
– 50% of
o Detailed summary of each current Added
element presented in the Qualification
application. Application Fee
o Examples and timeframes
below each statement
o CV
Geriatric Pharmacy Commission for Certified Geriatric Eligibility Pass Examination Commission New applicant
Certification Pharmacist Certified by NCCA exam fee
in Geriatric OR
n Must hold current licence to practise $600
Pharmacy Successful completion of 75 hours of designated
n M
inimum 2 years experience as a licensed ACPE accredited CE programs sponsored by Certification valid Re-applicant
pharmacist. ASCP for 5 years. exam fee
$300
n No CE requirements for certification
Recertification
Then by exam
$400
n 150 question MCQ in 3 hours
Recertification
by PDP
$400
Admin fee every
5 years
$250
Infectious Diseases BPS BCPS with added Eligibility n Maintenance of BCPS status and BPS accredited by Application
qualifications in Infectious resubmission of electronic portfolio annually. NCCA for added
Diseases n M
ust be Board Certified Pharmacotherapy qualification
Specialist. $100
Certification valid
Then for 7 years Renewal
application
n S
ubmit electronic copy of portfolio which
justifies the additional credential and defines $50
the distinction between the individual Annual fee
and other BPCS who do not qualify for the for added
additional recognition. Portfolio must contain: qualification
o Letter from applicant requesting $Nil
portfolio review
Reconfirmation
o Detailed summary of each of added
element presented in the qualification
application.
50% of
o Examples and timeframes below current added
each statement qualifications
o CV application fee
83

84
Nuclear Pharmacy BPS BCNP n Graduation from ACPE accredited program/ other n Self-evaluation: review of changes BPS accredited Application for
outside US that qualifies. to practice / functions since last by NCCA certification
certification. $600
n Foreign trained pharmacists must pass the Foreign
Pharmacy Graduate Examination Committee (FPGEC) Certification valid Certification
n Peer review: Document Nuclear
exam. for 7 years retake
Pharmacy Practice activities of the
$300
n Current licence to practise in the US 7 years -> reviewed by the specialty
council on Nuclear pharmacy Pass score Maintenance fee
n 4000 hours training/experience in nuclear pharmacy
approx. 70%
$100 per year for
practice. n Formal assessment: either (a) (based on 2009
years 1-6; $400
exam)
Achieve pass mark on 100 item MCQ recertification fee
n Achieve Pass score in Nuclear Pharmacy Specialty recertification exam OR (b) earn 70 in year 7.
Certification Exam (200 MCQ) hours CE credit provided by a PD
program approved by BPS. At least
30 hours must be earned in the last 3
years.
Nutrition Support BPS BCNSP n Graduation from ACPE accredited program/ other n E
arn minimum of 3 CE units in nutrition BPS accredited Application for
Pharmacy outside US that qualifies. support (no less than 1CEU every 2 by NCCA certification
years). CEU must be completed with an $600
n Current licence to practise in the US accredited provider accredited by ACPE. Certification valid Certification
for 7 years retake
n Completion of 3 years practice n Achieve pass score on 100 item MCQ
experience with at least 50% time spent in specialty $300
area (as defined by BPS nutrition support content 1CEU = 10 hours Maintenance fee
outline) OR PGY2 residency accredited by AHSP/other of approved CE
$100 per year for
recognised body years 1-6; $400
recertification fee
in year 7.
Oncology BPS BCOP n Graduation from ACPE accredited program/ other n Achieve pass score on 100 item BPS accredited Application for
Pharmacy outside US that qualifies. MCQ exam by NCCA certification
OR $600
n Current licence to practise in the US
Certification valid Certification
n Earn 100 hours CE credit provided by for 7 years retake
n Completion of 4 years experience with at least 50% of
time spent in specialty PD program approved by BPS. $300
OR Maintenance fee
$100 per year for
n Completion of PGY2 residency (accredited by ASHP / years 1-6; $400
other recognised body) in oncology pharmacy PLUS one recertification fee
additional year with at least 50% time in specialty. in year 7.
AND
n Achieving pass score on oncology pharmacy specialty

certification exam.
Pharmacotherapy BPS BCPS n Graduation from ACPE accredited program/ other n Current licence to practise BPS accredited Application fee
outside US that qualifies. by NCCA
AND $600
n Current licence to practise in the US Recertification

n Achieve pass score on 100 item MCQ Certification valid Fee
exam for 7 years
n C ompletion of 3 years experience with at least 50% of $400
time spent in specialty. OR Certification
OR retake (within 2
n Earn 120 hours CE credit provided by years)
PD program approved by BPS $300
n C
ompletion of PGY1 residency accredited by AHSP /
other recognised body. Recertification
retake (within 1
year)
$200
Annual fee $100
(not required
for year of
recertification)
Psychiatric BPS BCPP n Graduation from ACPE accredited program/ other n Current licence to practise BPS accredited Application fee
Pharmacy outside US that qualifies. by NCCA
PLUS $600
n Current licence to practise in the US Recertification

n Achieve pass score on 100 item MCQ Certification valid Fee
exam for 7 years
n Completion of 4 years experience with at least 50% of $400
time spent in specialty OR Certification
OR retake
n Earn 100 hours CE credit provided by
$300
PD program approved by BPS
n Completion of PGY2 residency accredited by ASHP /
Maintenance fee
other recognised body in psychiatric pharmacy PLUS 1 $100 per year for
year with at least 50% time spent in specialty. years 1-6.
Note: if recertifying via CE process, the
applicant must complete the review course
once (and a maximum of twice) during the
7 year recertification cycle.
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86
Specialty Area Who Certifies Qualification Achieved Requirements to achieve certification Requirements to Comments Cost
achieve recertification
Multidisciplinary Certifications
Anti-coagulation National Certifica- Certified Anticoagulation For pharmacists: Exam Disciplines certified (in addition to pharmacists): Application Fee
Care tion Board for Care Provider (CACP)
PLUS Registered Nurse (RN) $400
Anticoagulation n Hold professional licence for min
Providers (NCBAP) 2 years details as provided for Advanced Practice Nurse (NP)
original application.
Licenced Physician (MD)
n Current US licence to practise
Physician Assistant
n Minimum 750 hours active antico- (PA)
agulation patient management within
preceding 18 months. This is attested
as part of the application. Certification valid for 5 years
n Provide a written description of current

activities pertaining to specialty. Dura- Pass mark 80%
tion and types of activities should be
described, including number of patients,
practice setting, management of clinic,
the applicant’s roles and responsibili-
ties etc.
n Achieve pass in 160 question MCQ
Asthma Educa- Certified Asthma National Asthma Educa- For pharmacists: Re-exam NAECB not accredited Application
tion Educator (AE-C) tor Certification Board $295
(NAECB) n Current licence to practise Repeat candidate
Disciplines certified (in addition to pharmacists):
$195
n Achieve pass score on 175 question
MCQ exam Recertification
Physicians (MD, DO) Physician Assistants $245
(PA-C) Nurse Practitioners (NP) Nurses (RN,
LPN) Respiratory Therapists (RRT, CRT) Pulmo-
nary Function Technologists (CPFT, RPFT) Social
Workers (CSW) Health Educators (CHES) Physical
Therapists (PT) Occupational Therapists (OT)
OR
Individuals providing professional asthma
education and counselling with a minimum of
1,000 hours experience in these activities. These
individuals do not need to be health care profes-
sionals. NAECB may verify the eligibility of these
candidates by notarised letters from a supervisor.
Cardiovascular/ American Heart ACLS No verification of healthcare provider Retake class every 2 Am Heart Assoc accredited by CE Co-ordinating Cost variable
Life Support Association status necessary years Board for Emergency Medical Services
Also available in multidisciplinary specialties: Clinical Pharmacology, Diabetes Education, Diabetes Management – Advanced, HIV/AIDS, Health Information Technology, Lipids, Nutrition Support, Pain Education, Pain
Management, Poisons Information, Toxicology
Details obtained via the Council on Credentialing in Pharmacy website (site also details Pharmacy Technician Credentialing Framework) http://www.pharmacycredentialing.org/Files/CertificationPrograms.pdf
Appendix B: Advanced and Extended Practice in Other Countries: Supporting Organisations

Organisation Abbreviation Function Comments
USA
Board of Pharmacy BPS Established 1976 as an independent certification agency of the American Essentially the post-licensure certification agency for pharmacists.
Specialists Pharmacists Association (APhA).
Each area of practice has a Specialty Council composed of six pharmacists practising in the
specialty area along with three who practise outside of the specialty area.
Major Responsibilities:
Certification examinations consist of 200 multiple-choice questions and are administered an-
n Identifies and recognises critical specialty practice areas nually at designated sites throughout the USA and other countries. Total examination time is 5
hours (2.5 hours x 2) for the 200 questions. BPS routinely solicits questions from practitioners
working in the field, ensuring a democratic examination with real-life relevance.
n Sets standards for the certification and recertification of
pharmacy specialists
n Objectively evaluates individuals seeking certification and recertifica- BPS Recertification is required every seven years. Recertification may occur by exam or submit-
tion – administers yearly examinations. ted evidence of CPD (specialty dependent). The recertification examinations are 100 questions
in length administered over a 2.5 hour testing period. For specialties that allow recertification
n Serves as information resource and coordinating agency for pharmacy via CPD, the required number of hours is specified as is the CPD programs which the specialty
specialties. Offers preparatory courses for some (not all) of the spe- council accepts (e.g. ASHP, ACCP).
cialties recognised for certification.
BPS also recognises focused practice areas within the core specialties. The term, “added quali-
fications,” represents an enhanced level of training and experience within a practice area. Can-
Also: didates for added qualifications submit a structured portfolio, which is assessed by the Specialty
Council in accordance with published standards.
n Evaluates submissions for certification of new specialties – process
involves a formal role delineation study (determines tasks performed Source: http://www.bpsweb.org/
by pharmacists working in this specialty area) and profession-wide
consultation.
n Approves recertification professional development programs.
Board certification confers the letters “BC” and then details of specialty
as qualifications e.g. BCPS = Board Certified Pharmacotherapy Specialist;
BCOP = Board Certified Oncology Pharmacist.
87

88
Accreditation ACPE National agency for the accreditation of professional degree programs in ACPE does not currently accredit activities relating to the practice of pharmacy technicians.
Council for pharmacy and providers of continuing pharmacy education. Established Through membership on CCP, ACPE contributes to credentialing discussions relating to pharmacy
Pharmacy in 1932 for the accreditation of pre-service education. technicians.
Education
Autonomous and independent agency; Board of Directors is derived
through the American Association of Colleges of Pharmacy (AACP), the
American Pharmacists Association (APhA), the National Association Note: website contains significant amounts of information regarding white papers and
of Boards of Pharmacy (NABP) (three appointments each), and the discussions relating to pharmacy technician certification.
American Council on Education (ACE) (one appointment).
n E
stablishes standards and criteria for the accreditation of pharmacy
programs and CE providers.
n Accredits pharmacy education providers and programs.
n C
ollaborates, consults and reports on its activities which promote
Source: https://www.acpe-accredit.org/
n innovation in pharmacy, advances pharmacy education.
n Conducts research.
American Society ASCP Originally established in the nursing home setting. Now represents A consultant pharmacist is a pharmacist who is paid to provide expert advice on the use of
of Consultant pharmacists practising in the specialty of ‘senior care’ regardless of medications by individuals or within institutions, or on the provision of pharmacy services to
Pharmacists setting. institutions.
n A
SCP represents pharmacists working in senior care, provides
leadership, education, advocacy and resources.
n P
ublishes the journal “The Consultant Pharmacist” and provides an
online CPD resource.
Source: https://www.ascp.com/
n T
he Commission for Certification in Geriatric Pharmacy certifies
pharmacists as a Certified Geriatric Pharmacist (CGP). Resources to
prepare for the exam are available from the ASCP.

American Society ASHP Major Responsibilities: Provides review courses and Core Therapeutic Modules to help prepare for BPS exams and re-
of Health-System certification.
Pharmacists n A
dvocacy – Enters into discussions with The Joint Commission and
other Quality Organisations, Congress, Federal Regulators, State
government, and other healthcare organisations. ASHP and the ASHP Foundation offers a number of traineeships – postgraduate, short-term,
planned and structured self-study and experiential programs in specified areas of pharmacy
n C
areer Services - ASHP’s CareerPharm.com provides pharmacy job practice. A traineeship provides pharmacists with the knowledge and skills necessary to
seekers and employers a place to connect online with quality job implement a coordinated patient-care program. The self-study requirements vary from 10 to 50
postings and career advice. hours of work, while the experiential portion requires the participant to attend training sessions
at a predetermined site for 5 to 10 days. Some traineeships require post-training assignments to
be completed before a certificate will be awarded. Available in the areas of:
n C
ontinuing Education – One of the largest accredited providers
of Continuing Education for pharmacists. Also provides Continuing - Patient Care Impact (6 month program designed to enable pharmacists to implement
Education regarding medication therapy and medication safety for services in ED).
physicians and other health-care professionals.
- Antithrombotic Pharmacotherapy
n D
rug Information - For 50 years, ASHP has provided an evidence- - Oncology Patient Care
based foundation for safe and effective drug therapy through its
AHFS suite of drug information products (AHFS DI, AHFS Essentials, - Pain and Palliative Care
and AHFS MedMaster Consumer Medication Information).
n M
eetings and Conferences - Hosts a number of meetings, confer- Sets standards for residency recognition and conducts accreditation surveys of sites, programs
ences, and specialty courses each year. and organisations that provide residencies. Conducted by ASHP’s director of accreditation
services division and a second survey by the Commission on Credentialing.
n P
rofessional Policies and Practice Standards - Develops official
professional policies, policy positions and guidance documents.
Pharmacy Technicians:
n P
ublishing - Publishes American Journal of Health-System Phar- - Sets accreditation standards for pharmacy technician training programs which includes re-
macy, and other clinical and management references, textbooks, quirements for sites that support technician training programs.
online products, and video training programs.
n R
esidency and Technician Training Accreditation - Assists existing Source: http://www.ashp.org/
residencies refine their programs, helps prospective programs with
the process of seeking accreditation, and assists prospective resi-
dents to find the best residency program for them.
89

90
Accreditation ACPE National agency for the accreditation of professional degree ACPE does not currently accredit activities relating to the practice of pharmacy technicians.
Council for programs in pharmacy and providers of continuing pharmacy Through membership on CCP, ACPE contributes to credentialing discussions relating to pharmacy
Pharmacy education. Established in 1932 for the accreditation of pre-service technicians.
Education education.
Autonomous and independent agency; Board of Directors is Note: website contains significant amounts of information regarding white papers and
derived through the American Association of Colleges of Pharmacy discussions relating to pharmacy technician certification.
(AACP), the American Pharmacists Association (APhA), the National
Association of Boards of Pharmacy (NABP) (three appointments
each), and the American Council on Education (ACE) (one
appointment).
n E
stablishes standards and criteria for the accreditation of
pharmacy programs and CE providers.
Source: https://www.acpe-accredit.org/
n A
ccredits pharmacy education providers and programs.
n C
ollaborates, consults and reports on its activities which
promote innovation in pharmacy, advances pharmacy education.
n C
onducts research.
American Society ASCP Originally established in the nursing home setting. Now represents A consultant pharmacist is a pharmacist who is paid to provide expert advice on the use of
of Consultant pharmacists practising in the specialty of ‘senior care’ regardless medications by individuals or within institutions, or on the provision of pharmacy services to
Pharmacists of setting. institutions.
n A
SCP represents pharmacists working in senior care, provides
leadership, education, advocacy and resources.
n P
ublishes the journal “The Consultant Pharmacist” and provides
an online CPD resource.
n T
he Commission for Certification in Geriatric Pharmacy certifies Source: https://www.ascp.com/
pharmacists as a Certified Geriatric Pharmacist (CGP). Resources
to prepare for the exam are available from the ASCP.

American Society ASHP Major Responsibilities: Provides review courses and Core Therapeutic Modules to help prepare for BPS exams and re-
of Health-System certification.
Pharmacists
n A
dvocacy – Enters into discussions with The Joint Commission
and other Quality Organisations, Congress, Federal Regulators,
State government, and other healthcare organisations.
ASHP and the ASHP Foundation offers a number of traineeships – postgraduate, short-term,
planned and structured self-study and experiential programs in specified areas of pharmacy
n C
areer Services - ASHP’s CareerPharm.com provides pharmacy practice. A traineeship provides pharmacists with the knowledge and skills necessary to
job seekers and employers a place to connect online with quality implement a coordinated patient-care program. The self-study requirements vary from 10 to 50
job postings and career advice. hours of work, while the experiential portion requires the participant to attend training sessions
at a predetermined site for 5 to 10 days. Some traineeships require post-training assignments to
be completed before a certificate will be awarded. Available in the areas of:
n C
ontinuing Education – One of the largest accredited
providers of Continuing Education for pharmacists. Also - Patient Care Impact (6 month program designed to enable pharmacists to implement
provides Continuing Education regarding medication therapy services in ED).
and medication safety for physicians and other health-care
professionals. - Antithrombotic Pharmacotherapy
- Oncology Patient Care

n D
rug Information - For 50 years, ASHP has provided an
evidence-based foundation for safe and effective drug therapy
through its AHFS suite of drug information products (AHFS DI, - Pain and Palliative Care
AHFS Essentials, and AHFS MedMaster Consumer Medication
Information). Sets standards for residency recognition and conducts accreditation surveys of sites, programs
and organisations that provide residencies. Conducted by ASHP’s director of accreditation
services division and a second survey by the Commission on Credentialing.
n M
eetings and Conferences - Hosts a number of meetings,
conferences, and specialty courses each year. Pharmacy Technicians:
- Sets accreditation standards for pharmacy technician training programs which includes
n P
rofessional Policies and Practice Standards - Develops
requirements for sites that support technician training programs.
official professional policies, policy positions and guidance
documents.
n P
ublishing - Publishes American Journal of Health-System Source: http://www.ashp.org/
Pharmacy, and other clinical and management references,
textbooks, online products, and video training programs.
n R
esidency and Technician Training Accreditation - Assists
existing residencies refine their programs, helps prospective
programs with the process of seeking accreditation, and assists
prospective residents to find the best residency program for
them.
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92
Council on Major Responsibilities: Publication Examples:
Credentialing in
Pharmacy - Lists of certification programs for pharmacists
n E
nsures credentialing programs in pharmacy meet established
standards of quality and contribute to improvement in patient - Guiding principles for post-licensure credentialing of pharmacists
care and the overall public health.
- Pharmacy Technician Credentialing Framework
n D
evelops guidelines, establishes standards for credentialing - Guiding principles for the Accreditation of Organisations, Sites or Programs in
programs. Pharmacy
- Guiding principles for the Certification of Individuals in pharmacy
n C
ollects and disseminates information re credentialing programs.
n A
ssesses the need of the profession and the public for additional
credentialing programs in pharmacy.
n E
stablished a forum for discussion and collaboration among
pharmacy credentialing programs.
n S
upports, enhances and strengthens credentialing in pharmacy
and provides leadership and skill.
Source: http://www.pharmacycredentialing.org/
n D
evelopment for individuals and organisations working within the
pharmacy credentialing arena.
American AACP
National organisation which represents the interests of pharma-
Association
ceutical education and educators. Aims to advance pharmacy
of Colleges of
education, research, scholarship, practice and service.
Pharmacy
n P
rovides forums for faculty development and networking
n D
isseminates pedagogy re professional and graduate education
n F
osters development of innovative professional and graduate
education programs, assessment, resources and strategies.
n E
nsures appropriate infrastructure and resources are in place
to advance pharmacy education and educators Source: http://www.aacp.org/Pages/Default.aspx

American APhA Founded 1852 and has been the source of many other associations Provides resources or links to resources e.g. numerous guidelines for compounding pharmacists,
Pharmacists e.g. ASHP, AACP. immunisation guidelines, CPD webinars.
Association
Represents pharmacists, pharmaceutical scientists, student
pharmacists, pharmacy technicians.
Links with other organisations e.g. ASHP – advertises upcoming courses etc.
Participant of FIP.
Source: http://www.pharmacist.com/pharmacy-today-otc-supplement-march-2013
National NABP Impartial, international professional organisation that supports the Founded 1904.
Association state boards of pharmacy in creating uniform regulations to protect
of Boards of public health. Members are boards of pharmacy grouped into eight districts (including all 50 states plus Guam,
Pharmacy Puerto Rico, Virgin Islands, Australia, New Zealand, 8 Canadian provinces, Columbia).
Major Responsibilities: E-Advertisers - Google requires internet pharmacies seeking to display advertisements in its
sponsored US search results to be accredited through the VIPPS program.
n P
harmacist licence transfer and pharmacist competence
assessment programs.
n C
PE monitor service (allows pharmacists and technicians to
track their CPE). Has an e-profile ID which may be required to
receive CPE credit.
n N
APLEX (North American Pharmacist Licensure Examination)
pre-tests and exams. NAPLEX is one component of the
licensure process (knowledge based exam).
n F
PGEC (certification program for foreign educated pharmacists
seeking to practise in the USA).
Provides Accreditation Programs for:
n D
urable Medical Equipment, Prosthetics, Orthotics and Suppliers
Source: http://www.nabp.net/
n V
erified-Accredited Wholesale Distributors
n V
erified Internet Pharmacy Practice Site
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94
American College ACCP Major Responsibilities: ACCP Academy: provides unique professional development programs leading to
of Clinical certificates of completion in the following key areas: Leadership and Management,
Pharmacists n P
rovides leadership, professional development, advocacy, and resources that Research and Scholarship Development, and Teaching and Learning.
enable clinical pharmacists to achieve excellence in practice, research, and
education.
n A
dvances clinical pharmacy and pharmacotherapy through support and
promotion of research, training, and education.
n P
romotes innovative science, develops successful models of practice, and
disseminates new knowledge to advance pharmacotherapy and
patient care. Source: http://www.accp.com/
n P
rovides preparatory exams for BPS recognised specialty areas.
n P
rovides online CE via website.
American Council ACE Convenor of higher education association and agencies. Membership: higher education sector institutions. Also includes ACPE.
on Education
Leads discussion and influences policy as the key point of contact on higher Provides:
education matters e.g. for congress, federal agencies, legal issues and federal
court cases. n A
CE Institute for New Chief Academic Officers – a year long institute which
involves practical leadership development for CAOs.
n W
orkshops for senior administrators who are seeking presidency.
n P
residential roundtable discussions.
Source: http://www.acenet.edu/Pages/default.aspx
National NCCA The accrediting body of the Institute for Credentialing Excellence (ICE). Accredits BPS certification
Commission for Created in 1987 to ensure public safety through the accreditation of a variety
Certifying Agencies of certification programs that assess professional competence. NCCA standards require demonstration of a valid and reliable process for
development, implementation, maintenance, and governance of certification
Has accredited approximately 300 programs for more than 120 organisations. programs.
NCCA uses a rigorous peer review process to establish accreditation Certification of organisations that submit their programs for accreditation are
standards; evaluate compliance with the standards; recognise organisations/ evaluated based on the process and products, and not the content; therefore, the
programs which demonstrate compliance; and serve as a resource on quality Standards are applicable to all professions and industries.
certification.
Program content validity is demonstrated with a comprehensive job analysis
conducted and analysed by experts, with data gathered from stakeholders in the
occupation or industry.
Source: http://www.credentialingexcellence.org/ncca
Also: Pharmacy Technician Education Council (PTEC), Pharmacy Technician Certification Board (PTCB), Institute for the Certification of Pharmacy Technicians (ICPT).
Canada
Pharmacy PEBC Based in Toronto. National Certification body for the pharmacy profession in PEBC certificate of qualification is a licensing requirement for entry to practice
Examining Board of Canada. applicants in all provinces except Quebec.
Canada
Provinces define the legislation relating to licensure.
n A
ssesses qualifications for pharmacists and technicians on behalf of the
participating provincial regulatory authorities.
n E
valuates qualifications
n D
evelops and administers exams including the National Qualifying Exam
(which consists of Part I – MCQ run over 2 half day sessions and Part II –
OSCE mostly covering communication and the application of knowledge)
Source: http://www.pebc.ca/index.php/ci_id/3374/
n Issues certificates of qualifications.
Medical Council of MCC Grants the Licentiate of the Medical Council of Canada (LMCC). Assesses every Assessments performed in over 500 locations around the world and in Canada.
Canada medical school graduate as well as International Medical Graduates seeking to
practise in Canada.
Maintains a register of candidates who have been granted LMCC. Source: http://www.mcc.ca/en/
National NAPRA Voluntary not-for-profit organisation set up in 1995 by Canada’s regulatory Provides links to individual provincial licensing authorities and requirements for
Association bodies to facilitate a national approach to addressing common issues. licensure (which are set by each individual province).
of Pharmacy
Regulatory
Authorities Major Responsibilities: Provides guidelines for continuing competence, compounding pharmacies, standards
of practice for Canadian Pharmacists plus resources for pharmacy practice e.g.
n P
rovides national leadership in pharmacy regulatory practices that enhance distribution of medication samples, drug warnings for consumers, internet pharmacy
patient care and public protection. standards, minimizing medication errors.
n R
epresented by 14 pharmacy regulatory authority (PRA) members including:
Alberta College of Pharmacists, College of Pharmacists of British Columbia, Provides links to federal drug legislation e.g. Controlled drugs and substances act and
Manitoba Pharmaceutical Association, Newfoundland & Labrador Pharmacy regulations.
Board, Nova Scotia College of Pharmacists, Saskatchewan College of
Pharmacists, Government of Nunavut, Yukon Consumer Services.
n T
he Council of Pharmacy Registrars of Canada (CPRC) is responsible for
matters relating to professional practice, professional policy development,
and regulatory issues of national importance. This committee also offers
a venue for discussion and information sharing between provincial
and territorial regulatory bodies on matters affecting pharmacists
across Canada, and provides a useful forum for liaison with the federal Source: http://napra.ca/pages/home/default.aspx
government.
95

96
Canadian Council CCCEP Major Responsibilities:
on Continuing
Education in n A
ccredits continuing pharmacy education programs intended to be
Pharmacy delivered to pharmacy professionals in >1 province or nationally.
n A
ccreditation recognised in all provinces and territories.
n A
ccredits providers to accredit their own CPD in association with CCCEP
guidelines.
Source: http://www.cccep.org/
n A
ccredits certificate programs for CE.
n L
earning review panels – peer review programs.
Canadian Society CSHP National voluntary organisation of pharmacists committed to patient care Essentially run at a branch level as per SHPA with a national office and task forces,
of Hospital through the advancement of safe, effective medication use in hospitals and committees working around the country.
Pharmacists other collaborative healthcare settings.
CSHP supports its members through advocacy, education, information sharing,
promotion of best practices, facilitation of research and recognition of Publications include the Can J Hosp Pharm plus various hospital specific resources
excellence. (pain management, investigational and special access drugs list etc.)
Source: http://www.cshp.ca/
College of CPBC Founded 1891. The Professional Development and Assessment Program (PDAP) requires:
Pharmacists of
British Columbia Aims to protect public health by licensing and regulating pharmacists and · CE – annual requirement for all registrants linked to annual registration renewal.
pharmacy technicians and the places where they practise. Responsible for
making sure every pharmacist and pharmacy technician in B.C. is fully qualified · Knowledge Assessment – 10% registrants randomly selected each year to sit an
and able to provide the public with competent care. open book MCQ exam using a computerized format.
The College receives its authority from - and is responsible for administering -
provincial pharmacy legislation. Provides links to other provincial PD resources.
Source: http://www.bcpharmacists.org/
Canadian Hospital CHPRB Produces accreditation standards for residency programs.

Pharmacy
Residency Board Website unable to be accessed.

Alberta College of ACP Major Responsibilities: Registration requires demonstration of appropriate CE units.
Pharmacists
n D
evelop and enforce pharmacy practice standards and guidelines.
n E
nsure that only qualified pharmacists and pharmacy technicians are
licensed, all pharmacists and pharmacy technicians maintain their
knowledge and skills at the highest level possible, and all pharmacies
provide a practice environment that supports quality practice and patient
safety.
n M
anage the complaints resolution process related to pharmacists,
pharmacy technicians and pharmacies.
Participate in local, provincial and national forums when health policy is
debated.
n P
romote patient-centered, collaborative health care that best uses the
skills and knowledge of all health care professionals.
Activities are governed by the Health Professions Act. This Act outlines
the organisational structure of the college—namely council and its
committees—and dictates responsibilities related to licensure, practice
review and complaint resolution. Source: https://pharmacists.ab.ca/nCollege/default.aspx
ACP arranges licence renewals annually.
UK
Health and Care HCPC Maintains a register of health and care professionals who meet the HCPC
Professions Council standards for training, professional skills, behaviour and health.
Registers 16 professions (pharmacy NOT included).
Describe non-medical prescribers and references to the Medicines and
Healthcare Products Regulatory Agency (MHRA). Source: http://www.hpc-uk.org/
UK Clinical UKCPA Member association for clinical pharmacy practitioners. Supports CoDEG and the use of the GLF and ACLF by its members.
Pharmacy
Association Major Responsibilities:
n E
ncourage, support and promote advanced practice in pharmacy. Individual specialty groups run workshops, symposia and masterclasses in their area
of practice. Website allows access to details of these.
n E
stablishes professional curricula, develops professional recognition
(credentialing) processes and develop professional tools and frameworks
for practitioners.
In excess of 2400 members with 18 specialist groups. Each specialist group
has a committee which makes decisions about professional activities under
the UKCPA umbrella. Source: http://www.ukcpa.net/
In 2011, UKCPA became an official partner of the RPS.

97

98
Royal RPS The professional leadership body for pharmacists and pharmacy in England, RPS Faculty – new professional recognition programme. Will use the ACLF as a
Pharmaceutical Scotland and Wales. Aims to promote and represent the professional interests method of identifying and recognizing levels of practice.
Society of Great of members and represents all sectors of the profession.
Britain
Publishes the Pharmaceutical Journal and Clinical Pharmacist and provides
CPD articles and learning modules linked to the PJ online. Will also work with specialist partners and experts to develop professional curricula.
Accredits:
- Training courses e.g. face to face training courses, distance learning
courses.
- E-learning programs e.g. online training courses
- Published materials e.g. journal articles with CPD value
- Events e.g. conferences, seminars, workshops Source: http://www.rpharms.com/home/home.asp
Notes
99
Notes
Australian Pharmacy Council Ltd

ABN: 45 568 153 354
ACN: 126 629 785
Level 2, Ethos House
28-36 Ainslie Place
Canberra ACT 2601
AUSTRALIA
PO Box 269
Civic Square ACT 2608
Telephone: +61 2 6262 9628
Fax: +61 2 6247 9611
Email: admin@pharmacycouncil.org.au
Website: www.pharmacycouncil.org.au
100

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ADVANCED AND EXTENDED PHARMACY PRACTICE | AN ENVIRONMENTAL SNAPSHOT

ADVANCED AND EXTENDED PHARMACY PRACTICE | AN ENVIRONMENTAL SNAPSHOT

ADVANCED AND EXTENDED PHARMACY PRACTICE | AN ENVIRONMENTAL SNAPSHOT

ADVANCED AND EXTENDED PHARMACY PRACTICE | AN ENVIRONMENTAL SNAPSHOT

ADVANCED AND EXTENDED PHARMACY PRACTICE | AN ENVIRONMENTAL SNAPSHOT

ADVANCED AND EXTENDED PHARMACY PRACTICE | AN ENVIRONMENTAL SNAPSHOT

question/questions/exam/questionnaire, confidence/ cerrtainty based marking; viva voce/viva;

of which 69 were reviewed.

5.1 Assessment Methods

ADVANCED AND EXTENDED PHARMACY PRACTICE | AN ENVIRONMENTAL SNAPSHOT

5.1.1 Multiple Choice Questions

are called distractors.

form of assessment, particularly for assessing large number of students.(126)

ADVANCED AND EXTENDED PHARMACY PRACTICE | AN ENVIRONMENTAL SNAPSHOT

ADVANCED AND EXTENDED PHARMACY PRACTICE | AN ENVIRONMENTAL SNAPSHOT

ADVANCED AND EXTENDED PHARMACY PRACTICE | AN ENVIRONMENTAL SNAPSHOT

n Problem solving and reasoning Summary

ADVANCED AND EXTENDED PHARMACY PRACTICE | AN ENVIRONMENTAL SNAPSHOT

ADVANCED AND EXTENDED PHARMACY PRACTICE | AN ENVIRONMENTAL SNAPSHOT

ADVANCED AND EXTENDED PHARMACY PRACTICE | AN ENVIRONMENTAL SNAPSHOT

5.2 Blended models for assessment

ADVANCED AND EXTENDED PHARMACY PRACTICE | AN ENVIRONMENTAL SNAPSHOT

ADVANCED AND EXTENDED PHARMACY PRACTICE | AN ENVIRONMENTAL SNAPSHOT

ADVANCED AND EXTENDED PHARMACY PRACTICE | AN ENVIRONMENTAL SNAPSHOT

ADVANCED AND EXTENDED PHARMACY PRACTICE | AN ENVIRONMENTAL SNAPSHOT

n Problem solving and reasoning Summary

n Achieving pass score on oncology pharmacy specialty

n Current licence to practise in the US Recertification

n Provide a written description of current

n Achieve pass in 160 question MCQ

n Approves recertification professional development programs.