The foundations for specialized healthcare education in Spain were laid by Royal Decree 183/2008 (henceforth RD 183/2008), enacted on 8 February 2008, which established a catalog of health science specialties and regulated some aspects of the specialized healthcare education system1. The Royal Decree defined tutors as specialists with the knowledge, skills and attitudes required to fulfil a teaching role, who complete of an accreditation program. Entry into force of RD 183/20081 led to the development of new teaching methods, which have been built into the revised educational programs of different heath science specialties, such as medical oncology (2013)2.

Hospital Pharmacy (HP), however, has had the same curriculum since 19993, which does not reflect the current reality of the specialty or incorporate the most recent teaching methods. In addition, the education available to HP tutors is not specific to their professional profile, as most trainer training programs in healthcare are geared towards medical professionals. This stands in the way of ensuring that prospective hospital pharmacists benefit from the homogeneous and high-quality training programs advocated in RD 183/20081.

Against this background, a working group was brought together in 2016 by the Spanish Society of Hospital Pharmacists (SEFH Spanish acronym), made up of a series of tutors and a residents’ representative. The purpose behind setting up this group, named SEFH Tutors’ Group (hereinafter, GT-SEFH), was to provide tutors with the assistance they required as well as to promote collaboration and the exchange of knowledge and experiences between tutors and other hospital pharmacists involved in training activities. Another goal was to collect initiatives and develop projects aimed at improving the quality of training in HP4. Examples of the work done by the group include the publication of a document evaluating the competence level of residents5 and of a handbook on evaluation tools6, and the creation of a proprietary online platform (DOFIR)7.

Understanding the conditions under which HP resident tutors perform their duties as well as their concerns and requirements is fundamental for the development of initiatives by the GT-SEFH. Multiple surveys have been published on the needs of medical tutors specializing in the areas of family medicine8, internal medicine9, and anesthesiology and resuscitation10, among others. These surveys indicate that specialized education tutors are typically required to take on the responsibility of the residents’ training itinerary without having previously benefited from a systematic training-educational program or an exemption from their clinical duties to be able to fulfil their training function, although the situation may vary across different regions or even different hospitals.

Little has been published about the situation of HP resident tutors in Spain. In 2017 Saura-Llamas et al.11 conducted a survey among specialized education tutors across different specialties in the Balearic Islands in order to identify their training needs. Most of the training gaps detected were related to their competency and their teaching skills. Only one HP resident tutor participated in the survey. In 2002, Valladolid-Walsh et al.12 carried out a survey among HP residents and hospital pharmacists, some but not all of them tutors, in order to analyze the educational standards in HP. However, no studies have been published dealing specifically with the situation of HP resident tutors in Spain to shed some light on their situation and their needs.

The purpose of this study is to gain some insight into the activities carried out by HP resident tutors in Spain as well as to identify their needs in terms of education and resources and their level of motivation and satisfaction with their educational role.

The GT-SEFH developed a cross-sectional survey addressed to HP resident tutors. The survey's design and interpretation were based on the recommendations for surveys in healthcare contained in Casas Anguita et al.13. The survey was based on a self-administered online questionnaire prepared by the members of the GT-SEFH and designed using Google Forms® (Annex I). It was accompanied by an introductory text that explained the goals of the study as well as its voluntary and anonymous nature, which was distributed through SEFH's mailing list between January and March 2019, with periodic reminders being sent to addressees.

The survey included 55 questions grouped into five sections: 12 generic questions on tutors, pharmacy departments and hospitals, and 43 specific questions (6 on the educational activities offered, both those included in RD 183/20081 and other specialized educational contents14, 6 on the tutors’ motivation/satisfaction with their teaching functions, and 31 questions on the tutors’ training. The questions on training aspects were founded on the competencies-based model proposed by Saura-Llamas et al.15. The survey included open and closed (yes/no) questions, multiple choice questions and other formats such as Likert and numerical rating scales. Some multiplechoice questions contained an open-ended option.

Results are shown as percentages and number of respondents per question.

A descriptive analysis was carried out of the demographic variables collected. Central tendency and dispersion were calculated for numerical variables, and absolute and relative frequencies were estimated for qualitative variables. An univariate exploratory analysis was performed on the factors potentially related to satisfaction and motivation; the variables selected included age, tutor/resident ratio, years of experience as tutor/specialist, eligibility for paid exemption from clinical duties to fulfil tutor role (chi-squared test2 or Fisher's Exact Test). The level of statistical significance was set at p < 0,05). The SPSSv20 package was used for the statistical analysis.

Eighty-three HP resident tutors responded to the survey, which amounts to 52.8% of all tutors registered with SEFH at that point. Not all respondents answered all the questions.

Educational needs

In the last three years, 69.1% (56/81) of tutors participated in educational activities. The number of activities offered to 80 tutors over that period was 0 for 41.3% of tutors; one for 42.5%, and two for 16.2%. The number of training hours over the last year was 0 for 41.5% of tutors, 1-5 for 18.3%: 6-10 for 22.0%; 11-20 for 14.6% and over 20 hours for 3.7%. As regards the organizers of the different training activities, 66 tutors responded that 63.3% of activities had been organized by educational committees, 42.4% by regional health authorities, 13.6% by SEFH and 6.0% by other entities.

With respect to the thematic areas selected, 95.1% (78/82) of tutors chose training in teaching methods, 94.9% (75/79) clinical competencies, and 90.1% (73/81) communicative competencies. The respondents’ preferences regarding the subjects proposed for each competency are shown in figure 1, which reflects the values corresponding to the first tercile of the different scales used to rate the tutors’ preferences regarding each competency. The preferred mode of delivery (82 tutors) was hybrid (64.6%), followed by online (35.4%) and face-to-face (34.1%).

Figure 1.

Training areas identified as most desirable by respondents.

(0.12MB).

This study reports on the results of the first Spain-wide survey addressed to HP resident tutors with the aim of obtaining real world information on their needs so as to develop suitable educational structures and activities.

The response rate obtained (52.8%) comes across as rather low, especially taking into consideration that the survey was addressed to a specific target group, raised important issues, was anonymous and easily accessible (as it was sent by e-mail), was followed by a series of reminder e-mails and was administered by means of a user-friendly easy-to-use template. There being no national registry for tutors, the survey was sent to all pharmacists on SEFH's mailing list, i.e., it was not sent specifically to tutors. This could be a limiting factor, added to the fact that as recipients usually receive multiple messages from SEFH, getting one more message, which also asked them to devote time to complete a task, could have generated a certain level of annoyance. However, as compared with other similar surveys administered recently in Spain to specialized healthcare education tutors, the response rate stands halfway between the 68.42% achieved among physical medicine tutors16 and the 43.8% achieved among internal medicine tutors9.

The DOFIR7 HP residency educational platform has been equipped with a national HP resident tutor register intended to facilitate communication with that group of professionals. Currently the register contains 182 entries from 108 HP departments accredited for teaching.

The current survey showed that 3.6% of tutors did not carry out structured interviews and 21.7% of those who did, conducted only the legal minimum, set at four interviews per year1. These results indicate that lack of time is one of the factors preventing tutors from carrying out their expected number of interviews. Over 80% of tutors were found to perform all the teaching activities included in the regulations, i.e., management of external rotations, supervision the residents’ logbook/reports/portfolio, planning of rotations, and preparation of residents’ annual evaluation reports. Nonetheless, other, more complex, evaluation instruments such as clinical incident reports and the OSCE (Objective Structured Clinical Examination) are only used by a minority. This variability could be due to the varying extent to which the different Spanish regions have implemented the stipulations of RD 183/2008, which has only been fully enforced in Andalusía17, Catalonia18, the Canary Islands19, Castile-Leon20, Castile-La Mancha21, the Balearic Islands22, Extremadura23, La Rioja24 and the Basque Country25, and to the failure to apply the new curriculum of the specialty which described the type of evaluation tools available and the regularity with which they should be administered. Another important factor is the lack of paid time to carry out educational activities: only 17.1% of respondents was allowed a certain number of hours to perform teaching activities, which were anyway considered insufficient by the majority (91.7%). This factor is closely connected with what, in the opinion of an overwhelming majority of respondents (95.1%), was the main drawback about being a tutor, namely the heavy workload associated with the job. The high number of tutors coming from regions where the legislation requires that hospital pharmacists be exempted from part of their regular duties but who nevertheless get no dispensation at all should lead to a denunciation of the infringement of such rules and to the adoption of measures to rectify the situation. As regards the “heavy workload” denounced by tutors and the infringement of the regulations by some regional authorities, the survey shows that 1.2% of respondents must take care of 6 residents/year, which exceeds the limit of 5 stipulated by RD 183/20081.

However, the tutors’ satisfaction and motivation with their educational activities were high, which contrasts with the results of Valladolid-Walsh et al.12 where 33% of tutors said they would gladly give up their tutorship work. Moreover, most of the respondents in the present study consider the role of the tutor important and indispensable. These findings appear to be related with the “pleasure of conveying knowledge to others,” cited by over 50% of respondents as one of the advantages of being a tutor, which is indicative of a clear vocational component. The first survey launched by GT-SEFH, which was addressed to 4th year HP residents, also brought out the importance of the tutor role26. Although the univariate exploratory analysis in this study only considered the variables that were in principle most closely associated with motivation and satisfaction with teaching, no association whatsoever was found between them. Motivation and satisfaction were very high, regardless of the variables analyzed, and the analysis performed seems to indicate that they only decreased with age, with the years of professional experience as a tutor, when tutors were given no protected time or when their levels of remuneration were low. These results, again, suggest a potential vocational component.

As regards things to be improved, respondents stated that the time allowed for training activities should be extended. As early as in 2002, Valladolid-Walsh et al.12 discovered that pharmacists had little time to devote to their teaching role (92% had less than three hours a week) and suggested that a reorganization be made and that tutors be exempted from more of their clinical work to be able to properly fulfil their role. A comparison with the results obtained from the present survey shows that although the situation has improved in the intervening 17 years, the progress made is not enough. The lack of paid time does not seem to be a problem affecting only the training of hospital pharmacists as it has also come up in surveys administered to internal medicine9, medical oncology27, and anesthesiology and resuscitation10 tutors. Nor is it a problem specific to the Spanish training system. Indeed, in a survey conducted in 2015 among tutors and residents of the American Society of Health-System Pharmacists, Hartzler et al.28 reported that lack of paid time was the main barrier to the development of tutors.

Around 40% of the tutors surveyed had not received any training in the past three years and the percentage of those not receiving training during the last year was the same. As a result, respondents agreed that one of the key aspects to be improved was the time allowed for training. In contrast, in Valladolid-Walsh et al.12 63% of respondents did not consider it necessary to undergo specific training to fulfil their teaching roles. This difference with respect to the present survey may be due to the fact that Valladolid-Walsh et al.’s survey12 was not targeted only to tutors and, in addition, it was administered in 2002, i.e., before the entry into force of RD 183/20081, which elevated the tutors’ profile and increased the complexity and number of their activities. Other specialized education tutors also demand to be trained more comprehensively, as shown by several surveys conducted both in Spain27 and abroad29.

In the absence of a map of the competencies of HP resident tutors, questions on educational contents were founded on a generic professional model based on the competencies of specialized healthcare education tutors15. Availability of a specific competencies map is important as it specifies all the knowledge, skills and attitudes needed by tutors to correctly perform their work and is fundamental for their accreditation and training, thus contributing to excellence on the job. Drawing up a competencies-based map for HP tutors will be one of the priorities for GT-SEFH in the future.

The present study has shown the great interest of HP tutors in receiving the training they need on teaching methods and clinical and communicative competencies. The specific elements respondents stated as necessary to further their knowledge of such competencies, as well as the order in which such elements should be imparted and the delivery method to be used (hybrid) were in line with those found in other surveys among HP tutors. For example, in 2012 Truong et al.29 published the results of a survey where Canadian HP tutors were asked to spell out their needs, with a majority of them denouncing a lack of training. The areas where they felt more emphasis should be made, i.e., constructive feedback and practical evaluation strategies, were in line with those invoked by tutors in the present survey.

Only 50% of tutors responding to the survey were members of the GT-SEFH. This seems to indicate that a high number of tutors fulfil their role without the need to be backed by a professional network, which appears to contradict the findings of the survey in terms of the shortcomings and flaws identified in the present survey. The purpose of the GT-SEFH being precisely that of helping tutors, it is of the essence to increase its membership. The development of future projects for HP tutors based on the findings presented here could help achieve that goal.

One of the limitations of this study is that, although the questions asked were previously reviewed by the members of the GT-SEFH, the survey as such was not fully validated. Moreover, although the response rate (52.8%) was too low to take the results at face value, the broad representation obtained (tutors from 78.9% of Spanish regions sent in their answers) provides our findings with a measure of robustness. Finally, a certain selection bias may have existed (the survey was voluntary and could have attracted only particularly motivated tutors), which makes it difficult to generalize the results obtained.

This first Spain-wide survey of HP resident tutors provides, apart from a deeper understanding of the current profile of HP resident tutors, information about their activities, difficulties and needs. Although satisfaction with their educational activities is high, tutors demand to be allowed more time for these activities and to be provided with better training. Lastly, the survey emphasizes the need to develop a regulatory framework in several of the country's regions and improve compliance with the existing regulations.

No funding.

The authors would like to thank Elia Pérez Fernández from the Research Unit at Fundacion Alcorcón University Hospital for her help with the statistical analysis.

64th National Congress Sociedad Española de Farmacia Hospitalaria. Sevilla: 17-19 October 2019.

No conflict of interests.