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May I refer you to the article "The Mandatory Two Years" contributed by Debbie Rigby, an AACP Director Perspective.
I thank Ms Rigby for her response to my previous article, The FAQs concerning MMRs and the valuable debate that has followed.
I am a final year student, and am also a committee member of the NSW PSA Young Pharmacist Group (NSWYPG).
The NSWYPG has more than 170 pharmacist members who are less then 35 years of age or have been registered as a pharmacist for less than 10 years.
It is objective of the group to represent the views and interests of young pharmacists and present them to the wider profession.
At our May meeting we discussed the issue of the compulsory two year delay between graduation and being able to apply for accreditation to conduct MMRs.

There are several inaccuracies in Ms Rigby's reply. Final year students at the University of Sydney engage in a total of 3 clinical placements throughout the year, each consisting of 50 hours over a ten week period. The placements involve hospital and community pharmacy, specialist clinics, and aged care facilities. During these 150 hours, students complete up to 30 MMRs for real life patients, of which 12 are formally assessed. Additional practical experience is gained by students as part of compulsory externship placements in the third year of their course and informally as pharmacy employees.

Ms Rigby states that "other professions", namely law and medicine, "require experience as a necessary prerequisite for higher qualifications". I believe it is misleading to draw a comparison between a QC and an accredited pharmacist. . Law degrees do not teach students to become QCs, nor does a Bachelor of Medicine teach to become a medical specialist. Yet the Bachelor of Pharmacy is teaching its students theoretical and practical skills about conducting medication reviews. .

A challenge for the pharmacy profession is to increase both the quality and quantity of cognitive pharmaceutical services we deliver. Research has suggested that at least 80,000 medication related hospitalisations occur each year in Australia and that up to 69% of these may be avoided.1 Pharmacist conducted MMR is one strategy to address this problem. The service is likely to have the greatest impact if provision of medication review services becomes a core activity of all pharmacists. Strategies should therefore be utilised to harness the enthusiasm and skills of young pharmacists to achieve the greater uptake of professional services by pharmacists. This is a research priority area of the Third Community Pharmacy Agreement and supported by both the PSA and Pharmacy Guild.

It is disappointing that to know that one's age can still evoke "value judgements" in such a progressive era. It is postulated by Ms Rigby that 23 year old pharmacists would not have "effective communication skills" and then conceded that some people will "never develop these skills", necessary for the MMR job. Yet these individuals are still eligible to apply. I would agree with Ms Rigby that age is an unreliable measure of communication skills. But, the degree requirements are reliable. Today's pharmacy graduates must complete courses in communication and have a communication-based section as part of the pre-requisite for course entry2. Anecdotally, many accredited pharmacists are employing recently registered graduates to do the patient interviews, information gathering and even report writing - the pharmacist then signs it off.

Ms Rigby states "One of the main criticisms from GPs about medication reviews is their relevance to the individual patient". This can only be a reflection on those already accredited. The MMR process was added to the pharmacy syllabus in 2000, hence the first batch of graduates who were instructed under this change would only now be able to become accredited - the evidence of their performance is yet to be assessed and cannot be inferred from the results of others.

Ms Rigby states the pass mark at university is around 45%. However, marking of reviews in fourth year are done in a highly regimented and standardised fashion, through the use of established marking criteria. Let's not forget that we are only asking that registered pharmacists be eligible to attempt the accreditation procedure - whether the candidates pass is based on the MMRs submitted and the AACP assessment of those reviews.

The AACPs view on the requirements of an accredited pharmacist involves "experience" in many different areas. I agree that all these areas are fundamental to producing a worthwhile medication review. The only problem is: how do you define experience? If you can do that, the next question is: how can you measure it? If there can be some way of actually determining when a pharmacist has sufficient experience, I would happily support it. Unfortunately time is a poor indicator. The variation that could occur amongst pharmacists during those two years is phenomenal. The only true guide to competency must then lie in the submitted MMRs - it is the only fair means of comparison.

After careful consideration, we propose a review of the MMR accreditation eligibility with the following points in mind:
1. Develop mechanisms to harness skills and enthusiasm of newly registered pharmacists to increase the quality and quantity of professional services delivered.
2. That all pharmacists, registered under the Pharmacy Acts that apply in each state or territory, be able to undertake the roles and duties of a pharmacist.
3. To increase the number of registered pharmacists that become accredited in order to promote the uptake of MMRs by both pharmacists and general practitioners.
4. To maintain, retain and sustain the interest of young pharmacists in their chosen profession through increased opportunities to deliver professional services. A recent study by Greg Peterson revealed that 26% of 3rd and 4th year pharmacy students nominated consultant pharmacy as a career destination3
5. To engage in a broad consultancy process to ensure the amended accreditation processes are without prejudice

The NSWYPG aims to develop a position statement to be put before the PSA (NSW Branch) Council.

Pharmacists, upon registration, should be eligible to apply for MMR accreditation. Instead of making them pass the time, make them pass the test - we're ready for the challenge.

Lachlan Rose

The views expressed in this article reflect those of the author and the PSA NSW Young Pharmacists Group,
They do not necessarily represent the views of the Pharmaceutical Society of Australia (NSW Branch).

1. Roughead EE. The Nature and Extent of Drug-related Hospitalisations in Australia. Journal of Quality in Clinical Practice. 19(1):19-22, March 1999.
2. The University of Sydney Faculty of Pharmacy Handbook 2002.
3. Peterson G, Naunton M, Rasiah R. Pharmacy Students Career Aspirations and Attitudes towards their chosen Profession. Australian Pharmacist. 22(5) 391-397. May 2003.