Practice Handbook for Designated Medical Practitioners

Faculty of Health and Wellbeing Non Medical Prescribing Level 6 / Level 7 Practice Handbook for Designated Medical Practitioners

Contents Introduction 3 Aims of the course 4 Learning Outcomes 4 The Role of the Designated Medical Practitioner 6 The Practice Assessment Booklet 8 DMP Assessments 1. Initial Interview 2. Intermediate Interview 3. Final Interview 4. Assessing practice competencies and completing the Practice Assessment Booklet 5. The Objective, Structured Clinical Assessment 8 The Role of university staff 8 Appendix 1 The record of assessment 9 Appendix 2 the OSCA 18 Guidance for students Guidance for DMP s Internal moderation of OSCA s OSCA assessors checklist Appendix 3 assessment overview 20 2

INTRODUCTION Dear Colleague On behalf of the Course Team may we welcome you to Sheffield Hallam University and thank you for your support in facilitating learning for your Non Medical Prescribing student. This handbook contains information about the aims and content of the course and details the role of the Designated Medical Practitioner. Non Medical Prescribing represents a significant opportunity for nurses, pharmacists and other Allied Health Professionals to develop the critical skills necessary to meet the changing healthcare service needs. Through consultation with key stakeholders, including service providers, clinical practitioners, Strategic Health Authority Non Medical Prescribing leads and service users, the course has been developed to reflect the requirements of the Nursing and Midwifery Council (NMC), the Health Professions Council (HPC), and the Department of Health. Sheffield Hallam University provides an extensive portfolio of undergraduate and postgraduate healthcare programmes, and interprofessional learning has been an important feature of curriculum development for more than 20 years. This is particularly appropriate for Non Medical Prescribing students, who are working in advanced and senior roles within a diverse range of healthcare settings, whilst continuing to develop and enhance their clinical knowledge and skills. The curriculum content incorporates the single competency framework for competencies identified by the National Prescribing Centre (NPC) that all practitioners need to maintain in order to prescribe safely and effectively. Please do not hesitate to contact a member of the course team should you have either general comments about the course, of specific areas you would like to discuss in relation to your student and his / her progress throughout the course. Module Leaders Wayne Robson Faculty of Health & Wellbeing Room L107 College House 36 Collegiate Crescent Sheffield S10 2BP Direct Line: (0114) 225 6651 e-mail: w.robson@shu.ac.uk 3

Aims of the Non Medical Prescribing course: The course aims to prepare practitioners as Independent and/or Supplementary Prescribers in accordance with appropriate Professional Regulatory Body (RPSGB, NMC, and HPC) and Department of Health guidance. Students chose to undertake the module at either Level 6 (degree) or Level 7 (masters) Learning Outcomes The learning outcomes of the programme reflect Professional Body requirements and have been informed by the following documents: National Prescribing Centre -provided by NICE (2012) A single competency framework for all prescribers National Prescribing Centre: (2006) Maintaining Competency in Prescribing: An outline framework to help pharmacist supplementary prescribers National Prescribing Centre: (2004) Maintaining Competency in Prescribing: An outline framework to help allied health professional supplementary prescribers National Prescribing Centre: (2001) Maintaining Competency in Prescribing: An outline framework to help nurse prescribers National Prescribing Centre: (2003) Maintaining Competency in Prescribing: An outline framework to help supplementary nurse prescribers- update NMC (2006) Standards of proficiency for nurse and midwife prescribers Level 6 Upon completion of the full programme, the student will be able to: 1. Undertake effective history taking, consultation and physical assessment skills with patients, clients and carers, including medication history and current medication (including over the counter alternative and complementary health therapies), to inform accurate diagnosis 2. Critically evaluate safe, appropriate and cost effective prescribing practice, in partnership with Independent prescribers and the wider care team, including accurate record keeping in the context of medicines management 3. Reflect upon aspects of the law and the professional framework of accountability relevant to the practice of independent and supplementary prescribing, including the prescribing of unlicensed medicines 4. Identify and use sources of information, advice and decision support systems which underpin the practise of independent prescribing, and communicate the ethical management of influences on prescribing practice 4

5. Utilise knowledge of pharmacology to explain pharmacokinetics and pharmacodynamics in relation to the disease process and apply to the monitoring of response to medicines, treatment modification and referral 6. Critically evaluate the roles and relationships of others involved in prescribing, supplying and administering medicines and develop and document a clinical management plan (CMP) within the context of a prescribing partnership 7. Practice within a framework of professional accountability and responsibility and critically reflect upon the importance of continuing professional development 8. Demonstrate recognition of the unique implications and developmental context of the anatomical and physiological differences between neonates, children and young people For students undertaking the module at Level 7 the learning outcomes are the same but students are expected to show evidence of Masters level writing - including critical analysis and synthesis. The above module learning outcomes have been included in the DMP Handbook to illustrate the depth and breadth of knowledge required of students upon completion of the taught programme, and will be assessed in the student s Portfolio. DMP s are requested to focus upon addressing the 9 National Prescribing Centre (NPC) Competencies (see page 10) when undertaking their assessment of their student s practice Learning outcome 8 is an NMC requirement. The course team recognise that many students will never prescribe for neonates, children and young people. What is important is that students acknowledge that they understand that prescribing for these groups is a specialist area of knowledge. Anatomical, physiological, professional, legal and ethical issues relevant to prescribing will be explored in university, and to fulfil the summative assessment requirements by the NMC, students will be expected to include information in their portfolio that clearly defines the parameters of their prescribing role in relation to these patient groups. In terms assessment by the DMP, the course team ask the DMP to utilise appropriate opportunities to formatively explore, through discussion, the implications of prescribing for these patient groups, in relation to the student's role within their organisation. 5

The Role of the Designated Medical Practitioner The student is required to undertake a minimum of 12 x 7.5 days (90 hours) of supervised learning, and the DMP role is critical to the student in terms of facilitating and assessing the learning that has been achieved during this 12 day period It is expected that the DMP will be able to provide time and opportunities for: in depth discussion and analysis of clinical management, when patient care and prescribing behaviour can be examined further the student to observe how the medical practitioner conducts a consultation/interview with patients and/or their carers discussion and development of management plans facilitating student learning in order to develop prescribing skills encouraging critical thinking and reflection and the integration of theory and the student to carry out consultations and suggest clinical management and prescribing options, which are discussed with the DMP Learning opportunities are varied and individual. Some students have arranged observational activities outside of their normal working environment, or in other departments, which is often beneficial, for example: a nurse observing the work of a prescribing community pharmacist a respiratory nurse specialist observing a primary care led COPD clinic a community pharmacist observing a consultant working in an Elderly Care Out Patients Clinic All student applicants will be sent Designated Medical Mentor Handbooks, to enable prospective DMP s to review details of the programme and the DMP role, prior to confirming their support for the student on the student s application form. All confirmed DMP s will be invited to a half day of study at Sheffield Hallam University, with their student, upon commencement of the programme. Should DMP s be unable to attend, the student s personal tutor will be able to undertake a placement visit to provide an overview of the programme and further guidance. DMP s will be provided with a copy of Section 2 of the NMC (2006) Standards of proficiency for nurse and midwife prescribers, which details the Standards for prescribing practice which are integral to the course and to their student prescriber s continuing professional development 6

DMP s might also find the following document helpful in supporting their role: National Prescribing Centre: (2005) Training non-medical prescribers in practice: A guide to help doctors prepare for and carry out the role of designated medical practitioner http://www.npc.co.uk NMC Standards of Proficiency for Nurse and Midwife Prescribers http://www.nmcuk.org/documents/standards/nmcstandardsofproficiencyfornurseandmidwifeprescribe rs.pdf NMC (2008) The code: Standards of conduct, performance and ethics for nurses and midwives http://www.nmc-uk.org/aarticle.aspx?articleid=3056 This document defines the professional requirements for all registered nurses HCPC "Standards of conduct, performance and ethics: Your duties as a registrant" (2012) http://www.hpcuk.org/aboutregistration/standards/standardsofconductperformanceandethics/ HCPC Standards of Prescribing (2013) http://www.hcpc-uk.org/aboutregistration/standards/standardsforprescribing/ 7

The Practice Assessment Booklet This is the record of learning and assessment, which the student and DMP need to both complete in order for the student to submit to the University, within the Portfolio upon completion of the course. The DMP is required to undertake the following 5 assessment activities: 1. Initial Interview (Formative) The DMP will discuss the Practice Assessment Booklet with the student prescriber, to explore past experiences, knowledge and skills, identify learning needs and plan learning opportunities that are relevant to the student's role and the needs of the organisation in terms of their future prescribing activities 2. Intermediate interview (Formative) About half way through the course the DMP will review with the student the competencies and the progression being made by the student. If the student is not progressing as expected, this must be documented, with the specific areas of concern noted and a plan of action highlighted. The DMP must discuss this with the student and the university lecturer 3. Final Interview (Summative) The DMP will need to complete and sign each learning competence by the end of the placement. This will confirm that the student has completed the required period of learning in and achieved the stated competencies. 4. Assessing competencies: There are 9 competencies outlined by the National Prescribing Centre documents which structure assessment and which all have to be passed by the end of the course: The Consultation 1. Knowledge ( Clinical and pharmaceutical knowledge ) 2. Options ( Establishing options) 3. Shared decision making (Communicating with patients and carers) Prescribing Effectively: 4. Safe (Prescribing safely) 5. Professional (Prescribing professionally) 6. Always improving (Improving prescribing) Prescribing in Context 7. The Healthcare System (The NHS in context) 8

8. Information 9. Self and others (The team and individual context) Please see National Prescribing Centre (2012) A single competency framework for all prescribers - http://www.npc.co.uk/improving_safety/improving_quality/resources/single_co mp_framework.pdf Completing the Practice Assessment Booklet: When the DMP is satisfied that the student has met each competency he/she will indicate this in the pass box and sign his/her name and date of completion. Assessment can be undertaken through discussion, observation or simulation, as appropriate. A student can be referred if the DMP feels that the student has not yet achieved a competency. If however the competency is not achieved by the end of the 90 hours in practice the DMP will indicate this in the fail box. It is anticipated that any problems achieving the competence will be recognised before the end of the placement and the student's tutor contacted prior to failing the student. The university tutor may be accessed at any time deemed appropriate by the student or DMP, and a visit will be arranged if it is requested. The DMP may be a doctor with whom the student normally works. However, arrangements can be agreed where another doctor acts as supervisor, provided the criteria are met. Competencies must be achieved under the guidance of the DMP, who is responsible for assessing competence, completing and signing the Practice Assessment Booklet with the student. 5. Objective Structured Clinical Assessment The DMP is required to assess the student's clinical assessment skills through an OSCA. See Appendix 3 for guidance The Role of University Staff The primary responsibility of University staff is to advise the student in all aspects of the curriculum and to evaluate the learning that has taken place. They also have responsibility for providing guidance and support for the academic development of the student. University staff will: Advise in the preparation of the Portfolio Provide advice, support and guidance to the student, employer and mentor Evaluate the students learning for the purpose of awarding academic credit 9

Appendix 1 The competencies are taken from the National Prescribing Centre Single Competency Framework (2012) The prescribing competencies are relevant to all prescribers. The statements in the framework should be interpreted in the context in which the individuals are prescribing, taking into account their scope of practice The competency framework (illustrated below) sets out what good prescribing looks like. There are three domains, each containing three dimensions of competency (nine in total). Within each of the nine competency dimensions there are statements which describe the activity or outcomes prescribers should be able to demonstrate. 10

RECORD OF ASSESSMENT: The consultation Competency 1: Knowledge Has up-to-date clinical pharmalogical and pharmaceutical knowledge relevant to own area of practice 1. Understands the conditions being treated, their natural progress and how to assess their severity. 2. Understands different non-pharmacological and pharmacological approaches to modifying disease and promoting health, identifies and assesses the desirable outcomes of treatment. 3. Understands the mode of action and pharmacokinetics of medicines and how these mechanisms may be altered (e.g. by age, renal impairment), and how this affects treatment decisions. 4. Understands the potential for adverse effects and how to avoid/minimise, recognise and manage them. 5. Uses up-to-date information about relevant products (e.g. formulations, pack sizes, storage conditions, costs). 6. Applies the principles of evidence-based practice, including clinical and costeffectiveness. 7. Aware of how medicines are licensed, sourced and supplied, and the implications for own prescribing. 8. Knows how to detect and report suspected adverse drug reactions. 9. Understands the public health issues related to medicines and their use. 10. Appreciates the potential for misuse of medicines. 11. Understands antimicrobial resistance and the roles of infection prevention, control and antimicrobial stewardship 1 measures. 1 Antimicrobial stewardship - Advisory Committee on Antimicrobial Resistance and Healthcare Associated Infection (ARHAI) 11

Competency 1 - Evidence to support the above statements (i.e. I am able to state this because): Competency 1 Progressing PASS REFER FAIL DMP Signature Intermediate Interview Final Interview Date Student Name Signature of Mentor Signature of student 12

RECORD OF ASSESSMENT: The consultation Competency 2: Options Makes or reviews a diagnosis, generates management options for the patient and follows up management 12. Takes an appropriate medical history and medication history which includes both current and previously prescribed and non-prescribed medicines, supplements and complementary remedies, and allergies and intolerances. 13. Undertakes an appropriate clinical assessment using relevant equipment and techniques. 14. Accesses and interprets relevant patient records to ensure knowledge of the patient's management. 15. Makes, or understands, the working or final diagnosis by considering and systematically deciding between the various possibilities (differential diagnosis). 16. Requests and interprets relevant investigations. 17. Considers all treatment options including no treatment, non-pharmacological interventions and medicines usage. 18. Assesses the effect of multiple pathologies, existing medication, allergies and contraindications on management options. 19. Assesses the risks and benefits to the patient of taking or, not taking a medicine or treatment. 20. Where a medicine is appropriate, identifies the different options. 21. Establishes and maintains a plan for reviewing the therapeutic objective, discharge or end point of treatment. 22. Ensures that the effectiveness of treatment and potential unwanted effects are monitored. 23. Makes changes to the treatment plan in light of on-going monitoring and the patient's condition and preferences. 24. Communicates information about medicines and what they are being used for when sharing or transferring prescribing responsibilities/information. 13

Competency 2 Evidence to support the above statement (i.e. I am able to state this because): Competency 2 Progressing PASS REFER FAIL DMP Signature Intermediate Interview Final Interview Date Student Name Signature of Mentor Signature of student 14

RECORD OF ASSESSMENT: The consultation Competency 3: Shared decision making (with parents, care- givers or advocates where appropraite) Establishes a relationship based on trust and mutual respect. Recognises patients as partners in the consultation 25. Identifies and respects the patient s values, beliefs and expectations about medicines. 26. Takes into account the nature of peoples diversity when prescribing. 27. Undertakes the consultation in an appropriate setting taking account of confidentially, dignity and respect. 28. Adapts consultations to meet needs of different patients (e.g. for language, age, capacity, physical or sensory impairments). 29. Deals sensitively with patients' emotions and concerns about their medicines. 30. Creates a relationship which does not encourage the expectation that a prescription will be supplied. 31. Explains the rationale behind and the potential risks and benefits of management options. 32. Works with patients to make informed choices about their management and respects their right to refuse or limit treatment. 33. Aims for an outcome of the consultation with which the patient and prescriber are satisfied. 34. When possible, supports patients to take responsibility for their medicines and self-manage their conditions. 35. Gives the patient clear accessible information about their medicines (e.g. what it is for, how to use it, where to get it from, possible unwanted effects). 36. Checks patient s understanding of and commitment to their management, monitoring and follow-up. 37. Understands the different reasons for non-adherence to medicines (practical and behavioural) and how best to support patients. Routinely assesses adherence in a non-judgemental way. 15

Competency 3 Evidence to support the above statement (i.e. I am able to state this because): Competency 3 Progressing PASS REFER FAIL DMP Signature Intermediate Interview Final Interview Date Student Name Signature of Mentor Signature of student 16

RECORD OF ASSESSMENT: Prescribing Effectively Competency 4: Safe Is aware of own limitations. Does not compromise patient safety 38. Knows the limits of their own knowledge and skill, and works within them. 39. Knows when to refer to or seek guidance from another member of the team or a specialist. 40. Only prescribes a medicine with adequate, up-to-date awareness of its actions, indications, dose, contraindications, interactions, cautions, and side effects (using, for example, the BNF/BNFC). 41. Accurately calculates doses and routinely checks calculations where relevant, for example for children. 42. Keeps up to date with advances in practice and emerging safety concerns related to prescribing. 43. Knows about common types of medication errors and how to prevent them. 44. Ensures confidence and competence to prescribe are maintained. 45. Makes accurate, legible and contemporaneous records and clinical notes of prescribing decisions. 46. Effectively uses the systems necessary to prescribe medicines (e.g. medicine charts, electronic prescribing, decision support). 47. Writes legible, unambiguous and complete prescriptions which meet legal requirements. 17

Competency 4 Evidence to support the above statement (i.e. I am able to state this because): Competency 4 Progressing PASS REFER FAIL DMP Signature Intermediate Interview Final Interview Date Student Name Signature of Mentor Signature of student 18

RECORD OF ASSESSMENT: Prescribing Effectively Competency 5: Professional Ensures prescribing practice is consistent with scope of practice, organisational, professional and regulatory standards, guidance and codes of conduct 48. Accepts personal responsibility for prescribing and understands the legal and ethical implications of doing so. 49. Makes prescribing decisions based on the needs of patients and not the prescriber s personal considerations. 50. Knows and applies legal and ethical frameworks affecting prescribing practice (e.g. misuse of drugs regulations, prescribing of unlicensed/off label medicines). 51. Takes responsibility for own learning and continuing professional development. 52. Maintains patient confidentiality in line with best practice and regulatory standards and contractual requirements. Competency 5 Evidence to support the above statement (i.e. I am able to state this because): Competency 5 Progressing PASS REFER FAIL DMP Signature Intermediate Interview Final Interview Date Student Name Signature of Mentor Signature of student 19

RECORD OF ASSESSMENT: Prescribing Effectively Competency 6: Always Improving Actively participates in the review and development of prescribing practice to optimise patient outcomes 53. Learns and changes from reflecting on practice. 54. Shares and debates own and others prescribing practice, and acts upon feedback and discussion. 55. Acts upon colleagues inappropriate prescribing practice using appropriate mechanisms. 56. Understands and uses tools to improve prescribing (e.g. review of prescribing data, audit and feedback). 57. Reports prescribing errors and near misses, reviews practice to prevent recurrence. 58. Makes use of networks for support, reflection and learning. Competency 6 Evidence to support the above statement (i.e. I am able to state this because): Competency 6 Progressing PASS REFER FAIL DMP Signature Intermediate Interview Final Interview Date Student Name Signature of Mentor Signature of student 20

RECORD OF ASSESSMENT: Prescribing in Context Competency 7: The Healthcare System Understands and works within local and national policies, processes and systems that impact on prescribing practice. Sees how own prescribing impacts on the wider healthcare community 59. Understands and works within local frameworks for medicines use as appropriate (e.g. local formularies, care pathways, protocols and guidelines). 60. Understands the need to work with, or develop, safe systems and processes locally to support prescribing, for example, repeat prescribing, transfer of information about medicines. 61. Works within the NHS/organisational or other ethical code of conduct when dealing with the pharmaceutical industry. 62. Understands budgetary constraints and prioritisation processes at local and national level (health-care resources are finite). 63. Understands the national frameworks for medicines use (e.g. NICE, SMC, AWMSG and medicines management/optimisation). 64. Prescribes generically where appropriate, practical and safe for the patient. Competency 7 Evidence to support the above statement (i.e. I am able to state this because): Competency 7 Progressing PASS REFER FAIL DMP Signature Intermediate Interview Final Interview Date Student Name Signature of Mentor Signature of student 21

RECORD OF ASSESSMENT: Prescribing in Context Competency 8: Information Knows how to access relevant information. Can use and apply information in practice 65. Understands the advantages and limitations of different information sources available to prescribers. 66. Accesses relevant, up-to-date information using trusted evidence-based resources. 67. Regularly reviews the evidence base behind therapeutic strategies. Competency 8 Evidence to support the above statement (i.e. I am able to state this because): Competency 8 Progressing PASS REFER FAIL DMP Signature Intermediate Interview Final Interview Date Student Name Signature of Mentor Signature of student 22

RECORD OF ASSESSMENT: Prescribing in Context Competency 9: Self and Others Works in partnership with colleagues for the benefit of patients. Is self-aware and confident in own ability as a prescriber 68. Thinks and acts as part of a multidisciplinary team to ensure that continuity of care is developed and not compromised. 69. Establishes relationships with other professionals based on understanding, trust and respect for each other's roles in relation to prescribing. 70. Recognises and deals with pressures that might result in inappropriate prescribing (for example, pharmaceutical industry, media, patient, colleagues). 71. Negotiates the appropriate level of support and supervision for role as a prescriber. 72. Provides support and advice to other prescribers where appropriate. Competency 9 Evidence to support the above statement (i.e. I am able to state this because): Competency 9 Progressing PASS REFER FAIL DMP Signature Intermediate Interview Final Interview Date Student Name Signature of Mentor Signature of student 23

Appendix 2 Non Medical Prescribing: The Objective, Structured Clinical Assessment Guidance for Students: You are required to select a patient consultation that is mutually acceptable and convenient to you and your Designated Medical Practitioner, to enable assessment of your consultation and clinical decision making skills in relation to non medical prescribing You can undertake the OSCA at any point during the module the selected consultation could be a new referral or a follow-up appointment the completed OSCA assessment form should be included in your portfolio You should obtain consent from your patient for your OSCA assessment, and maintain patient confidentiality Guidance for Designated Medical Practitioners: The main aim of the OSCA is that the student demonstrates safe and effective consultation skills, sound clinical decision making and appropriate prescribing decisions Your student should be able to score a "Yes" or "not applicable" on all items. Clarification of any minor issues can be undertaken through discussion with your student before making your decision The student does not have to issue a prescription. If she/he decides that the consultation does not warrant the issue of a prescription and provides clear justification for this decision, this would be acceptable The student can legally only write a "training" prescription - which should be destroyed after the OSCA. The DMP should provide the patient with a legal prescription which you have signed yourself. If clear demonstration of unsafe is evident, then the student should be referred. University Assessment Regulations permit one further attempt. If a referred student demonstrates unsafe upon the referred attempt, this is deemed a Fail, and the student is required to re-enrol upon the programme and repeat all the module assessments. Please notify the Module Leader (Wayne Robson: 0114 225 6651) should you have any concerns or require further information Internal Moderation of OSCA's In line with SHU, NMC and HPC requirements for nursing, midwifery and AHP students, personal tutors will arrange to undertake internal moderation for a representative sample of the student group.. 24

OSCA Assessors Checklist Has the student: ensured sufficient information to establish whether a prescription is appropriate? ascertained what symptoms the patient has presented with? enquired how long the symptoms have been present? enquired about allergies / previous Adverse Reactions etc? asked what action the patient has taken up to now? checked if the patient is on any other medication & if so, what? considered other treatment options? considered whether a referral to the patients GP/Consultant was required? listened to the patient and demonstrated a partnership approach? made a final diagnosis? Yes/No N/A If a prescription was not issued, did the student: provide a satisfactory rationale for this decision to the patient? collaborate with the medical mentor to generate an appropriate CMP? If a (sample) prescription was issued, did the student consider any possible contraindications? fill the prescription in correctly? given appropriate advice regarding how long the drug would take to work? given advice on how and when to take or use the product? given information about what dose to take the drug and for how long? discussed possible side effects of the drug with the patient? set a review date with the patient? made the patient aware of who to contact if there was a problem with the medication? Has the student confirmed competence and safe and effective in relation to: understanding the responsibility that the role of the independent prescriber entails being aware of his/her own limitations, and working within the limits of their professional competence, knowing when and how to refer / consult / seek guidance from another member of the health care team taking an accurate history and carry out a relevant clinical assessment using common diagnostic aids e.g. stethoscope sphygmomanometer, relevant to the condition(s) for which the nurse,/ahp / pharmacist intends to prescribe applying clinical assessment skills t o inform a working diagnosis and formulate a treatment plan being able to describe the pathophysiology of the condition being treated and recognise the signs and symptoms of illness carrying out a checking process to ensure patient safety monitoring response to therapy, review the working/differential diagnosis and modify treatment or refer / consult / seek guidance as appropriate Yes/No N/A Date: Pass / Refer Signed (DMP) Signed (Student) 25

Appendix 3 Assessment Overview All students undertaking the module at Level 6 and Level 7 are required to complete the following assessment tasks: 1. An examination, comprising short and multiple choice questions designed to assess the student's knowledge of pharmacology, numeracy, prescription writing and the principles and legal issues central to prescribing 2. The Portfolio (100% weighting if Level 6 and 50% weighting if Level 7) requires the student to demonstrate achievement of the module learning outcomes by providing confirmation of: satisfactory completion of a period of 90 days learning and assessment of competence by a DMP through a completed assessment booklet* satisfactory completion of an Objective, Structured, Clinical Assessment, undertaken in, by a DMP* a 4,500 word reflective commentary supported by evidence to confirm achievement of the learning outcomes, including a Clinical Management Plan and examples of prescription writing For students undertaking the module at Level 7 there is an additional assessment task: 3. A 3.000 word case study (50% weighting) selected from the forefront of their field of competence. Students will work independently but in consultation with their academic tutor and DMP and are expected to draw heavily on current research, academic publications and other appropriate primary sources in order to select and critically appraise the information and contextualise findings using reasoned arguments. Findings should be communicated in a coherent, well written, referenced case study which creates and justifies the links between aspects for an academic/professional audience * Components for the DMP to assess Module tutors will support students for the remainder of the portfolio, and undertake all marking 26