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The National Alliance for Pharmacy Education (NAPE): Leading pharmacy intern training in Australia

Four of Australia’s leading pharmacy schools formed the National Alliance for Pharmacy Education (NAPE) to support the advancement of the pharmacy profession as a critical member of the healthcare team. NAPE builds capacity to design, implement, and evaluate an accredited curriculum framework, learning and assessment strategy, and workplace-integrated learning program for intern pharmacists through a commitment to shared values, collaboration, and engagement with key stakeholders. This article discusses NAPE’s strategies for delivering a consistent, outcomes -driven, accredited pharmacy intern training program (ITP) across Australia. Since the program's commencement 12 years ago, enrolments in the program have increased, accompanied by high completion rates and excellent outcomes. The strategies which underpin the collaboration have been successful in ensuring the program’s quality, consis tency, and sustainability.


Background
To be eligible to practice unsupervised as a registered pharmacist in Australia, pharmacy graduates, referred to as intern pharmacists, must meet the legislative requirements specified by the Pharmacy Board of Australia (PharmBA) (Pharmacy Board of Australia [PharmBA], 2015) and administered by the Australian Health Practitioner Regulation Agency (Ahpra). These mandatory requirements include completing a set term of supervised practice and an accredited pharmacy intern training programme (ITP), as well as passing the PharmBA Registration Examination (Part A is a written [computer-delivered] examination, and Part B is an oral examination). The Australian Pharmacy Council (APC) accredits pharmacy education programmes in Australia to ensure graduates and foreign pharmacists possess the necessary knowledge, skills, and attributes to practice safely as registered pharmacists (Australian Pharmacy Council [APC], 2020a; 2020b). Providers of education must adhere to the APC's standards, and the programme must be approved by the PharmBA.
The National Alliance for Pharmacy Education (NAPE) was formed in 2010 by four Australian schools of pharmacy (Monash University, The University of Queensland, The University of Sydney, and University of South Australia) to support the advancement of the pharmacy profession as a key contributor to the healthcare team (National Alliance of Pharmacy Education [NAPE], n.d.). The initial focus was on advancing pharmacy intern training through the delivery of an accredited ITP across the four NAPE universities. A staffing structure, provision of adequate resources and mechanisms for fostering collaboration were agreed upon to ensure the programme remained contemporary. The NAPE ITP's mission is "To ensure each intern pharmacist experiences a high-quality programme, feels supported, and completes a period of supervised practice with a strong enthusiasm about the

Abstract
Four of Australia's leading pharmacy schools formed the National Alliance for Pharmacy Education (NAPE) to support the advancement of the pharmacy profession as a critical member of the healthcare team. NAPE builds capacity to design, implement, and evaluate an accredited curriculum framework, learning and assessment strategy, and workplaceintegrated learning program for intern pharmacists through a commitment to shared values, collaboration, and engagement with key stakeholders. This article discusses NAPE's strategies for delivering a consistent, outcomes-driven, accredited pharmacy intern training program (ITP) across Australia. Since the program's commencement 12 years ago, enrolments in the program have increased, accompanied by high completion rates and excellent outcomes. The strategies which underpin the collaboration have been successful in ensuring the program's quality, consistency, and sustainability. The NAPE ITP team consists of four experienced faculty academic pharmacists (one at each NAPE university) who serve as programme managers and an additional academic pharmacist who centrally coordinates and synchronises the team's activity. The NAPE ITP team report to and is supported by NAPE leadership.
The NAPE ITP team has combined employment experience across community, hospital, and military pharmacy settings, the pharmaceutical industry, professional pharmacy organisations, pharmacy ownership, and academia. It is expected that all team members maintain strong links to the pharmacy profession. There is a focus on, and expectation of, teamwork, regular communication, sharing of resources and engagement with key stakeholders. Additional clinical educators and administrative staff contribute locally to address the unique demands of each individual university.
The collaboration of NAPE ITP team members enables the delivery of high-quality, dynamic programmes and award courses taught by experienced educators and practitioners -all in support of the ongoing advancement of the pharmacy profession.

Programme description
The NAPE ITP is a performance and competency-based programme developed to address the National Competency Standards Framework for Pharmacists in The NAPE ITP is the only ITP in Australia that also offers intern pharmacists an opportunity to build on their foundational pharmacy intern programme to obtain formal university postgraduate qualifications in pharmacy practice and clinical pharmacy. These qualifications will assist pharmacists in their pursuit of advancement in pharmacy and professional practice. Additionally, the NAPE ITP aligns with International Pharmaceutical Federation (FIP)'s Development Goal 2 Early Career Training Strategy (International Pharmaceutical Federation [FIP], 2020).
The NAPE ITP is intended to complement and support intern pharmacists in their experiential learning so that at the completion of the programme they can apply the required knowledge, skills, and attitudes to demonstrate competence in the required standards. A summary of the programme objectives of the NAPE ITP are shown in Table I. Intern pharmacists must achieve professional performance standards at the time of initial general registration, i.e practice unsupervised (Australian Pharmacy Council [APC], 2020b). The programme is intended to complement the training that intern pharmacists undertake in their workplace.
To build programme capacity, the NAPE ITP demonstrates strong programme consistency across the four universities through a core curriculum framework and learning and assessment strategy. This means that a majority of the programme elements are consistent across the country and independent of the location where the programme is delivered; this contributes to the rigour and efficiency of the team's operations. Therefore, an intern pharmacist enrolled at any of the four NAPE universities will experience the same programme subject to local jurisdictional legislation and practice.
NAPE has a national perspective on pharmacy intern training. The distribution of the team across the country builds capacity by facilitating shared knowledge and experiences to help keep abreast of contemporary pharmacy practice issues and facilitate team learning. If one team member has particular expertise, this is shared and utilised within the team environment and applied to programme development and delivery. To ensure the programme remains contemporary, the team needs to be agile and responsive to adapt and be flexible. The team also seeks input and maintains close engagement with stakeholders, including discussion about workforce development.

Crockett et al NAPE leading pharmacy intern training in Australia
Pharmacy Education 22(4) 90 -94 92 As this is a competency-based programme, many of the assessments and tasks that the intern pharmacist must complete are supervised by their Ahpra-approved registered pharmacist preceptor during their period of supervised practice. It is essential when implementing an intern training programme that preceptors be engaged with the programme and treated as major stakeholders. This can be a challenge as preceptors are not paid to undertake this role, and there is no legislative requirement to undertake training. Preceptor development and support are key components of the NAPE programme. The NAPE ITP includes localised training and support for preceptor and clinical educator development in clinical supervision, feedback, and teaching. Regular communication with preceptors and practice sites ensures both intern pharmacists and preceptors receive guidance around expectations and feel well supported as they progress through training.
Even though individuals within the NAPE ITP team are all highly skilled, the team is aware that positive interaction and collaboration are essential for positive outcomes. The team actively seeks to demonstrate efficient and effective collaboration. As described by Hoegl & Gemuenden (2001), the six facets of team quality and collaboration, i.e communication, coordination, balanced member contributions, mutual support, effort, and cohesion, are displayed continuously by all team members. Shared mission and values are essential elements in high-functioning teams. Effective teams demonstrate a shared focus -on their mission, values, and objectives and the team in which they work (Salas et al., 2018).
When NAPE was formed, it was agreed that the initial focus of the collaboration would be to advance pharmacy intern training via the delivery of the NAPE ITP across the four universities. This gave the NAPE ITP team a strong and compelling reason to come together, and through a commitment to team tasks, to the team itself, and belief in the strategic vision, each of the team members, makes significant ongoing contributions. As expected, since 2010, there have been personnel changes to the NAPE ITP team. Despite this, capacitybuilding and teamwork strategies have ensured the continuation of this collaboration.
The NAPE ITP team is self-organised and self-regulated so that challenges are identified and managed effectively and efficiently to achieve objectives in a timely manner. The ITP teams function autonomously within each university, which affords the managing pharmacists the respect and trust needed to make critical strategic decisions for the programme. Within the NAPE ITP team, there is a leadership model where the authority and responsibility for the decision-making process is distributed and shared amongst the team.
Efficiency is enhanced because the workload is shared between team members, and the contribution of each team member is strategically allocated, balanced, and aligned with team priorities being mindful of each individual team member's unique responsibilities at their respective university. The collaboration between the four NAPE universities delivers key performance outcomes underpinned by a cohesive and collaborative team structure, intellectual capital, and organisational support.
Team redundancy refers to the ability of one or more of a team's member's capacity to carry out other team members' roles when required and without training (Freire et al., 2018). For the NAPE ITP, this means that when one team member needs support to complete a task, or perhaps they may be unable to complete a task, one or more of the other members of the team can assist at short notice, and this is irrespective of geographic location. Every member within the NAPE ITP could do another's tasks or replace another team member without significant issues. This allows the team to be Table I: NAPE ITP objectives Provide high-quality, multimodal, comprehensive learning experiences, so, at the completion of the programme, intern pharmacists have: a. the knowledge, skills, behaviours, and attitudes congruent with a commitment to safe and socially accountable practice, including public service and safety; cultural safety, respect and responsiveness, person-centred care; reduction of disparities in healthcare; and addressing community aspirations for health (Australian Pharmacy Council [APC], 2020a; 2020b); and b. demonstrated competency in the current National Competency Standards Framework for Pharmacists in Australia (Pharmaceutical Society of Australia, 2016) necessary to commence unsupervised practice as a competent registered pharmacist; and c. demonstrated achievement in the required performance outcomes contributing to fitness-to-practice as outlined in the current Accreditation Standards for Pharmacy Programmes in Australia and New Zealand Performance Outcomes Framework (Australian Pharmacy Council [APC], 2020b). Assist intern pharmacists to integrate their academic training into professional practice Provide comprehensive support to intern pharmacists to assist them as they progress from intern pharmacist to registered pharmacist Immerse intern pharmacists in the experience of lifelong learning and provide an opportunity for pharmacists to obtain formal postgraduate University qualifications in pharmacy practice.

NAPE leading pharmacy intern training in Australia
Pharmacy Education 22(4) 90 -94 93 adaptable and responsive and adjust strategies and processes in response to changes in circumstances.

Regular communication and information sharing between and amongst team members is a priority.
Communication is solution-focused to improve efficiency and capacity, ensure that specific questions are answered, and foster innovation and creativity with key outcomes in mind. The centrally coordinating academic pharmacist is key to the coordination of communication, ensuring careful planning, documenting and recall of interactions irrespective of meeting format.
From its inception, the NAPE leadership (consisting of the Heads of Schools of Pharmacy or equivalent) has set and supported a team-orientated culture. NAPE leadership continues to provide outstanding support and mentorship for the NAPE team through adequate human and financial resources to support the programme.
One of the challenges for the NAPE ITP team is geography. Australia is a large and sparse country, and it takes a few hours of plane travel for a face-to-face meeting. Prior to the travel challenges associated with COVID-19, the NAPE ITP team was able to meet regularly face-to-face. However, because of pandemic-related travel restrictions, the team has focussed on remote/online communication that is frequent, open, and efficient, accompanied by structured coordination of individual efforts synchronised with team strategy to ensure cohesive function.

Evaluation
To ensure that the NAPE ITP remains fit-for-purpose, it is informed by contemporary evidence and several continuous quality improvement mechanisms. Evaluation and review of the programme are conducted regularly and include both quantitative and qualitative feedback from all stakeholders involved, including intern pharmacists, preceptors, educators, and practitioners.
Enrolment of intern pharmacists into the NAPE ITP has increased steadily over the course of the collaboration, from 243 enrolments in 2010 to approximately 500 in 2022. There is a high completion rate, and reviews indicate that intern pharmacists and preceptors are extremely satisfied with their experience. Additionally, practitioners express a great desire to participate and teach in the NAPE ITP programme, demonstrating the development of positive reputational capital.
The key characteristics that have contributed to a robust NAPE ITP team include a dynamic and networked group of programme managers, distribution of programme managers and support staff at each university, cohesive and collaborative team structure, and organisational support through the NAPE leadership. The collaboration works because of coordination, communication, distributed effort, and an expectation of demonstrable commitment to the partnership. A culture of autonomy, continuous quality improvement, trust, shared mission, and values are critical to the team's success. A framework that includes the above components may assist with the implementation of similar pharmacy educator collaborations in other countries around the world.

Future plans
In its twelfth year of operation, and despite its extensive geographical spread across Australia, the NAPE ITP collaboration continues to work as a high-functioning team that demonstrates excellent outcomes. NAPE leverages the expertise, experience, and resources of this alliance of leading pharmacy schools to provide highquality, accessible and relevant opportunities for postgraduate development, achievement of professional excellence and career advancement.
The NAPE ITP team has an exceptionally strong collaborative spirit, and the team's creativity, innovation, energy, and motivation come from a commitment to every intern pharmacist. Interpersonal connection further strengthens the professional partnership.