This is an observational assessment used to assess an individual performing multiple patient reviews over a continuous period of practice. Skills such as clinical assessment and reasoning, teamwork, time management, prioritisation and record keeping can be evaluated during this observation. One of the advantages of this tool compared to other observational SLEs is that it doesn't rely on a particular patient or scenario being available on that day.
Any period where a pharmacist is required to review a series of patients or deal with several enquiries can be used. The scenarios will vary depending on the setting.
The ACAT can be conducted in any setting, with examples including observations of:
A pharmacist working on ward – this could be part of a multidisciplinary ward round or reviewing patients autonomously
A pharmacist clinically screening prescriptions in a dispensary (either a hospital or community pharmacy)
A pharmacist reviewing a case load in clinic or GP surgery
A pharmacist taking telephone enquiries whilst working in medicines information
The pharmacist and assessor will agree a date and period of time during which the observation will take place. The RPS recommend a minimum of five patients / cases are observed, however, this may not be possible on some occasions (e.g. a quiet period in medicines information). Similar to recommendations for the Mini-CEX, the assessor should position themselves carefully (to avoid being intrusive) and limit their questioning of the student to confirming how they are prioritising problems and how they can justify their proposed actions. Therefore, students need to lead the discussion to demonstrate how they synthesise information (rather than read out verbatim the content of the case notes), articulate thought processes and use clinical reasoning.
There are no minimum numbers of each type of SLE that needs to be completed. Since the tool involves direct observation of practice and does not require the pharmacist to undertake any specific preparation, examples of when it could be used most effectively include:
During the first few weeks of a rotation to assess how the pharmacist is working in the new clinical area. If they have moved from a rehabilitation facility to acute medical admissions, this will require a different approach to workload management and operating in the multi-disciplinary team
If the pharmacist did not perform well during an ACAT, a subsequent one can be arranged for a few weeks later to assess whether feedback from the previous one has been addressed