Learning professionalism through practice exposure and role models
How do pharmacy students learn professionalism? Ellen Schafheutle and colleagues from the Workforce Academy and the National Primary Care Research and Development Centre in Manchester are trying to find out
In recent years, the pharmacy profession has increasingly engaged in a debate about professionalism, what it means in a pharmacy context, how it can be nurtured among students and practitioners alike, and how it can be supported over the course of a pharmacist’s career.
However, given the lack of empirical evidence about professionalism in pharmacy we have looked to medicine, which has led the way in both debate and investigation about professional values and behaviours in modern day healthcare.
In parallel with similar developments in the US,1 the medical profession in the UK underwent considerable consultation to reach a definition of modern medical professionalism as “a set of values, behaviours and relationships that underpin the trust the public has in doctors.”2
In pharmacy, no such overarching definition is available, but some attempts have been made at least to describe elements or attributes of professionalism, which are often broken down into values, attitudes or behaviours.
Most of the literature stems from the US, where the focus has been more on how students learn professionalism during their undergraduate education, rather than on how this continues to develop among the registered pharmacy profession. This in itself is, of course, not a problem, since general agreement exists that the process of learning professional values, attitudes and behaviours starts early.3
Thus, exploring how the foundations of pharmacy professionalism are laid during the MPharm course was the obvious place to begin the first ever study to investigate the topic in depth here in the UK. We designed a study, funded by the Pharmacy Practice Research Trust (PPRT), with the overall aim of understanding and clarifying how professionalism is defined, learnt, cultivated and facilitated in the UK academic environment. This article summarises some of the findings and places them in the context of current debates about, and developments in, pharmacy education.
What we did
Why the work was done
In order to nurture professional values and practice in pharmacy and to create pharmacy leaders, it is important to understand what aspects of professionalism in practice are valued by pharmacists, patients and the
To address this, the Pharmacy Practice Research Trust commissioned a series of studies to investigate three different areas:
An overview from the first study is presented here.
No over-arching definition of professionalism exists for pharmacy in the UK
Pharmacy students and teaching staff have difficulty defining professionalism in the abstract sense but are able to describe good and bad examples of it
Exposure of students to pharmacy practice and pharmacy teacher-practitioners supports their learning of professionalism
We recruited three established UK schools of pharmacy in this study and employed a qualitative methodology because we wished to explore the area in some depth and detail.
The lead author (EIS) visited all three schools and conducted semi-structured, face-to-face interviews with two or three members of teaching staff in each.
These were staff who were either involved in the direct delivery of professional pharmacy practice teaching or had a wider curriculum overview.
The interviews aimed to find out where in the curriculum the staff saw professionalism being taught or addressed.
EIS also facilitated two focus groups with between five and eight fourth-year MPharm students in each of the three schools, to find out where and how they felt they learnt professionalism.
EIS further observed professional pharmacy practice classes to see an example of a setting where professionalism learning may be supported by staff and received by students. Finally, EIS reviewed written curriculum materials, such as course or year handbooks containing information on individual module outlines as well as more general course information, including policies and codes of conduct. This aimed to get at what written course materials stated explicitly as intended learning with regard to professionalism.
All of these different data sources were analysed by identifying common themes. Comparisons were then made between, for example, staff and student views, but also between different schools. This helped us to understand not only how professionalism was defined and described, but also how its learning was supported by staff and received by students, thus allowing the identification of elements that appear important for positive learning of professionalism.
A flavour of what we found
Something that struck us early on in this study was the difficulty both students and teaching staff had in defining professionalism in pharmacy in the abstract sense. What they found somewhat easier to describe were examples of good or bad professionalism, both in terms of attitudes and behaviours.
Examples of attitudinal attributes of professionalism included altruism, duty of care, empathy, honesty, integrity, accountability and excellence.
Behavioural attributes were also mentioned and they included taking responsibility for one’s actions in terms of learning, communicating sensitively and respectfully, putting others’ needs first, being non-judgemental in one’s actions and communication, being punctual and dressing appropriately.
Following these early discussions with students and staff, what became apparent was the extent to which fourth-year students based their descriptions of experiences of professionalism on practice rather than on what they had experienced or learnt in the academic environment.
Furthermore, not only were these practice experiences gained outside the school environment, they were gained through vacation and part-time jobs that students had organised outside their MPharm courses.
Teaching staff recognised the importance of such practice exposure and all three schools had also incorporated community and hospital pharmacy visits or placements into their curricula. Both staff and students regarded these as important for supporting students’ learning of professionalism.
However, they also recognised the limited availability of placements organised by the schools in the current set-up, and the logistical problems as well as cost implications of trying to introduce further placements into the course.
Staff, therefore, generally encouraged practice experience that students organised themselves. Importantly, staff noted that, in their experience, those students who had such additional practice experience adapted to professional pharmacy practice classes more easily. They also believed that students with practice experience probably gained more or differently from them owing to their being able to make links between their academic learning and its applicability and relevance in practice.
Related to the importance and relevance of practice experience for professionalism learning was the particular significance of role models. Again, when talking about role models, students would most commonly refer to ones they had experienced in the practice work environment.
Here, they talked about working with and observing pharmacists they had been, or were still, working with. In some cases they also mentioned pharmacy support staff as role models, particularly when learning about communication with patients and customers.
Identifying role models within pharmacy schools was more secondary for students. Even though they did identify individuals, or groups of individuals, in the academic environment, their function as role models may not be recognised as clearly by students (as it may be by staff) in terms of supporting their professionalism learning. Some eminent scientists, for example, were respected for their reputation and recognition in their particular field or area of expertise.
In other cases, certain elements of professionalism were seen as being learnt through non-pharmacist or science teaching, where, for example, good laboratory practice, the importance of dressing in a particular way (eg, clean environment) or accuracy of work were enacted in more science-focused practical classes.
Nevertheless, even though non-pharmacists and other pharmacist academics were seen, to an extent, as having a role to play in the students’ development of their professionalism, this role appeared to be limited. However, there was one group of teaching staff who were clearly recognised by students as role models, who were imparting professionalism learning that was closely linked to practice.
These staff were pharmacists who retained an element of patient-facing practice in either hospital or community. They were usually teacher practitioners or teaching fellows, and they were influential and respected for teaching and role modelling that was very much grounded in current practice.
The above summary only gives a flavour of what emerged from the study. We focused on practice exposure and the importance of role models here, but there are many other aspects that are important to explore and analyse further.
For example, what kinds of things can be provided within the academic environment to support positive professionalism learning and development effectively? What happens, for example, if students’ practice experience is bad or provides them with poor role models?
Is there a role for teaching staff in schools of pharmacy to support students in managing their experiences, by providing guidance and feedback on what constitutes good or bad professionalism, thus supporting them to form their own ideas of professionalism?
Also, if a definition or description of professionalism (or its elements) is still rather difficult and elusive, can professional attitudes and behaviours be assessed? Or should they be assessed?
What form of assessment can and should such assessments take? Is professionalism learning about a process that requires support and thus makes formative assessment more appropriate? Or should we, at some point, aim to assess professionalism in a summative way? And, if so, would we expect to fail some students on their (poor) professionalism?
It may be that this debate will move forward following experience with the code of conduct for pharmacy students4 that was introduced last year, and fitness-to-practice procedures that are due to be in place in all schools from September this year (2010).5
Nevertheless, our study clearly shows the importance of practice exposure and experience in supporting students’ learning of professionalism, which is something that only fully comes into play in the practice context. However, practice placements continue to be rather limited as part of the MPharm course, with students often relied on to organise their own work experience.
Since they are then outside university control, there may be concerns over quality control and consistency of appropriate professionalism learning. The insights from this study thus add to the current and ongoing debate in pharmacy education about integration into a five-year programme spanning both academic and practice learning.6
Furthermore, and recognising the importance of practice for professionalism learning, it will be important to understand how professional attitudes and behaviours are affected once students enter practice.
This will, at least in part, be addressed in another PPRT-funded study that we are currently undertaking at the University of Manchester. It explores how early career pharmacists learn and develop professionalism during their pre-registration year and beyond, and focuses in particular on tutors and support staff as potential role models.
ACKNOWLEDGEMENTS Thanks to the three schools that agreed to take part and to their named contacts for facilitating access and data collection. The work was funded by the Pharmacy Practice Research Trust. The views expressed in this article are the authors’ own and do not necessarily reflect those of the PPRT.
Ellen I. Schafheutle, PhD, MRPharmS, Karen Hassell, MA, PhD, Darren M. Ashcroft, PhD, MRPharmS, and Jason Hall, PhD, MRPharmS, are from the Workforce Academy
Stephen Harrison, PhD, AcSS, is from the National Primary Care Research & Development Centre
All at the University of Manchester, Oxford Road, Manchester M13 9PT.
Correspondence to Dr Schafheutle (email email@example.com)
Citation: The Pharmaceutical Journal URI: 11020136
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