October 10, 2011

Responsibility: Can it be Taught?

By: Emeri D. Potter, Pharm.D., PGY2 Ambulatory Care Pharmacy Resident, VA Maryland Health Care System
This past June, towards the end of my PGY1 Pharmacy Practice Residency, I had an administrative rotation at the Veterans Affairs (VA) Central Office. My preceptor posed a question to me: “Can you teach pharmacists accountability and responsibility?” My preceptor told me it would not be an easy question to answer.
I wondered, “What exactly is responsibility in pharmacy?” A responsibility is a duty for which you can be held liable.1  Although the willingness to accept a responsibility ultimately resides within the individual, it does not alter the expectation.  Nonetheless, although responsibility exists, it can be a challenge to teach someone to feel responsible.  Pharmacy has changed in the last few decades.  Rather than concentrating primarily on chemistry, compounding, and dispensing, pharmacy now takes a more patient-centered approach.  Pharmacists today have a new set of responsibilities, in addition to the traditional ones.  As the profession is becoming more “patient-centered”, pharmacists make decisions and recommendations to improve patient care in addition to dispensing.  Some pharmacists may not feel comfortable in this new role depending on their training.  The management of patients requires us to consider what is optimal for the patient in terms of adherence, cost, and quality of life as well as what’s recommended by various practice guidelines.
After a comprehensive search, I did not find any data or research regarding how to teach responsibility to pharmacists. However, I did find a useful review that offers guidance on teaching responsibility to medical students.2  I believe this review can be extrapolated to pharmacy training.  Here are some of the best practices that are discussed in the article.   First, educational objectives relating to professional responsibilities should be included in each year of the pharmacy curriculum. It should be longitudinal, rather than a single elective or course.  Responsibilities can be taught in didactic format but, second, should also be taught during practice-based experiences.  For instance, a pharmacy student can be taught in a lecture about the responsibilities of a pharmacist in a hypertension clinic. This can be reinforced during an experiential rotation and/or health fair, where the student has to take and record blood pressures, and provide medication counseling.  The connection between both the didactic and professional experiences should be clear to both the faculty and students.  Evaluations by students and faculty are a key part of gauging whether the connection between didactic and experiential learning have been made.2
In pharmacy school, I listened to lectures and took exams relating to pharmacy laws, morals, and ethics. However, ”what students learn is not confined to what they learn in the classroom setting.”1 These topics were reinforced during my pharmacy practice experiences in school, where I believe social learning and constructivism were the most common educational themes.  In addition, group discussions and class debates about topics such as Plan B were also helpful.  I learned a lot about myself and how to handle sensitive situations.  At the conclusion of these exercises, the faculty and students debriefed, exchanging feedback and evaluations.  I realize now that the process of accepting new responsibilities did not end at the conclusion of pharmacy school and will continue throughout my career.
I feel that I have learned more about responsibility since starting my PGY2 Ambulatory Care Pharmacy Residency.  As a student and a PGY1 resident, I did a lot of observing.  I was more passive.  In my PGY2 residency, I am expected to order laboratory tests and recommend changes in drug therapy.  I must take full responsibility for my actions based on the results.  In the past, when I made recommendations to practitioners, the ultimate responsibility was still theirs.
As pharmacy moves towards the Pharmacy Practice Model Initiative (PPMI) 3, taking responsibility will become increasingly important and it must be taught throughout the pharmacy curriculum. PPMI is an initiative from the American Society of Health-System Pharmacists (ASHP).  The goal of PPMI is to “significantly improve the health and safety of patients by capitalizing on pharmacists’ unique knowledge of the medication-use system, and professional acumen as direct patient care providers.”3 The pharmacy profession is more specialized and additional training is required to meet our new responsibilities.  Pharmacy practice is undergoing a mutation and I think everyone must be ready to adapt.
1.  Jacono BJ, Jacono JJ. A holistic approach to teaching responsibility and accountability. Nurse Educator. 1995;20(10):20-23.
2.  Faulkner LR, McCurdy RL. Teaching medical students social responsibility: the right thing to do. Acad Med. 2000 Apr;75(4):346-350.
3.  Hertig J. New practitioners and the pharmacy practice model initiative: our opportunity to define the future. Am J Health-Syst Pharm. 2011 Jun;15(68):1074-1076.

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