Leadership Education for Pharmacists

by Ryan Costantino, Pharm.D., PGY1 Pharmacy Practice Resident, University of Maryland Medical Center

In sports, business, politics, or healthcare, leadership is a highly sought after character trait. Over the past several years I have repeatedly heard “Pharmacy needs to train more leaders.”  Interest in training and developing leaders has been mentioned by Harvey A.K. Whitney Award recipients¹, in a Rho Chi Lecture², and it appears several times in the current ACPE accreditation standards.³ While the need for leadership education and training is clear, the best method to train leaders in pharmacy is not.

Articles or reports published in scholarly journals that specifically address leadership education for pharmacy students are sparse.^4,5  Boyle and colleagues describe an elective course implemented to develop pharmacy students’ leadership and political advocacy. Course evaluations from the elective identified benefits including building public-speaking skills, debating skills, increasing confidence at business functions, and networking.  The authors also report that students sought leadership positions after completing the course and felt a sense of empowerment with increased confidence to become more involved in organizations as leaders and advocates.

From an instructional design standpoint, Boyle and colleagues designed their course well. It had clearly stated objectives and used a variety of assessment methods that required students to verbally discuss and debate issues as well as summarize their course experience in a written reflective paper. The course also had an experiential component that required students to participate in various professional organizations or activities. I believe an experiential component is essential for any leadership education program because leadership is more than having knowledge or skills. It’s also the ability to act at the appropriate time and in the appropriate way to exert influence.

Another manuscript that described leadership education was published by Sorensen and colleagues from the University of Minnesota.  The course included didactic, experiential, and self directed learning activities. It focused on developing core leadership skills, self-awareness, and awareness of the process for leading change. The authors used activities such as StengthsFinder^®, and reputable books such as Our Iceberg is Melting to augment the classroom-based activities. Course evaluations by the students were generally positive and students rated the activities in the course moderately to very useful. The authors also stated that evaluations from both students and practicing pharmacists suggested that the course could serve as an effective tool in preparing students to lead change when they enter the profession.

Both of these courses appear to have been constructed with sound principles of instructional design in mind.  They incorporated a variety of didactic classes and experiential experiences to convey knowledge regarding leadership.  However, on the negative side, both courses relied heavily on course evaluations from student to evaluate course effectiveness.

After searching the literature regarding leadership education, it’s clear that there is a lack of evidence about how best to teach someone to be a leader. It is unclear if either of these courses have had a long-term impact on students. Evaluating additional outcomes is needed. For example, it would be useful to survey the entire pharmacy class and see if students who took the course were more involved in leadership roles or professional organizations than students who did not enroll in the course. Or perhaps surveying employers of these graduates to assess whether the employer thought the student possessed leadership skills or traits at a higher level than what would be expected for an entry-level pharmacist.

Leadership courses for pharmacy students have approached leadership development in a very appropriate manner using a variety of instructional activities and tools. What we don’t seem to do well is critically evaluate and assess whether these courses actually produce the desired results.  Leadership education would be well served to apply the same rigorous standards we apply to other disciplines by examining long-term outcomes.

Leadership will continue to be a desired character trait in pharmacy and healthcare.  All pharmacists should possess fundamental leadership skills regardless of whether they hold a formal leadership position because all pharmacists influence people.  Pharmacy schools would be prudent to continue to encourage faculty to develop innovative programs and courses that work to mentor and develop future leaders and equip all graduates with the skills they need to lead at all levels in an organization. Leadership courses and programs should continue to be created using the principles of instructional design but must employ more rigorous evaluations if we want to critically assess whether they are effective.

References

1. White SJ. Leadership: successful alchemy. Am J Health Syst Pharm 2006; 63:1497-1503.

2. Grabenstein, JD. 2011 Rho Chi Lecture: Mortars & Pestles, Maps & Compasses, Vaccines & Syringes. Am J Pharm Educ 2011: 75: Article 79.

3. Accreditation Council for Pharmacy Education. Accreditation standards and guidelines for the professional program in pharmacy leading to the doctor of pharmacy degree [Internet]. Chicago: Accreditation Council for Pharmacy Education; 2011.  97 p.  [cited 2012 Oct 8]

4. Boyle, CJ, Beardsley, RS, Hayes, M.  Effective leadership and advocacy: amplifying professional citizenship. Am J Pharm Educ 2004;68:Article 63.
5. Sorensen, TD, Traynor, AP, Janke, KK.  A pharmacy course on leadership and leading change.  Am J Pharm Educ 2009;73:Article 23.

Reducing Test Anxiety

by Jesse Foster, Pharm.D., PGY1 Pharmacy Practice Resident, Medstar Georgetown University Hospital

When I was a pharmacy student, I had a friend who seemed to understand the course content very well. When my friend took the final exam — an exam that weighed a lot toward our final grade — he failed the exam.  It was a classic case of test anxiety. Test anxiety can be a serious problem for some students.  An estimated 15-20% of students feel impaired by exam stress.²

The impact of test anxiety can lead to several negative outcomes.  Students with test anxiety can have a good understanding of the material but may be unable to recall what they know.  Anxiety can also impair problem solving and lead to poor decisions on exams. Some learners may develop avoidance behaviors and pass up learning opportunities. Avoidance behavior develops after past poor performance.  Understandably, students don't want to repeat the negative experience. ⁴  Further, test anxiety shifts the focus toward performance and outcomes rather than on learning the subject matter.  Lastly, poor performance due to test anxiety can lead to lost educational and job opportunities.²

At the heart of test anxiety is stress. In a study by Yusoff, the impact of stress on exam scores was examined in first year Malaysian medical students. This study looked at students' mental status immediately after taking a final exam. The results show that students with severe stress were 2.43 times more likely to fail the exam compared to students with normal to mild stress.⁵

Cognitive interference is a possible cause for exam anxiety. This model postulates that cognitive processes are occupied by negative and irrelevant thoughts resulting in poor exam performance.²  Test anxiety has been correlated to feelings of unpreparedness when students are unfamiliar with the exam style and content. Students can also feel unprepared when there is a large amount of content and limited amount of time to review what will be covered on the exam.⁵ Poor study habits add to test anxiety as well. Studies have shown that students with high test anxiety are more likely to procrastinate and use less effective studying strategies.¹

The perception by the student that the exam or assessment has significant implications can also increase anxiety and stress.  Students become overly concerned that poor performance on an exam will result in major negative consequences.  If a student has an unrealistic expectation that he/she will achieve a perfect score on an exam, then stress and anxiety can increase when he/she is unable to answer an exam question.⁶

To help with cognitive interference, cognitive behavioral therapy can be used to help reduce stress. Expressive writing is a technique to help with these disruptive thoughts. Using this technique, the student writes out his/her negative thoughts for 10 minutes before the exam. This allows the student to vent and express their concerns on paper before the exam. Expressing their concerns will clear their mind so they can better focus on the exam. Another approach to help reduce test anxiety is relaxation techniques. These techniques have the student focus on deep breathing along with muscle relaxation of the arms, legs and stomach. Similar to expressive writing, this helps the person clear their mind of negative thoughts and anxiety.⁴

Reducing the perceived significance of the exam can help to alleviate the stress and anxiety that a student may feel.  Both the learner and teacher can help minimize this type of stressor.  Its important not to overemphasize the importance of an exam and its potential impact. Multiple exams in a course can help reduce anxiety by minimizing the impact any one exam might have on the overall outcome.²

Providing more realistic expectations for the exam will help students who panic when they don’t know or understand questions. Answering questions where the answers are known and understood first can improve test anxiety. This helps to improve confidence and in turn, reduce anxiety during the exam as well as diminishes the sensation that time is running out.^{3, 4}

For students who feel unprepared, teachers can provide insight into the exam content and style to help reduce the fear of the unknown. Study habits can be improved by providing a clear, regimented course schedule. Study groups can also be beneficial by helping keep students focused. Having more frequent exams can also improve study habits since students will need to review material more frequently.^{1, 2}

Test anxiety is a major concern for some students. It can prevent students from advancing academically and professionally. Test anxiety also causes students to avoid other educational experiences and to focus more on passing exams instead of learning the content. However, test anxiety can be minimized if both the student and teacher employ some proven strategies.

References

1. Sansgiry SS, Sail K. Effect of Students’ Perceptions of Course Load on Test Anxiety. Am J Pharm Edu. 2006; 70(2): Article 26.

2. Neuderth S, Jabs B, Schmidtke A. Strategies for reducing test anxiety and optimizing exam preparation in German university students: a prevention-oriented pilot project of the University of Wurzburg. J Neural Transm. 2009; 116: 785–90.

3. Abolafia J, Lumpkins A, Malandro T. High Stakes Testing: Managing Test Anxiety. [Internet]. Accessed April 27, 2013.

4.  Paul A. Relax, It's Only A Test. Time 2013;181(5):42-5.

5. Yusof M, Associations of Pass-Fail Outcomes with Psychological Health of First-Year Medical Students in a Malaysian Medical School. Sultan Qaboos University Med. 2013; 13(1): 107-14.

6. Chinta R. Exam Anxiety Effect on Exam Performance: An Empirical Replication in the Middle East. Aryan Hellas Limited, IRBC Athens, 2005. Accessed 5 May 2013.