Soft Skills Are Important Too

by Chelsea McSwain, Pharm.D., PGY1 Pharmacy Practice Resident, Holy Cross Hospital

Soft skills vs. hard skills…what is the difference?  Soft skills are those personal qualities and interpersonal abilities that are needed to relate to other people and work in groups.¹ In contrast, “hard skills” are those skills that are essential to job function and can more easily be quantified.  For pharmacists hard skills include filling and checking the accuracy of prescriptions, calculating doses, and recalling information about drug therapy.  The pharmacist’s soft skills would include communicating effectively, critical thinking, problem solving, teamwork, time management, conflict management, cultural awareness, responsibility, leadership, and work ethic (to name but a few!).  These skills, although often under-appreciated, are essential to a successful career in pharmacy.  Unfortunately, these important skills are frequently overlooked and have been historically de-emphasized in pharmacy curricula.

A recent editorial by Dr. Cynthia Boyle in the American Journal of Pharmaceutical Education (AJPE) titled “Leadership is Not a Soft Skill” discusses the importance of emphasizing leadership in pharmacy education.² She argues that leadership development is a lifelong process – the time and dedication required to master self-efficacy, self-assessment, reflection, entrepreneurship, and advocacy does not happen overnight.  The importance of leadership, rooted in the social and administrative sciences, has diminished in recent years and was placed on the “back burner” relative to the other two core areas of pharmacy education – clinical and pharmaceutical sciences.  Boyle argues that there needs to be more emphasis on the affective domain as we design and develop pharmacy curricula and courses.³

The Center for the Advancement of Pharmacy Education (CAPE) released its revised educational outcomes in 2013.  The new CAPE outcomes document addresses feedback that called for the “inclusion of an affective domain that would address personal and professional skills, attitudes, and attributes required for the delivery of patient-centered care.”⁵ The educational outcomes are centered around four domains, including 1) foundational knowledge, 2) essentials for pharmacy practice and patient-centered care, 3) effective approaches to pharmacy practice and care, and 4) the ability to develop personally and professionally. The document cites self-awareness, leadership, innovation, entrepreneurship, and professionalism as key outcomes in this fourth domain.⁵ These outcomes have been included in the 2016 American Council for Pharmacy Education (ACPE) Draft Accreditation Standards, and if accepted, it will be a requirement for all pharmacy schools and pharmacy educators to ensure that graduates of Doctor of Pharmacy curricula have achieved them.⁶ At the American Society of Health-System Pharmacists (ASHP) Midyear Clinical Meeting 2013, the proposed revised PGY1 Pharmacy Residency Accreditation Standards were discussed at a town hall session.  In the draft standards, a new competency domain was articulated: Professionalism, Leadership, and Practice Management.⁷ As a participant in the town meeting, I noted that many speakers advocated for increased emphasis on these competencies.  It makes sense that all three major bodies in pharmacy education have proposed changes. 

With revised standards on the horizon with a renewed emphasis on “soft skills”, educators should be aware of the impact that this may have on instructional design and curriculum development.  Boyle notes that with the addition of these new expectations, we will be exposing a “hidden curriculum” – skills for which students have not been held directly accountable will now become major components of the formal curriculum. Students will need to develop their knowledge and skill through need guided learning opportunities and teachers will need to develop learning materials.  This poses significant challenges — how does one teach soft skills like leadership, professionalism, and advocacy? Perhaps it is not the act of teaching such skills that is the challenge, but a lack of effective evaluation and assessment tools that pose a problem.  Sorenson et al. piloted an elective course at the University of Minnesota that taught leadership skills to students.⁸ They utilized an end-of-course evaluation and focus groups to evaluate instructional design and student reactions to the learning experiences.  This may be the key to “evaluating” pharmacy leadership.  While it is difficult to objectively assess another person’s leadership skills, encouraging students to self-assess and reflect on the core components of leadership may well prove to be a key element of leadership education.  

With the evolution of new standards and a focus on the affective domain, graduates will (hopefully) possess not only the knowledge and clinical skills needed to care for patients but also the soft skills to lead and advocate for change. 

References

1. Schulz B. The importance of soft skills: education beyond academic knowledge. NAWA Journal of Language and Communication 2008;146-154. 
2. Boyle CR, Robinson ET.  Leadership is Not a Soft Skill. Am J Pharm Educ. 2013;77(10):Article 209. 
3. Clark DR. Bloom’s Taxonomy of Learning Domains. Accessed February 17, 2014.
4. Bradley-Baker LR, Murphy NL. Leadership Development of Student Pharmacists. Am J Pharm Educ. 2013;77(10):Article 219
5. Medina MS, Plaza CM, Stowe CD, et al. Center for the Advancement of Pharmacy Education (CAPE) Educational Outcomes 2013. Am J Pharm Educ. 2013;77(8):Article 162. 
6. Accreditation Standards and Key Elements for the Professional Program in Pharmacy Leading to the Doctor of Pharmacy Degree [draft]. American Council for Pharmacy Education. 2016; in progress. 
7. Annotated PGY1 Pharmacy Residency Accreditation Standards Revision Drafts, For Comment and Feedback. American Society of Health System Pharmacists. Dec 2013. Accessed May 10, 2014.
8. Sorenson TD, Traynor AP, Janke KK. Instructional Design and Assessment: A Pharmacy Course on Leadership and Leading Change. Am J Pharm Educ. 2009;73(2):Article 23. 

Accreditation – Should All Pharmacy Programs Be Alike?

by Caitlin Frese, Pharm.D., PGY1 Pharmacy Practice Resident, Johns Hopkins Bayview Medical Center

The Accreditation Council for Pharmacy Education (ACPE) is the national agency responsible for accrediting professional pharmacy degree programs since 1932.¹  According to ACPE’s 2013 annual report, there were 109 fully accredited programs, 16 schools in candidate status, and 4 with pre-candidate status.²  Accreditation in healthcare is commonplace – schools/colleges, continuing education providers, and residency training programs are all accredited. Why is accreditation important?  And should all programs be the same?

Accreditation is intended to ensure that high standards are met – not only in terms of the instructional design of the learning program but also its execution. For colleges/schools that offer the Doctor of Pharmacy degree, standards relate to the curriculum, experiential education program, strategic plan, faculty qualifications, and organizational support.  Although accreditation is intended to ensure that every school/college meets and maintains high standards, there is wide variability in skills and competencies obtained by students.  For example, schools of pharmacy located on a academic health sciences campus provide the opportunity for interdisciplinary interactions earlier in their curricula.  Programs located in states with progressive pharmacy practice acts may offer students a greater breadth of practice experiences relative to other programs that are limited by legal constraints.  Differences in curricular design, assessment strategies, experiential education opportunities, and interprofessional interaction often sets one accredited school apart from another.

National pharmaceutical organizations have advocated for revisions in the ACPE accreditation standards to ensure that future graduates are ready for practice and can meet employer expectations.  At a 2012 conference, stakeholders provided recommendations including:

• Greater emphasis on developing skills for literature evaluation and data interpretation.
• Identifying and cultivating behavioral attributes needed by pharmacists in practice including interprofessional collaboration, clinical reasoning, and motivation.
• Ensuring assessment data is utilized for program improvement.
• Using standard assessment questions at the conclusion of advanced practice experiences such as “Would you hire this student?” and “Are the student’s skills at a level ready to enter practice?”³

Many of the recommendations focus on ensuring the pharmacy program adequately trains student pharmacists to enter the workforce as healthcare providers capable of providing direct-patient care.

Reviewing future employer expectations highlights gaps in the current ACPE standards.  Some expectations relate to managerial and business aspects of pharmacy (e.g. delegating tasks, measure/report performance, pharmaceutical supply chains); others place emphasis on health care delivery systems.⁴  Some employers expressed expectations that students should be competent in everyday activities such as documenting in electronic records, respecting patient confidentiality, managing drug waste, and administering common dosage forms.⁴   

After reflecting on my education and listening to the experiences of other recent graduates from different schools of pharmacy, many (but not all) of these expectations are already included in the curriculum.  However, the depth to which they are taught (if they are taught at all) varies greatly.  This likely explains the variability in competencies seen among graduating students today.

ACPE has released a draft version of the 2016 accreditation standards for comment.  These draft standards incorporate many of the recommendations from the stakeholders conference.⁵ These new standards would force schools/colleges of pharmacy to critically review their current curriculum and find opportunities for enhancement. Terminology within the proposed standards better delineates which items are necessary (i.e. “must” statements listed in the standard document) versus items recommended to enhance the quality of the program (i.e. “should” and “could” statements listed in the guidance document).⁵ Twenty-six standards are organized into three major themes: Educational Outcomes, Structure and Process to Promote Achievement of Education Outcomes, and Assessment.⁵ This change in organization of the standards document mirrors the change pharmacy. As health care delivery changes, the pharmacist’s role has shifted from the traditional dispensing/drug distribution functions to a focus on patient care functions, health outcomes, and cost-effective use of drugs.  This shift is evident within the proposed draft of Educational Outcomes as there is greater emphasis on patient care functions and practicing in interprofessional healthcare teams.⁵

One key change between the current and proposed standards is the separation of standards and guidance statements.^5,6 This separation is where pharmacy schools/colleges can customize their program and truly shine.  ACPE acknowledges that pharmacy programs differ and the guidance document is intended to elevate a program from meeting the bare minimum to producing outstanding graduates with unique skills that are highly sought by employers.

For faculty (or those seeking faculty positions), knowledge of the proposed standards and guidance documents should inform course development. The new standards allow for flexibility in terms of innovative course design and delivery methods.⁶  This could include adopting the “flipped classroom” method when redesigning a course or creating a new interdisciplinary elective.  The guidance document includes examples of co-curricular experiences that can be built into courses including student participation in activities such as Legislative Day, brown bag and medication review events, and serving as an institutional ambassador.⁶  It is unlikely that a school/college of pharmacy will be able to successfully implement and master all recommendations included in the guidance document.  Being selective about what can be optimally incorporated into the pharmacy program will maximize student learning and help set the school/college apart.

Ultimately the guidance document encourages schools to strive for excellence.  Accreditation ensures that students gain foundational knowledge and attain a reasonably similar level of competency to perform core professional functions regardless of what school/college they attend.  However, not all schools / colleges are alike.  Utilizing the guidance recommendations and capitalizing on local or state resources will help good programs become great programs.

References

1. Accreditation Council for Pharmacy Education. Accreditation standards and guidelines for the professional program in pharmacy leading to the doctor of pharmacy degree (Guidelines Version 2.0, Adopted: January 23, 2011, Effective: February 14, 2011). Accessed March 14, 2014.
2. Vlasses PH, Wadelin JW, Boyer JG, et al. Annual Report of the Accreditation Council for Pharmacy Education. Am J Pharm Educ 2013; 77(4):Article 83.
3. Zellmer WA, Beardsley RS, Vlasses PH. Recommendations for the Next Generation of Accreditation Standards for Doctor of Pharmacy Education. Am J Pharm Educ 2013; 77(3):Article 45.
4. Vlasses PH, Patel N, Rouse MJ, et al. Employer Expectations of New Pharmacy Graduates: Implications for the Pharmacy Degree Accreditation Standards. Am J Pharm Educ 2013; 77(3):Article 47.
5. Accreditation Council for Pharmacy Education. Accreditation standards and key elements for the professional program in pharmacy leading to the doctor of pharmacy degree (Draft Standards 2016, Released: February 3, 2014).  Accessed March 14, 2014
6. Accreditation Council for Pharmacy Education. Guidance for the accreditation standards and key elements for the professional program in pharmacy leading to the doctor of pharmacy degree (Draft guidance for standards 2016, Released: February 3, 2014).  Accessed March 14, 2014.