October 20, 2011

Professionalism: An Important Lesson

by Brandon Shank, Pharm.D., PGY-1 Pharmacy Practice Resident, The Johns Hopkins Hospital

When I entered pharmacy school, the concept of professionalism was presented early in my program.  I distinctly remember reciting the Oath of a Pharmacist at my white coat ceremony.  However, at that time, I did not fully understand the importance of professionalism or the skills needed to behave as a professional. The American Pharmaceutical Association Academy of Students of Pharmacy (APhA-ASP) and the American Association of Colleges of Pharmacy Council of Deans (AACP-COD) Task Force on Professionalism defined professionalism as the demonstration of the traits of a professional.1 The American Board of Internal Medicine describe professionalism as the commitment to the highest standards of excellence in the practice of medicine and in the generation and dissemination of knowledge, sustain the interests and welfare of patients, and the responsiveness to the health needs of society.2

The Ten Traits of a Professional according to APhA-ASP and AACP-COD are:1
1.     Knowledge and skills of the profession
2.     Commitment to self-improvement of skills and knowledge
3.     Service orientation
4.     Pride in the profession
5.     Covenantal relationship with client
6.     Creativity and innovation
7.     Conscience and trustworthiness
8.     Accountability for his or her work
9.     Ethically sound decision making
10.  Leadership
When teaching professionalism, it is essential that educators lead by example. Faculty should act in a manner that exemplifies professionalism and creates an environment in which students can effectively learn. A systematic approach to teaching professionalism should be implemented.  Having students set goals and objectives as well as tracking and assessing progress are important steps to fostering a student’s development as a professional. Expectations should be established early on in the pharmacy program. Opportunities for students to learn and practice professionalism should be made available. Such opportunities may include professional organizations, Introductory Pharmacy Practice Experiences (IPPEs), Advanced Pharmacy Practice Experiences (APPEs), community service, and work experience.

Assessing a student’s professionalism can be challenging.  Dr. Chisholm and colleagues developed a pharmacy professionalism self-assessment instrument.3  Their 18-item instrument assesses six tenets: excellence, respect for others, altruism, duty, accountability, and honor/integrity. The authors compared the professionalism of first year pharmacy students with recent graduates. There were no differences between the two groups.  Another study found that professionalism measured by this instrument was greatest during the first and fourth professional years of pharmacy school.4  Therefore, widely implementing this tool may have limited utility for the purpose of monitoring an individual student’s growth. Preceptor or faculty evaluation offers another avenue for evaluating professionalism in didactic and experimental components of a pharmacy curriculum. However, the opinion of faculty and preceptors can be subjective.  Thus further research is needed to develop objective evaluation methods. At the present time, preceptor and faculty facilitated discussions and formative feedback is the most appropriate way to teach and assess professionalism until validated tools are created.

Professionalism remains a core element of a pharmacy student’s education. More research is needed regarding the effectiveness of various methods to develop student’s professionalism skills. Patient interaction throughout the curriculum, in the form of IPPEs and APPEs, will aid in fostering professionalism traits beyond what can be learned in the classroom. Schools of pharmacy should strategically integrate, assess, and track students’ professionalism.

2.     American Board of Internal Medicine, Committees on Evaluation of Clinical Competence and Clinical Competence and Communication Programs. Project Professionalism [Internet]. Philadelphia, (PA): American Board of Internal Medicine; 1995 [updated 2001; cited 2011 Oct 2]
3.     Chisholm MA, Cobb H, Duke L, McDuffie C, Kennedy WK.  Development of an Instrument to Measure Professionalism. Am J Pharm Educ. 2006;70(4):1-6.
4.     Duke LJ, Kennedy WK, McDuffie C, Miller M, Sheffield M, Chisholm M. Student attitudes, values, and beliefs regarding professionalism. Am J Pharm Educ. 2005;69:1-11.

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