November 28, 2012

Role Modeling: The Forgotten Influence

by Ashley Janis, Pharm.D., PGY1 Pharmacy Practice Resident, the Johns Hopkins Hospital

The role of an educator, in the classroom and in practice, is to foster learning and serve as a role model.  Role modeling can be defined as teaching by example and influencing people in an oftentimes unintentional, unaware, informal, and episodic manner.1 Thus, we all serve as role models for learners in our field through our routine actions.  Role modeling has often been referred to as the “hidden curriculum” of professional education as we often lack understanding regarding the influence role modeling has on learners.1 Students learn behaviors that appear successful to them in light of their personal goals and rewards.  This is a foundational principle of social learning theory and how role models exert influence on others.

In a study published in 1997, researchers at the McGill University School of Medicine examined opinions of fourth year medical students using a questionnaire.3  Ninety percent of the responders identified one or more role models during their training.3 Many (35%) indicated that resident physicians were the most influential role models during the clinical portion of their academic training.2 This finding demonstrates that pharmacy residents have a profound effect on student pharmacists.  As pharmacy residents, we have frequent interactions with students.  It may be easy to forget that we have an obligation to be a positive model of pharmacy practice.

Several common factors were consistently ranked high when students selected role models: personality, clinical skills and competence, teaching abilities.2 Interestingly, position, academic rank, research experience, and publications were less important.2 This finding suggests that is it not just the well-established, published, infamous leaders who are revered as models.  Instead, professionals of all age and rank may be influential.

Role models were not only important in helping students develop their knowledge and skill but 57% of students claimed their role model influenced their decision regarding their clinical specialty for residency training.2  Thus, the potential impact of a role model is very significant and can shape and inspire a career. 

While role models often influence learners in positive ways, it is important to discuss the potential for a negative impact.  In a study surveying students at the University of Texas Medical Branch in Galveston, the professional behavior of faculty and residents was examined.4  The authors found that the preceptors scored lowest on the following behaviors:  1) use of constructive criticism instead of backbiting about peers, and 2) consulting others when they lack the required knowledge.4  Prior research noted that students find bad-mouthing others as the most unprofessional behavior of faculty.4 Making negative comments about a specialty may discourage or decrease recruitment into that field.And, it might incite pessimistic attitudes towards a learner’s chosen profession.1  As we are emerging leaders and role models for future generations of pharmacists, we must hold ourselves to higher standards.  Negatively discussing colleagues sets a poor standard for ourselves and may also encourage bad habits.  In order to cultivate positive relationships between disciplines, we must refrain from voicing negative personal opinions in workplace conversations. 

To become positive role models, we must understand how our behavior affects others.  “Silent modeling is inadequate as a strategy.”1 Where do we begin?  Role models must pay attention to their individual acts, encourage teamwork, and support others in their growth and development.5   Ideal role models inspire and teach by example.  The key is to be self-aware and self-critical.6

In order to change our behavior, we need to have the desire to improve and the insight to identify our strengths and weaknesses.6 Being self-critical of our current positive and negative actions in the workplace, allows us to develop personal improvement plans.  Self-reflection has two forms: “reflection-in-action,” thinking about changing the experience while it is underway, and “reflection-on-action,” critically evaluating an experience once it has passed.1 Both are valuable tools to encourage change, and learner evaluations are a key source to identify areas of potential improvement.  Encourage your learners to critically evaluate you as a preceptor.  Skills to evaluate might include your ability to encourage teamwork and solve challenging problems with composure.  This may not be on the standard evaluation form, but it is appropriate to ask learners to evaluate you as a role model and as a source of clinical knowledge.  As you achieve positive marks, add new professional goals for learners to evaluate.  In this way, you have used your self-reflection and created a process to evolve and grow as a model.

Learners must learn to “talk the talk, and walk the walk.”1 In this dynamic teaching method, role models talk through activities, explain their thought process, and allow for learners to discuss their own ideas and methods.1 In this coaching method, students engage in the actions of their model, and receive verbal feedback.  For example, a preceptor on rounds may have a student observe the first day to familiarize with the experience.  After rounds, this preceptor can break down their thought process for recommendations by working through a patient with their learner.  In the following days, students learn how to model the appropriate behavior by presenting recommendations to both their preceptor and team, receiving feedback and constructive comments all the while.  We must set expectations.  If we fail to set appropriate guidelines for behavior, we have no basis for constructive criticism and students may feel lost without guidance.

Think back to the people who had a positive influence on your development and career choices.  Let their strengths serve as guide in your career.  When we become the person to be emulated, we have a profound effect on others.

3.  Wright S, Wong A, Newill C. The impact ofrole models on medical students. J Gen Intern Med. 1997; 12: 53-56.
4.  Szauter K, Williams B, Ainsworth MA, et al. Student perceptions of the professional behavior of faculty physicians. MedEduc Online. 2003; 8: 17.
5.  Macaulay S. Are you a good role model? Think:Cranfield. Feb 2010. Accessed 24 Nov 2012. 
6.  Ray S. Role Models. BMJ Careers. 13 Mar 2010. Accessed 24 Nov 2012.

No comments: