Professional Identity Formation (PIF) in Health Professions Education: Doing is Different from Being

by Lauren C. McConnell, PharmD, PGY1 Pharmacy Practice Resident, Baptist North Mississippi Hospital

Professional identity formation, or PIF, is the process through which a person becomes a professional — typically from student to practicing professional. The progression of PIF is uniquely individualized and superimposed on each student’s personal identity, values, morals, and beliefs.¹ The goal of forming a professional identity is to develop a resilient sense of belonging within a health profession.² PIF goes beyond students acquiring knowledge (‘thinking’) and demonstrating professionalism (‘acting’) to support one’s perception of self (‘feeling’).

Professionalism, as defined by The White Paper on Pharmacy Student Professionalism, is “the active demonstration of the traits of a professional”.³ Health professions students are intrinsically and extrinsically motivated to join a professional community and are willing to uphold certain professional expectations, such as wearing a white coat, communicating respectfully, and being accountable.^4,5 However, acting like a professional and being a professional are two different phenomena.

Interrelationship Between Professional Identity and Professionalism

Professionalism and professional identity are distinct yet related concepts, which makes the fluid relationship between the two challenging to describe (see Figure 1). Professionalism is an outward display of the conduct of a professional, while a professional identity is the internal perception of one’s role as a professional.⁶ Professional traits and behaviors are crucial for PIF, as ‘acting’ like a professional encourages assimilation to that role.⁷ Similarly, self-awareness of a professional identity is essential for developing a professional demeanor. Several stepwise models exist that have attempted to describe this relationship. Acts of professionalism are observable signs which indicate the concurrent development of professional identity.⁶ Therefore, my professors at Auburn University and I recently proposed a model to illustrate the infinite and undirected interplay between PIF and professionalism, the Möbius Strip.⁷

Figure 1: Professionalism-Professional Identity Möbius Strip

According to Moseley et al., “as the internalization process of PIF occurs, outward professional behaviors are displayed, and as one chooses to behave as a professional, their sense of identity blossoms”.⁷ This model aligns with the proposal that the end goal of health professions education should not just focus on ‘doing’ but also on ‘being’.⁸ As with all educational goals, methods for teaching and evaluating progress are essential. The conundrum is how this fluid process can be measured and supported.

PIF-Friendly Pedagogy

Obtaining a professional identity is the desired outcome in health professions education, as it is the backbone of all decisions students will make as professionals.⁸ However, many students (and admittedly, myself included) fail to recognize themselves as professionals early in their health education journey. For this reason, PIF has long been an elusive target amongst health professions educators. Furthermore, PIF is a non-linear process, and each student progresses toward their professional identity at a different pace, which makes it challenging to foster and evaluate progress.⁹ For this reason, health professions educators should incorporate PIF-friendly teaching strategies into curricula.

PIF pedagogy is the practice of teaching, facilitating, and coaching students through their PIF journey — teaching methods that support the development of an identity that aligns with the values of their profession. Educators are a fundamental component of the student’s journey. The formation of a professional identity is influenced by external factors, such as curricula, learning environments, expectations, mentorship, and feedback.⁵ I distinctly remember key preceptors who created positive learning environments and served as role models that positively impacted how I perceived myself as a future pharmacist. Therefore, it is important for educators to foster relationships and create experiences that are meaningful to students, as PIF is facilitated, not taught.

Self-assessment and self-reflection are two PIF-friendly strategies that educators can use in curricula to help students become more aware of their professional strengths and weakness.¹⁰ The ability of the student to be self-aware of their presence and growth within a professional community increases PIF and creates a sense of belongingness.⁹ Other meaningful relationships outside the formal education environment (e.g., with preceptors, other health professionals, and patients) play a similar and equally important role. To me, there is no replacing the feeling you get the first time a patient mistakenly refers to you as a pharmacist or when a physician shows appreciation by stating ‘good catch.’ Through these interactions, students gain recognition for their place on the healthcare team. Situated learning theory suggests that “learning should take place in a setting the same as where the knowledge will be used”.¹¹ Therefore, it is no surprise that students report early introduction to their profession, direct interaction with patients, and frequent collaboration with other health professionals as key drivers of identity construction.¹²

Because educators are facilitators of PIF, structured evaluations (e.g., exams or performance-based assessments) are not helpful measures of student progression, particularly given that PIF does not occur at a single point in time. Experts recommend that assessments of PIF should occur longitudinally to ensure that the student’s professional identity is progressively developing over time.¹³ Unfortunately, there are no standardized methods for measuring PIF, and assessments rely on student understanding of who they are within a profession. I remember creating short- and long-term career goals as a first-year student pharmacist, thinking I knew exactly who I was and what pharmacy career path I wanted to pursue. But with each semester, I revisited these goals and was honestly embarrassed by what I thought I knew about who I wanted to be. 

In one study, investigators designed a Professional Self Identity Questionnaire (PSIQ) that attempts to measure the degree to which health professions students identify as a member of their profession.¹⁴ Building on this notion, faculty at Auburn University Harrison College of Pharmacy recently created a PIF instrument to encourage students to reflect on their professional identity. This instrument asks students to self-assess fourteen qualities/behaviors, such as confidence, knowledge, personality, professionalism, and communication.¹⁰ These PIF-friendly exercises, using a combination of self-assessment and self-reflection, attempt to measure what educators cannot see: how students see themselves in relation to their profession.

There are several other activities and instructional strategies that can be used to promote PIF, such as feedback, experiential education, co-curricular activities (e.g., health fairs), mentoring/role modeling, student well-being groups, and white coat ceremonies.^7,15 Of course, most professional curricula already incorporate many of these pedagogical methods, but require active effort by educators to intentionally foster PIF. Reflecting on my time as a student, I now know why I have always appreciated professors who were passionate about what they taught, preceptors who encouraged autonomous work, and mentors who led by example – they intentionally helped create my professional identity. Educators should continue to purposefully use and prioritize PIF-friendly pedagogical methods, particularly early in curricula, to support the process of professional identity formation amongst their students.

References

1. Cruess RL, Cruess SR, Steinert Y. Amending Miller's pyramid to include professional identity formation.Acad Med. 2016;91(2):180-5.
2. Kellar J and Austin Z. The only way round is through: Professional identity in pharmacy education and practice. Can Pharm J (Ott). 2022 Aug 13;155(5):238-240.
3. Roth MT and Zlatic TD. American College of Clinical Pharmacy. Development of student professionalism. Pharmacotherapy. 2009 Jun;29(6):749-756.
4. Holden M, Buck E, Clark M, Szauter K, Trumble J. Professional identity formation in medical education: The convergence of multiple domains. HEC Forum. 2012 Dec;24(4):245-255.
5. Findyartini A, Greviana N, Felaza E, et al. Professional identity formation of medical students: A mixed-methods study in a hierarchical and collectivist culture. BMC Med Educ. 2022 Jun 8;22(1):443.
6. Forouzadeh M, Kiani M, Bazmi S. Professionalism and its role in the formation of medical professional identity. Med J Islam Repub Iran. 2018;32(1):765-8.
7. Moseley LE, McConnell L, Garza KB, Ford CR. Exploring the evolution of professional identity formation in health professions education. New Dir Teach Learn. 2021 Dec 6;168:11-27.
8. Snell R, Fyfe S, Fyfe G, Blackwood D, Itsiopoulos C. Development of professional identity and professional socialisation in allied health students: A scoping review. Focus on Health Prof Educ. 2020 Apr 30;21(1):29-56.
9. Cruess SR, Cruess RL, Steinert Y. Supporting the development of a professional identity: General principles. Med Teach. 2019 Jun;41(6):641-9.
10. Ford CR, Astle KN, Kleppinger EL, Sewell J, Hutchison A, Garza KB.Developing a self-assessment instrument to evaluate practice-readiness among student pharmacists. New Dir Teach Learn. 2021 Dec 6;168:133-145.
11. Li LC, Grimshaw JM, Nielsen C, Judd M, Coyte PC, Graham, ID. Use of communities of practice in business and health care sectors: A systematic review. Implement Sci. 2009 May 17;4:27.
12. Wald HS. Professional identity (trans)formation in medical education: Reflection, relationship, resilience.Acad Med. 2015 Jun;90(6):701–6.
13. Garza KB,Moseley LE, Ford CR.Assessment of professional identity formation: Challenges and opportunities.New Dir Teach Learn. 2021 Dec 6;168:147-151.
14. Crossley J and Vivekananda-Schmidt P. The development and evaluation of a Professional Self Identity Questionnaire to measure evolving professional self-identity in health and social care students. Med Teach. 2021 Dec;31(12):e603-7.
15. Chandran L, Iuli RJ, Strano-Paul L, Post SG. Developing "a Way of Being": Deliberate approaches to professional identity formation in medical education.Acad Psychiatry. 2019 Oct;43(5):521–7.

Interprofessional Team Teaching, What’s It All About?

by Taemi Cho, Pharm.D., PGY1 Community Pharmacy Practice Resident, University of Maryland School of Pharmacy

When you were a pharmacy student, did you ever experience interprofessional team teaching? Many will probably answer without hesitation, “Yes of course. On rounds during my acute care rotation.”  But consider these questions: What exactly is an interprofessional team? How does an interprofessional team differ from a multidisciplinary team?

Although the terms multidisciplinary and interprofessional are frequently used interchangeably, multidisciplinary teams differ from interprofessional teams. Multidisciplinary and interprofessional teams differ based on the degree of interaction and sharing of responsibilities.¹ In patient care, multidisciplinary teams are described as being led by the highest ranking team member which is usually the physician.¹  Each member works independently but in parallel.  The medical record serves as the primary tool for information sharing.¹

In contrast, interprofessional healthcare teams include members with different professional training coming together to interdependently develop goals.^1,2 In an interprofessional team, leadership is shared, members engage each other and learn from one another.¹ An interprofessional team approach involves the collaboration of people with diverse perspectives to devise a unified approach.² The aim of the interprofessional team is to provide more comprehensive patient care than what is typically achieved today.

Are there real benefits to adopting interprofessional team teaching in healthcare education?  Unlike instruction received from people from a single professional background, interprofessional teaching introduces multiple (two or more) perspectives in a teaching-learning process that enhances each profession.³  Interprofessional teaching challenges students to integrate alternative views and helps them to understand complex issues that must be considered when providing optimal patient care.²  This approach also educates students about conflict resolution and group dynamics, important skills that must be learned in order to be an effective member of a high-functioning team.⁴

A recent paper described interprofessional education at the Rosalind Franklin University of Medicine and Science, the University of Florida, and the University of Washington.⁵   Each of these interprofessional education programs included didactic instruction, a community-based experience, and an interprofessional-simulation exercise.⁵ The didactic instruction taught principles of collaborative patient centered care and clinical concepts.⁵ The community service component included interprofessional teams working with community partners on a community service project.⁵ And the simulation activity had students from different disciplines working together on a skills assessment. All three interprofessional education programs felt they had achieved their programmatic goals.  Students were reported to comprehend their professional roles and understood the contribution of other professional’s roles on the team.⁵    

One pilot study assessed an interprofessional team reasoning framework

(IPTRF) utilized to teach and learn cases studies among student of different health professions.⁶ The following flowchart is the framework used in the study:

Figure from:  Packard K et.al.  Interprofessional team reasoning framework as a tool for case study analysis with health professions students: A randomized study. 
JRIPE Vol 2.3  August 2012.

Eighteen students from dentistry, medicine, nursing, occupational therapy, pharmacy, and physical therapy were randomized into 3 teams of six members.⁶ The first team received only the case; the second received the case and framework; and the third received the case, framework, and a videotaped example of interprofessional interactions. The primary end point evaluated students’ perceptions and the secondary endpoint evaluated students’ performances.⁶ The results found that students’ perception of team skills improved when they were given the IPTRF tool (second and third teams). Moreover, team three’s students’ performance was significantly better when compared to students on the other two teams.⁶

The success of an interprofessoinal education lies in developing a curriculum that prepares students to collaborate in an interprofessional manner. One cannot expect recently graduated pharmacists to successfully work within an interprofessional team without instruction, both didactic and experiential. Many barriers exist in implementing interdisciplinary team education including a lack of administrative/faculty support, insufficient faculty with interdisciplinary training, limited financial resources, entrenched power dispositions/territorial imperatives, logistics, scheduling, and reimbursement.³

To progress, these barriers need to be addressed. Collaborators from successful schools that have implemented interprofessional education indicated that their success relied on resolving conflicts in the initial stages of developing an interprofessional course.⁷   Collaborators need to understand each other’s pedagogical views and negotiate those differences.⁷ Integral to an interprofessional education are the core competencies identified by the Interprofessional Education Collaborative Expert Panel.⁸

You may be wondering if I have experienced interprofessional team teaching.  I can honestly say, “Yes!”  I took a class as a pharmacy student that had interdisciplinary components. My Geriatric Imperative class had a geriatric dementia team consisting of a physician, nurse, pharmacist, psychologist, and social worker from the Veterans Affairs (VA).  The team members discussed how they met with their patients and shared their perspectives to optimize each patient’s care. Later, as a P4 student, I rotated through the Dementia clinic at the VA.   For 3 months, I worked in this interdisciplinary team where we made assessments based on our various perspectives, integrated the information, and together developed a patient care plan.

References

1.   Cooper BS, Fishman E. The interdisciplinary team in the management of chronic conditions: has its time come? Partnerships for Solutions Better Lives for People with Chronic Conditions [Internet]. New York: Mount Sinai School of Medicine; 2003 June: 2-4.

2.   Goldsmith AH, Hamilton D, Hornsby K, Wells D. Interdisciplinary Approaches to Teaching. Lexington (VA): Washington and Lee University; [updated 2012 May 29; cited 2012 Nov 17].

3.   Page RL, Hume AL, Trujillo JM, & Leader WG. ACCP White Paper Interprofessional Education: Principles and Application. A Framework for Clinical Pharmacy. Pharmacotherapy 2009; 29: 145e-164e.

4.   Allen DD, Penn MA, Nora LM. Interdisciplinary Healthcare Education: Fact or Fiction? Am J Pharm Educ 2006 April 15;70(2): Article 39.

5.   Bridges DR, Davidson RA, Odegard PS, Maki IV, Tomkowiak J. Interprofessional collaboration: three best practice models of interprofessional education. Med Educ Online 2011 April 8;16:6035.

6.   Packard K, Hardeep C, Maio A, Doll J, Furze J, Huggett K, Jensen G, Jorgensen D, Wilken M, Qi Yongyue. Interprofessional Team Reasoning Framework as a Tool for Case Study Analysis with Health Professions Students: A Randomized Study. JRIPE 2012; 23: 251-263.

7.   Shibley I. Interdisciplinary Team Teaching Negotiating Pedagogical Differences. College Teaching. 2006; 54(3): 271-274.

8.   Interprofessional Education Collaborative Report of an Expert Panel. Core Competencies for Interprofessional Collaborative Practice [Internet]. 2011: 1-47.

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.¹  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.

References:

1.  Kenny NP, Mann KV, MacLeod H. Rolemodeling in physicians’ professional formation” reconsidering an essential butuntapped educational strategy. Academic Medicine 2003; 78: 1203-1209.

2.  Asghari F, Fard NN, Atabaki A. Are weproper role models for students? Interns’ perception of faculty and residents’professional behavior. Postgrad Med J. 2011;87:519-523.

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.

An Interprofessional Approach to Teaching

by Raymond F. Lamore III, Pharm.D., PGY1 Pharmacy Resident, the Johns Hopkins Hospital

The strategy of treating patients as a part of a “multidisciplinary team” has become common in many progressive medical centers. Utilizing the various skills of different members of the medical team can lead to significant improvements in patient care. Recently, literature has been published demonstrating the impact that pharmacists can have on patient outcomes as a part of the multidisciplinary team.^1-3  Based on this body of literature, there has been a surge of opportunities for pharmacists to participate in point-of-care treatment as a part of an  inter-professional team.   

As a part of the medical team it is a necessity for the pharmacist to be able to appropriately interact with the other members and understand their point of view. This expansion in our “job description”, begs the question: Are we trained to do this!?  I am not questioning a newly trained pharmacist’s ability to answer pharmacological questions and make clinical decisions, rather asking if we have been properly trained to be an effective member of the medical team. Unless you have had a job within a hospital as an intern, your interaction with various members of the medical team was probably minimal; with most occurring during your final year in school during advanced pharmacy practice experiences (APPEs). Many have concluded that the difficulties encountered in working with multiple professions stem from a lack of knowledge regarding the different roles and a relative absence of teamwork skills.⁴ In 2007, the American Association of Colleges of Pharmacy (AACP) Professional Affairs Committee advocated that “all colleges and schools of pharmacy provide faculty and students meaningful opportunities to engage in education, practice, and research in interprofessional environments to better meet the health needs of society.”⁴

This leads to a second question.  Should students be introduced to the different members of the medical team during classroom-based instruction. Interprofessional education can add many benefits to a college of pharmacy’s curriculum.⁵  The World Health Organization defines interprofessional teaching as “…students from two or more professions learn about, from, and with each other to enable effective collaboration and improve health outcomes.”⁵ An expert panel from the Interprofessional Learning Collaborative suggested the following key objectives for interprofessional teaching:⁶

·       Relationship focused

·       Process oriented

·       Linked to learning activities, educational strategies, and behavioral assessments

·       Able to be integrated across the learning continuum

·       Sensitive to the systems context/applicable across practice settings

·       Applicable across professions

·       Stated in language common and meaningful across the professions

·       Outcome driven

Interprofessional teaching would also add depth to the students’ ability to perform analysis, as different members of the medical team utilize a variety of thought processes in clinical decisions.  These perspectives and processes differ from a pharmacist’s. Educational researchers have found benefits to this teaching modality, as it helps students to recognize bias, think critically, tolerate ambiguity, and acknowledge and appreciate ethical concerns.⁵  Introducing students to different members of the medical team may also increase their confidence when communicating recommendations. This interprofessional model of teaching and learning could seamlessly progress from the classroom into experiences partnered with students from many health professional programs.

In 1995, a nursing and pharmacy school completed an interesting clinical collaborative project, in which students from each school were paired so that they could utilize their “profession specific” skills in patient care situations.⁷ During the project, students met weekly in the hospital to jointly present at case conferences to their peers. The students worked in pairs, one from each discipline, in selecting a patient case, plan a case study, and present the results to the group. This experience required the students to collaborate, utilizing negotiation skills and critical thinking processes. Common issues that were addressed by the nursing students, included: physical signs and symptoms, medication administration, laboratory values, discharge needs, and self care abilities. Whereas, student pharmacists would address pharmacological therapy, allergies, polypharmacy, pharmacokinetics, contraindications, route of administration, and adherence.

After the completion of the project student comments were positive.  They expressed appreciation for a collaborative approach to patient care. This project demonstrated great success as both groups of students expressed an appreciation for the complementary nature of the two health care professions.  This early experience lead to expanded implementation of these experiences in the respective curriculum.⁸ This form of interprofessional education is a great way to collaborate with other members of the team and gain an early appreciation for their roles in patient care. The only foreseeable complication in this approach would be possible scheduling complications between academic institutions and having resources (hospital, staff, etc.) to allow for team meetings and collaboration.     

Taking a interprofessional approach to teaching and learning is a tool to enrich the curriculum of any college of pharmacy. Utilizing this approach to educate pharmacists will open the doors for early interaction and collaboration with the various members of the health care team and broaden learning experiences for students.

References:

1.  Marshall J, Finn C, Theodore A. Impact of a clinical pharmacist-enforced intensive care unit sedation protocol on duration of mechanical ventilation and hospital stay.  Crit Care Med. 2008;36:427-433

2.  Cohen V, Jellinek S, Hatch A, et al. Effect of clinical pharmacists on care in the emergency department: A systematic review. Am J Health-Sys Pharm 2009;66:1353-61.

3.  Gattis W, Hasselblad V, Whellan D, et al. Reduction in heart failure events by the addition of a clinical pharmacist to the heart failure management team. Arch Intern Med. 1999;159:1939-1945

4.  Page R, Hume A, Trujillo J, et al. Interprofessional Education: Principles and Application. A Frame Work for Clinical Pharmacy. Pharmacotherapy 2009;29(3):145e–164e.

5.  Romanelli F, Bird E, Ryan M. Learning Styles: A review of theory, application, and best practices. Am J Pharm Educ 2009;73:1-5.

6. Interprofessional Education Collaborative Expert Panel. (2011). Core competencies for interprofessional collaborative practice: Report of an expert panel. Washington, D.C.: Interprofessional Education Collaborative.

7. Science Education Resource Center at Carlton College. Starting Point: Teaching and Learning Economics. Why Teach with an Interdisciplinary Approach? Accessed: November 6, 2011.

8. Robertson K. Interdisciplinary professional education: A collaborative clinical teaching project. Am J Pharm Educ 1995;59:131-136.