An Escape Room Activity for Preceptor Development

by Elizabeth Akers, Doctor of Pharmacy Candidate, University of Mississippi School of Pharmacy

Summary and Analysis of: Richter LM, Frenzel JE. Design and Assessment of a Preceptor Development Escape Room. Am J Pharm Educ. Published online July 28, 2020: ajpe8073. doi:10.5688/ajpe8073

Learning is often informative but boring.  Or it can be entertaining.  But I think the best learning is both informative and fun! When learning is fun, it helps grab my attention and engages me in the topic.  That’s why a recent article published in the American Journal of Pharmaceutical Education got my attention. The investigators created an escape room activity for preceptor development. Escape rooms are a form of amusement where a group of participants works together to actively solve puzzles in order to “escape” confinement from a room. Applying escape room principles to health professions education allows learners to participate in life-like scenarios but in a low-stakes environment. They offer an opportunity to learn and change perspectives based on experience in a practice scenario. While this instructional strategy was initially used to provide instruction to student pharmacists, this study looked at changes in preceptor knowledge following participation in an escape room game.

When structuring this game, the investigator wanted to create an interactive, fast-paced, hands-on preceptor development program.¹ The intent of this hands-on experience was for participants to use the school’s preceptor handbook, locate and understand the School of Pharmacy’s mission and vision statement, use the pharmacist's patient care process (PPCP), and problem-solve a patient case. The escape room activity was offered on two separate occasions, one to preceptors at a district meeting of the North Dakota (ND) Pharmacists Association and at the ND annual pharmacy convention. Facilitators created a virtual escape room which consisted of five rooms, each with a puzzle.  The participants were given a total of 45 minutes to escape. To move from one puzzle to the next, the participants had to submit their answers using a Google Form. The Google Form would “unlock” the next puzzle when the correct answer was submitted and this directed them to move on to the next station in the room. Teams also received a PPCP passport to document their progression through the PPCP wheel. If a puzzle was solved incorrectly or the team ran into a roadblock, teams could write a preceptor pearl in exchange for a hint. Teams were instructed to be efficient.  The team that solved all of the puzzles in the shortest amount of time was considered the “winner.” After all of the teams had completed the game, the faculty facilitators debriefed to enforce the core concepts that were encountered during the experience.

To document the impact of the escape room method, the investigators asked participants to complete an electronic survey via Qualtrics immediately before and after the experience.  They collected demographic information about the preceptor’s practice experiences and administered a knowledge-based multiple-choice test about the PPCP and the school’s mission, and asked questions about the preceptor’s perceptions of the game. They analyzed the perception and knowledge questions using a paired t-test to determine if participation in the escape room lead to statistically significant improvements when compared to the baseline responses.

Preceptors (n=15) who participated in the escape room experience had statistically significant increases in their perceived abilities to locate and access the preceptor handbook and to describe and use the PPCP. Before the experience, only nine preceptors could correctly order the 5 steps of the PPCP.  Following the escape room activity, 13 preceptors were able to do so. On the other hand, preceptors were less likely to correctly answer the type of approach the PPCP uses. Of the preceptors participating, ten had previously participated in an escape room and all 15 participants stated they would recommend the experience to another preceptor. Preceptors indicated they were open to the gaming format and their preference for using various resources remained unchanged.¹

The methods used to perform and evaluate this study were appropriate. A strength of the study was the diverse group of preceptors (from different practice environments) and it was offered on two different occasions in different locations. The weaknesses of this study included a very small sample size and previous exposure to escape rooms. Some participants felt less inclined to contribute compared to others. This could be due to the size of the team or their attitudes towards other team members. The time constraint and pace of the game could have caused participants to miss information needed to answer the post-game questions. The post-survey was also completed with a limited amount of time; therefore, they could have rushed through and not provided errant responses. Participants who had no experience with escape rooms would likely be less efficient at solving the puzzles and this may have reduced their motivation to participate in gameplay. Based on previous work, the investigators also discovered many preceptors prefer online preceptor development programs over face-to-face programs.² This led researchers to believe an online escape room may be more appealing and draw in a larger number of participants.

Previous studies have examined the impact of escape rooms on educating student pharmacists.^3-5  The previous studies showed mixed effects on learning but participants generally had positive perceptions of the escape room format.^3-5 In one study, students performed poorly on the post-assessment test but reported a positive perception of the game.⁴ Another study found that while the escape room was an effective method for reinforcing course content, knowledge retention was poor.⁶ Similarly, the participants stated they had positive experiences and believed they would use institution-specific tools more often.

This study demonstrates that an escape room is an interesting and fun way to learn. An escape room might not be the most efficient way to learn and didactic instruction might still be needed.  Moreover, learners might miss some of the key concepts if the activity isn’t reinforced by debriefing afterward with the facilitator. Using game-like scenarios in an escape room provides an opportunity for learners to practice teamwork which is an important skill in health care today. 

References

1. Richter LM, Frenzel JE. Design and Assessment of a Preceptor Development Escape Room. Am J Pharm Educ. Published online July 28, 2020: ajpe8073. doi:10.5688/ajpe8073
2. Davison M, Medina MS, Ray NE. Preceptor preferences for participating in electronic preceptor development. Pharm Pract 2009;7(1):47-53.
3. Eukel HN, Frenzel JE, Cernusca D. Educational gaming for pharmacy students – design and evaluation of a diabetes- themed escape room. Am J Pharm Educ. 2017;81(7):6265.
4. Clauson A, Hahn L, Frame T, et al. An innovative escape room activity to assess student readiness for advanced pharmacy practice experiences (APPEs). Curr Pharm Teach Learn. 2019;11(7):723-728.
5. Kavanaugh R, George S, Lamberton N, Frenzel JE, Cernusca D, Eukel HN. Transferability of a diabetes escape room into an accelerated pharmacy program. Curr Pharm Teach Learn. 2020;12(6):709-715.
6. Nybo SE, Klepser SA, Klepser M. Design of a disaster preparedness escape room for first and second-year pharmacy students. Curr Pharm Teach Learn. 2020;12(6):716-723.

The Positive Effects of Promoting Mental Illness Stigma Awareness

by Amber Forsman, Doctor of Pharmacy Candidate, University of Mississippi School of Pharmacy

Summary and Analysis of: Bamgbade BA, Ford KH, Barner JC. Impact of a Mental Illness Stigma Awareness Intervention on Pharmacy Student Attitudes and Knowledge. Am J Pharm Educ. 2016; 80(5): Article 80.

Mental illness has been part of recorded history dating back to 400 B.C. in Ancient Greece and described by the physician Hippocrates.¹  The societal stigma that frames the diagnosis of mental illness has varied over time and culture. Pharmacy students, just like other members of society, have been exposed to and influenced by such stigmas. But unlike other members of society, pharmacy students (indeed, all health professions in general) have a special obligation to provide patient-centered care to all individuals, including those with mental illness. Thus, programs that are intended to address misconceptions about and stigma related to mental illness are a critical component of health professions education.  The Impact of a Mental Illness Stigma Awareness Intervention on Pharmacy Student Attitudes and Knowledge is a study conducted at the University of Texas at Austin that provides evidence that a course on mental illness stigma awareness can make a difference by reducing mental health stigma and increasing mental health knowledge.²

In this pre-post study, a stigma awareness program was provided to Doctor of Pharmacy students on select mental illnesses — specifically depression and schizophrenia —over two class periods (2.5 hours total). Participants (n=120) were third-year student pharmacists who had previously completed the mental health pharmacotherapy module in the school’s curriculum.² The mental illness stigma awareness program was provided as part of a required pharmacoeconomics course, but the activity did not count toward the students’ grades in the course.² The stigma awareness program included videos on schizophrenia stereotypes, patient and provider testimony on the impact of stigma in healthcare practices, patient testimony on experiencing depression and schizophrenia, and a documentary of a patient refusing to be treated for schizophrenia.² After students watch each video, the instructors facilitated reflective discussions.² In addition, there were active learning exercises such as schizophrenic hallucination simulations and “Fact or Fiction” exercises. The videos, discussions, and active learning exercises were designed to target specific domains of mental health stigma (MHS): safety, social distance, separation, comfort, disclosure, and recovery. Participants completed anonymous surveys immediately before and after the program using identical instruments.² The pre and post-surveys included questions related to MHS subdomains: recovery, safety, disclosure, separation, and comfort.² Responses to most survey questions were based on a 5-point Likert scale [strongly disagree (1) to strongly agree (5)].² However, the MHS separation subdomain was measured using an 8-item Social Distance Scale and two additional questions derived from the primary literature.^2,3-5 The pre and post-survey also included ten true/false questions to determine the students’ mental health knowledge (MHK).² The MHS data were analyzed using paired t-tests to compare mean scores before and after the program.² The MHK true/false question data (based on answer correctness) was analyzed using McNemar’s tests to compare the accuracy of student’s answers before and after the program.² 

The pre-program survey revealed significant knowledge deficits among students who had already taken a pharmacotherapy module regarding the treatment of various mental illnesses (pre-test MHK mean score = 5.9/10).  Moreover, the MHS subdomain mean scores range of 1.8 to 3.4 suggested that many students have some level of stigma toward individuals with mental illness.²  After completing the program, post-program survey results found the MHK improved significantly and there was diminished stigma towards mental illness.²  See a summary of the study results in Table 1.

Table 1:  Summary of Study Results²

MHS	Overall stigma toward depression and schizophrenia decreased after the mental illness stigma awareness program
	Significant improvements in the (p<0.01) mental illness stigma occurred in the following subdomains: recovery, safety, separation, and comfort stigma.
	There was a significantly greater decrease in stigma subdomains: recovery and separation for schizophrenia when compared to the changes in the recovery and separate subdomains for depression
MHK	MHK significantly increased after the program, with the mean score improving from 5.9 to 6.8 (<0.01).
	Improvements in student knowledge related to pharmacy counseling, outcomes associated with mental illness, and symptomology of mental illness significantly increased (P<0.05)

One strength of this study was the data collection about the students’ personal (including family members) experience with mental illness. This data was valuable because personal experience could impact a student’s responses to the survey. Conversely, a weakness is the limited diversity of the population.  The intervention was conducted and assessed in only one group of students at a single pharmacy school, with only 88 participants completing both the pre and post-survey. In order to get a more precise picture of the benefits of this intervention, it will be necessary to repeat the program in multiple groups of pharmacy students at several schools across the nation, or even internationally. I believe that the methods used in this study were appropriate, especially because the program included several elements (videos, reflective discussion, and active learning exercises), and the survey instruments included validated questions that measure the intended constructs related to MHS.

Similar studies have been conducted at other pharmacy schools.   Consumer- led Mental Health Educations for Pharmacy Student⁶, A Mental Health Elective to Improve Pharmacy Students’ Perspectives on Mental Illness ⁷, and An Elective Psychiatric Course to Reduce Pharmacy Student’s Social Distance Toward People with Severe Mental Illness⁸ all came to a similar conclusion -  that stigma toward individuals with mental illness can be reduced when student pharmacists interact with patients with mental illness and provided instruction regarding mental health.^2,6-8

The fact that student’s biases and knowledge can be positively impacted through an educational program seems like common sense. However, instruction can take many forms and some strategies may be more effective than others.  What I have found in the components of this study and the comparable studies is that the instructional materials used attempt to humanize mental illness in contrast to the textbook-type (detached and unemotional) way pharmacy students most often learn about diseases. Additionally, this study provides evidence that using diverse and engaging materials such as videos, discussions, and active learning exercises can have a positive impact. Moreover, this study provides some helpful insight into how programs intended to address highly stigmatized disease states could be designed and implemented. I sincerely hope that the positive effects observed in this short intervention will positively impact the way these students communicate with and care for their future patients with mental illness.

References

1. WGBH Educational Foundation. Treatments for Mental Illness [Internet]. PBS. Public Broadcasting Service; [cited 2020Sep29].
2. Bamgbade BA, Ford KH, Barner JC. Impact of a Mental Illness Stigma Awareness Intervention on Pharmacy Student Attitudes and Knowledge. Am J Pharm Educ. 2016; 80(5):Article 80.
3. Corrigan PW, Green A, Lundin R, Kubiak MA, Penn DL. Familiarity With and Social Distance From People Who Have Serious Mental Illness. Psychiatric Services. 2001; 52(7): Pages 953–8. [Pub Med]
4. Penn DL, Guynan K, Daily T, Spaulding WD, Garbin CP, Sullivan M. Dispelling the Stigma of Schizophrenia: What Sort of Information Is Best? Schizophrenia Bulletin. 1994; 20(3): Pages 567–78.
5. Link BG, Cullen FT, Frank J, Wozniak JF. The Social Rejection of Former Mental Patients: Understanding Why Labels Matter. American Journal of Sociology. 1987; 92(6): Pages 1461–500.
6. O'Reilly CL, Bell JS, Chen TF. Consumer-led Mental Health Education for Pharmacy Students. Am J Pharm Educ. 2010; 74(9): Article 167.
7. Gable KN, Muhlstadt KL, Celio MA. A Mental Health Elective to Improve Pharmacy Students' Perspectives on Mental Illness. Am J Pharm Educ. 2011;75(2): Article 34.
8. Di Paula BA, Qian J, Mehdizadegan N, Simoni-Wastila L. An Elective Psychiatric Course to Reduce Pharmacy Students’ Social Distance Toward People With Severe Mental Illness. Am J Pharm Educ 2011;75(4): Article 72.

Engaging Students in a Videoconference Classroom

by Kassidy Voinche, PharmD, PGY-1 Community Pharmacy Resident, University of Mississippi School of Pharmacy

Teaching and learning have looked different over the past six months. Due to the need for social distancing during the COVID-19 pandemic, many schools have turned to virtual classrooms. Using video teleconferencing for live educational seminars is a great solution to keep everyone safe and to keep learning on track. Indeed, there are many technologies available that can help bridge the distance between students and teachers. However, teaching at a distance, either synchronously or asynchronously, presents several challenges for both the instructor and the learner. It can be difficult to engage students in discussions, group work, and in-class assignments when they are home with lots of potential distractions. Although there are inherent obstacles, with some extra tools, creative thinking, and problem-solving, the online classroom can become a place for engaged learning.

According to an article in Teach for America (TFA), creativity, clarity, and self-reflection are key to being a great teacher in the virtual classroom.¹ It’s essential, particularly in an online environment, to establish clear learning goals and objectives. With so much digital communication to keep up with, expectations need to be well-defined to ensure everyone is on the same page. Instructor feedback on assignments should be more thorough. It's helpful to reflect on student engagement, both in and out of class-time, using these questions from the TFA article, 7 Tips for Being a Great Virtual Teacher:

• What trends do I see in student participation? Possible causes?
• What am I learning about my students as participants in my virtual classroom?
• What could I do to make learning more accessible, inclusive, and meaningful?
• How are we, as a class, doing physically, mentally, and emotionally? ¹

Checking in with yourself and the students allows for adaptation. Investigate what works and what does not, listening to and recognizing what the students seem to be responding to well.

Combining offline, asynchronous activities with synchronous videoconferencing can improve participation.²  Create brief recorded videos or other learning activities for students to complete before class. Then, use class-time to summarize this content. Students can divide into breakout rooms for problem-based learning.  Ask students to create a Google doc to keep them accountable. Allow students some autonomy over assignments and encourage them to experiment.  This can lead to richer discussions. ² Asynchronous participation could include allowing students to view other students’ work and asking them to give feedback with guiding questions. This method promotes peer-to-peer accountability. 

Incorporating personality with a little humor and fun goes a long way when capturing student’s attention. The article Don't Turn into a Bot Online: Three Easy Strategies to Let Your Personality Shine in Your Online Course provides several tips on how to add a personal touch to your virtual classroom.³ Let some of your personality shine through! This can be done using humor or relatable stories. Humor can be tricky, but in small doses, effective. Searching online for a popular meme or gif to throw into a PowerPoint presentation can provide a light-hearted visual. ³ An Inside Higher Ed article suggests allowing students to create various fun content in the forms of memes or tweets to summarize the discoveries made in the session. Instructors can then open the next class meeting with some of their favorites to recap.⁴

Teaching to a virtual classroom where no student has their camera on can seem like talking to a wall. However, students with their camera off could be more engaged than you think.⁵ Indeed, engagement may even be enhanced when the teacher allows students to turn off cameras. Students can record their break-out group sessions with cameras off and turn in the recording.⁵ Providing a choice of camera usage enhances student agency. Another option is to build in ‘camera-off’ time during a class session for students to reflect independently. Without the camera’s constant gaze, students are not rushing to the next step to prevent the awkward silence.⁵ This method provides a specified amount of time for students to work and develop an answer, then share when everyone regroups.  It is always a good idea to check in with students to assess their personal needs and preferences, asking them how they can most effectively interact with the class and material.

The impact of widely used virtual classrooms on student progression and success is unknown at this time, but a study done in 2019 found that the impact may be minimal. Based on eight years’ worth of data from Wingate University School of Pharmacy, investigators found that distance learning via synchronous videoconferencing did not impact performance in a basic biological sciences course among professional degree pharmacy students.⁶ These findings are consistent with several similar studies conducted with various student populations. While using video conferencing for a majority of classes may seem daunting, with the right mindset, support, and tools, students can perform as well as when classes are conducted in-person.

There a few tools built into many videoconferencing applications to improve student engagement, like polls and whiteboards.  But you can combine these tools with countless other online tools. Kahoot, Flipgrid, and Poll Everywhere are a few examples of other applications that can be used to increase student participation. When choosing a platform or method, always consider accessibility. Reach out to students to determine which technologies they’ve had previous experience using and are most accessible. Inviting students to provide input about technologies that will be used in a course can build a connection between teacher and learner. Periodic reflection, by teachers and students, can improve the virtual classroom and generate new ideas on ways to engage. With some thought and resourcefulness, teaching can work just as well and, in some cases, even better in the virtual environment.

In summary, here are six tips for enhancing student engagement through distance learning:

1. Communicate clear, detailed learning objectives and expectations.
2. Combine asynchronous and synchronous learning methods.
3. Allow students to create fun content to summarize what they learned.
4. Survey students about how they best engage with the content and their preferences.
5. Reflect on which strategies are working and how to continue improving.
6. Use tools such as polling and collaboration platforms.

 

References:

1. The TFA Editorial Team. 7 Tips for Being a Great Virtual Teacher. Teach For America [Internet]. 2020 Mar 24.
2. Minero E. 8 Strategies to Improve Participation in Your Virtual Classroom. Edutopia [Internet]. 2020 Aug 21.
3. Evans J. Don't Turn into a Bot Online: Three Easy Strategies to Let Your Personality Shine in Your Online Course. Faculty Focus [Internet]. 2020 Sep 08.
4. Crook A, Crook T. 6 Tips for Teaching Online and In Person Simultaneously. Inside Higher Ed [Internet]. 2020 August 26.
5. Seltzer K. Engaging Students in Virtual Instruction With the Camera Off. Edutopia [Internet]. 2020 Sep 14.
6. Dirks-Naylor AJ, Baucom E. Impact of distance learning via synchronous videoconferencing on pharmacy student performance in a biological science course sequence: an 8-yr analysis. Adv Physiol Educ. 2019;43(4):534-536.

Practice Reinforces Knowledge and Builds Confidence

by Shannon Buehler, Doctor of Pharmacy student, University of Mississippi School of Pharmacy

Summary and Analysis of: Manigault KR, Augustine JM, and Thurston MM. Impact of Student Pharmacists Teaching a Diabetes Self-Management Education and Support Class. Am J Pharm Educ 2020; 84 (3): Article 7621.

This article caught my attention because it involved student pharmacists implementing a diabetes self-management class for patients.¹ As a student pharmacist, diabetes is an interest of mine – something I think that will be important in my future career. This study attempted to demonstrate that students learn best by practicing in a real-life, authentic setting. The authors of this study compared two groups, one group received traditional instruction and experiences working with people with diabetes, the control group, and the other group, the intervention group, had an opportunity to apply what they learned by teaching a diabetes management class to patients. A study like this is needed to help determine what ways are most effective in teaching health professional students.

This study took place at Wellstar Atlanta Medical Center outpatient clinic. The investigators precept Doctor of Pharmacy students from the Mercer University College of Pharmacy during their fourth-year ambulatory care advanced pharmacy practice experience (APPE). This investigation took place from June 2016 to April 2018 and there were one to two student pharmacists participating in the experience each month. The control and intervention alternated each month so that there was an equal distribution of participants in the two groups. During the first week of the APPE, both groups completed two assessments: one on knowledge of diabetes and the other about their perceived aptitude and confidence. Both groups engaged in traditional patient care activities throughout the five-week APPE. The intervention group conducted a single diabetes self-management education and support (DSMES) class during their fourth or fifth week. Students in the control group did not.  During this investigation period, a total of 15 DSMES classes were taught. The DSMES classes typically had three to five patients participate.  The patients had been previously seen in the clinic by the student. These classes were in-person and lasted approximately two hours.  The students used the US Diabetes Conversations Map Kit provided by the American Diabetes Association (ADA) to help guide the class.² Immediately after conducting the class, the intervention group completed two post-intervention assessments – the same assessments that were administered during the first week of the APPE. Similarly, the control group received the post-intervention assessments in the 4^th or 5^th week.

The results showed that the intervention group substantially increased their level of knowledge and confidence. The intervention group students had a significant improvement in their knowledge (increased from 68.4% at baseline to 81.8%) while the control group did not (increased from 70.0% to 74.1%). Both groups showed significant improvement in aptitude and confidence from baseline. However, the change in mean aptitude/confidence scores was greater in the intervention group (11.9 point increase) when compared to the control group (6.7 point increase, p=.0026).

Measuring knowledge and confidence are two important constructs to assess. Both contribute to what makes a good healthcare provider, thus making this study relevant to APPE preceptors for student pharmacists. It is important to note that students in the intervention group put forth more time and effort and this likely explains why their knowledge gains were greater. Although the post-assessment confidence levels improved in both groups, a confidence boost might come from simply getting real-world experience when completing an APPE rotation. Both groups provided one-on-one counseling about diabetes to patients. This might explain the increased confidence in both groups. The intervention group had greater improvement in confidence which can be explained by their additional experience leading the DSMES class. 

The strengths of this study include using alternating months to enroll participants in the control vs. intervention groups and using consistent pre- and post-assessments. Although they were not randomly assigned by the investigators, students were not “selected” to participate in the intervention or control groups. However, there are some weaknesses including the fact that all participants (students, patients, and preceptors) were from the same clinic and the same school of pharmacy. Moreover, we don’t know if all students had similar experiences and patients may have had different issues or complications. Lastly, some students (20%) had previously participated in a diabetes management elective course offered during their curriculum.  Slightly more students in the control group had taken the elective course but it is unclear if this difference impacted the study results.

A similar study was previously conducted by Shrader and colleagues. Similarly, student pharmacists were engaged in teaching DSMES, but the study did not include a control group. Moreover, the investigators did not perform a comprehensive assessment – they only measured changes in student confidence.³ Another small study evaluated student pharmacists who participated in an interprofessional elective.  Again, the investigators only measured improvements in student confidence when providing DSMES to patients.⁴ In both of these studies, there were positive effects on student confidence levels.  It is perhaps not surprising that student confidence consistently improved in all of these studies as one would hope an educational intervention would improve how students perceive their ability to perform these tasks.

I believe this study provides solid evidence that practice, applying one’s knowledge, improves both knowledge and confidence. From my own experience, I know that putting my knowledge into action in “real” life truly solidifies my knowledge. Every preceptor should provide opportunities for hands-on, authentic practice. This article is a good example that could be applied during any ambulatory care APPE but it can be modified for experiences in other settings too. The key is to provide students with opportunities for more practice.  And this will increase their knowledge and confidence as they transition to independent practitioners. 

References:

1. Manigault K, Augustine J, Thurston M. Impact of Student Pharmacists Teaching a Diabetes Self-Management Education and Support Class. Am J Pharm Educ. 2020;84(3): Article 7621.
2. Diabetes Care. American Diabetes Association Standards of Medical Care in Diabetes – 2020 [Internet]. Diabetes Care 2020;43(1): S1-S212
3. Shrader S, Kavanagh K, Thompson A. A Diabetes Self-Management Education Class Taught by Pharmacy Students. Am J Pharm Educ 2012 Feb 10;76(1): Article 13.
4. Fazel M, Cooley J, Kurdi S, Fazel M. A co-curricular diabetes-specific elective with interprofessional students and faculty. Curr Pharm Teach Learn 2019 Feb;11(2):172-177.

Forming One’s Professional Identity

by Alex Craig, PharmD, PGY1 Pharmacy Practice Resident, University of Mississippi Medical Center

Making the transition from pharmacy student to practicing pharmacist is challenging.¹ New pharmacists are tasked with actively applying learned materials in their everyday practice as well as problem-solving when areas of practice are often more gray than black and white. During this transition, a pharmacist’s professional identity plays a crucial role. Professional identity has been defined as “a representation of self, achieved in stages over time during which the characteristics, values, and norms” of the profession are “internalized, resulting in an individual thinking, acting, and feeling” like a health professional.² Those with strong professional identities tend to be confident, driven, and adaptive when faced with uncertainty.³ I believe professional identity can and must be actively developed through thoughtfully designed student experiences.

Over the last two decades, there has been an explicit effort to teach “professionalism” in health professions education. In recent years this has evolved and helping students form their “professional identity” during their journey to become healthcare professionals has become the educational objective.⁴ In 2014, the American College of Clinical Pharmacy formed a task force on how to help foster professional identity formation. The task force made recommendations for best practices, created a framework for educational methods to support the formation of professional identity within interprofessional contexts, and generated recommendations to support faculty in helping students develop their professional identities.⁵

Facilitating professional identity formation requires consideration of many factors: What kind of pharmacist (generalist, specialist, practice setting) does the student pharmacist want to become? What are the hallmark characteristics society needs in a pharmacist now and into the foreseeable future? What processes are in place to support and promote identity formation?¹ Forming a professional identity is a dynamic process with many influences.  It is influenced not only by the student’s personal identity, but also factors such as clinical/non-clinical experiences, role models/mentors, formal instruction, self-assessment, reflection, and socialization. Among these, role models/mentors and experiences appear to have the biggest impact. In professional identity formation, a positive mentor/mentee relationship is facilitated by constructive feedback. Feedback serves as a reinforcement of learning and it assists in the confirmation of the learner’s self-perception.⁴ Preceptors and mentors can aid in identity development by sharing personal experiences and encouraging the student to shift into an independent mindset. For example, when encountering a situation where the best decision is unclear, the preceptor should encourage the student to express their thoughts and suggest potential solutions. Encouraging students to combine foundational knowledge with recent literature and applying that to a patient case or practice management scenario can facilitate this independent thinking.  Indeed, students should be encouraged to be responsible for making choices and this should align with who they want to become as a healthcare professional. Exposure to increasing complex scenarios can also help prepare students for their future practice. There also needs to be opportunities for students to share and reflect on their experiences and what was gained or learned. This may be facilitated through debriefing sessions that are student-led.⁴

A 2019 scoping review investigated pharmacy student professional identity formation.¹ The paper pointed out important aspects to be considered when developing curricula to foster professional identity formation. First, it's important to examine how pharmacy students see themselves. Pharmacy students often lack an understanding of their professional selves and are unable to articulate what it means to be a pharmacist. Pharmacy students tended to focus on traditional pharmacist roles (dispensing and counseling) and this understanding was reinforced by experiential learning and part-time work experiences. Pharmacy students also found it challenging when engaging with patients when they were met with disinterest or anger. Experiences gained within the pharmacy curriculum often led to unresolved identity dissonance because students’ practice experiences did not align with the idealist view taught in the classroom about the pharmacist role.¹ This includes ambiguity about the definition of “clinical” pharmacy. For example, the definition of “clinical” often vary by practice setting, and students perceive big differences in the role and responsibilities of pharmacists in community, ambulatory care, and hospital settings. Some educators suggest that role-play activities can help encourage students to merge the gap between the “ideal” professional role and their lived experiences. Students should be given opportunities to discuss their experiences with a trust role model and re-enact how they responded to the experience.  This enables students to envision their professional identity but also critically examine their personal identity.⁶

To facilitate professional identity formation, faculty will likely need to be educated about the construct. It is important that faculty understand that students must participate in developing their own professional identities and maintaining a welcoming environment for open dialog is critical.  The curriculum should address known factors that affect identity formation and there should be a mechanism to assess student progress. Some schools engage students in the development of professional identity by using reflective strategies.³ This strategy can consist of some foundational instruction about professional identity formation and periodically asking student pharmacists to reflect on their stage of development. These reflections can help gauge the student’s understanding, track their progress, and identify gaps. A tiered approach is needed and activities should be appropriate for the learner’s stage of development.

I challenge you to think about your own transition into practice and your understanding of your role. What experiences did you have that fostered the development of your professional identity? What experiences or role models do you wish you could have had during your training?

The aim is not to homogenize all personal identities into a standard; rather, the student maintains his or her ‘self-identity’ while building a professional identity through exposure to diverse experiences while upholding the key virtues of a … professional including competence, kindness, honesty, and integrity.⁷

References:

1. Noble C, McKauge L, Clavarino A. Pharmacy student professional identity formation: a scoping review. Integr Pharm Res Pract. 2019; 8: 15-34.
2. Cruess R, Cruess S, Boudreau J, et al. Reframing medical education to support professional identity formation. Acad Med. 2014;89(11):1446–1451.
3. Scanlon L. “Becoming” a professional. Dordrecht: Springer; 2011. 
4. Cruess S, Cruess R, Steinhert Y. Supporting the development of a professional identity: General principles. Medical Teacher. 2019; 41(6): 641-649.
5. American Association of Colleges of Pharmacy. Taskforce on professional identity formation – final report. 
6. Monrouxe LV, Rees CE, Endacott R, et al. “Even now it makes me angry”: health care students’ professionalism dilemma narratives. Med Educ. 2014; 48(5): 502–517.
7. Forouzadeh M, Kiani M, Bazmi S. Professionalism and its role in the formation of medical professional identity. Med J Islam Repub Iran. 2018; 32: 130.