Defining the Challenges in Teaching Pharmaceutical Care Practice: A Pharmacist Does What?!

By: Benjamin Aronson, PharmD, PhD; Kathryn J Smith, PharmD, BCACP; Keri D. Hager, PharmD, BCACP

Teaching Pharmaceutical Care and the Pharmacists’ Patient Care Process (PPCP) is an essential, yet challenging duty. As pharmacists, we have made a commitment to “take responsibility for a patient’s drug-related needs, and (be) held accountable for this commitment… for the purpose of achieving positive patient outcomes.”1 As faculty, we have made a commitment to prepare the next generation of pharmacists to care for patients.

What is it about our students, ourselves, and our profession that make it so challenging to transform from a student into a Pharmaceutical Care practitioner?

Charles Kettering said “A problem well-stated is half-solved,” for we must first name the challenge before we can address it. In writing this Pulses blog, our intent is to foster a dialogue about the teaching and learning challenges related to pharmaceutical care, so as faculty, we can collectively focus our teaching efforts on the most important challenges to improve student learning in this arena.

The conversation about the challenges in teaching Pharmaceutical Care and PPCP often starts with student surprise and shock when introduced to these concepts. Not only is it surprising, but in some cases, a point of resistance for them. Why are students shocked when they are introduced to our professional practice? Why are they surprised to find out that pharmacists are responsible for meeting patients’ medication-related needs as the medication expert on the healthcare team? How did they so successfully answer “Why pharmacy?” during their admissions interview? Other health professions’ students seem to have a good grasp on the profession they are entering, and their future professional role. So, why not our new pharmacy students?

Some of the confusion can be attributed to our students’ preconceived notions of a pharmacist’s role, as discussed in a recent Pulses blog post.  Many students come to us with narrow views of the roles of pharmacists based on their work or shadowing experiences, their personal experiences as a patient, or their interpretation of others’ experiences within the profession of pharmacy. What about portrayals of pharmacists and pharmacies in the media? When we introduce Pharmaceutical Care, the PPCP, and pharmacists’ roles they haven’t seen before, we may be challenging their preconceived understanding of what it means to be a pharmacist.2 No wonder we sometimes encounter resistance! No wonder we see the “Why do we have to learn this?” attitude emerging. If our job is to encourage all students to adopt a consistent professional identity of a “pharmacist” — the practitioner responsible for a patient’s drug-related needs and medication outcomes — we do not have a firm foundation from which to launch.3,4

How do we encourage students to be open to engaging with material that expands their understanding of the primary roles and functions of a pharmacist?

This type of learning can be more challenging than just learning content to repeat or apply at a later time. Understanding Pharmaceutical Care and PPCP is part of growing and becoming a pharmacist.

How do we facilitate the incorporation of Pharmaceutical Care and PPCP into our students’ professional identity development?

Let’s meet our students where they are — we need to acknowledge students’ prior experiences and beliefs about the profession of pharmacy and seek to understand the origins of the misunderstanding. Our students don’t know what they don’t know about the practice of pharmaceutical care. We need to personalize their learning and make the practice of pharmaceutical care “real” for students. Rather than expecting our students to believe something they’ve never seen before, we need to model what it looks like to be a pharmacist. One method is to introduce the PPCP early in the curriculum and link it to aspects of the profession students are familiar with, such as taking a medication history or reading a patient chart.5

Join us in a conversation using the comment box below!  Here are a few questions to get you thinking:

  1. What other methods could we use to help our students gain comfort and familiarity with Pharmaceutical Care Practice and the PPCP?
  2. What other challenges have your students presented when it comes to learning Pharmaceutical Care and the PPCP?
  3. How have you approached these topics in your courses?

We know students aren’t the only ones struggling with the concepts of Pharmaceutical Care and PPCP. In future posts, we will seek to define teaching and learning problems and professional practice challenges related to Pharmaceutical Care and PPCP and ask for your help in solving them.

Acknowledgements:

The authors would like to acknowledge Dr. Kristin Janke for her help in reviewing this post before submission.

References:

  1. Cipolle RJ, Strand LM, Morley PC. Pharmaceutical Care Practice: The Patient-centered Approach to Medication Management Services. New York, NY: McGraw Hill; 2012.
  2. Pestka DL, Sorge LA, Mcclurg MR, Sorensen TD. The Philosophy of Practice for Comprehensive Medication Management: Evaluating Its Meaning and Application by Practitioners. Pharmacotherapy. 2018;38(1):69-79.
  3. Cruess RL, Cruess SR, Boudreau JD, Snell L, Steinert Y. Reframing Medical Education to Support Professional Identity Formation. Acad Med. 2014;89(11):1446-1451.
  4. Irby DM, Hamstra SJ. Parting the Clouds: Three Professionalism Frameworks in Medical Education. Acad Med. 2016;91(12):1606-1611.
  5. Rivkin A. Thinking Clinically from the Beginning: Early Introduction of the Pharmacists’ Patient Care Process. Am J Pharm Educ. December 2016;80(10):Article 164.

Ben Aronson is an Assistant Professor of Social and Administrative Pharmacy at Ohio Northern University College of Pharmacy. Educational scholarship interests include student success, professional engagement, and helping students find their fit in the profession. In his free time, Ben enjoys cooking for his wife and four sons, winning food eating competitions, and running off all those calories with his very active dog.

Kathryn J Smith is a Clinical Assistant Professor at the University of Florida College of Pharmacy. Educational scholarship interests include professional development and the Pharmacists’ Patient Care Process. In her free time, Kate enjoys watching Chicago Cubs baseball and hanging out with her husband and their three daughters.

Keri D. Hager is an Associate Professor at the University of Minnesota College of Pharmacy in Duluth. Educational scholarship interests include Pharmaceutical Care & interprofessional collaborative practice development. In her free time, Keri enjoys playing ukulele in her band #airfiddle and enjoying the outdoors with her hubby & geriatric dog, Melinda Doolittle.


Pulses is a scholarly blog supported by Currents in Pharmacy Teaching and Learning

7 Comments

  1. One thing to consider that contributes to students’ limited view of the PPCP is the inability of pharmacists in all practice settings to fully implement the PPCP. In most states, pharmacists are prevented from practicing at the top of their education and training (i.e. fully participating in all steps of the PPCP) because they are restricted by what their pharmacist license allows. When future student pharmacists form their perceptions of what their future practice might look like, based on work or shadowing experiences where pharmacists do not have the ability to: 1) collect; 2) assess; 3) plan; 4) implement; and 5) follow-up we should not be surprised that we are met with resistance when trying to teach the concepts.

    See “Pharmacists’ Patient Care Process: A State “Scope of Practice” Perspective” DOI: https://doi.org/10.24926/iip.v10i2.1389 for more detail on this perspective.

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    1. Jennifer, Thank you for your comments! I agree that this is certainly a problem. Stay tuned for Post 3 in this series where we plan to address this and other practice and profession issues that impact the way we teach PC and PPCP.

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  2. Thank you for this insightful dialogue. There is definitely a disconnect with the preparation of the academy. One area eluded to within the post is the need for professional identity formation, which was the topic of a previous Pulses article (https://cptlpulses.com/2017/07/06/professional-identity-formation-has-nothing-to-do-with-a-clean-white-coat/).

    While medical education has initiated the transition away from professionalism into professional identity formation, pharmacy education, training, and practice organizations must unite to address how to encourage and facilitate student, resident, fellow, graduate student, and pharmacist professional identity formation. Currently, the CAPE Outcomes 3/4 elude to components of professional identity and professional identity formation; however, it is not clearly stated within educational guidance documents. Additionally, the emphasis within pharmacy residency training and practice standards focus on professionalism. To address this void, collaboration across the profession (Joint Commission of PH=harmacy Practitioners – JCPP) must take place to define, create consistent terminology, and guidance for professional identity formation.

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    1. Yes Alex, I’m also glad to see the growing conversation on Professional Identity Formation (PIF) for pharmacists and pharmacy students. Standards 3 and 4 are a good starting point to help students understand what types of values we’d like them to embody, but more collaboration is certainly needed to make these concepts more tangible to students. When we say “patient advocate”, what does that actual look like in practice? When we say “leader”, what are we expecting students to be able to do or know? Looking forward to seeing how these Standards evolve in light of the PIF conversation.

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  3. We are excited that Professional Identity Formation (PIF) within pharmacy has been raised as an area requiring further exploration. Thank you for your work! The 2019-2020 AACP Student Affairs Committee (SAC) has been working on several charges relative to PIF. We have found that while PIF has been a focus within medical education, there are often misconceptions within pharmacy education and PIF is often confused with professionalism. Our committee believes understanding the difference and the importance of PIF is essential to educators, preceptors, and practitioners. Professionalism relates to one’s observable actions. PIF is more than thinking and acting like a pharmacist; it includes “feeling” like a pharmacist (Think, Feel, Act). PIF has been defined as “the transformative process of identifying and internalizing the ways of being and relating within a professional role (1).” The AACP SAC is working to elevate the awareness of PIF and provide education opportunities through programming and advocating for promotion of PIF within the profession.
    There is identity ambiguity within pharmacy (2,3). Perhaps this is related to the lack of a universally accepted identity for the profession. Most identities of pharmacists and student pharmacists relate to specific roles or areas of practice, rather than what is at the core of pharmacists’ beliefs and ways of being. (2,4). Identity in its simplest terms is how one sees themselves and is seen by others. As can be seen by the definition of PIF offered above that identity is influenced by relating to others within a professional role. As you point out, when pharmacy students are introduced to professional practice, they may be shocked and confused as they may enter with preconceived notions developed through prior experiences. Within pharmacy education we have the responsibility to mold both an authentic and progressive identity which is challenging during a time of practice transformation. If it is not authentic, graduates will enter practice with an ill-conceived identity.
    The committee believes that the profession needs to develop more understanding of the professional identity of a pharmacist and this should be inclusive – spanning practice roles. We believe this work is also important for professional unity, public awareness, and to guide pharmacy educators in developing educational experiences to assist in PIF.

    1. Scott J, Bell H, Welch B, et al. American Association of Colleges of Pharmacy Council of Deans Taskforce on Professional Identity Formation – Final Report. http://www.aacp.org/governance/councildeans/Documents/COD%20Taskforce%20on%20Professional%20Identity%20Formation%20Final%20Report%20July%202014.pdf.
    2. Elvey R, Hassell K, Hall J. Who do you think you are? Pharmacists’ perceptions of their professional identity. Int J Pharm Pract 2013;21:322-332.
    3. Noble C, McKauge L, Clavarino A. Pharmacy student professional identity formation: a scoping review. Int Pharm Res and Pract 2019;8:15-34.
    4. Noble, C, Coombes I, Shaw PN, Nissen, LM, & Clavarino A. Becoming a pharmacist: the role of curriculum in professional identity formation. Pharm Pract 2014; 12(1): 380.

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    1. Beth, I’m grateful to hear the AACP Student Affairs Committee is working on sharing more about Professional Identify Formation. I also really appreciated the way you differentiated professionalism and professional identify formation- I don’t think we do a good job of explaining to students how those are different. Often, we just expect students to “behave like professionals” without putting in the work required to help them internalize what it means to be a pharmacist. And, as you said, it doesn’t help when we can’t agree on the what it means to be a pharmacist! I think the Pharmacists’ Patient Care Process (PPCP) is a good first step, but this is certainly an area where we need innovation in education and collaboration across the profession (APhA, AACP, ACCP, NCPA, ASHP, etc…). Stay tuned for Post 3 where we will address this and other “profession” issues that make it challenging to teach students about Pharmaceutical Care and the PPCP.

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  4. Great conversation!

    Thanks Jen, Alex, and Beth for the terrific points and furthering this discussion! I think this discussion of where practice is, where we teach to, and professional identity formation is great. And they are all inextricably tied together right?

    Students come in with misconceptions of the profession based on what other pharmacists have said, what family/friends/advisors have said, and what they’ve seen of the profession (but often from a narrow part of the profession, not understanding the entirety of the field, and based on the fact that the future is here, just not equally distributed). Read here, we need to confront alternative identities from day 1. We then try to grow this consistent pharmaceutical care practitioner, in essence growing a consistent professional identity. In this post, we focused primarily on problems at this stage.

    But, what if we succeed? If we’re successful, they likely adopted a professional identity that will lead to problems as they attempt to reconcile professional identities they see on the job and rotations. Will they question their future at this point? I know a lot of my classmates did. Will they accept alternative professional identities inconsistent with accepting responsibility for a patient’s drug related needs? I hope not! But this is a whole other problem (or set of problems- see for example the Adams & Weaver article Jen suggested) that requires multiple fixes. Boy oh boy, the can of worms feels like it’s exploding!

    One last thought – I believe all pharmacists should take responsibility for ensuring optimal drug therapy outcomes, and take care of patients using the philosophy of practice and PPCP regardless of location, work activities, procedures, and policy. It’s a mentality that is adopted to one’s core and applies no matter what. While I think the practice landscape is very important (and we need attention to solve problems here too!) a pharmacist should take responsibility and follow a consistent process without fail. They just may have to do it slightly differently depending on context. But how do we prepare students for the disconnect they may see in practice and from some pharmacists?

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