Pharmacy Leaders’ Advice to Students Pursuing Leadership: A Qualitative Study

Abstract

Introduction: Leadership development is important both from a curricular standpoint and for continued advancement of the profession. Advice from current leaders in the profession may serve as a powerful motivator to students desiring to be leaders. The purpose of this qualitative study was to provide advice from experienced pharmacy leaders.

Methods: Fifty-four pharmacy leaders were identified based on pre-determined, specific criteria and by using a snowball sampling method. Interviews with leaders were conducted via Zoom to learn about their leadership journey, their legacy, and advice they would give students. The interviews were transcribed, de-identified and analyzed using the inductive, modified constant comparison approach for open and axial coding. Advice themes were compared by gender and generational category.

Results: The majority of the interviewees were male (69%), belonged to the Baby Boomer Generation (1946-1964, 59.3%), and held leadership positions in education (78%) and health systems (48%). Thirty-seven leadership advice themes were present. The topmost advice to students was to keep an open mind (35%) and to get involved in organizations (32%). Pieces of advice shared by both men and women leaders included: being open minded, getting involved in organizations, taking initiative, trying new or difficult things, and finding your passion. Keeping an open mind, and taking initiative were common across the three generations.

Conclusion: Pharmacy leaders have insightful information for students aspiring to be future leaders. Leadership advice was similar by gender and generational category. Students would benefit in developing their leadership based on advice from the lived experience of pharmacy leaders. Future studies could examine students’ perspectives on leadership advice.

Introduction

The pharmacy curriculum has evolved to emphasize development of skills beyond foundational knowledge to prepare students to be ready for practice and to work in interprofessional teams. These additional skills are considered part of personal and professional development (PPD). The Accreditation Council for Pharmacy Education (ACPE) Standards 2016 include PPD content such as leadership, self-awareness, and professionalism.¹ Schools and colleges of pharmacy are therefore required to demonstrate how they develop and foster students’ leadership skills. More importantly, the field of pharmacy needs to develop its future leadership to help advance the field in all aspects.

Leadership development has been incorporated into the pharmacy curriculum through advanced pharmacy practice experience (APPE),² co-curricular programs,³ optional global leadership modules,⁴ didactic courses, seminars, workshops, and retreats,⁵ and as part of interprofessional education (IPE) efforts.⁶ Similarly, Harvey K Whitney lectures have been used as part of leadership training for residents.⁷ The use of interviews with current leaders to teach students about leadership has not been described. Learning about leadership from interviews with current leaders could offer students an understanding of leadership that is grounded in real world experiences and offers an authentic perspective of the qualities exhibited by leaders in pharmacy. The interviews and the advice shared could serve as leadership teaching materials for other schools of pharmacy as well. Learning about leadership from experiences of others may also offer the opportunity to seek the leaders’ perspectives on qualities and behaviors that contributed to their success and growth. This could serve as a powerful motivator to students when contemplating their own personal behaviors, goals and plans to achieve their vision of contributing to the pharmacy profession and leadership. Advice from current leaders including some whose contributions have significantly shaped the profession, also offers direct evidence of leadership success based on their lived experiences and imparts context for and credibility to their advice. A qualitative study focused on the advice that leaders would impart to current and future generations based on their life’s journey and leadership experiences was conducted. As men and women, as well as different generations may have differing life experiences related to ascending to leadership roles, we explored whether there were differences in leadership advice based on gender or generational category. It was part of a larger project that inquired about the journey, legacy, and contributions of individuals recognized as leaders and who have helped shape the profession of pharmacy.⁸ The objectives of this study were to determine: a) advice that pharmacy leaders had for students aspiring to be future leaders, and b) whether there were differences in leadership advice by gender and generational category of leaders.

Methods

Leaders with national impact in the pharmacy profession were identified by convenience sampling and further expanded upon using snowball sampling based on the following criteria: 1) Held national leadership position, i.e., President/past President, Board of Directors seat in pharmacy organization(s); 2) Received national awards or external recognition (e.g., Remington Honor Medal, American Society of Health-System Pharmacists Harvey A.K. Whitney Lecture Award, American Pharmacists Association Gloria Niemeyer Franke Leadership Mentor Award, American College of Clinical Pharmacy (ACCP) Paul F. Parker Medal, ACCP Russell R. Miller Award, American Association of Colleges of Pharmacy (AACP) Distinguished Teaching Scholar Award, AACP Volweiler Research Achievement Award, and/or AACP Robert K. Chalmers Distinguished Pharmacy Educator Award); and/or 3) Documented in Elenbaas’s Clinical Pharmacy in the United States book for making significant contributions to advance the profession and being considered a pioneer in specific areas.⁹ Using the above criteria, 51% (n=28) of the sample met criteria 1, 73% (n=40) met criteria 2, and 33% met criteria 3 leading to a total of 55 individuals who were identified. All were contacted via email and agreed to participate with the exception of one individual who declined due to health reasons.

Fifty-four leaders were interviewed about the advice they would give pharmacy students regarding leadership. Intentional efforts were made to identify individuals who represented a diversity of practice settings, gender (identified as male/female), generations, and underrepresented minorities; gender identity information was not solicited from individuals. This was part of a larger study on pharmacy leaders’ perceptions of their journey and legacy.⁸ All interviews of leaders were conducted by one investigator (TP). The question was phrased as follows: “What advice would you offer for students in their professional journey, especially how they can develop as leaders?” Interviews were recorded and conducted via Zoom (Zoom Video Communications, San Jose, CA, USA) in Spring and Summer 2020.¹⁰ Interviewees were notified that a qualitative study would be performed on the data and were given the question in advance to help them gather their thoughts prior to the interview. Participation in the interview was considered as consent for the study. The question was tested for clarity by three pharmacy faculty. The White Pages People Finder website was used to identify birthdates and thus generational categories.¹¹ The interviews were transcribed using NVIVO v12 (Lumivero, Denver, CO, USA) transcription services.¹² After transcription, the interviews were reviewed for accuracy and then de-identified by the interviewer (TP). Two independent investigators (AC, RD) were involved in the text analysis and reviewed the transcribed notes. Each investigator read the text independently in response to the advice question and created codes.^13,14 The inductive approach used to code the interview text was facilitated by using NVIVO v12 (Lumivero, Denver, CO, USA). After individually reading the responses to the advice question from the transcript and creating codes for various advice themes, the investigators (AC, RD) held multiple joint meetings to compare codes and address any differences in the coding. Modified constant comparison approach for open and axial coding was used.¹⁵ The investigators resolved differences and achieved 100% inter-rater reliability. Finally, the two investigators combined the coding categories to reflect broader themes when needed. The themes were compared based on gender and generational category. The study was considered exempt by the university Institutional Review Board.

Results

Fifty-four pharmacy leaders were interviewed. Each interview averaged 20 minutes (range 10-33 minutes) in length. The recorded video interviews are freely available and are archived with the American Institute of History of Pharmacy.¹⁶ The majority of the interviewees identified as male (n=37, 69%), belonged to the Baby Boomer Generation (1946-1964, n=32, 59%) and the Silent Generations (1928-1945, n=16, 30%), and held leadership positions in education (n=42,78%), health systems (n=26, 48.1%), and professional organizations (n=12, 22%). Six interviewees were from community pharmacy, managed care, or industry. Under-represented minorities formed 11% (n=5). Only three respondents (6%) held leadership positions in the government. Generation X (1965-1980) represented 11% (n=6) of the sample.

A total of 37 unique themes were identified as advice to students. Table 1 describes the overall top themes as well as sample advice quotes shared by leaders. The topmost advice to students was to ‘keep an open mind’ (n=19, 35%), and ‘to get involved in organizations’ (n=17, 32%). A quote representing the ‘open mind’ theme is, “I tell all of my students, be really, really open minded about everything in pharmacy.” Regarding getting involved in organizations, one leader said, “Don’t just join organizations, but get involved and join a committee… you look at the bigger picture even more because you’re with associates and colleagues and so forth.”

Table 1:

Top themes and sample quotes regarding advice to students (n=54)

Themes	N (Percent)	Sample Verbatim Quotes
Open mind	19 (35)	“Keep your options open and keep your mind open about what it is you really enjoy doing.” “There are so many approaches that I have appreciated along the way. The first is to know enough about the profession that they’re pursuing and the fact that it has so many different pathways for professional fulfillment and engagement.”
Involvement in organizations	17 (32)	“I obviously advocate being involved in national associations. There are the people that are doing the work they’re pushing, and we don’t have enough pharmacists participating in our national associations. And I think you do have a debt and an obligation.” “So, I would say to all you pharmacy students make time to get involved in the profession. It’s really important and it gives back to you way more than you put into it.”
Take initiative	14 (26)	“It never hurts, and you should never hesitate in asking to do more. Can I get involved here? Can I help with that opinion paper? Can I? Would you like some help with this book chapter?” “But my experience is that when you really want to grow in an area and you really want to connect, you have to be proactive. You can’t just sit around and wait for things to happen. So, you take a proactive approach to finding mentors that have achieved or accomplished what it is you want to accomplish in your profession. You know, buy them cup of coffee. And, you know, I ask to take them to breakfast and just spend a couple hours with them.”
Try new or difficult things	12 (22)	“And then the third piece of advice and this is one I give in my classes, my last lecture, which I teach in the spring of P three year, and I would say that piece of advice is do difficult things. Know that doing difficult things changes you. It gives you confidence to do more difficult things. It gives you perspective when you think things are rough or hard. But if you’ve done something really difficult. You can look back and say, you know what, this is not really as bad as that.” “You have to be in the flow of things, and you have to be willing to take some risks and do some things that may not always be in in your comfort zone.”
Find your passion	11 (20)	“Find out those areas to where you’re really passionate about and that you really like, and you really enjoy and go deeper. And I see too many students that go really, really wide, but not very deep in anything to not get anything super meaningful out of stuff. But, you know, narrow that focus down to things and really go in and go at it a hundred percent.” “And so, I think leadership is that ability to be able to be aware of what your passion and purpose is and then be able to influence others, to be able to follow that passion and purpose with you, because you really can’t do it alone.”
Have mentors	11 (20)	“Another important piece of advice that I have for students, is make sure that you have strong mentors in various aspects. One mentor is never enough. You have a mentor when it comes to clinical decision making, have a mentor when it comes to making professional decisions about your career. And they don’t have to be the same person. But it should be somebody that you’re very comfortable sitting down talking to and likewise hearing answers that you may not necessarily like as you ask them very difficult questions.” “I would also say that in any stage of your life, I think you need a mentor, maybe personally and professionally. And it may be a different person depending on where you are in your life. But I think those mentors are so important.”
Seize the opportunity	11 (20)	“And as a leader, I would say strike when the iron’s hot. When the opportunity is there, take it. Don’t hold back ” “One thing I always told our students was to take advantage of opportunities as they arise, as they come about.”
Surround yourself with good people and relationships	11 (20)	“And being around inspirational people has always been and continues to be what drives me. And what gives me a lot of hope and optimism. SoI started to get involved in ACCP, for example, get around the leaders, you know, and find out what makes them tick and how they conduct themselves and how they feel about things. That will inspire you. You know, being with colleagues and hearing their stories and their hopes for the future is very important and it’s what propels everyone forward.” “Surrounding yourself by talented people that are smarter than you are. And so, I had a good CFO to manage the books and I had, you know, good people to run the operations side of the organization. And my job was to lead and to create a place where great people could do their best work.”
Do the right thing or integrity	9 (17)	“And then, you know, I always used to tell residents and students should just do that. You just do the right thing.” “And all of that stuff is great and valuable. But the one indispensable thing is integrity. All of that stuff is wonderful. If you don’t have integrity, forget all the rest of it because you’re not going to be effective in the long run. You’ll be effective in the short run. You may go up the ladder a bit, but in the long run, when your life is over, if you haven’t had integrity, then it’s really not worth it. So, integrity is the key.”

Multiple themes such as ‘find your passion’, ‘have mentors’, ‘seize the opportunity’, and ‘surround yourself with good people’ showed the same percentage of reporting (n=11, 20%) among the top themes suggesting that they were equally important to leaders. Regarding the theme of ‘seizing the opportunity’, one leader quoted “I think you take advantage of those opportunities that are presented to you to stretch and be a little bit humble about what you don’t know.” A mentorship theme quote stated, “The goal is to find a mentor … often times [we are] overwhelmed with the volume of information and opportunities… chances are there’s somebody that’s walked roads that you’re walking and that’s called a mentor, and you’ve got to seek out mentors.”

Table 2 shows how the themes differed in their importance based on two demographic characteristics—gender and generational category. Both men and women leaders had common advice to students about how to become leaders. From among the top themes, female leaders indicated ‘involvement in organizations’ (n=9, 53%), and ‘seize the opportunity’ (n=6, 35%) most frequently, while male leaders’ most frequent advice to students was to ‘have an open mind’ (n=14, 38%), and ‘to take initiative’ (n=9, 24%). ‘Involvement in organizations’ was the third most frequently stated theme (n=8, 22%) by male leaders. Among the top themes for advice not previously stated that differed substantially (≥ 5 percentage points) between male and female leaders, where a higher percent of female leaders reported it included ‘take initiative’ (29% female versus 24% male), ‘try new or difficult things’ (29% female versus 19% male), ‘find your passion’ (24% female versus 19% male), and ‘surround yourself with good people and relationships’ (29% female versus 16% male). A theme that was mentioned more frequently by male leaders was to ‘have mentors’ (22% male versus 18% female leaders).

Table 2:

Advice themes by gender and generational category (n=54)

	Gender		Generational category n (%)
Top Themes	Female (N=17) (%)	Male (N=37) n (%)	Silent Generation (1928-1945) (N=16, 29.6%)	Baby Boomer (1946-1964) (N=32, 59.3%)	Generation X (1965-1980) (N=6, 11.1%)
Open mind	5 (29)	14 (38)	3 (19)	14 (44)	2 (33)
Involvement in organizations	9 (53)	8 (22)	7 (44)	10 (31)	0
Take initiative	5 (29)	9 (24)	3 (19)	9 (28)	2 (33)
Try new or difficult things	5 (29)	7 (19)	1 (6)	9 (28)	2 (33)
Find your passion	4 (24)	7 (19)	2 (12)	6 (19)	3 (50)
Have mentors	3 (18)	8 (22)	1 (6)	8 (25)	2 (33)
Seize the opportunity	6 (35)	5 (13)	1 (6)	9 (28)	1 (17)
Surround yourself with good people and relationships	5 (29)	6 (16)	4 (25)	7 (22)	0
Do the right thing or integrity	3 (18)	6 (16)	5 (31)	4 (12)	0

Table 2 also shows the most common advice themes by generational category. The three generational categories used to classify the interviewees were: Silent Generation (1928-1945), Baby Boomer (1946-1964), and Generation X (1965-1980). ‘Keeping an open mind’, and ‘taking initiative’ were the only two advice themes that were stated more frequently across the three generations. The most common advice given by the Silent, Baby Boomer, and Generation X groups respectively was ‘being involved in organizations’ (n=7, 44%), ‘to keep an open mind’ (n=14, 44%), and ‘find your passion’ (n=3, 50%). None of the Generation X participants gave advice about ‘involvement in organizations’, or ‘surrounding yourself with good people and relationships’, or about ‘doing the right thing’. The themes of ‘taking initiative’, ‘trying new or difficult things’, and ‘having mentors’ were more frequently reported by the Baby Boomer and Generation X interviewees. ‘Seize the opportunity’ was a theme mentioned largely by Baby Boomer generation (n=9, 28%) compared to Silent (n=1, 6%) and Generation X (n=1, 17%).

Discussion

Current leaders can play a valuable role in shaping future leaders.¹⁷ Suitable mentors from which to learn, while optimal, may not always be readily available to developing leaders. A broader more accessible approach to building leadership skills is to learn from the lived experience of current leaders. Our study uncovered useful advice given by profession leaders that may be advantageous to future generations of leaders. Importantly, we were able to collate leadership advice from the Silent Generation to Generation X. The top five pieces of advice (‘open mind’, ‘involvement in organizations’, ‘taking initiative’, ‘trying new or difficult things’, and ‘finding your passion’) were common to both genders and point to advice that students should keep in mind as they develop into leaders.

‘Being open minded’ refers to being open to new and unexpected opportunities as they arise and complements the idea of open-mindedness to new or creative ideas which has been recognized as an important trait of a leader.¹⁸ The advice about ‘being involved in organizations’ suggests that aspiring leaders should take an active role in committees and other efforts within professional organizations, rather than simply be passive, enrolled members. This advice stems from interviewees’ relating their personal experiences of opportunities for professional collaborations, development, networking, and a sense of belonging realized from active participation in professional organizations. Additionally, organizational involvement also contributes to enhancing open-mindedness by exposure to differing perspectives from other members.

Students should take advantage of leadership opportunities within student organizations as they may become important conduits for future leadership roles (both positional and non-positional). Advice on ‘taking initiative’ that leaders gave implied being proactive rather than waiting for things to happen, seeking out opportunities, and identifying problems and offering solutions. Students may possess some of these traits already as they learn to identify and solve clinical cases, and juggle difficult work, school, and family life commitments and schedules. Leaders provided advice regarding trying new or difficult things using multiple phrases such as: ‘taking on challenges’, ‘taking risks’, ‘going outside one’s comfort zone’, and ‘not being afraid to fail’. Leaders also frequently mentioned passion for their work and the enjoyment they experienced with it. Their advice about ‘finding your passion’ encourages students to introspect, reflect and identify areas within pharmacy that they truly enjoy and for which they are willing to give their maximum effort so that “work does not seem like work anymore” as stated by some leaders.

When examining the top advice themes by gender, we can gather that women leaders interviewed attributed their success in their leadership journey to being ‘involved in organizations’, ‘seizing opportunities’, ‘keeping an open mind’, ‘taking initiative’, ‘trying new or difficult things’, and ‘surrounding themselves with good people’. Male leaders attributed success in their leadership journey to having an ‘open mind’, ‘taking initiative’, ‘having mentors to guide them’, and ‘being involved in organizations’ (Table 3). While most frequent advice themes were similar between men and women, there were some differences which reflect the experiences of the two genders. Among the common advice themes by gender, women leaders mentioned ‘seize the opportunity’ far more frequently than men. Gender inequity in leadership is well-known and documented.¹⁹ Women’s more frequent advice to ‘seize the opportunity’ may reflect greater challenges experienced such as not being sponsored for higher strategic roles,²⁰ negative organizational culture and institutional policies, and being perceived as invisible, overlooked, or unrecognized,²¹ that women face in their ascent to leadership roles due to gender. Several interviewed women leaders mentioned being “the first one” to hold a position or perform an activity. It is not surprising that women leaders’ advice for themes such as ‘take initiative’, ‘try new or difficult things’ were more than five percentage points higher than males as they may have needed those behaviors when building their leadership skills. Male leaders mentioned the importance of ‘having mentors’ more frequently than women. While ‘seeking mentors’ as an advice theme is a gender-neutral concept and is valuable to both genders, one explanation of why seeking mentors was a more frequent advice stated by male leaders may be that the interviewed women leaders had to pave their leadership path and may not have had easy access to mentors, while men leaders may have had an easier time finding mentors. The value of mentorship, especially for women, is now well-recognized as an essential need for faculty growth. AACP’s Women Faculty Special Interest Group has addressed the need by pairing faculty with mentors. As more faculty have access to mentors, they can mentor student pharmacists as mentorship is essential for professional development.

Table 3:

Men and Women Top pieces of advice^*

Involved in organizations	Involved in organizations
Keeping an open mind	Keeping an open mind
Taking initiative	Taking initiative
Trying new or difficult things	Trying new or difficult things
Find your passion	Find your passion
Seizing opportunities	Having mentors to guide them
Surrounding themselves with good people

^*Table shows common advice between men and women and is not in order of priority.

Advice themes varied by generational category, the Silent and Baby Boomer Generations were largely responsible for the significant pharmacy transformation from a dispensing role to a more clinical role. Some examples of key events that transformed the profession due to efforts of these leaders include the University California of San Francisco’s ‘ninth-floor’ project contributing to the establishment of clinical pharmacy, expansion of board-certified pharmacy specialties, residency training, and the concept of pharmaceutical care. Their advice such as ‘involvement in organizations’, ‘having an open mind’, ‘seizing the opportunity’, and ‘taking initiative’ reflect their experiences.

Interestingly, the Generation X leaders who came into leadership roles at the end of the 20^th or early 21^st century after the profession had moved to a more clinical role for the pharmacist, indicated their top advice as “find your passion.” The lack of mention about involvement in organizations by Generation X leaders is noteworthy as it is important advice for current and future generations and was also mentioned frequently by Silent and Baby Boomer Generation leaders. The value of being an involved member of professional organizations is immense as it offers networking opportunities, potential to make profession-wide impact on key agenda topics, leadership skill development, and provides exposure to new professional opportunities. One explanation why this advice theme was not mentioned by Generation X may be that each generation faced different challenges or benefitted from the efforts of previous generations, hence, it is not surprising that the focus of their advice to students was different. But the themes of ‘having an open mind’ and ‘taking initiative’ were consistent across generations suggesting that these are cardinal pieces of advice for future leaders.

Limitations to this study include selection bias of study participants by the use of convenience and snowball sampling to identify leaders, low numbers of leaders in the Generation X category, and the sample being comprised mostly of men. Besides selection bias, snowball sampling also limits generalizability of the data to the larger population as it does not result in a random sample.²² Use of Elenbaas’s book to identify potential interviewees may also skew the sample as it highlights transformative, clinical pharmacy pioneers. Another limitation was that only those individuals who had email addresses were included in the study as email was the primary method of initial contact. Additionally, many leaders were from educational institutions at the time of interview implying that the advice may be limited in scope based on narrow perspectives or experiences. We also had few leaders from community pharmacy, managed care, or industry. While there may be some unique advice depending on the professional setting of practice, a significant portion of leadership advice may be similar, irrespective of the type of professional setting as the question posed was broadly written. Nevertheless, we reached saturation in advice themes implying comprehensiveness of data on advice provided by leaders. Finally, the question was directed towards student pharmacists; thus, it is unknown whether advice would be different if the advice was solicited for different groups of pharmacists (i.e., new practitioners in the first 1-5 years of practice or more seasoned ones, etc.).

Conclusion

Pharmacy leaders have a wealth of knowledge and lived experiences that can help current and future generations of students to develop leadership skills. Among the top five pieces of advice were to ‘keep an open mind’, ‘be involved in organizations’, ‘take initiative’, ‘try new or difficult things’, and ‘find your passion’. Advice given by leaders irrespective of gender and generational category were similar, but the frequency of mention varied. Access to interviews archived with the American Institute of History of Pharmacy will serve as a useful educational resource for learning about leadership. Learning and absorbing the valuable insights given by current leaders can inspire and guide students to develop as future leaders. Future studies could evaluate students’ perceptions on leadership advice received and examine students’ perspectives on ways to develop as leaders.