Perceptions of Professional Behavior in a Midwestern College of Pharmacy Community: A Mixed-Methods Study

Abstract

Objective:

Professionalism is integral to pharmacy education and practice, but evolving societal dynamics, including generational differences and technological advancements, challenge traditional norms. This study aimed to explore perceptions of professionalism across generations and roles in a College of Pharmacy through behavioral scenarios and survey research.

Methods:

A prospective convergent parallel mixed methods study was conducted using an anonymous online survey, including quantitative (closed-ended) and qualitative (open-ended) questions. Participants from different age-based generations in a Midwestern College of Pharmacy, including students, staff, and faculty, evaluated 8 scenarios reflecting various aspects of professionalism.

Results:

The study included 134 participants, with a response rate of 19.1%. Findings revealed similarities by age-based generations in respect for academic hierarchy across all roles, but younger participants (including pharmacy and graduate students) more readily embraced multitasking and digital communication, despite recognizing them as unprofessional. Common barriers, such as time management and health emergencies, impacted professional commitments across generations. Participants faced challenges with cross-cultural collaboration, such as language barriers and a lack of cultural respect.

Conclusion:

The study highlights both similarities in some professional values and discordance in adapting to technology and cross-cultural challenges by age-based generations and roles. There is a need for cultural competence training and strategies to address modern challenges to ensure that future pharmacists can navigate a dynamic health care setting effectively.

1. Introduction

Professionalism is a social construct in which society entrusts professionals in exchange for their knowledge, skills, and contributions to the community/society.^1,2 This trust is critical within the health care context, where professionalism serves as a cornerstone, deeply rooted in ethical standards that have guided health care practice.³ Professionalism is defined as “the conduct, aims, or qualities that characterize or mark a profession or a professional person.”⁴ It includes a set of core values such as integrity, respect, commitment, accountability, and altruism, among others.^3,5 These values are integral to a pharmacist’s professional identity,⁶ grounding their role as key contributors to health care delivery^6,7 and vital for maintaining society's trust among health care providers.⁸ Further, professionalism is impacted by societal changes, such as generational differences and the rapid advancement of technology.^9,10

The development of professionalism in pharmacy education is a multifaceted process because it is heavily influenced by mentors, faculty, preceptors, and peers who serve as role models.^3,11 Student pharmacists are expected to adopt and integrate professional behaviors from the start of their education, during their training, and ultimately into their professional practice. However, the imparting of these values can vary due to the generational diversity in pharmacy and society.¹² For example, many faculty and staff belong to older generations, such as Baby Boomers and Generation X. In contrast, pharmacy and graduate students are mostly from Generation Z and Millennials.¹² These generational differences can lead to varied interpretations of what comprises professional behaviors, values, and attitudes.¹³ For example, Baby Boomers often show strong loyalty to their workplace and respect for authority, whereas Generation X is usually less loyal and seeks autonomy. Millennials, however, emphasize meaningful work and embrace diversity and inclusion.¹³ Consequently, behaviors considered professional by 1 generation may be perceived differently by another, which in turn challenges traditional norms.¹⁴

The rapid advancement of technology further complicates the landscape of professionalism in pharmacy education.¹⁵ Tools like ChatGPT, along with other online learning platforms and hybrid education models, have transformed how students interact with educators and patients.^16,17 As well, artificial Intelligence (AI)-based technologies offer significant benefits, including the potential to advance health care education; however, they also raise new challenges about what it means to be professional in a digital age.^18–20 These challenges include ensuring the ethical use of AI, such as maintaining trust, privacy, and transparency.¹⁸ As virtual communication and AI-assisted decision-making become more common, it is essential to reconsider professionalism, such as academic integrity or reliability, to align with the realities of pharmacy education and practice.²¹

Given these evolving dynamics, there is a critical need to reconsider the meaning of professionalism in pharmacy education. Although previous efforts have been made to define pharmacist professionalism,^22–25 there is no globally accepted definition.² Identifying and defining the professional behaviors expected from pharmacists enables the profession and/or researchers to effectively assess and track professionalism levels.^2,26 Further, this clarity aids in crafting targeted strategies to refine and improve professionalism.^2,26 Therefore, the purpose of this study was to explore and describe the perceptions of professionalism among all college of pharmacy students and employees using behavioral scenarios. This understanding is vital to guarantee that future pharmacists are well prepared to meet the ethical and professional demands of their roles in a rapidly evolving health care setting.

2. Methods

2.1. Study Design

A prospective convergent parallel mixed-methods study was used. This approach included a cross-sectional, anonymous survey consisting of both closed- and open-ended questions to collect quantitative and qualitative strands, respectively (Figure S1). This study was considered exempt by the Institutional Review Board at the University of Michigan (HUM#00249645). Informed consent was obtained at the beginning of the survey, where participants were presented with the objectives and benefits of the study and asked to click forward to participate. This study was conducted as part of a pharmacy health services research class, and the integrated analyses were completed primarily by the first author.

2.2. Study Setting and Participants

This was a single-center study conducted at the University of Michigan College of Pharmacy, located in the Midwestern United States. Given that professionalism is shaped by the shared cultural norms within an institution, it was essential to explore diverse perspectives by including all individuals in the academic community to better understand how professionalism is perceived across different roles. Accordingly, all individuals affiliated with the college (n = 700) were invited to participate.

Participants were grouped into generational categories based on birth year ranges: Generation Z (born 1997–2012), Millennials (born 1981–1996), Generation X (born 1965–1980), and Baby Boomers (born 1946–1964). Further, participants were classified by their roles within the college as student pharmacists (eg, Bachelor of Science in Pharmaceutical Sciences and PharmD students), graduate students (eg, Master’s in Integrated Pharmaceutical Sciences and Doctoral students), staff, and faculty members.

2.3. Questionnaire Design and Development

A 36-item questionnaire including demographic characteristics, closed-ended questions (ie, quantitative strand), and open-ended questions (ie, qualitative strand) was developed. Eight professionalism scenarios comprised the quantitative strand and are described below. Selected scenarios included open-ended questions and represented the qualitative strand.

2.3.1. Demographic characteristics

Demographic variables, such as age, gender, race, ethnicity, nationality, and specific role at the college (classified into student pharmacists, graduate students, staff, and faculty), were collected.

2.3.2. Closed-ended questions (quantitative strand)

Eight different scenarios were developed to evaluate professionalism in academia, each focusing on a specific aspect of professionalism, such as respect, integrity, collaboration, reliability, and communication, and illustrating a particular behavior. Students on the research team were invited to select a professionalism concept of interest, each representing a common challenge encountered in an academic setting, and drafted initial scenarios accordingly. Thereafter, 2 faculty members independently reviewed and refined these scenarios, and final versions were agreed upon through team consensus. A list of scenario names is provided in Table 1. For each scenario, participants were asked to assess the level of agreement that the behavior was professional or not professional, the frequency with which they performed or observed the behavior, and their confidence in their ability to do the behavior. Each question used a 5-point Likert response scale. For instance, professionalism perceptions ranged from “mostly unprofessional,” “somewhat unprofessional,” “neither,” “somewhat professional,” to “mostly professional.” Behavior frequency ranged from “never,” “sometimes,” “about half the time,” “most of the time,” to “always.” Confidence level ranged from “not confident,” “somewhat confident,” “confident,” “very confident,” to “extremely confident.”

Table 1.

Descriptions and Core Concepts of the 8 Professionalism Scenarios.

Scenario	Brief description	Title (concept)
1	A student, without inquiring about the professor's preferred form of address, casually used the professor's first name while asking a question in the hallway. The professor, noticeably uncomfortable, gently interrupted and expressed a preference for a more formal title, "Professor [Last Name]."	Addressing Professors (Respect)
2	When there is a synchronous online option offered for in-person events such as classes, meetings, or seminars, you are more likely to choose to attend online and be in “multitask mode” so that you can also reply to emails, text friends, or do other work.	Choosing Convenience over Engagement (Conscientious)
3	Numerous seminars and conferences are provided by the College and University for your professional development. You sign up to attend an in-person event, such as a seminar with an invited speaker. You decide not to attend on the day of the event.	Commitment to Professional Development (Reliable)
4	You become aware that a classmate or colleague has plagiarized another researcher’s paper by copying sections from various sources without proper citation. You decide to report this behavior.	Reporting Academic Misconduct – Plagiarism (Integrity)
5	Because you now have access to advanced AI technology such as ChatGPT or U-M GPT for research and learning purposes, you now use it as your first resource over traditional methods like books or academic papers. You fail to cite the use of ChatGPT in your submitted assignment.	Proper Citation of AI Resources (Integrity)
6	In preparing your CV and cover letter for an application for an internship or new job, you include wording that slightly exaggerates or inflates your role on a project.	Integrity in Application Materials (Integrity)
7	Collaborating with team members from various cultural backgrounds can be difficult, as customs, gestures, and terminology can be unfamiliar. You are spending time getting to know your colleagues and working to understand their cultures.	Cross-cultural Collaboration (Collaborative)
8	Communication between faculty, staff, and students can be complicated due to the many channels of communication. A new faculty sets up a group chat like an iMessage or a Slack channel for students to join for questions and answers.	Effective Communication Channels (Communications)

Abbreviations: AI, artificial intelligence; ChatGPT, chat generative pretrained transformer; CV, curriculum vitae; U-M GPT, University of Michigan generative pretrained transformer.

2.3.3. . Open-ended questions (qualitative strand)

Four open-ended questions were incorporated in scenarios 1 (addressing professors), 2 (choosing convenience over engagement), 3 (commitment to professional development), and 7 (cross-cultural collaboration) from the 8 scenarios to gather additional insight into participants’ perceptions of professionalism. Similar to the scenarios themselves, these questions were initially drafted by student members of the research team and subsequently reviewed and refined by faculty members to ensure clarity. For instance, “What is your preferred form of addressing your professor?”, “Provide some examples of other tasks you have done while attending classes or seminars,” “What factors prohibited you from taking part in such an event?”, and “Please share instances, if any, from your experience where cultural or background differences have influenced teamwork and collaboration.”

2.4. Pretesting Process

Ten potential participants completed a survey pretest to assess the clarity and comprehensiveness of the questions. Most of these participants were graduate students enrolled in master’s and doctoral programs within the college. Minor modifications were made based on their feedback.

2.5. Data Collection Procedure

The survey was distributed to all student pharmacists (eg, Bachelor of Science in Pharmaceutical Science and PharmD students), graduate students (eg, Master’s in Integrated Pharmaceutical Sciences and Doctoral Students), staff, and faculty members in the college via institutional email lists. The survey was administered online using the Qualtrics platform over a 2-month period, from February to March 2024. Potential participants received 2 emails; the first email introduced and provided detailed information about the study, including its purpose, duration, survey link, and incentives. The second email was sent 1 week later as a reminder. The survey link remained open until the end of March. Within the consent process, participants were informed that they could skip any questions that did not apply to them or that they did not feel comfortable answering. As an incentive, 4 random respondents who volunteered to enter a raffle were selected to receive a $50 gift card.

2.6. Quantitative Data Analysis

Quantitative data were coded and analyzed using the Statistical Package for the Social Sciences (SPSS), version 23. Descriptive statistics were used. Categorical variables were reported as counts (n) and percentages (%), whereas continuous variables were presented as means and standard deviations (SD). The χ² and Fisher exact tests were used to assess the association between participants’ roles at the college and the 3 ratings for each scenario.

Continuous variables were dichotomized for analysis. Participants’ perceptions of professionalism were categorized as “unprofessional,” if they responded “mostly unprofessional” to “neither,” and as “professional” if they responded from “some professional” to “mostly professional.” “Neither” responses were categorized with “unprofessional” to create a clear distinction between active recognition of professionalism and its absence, thereby preventing the overestimation of professional perceptions. Further, behavioral frequency responses were categorized as “infrequent” for “never” and “sometimes,” and as “frequent” for “almost half of the time” to “always.” Finally, confidence levels were categorized as “unconfident” for responses of “not confident” and “somewhat confident,” and as “confident” for responses of “confident” to “extremely confident.”

Findings were considered statistically significant when the p-value was < .05.

2.7. Qualitative Data Analysis

Text responses from the open-ended questions were extracted and analyzed using summative content analysis.²⁷ Four members of the research team independently coded the text responses and then met to discuss and reach consensus on the codes. Thereafter, codes were grouped to create themes that reflect perceptions of professionalism. For example, in addressing professors (scenario 1), participants’ responses such as “Dr. Last Name” and “Professor Last Name” were inductively grouped into a broader theme of “Formal,” whereas “First Name” responses were organized under the theme of “Informal.” Lastly, the frequency of each code was quantified.

2.8. Mixed-Methods Integration and Analysis

The integration of mixed-methods data occurred at different levels (Figure S1).²⁸ At the study design level, a concurrent parallel analysis was used. At the method level, a merging technique was utilized. Frequency and percentages from the quantitative strand were merged with the themes and codes developed from the qualitative strand within 4 professionalism scenarios. At the interpretation and reporting level, a statistics-by-theme joint display²⁹ was created as a visual representation to show the integration of quantitative and qualitative results. Concordance was observed when the qualitative and quantitative findings aligned, whereas discordance occurred when the 2 findings contradicted or conflicted with each other.³⁰

3. Results

3.1. Participants’ Demographic Characteristics

Of the approximate 700 potential participants in the college, 134 completed the survey (response rate = 19.1%). Participants had a mean (± SD) age of 35 ± 12.8 years. The age range was 20–70 years, with a median (interquartile range) of 30 (19) years. Participants were predominantly female (70.7%), White (65.2%), non-Hispanic (93.3%), and American citizens (82.6%). Regarding roles at the college, 32.1% were student pharmacists, 28.4% were staff, 21.6% were faculty, and 17.9% were graduate students (Table 2). The sample of 134 participants provides a reasonable representation of the broader college population, which consists of about 530 students (75.7%), 100 staff members (14.3%), and 70 faculty members (10%). The gender distribution (27.8% male) is consistent with college trends, particularly among pharmacy and graduate students at 23% and 36%, respectively. Lastly, the racial composition of the sample (65.2% White) aligns with the institutional demographic profile, further supporting the sample’s representativeness.

Table 2.

Demographic Characteristics of the Participants (N = 134).

Characteristics	Mean ± SD or n (%)
Age (in y)	35 ± 12.8
Gender (n = 133)
Male	37 (27.8)
Female	94 (70.7)
Othersa	2 (1.5)
Race (n = 132)
White	86 (65.2)
Black or African American	5 (3.8)
American Indian or Alaska Native	0 (0)
Asian	29 (22.0)
Native Hawaiian and Other Pacific Islanders	0 (0)
Middle Eastern, North African, or Arab American	6 (4.5)
Multiracial	6 (4.5)
Ethnicity (n = 134)
Hispanic, Latine, or Spanish origin	9 (6.7)
Non-Hispanic, Latine, or Spanish origin	125 (93.3)
Nationality (n = 132)
Non-American Citizen	23 (17.4)
American Citizen	109 (82.6)
Role at the College (n = 134)
Student Pharmacists	43 (32.1)
Graduate Students	24 (17.9)
Staff	38 (28.4)
Faculty	29 (21.6)

^aOthers include nonbinary and prefer not to say.

3.2. Generational Distribution of Roles in the College of Pharmacy

Generation Z (ages 14–27, n = 62) consisted mostly of student pharmacists (66.1%), with some graduate students (29.0%) and very few staff members (4.8%), but no faculty. Millennials (ages 28–43, n = 37) were more diverse, with most being faculty (45.9%), followed by student pharmacists (32.4%), graduate students (n = 16.2%), and a few staff members (n = 5.4%). Generation X (ages 44–59, n = 29) was predominantly faculty (62.1%), with some staff members (37.9%) and no students. Baby Boomers (ages 60–78, n = 5) were entirely faculty members (100%). Overall, younger generations were mainly students, while older generations were primarily faculty and staff.

3.3. Distribution of Professionalism, Frequency, and Confidence Ratings Across Different Scenarios

Figure S2 is a stacked bar plot showing distribution percentages for professionalism perception, behavior frequency, and confidence level across 8 scenarios. For example, in scenario 1, most participants (93.6%) perceived addressing professors by their first names as unprofessional. Similarly, 87.1% of the participants reported they would infrequently call professors by their first names, and 95.2% felt confident in addressing their professors correctly. Five scenarios, including addressing professors (scenario 1), choosing convenience over engagement (scenario 2), commitment to professional development (scenario 3), proper citation of AI resources (scenario 5), and integrity in application materials (scenario 6), exhibited high ratings of unprofessionalism and high confidence to manage or learn to manage. Further, 2 scenarios, reporting academic misconduct (scenario 4) and cross-cultural collaboration (scenario 7), were generally considered professional, and ratings of all 3 questions were positive. Lastly, communication channels (scenario 8) showed more variability across the 3 ratings (Figure S2).

3.4. Differences in Professionalism, Frequency, and Confidence Ratings Across Different Roles Within the College

Within professionalism perceptions, 2 scenarios, integrity in application materials (scenario 6) and communication channels (scenario 8), differed by role in the college. For instance, in communication channels (scenario 8), student pharmacists (31.3%) and staff members (35.9%) were more likely to agree that it is professional to set up and communicate using channels like Slack and iMessage, whereas faculty members (35.7%) were more likely to view this as unprofessional (p =.00) (Table 3).

Table 3.

Perceptions of Professionalism, Reported Behavior Frequency, and Level of Confidence by Role Across Various Professional Scenarios.

Role of the participant in college	n (%)
	Professionalism			Frequency			Confidence
	Unprofessional	Professional	p-Value	Infrequent	Frequent	p-Value	Unconfident	Confident	p-Value
Scenario 1: Addressing professors
Student pharmacists a	40 (34.2)	1 (12.5)	.14	37 (34.3)	4 (25.0)	.47	0 (0)	41 (34.5)	.18
Graduate students b	19 (16.2)	4 (50.0)		21 (19.4)	2 (12.5)		1 (16.7)	22 (18.5)
Staff	32 (27.4)	2 (25.0)		26 (24.1)	7 (43.8)		3 (50.0)	31 (26.1)
Faculty	26 (22.2)	1 (12.5)		24 (22.2)	3 (18.8)		2 (33.3)	25 (21.0)
Total	N = 117	N = 8		N = 108	N = 16		N = 6	N = 119
Scenario 2: Choosing convenience over engagement
Student pharmacists	32 (30.2)	8 (47.1)	.21	4 (14.3)	36 (37.9)	.01c	23 (38.3)	17 (27.0)	.14
Graduate students	20 (18.9)	2 (11.8)		9 (32.1)	13 (13.7)		11 (18.3)	11 (17.5)
Staff	28 (26.4)	6 (35.3)		11 (39.3)	23 (24.3)		11 (18.3)	23 (36.5)
Faculty	26 (24.5)	1 (5.9)		4 (14.3)	23 (24.3)		15 (25.0)	12 (19.0)
Total	N = 106	N = 17		N = 28	N = 95		N = 60	N = 63
Scenario 3: Commitment to professional development
Student pharmacists	38 (32.2)	1 (25.0)	.42	30 (33.0)	9 (30.0)	.98	3 (21.4)	36 (33.3)	.67
Graduate students	20 (16.9)	2 (50.0)		16 (17.6)	6 (20.0)		4 (28.6)	18 (16.7)
Staff	33 (28.0)	1 (25.0)		25 (27.5)	8 (26.7)		4 (28.6)	30 (27.8)
Faculty	27 (22.9)	0 (0)		20 (22.0)	7 (23.3)		3 (21.4)	24 (22.2)
Total	N = 118	N = 4		N = 91	N = 30		N = 14	N = 108
Scenario 4: Reporting academic misconduct – plagiarism
Student pharmacists	9 (36.0)	29 (30.9)	.07	17 (51.5)	20 (25.3)	.00c	11 (44.0)	28 (29.8)	.09
Graduate students	6 (24.0)	16 (17.0)		8 (24.2)	14 (17.7)		7 (28.0)	15 (16.0)
Staff	2 (8.0)	30 (31.9)		6 (18.2)	22 (27.8)		5 (20.0)	26 (27.7)
Faculty	8 (32.0)	19 (20.2)		2 (6.1)	23 (29.1)		2 (8.0)	25 (26.6)
Total	N = 25	N = 94		N = 33	N = 79		N = 25	N=94
Scenario 5: Proper citation of AI resources
Student pharmacists	36 (31.6)	3 (50.0)	.89	28 (32.6)	10 (41.7)	.03c	15 (41.7)	24 (30.4)	.25
Graduate students	21 (18.4)	1 (16.7)		13 (15.1)	9 (37.5)		9 (25.0)	13 (16.5)
Staff	31 (27.2)	1 (16.7)		25 (29.1)	3 (12.5)		6 (16.7)	24 (30.4)
Faculty	26 (22.8)	1 (16.7)		20 (23.3)	2 (8.3)		6 (16.7)	18 (22.8)
Total	N = 114	N = 6		N = 86	N = 24		N = 36	N=79
Scenario 6: Integrity in application materials
Student pharmacists	35 (31.0)	4 (57.1)	.03c	23 (31.1)	16 (37.2)	.10	1 (20.0)	38 (33.6)	.12
Graduate students	19 (16.8)	3 (42.9)		10 (13.5)	12 (27.9)		3 (60.0)	19 (16.8)
Staff	32 (28.3)	0 (0)		24 (32.4)	7 (16.3)		1 (20.0)	31 (27.4)
Faculty	27 (23.9)	0 (0)		17 (23.0)	8 (18.6)		0 (0)	25 (22.1)
Total	N = 113	N = 7		N = 74	N = 43		N = 5	N = 113
Scenario 7: Cross-cultural Collaboration
Student pharmacists	3 (37.5)	36 (32.4)	.92	5 (17.9)	34 (37.8)	.03c	1 (25.0)	37 (32.7)	.49
Graduate students	2 (25.0)	20 (18.0)		3 (10.7)	19 (21.1)		2 (50.0)	20 (17.7)
Staff	2 (25.0)	30 (27.0)		9 (32.1)	22 (24.4)		1 (25.0)	31 (27.4)
Faculty	1 (12.5)	25 (22.5)		11 (39.3)	15 (16.7)		0 (0)	25 (22.1)
Total	N = 8	N = 111		N = 28	N = 90		N = 4	N = 113
Scenario 8: Effective Communication Channels
Student pharmacists	19 (33.9)	20 (31.3)	.00c	29 (38.2)	10 (27.8)	.00c	1 (25.0)	38 (33.3)	.07
Graduate students	8 (14.3)	14 (21.9)		10 (13.2)	12 (33.3)		0 (0)	22 (19.3)
Staff	9 (16.1)	23 (35.9)		14 (18.4)	13 (36.1)		0 (0)	32 (28.1)
Faculty	20 (35.7)	7 (10.9)		23 (30.3)	1 (2.8)		3 (75.0)	22 (19.3)
Total	N = 56	N = 64		N = 76	N = 36		N = 4	N = 114

Abbreviation: AI, artificial intelligence.

^aStudent Pharmacists include BSc and PharmD Students.

^bGraduate Students include Master’s in Integrated Pharmaceutical Sciences and Doctoral Students.

^cStatistically Significant p < .05.

Five scenarios, including choosing convenience over engagement (scenario 2), reporting academic misconduct (scenario 4), proper citation of AI resources (scenario 5), cross-cultural collaboration (scenario 7), and effective communication channels (scenario 8), differed significantly in behavior frequency ratings by role in the college. Specifically, choosing convenience over engagement (scenario 2) demonstrated a difference, with student pharmacists (37.9%) more likely to frequently choose to attend online and multitask, whereas staff and faculty (24.3%) and graduate students (13.7%) were less likely to do so (p =.01). Moreover, cross-cultural collaboration (scenario 7) indicated a difference across roles in the college. Student pharmacists (37.8%) were more likely to frequently engage and collaborate with members from different cultural backgrounds, whereas staff (24.4%), graduate students (21.2%), and faculty (16.7%) were less likely to do so (p =.03) (Table 3).

There was no difference in confidence levels by role in the college for all 8 scenarios (Table 3).

3.5. Qualitative Analysis

Content analysis results are provided in Table 4. Commitment to professional development (scenario 3) revealed several barriers that influenced the decision not to attend a professional development event despite prior registration. Time management issues (eg, time conflicts and being busy) were reported by 45% of participants. For example, 1 participant mentioned, “busy schedule leading to time constraint,” while another said, “unforeseen time conflict.” Health and emergencies emerged as another significant barrier, reported by 40% of participants. Specifically, participants mentioned “family emergency” and “if I am sick or my child is sick” (Table 4).

Table 4.

Content Analysis of Responses to Open-Ended Questions to Various Professionalism Scenarios.

Themes	Codes	n (%)	Example quotes
Scenario 1: Addressing Professors (Respect)
Question: What is your preferred form of addressing professors? (Total Comments; N = 177)
Formal	Dr. Last Name	86 (48.6)	“Dr. ———”; “Dr. + Last Name”; “Dr. ‘Last Name’”
	Prof. Last Name	49 (27.7)	“Professor [Last name]”; “Professor X”; “Professor *blank*”
Informal	First Name	26 (14.7)	“Professors ask that PhD students call them by their first name.” “As a staff member, usually by their first name, as we are colleagues.”
Others	Depends on the Situation	3 (1.7)	“First name on one-on-one settings; In a professional setting like a conference or classroom, I will address a Professor or Doctor”; “I am faculty, so generally address other faculty by first name if personal communication, but by Dr. or Prof. X if in a class setting.”
	Preference by the Person Addressed	12 (6.8)	“First name, unless they specify that they prefer a different title”; “Using titles like ‘Dr.’ or ‘Professor’ unless explicitly told otherwise (eg, ‘call me by my first name’).”
	No Preference	1 (0.6)	“No preference”
Scenario 2: Choosing Convenience over Engagement (Conscientious)
Question: Please provide 1 or 2 examples of other tasks that you have done while attending in-person/online classes and/or seminars. (Total Comments: N = 190)
Balancing Professional Responsibilities	Classwork	27 (14.2)	“Doing homework,” “Reviewing flashcards.”
	Scheduling	10 (5.3)	“Made to-do lists for the rest of the week”; “Update Planner.”
	Working	21 (11.0)	“Grading”; “Responding to patient-care questions if they arise”; “Writing a midterm exam”; “Reading articles/papers.”
Managing Personal Tasks	Shopping	4 (2.1)	“Browsing the internet (online shopping, etc.)”; “Shopping for birthdays.”
	Eating/Drinking	3 (1.6)	“Drinking water”; “Eating”
Communication and Social Interaction	Using Emails	75 (39.5)	“Check emails”; “Reading/Replying to emails.”
	Using Phone	42 (22.1)	“Check phone for texts,” “Phone game,” “Texting friends.”
Opting Out of Multitasking	Do not do “multimode task”	6 (3.2)	“During an in-person class or seminar, I usually pay full attention.” “I try to avoid that exclusively.”
Miscellaneous Activities	Others	2 (1.1)	“Surveys”; “Other Work”
Scenario 3: Commitment to Professional Development (Reliable)
Question: What factors prohibit you from taking part in such an event? (Total Comments: N = 127)
Time Management Issues	Day-of-Conflict	25 (19.7)	“Scheduling conflicts”; “Conflict arises”; “Unforeseen time conflict.”
	Priorities/Being Busy	32 (25.2)	“Busy schedule leading to time constraint.” “As a clinician, it is nearly impossible to guarantee attendance at a previously scheduled event. When patient issues arise over the course of the day, they are often given priority.”
Logistic Challenges	Transportation/Distance	11 (8.7)	“No transportation”; “Parking”; “Travel back to campus in the evening/on a day I am not already there”
	Weather Conditions	7 (5.5)	“Sometimes the weather is nasty, and I would just rather not go.” “Severe weather.”
Health and Emergencies	Sickness	25 (19.7)	“Being sick”; “Illness”; “Health problems”; “If I am sick or my child is sick.”
	Emergency Situations	25 (19.7)	“Urgent conflicting matters”; “Family emergency”; “Generally, I avoid canceling my attendance/participation last minute unless an emergency comes up.”
Commitment to Attendance	Do not skip events	2 (1.6)	“Do not sign up for events I would not participate in. Always attend if I sign up, I do not sign up if they are not worthwhile.”
Scenario 7: Cross-cultural Collaboration (Collaborative)
Question: Please share instances, if any, from your experiences where cultural or background differences have influenced teamwork and collaboration (Total Comments: N = 30)
Cultural and Religious Practices	Lack of Cultural Respect	4 (13.3)	“Disrespect for fasting during Ramadan, disrespect for other cultural and/or religious practices.”
	Cultural Awareness	6 (20.0)	“I have always worked with multicultural teams and have enjoyed learning about others' cultures, and in several instances, it has been sharing food and being part of multicultural events.”
Multicultural Experience	Being an International Student	3 (10.0)	“Because I’m an international student, sometimes my opinions get brushed off.” “I've experienced where some international students will stick together to do projects, especially if they are from the same country.”
Discrimination	Racism	2 (6.7)	“Someone in our team made a generalized statement of race based on a personal encounter. That act was very offensive to another team member, and an apology was tendered.”
Language Barriers	Language	6 (20.0)	“Language barriers, primarily when working with someone whose English is not their first language, significantly impact my ability to work or communicate with them.”
Team Dynamics and Collaboration	Team building	3 (10.0)	“I don’t understand. How could spending time getting to know your team ever be considered unprofessional? Isn’t this just part of team building?”
	Collaboration	3 (10.0)	“Being open-minded and accepting has always been a benefit throughout my career and has bolstered my ability to inspire collaboration.”
Lack of Cultural Clashes	None	3 (10.0)	“I cannot think of any time when it has been a problem or influenced teamwork.”

Cross-cultural collaboration (scenario 7) revealed both barriers and facilitators in working with team members from various cultural backgrounds. The cultural and religious practices theme (33.3%) can serve as either a facilitator or a barrier, depending on the context. For example, a lack of cultural respect was identified by 13.3% of participants, with a participant stating, “disrespect for fasting during Ramadan, disrespect for other cultural and/or religious practices,” illustrating a barrier. On the other hand, cultural awareness, identified by 20.0% of participants, was shown as a facilitator, where a participant shared, “I have always worked with multicultural teams and have enjoyed learning about cultures….” Language was another barrier identified by 20.0% of the participants. One participant stated, “language barriers, primarily working with someone with whom English is not their first language, and it significantly impacts my ability to work or communicate with them.” However, 20.0% of the participants showed that team dynamics facilitate cross-cultural collaboration, with a participant’s statement, “I don’t understand. How could spending time getting to know your team ever be considered unprofessional? Isn’t this just part of team building?” (Table 4).

3.6. Mixed-Methods Analysis

Table 5 presents a statistics-by-themes joint display. There was a strong concordance between the quantitative and qualitative findings for addressing professors (scenario 1). From the quantitative strand, 93.6% of participants said it is unprofessional to address professors informally, which aligns with the qualitative theme of formality, where participants mentioned quotes such as “Dr. ————,” and “Professor [Last Name].” This indicates a shared understanding of respect when addressing professors in academic settings (Table 5).

Table 5.

Integration of Quantitative and Qualitative Data on Professionalism Across Different Scenarios (Statistics-by-Themes Joint Display).

Scenarios	Quantitative results n (%)	Qualitative results theme (codes)	Example quotes	Meta-inference
Scenario 1: Addressing Professors	Unprofessional: 117 (93.6) Professional: 8 (6.4)	Formal (Dr Last Name; Prof. Last Name)	“Dr. ————”; “Professor [Last Name]”	Concordance The high percentage of participants who perceive informal addressing as unprofessional behavior aligns with participants’ text responses.
Scenario 2: Choosing Convenience over Engagement	Unprofessional: 106 (86.2) Professional: 17 (13.8)	Communication and Social Interaction (Using Emails)	“Check email”; “Reading/Replying to emails.”	Discordance The high percentage of participants who perceive choosing to attend an event online and multitasking as unprofessional behavior does not match the qualitative preference for multitasking.
Scenario 3: Commitment to Professional Development	Unprofessional: 118 (96.7) Professional: 4 (3.3)	Time Management Issues (Priorities/ Being Busy)	“Busy schedule leading to time constraint”; “As a clinician, it is nearly impossible to guarantee attendance to a previously scheduled event. When patient issues arise over the course of the day, they are often given priority.”	Discordance The high percentage of participants who perceive not attending a professional development event despite prior registration as unprofessional behavior contradicts participants’ practical challenges.
Scenario 7: Cross-cultural Collaboration	Unprofessional: 8 (6.7) Professional: 111 (93.3)	Cultural and Religious Practices (Cultural Awareness)	“I have always worked with multicultural teams and have enjoyed learning about others' cultures, and in several instances, it has been sharing food and being part of multicultural events.”	Concordance The high percentage of participants who perceive collaborating with team members from different cultural backgrounds is supported by positive qualitative experiences.
		Cultural and Religious Practices (Lack of Cultural Respect)	“Disrespect for fasting during Ramadan, disrespect for other cultural and/or religious practices.”	Discordance The high percentage of participants who perceive collaborating with team members from different cultural backgrounds does not match with participants’ comments.

Choosing convenience over engagement (scenario 2) showed that there is a significant discordance between the quantitative and qualitative results. Quantitatively, 86.2% of participants revealed that choosing to attend an event online and multitasking was unprofessional. However, communication and social interaction emerged as a theme, in which participants mentioned multitasking behaviors like “check email” and “reading/replying to emails.” (Table 5).

Similarly, the mixed-methods results for commitment to professional development (scenario 3) revealed notable discordance. Almost all participants (96.7%) perceived not attending a professional development event, despite prior registration, as unprofessional. Yet, the theme of time management issues was identified, and participants mentioned practical challenges, including “busy schedule leading to time constraint” and “as a clinician, it is nearly impossible to guarantee attendance to a previously scheduled event. When patient issues arise over the course of the day, they often take priority.” In addition, health and emergencies were noted as barriers, where participants said, “being sick” and “health problems” (Table 5).

Lastly, cross-cultural collaboration (scenario 7) showed both concordance and discordance. Quantitatively, 93.3% of participants rated cross-cultural collaboration as professional behavior, and this was corroborated in the qualitative results with a theme of cultural awareness. Participants reported positive experiences: “I have always worked with multicultural teams and have enjoyed learning about others' cultures, and in several instances, it has involved sharing food and being part of multicultural events.” Nonetheless, there was also a discordant theme of lack of cultural respect, with a participant statement, “disrespect for fasting during Ramadan, disrespect for other cultural and/or religious practices” (Table 5).

4. Discussion

This study explored the perceptions of professionalism across 8 professional behavioral scenarios in a Midwestern College of Pharmacy to gain new insights into how individuals of different generations and/or roles within the college perceive professional behaviors. Generally, the findings showed generational alignment in respecting academic hierarchy and shared challenges in managing professional commitments, based upon the results related to roles. However, discrepancies were observed between perceived and actual behaviors regarding technology use and cross-cultural collaboration. A comprehensive understanding of these perceptions will contribute to the ongoing development of education practices and academic environments to help ensure future pharmacists and scientists meet the ethical and professional standards required in health care and research.

4.1. Generational Similarities and Continuity in Professional Standards

There were notable generational similarities in upholding some professional values illustrated in the scenarios. For example, in addressing professors (scenario 1), respect for formality seems to be consistent across different roles and generations within the college, indicating that younger generations are adherent to academic titles and traditional professional norms while communicating. This behavior reflects that younger generations (ie, pharmacy and graduate students) are aware of hierarchical structures within academia and view these norms as a part of their professional identity and development, rather than as a barrier to effective communication. Previous studies showed conflicting results,^31–33 suggesting that reducing the social distance within teams can improve teamwork.³³ For instance, medical students reported that the perception of hierarchy norms, including addressing professors by their titles and last names, can prevent them from reaching out for assistance, which potentially hinders the learning and collaboration experience.^32,33

Another commonality was that barriers, including time management and health emergencies, frequently restricted members from fulfilling their professional commitments. These challenges were reported across all roles, which reflects that this issue is not only a generation-specific concern but a broader issue that impacts professionals at all career stages. Similar barriers were identified in previous studies, such as difficulties in maintaining a life-work balance, obtaining time off from work, and managing costs.^34–36 These results pinpoint the importance of flexibility and support to help members navigate these challenges.

4.2. Discordance in Technology Use and Professional Commitments

There was a clear disconnect between participants’ perceptions of professionalism and their actual behavior regarding technology use. For example, when choosing convenience over engagement (scenario 2), the majority of college community members reported multitasking to be unprofessional, but many still engaged in it. This behavior reflects the challenges of maintaining ideal professional standards in a digitally dominated environment, where the pressure to be efficient and productive can conflict with previously established traditional norms.^15,37,38 Younger generations may view multitasking as essential to adapt to the demands of contemporary academic and professional life, even though they recognize that it is unprofessional.^39,40 However, evidence indicates that multitasking behavior is not exclusive to younger generations.⁴⁰ Though younger generations reported more frequent multitasking, older generations also engaged, but to a lesser extent.⁴⁰ This suggests that multitasking is a common practice across age groups, challenging the assumption that it is unique to younger individuals.

4.3. Discordance in Cross-Cultural Challenges and Professional Expectations

Cross-cultural collaboration (scenario 7) revealed a notable recognition of the value of cultural awareness and competence, yet some respondents reported barriers to collaboration, including the lack of cultural respect and language difficulties. This contrast underscores a gap between the theoretical acceptance of diversity and its practical implementation. Moreover, the results suggest that persistent challenges remain in creating a truly inclusive environment where every member of the community feels respected and valued. Therefore, to address these challenges, there is a need for targeted interventions such as cultural competence training and the development of inclusive communication strategies.^41–43 Implementing these interventions would not only be beneficial to enhance the collaboration of student pharmacists but could possibly improve interactions between future pharmacists and their patients.⁴⁴

This study has several limitations. First, a low response rate (19.1%) and a single institution raise concerns about potential response bias and limit the generalizability of the findings, as participants may not fully represent the entire College of Pharmacy community. Second, the cross-sectional nature of the study precludes causal inferences, since it captures perceptions at a single point in time. Third, the use of self-reported measures rather than unobtrusive observation might introduce social desirability bias, where participants might overestimate their beliefs or behaviors to align with socially acceptable norms. However, this concern is addressed, as the survey was anonymous. Fourth, the analysis examined differences in responses across roles (eg, students, faculty, and staff), yet provides some insights into generational cohorts, as Baby Boomers were faculty, whereas Millennials and Generation Z were mostly students. Fifth, participants’ interpretations of certain scenario prompts may have differed based on their roles in the college, but the survey was pretested for understandability before it was put in the field. Future studies with larger sample sizes should consider subgroup analyses (eg, student pharmacists vs graduate students) to unravel potential role-specific or generation differences in perceptions of professionalism. Lastly, the selected scenarios may have influenced the findings, as 1 scenario cannot fully capture the complexity of professionalism concepts. Alternative scenarios might have elicited different responses.

5. Conclusion

This study explored both similarities and differences in professionalism behavior by roles in the College of Pharmacy. Although respect for academic hierarchy remains strong across all roles and generations, students and younger generations tend to embrace multitasking and digital communication. Challenges in cross-cultural collaboration persist, necessitating the need for cultural competence training to foster more inclusive and effective teamwork.

Appendix A. Supporting information

Supplementary data associated with this article can be found in the online version at doi:10.1016/j.ajpe.2025.101921.