Report of the AACP Professionalism Task Force, May 2011

CHARGE TO THE TASK FORCE

President-Elect Rod Carter created the AACP Professionalism Task Force as a special committee to serve during his term of office in 2010-2011. The Task Force met in Chicago, Illinois on February 4-5, 2011 and conducted the remainder of its business via conference calls and electronic media. The Task Force was specifically charged to examine the current status of the various initiatives, which aim to build and assess professional attitudes and behaviors in student pharmacists, including:

• Leadership;

• Interprofessional professionalism;

• Honesty, ethics and e-professionalism; and

• Admissions implications.

BACKGROUND

Professionalism of its practitioners is an area the profession of pharmacy has been striving to improve for many years. As the pharmacist's role has evolved to include more patient care activities and less dispensing activities, professionalism has become a critical component of the skills necessary to provide this level of patient care and to be fully recognized as an equal partner in healthcare. The profession has adopted the Doctor of Pharmacy entry-level degree, resulting in longer and more rigorous educational programs. In addition, these programs require an increased duration of pre-pharmacy work to prepare graduates for a more patient-centered role in healthcare. An essential component of this preparation is the development of professional attitudes and behaviors. The responsibility of the development of these professional attitudes and behaviors ultimately lies with the student. However, it is influenced by their pre-pharmacy experiences, as well as by the faculty of colleges and schools of pharmacy (COP/SOP) where they earn the Doctor of Pharmacy degree.

The American Association of Colleges of Pharmacy (AACP) has been significantly engaged in addressing the issue of professionalism in the past. Two important reports serve as examples of the association's work in this area. In 1999, the AACP Council of Deans/APhA-ASP Task Force on Professionalism published a white paper on pharmacy student professionalism that was a culmination of a five-year commitment to study and promote pharmacy student professionalism. Recommendations were made for students, academia (including recruitment, admissions, educational programs, and practice), and practitioners.¹ After reviewing the recommendations of the AACP-ASP Task Force, the AACP House of Delegates later adopted a resolution that encouraged the inclusion of students in the admissions process as a means of enhancing professionalism within the Academy.² Among other things, the AACP-ASP Task Force also developed the Pharmacy Professionalism Toolkit for Students and Faculty. This resource is still available on the APhA website and provides specific activities and strategies students and administrators can utilize to promote and assess professionalism effectively on their own campuses.³ The second major report was the AACP White Paper on Student Professionalism commissioned in 2003.⁴ This report identified specific strategies the Academy should embrace to enhance professionalism in COP/SOP. In addition to these two reports, AACP's current Strategic Plan includes numerous strategic directions and objectives dealing with professionalism in its Critical Issue #1 (Human Resources for Education, Research, Service) and Critical Issue #3 (Professional Practice Development) sections.⁵ Many of AACP's surveys also work to assist COP/SOP in assessing elements of professionalism through the Graduating Student Survey, Alumni Survey, Faculty Survey, and the Preceptor Survey.

The Accreditation Council for Pharmacy Education (ACPE) has also emphasized the importance of professionalism in its Standards and Guidelines, especially through Standard Number 23: Professional Behavior and Harmonious Relationships.⁶ This standard outlines policies that should be developed related to expected behaviors and consequences for deviation from these policies, as well as student government opportunities. This standard also encourages formal and informal activities to foster harmonious relationships and mentoring opportunities, along with strategies and programs designed to broaden the professional horizons of students. Also included is the encouragement to evaluate the status of these relationships.

SUMMARY OF THE TASK FORCE'S WORK

The Professionalism Task Force used a variety of approaches to address the various issues it identified. The following provides a description of actions taken, as well as recommendations from the Task Force.

The Task Force first discussed current barriers and challenges to professionalism within the Academy. Common barriers included:

• lack of effective instruments to assess student professionalism at the time of admissions and throughout the curriculum;

• behaviors of faculty members, preceptors, and practicing pharmacists that sometimes fail to model excellent professional behaviors and skills;

• decreased faculty morale in some institutions;

• ineffective advising and a lack of career development opportunities; and

• difficulty in identifying the true cause of anti-professionalism culture within professional education.

As the barriers and challenges were being discussed, the Task Force expressed the desire for tangible, practical, and faculty-friendly tools to overcome these barriers and challenges.

The Task Force then determined how it would define professionalism throughout its discussions. Many definitions were cited, which also represents another barrier to addressing professionalism – many definitions exist, and professionalism is often described as something that “you know when you see it.” In 1999, the AACP Council of Deans/APhA-ASP Task Force on Professionalism defined professionalism as the active demonstration of the traits of a professional. The traits of a professional include:

1. Knowledge and skills

2. A commitment to self-improvement and lifelong learning

3. A service-minded orientation

4. Pride in the profession and a dedication to advance its value to society

5. Create a covenantal relationship with those served

6. Alertness, creativity, initiative, and innovation

7. Conscientiousness, integrity, and trustworthiness

8. Flexibility and punctuality

9. Accountability for his/her performance

10. Ethically sound decision making and moral behavior

11. Leadership

The next phase of the deliberations centered on the question of how professionalism is nurtured and developed in professional students. Many influences were identified including: the influence of faculty and faculty advisors, the influence gleaned from participation in student organizations and participation in service learning and extra-curricular projects. Also discussed were the topics of e-professionalism and social media, leadership development, and interprofessional professionalism behaviors. Effective strategies articulate the message of the importance and necessity of professionalism and the consequences of unprofessional behaviors. These strategies must begin during the admissions process and be built upon and reinforced throughout the curriculum. Strategies must be inclusive of the behaviors of all the members of the Academy (i.e., faculty members, administrators, preceptors, students).

The Task Force recognized elements of professionalism can certainly be taught within the curriculum. More importantly, professionalism must be modeled and demonstrated by the entire Academy. The Task Force also recognized that elements of professionalism are intertwined with elements of leadership. So, leadership development programs must include discussions of professionalism issues, and vice versa.

The Task Force also discussed service learning as an integral mode for pharmacy students to learn, to care and to develop professional behaviors. Jacoby and colleagues⁷ defined service learning as “…a form of experiential education in which students engage in activities that address human and community needs together with structured opportunities intentionally designed to promote student learning and development.” To survive, the profession of pharmacy must establish its place as a patient- and relationship-centered profession.⁸ The challenge proposed by Murawski and colleagues⁹ is to “incorporate ways to train pharmacy students to use knowledge and care giving capabilities more effectively in patient problem solving and serving patient needs.” Service learning increases student sensitivity to patient needs and the social context in which those needs are met. Service learning experiences contribute to student development of desired general outcomes, such as communication, aesthetic sensitivity, professional ethics, social interaction and citizenship, and nurture development of professionalism.

RECOMMENDATIONS

Based on its research and deliberations, the Task Force makes the following recommendations:

Recommendation 1: Members of the Academy should re-read the two previously developed reports regarding professionalism: the 1999 report of the APhA-ASP/AACP-COD Task Force on Professionalism¹ and AACP's 2003 White Paper on Student Professionalism.⁴ Many of the issues discussed within these reports still exist today, especially the necessity to change positively the culture of professionalism within COP/SOP.

Recommendation 2: The Professionalism Task Force should become a long-standing committee of the Student Services Special Interest Group to continue necessary work to develop tangible, practical, and faculty-friendly tools to overcome the barriers and challenges of professionalism.

Recommendation 3: AACP should develop Train-the-Trainer faculty development programs focused on professionalism to expose more faculty to professionalism issues existing within the Academy. These programs would be presented in a 2-year format where attendees would reconvene to report about successes and challenges of implementing the suggested strategies at their institutions.

Recommendation 4: AACP should also develop Train-the-Trainer programs designed to acquaint faculty with how to assess emotional intelligence during the interview process and throughout the curriculum. The concept of emotional intelligence as an underpinning to professional behaviors and attitudes should be an integral component of these programs.

Recommendation 5: ACPE should modify Standard 23 to assure COP/SOP employ professionalism assessment instruments as part of their assessment processes. In addition, COP/SOP should be encouraged to map professionalism initiatives back to the curriculum to demonstrate evidence that COP/SOP are achieving the Standard. ACPE should also modify Guideline 26.1 to assure faculty development programs include strategies to enhance faculty professionalism, especially related to their advising of students.

Recommendation 6: ACPE should ask ACPE site visitation teams to identify best practices related to professionalism, such as effective service learning experiences. These then could be included in the AACP/ACPE Assessment and Accreditation Management System for the benefit of other COP/SOP.

Recommendation 7: Within the Pharmacy College Application Service (PharmCAS) essay question process, students should be asked to describe their concept of professionalism, assess their own, and how it has shaped their career goals.

Recommendation 8: PharmCAS should also revise the evaluation rubric for letters of reference to provide more guidance to evaluators so that they monitor professionalism issues within student applications.

Recommendation 9: AACP should support the development of pre-professional portfolio systems and their use in the admissions process; and extending portfolio use throughout the professional curriculum.

Recommendation 10: The Career Information Clearinghouse (a collaboration of national pharmacy organizations committed to promoting the pharmacy profession and the pharmaceutical sciences) should work to develop a tool for assessing professionalism during the admissions process.

Recommendation 11: AACP should develop an award for innovative professionalism program collaboration amongst multiple COP/SOP.

Recommendation 12: AACP should explore the creation of an interprofessional professionalism project involving other health disciplines. At the same time, AACP should continue its involvement with the current Interprofessional Professionalism Collaborative (IPC) http://interprofessionalprofessionalism.weebly.com/.

Recommendation 13: AACP should work with APhA-ASP to review the previously developed Professionalism Toolkit and update its relevancy and utility in today's environment. APhA-ASP should be encouraged to explore the possibility of providing a search option within the online Toolkit to make it more user-friendly. One proposed idea is to involve the Walmart Scholars in the Toolkit revision process.

Recommendation 14: AACP should partner with other national organizations whenever appropriate to assure that professionalism-related topics are addressed in various venues (e.g., conferences, journal articles). For example, collaborative programming programs with AAPS would provide excellent opportunities to discuss professionalism with pharmaceutical scientists.

Recommendation 15: Leadership development programs/initiatives (e.g., embedded in course work, service learning initiatives, or experiential learning) must include creation of strategies needed to enhance individual student-leader professionalism and professionalism within student organizations.

Recommendation 16: AACP should develop a template for COP/SOP endeavoring to develop a social media policy. COP/SOP are encouraged to incorporate statements related to e-professionalism and the student-faculty relationship on the social network into their student handbook and individual course syllabi.