Selecting students with personal characteristics relevant to pharmaceutical care

American Journal of Pharmaceutical Education, Summer 1999 by Wright, Sandra S, Miederhoff, Patrick A

This article proposes that pharmacy schools incorporate formal assessments of self-reported empathy in the admissions process. A valid measure of this construct will allow for the selection of students with the personal qualities necessary for patient counseling and other aspects of pharmaceutical care. With this in mind, two approaches to measuring self-reported empathy (forced-choice format versus direct self-ratings) were examined to determine which method was the best predictor of patient counseling skills. The results suggested that forced-choice self-descriptions of empathy were more predictive of performance in simulated patient-pharmacist interactions than a more traditional, direct self-rating approach. Suggestions for the appropriate use of self-reported empathy in the pharmacy school admissions process are discussed.

INTRODUCTION

The full implementation of pharmaceutical care will require practitioners that are committed to working with patients with a caring, compassionate concern for their total well-being. Pharmacy education has a primary responsibility for producing graduates with qualities that contribute to this helping orientation. While these qualities may, to some extent, be engendered by appropriate educational experiences(1), an admissions process that selects for individuals with a helping orientation may increase the likelihood of success(2,3).

According to Carl Rogers, one of the most influential theorists in the counseling professions, one prerequisite to effective helping relationships is empathy. Empathy may be defined as "the ability to accompany another to wherever the other person's feelings lead him."(4) In Roger's view, empathy enables practitioners to establish the trusting relationship necessary to help patients. Studies of practitioner-patient interactions in health settings have confirmed that practitioners who are high on measures of empathy, as rated by trained observers, elicit more positive responses from patients than practitioners low on measures of empathy(5).

In light of research which suggests that empathy is an important quality for helping relationships, including health practitioner-patient relationships, it is proposed that pharmacy schools include an assessment of this trait, along with more traditional criteria (e.g., GPA and PCAT scores) for use in admission decisions. However, a valid and practical measure of this construct is needed before it can be introduced into the pharmacy school application process.

Difficulties in Selecting Empathic Students

Empathy, like any personality trait, is a difficult construct to measure accurately. This is particularly true in college admissions or job applicant situations where respondents wish to create a positive impression(6). For example, pharmacy school applicants, if asked whether they enjoy helping people or if they are caring individuals, may answer in the affirmative if they realize these traits are considered to be important for future health professionals. Because the questions included in most inventories which measure empathy are very obvious in their intent, they may be of little use in discriminating between applicants who are truly empathic and those who are "faking it" in order to be selected for admission to pharmacy school.

The inclination to fake responses to present a positive image, known as "social desirability," limits the usefulness of many self-report psychological inventories(6,7). For example, in one study of simulated patient-health practitioner interactions, Jarski(8) found that students' self-reported empathy scores were unrelated to behavioral measures of empathy, as assessed by trained observers. Invalid self-ratings, such as those found by Jarski, hinder the predictive validity of such instruments. In other words, self-ratings that are inaccurate will not allow for the prediction of behaviors that are supposed to be related to a particular personality trait.

To overcome the problem of social desirability associated with the use of many personality inventories, some inventories utilize a forced-choice format, which requires respondents to choose between equally positive alternatives when describing themselves(6). In one adaptation of this methodology, DuncanHewitt attempted to create a personality inventory to identify applicants who possess the necessary qualities to practice patient-centered pharmacy(8). The instrument instructed applicants to write down three nonacademic activities in which they were involved over the past year. Afterwards they were asked to choose, from a list of positive descriptors, up to three adjectives to describe themselves when they participate in each of the three activities. She then compared their responses to a list of 35 descriptors previously identified by community pharmacists as necessary for practicing pharmaceutical care to determine which students would be most likely to be successful. She tested the predictive validity of the inventory by examining the relationship between students' responses and performance in the first year of the problem-based and practice-oriented curriculum at the University of Toronto. She found that students' scores on the personality inventory were a significant predictor of academic success in that curriculum.