Self-directed professional development: The pursuit of affective learning

American Journal of Pharmaceutical Education, Fall 2001 by Brown, Daniel L, Ferrill, Mary J, Hinton, Andrea B, Shek, Allen

The inconsistent professional socialization of students is a growing concern among pharmacy educators. Numerous commission reports highlight the need for curricular reform designed to inculcate strong professional values. Student-centered learning methods aimed at developing affective skills need to be integrated into the predominantly cognitive teaching practices that currently exist. A "self-directed professional development"(SPD) program was established that included three elements: (i) patient medication advocacy that promotes a service-oriented covenant between students and patients; (ii) self-directed learning that prompts students to take responsibility for their own professional growth and develop lifelong learning habits; and (iii) effective time management that provides students with the tools and motivation to manage multiple tasks. SPD was implemented in a six-week internal medicine rotation. Results after eight rotations demonstrated the benefit of values-based, affective teaching methods. This program focused exclusively on an experiential training environment, but every component of a pharmacy curriculum should emphasize the development of sound professional values.

INTRODUCTION: A PROFESSION IN SEARCH OF PROFESSIONALISM

During the past decade, pharmacy educators have become increasingly aware of the need to focus on values that foster professionalism. The AACP Argus Commission reported in 1991 that many pharmacists lack pride in their profession and do not hold their professional self-worth in high regard(1). The Commission further stated that pharmacy educators bear a responsibility to instill in students a clear sense of the profession's societal purpose and to encourage each student to develop a personal practice philosophy. The 1993 report "Health Professions Education for the Future: Schools in Service to the Nation" of the PEW Health Professions Commission, emphasized a need for education that centers on a clear set of professional values(2,3). In 1998, the Advisory Panel on Educational Outcomes of the AACP Center for the Advancement of Pharmaceutical Education reconvened to revise the guidelines that it originally developed in 1994(4). These outcomes were intended to guide faculty and administrators in assessing and revising pharmacy curricula. Among the educational objectives listed were, "Display the attitudes, habits and values required to render pharmaceutical care," and "Self-assess learning needs and design, implement, and evaluate strategies to promote intellectual growth and continued professional competence." In 2000, the White Paper on Pharmacy Student Professionalism culminated a five-year effort by the APhA Academy of Students of Pharmacy-AACP Council of Deans Task Force on Professionalism(5). This report emphasized that pharmacy students should be guided to pursue two parallel tracks of accountability: to assume greater responsibility for patient care, and to assume greater responsibility for their own professional development.

Impact of Pharmacy's Identity Crisis on Professional Socialization

The White Paper on Pharmacy Student Professionalism also explores the concept of "inconsistent socialization," as originally described by Manasse, et al.(6). Professional socialization refers to the process by which entrants into a profession acquire the attitudes, values, skills and knowledge that are characteristic of the profession(7). However, a profession that is characterized by conflicting ideologies does not provide a consistent, uniform identity upon which to base professional attitudes(6). The professional socialization of pharmacy students is undermined by the ongoing dichotomy that exists between the professional and mercantile aspects of pharmacy(5,8). Many students find themselves increasingly disillusioned and disappointed with pharmacy as a career. They see the highly-professional pharmaceutical care model of practice for which they have been preparing, in stark contrast to the technical, product-oriented, distributive practice that awaits many upon graduation. This uneasy balance between the professional and business functions of pharmacy has generated conflict and ambiguity among pharmacy practitioners since the earliest days of the "clinical pharmacy" movement(8). Despite a continually shifting emphasis from product distribution to pharmaceutical care, the pendulum has yet to swing far enough to provide students with a consistent vision of pharmacy practice, one that can serve as a framework upon which to build a solid set of professional values.

As the 1991 Argus Commission highlighted, pharmacy practitioners and educators share in the responsibility to raise the level of professionalism in pharmacy(1). Nurturing strong professional values in students as they progress through the pharmacy curriculum is no easy task. Some studies have shown that students' beliefs about professionalism do not significantly improve during pharmacy school and that the process of professional socialization is incomplete(9,10). Other studies suggest that professional attitudes deteriorate during pharmacy school, despite faculty efforts to the contrary, and students tend to become more cynical and disillusioned about pharmacy as graduation approaches(11,12).