PROFESSIONALISM

S. Scott Wisneski, PharmD, MBA, and Mate M. Soric, PharmD, BCPS

CASE

M.B. is a pharmacy student currently completing her ambulatory care APPE rotation. During the midpoint evaluation, her preceptor expresses concern regarding certain behaviors that she had displayed during the rotation. M.B. arrived late on three separate occasions and did not complete a recent patient case exercise by the assigned due date. The preceptor is also extremely concerned about a comment that M.B. made to a fellow pharmacy student, in which she stated, “I don’t like working with the diabetic patients at this clinic; they are all noncompliant and don’t follow recommendations for their diet and blood sugar checks. I just want to get through this rotation so I can graduate and start working as a hospital pharmacist.” The preceptor informs M.B. that if her professional behavior does not improve over the remaining weeks of the rotation, she will likely receive a failing grade. M.B. is surprised with the evaluation and believes her tardiness was not excessive and that her lateness in completing the assignment should be excused due to the high demands of the rotation. She admits to the comment regarding the clinic patients but states, “I was just joking, and I really care about the patients. I am always professional.” She asks to have fewer patients to follow so she can spend more time increasing her drug knowledge. M.B.’s preceptor denies this request; he indicates that he wants her to spend more time counseling patients. He also states that he will not tolerate any further occurrences of tardiness or delays in completing assignments.

WHY IT’S ESSENTIAL

Over the course of the didactic curriculum, you likely heard the term professionalism mentioned many times. Although the many definitions of the word may not be easily recited, most students can describe its characteristics and identify its importance to the profession. Faculty and preceptors expect their students to act professionally. Beyond the academic setting, employers, staff, healthcare providers, peers, and patients will all presume a high degree of professionalism from you as well. Professionalism is the essential element of the profession of pharmacy.

To care for patients, you must not only acquire the vital clinical knowledge and practice-related skills but also develop the values, attitudes, and behaviors of a healthcare professional. Without these elements, clinical knowledge cannot be effectively parlayed into improved patient outcomes. Luckily, before your formal training begins, you already possess some of the key values and attitudes of a pharmacist. For example, applicants to a pharmacy school often indicate that wanting to “care for patients” is their prime reason for pursuing a career as a pharmacist. Once in the classroom, students learn the definition of professionalism and its associated behaviors. You may participate in a white coat ceremony, recite a code of ethics, sign a statement of professionalism, and join professional organizations, all of which aid in your professional development.

The IPPEs provide an opportunity to observe preceptors and further develop the attributes and behaviors of professionalism. You will develop professional communication skills through your interactions with practice site staff, healthcare professionals, and patients. Throughout the IPPEs, you are assessed not only on your practice-related skills and knowledge but also your professionalism. Preceptors and experiential program staff will provide feedback and, if needed, counseling on how you can improve your professional behavior. Positive feedback includes statements such as the following:

“The student displays a high level of professionalism and will be an excellent pharmacist.”

“The student dressed professionally and was always either on time or early for rotation activities.”

“Remarkable student — I would like him to be my partner pharmacist in the future.”

When a student has displayed unprofessional behavior, examples of comments from a preceptor may include:

“The student was continually 5 to 10 minutes late to the site and needs to improve if she wants to become a pharmacist.”

“The student shows no initiative to want to learn and ask questions.”

“Needs to be more aware of his appearance and how he presents himself to my customers.”

By the time you begin your APPEs, you should have had ample opportunity to develop appropriate professional behavior. The APPEs bring their own unique circumstances to test one’s professionalism. You will be spending more time on rotations, interacting with healthcare providers, and caring for a greater number of patients. There are additional assignments and increased demands placed on you by your preceptors. Being on time for daily activities, maintaining a professional appearance, and interacting properly with others will be more challenging compared to the IPPEs. You need to be aware of this in order to avoid any erosion of your professionalism. By the end of the APPEs, you should have developed your professionalism to a level where you are prepared to begin a career as a pharmacist.

PROFESSIONALISM DEFINED

Many definitions of professionalism have been published in the healthcare literature.^1-3 In pharmacy, we often focus on the behavioral attributes of professionalism, including appearance, timeliness, politeness, initiative, and life-long learning. Chalmers described professionalism in the following way:

Professionalism is displayed in the way pharmacists conduct themselves in professional situations. This definition implies a demeanor that is created through a combination of behaviors which include courtesy and politeness when dealing with patients, peers, and other healthcare professionals. Pharmacists should consistently display respect for others and maintain appropriate boundaries of privacy and discretion. Whether dealing with patients or interacting with others on a healthcare team, it is important to possess and display an empathetic manner.²

QUICK TIP

Take a moment to reflect on the personal attitudes you have regarding the profession of pharmacy. Have your attitudes changed since you entered pharmacy school? Who or what has influenced those attitudes? How does your professional behavior stem from your attitudes and beliefs about the profession?

The American College of Clinical Pharmacy National StuNet Advisory Committee developed the Tenets of Professionalism for Pharmacy Students, which outlined the key attitudes and behaviors that exemplify professionalism and that should be developed and practiced by all students.⁴ These tenets and associated behavioral attributes include the following:

Altruism

• Commit to serve the best interest of the patient above one’s own
  
• Make the patient the top priority in all healthcare decisions
  
• Place patient care before ability to pay, managerial opinions, or self-interests
  
• Actively listen; be patient and compassionate when interacting with the patient

Honesty and Integrity

• Display honor and trustworthiness
  
• Preserve patient and business confidentiality
  
• Maintain academic honesty in the classroom and on experiential rotations
  
• Avoid plagiarism

Respect for Others

• Treat others as you would want to be treated
  
• Show respect for patients, preceptors, faculty, and healthcare providers
  
• Demonstrate empathy
  
• Demonstrate effective listening skills
  
• Display cultural sensitivity and tolerance
  
• Exhibit self-control in interactions with others
  
• Value the opinions and recommendations of others in practice

Professional Presence

• Conduct yourself in a professional manner in both professional and personal settings
  
• Maintain proper professional dress, proper hygiene, grooming, and overall appearance
  
• Maintain a professional, organized portfolio
  
• Carry yourself in a way that will instill confidence and trust with patients and colleagues
  
• Display an enthusiastic attitude and personal commitment to the profession

Professional Stewardship

• Actively participate in professional organizations
  
• Volunteer for service-oriented activities
  
• Be a role model for those in the profession and other healthcare fields
  
• Inform the community about the profession

Dedication and Commitment to Excellence

• Accept responsibility for your own learning and self-development
  
• Be self-directed and demonstrate accountability in completing tasks
  
• Demonstrate timeliness and appropriate time-management skills
  
• Aspire to be a life-long learner
  
• Stay current with changes in the profession, practice guidelines, new drug therapies, emerging technology, and state and federal legislation
  
• Proactively seek guidance to achieve the goal of excellence
  
• Exceed the expectations of others

These tenets are similar to those that have been published elsewhere^1,3,5-8 but are unique by focusing primarily on student professionalism. Throughout the APPEs, you should strive to follow and practice according to these tenets. This will help you to fully incorporate the lifelong attitudes and behaviors expected by members of the pharmacy profession and the patients you will serve.

CASE QUESTION

Which of the tenets of student professionalism is M.B. failing to exhibit? Describe one way that M.B. can improve her behavior based on the tenets of student professionalism described above.

QUICK TIP

Identify whether each tenet of student professionalism can be categorized as challenging or simple to incorporate into your professional practice. For each one that is challenging, develop a plan to bring your behaviors into alignment with professional expectations.

Professionalism in Pharmacy Practice

Historically, pharmacists have been regarded by the public as professionals with a high level of integrity and ethics. A 2009 Gallup poll ranked pharmacists the highest in honesty and moral standards among all professions.⁹ In pharmacy practice, the relationship between a pharmacist and a patient is not commercial but covenantal, or fiducial. Fiducial is derived from the Latin fides, meaning faith, clearly affirming that faith and trust underlie professional interactions.¹⁰ Pharmacists have the knowledge and skills critical to help maintain the well-being of their patients. Because patients do not fully understand the knowledge and skills provided, they entrust the pharmacist with their well-being. As a result, the pharmacist, as a professional, must always act in the best interest of the patient. If the profession is to maintain its prestige, pharmacists and students must keep the covenantal relationship as the core element of their practice. It demands that one be altruistic, maintain a high standard of integrity and competence, and provide expertise on matters of appropriate medication use and health.

In 1990, Hepler and Strand introduced the concept of pharmaceutical care.¹¹ Pharmaceutical care involves the pharmacist assuming responsibility for drug therapy outcomes in addition to the safe, accurate, and efficient distribution of pharmaceutical products. It moved the profession from a product focus to more of a patient focus. This shift in practice brings an expanded sense of professionalism among pharmacists committed to achieving optimal therapeutic outcomes in their patients.¹ Many in the profession have embraced and implemented pharmaceutical care to make a difference in the health and lives of patients. Services such as medication therapy management, collaborative practice, medication reconciliation, and administration of immunizations are just a few examples of pharmacists incorporating pharmaceutical care into practice. As these services become more prevalent, the commitment to professionalism will continue to expand. You need only to refer to the Pledge of Professionalism adopted by the APhA-ASP/AACP Council of Deans Task Force on Professionalism to understand how professionalism is implemented in everyday practice (see Figure 1-1).

Figure 1-1. Pledge of Professionalism

As a student of pharmacy, I believe there is a need to build and reinforce a professional identity founded on integrity, ethical behavior, and honor. This development, a vital process in my education, will help to ensure that I am true to the professional relationship I establish between myself and society as I become a member of the pharmacy community. Integrity will be an essential part of my everyday life and I will pursue all academic and professional endeavors with honesty and commitment to service.

To accomplish this goal of professional development, as a student of pharmacy I will:

A. DEVELOP a sense of loyalty and duty to the profession by contributing to the well-being of others and by enthusiastically accepting responsibility and accountability for membership in the profession.

B. FOSTER professional competency through lifelong learning. I will strive for high ideals, teamwork, and unity within the profession in order to provide optimal patient care.

C. SUPPORT my colleagues by actively encouraging personal commitment to the Oath of a Pharmacist and the Code of Ethics for Pharmacists as set forth by the profession.

D. DEDICATE my life and practice to excellence. This will require an ongoing reassessment of personal and professional values.

E. MAINTAIN the highest ideals and professional attributes to ensure and facilitate the covenantal relationship required of the pharmaceutical caregiver.

The profession of pharmacy is one that demands adherence to a set of ethical principles. These high ideals are necessary to ensure the quality of care extended to the patients I serve. As a student of pharmacy, I believe this does not start with graduation; rather, it begins with my membership in this professional college community. Therefore, I will strive to uphold this pledge as I advance toward full membership in the profession.

I voluntarily make this pledge of professionalism.

Adapted from the University of Illinois College of Pharmacy’s Pledge of Professionalism, 1993.

Developed and adopted by the American Pharmaceutical Association Academy of Students of Pharmacy and the American Association of Colleges of Deans Task Force on Professionalism on June 26, 1994.

Source: Reprinted by permission of APhA. Copyright American Pharmacists Association (APhA). APhA-ASP/AACP-COD Task Force on Professionalism. White paper on pharmacy student professionalism. J Am Pharm Assoc. 2000;40:96-102.

FIRST IMPRESSIONS

At the start of the APPEs, preceptors expect that you already possess a high level of professionalism. You can live up to this standard by displaying a positive first impression when you start a rotation. The following are suggestions for you to consider in making a good first impression:

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