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Sarah Wilson, Wendy Gidman and Gordon
Becket are
from the University of Central Lancashire
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The Broad spectrum feature is
open to any reader. Contributions of around 1,100 words commenting
on topical issues
may be posted to Graeme Smith, managing editor, or
e-mailed to graeme.smith@pharmj.org.uk for consideration
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Enthusiastic rhetoric has surrounded the issue of professionalism in recent discussions concerning desirable skills and attitudes within the healthcare context (eg, PJ, 15 December 2007, p678). This is part of a wide ranging debate on what it is to be a professional. A particular
point of contention relates to how professional attitudes and behaviours
can be learnt, and what can be done at an undergraduate level to foster
appropriate professional attitudes and skills.
In recent years, such attitudes and skills have been increasingly included
in healthcare professions’ training programmes, with the General
Medical Council taking the lead by establishing a requirement for professional
attitudes to be taught, as set out in “Tomorrow’s Doctors” (2002).
Indeed, medical educators have acted as pioneers in this area, developing
techniques for teaching and evaluating professional attitudes at undergraduate
level.
This moves away from the old model, which placed a heavy emphasis
on teaching knowledge and skills. In the past, professional attitudes
and behaviour were considered important, but were not taught explicitly
or assessed systematically. This could, potentially, lead to a situation
where students graduate with high grades but poor professional attitudes.
Students do not arrive at university with fully formed professional attitudes
and behaviours, and these need to be taught and modelled.
Pharmacists, like other healthcare professionals, value their professional
status and, consequently, need to adhere to a standard of professionalism.
This is reinforced by the Council of the Royal Pharmaceutical Society
through developments, such as the new code of ethics. The Society’s
recent “Fit for the future” consultation (phase 2), part
of the education policy development programme (available on the consultations
page of the Society’s website), is a clear indication
of pharmacy’s commitment to the goal of enhancing professionalism
through undergraduate education.
Within the wider context of professionalism in and professionalisation
of pharmacy, educators must look to their role in developing mechanisms,
first to teach professional attitudes and behaviours, and, secondly,
to assess students’ skills in this area. To this end, a new model
of assessment will be implemented at the School of Pharmacy, University
of Central Lancashire (UCLan) later this year and be used for our first
year MPharm students.
This system was previously adapted by one of us
(Gordon Becket) in New Zealand, from a model developed for use in the
schools of medicine at the University of Otago. The school of pharmacy
will institute a system of professional attitudes and conduct (PAC) assessment
and evaluation, with the aim of continuously assessing student performance.
The system will add to existing assessment methods that measure the
traditional aspects of knowledge and clinical skills. It will evaluate
professional
behaviour by monitoring professional skills and attitudes.
The scope of the assessment will increase in complexity as undergraduate
training progresses. In the first year of the MPharm course, assessment
mainly involves learning and demonstrating a professional attitude to
attendance, cultural sensitivity, tutorial performance, communication
and teamwork.
In later modules, PAC teaching and assessment will be adapted
to reflect the module aims, for example, appropriate attitudes to patient
care, professional attitudes in cancer therapy and care, minimisation
of harm and supervision of pharmacy staff.
Professionalism teaching and assessment will also be developed though
the third and fourth years of the MPharm programme. This will include
feedback from real and role-playing patients in placements and objective
structural clinical examinations, enabling higher level communication
skills and interpersonal relationships to be assessed.
The assessment will be a team effort in each section of the pharmacy
school. Teaching staff from each curriculum area will tailor the instrument
to include the most relevant professional attitudes for their discipline.
An important aspect of the process is the use of the assessment as a
formative process to help a student recognise and modify areas that require
improvement. Critically, this technique provides individualised feedback
so that students with attitudinal and behavioural shortcomings can improve.
Where necessary, the existing pastoral care functions of the university
can be brought into play to support students.
Although primarily designed as a mechanism to support student development,
the process can also have a regulatory function. Potentially, a student
could pass all of the knowledge based assessments throughout the course
but persist in displaying inappropriate attitudes and behaviours. The
PAC evaluation provides documentary evidence from a range of sources
to support any necessary course of action.
The documentation also provides
the opportunity to reward exceptional standards of behaviour, recognising
students who are role models. By way of example, the school might award
prizes to encourage students to adopt appropriate behaviours. The PAC
evaluation also functions as an effective tool for small group teaching
because it presents an opportunity for students to discuss and develop
their own responses to professionalism.
In line with the continuing development of a professional identity, UK
schools of pharmacy would benefit from adapting the PAC model for their
MPharm degrees. The PAC model adds greater depth and subtlety to the
fitness to practise procedures and codes of conduct that already exist
in schools of pharmacy.
Such an approach will work best as part of a
fully integrated model of education for professionalism, which identifies
effective techniques to enable students to develop and put into practice
the appropriate skills and behaviours.
The existing PAC process currently encompasses a set of key attitudes
reflecting an implicit model of professionalism, but we are working to
make this model explicit. The PAC programme at UCLan will be subject
to robust evaluation and modified, as necessary, to respond to the changing
nature of the profession. Further research is also planned into how professional
attitudes and behaviours might be assessed and encouraged throughout
the preregistration year.
Clearly, there are problems to overcome in introducing such a scheme,
not least of which relate to resources in terms of funding, and of additional
time demands on teaching staff in schools of pharmacy. At UCLan, an enthusiastic
and committed team has worked hard to bring this innovative approach
into practice.
However, education for professionalism should not be left
to develop in a piecemeal fashion, dependent on the goodwill and enthusiasm
of schools of pharmacy and their staff. To maintain UK pharmacy’s
place as a leader in the field, all those involved with pharmacy education
need to develop a co-ordinated and effective response to the challenges
of educating for professionalism.
To this end, we would welcome communication
with any teams involved in developing similar processes, and comment
from other interested parties. |
The
Pharmaceutical Journal