Becoming pharmacists: exploring professional development of pharmacists following graduation

Abstract

This qualitative study draws on hermeneutic phenomenology to explore how pharmacy practice was understood, enacted and developed in a cohort of pharmacy students graduating from The University of Queensland. Adopting this theoretical framework allowed me to interpret and describe the meaning of the lived experience of pharmacy practice among final-year pharmacy students and new graduates.In Phase 1, a cohort of final-year pharmacy students were invited to complete an online questionnaire containing open-ended questions relating to pharmacy practice. A total of 104/252 (41%) students participated. Responses were analysed using a phenomenological approach, involving an iterative process of synthesising how the work of the pharmacist was understood by each participant, identifying core dimensions in these understandings of pharmacy practice, and grouping the understandings of practice into categories with descriptors. The analysis revealed that pharmacy practice was understood in six distinct ways. One-third of participants understood pharmacy practice in the traditional sense of ‘dispensing and/or providing counselling, information and advice’, where medicines were the focus. The remainder understood pharmacy practice more broadly to varying extents, with patients/customers featuring more centrally at the more inclusive end of the spectrum, ‘providing an accessible healthcare service to all members of the community as part of a healthcare team’.In Phase 2, twelve recent graduates, working in hospital and community practice, participated in a longitudinal study. Participants were observed at work and interviewed, every six months, for two years. Observation notes and transcribed interviews were analysed using the principles of hermeneutic phenomenology, underpinned by Heidegger’s philosophical concepts. How each participant understood and enacted pharmacy practice was explored for each observation and conversational interview, using an iterative process of explicating meaning while staying true to participants’ lived experience.A distinguishing characteristic was how patients/customers featured in their practice, prompting further interpretation of the meaning of patient-centredness in pharmacy practice. These graduates initially understood and enacted patient-centredness in pharmacy practice in a range of ways. For some graduates, tasks and procedures were the frame of reference, with patients viewed as source and recipient of information, allowing them to complete a series of required tasks to ensure medicines were safe and appropriate. For others, patients featured more centrally, where completing the required tasks was necessary to achieve a broader goal of providing individualised care to optimise health outcomes from medicines.Understanding of patient-centredness remained largely unchanged for most participants during the two years of Phase 2, despite the passage of time, experience gained and feedback received. Experiences of work usually served to refine practice within the graduates’ existing understanding of practice and to reinforce existing ways of being pharmacists. However, for one graduate, a transformation in understanding of patient-centredness resulted in a noticeable change in practice and subsequent development. How pharmacy practice was understood was a key influence on how learning opportunities were interpreted and integrated into practice, and how development trajectories unfolded.This thesis makes an original contribution to knowledge in pharmacy practice, pharmacy education and professional education from theoretical, methodological and empirical standpoints. Theoretically, this research demonstrates variability, complexity and ambiguity in the meaning of patient-centredness in pharmacy practice. Methodologically, the phenomenological approach provides a novel way of exploring pharmacy practice and development, in general, and patient-centredness, in particular. Empirically, the findings reveal the range of ways that pharmacy practice and patient-centredness were understood and enacted that do not always align with the recognized vision for the profession. In addition, the findings provide new empirical evidence in a cohort of professional graduates, to confirm a professional development theory and model in which understanding of practice forms the basis of the development of professional skill, and to support the notion that understanding of practice underpins many barriers to practice change in pharmacy.The findings point to ways forward for pharmacy educators and researchers, and the profession as a whole, to stimulate dialogue about what patient-centredness means in pharmacy practice and to facilitate the embodiment of this this aspirational concept into practice. The findings also confirm the importance for researchers and educators to take into account that the development of pharmacy practice is influenced by how it is understood. More specifically, there is a need for pharmacy educators at all levels to give greater emphasis on who students and graduates are becoming, to make explicit what effective contemporary pharmacy practice entails, and to promote more inclusive ways of being pharmacists, who fulfil their mandate to be patient-centred clinicians. Finding effective initiatives to broaden and deepen how pharmacy practice is understood through undergraduate programs into professional life, as well as providing the necessary knowledge and skills, holds promise to enable more pharmacists to embrace practice change and to overcome some of the barriers to the advancement of pharmacy as a profession.