Becoming pharmacists: how the pharmacy curriculum influences professional identity formation

Abstract

Making the transition from being pharmacy students to pharmacists is difficult. Students need to reconcile their professional aspirations and what they have learnt with the realities of practice. A smooth transition can be hampered when they are unable to enact the role or if it doesnrt meet their expectations. These challenges relate to professional identity, that is, the sense of being a professional formed through interaction between self and context. Those with strong professional identities tend to be confident, motivated and able to cope with the complex and uncertain aspects of practice. The nature and structure of the curriculum and the learning experiences offered by professional education influence studentsr construction of their professional identities. Being unaware of this can lead to narrow or poorly defined professional identities. Despite extensive research in other professions (for example, medicine, nursing and education) into student professional identity formation, to date, there is little in the pharmacy education literature on this topic. This study aimed to examine how the structure and experiences of a pharmacy curriculum enabled studentsr professional identity formation. This mixed-methods case study, conducted in an Australian Pharmacy School, drew on the theory of social learning and contemporary professional identity literature. The curriculum was examined in three phases: the intended curriculum, enacted curriculum and curriculum outcomes. The first phase of this study examined the intended curriculum, that is, the curriculumrs purpose and its vision. This was examined from two perspectives: 1) content analysis of all of the subjectsr learning objectives and assessment and 2) survey of the academic staff (n=33). For the content analysis, the learning objectives and assessment were collected, coded and thematically analysed. The study found that the curriculum was focused on the drug rather than the patient, the course content was not well integrated and was likely to promote the acquisition of decontextualised knowledge. This suggested potential difficulties for student professional identity formation, in that their understanding of the profession could be fragmented. The second part of this phase investigated the academicsr intention for the curriculum. Thirty-three pharmacy educators (academics and tutors) completed a questionnaire. The results indicate that their intention for the curriculum was to develop competent practitioners through the provision of knowledge and skills. Most felt they contributed to studentsr pharmacist development through facilitating learning and being practice-oriented. There were limited references to patients. The second phase of the study examined the enacted curriculum, that is, the student experience and what happens when the curriculum comes laliver. An observational study and student focus groups were conducted to investigate this. The observational study, conducted over four weeks, examined the ltypicalr student experience from the perspective of a pharmacist. Data were thematically analysed. Consistent with the results from Phase One, the findings showed that the observed curriculum focused on the provision of technical knowledge, however, it also provided some opportunities for practical engagement. This meant that students were able to begin to imagine themselves as pharmacists. There were limited opportunities to observe pharmacist role models, to experiment with being a pharmacist and to evaluate their professional identities. The 10 focus groups comprised 82 students across all year groups. Data were thematically analysed and confirmed the findings from the observational study but also highlighted the fact that the pharmacy students struggled with their professional identity formation. Many were entering the degree with little understanding of what it means to be a pharmacist. Once in the educational context the nature of the role became apparent and idealistic but not enacted and the students commonly experienced dissonance between the ideal and the realities of placements; this may have been enhanced by a lack of patient-centred role models. This conflict left them concluding that the role could be constrained and limited. Phase three of the study examined the curricular outcomes, that is, what students experience, construe, and learn as a result of the enactment. Semi-structured interviews were conducted with 15 intern pharmacists and the data were analysed thematically. The findings assert that internsr entered the profession with naive professional identities but valued the patient-focused aspects of practice. The nature of the context significantly influenced the validation and enactment of their professional identities. In particular, the interns were challenged by interactions with patients and doctors and found it difficult to reconcile this with their professional identities. As a result, interns continued to have naive professional identities with some exploring alternative ways of being pharmacists. This study contributes to an enhanced understanding of how the pharmacy curriculum influences studentsr construction of their professional identities. The main difficulty experienced by the students was the process of reconciliation between learning experiences in university and in practice. This indicates that supporting the professional identity formation of students should be a priority for the design of pharmacy curricula and this could be achieved through: strengthening partnerships with the profession; supporting academics to broaden their concepts of learning; creating opportunities for authentic learning; and incorporating assessment practices which promote collaboration and professional responsibilities.n