An Elective Course in Leader Development

INTRODUCTION

The 1982 Argus Commission’s report identified the need to build leadership skills in pharmacy students during challenging times.¹ Thirty years later, with healthcare reform challenges looming in the context of a difficult economic period, the need to build leadership skills in pharmacy students persists and is arguably of greater urgency.^2-4 For the profession of pharmacy to achieve the vision of shifting practice from an emphasis on product distribution management to patient-centered care, pharmacists need the skills to lead change effectively.^5,6 It is insufficient to only provide pharmacy students with the knowledge and skills required for contemporary pharmacy practice.^6,7 To equip pharmacists to lead change, pharmacy curricula must also provide pharmacy students with sufficient personal and professional leadership skills.⁸

The 2009 American Association of Colleges of Pharmacy (AACP) Curricular Change Summit Supplement included several recommendations related to leader-development: (1) providing graduates with the skills and confidence to adapt to changes they will encounter during their careers and to embrace life-long learning as essential to their roles as providers of pharmacy knowledge, services, and care; embracing their roles as agents of change and advancing new practice roles; (2) empowering graduates to take responsibility for their continuous professional development through mastery of self-assessment and self-efficacy; and (3) developing leaders and advocates, regardless of their positions or titles, for pharmacy and for advancing the diverse pharmacist provider roles.² In addition, this paper recommended students learn reflective practices, in relation to self-assessment of their strengths and weaknesses, to enhance their skills as life-long learners, ultimately leading to creating individualized plans for their continuous professional development.

The Accreditation Council for Pharmacy Education (ACPE) released revised guidelines (Standards 2007 Version 2.0) in 2011 that included a greater emphasis on leadership in the curriculum. Guideline 9.3, a new guideline, states “The college or school curriculum should foster the development of students as leaders and agents of change. The curriculum should help students embrace the moral purpose that underpins the profession and develop the ability to use tools and strategies needed to affect positive change in pharmacy practice and health care delivery.” Additionally, the appendix B Practice Management competencies were revised to include “leadership development, management of transformational change, emotional intelligence for leaders, and creating/implementing shared mission and vision.”⁹

This article describes an elective course designed to provide insights to help today’s students become tomorrow’s leaders – as pharmacists and in life. In addition to supporting the aforementioned recommendations and requirements from AACP and ACPE, this course also provides additional curricular emphasis in 4 areas highlighted by the 2009 AACP Curriculum Change Summit Supplement: (1) self-assessment and reflection, (2) leadership development and advocacy, (3) personal development, and (4) continuing professional development.² This article also provides research data addressing the achievement of the learning outcomes of this course and the placement of students on a development track to continue to grow as leaders.

DESIGN

Survey instruments and the research protocol were reviewed and approved as exempt by the institutional review board of Regis University. The 4-year doctor of pharmacy (PharmD) curriculum at Regis University School of Pharmacy is taught primarily using team-based learning.^10,11 Applied Leadership in Pharmacy Practice, was a 3-credit-hour elective course offered in 2011 (n = 8) and 2012 (n = 15) to pharmacy students who had successfully completed their hospital and community pharmacy practice introductory pharmacy practice experiences (IPPEs), which are completed in the second and third semesters of the curriculum.

The learning outcomes for this course are listed in Table 1. Enrollment was limited to 15 students to create an environment in which all students could contribute to faculty-led and student-led class discussions. Additionally, the small class size allowed for each student to lead a team-building activity and provide a leadership quality presentation within the course.

To ensure class participation, attendance was required. The small class size allowed for faculty monitoring of participation, and class activities were designed to foster student involvement (eg, faculty-facilitated random round-robin discussions, physical [correlated to cognitive] activities during class, and small-group case-study analysis).

This course focused on discovery and development within the classroom, while challenging students to apply what they learned outside the classroom in personal life, school life, work life, and IPPEs. Rather than focusing on leadership techniques (eg, how to run a meeting, setting expectations), the premise that discovering yourself is the first step in leader-development was emphasized. Instead of analyzing the external act of leadership, this course endeavored to help students discover, reflect on, and enhance leadership skills expected of today’s PharmD graduates. In-class discussions (facilitated by either instructors or students), in-class case studies, and journal entries emphasized emotional intelligence, timeless leadership and influence principles, interpersonal communication, embracing adversity, conflict management, leading change, positive reinforcement, strategic planning, and Jesuit leadership principles. Assignments included validated self-discovery, development, and application tools (ie, Conflict Management Scale, Emotional and Social Competence Inventory and Development Plan, Kolb Learning Style Inventory, Strength Deployment Inventory, and StrengthsFinder), writing a personal mission statement, student-led team-building activities, student-led leadership quality presentations, and student-led pharmacy performance matrix presentations. Several assignments (ie, journal entries, leadership quality presentations, relationship awareness and the Strength Deployment Inventory, StrengthsFinder, Emotional and Social Competency Inventory and Development Plan, and personal mission statement) included components that provided a structured framework for the creation of personalized leader-development tracks.

Journal Entries. Journal writing assignments were assigned throughout the semester when appropriate to the topic discussed in class. The purpose of journaling was to record and reflect on activities that contributed to leader development. Reflecting through journal entries formed the basis for identifying accomplishments and opportunities for growth.

Leadership Quality Presentation. Students were introduced to strategic planning using the Nominal Group Technique.¹² This technique fully engages all participants and equalizes influence among participants as goals are identified and participants provide anonymous feedback, ultimately leading to prioritization of common goals. Students applied this technique to identify and prioritize leadership qualities perceived as essential for effective leaders. Students were charged with creating a system to determine in a fair manner how to assign leadership quality presentations and the order of presentations. Each student developed a 5- to 10-minute presentation and handout on their assigned leadership quality, which included a personal story or reflection and an application in pharmacy practice. Presentations were shared throughout the semester at the beginning of class, and students observing the presentations reflected in their journals as to whether the leadership quality was a strength or opportunity for growth for themselves. If the leadership quality was an opportunity for growth, students also included the steps they would take to grow in this area.¹³

Team-Building Activity. A pharmacy-based scenario in need of leadership was randomly assigned to each student, and students selected a team-building activity pertinent to the scenario.^14,15 During the course of the semester, each student led a team-building activity, which included introducing their peers to the scenario, providing the take home points of the activity, and discussing the rationale for selecting the specific team-building activity for the given scenario.

Relationship Awareness and the Strength Deployment Inventory. The Strength Deployment Inventory (SDI) is a valid and reliable instrument that measures core values based on Relationship Awareness Theory.¹⁶ Relationship Awareness Theory relates behavior to the motives that drive behavior, and as such, is effective in helping people understand and manage conflict and improve interpersonal relationships. The fundamental concept behind Relationship Awareness Theory is that people are motivated to behave in ways that achieve a sense of self-worth according to one’s motivational value system (MVS). One unique quality of the SDI is that it assesses motivation under 2 conditions: when everything is going well and when conflict exists. Most individuals experience different motivations when they are in conflict. Class activities and discussions were selected to: (1) distinguish behavior from motivation; (2) experience how different perceptions can generate conflict; (3) appreciate different MVSs; (4) demonstrate how filters affect perception and judgment; (5) identify overdone strengths of different MVSs; (6) practice borrowing a different MVS’s strengths to influence others; (7) discover the importance of self-worth as it relates to conflict; (8) identify conflict triggers for different people; (9) demonstrate the internal changes and related observable behavior as conflict progresses through 3 different stages; (10) identify strategies for improving effectiveness when approaching others during conflict; and (11) develop an action plan to apply relationship awareness to real-life situations.¹⁶

Pharmacy Performance Matrix. The first step to improve the effectiveness of compensation and appraisal systems is to pinpoint the results and behaviors needed for every job. An ideal format for this is the performance matrix, which allows measurement of every job and is ideal because it is flexible.¹⁷ The performance matrix allows for measuring how well the performer is doing against expectations. Instructors used the results of students’ SDI and StrengthsFinder to create teams of 3 or 4 students who collectively had strengths representing all 4 of the domains of leadership strength.¹⁸ Each team also included individuals with different MVSs.¹⁹ Students were challenged to focus their first team meeting on discussing their perception of why they were selected to be on that team and determining the unique gifts each team member could contribute. Each team was randomly assigned to create a pharmacy performance matrix for (1) community pharmacists, (2) community pharmacy technicians, (3) hospital pharmacists, or (4) hospital pharmacy technicians. One class session was allocated for each of the teams to present their pharmacy performance matrix to their peers.

Kolb Learning Style Inventory. The Kolb Learning Style Inventory describes the ways each student learns and how they deal with ideas and day-to-day situations. An awareness of a student’s learning style helped students better understand how they solve problems, work in teams, manage conflict, make career choices, and communicate in personal and professional relationships. Completing this inventory and class discussion allowed students to apply knowledge of their learning style to communication and conflict management case studies.²⁰

Conflict Management Scale. As pharmacists collaborate with other healthcare providers and patients on a more frequent basis, there is an increased likelihood of interpersonal conflict. Therefore, understanding the nature of conflict in pharmacy practice and providing pharmacists with skills for managing interpersonal conflict are important for leader-development. The Conflict Management Scale prompts self-reflection, self-awareness, and discussion related to one’s conflict management style.²¹ Each student’s conflict style was displayed to the class to reinforce the concept of variability in how individuals manage conflict and allowed for students to discuss and contrast their style of conflict management with their peers. In addition, students were placed into homogenous conflict style teams to demonstrate how different conflict styles manage the same conflict scenario case study differently.

StrengthsFinder. Leader development is a process that takes knowledge, skills, and practice, and it requires intentional use of and development of talents. Completing the StrengthsFinder instrument helped students develop as a leader by: increasing self-awareness; deepening knowledge and appreciation of others' talents; forming and maximizing teams; and helping others to affirm, develop, and apply their talents. Class activities and journal assignments were selected to include the 4 themes of the Strengths Development Framework.²²

Emotional and Social Competency Inventory and Development Plan. Emotional intelligence refers to the capacity for recognizing one’s own feelings and those of others, motivating oneself, and managing emotions effectively in oneself and in relationships. Class discussions on emotional intelligence competencies were conducted^23,24 and at their conclusion, an abbreviated version of the Nominal Group Technique was used to allow the class to collectively rank emotional intelligence competencies based on what they perceived to be most essential for a pharmacist.¹² Completing this inventory helped students identify their individual strengths as well as areas for growth. Students compared their individual results from this inventory with the class’s ranking of emotional intelligence competencies essential for pharmacists. Each student selected 3 of their high-scoring competencies and 3 of their low-scoring competencies, and created an emotional intelligence competency development plan, including specific activities related to each competency.

Personal Mission Statement. Students created a personal mission statement that expressed their sense of purpose and meaning in life.^25,26 Creating a personal mission statement encouraged students to think deeply about their life, clarify what is really important to them, expand their perspectives, identify values, develop commitment to values, and make daily progress towards long-term goals. The deadline for completion of this assignment was intentionally set for the latter half of the semester to allow students to incorporate what they learned about themselves and about leadership into their personal mission statement.

Jesuit Leadership Principles. Regis University is a Jesuit university. Ignatian pedagogy, a model which promotes the goal of Jesuit education, strives to develop the whole person to the fullest degree possible. Given the focus on this course on personal development coupled with the Jesuit Mission at Regis University, the addition of material on leadership principles and concepts arising from Ignatian pedagogy was appropriate to include in this course. Specifically, 4 class sessions were devoted to reading assignments on the 4 Jesuit leadership pillars.²⁷ Students facilitated discussions and activities covering concepts of each pillar.

EVALUATION AND ASSESSMENT

DISCUSSION

Inspiration for developing a course of this nature occurred through attending a Leader-Development Seminar hosted by the Pharmacy Leadership and Education Institute (PLEI). The focus of this course was on pharmacy students’ professional and personal development in the context of leadership best practices. The content and activities in this course were broad in scope to parallel the broad understanding of leadership, offering each student a menu of tools and concepts related to leadership. This allowed for each student to personalize his/her own leader-development plan. The interactive nature of the course was a perceived strength, resulting in class sessions in which students used leadership tools, applied leadership concepts, and participated in facilitated discussions by the instructors. An additional perceived strength of this course was that it inspired students to continue their development as leaders after its completion.

Use of the SDI has been described in the medical literature; however, to the authors’ knowledge, this is the first course described in the pharmacy literature to use the SDI.²⁸ The use of the StrengthsFinder in leader-development has been well described in the pharmacy literature.^6,8,29-31 Although SDI and the StrengthsFinder both include the word “strength,” they offer distinct advantages. Several advantages of StrengthsFinder are described above; however, it can be challenging to relate with others who have not completed this inventory. StrengthsFinder contains 34 unique strengths, and it can take time to learn specifically how individuals with different strengths can provide added value to a team. The SDI is easier to remember because there are 7 MVSs, which can be further simplified into 4 primary MVSs and 3 MVS blends. With practice, one can even determine another person’s MVS and conflict sequence by observing language used in communication and behaviors, such that the SDI may be applied to relating with others who have not completed the inventory. The SDI also helps one to increase effectiveness when communicating with others and has applications to conflict management. However, a strategy for further developing one’s MVS is not applicable to the SDI. Therefore, StrengthsFinder and the SDI offer unique advantages and complement each other well for leader-development.

A perceived weakness of this course was the limitation on enrollment size because of the design of the course (eg, the inclusion of student-led presentations and discussions). Another perceived weakness was that completion of the course assignments did not guarantee achievement of learning outcomes. Faculty members placed a considerable amount of trust in students to give their best effort when completing the assignments.

There are several potential barriers to the successful implementation of this course at other institutions. The broad content of this course resulted in a substantial investment of faculty time for instructors to research the content included, master the concepts, and develop the course. In the absence of course release accommodations, it may take several years for instructors to become well versed in the content. Development of the initial course design and content, a 2 credit-hour elective offered at Palm Beach Atlantic University Gregory School of Pharmacy, occurred gradually over 3 years by studying a variety of leadership books and seeking guidance from mentors. Development of the course design and content described in this article occurred over another 2 years. A related potential barrier is the financial cost of developing faculty members to teach the content. Faculty development included support (approximately $3,500) to attend the Leadership Can Be Taught Symposium and a Level 1 SDI Certification Course. Regis University supported the acquisition costs (approximately $30 per student) for the SDI and StrengthsFinder. Students were required to purchase the remaining leader-development inventories and 4 required books (approximately $80 per student).^13,14,27,32 Instructors having leadership experience is also valuable when teaching a course of this nature, so they can share examples of challenges faced, real-life applications of leadership concepts, and personal successes and failures. The lack of examinations may present a potential barrier to implementation if an institution’s assessment philosophy calls for traditional examinations in all courses. Rather than deliver traditional lectures, the instructors served as facilitators who guided students in the discovery, development, and application phases of leader-development. This could be a potential barrier to implementation for faculty members who prefer a concrete classroom experience. Finally, the small class size necessitated by the course design may be a potential barrier to implementation as a required course.

With regard to adaptation of this course by other institutions, the authors recommend that faculty members modify portions of the course content to achieve alignment with their institution’s mission, vision, and values. For example, when the course was offered at Palm Beach Atlantic University Gregory School of Pharmacy, where integrating faith into the classroom is an added priority, students created and led leadership quality devotions drawn from the Bible instead of leadership quality presentations.³³

Several measures appeared to demonstrate achievement of the learning outcomes by students. Average performance assessment results were ≥97% for all students with respect to major assignments (Leadership Quality Presentation and Pharmacy Performance Matrix) and nearly all students (91%) earned an A- or higher (the 2 exceptions earned a B+). Attitudinal data supported achievement of the learning outcomes as evidenced by all but 1 or 2 students agreeing or strongly agreeing with survey items linked to learning outcomes. Of particular importance, all students agreed or strongly agreed that as a result of this course they knew what they can do to further develop as a leader; they intended to use what they learned about themselves to develop as a leader and increase their effectiveness as a leader; they were better equipped to serve as a leader; their intention to pursue leadership positions as a pharmacist increased; and they were better equipped to succeed at leading change. One limitation of this attitudinal data is its dependence upon self-perceptions, which may not represent actual achievement of learning outcomes. Interestingly, the 3 topics and assignments most valued by students involved inventories in which students learned about their and others’ MVS, strengths, and learning styles, and how to apply this knowledge to increase effectiveness as a leader. Observational data appeared to demonstrate mastery of learning outcomes as evidenced by appropriate completion of nearly all assignments by all students. Journal entries scored the lowest for both completion (92%) and student ranking of assignment preference. This is likely because of waiting until the end of the course to collect all journal entries, although additional factors may have contributed, such as a lack of comfort and skills among pharmacy students to reflect. The high student performance in this course may have been related to self-selection bias as this was an elective course. For example, all of the students enrolled indicated they served in one or more leadership positions (mean = 3) prior to the start of the course (Table 2). Prior experience in leadership positions may positively affect the motivation to succeed in a course of this nature. If implemented as a required course, the same results might not be obtained. Additionally, if grading was based on quality rather than on completion, different results might be obtained.

Data presented in this paper and additional data obtained from future course offerings will be used for continuous quality improvement of this course. For example, in 2011, 25% (2/8) of students disagreed they were better equipped to prevent conflict escalation. In the 2012 course offering, conflict management case study work was enhanced, resulting in all students agreeing they were better equipped to prevent conflict escalation. Furthermore, quality improvement will be achieved by the continual development of the course instructors by staying abreast of new leader-development material, attendance at leader-development conferences, regular review of pharmacy leader-development literature, and maintenance of relationships with leader-development organizations (eg, PLEI).

SUMMARY

This leader-development elective course appeared to be effective in placing pharmacy students on a track to continue to grow as leaders and also to inspire students to continue their development beyond the course. The most valued topics and assignments involved validated instruments, which promoted self-discovery and development. Course assignments guided the creation of personalized leader-development tracks, ultimately promoting lifelong learning.