Abstract
Objective. To summarize student pharmacist leadership development opportunities delivered by pharmacy programs, to describe selected opportunities, and to assess how these opportunities meet leadership development competencies.
Methods. A multi-method study was conducted that comprised a systematic content analysis of pharmacy education journals, pharmacy program websites, and telephone interviews with key informants, which included open-ended questions and scaled responses.
Results. Review of six articles, 37 American Association of Colleges of Pharmacy (AACP) Annual Meeting abstracts, and 138 websites resulted in the identification of 191 leadership development opportunities. These consisted of courses, projects/programs, and events/speaker series. Interviews with 12 key informants detailed unique events that developed leadership competencies. Formal assessments of student leadership development were limited and primarily focused on informal feedback and course evaluations.
Conclusion. Most US pharmacy programs offer their students an array of opportunities to develop leadership abilities. Pharmacy programs should consider expanding opportunities beyond elective courses, learn from the successes of others to implement new leadership development opportunities, and bolster the assessment of student leadership competencies and outcomes.
INTRODUCTION
Upon graduation, student pharmacists are expected to be equipped for pharmacy practice with the necessary patient care skills and practice management skills as a result of the abundance of curricular and cocurricular activities provided by schools and colleges of pharmacy (pharmacy programs).1 However, whether student pharmacists possess the necessary leadership skills to provide patient care and advance the profession of pharmacy is now questioned. Since 2005, when the report, “Will There be a Pharmacy Leadership Crisis?” was published, there has been an increase in the literature describing leadership development strategies for student pharmacists.2 The 2008-2009 AACP Argus Commission recommended that pharmacy programs integrate leadership education into curricular, cocurricular, and extra-curricular activities to encourage leadership development. Moreover, the 2013 Center for the Advancement of Pharmacy Education (CAPE) report added leadership as an educational outcome in the personal and professional development domain.3,4 Aligning with the CAPE outcomes, the Accreditation Council for Pharmacy Education (ACPE) also identified leadership as a key element of personal and professional development in their 2016 Standards.5
In anticipation of the new requirements and need for student pharmacist leadership development, pharmacy programs across the United States have implemented a variety of leadership development opportunities, including, but not limited to, courses, retreats, and speakers. To assist with the development of such opportunities, Janke et al defined 11 competencies that leadership instructors for doctor of pharmacy (PharmD) students agreed were essential for including in pharmacy leadership development curricula.6 Examples of competencies include explaining the importance of leadership in pharmacy, demonstrating self-awareness in leadership, and developing knowledge of organizational culture.6 While student pharmacist leadership development activities are becoming more common, there has been little assessment and evaluation of leadership development opportunities offered by pharmacy programs. One conference abstract by Patel reported results of a survey of 29 associate deans on the prevalence of leadership skill development in the PharmD curriculum.7 The majority of schools reported offering required didactic coursework (78%) and elective experiential opportunities (89%), although little detail was provided. The majority of respondents indicated plans to add additional leadership development courses in the next five years.7 This, however, represents only a small, self-selected minority of schools in the United States.
The purpose of this work was to catalog the student pharmacist leadership development opportunities offered by pharmacy programs in the United States. The objectives were to summarize the existing student pharmacist leadership development opportunities being delivered at schools of pharmacy, to describe selected leadership development opportunities, and to assess the ability of these opportunities to meet leadership development competencies.
METHODS
A multi-method study design was used to address the objectives of this assessment of student pharmacist leadership development opportunities. The first phase involved a systematic content analysis of pharmacy education journals and the websites of pharmacy programs to identify student pharmacist leadership development activities.8 The second phase consisted of semi-structured telephone interviews with 12 key informants about innovative leadership development activities identified in phase one. The Human Subjects Office at the University of Iowa approved this study.
The literature review portion of the first phase involved a search for student “leadership development” in the American Journal of Pharmaceutical Education and in Currents in Pharmacy Teaching and Learning. Abstracts from posters presented at the AACP Annual Meeting from 2003-2014 also were searched for the term “leadership.” For each leadership development opportunity, the collected variables included: name, brief description, contact person, whether or not participation in the activity was required by the pharmacy program, the selection process for the activity if not required, the existence of a collaborating organization, and the identity of the collaborating organization if applicable.
A systematic approach for website analysis was used to limit variability in the search methods. For each US pharmacy program listed in the AACP directory (N=138), the following information was examined to identify student leadership development opportunities: information for current students (including student organizations), the PharmD curriculum (including course descriptions), and the experiential component of the curriculum. Most websites had a search tool that was used to scan the website for the term “leadership development.” The search tool also was used to find specific leadership development activities if more information was needed to collect the desired variables.
Each student leadership development opportunity was coded. Courses were classified as required, didactic, experiential, or didactic and experiential (Table 1). Projects and programs were labeled as speakers, seminars and workshops, either one-time or as a series, certificates, series of courses, retreats, centers or institutes, or other (Table 1). The content of the leadership development opportunities, as determined by the description in the original source (poster abstract, journal article, or website) was classified into one of five categories: leadership, leadership + advocacy, leadership + professionalism, leadership + entrepreneurship, or other.
Description of Pharmacy Student Leadership Development Opportunities from Pharmacy Program Websites and Literature Review
Following classification of the leadership development opportunities, 12 entries were targeted for further investigation via a telephone interview with a key informant. The overall objective of these interviews was to collect numeric assessments of the extent to which the activities addressed published leadership competencies and describe elements of the leadership opportunities in greater detail. To select the opportunities, two of the investigators independently chose 30 opportunities of varying types they thought were unique or innovative. Unique or innovative were not concretely defined, rather both investigators made their selections based on the description of the activity obtained during the data collection phase and their belief that the selected activity offered a novel method to teach leadership development. From the overlap, it was decided that key informants for four projects/programs, three courses, one series of courses, one credential, one series of events, one center/institute, and one 1-time event would be contacted for an interview to sample a variety of activities from the first phase. If more than the stated number of opportunities were present in a category, activities were selected at random.
Key informants (listed on the website or as an author) of the selected leadership development opportunities were contacted via e-mail, which briefly explained the background and purpose of the study and asked informants if they would be willing to speak with one of the investigators via phone about the selected activity. Sampling with replacement was used in the event that a key informant did not respond to the initial e-mail within one week. When this occurred, the randomly chosen leadership development activity was not restricted to be the same opportunity type as the one it was replacing. Prior to the interview, participants were e-mailed a measure asking for their assessment of how well their leadership development opportunity addressed a set of 11 leadership development competencies.6 Participants were asked to fill out the measure by entering their numeric response next to the item and e-mail it back to the researchers to supplement the upcoming interview. Each informant was asked to rate the extent to which the opportunity addressed each competency, using a scale of 0=not at all to 10=completely, with only the poles being labeled. This scale was selected to allow participants to exercise a range of responses and allow for intuitive extreme responses. Interviews were arranged for mutually agreeable times and a semi-structured interview guide (Appendix A) was used to gather details about the leadership opportunities, including the origin of the activity, resources required, assessment, and the leadership competencies addressed. The interviews were audio-recorded with permission of the interviewee.
Following the phone interview, one of the primary investigators listened to the audio-recording to create summaries of the responses in the form of a contact summary sheet.9 The summaries focused on the following four global prompts, which were developed to encompass the items from the semi-structured interview guide: (1) What are the origin and trajectory of this leadership development opportunity? (2) What resources are necessary for this leadership development opportunity? (3) How do you formally or informally evaluate the success of this leadership development opportunity and what is your personal assessment of its success? (4) Which student pharmacist leadership development competencies does this opportunity address? The goal of these questions was to systematically describe the activities based on the four main questions, not to apply interpretive codes to the lived experiences of the facilitators or select quotes. To address validity, a coauthor debriefed the interviewer after reading the summaries. For the leadership competency measure, the mean and range was calculated for each of the 11 items.
RESULTS
The review of six articles, 37 AACP Annual Meeting abstracts, and 138 websites resulted in the identification of 191 student pharmacist leadership development opportunities (Table 1) at 94 schools of pharmacy.10-15 Using a denominator of all 138 schools, courses (41.3% of schools) and projects/programs (19.6%) were most likely to be offered as student leadership development opportunities. No leadership development activities were identified for 44 schools of pharmacy. Of these, 21 were granted precandidate status by ACPE in 2005 or later.
At the opportunity level of analysis (N=191), courses were the most commonly identified leadership development opportunity (41.9% of opportunities), followed by projects/programs (18.8%), and series of events (10.9%). The identified courses were primarily didactic in nature (83.6%), and 28.9% were required for all students. For the majority of leadership development activities, the content focused exclusively on leadership (72.2%), while the remaining activities split the content focus with at least one other topic such as professionalism or advocacy (Table 1). Most opportunities occurred over multiple events (62.6%). Only 27.8% of the leadership development opportunities used an external collaborator such as another health professional program, state pharmacy association, a provider, or a community organization.
The sampling process resulted in interviews with key informants of four courses, four projects/programs, one series of courses, one credential, and two series of events (Table 2). Ten of the key informants for the selected leadership development activities were pharmacy program faculty members and two were staff employed by the pharmacy program and involved with student development. Five of the faculty respondents were members of a department of pharmacy practice, whereas the remaining faculty key informants belonged to other departments including pharmaceutical care and health systems, clinical sciences, and experiential education. Six of the key informants were female.
Description of Leadership Development Opportunities Selected for Key Informant Interviews
The key informants identified common reasons for creating the selected leadership development opportunities and for necessary resources to facilitate the activities. Half of the key informants stated that the opportunity was created after realizing that a student leadership development component was missing either in the school’s curriculum or within an existing activity. Other reasons that prompted creation of the leadership development opportunities included receiving a grant or endowment, the expansion of a university-wide opportunity specifically to student pharmacists, and the opening of a new school. All key informants stated that a faculty member willing to champion the activity through dedication of time was a necessary resource. At least four of the selected leadership development opportunities used a personal strengths assessment tool such as Strengths Finder (Gallup Press, New York, NY), which was either purchased by the students or provided to the students. Other resources identified by multiple key informants included support of the school’s administration, guest speakers, and nonfaculty pharmacists.
Key informants indicated that course evaluations were used for all opportunities that were courses or included a course as a component (n=7). For leadership development activities that did not involve courses, methods used to evaluate the opportunity ranged from informal verbal feedback to surveys completed by participants. Grading of students varied within courses as some used traditional methods such as quizzes and papers to determine a grade, whereas others assigned grades based on completion of activities and participation in class. In noncourse leadership development activities, students varied in providing evaluations, depending on the activity. Some of the selected opportunities involving nonfaculty pharmacists, nonpharmacy program faculty members, other health professionals, or the public resulted in evaluations of the student by these external parties.
Eleven of the twelve key informants completed a measure to assess the achievement of leadership development competencies by the selected opportunity (Table 3). One key informant did not return the measure. The two leadership development competencies receiving the highest average scores were “Collaborate with others” (9.3 out of 10) and “Describe the characteristics, behaviors, and practices of effective leaders” (8.6). The two leadership development competencies receiving the lowest averages scores were “Develop knowledge of organizational culture” (5.3) and “Distinguish between leadership and management” (6.5). While the average scores were all above 5.3, scores provided by key informants varied considerably, with five of the 11 competencies spanning the entire response range (0-10).
Scores from Preinterview Measure of Key Informants about How Well Their Activity Addresses Leadership Development Competencies6
DISCUSSION
The website analysis and literature search identified 191 student pharmacist leadership development opportunities including courses, speakers, seminars, workshops, retreats, certifications, degrees, and institutes. Knowledge of the variety of opportunities that promote student leadership development may promote the formation of new activities in schools of pharmacy where there are currently few opportunities. The quantity of and variability in leadership development activities support that schools of pharmacy have embraced the 2008-2009 Argus Commission recommendation to integrate leadership education into curricular, cocurricular, and extracurricular activities.3
Courses were the most common leadership development opportunity offered by schools. This finding partially aligns with the recommendation of the 1999-2000 AACP Professional Affairs Committee that “didactic exposure to basic leadership theory and practice” should be an activity for all students.16 However, less than 30% of courses were required, suggesting there is room for improvement in providing leadership opportunities for all students. The percentage of schools offering a leadership course (41.2%) or series of courses (7.1%) was lower than the 75% of schools offering a leadership course reported by Patel et al.7 The Patel finding could be a manifestation of selection bias or the inclusion of management courses that contain a small number of leadership lectures. The present study included course descriptions and/or syllabi when available to determine if leadership appeared to be the focus of the course being examined.
More than half of the identified opportunities were not courses, indicating the broader recognition that application of leadership knowledge and skills outside the classroom is important. Most opportunities consisted of multiple interactions or activities indicating that leadership development instructors and facilitators recognize that leadership development is a continuous process.17,18 While most development activities focused solely on leadership, some opportunities incorporated topics such as professionalism, advocacy, and entrepreneurship, which lend themselves to experiential activities. Adoption of new topics to illustrate leadership development may lead to fulfillment of leadership development competencies not previously achieved.
The leadership development competency measure pilot-tested in this study may be a useful tool for self-evaluation of existing and future leadership development activities. The measure is brief, yet comprehensive, and has well-defined competencies established by leadership development experts participating in a Delphi process.17 Responses provided by key informants to the competency measure (Table 3) varied considerably, with many exercising the entire range of responses. It may not be possible for all competencies to be completely addressed by every leadership development activity and that a variety of activities is needed to prepare future leaders. Key informants also may have had differing interpretations of each competency and how to apply the scale. The two competencies with the lowest averages (“Develop knowledge of organizational culture” and “Distinguish between leadership and management”) may warrant targeted activities. Alternatively, these may be better addressed, if not already addressed, in management courses. Other measures of leadership development competencies have been developed and could be adapted for pharmacy education for future studies.18,19
Key informants illustrated the important role of assessment and quality improvement processes in ensuring the growth and development of student leaders participating in their leadership development opportunities. Course evaluations and informal feedback acquired through multiple years of experience were commonly used to fuel important changes. For example, the key informant of the certificate program explained how initially one elective leadership development course was offered, which led to offering an APPE in leadership, which eventually led to one required leadership course for all students and the option to continue on to take the elective course and the advanced pharmacy practice experience (APPE) to complete the certificate. The key informant for the Emerging Leaders program explained that the selection of guest speakers partially depended on speakers’ ability to align their message with the leadership theme of the class session in which they participated, as well as their ability to engage students in their presentation. This resulted in variation in the speaker schedule from year to year. Collaborators and guests emerged as a key component of the innovative offerings.
Facilitators of leadership development activities should be prepared for the evolution of the opportunity based on a measure assessing the fulfillment of competencies, the availability of resources, and the effectiveness of the opportunity on student pharmacists’ leadership abilities. Evaluation of the effectiveness of student pharmacist leadership development opportunities to improve student leadership abilities warrants further research. The key informants of many of the selected leadership development opportunities shared that participating students often receive informal verbal feedback and/or evaluations completed by those involved in the activity. While these methods may address a student’s performance in a single event, they may not impart the necessary information to determine if essential leadership skills have been attained over an entire curriculum or set of activities. This has implications for assessment, particularly with relation to the 2013 CAPE Educational Outcomes and the 2016 ACPE Standards. For example, the ACPE Standard addressing leadership states that a PharmD graduate “must be able to demonstrate responsibility for creating and achieving shared goals, regardless of position.”5 Schools must be able to demonstrate how this standard will be achieved. Key informants in this study indicated that none of the selected leadership development activities have formally evaluated leadership endeavors of the students after participation in the activity. Further work could focus on the leadership roles that students completing leadership development opportunities have pursued, either while still a student pharmacist or postgraduation, and what components of the activity were most influential to their future success.
There are several explanations for finding 44 schools of pharmacy with no leadership development opportunities listed on their websites. One reason may be that almost half of the sites without a leadership development activity enrolled their first class within the last decade. During this time, the development of leadership courses and other leadership-focused activities may not have been a priority compared to meeting accreditation standards related to other competencies. In addition, well-established pharmacy programs may have yet to identify shortcomings in the curricular and extracurricular leadership development opportunities for their students. A second explanation may be lack of a faculty champion or the inability of a faculty champion to dedicate the necessary time to a leadership development activity as this was the one common resource identified by all key informants of the selected leadership development opportunities.
Both phases of this study had limitations. The cross-sectional search of phase one may have missed opportunities that were not accessible in the search strategy. Additional sources and/or search terms may have resulted in the identification of additional opportunities. Also, websites were not archived as part of this analysis so reproduction of the methods will become challenging as websites update their materials and make changes to their student leadership development offerings. The study could, however, be repeated after a period of time to track changes. The categorization of the opportunities into the variables of interest was based on the information available and the authors’ interpretation of the information, which was verified using a consensus process. This study did not include student leadership development opportunities in which students may have participated outside the pharmacy program. Furthermore, this study excluded participation in student organizations alone as a source of leadership development. This exclusion was not made because of a belief that participation in student organizations does not contribute to leadership development, but rather that student organizations are commonplace and participation alone does not necessarily address leadership development. However, activities initiated by student organizations with the specific intention of leadership development were included in this study when identified. While not quantified, it is our assessment that student organizations were involved with many of the leadership development opportunities identified. This observation somewhat aligns with Patel et al, who found that 100% of survey respondents offered leadership development activities through student organizations.7 A next step to build on the current work focusing on websites would be to conduct a comprehensive survey of pharmacy programs addressing their approaches to leadership development and competency assessment. Phase two resulted in interviews with a sample of key informants for leadership development opportunities selected on the basis of the authors’ judgment of innovativeness. The use of an innovativeness criterion may have resulted in a sample of opportunities that would differ than if other selection criteria were used. Further, the information provided by the key informant was not verified using a secondary source.
CONCLUSION
Many US schools and colleges of pharmacy offer students an array of opportunities to develop leadership skills. However, no information was available from some schools, which may suggest a lack of opportunities. There appears to be a need for greater assessment of student outcomes in the area of student pharmacist leadership development. The competency assessment used here could aid instructors and school administrators in designing leadership opportunities that address a variety of competencies for student pharmacists.
Appendix 1. Interview Guide
Why was this opportunity created?
Probe: Was it in response to new guidelines or something that you thought was missing in the curriculum, a student idea, something else?
Is this opportunity still available to student pharmacists?
Probe: How has this opportunity changed over time?
How many students have been involved/participated in this opportunity?
How do you assess student performance?
Other than students, who is involved in this opportunity? (ie, just college of pharmacy faculty members, outside practitioners, other schools of health professions, etc. This may be answered during the background information)
How do you evaluate the success of the opportunity?
Is there any external evaluation of the opportunity?
Probe: course evaluation, evaluation opportunity for participants
What resources are available/necessary to support this opportunity?
Any external resources?
What types of setbacks, if any, have you had as far as establishing or maintaining this opportunity?
What do you see in the future for this leadership development opportunity?
- Received April 12, 2015.
- Accepted August 18, 2015.
- © 2016 American Association of Colleges of Pharmacy
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