Pharmapreneur – Defining a Framework for Entrepreneurship in Pharmacy Education

Defining a Pharmacist Entrepreneur

According to our expert panel, a pharmacist entrepreneur combines several characteristics identified with a more traditional entrepreneur construct with the characteristics of an individual devoted to achieving outcomes beyond his or her personal gain. Lumpkin and Dess describe entrepreneurial orientation in terms of five dimensions: autonomy, innovativeness, risk-taking, proactivity, and competitive aggressiveness.¹⁴ The pharmacist entrepreneur definition proposed as a result of this study (Figure 3) captures four of those five domains, only omitting competitive aggressiveness. Competitive aggressiveness refers to an entrepreneur directly challenging others in a marketplace to gain position or market share.¹⁴ While not included in our final definition, principles of strategy related to market analysis and competition were identified by our panel as essential knowledge and skills needed for a pharmacist entrepreneur.

The 2010-2011 AACP Academic Affairs Standing Committee described the entrepreneurship trait as one that revolves around taking on the risks and responsibilities associated with implementing innovations.¹⁵ Additionally, the committee considered critical thinking and problem-solving foundational components and cited Rubino and Freshman’s eight entrepreneurship competency clusters (decision making, strategic thinking, risk-taking, confidence building, communicating ideas, motivating team members, tolerance of ambiguity and internal locus of control) as potential areas for development for pharmacist entrepreneurs.^15,16 The CAPE’s 2013 Educational Outcomes reinforced Rubino and Freshman’s competency clusters and further specified entrepreneurship recommendations to “engage in innovative activities by using creative thinking to envision better ways of accomplishing professional goals.”³ This study’s proposed definition of a pharmacist entrepreneur encompasses the CAPE recommendation and expands the construct to give pharmacy educators more guidance.

Approaches Effective for Entrepreneurship Education

Our expert panel ranked a mixed instructional approach (didactic and experiential) as the most important process for educating pharmacist entrepreneurs. While didactic lectures were recognized for some of the foundational knowledge items, the panel ranked active-learning methods highly supporting the use of structured exercises, team-based projects, and business plan competitions. Additionally, the panel found value in proactively targeting students with greater interests in entrepreneurship with more advanced elective opportunities.

Knowledge, Skills, and Attitudes

This study adds a comprehensive list of KSAs ranked in order of importance for pharmacy educators to consider during the instructional design process (Table 4). The ability to communicate effectively (oral, written, and interpersonal) was ranked the most important item identified both as knowledge and a skill. This supports the use of written and oral presentations throughout the curriculum and may demonstrate how many other pharmacy courses indirectly benefit the future pharmacist entrepreneur. Developing a business plan was also ranked highly as foundational knowledge and a skill. Schools may consider engaging with the National Community Pharmacists Association for guidance related to business plan development given the organization’s history of running a national business plan competition specifically for student members.¹⁷

Several foundational knowledge areas overlap with the knowledge students should be gaining in existing pharmacy management courses. These areas relate to items often taught in masters programs in business management such as strategy, project management, finance, accounting, marketing, and human resource management. Dual PharmD/Master of Business Administration (MBA) programs capture these topic areas in more depth, but our panel did not explicitly recommend that the pharmacist entrepreneur have an MBA or equivalent education. Previous research related to dual PharmD/MBA degree-earning students found that the majority of graduates entered the pharmaceutical industry, chain pharmacy, hospital/institutional, or managed care pharmacy.¹⁸ Business management programs may be helpful to gain the foundational knowledge and skills frequently identified with entrepreneurs, but evidence from a sample of these dual degree students suggests the motivation stems from a desire to be more competitive in an existing job market rather than to create new business opportunities.¹⁹

Leadership was also identified as foundational knowledge as well as a skill necessary for entrepreneurs, which CAPE identified in its own subsection of the 2013 Educational Outcomes.³ Our panel found several characteristics typically identified with multiple leadership frameworks important for entrepreneurs. Items such as adaptability, self-assessment, dealing with failure, and communication are all consistent with different models of leadership.^20,21 Other items identified such as health system literacy and pharmacy core sciences demonstrate how being competent in pharmacy is necessary (by definition) to be a successful pharmacist entrepreneur.

In terms of attitudes, the concept of failure may be closely tied to several highly ranked characteristics for a pharmacist entrepreneur. Resiliency, determination, positivity, and risk-taking were the four most important attitudes identified in this study, which may all be linked to different stages of (before, during, and after) failure. During the semi-structured interviews and round 1 open response analysis, several experts recognized the ability to bounce back from failure as a critical attitude for any future entrepreneur. Our experts recognized failure as part of the process and being resilient to failure as a necessity. If the potential for failure is viewed through an optimistic lens, then one may be more predisposed to greater risk-taking. Gaining experience through failure (or multiple failures) may be valuable for the pharmacist entrepreneur, however, the pharmacy education apparatus does not support this type of learning. An old adage, “C equals PharmD,” has been passed down to many students over the past two decades. This embodies the notion that anything but failure within the formal curriculum of a school of pharmacy will be rewarded with the doctoral hood. Failure within a single pharmacy class may lead to the probation or expulsion of a student as they have not demonstrated the mastery of the course objectives deemed necessary to eventually become a pharmacist. One could argue that the environment created to educate pharmacists to meet the competency standards to practice pharmacy directly inhibits the growth of an environment that encourages a “try-fail-and-try-again” approach. We are not advocating or encouraging student failures in core pharmacy classes, but simply calling for more opportunities embedded throughout the curriculum where students may experiment with new ideas without the fear that failure could end (or stall) their pharmacy career.

Entrepreneurship Education for Pharmacists Applied to Bloom’s Taxonomy

For schools and colleges of pharmacy considering curricular development or integration of entrepreneurship education, we propose a framework combining the cognitive processes identified in Bloom’s taxonomy with specific application to entrepreneurship (Figure 2). As faculty develop instructional plans, we recommend using didactic lectures to cover foundational knowledge components (remember function of Bloom’s taxonomy) and to explain the role of pharmacy within the broader context of healthcare so that students may begin to identify areas of unmet need (understand function). Within these didactic classes, we recommend incorporating structured exercises that allow students to use the newly acquired knowledge in new settings, forcing them to propose an innovative solution to a problem (apply function). Team-based activities may be preferred for these structured activities based on the feedback from our Delphi study. Examinations may be helpful to assess how well students are able to differentiate between strengths, weaknesses, opportunities, and threats for a given business proposal (analyze function) and to critique the value proposition of the business idea (evaluate function). While on rotation or through other experiential opportunities (summer internship or fellowship), students should be tasked with activities that cover the apply, analyze, and evaluate functions. Depending on the length of the experience, the students may have the opportunity to help preceptors design, develop, and implement a new business idea that adds value to patient care, practice, or the pharmacy profession (create function). It may be difficult for most students to reach the create function while in pharmacy school, because implementation of the business plan may be time consuming for a full-time student. Engaging in business plan competitions or other proposal development activities may help capture the rest of the create domain; however, students must recognize that more learning will be achieved through doing or executing the plan.

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Figure 2.

Bloom’s Taxonomy Applied to Entrepreneurship Education for Pharmacists

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Figure 3.

Proposed Definition for the Pharmacist Entrepreneur Construct

Place in the Strategic Plan and Curriculum

Given our higher threshold for panel agreement, none of the statements developed from our Delphi related to the importance of entrepreneurship inclusion in a school’s mission or curriculum reached ≥75%. While multiple items did meet a ≥50% threshold, these statements clearly did not resonate with everyone on the panel. During the six in-depth interviews with experienced entrepreneurs, the consensus was that entrepreneurship was vital to a school’s mission and vision as the interviewees felt that entrepreneurship would be necessary for the profession to survive and advance. While this sentiment was shared by several Delphi panel members, there was still hesitancy to make a firm statement that entrepreneurship should be an integral part of a school’s strategic plan. We recommend that deans, faculty members, students, and other key institutional stakeholders consider how the entrepreneurship construct may fit within their current educational environment before making it a formal component of the school’s mission and vision. Considering the ACPE Standards, schools must address entrepreneurship within the curriculum to meet Standard 4, but our study reveals that several experts are not on board with the notion that entrepreneurship must be in the curriculum for a PharmD program.^1,3 We recommend further discussion at the AACP-level to hear dissenting opinions or concerns with curricular inclusion.

In a Delphi process, the selection of appropriate experts may be the most challenging step that researchers must consider in terms of bias.²² We focused on successful entrepreneurs for the semi-structured in-depth interviews to build the first round of the Delphi, but then we purposefully recruited a large proportion of panelists with direct ties to academia as an instructor or administrator (62%) who had demonstrated interest in entrepreneurship education. While we felt this was appropriate to gain the opinions of pharmacy educators, results may have been different if we had focused solely on recruiting a panel of experienced entrepreneurs. Another limitation of our Delphi process involves the more stringent definition of panel agreement at ≥75%. This definition was chosen to be more selective and to include only the items where a supermajority agreed, but it is important for readers to consider those items in Tables 2 and 3 that were mentioned by multiple panelists but failed to meet the a priori threshold. For example, attitudes representing empathy, humility, altruism, and cultural sensitivity were mentioned during the in-depth interviews as well as the first Delphi round, but were not included in the final set. If we had focused our Delphi recruitment solely on social entrepreneurs, we believe that these attitudes would have been more widely accepted. We have presented all items for the sake of transparency as well as to encourage other researchers to explore whether constructs with less agreement in our panel should be examined further.