Exploring the Impact of Participating as Pharmacy Camp Counselors on Student Pharmacists’ Professional Identity

INTRODUCTION

The role of professionalism and professional identity continues to be an area of concern with pharmacy educators as they recognize a lack of effective training on these concepts within pharmacy education.^1-3 One reason for the lack of effective training is educators’ difficulty with accurately defining professionalism and professional identity and how these concepts should be assessed in students. There are also discrepancies among pharmacy educators regarding how they associate professionalism with professional identity. Some feel that the two concepts go together, while others recognize a distinction between the two.⁴ To clarify this distinction, one must first understand the overall intent of each concept.

It was medical educators who first saw the importance of and advocated for integrating professionalism into medical education.⁵ The drive to integrate professionalism into all healthcare education was embraced as educators recognized a decline in societal norms, such as common civility, and as professional misconduct became a growing concern in academia.² With the acknowledgment of this trend, the discussion to accurately define professionalism began. Historically, educators have attempted to lump multiple meanings into the core concept of professionalism. The evolution of professionalism as a concept has been thoroughly documented in the literature,^2,6 and for the purposes of this paper will be defined as one’s ability to understand and emulate the values, attitudes, and behaviors recognized within one’s profession. The authors also recognize the professionalism traits identified by the American Association of Colleges of Pharmacy (AACP) Professionalism Task Force as essential to students’ evolution to practicing pharmacists. These traits include: development of the essential skills and knowledge of the profession, continuous professional development, a service-oriented mindset, professional advocacy, development of patient relationships, innovation and creativity, integrity and trustworthiness, self-accountability, ethical conduct and behavior, and leadership within the profession.^2,6

Professional identity, however, is less of a concept and more of a developmental process that students must transition through on their journey to becoming practicing professionals.³ Because of its link to social identity theory, professional identity has been framed as incorporating not only what a person learns in correlation to his or her profession, but also how the person’s own experiences outside the profession impact his or her sense of belonging, both in the world and within the profession.^3,5 To establish a professional identity, students must accept the values expected within their profession and are “not at liberty to pick and choose among the obligations resulting from them.”⁵ The AACP describes the impact of the differences in professional socialization that occurs between pharmacy education and the practice of pharmacy. Through their training, students are provided with specific expectations regarding roles and beliefs within their anticipated roles as pharmacists; however, too often, these expectations do not meet the reality of what students face as practitioners.⁶ This can often result in negative differences that damage the underlying professional identity developed during training. These challenges must be acknowledged throughout the educational process in order to minimize this disconnect.

A significant component of professional identity is developed through stepwise socialization as others’ expectations affect a person’s perception of his or her own role within society. According to Tajfel and Turner’s Theory of Social Identity, there are three distinct cognitive processes which contribute to socialization.⁷ First, there is social categorization in which individuals choose the group to which they belong. Second, social identification occurs when an individual’s beliefs and attitudes align with the chosen group. This step is the point at which students would typically enter pharmacy school. Finally, in the third step, Tajfel and Turner define social comparison as the point at which an individual’s concept of self is developed based on the beliefs of the groups to which they belong.⁷ Development of self comes from the individual’s ability to defend the beliefs of his or her identified group to outside entities. For this principle, students must have a strong and confident understanding of their roles within the group in order to develop positive, socially accepted attributes. Individuals who reach Tajfel and Turner’s social comparison without this confident understanding may experience lack of clarity concerning their roles and the principles of their group. This can lead to disengagement and may result in lost opportunities for developing social comparison and confirmation of group identity.⁷ This further drives the need for strong foundational experiences during professional training that allow students to solidly establish their assimilation with group beliefs.

In addition to social identity, professional identity, and professionalism, students continue to learn the skills and knowledge associated with their profession through teaching and mentoring opportunities. Kolb’s experiential learning theory stems from various educational theorists and is built around six fundamental concepts. These state that learning is a process, occurs through relearning, is enhanced by resolution of conflict, requires a holistic approach, results from interactions between the learner and the environment, and requires knowledge to be reshaped by personal experiences. Kolb’s theory describes how learning occurs through transformative experiences which lead to observation and reflection, the formation of abstract concepts, and application to new learning situations.⁸

Camps that introduce professional programs to high school students have been shown to be instrumental in recruiting them into healthcare degree programs, including pharmacy.^9-14 Yet, to effectively reach high school students, it is important to engage current healthcare students as peer instructors to enhance the overall learning experience for campers.^15-17 Research has shown that the inclusion of peer instructors within learning is successful because of social congruence, as peers share similar social roles. Peer instructors are best able to understand the challenges of the learning experience as they have completed these same experiences in recent months or years.^15-17 With these things in mind, the objective of this research was to explore how participation as pharmacy camp counselors impacted student pharmacists’ professional identity and views of professionalism.

METHODS

A pharmacy camp was developed at a state land-grant university to provide rising high school juniors and seniors the opportunity to explore the profession of pharmacy. Campers participated in a residential, one-week, interactive experience intended to expose campers to a variety of pharmacist responsibilities and career options. The camp development team recognized that the camp could also serve as a learning experience for student pharmacists by having them serve as team leaders and facilitators.

Student pharmacists who had completed at least one year of the Doctor of Pharmacy (PharmD) curriculum were invited to participate as camp counselors. For the inaugural year, student pharmacists who had completed their first (P1) or second year (P2) of the PharmD program and had shown leadership within the school and community were identified by the Office of Academic and Student Affairs and recruited to serve as camp counselors. The counselors served as peer instructors under faculty supervision for the week-long experience and were tasked with facilitating both classroom and clinical activities (see Table 1 for camp experiences). Faculty members included those with expertise in pharmacy practice, basic sciences, and higher education, and were present at all camp-related activities. Two to three counselors were assigned to each small group of campers for all camp activities. Counselors were responsible for leading several learning experiences and often served as content resources within their individual groups utilizing knowledge and skills learned as part of the PharmD curriculum. Further, counselors served as mentors for the campers and were available to address any questions regarding the pharmacy profession. Additional counselors were provided by the university’s youth outreach program but were excluded from the study because of their minimal involvement in educational and professional activities.

As a quality improvement project, investigators used focus group data to explore the impact of the learning experience on the student pharmacists who served as camp counselors. The researchers chose a focus-group format over individual interviews for several reasons. Traditionally, participants are more likely to respond honestly in focus groups as they allow for socially oriented discussions to take place in an informal, low-threat environment. Participants find a group format helpful as they can voice their own ideas and opinions and seek consensus from other participants.^8,19-21 Investigators also chose to use a single focus group because of the duration of the camp activities and the number of camp counselors involved. Furthermore, the counselors worked collaboratively throughout the camp; therefore, feedback was more representative when provided through a collective method.^19,21

Data collection occurred during a two-hour focus group held immediately following the camp experience. All student pharmacists who served as camp counselors were invited to participate in the focus group via email. Once they committed, student pharmacists received a calendar appointment with the focus group location and time. Student pharmacists were offered lunch as an incentive for attendance.

Student pharmacists were interviewed using a guiding document that was developed by one member of the research team, peer-reviewed by the remaining team members, and refined based on feedback. The interview questions included in the guiding document are listed in Table 2. The research team led the focus group with one member serving as the primary interviewer and remaining members documenting feedback. Because of the nature of the study, a loosely structured approach to interviewing was used which allowed students to lead the discussion. This fits within Rubin and Rubin’s seven steps model which allows for questions to occur naturally.²² In the Responsive Interviewing Model, as defined by Rubin and Rubin, the interviewer encourages a relationship between the researcher and the participants being interviewed. This approach allows for the interviewer to change the direction of the interview based on the responses of participants rather than maintaining a specific script. Similarly, in the current study, initial topics and questions were developed, but these were used only as a guide for the discussion. Recording procedures included digital recording in addition to the two researchers serving as note takers. All digital recordings were transcribed word-for-word using a third party unfamiliar with the camp experience. The transcription was de-identified for analysis. The richness of the data collected indicated that further analysis using a single instrumental case study approach was warranted. The research team chose this approach as it allowed the exploration of a single instance of a real-life experience (ie, participation in an inaugural pharmacy camp). As an instrumental case, the research team was attempting to explore how the pharmacy camp experience impacted the overall development of student pharmacists serving as pharmacy camp counselors.²³

Using Strauss and Corbin’s constant comparison analysis approach, the researchers assessed the focus group data using two of the three major stages.²⁴ In stage one, the researchers transitioned focus group data into smaller units prior to attaching a descriptor/code to each identified unit. Each researcher completed stage one individually, assessing data inductively to allow for the natural discovery of codes. The researchers then met to discuss a list of potential codes found during the inductive analysis and identified the need for a second round of deductive coding prior to assigning final descriptors/codes. During stage two, the researchers reached a shared understanding and grouped the discovered codes into themes. As a final step, the team formally defined the themes and identified illustrative quotes that supported those findings. The researchers did not include stage three of Strauss and Corbin’s analysis as it was not appropriate for this study because it includes comparison of findings across multiple groups rather than just one.

A direct interpretation approach was used to further examine data as it allowed the research team to assess this single instance and draw meaning from the focus group findings.^23,25 This approach involved assessing data, deconstructing the results, and identifying new categories/themes. To identify these categories/themes, interpretations were made based on patterns and relationships found within the deconstructed results. These patterns were then assessed for similarities and differences.²³ The final step of the analysis, naturalistic generalization, included comparing study findings to trends seen in other student pharmacists at the researchers’ institution as well as to professional students’ perceptions described in the literature. The use of natural generalizations was appropriate as it allowed the team to assess the case study and learn from the findings to better understand how the pharmacy camp experience affected the pharmacy camp counselors.^23,25 The Auburn University Institutional Review Board approved this study.

RESULTS

Twelve student pharmacists served as camp counselors; however, only 10 served as counselors for the entire week and chose to participate in the focus group. Of the focus group participants, four had completed their P1 year while the remaining six had completed their P2 year. All participants were included in the same focus group session.

Throughout the focus group discussion, counselors gravitated towards the topic of professionalism. Overarching themes emerged as student pharmacists considered their thoughts on professionalism from three different perspectives: themselves serving as a camp counselor, campers attending the camp, and differences observed between student pharmacists and other camp counselors who were not pharmacy students. The 10 overarching themes included professional identity, appropriate professional and personal boundaries, engagement, team building, rapport building, empathy, teaching/mentoring, learning, dress code compliance, and respect/appreciation for faculty members. The definitions and selected illustrative quotes from each of the 10 overarching themes are presented in Table 3.

Discussion of advocacy for the profession and professional identity emerged early in the focus group when participants were asked about their motivations for serving as counselors for the pharmacy camp. Student pharmacists identified rapport building with the campers, serving as a mentor, and promoting the profession as positive aspects of participating as a camp counselor. Counselors also expressed an appreciation for lifelong learning and learning through their teaching in the various camp activities. The concept of legacy and being a part of something new and exciting was also a predominant sentiment with the group.

When asked about specific activities included in the camp that were the most or least successful, participants responded positively and provided constructive feedback. Most critiques of the activities focused on improved time management and organization. Common themes for positive camper activities included experiences with active learning that encouraged camper engagement, team-building activities, and hands-on activities completed in the skills laboratory setting. Thoughts on site visits and tours were varied and contingent on the activities included on those tours. Significant self-assessment of professionalism occurred during the discussion of student pharmacists’ preparation for leadership in educational experiences. Several suggestions arose outlining methods to better prepare camp counselors for this role, including additional training, access to resources, and opportunities to talk one-on-one with faculty members regarding facilitation of camp activities. Student pharmacist camp counselors recognized the importance of preparation in being a professional role model for campers. Throughout the discussion, unsolicited comments also arose on professionalism and engagement of the non-pharmacy student counselors compared to their own levels of professionalism and engagement. Concepts such as appropriate level of engagement with camp activities, dress code compliance, and appropriate discussions around campers were common themes in the discussion.

At the conclusion of the focus group session, student pharmacist counselors provided thoughtful insights and reflections on their experiences. Counselor feedback suggested that the week-long experience challenged their own perceptions of their professional identities. Several participants indicated that career decisions and perceptions of appropriate professional and social boundaries had changed through their participation as a camp counselor. Counselors recognized positive and negative models of professionalism and made personal judgments concerning these concepts.

DISCUSSION

Student pharmacists’ participation in the development and implementation of camp activities was critical to engage campers throughout the week as they navigated the numerous professional experiences offered. As most student pharmacists were at a stage of life in which they could closely relate to campers, positive peer-teaching and mentoring relationships occurred more naturally than they might among campers and faculty members.^15-18 These relationships led to meaningful dialogues regarding the profession and challenges faced navigating the pharmacy curriculum.

Serving as camp counselors allowed student pharmacists the opportunity to explore their own perceptions of pharmacy as a profession, their own reasons for choosing pharmacy, and their abilities to perform clinical skills necessary to lead camp activities. Student pharmacists challenged their internal views of professionalism and assessed their future roles and responsibilities as practicing pharmacists. As a component of this outreach program, student pharmacists were also forced to examine their ethical decisions and personal biases so they could effectively facilitate difficult conversations with campers new to these concepts. This opportunity to serve as pharmacy camp counselors inspired these student pharmacists to reflect and define their individual views of professional identity.

As the literature has shown, the role of professional identity and professionalism within pharmacy education is an ever-evolving concept, and pharmacy educators may not always identify and provide the experiences that will change students’ perceptions of these concepts.²⁶ This trend will continue as pharmacy educators are unable to consistently define professionalism as a result of the constantly changing role of the pharmacist within the patient care setting.²⁶ Educators are faced with balancing the varying educational requirements needed to graduate student pharmacists adept in the technical requirements of the profession, while also providing opportunities that will shape student pharmacists’ understanding of the ideals of pharmacy practice and, in turn, facilitate their development of professional identity.^27,28

Students’ participation in the inaugural pharmacy camp began as an opportunity for student pharmacists to give back to the school and to advocate for the profession. However, the research team discovered that student pharmacists’ perceptions of both professionalism and professional identity evolved throughout the week-long experience. This trend was identified from the feedback pharmacy camp counselors provided regarding their original purpose for participating in the camp experience and how it evolved over the course of the week. They identified that while the purpose of the camp was to expose high school students to the pharmacy profession, the camp was, as one participant commented, to inspire others to be pharmacists and to share his passion for pharmacy with them. This evolution from future pharmacist to advocate reflected the pharmacy camp counselors’ abilities to take their roles to the next level, recognizing that without passion and enthusiasm for their profession, they could not fully embrace their professional identities.

The pharmacy camp counselors were also able to recognize that the ability to engage with campers was essential if they hoped to transform the campers’ perceptions of pharmacy as a profession. One counselor noted that campers “were most excited when they heard that they would be meeting in lab, their eyes kinda lit up…they felt like real pharmacists.” The camp counselors took those impressions one step further and applied it to their own experiences in the classroom stating, “if anything, I learned how annoying it is to facilitate something that no one wants to be a part of. Like, I need you to answer my questions, or this isn’t going to go anywhere.” As part of this process, student pharmacists were relearning through teaching, which Kolb theorizes allows students to examine and deepen the personal beliefs and ideals of the profession. Further, when campers challenged the beliefs of the profession through questions or actions, student pharmacists learned to resolve this conflict through reflection and integration.⁸

Immersion into a faculty role provided pharmacy camp counselors with the opportunity to experience the world of academia from a whole new perspective. As noted in Table 3, the research team teased out multiple characteristics (empathy, mentoring, team building, rapport building) affiliated with teaching and learning and examined how counselors associated those experiences with their own professional identity development. The pharmacy camp counselors reflected on the various challenges they encountered when serving as peer instructors for the laboratory experiences offered over the course of the week. For example, one student pharmacist stated that it was “really difficult to try and keep track of what I had told people and what I hadn’t. I felt like I was repeating myself non-stop” She added that she had no idea how faculty members did that every day. While the pharmacy camp counselors expressed positive feelings regarding their overall camp experience, maintaining appropriate professional and personal boundaries with the campers proved challenging at times. “…because they just want to keep joking around with you and I’m just like ‘alright stop and listen now’ or ‘put your phones away’… there’s time to be your best friend and there’s time to be your teacher. Going back and forth was difficult.”

Professional identity is further developed by exposing student pharmacists to positive role models actively engaging in the profession.²⁸ These experiences should allow student pharmacists the opportunity to practice their roles within pharmacy through realistic scenarios, guided clinical experiences, or academic settings.²⁸ During the week-long experience, the pharmacy camp counselors were able to serve in two roles: as learners who were learning how to lead laboratory experiences that they had encountered as students but were now facilitating under the guidance of a faculty member, and as role models who were modeling how to complete laboratory assignments and serving as a resource to the campers completing the experience. These dual roles further advanced the student pharmacists’ professional identity development; these opportunities to teach others about the profession provided student pharmacists the opportunity to gain deeper insight and understanding of their own professional beliefs and ideals.

Another notable finding was the counselors’ transition from opposing the school-mandated dress code to embracing its role within the pharmacy profession and professionalism as a whole. While there is limited literature focused on the role of dress codes in pharmacy education, some studies have found that the inclusion of a dress code instills a positive perspective regarding self-perception, self-esteem, and confidence within student pharmacists regarding their professional role.^29,30 These findings suggest that professional dress correlates with positive performance.²⁹ The pharmacy camp counselors’ acknowledgment and acceptance of the role of professional attire on one’s professional identity reinforces their transition into the second stage of social identity theory which correlates with the larger theme of professional identity, embracing the values expected within the profession. This acceptance further supports the student pharmacists’ continued growth as a professional, as embracing the importance of professional dress solidified an ability to embrace the values, attitudes, and behaviors recognized within the pharmacy profession.

An equally important step in professional identity development is the act of reflection. Student pharmacists should be encouraged to evaluate their learning experiences and to assess how these experiences shape their views of their professional roles.²⁸ As a component of the camp experience, pharmacy camp counselors were asked to reflect upon how the experience changed their career paths. Most counselors commented on how this experience changed the way they viewed faculty members as their professors’ participation in the camp showed them they were “really invested” in their students’ success.

The core tenets of professionalism and professional development were met with the integration of the pharmacy camp experience for these student pharmacists. With this educational experience, the pharmacy camp counselors received an opportunity early in the development of their professional identity to explore the various aspects of the profession. This experience also served as an opportunity to reshape student pharmacists’ views of pharmacy practice. As Noble and colleagues¹⁸ noted, “The formation of a strong professional identity, early in a student’s career, has been found to enable the successful transition to the workplace, motivate the beginning practitioner, and assist in establishing confidence in their role.” Lastly, the pharmacy camp counselors’ reflections supported Kolb’s experiential learning theory, as student pharmacists were able to articulate how the experience impacted their own professional identities and senses of professional responsibility.⁸ The pharmacy camp counselors voiced how completing the experience changed their own views of pharmacy education and the profession. The integration of this pharmacy camp experience within early professional development was instrumental in the cultivation of professional identity and characteristics of professionalism within these student pharmacists.

CONCLUSION

As a result of the focus group, the research team gained a better understanding of how student pharmacists viewed their roles within the inaugural pharmacy camp as well as their future roles within the profession. While initially intended to assess the week-long camp for quality improvement purposes, the focus group discussion provided novel insights into the professional mindset of student pharmacists who served as camp counselors. Counselors described new perspectives on the importance of professionalism in their individual journeys, among their peers, and as future student pharmacists. Further, this experience provided a better understanding of the counselors’ professional identities as future practicing pharmacists and the importance of professional identity in establishing respect among peers and patients. This study supports the education outcomes outlined within Accreditation Council for Pharmacy Education Standard 4, which describes the significance of participation in experiences such as the pharmacy camp in promoting personal and professional development.³¹ Experiences such as this one help ensure that graduates are prepared to continuously examine and reflect on how experiences shape their future as practicing healthcare providers.