Teaching Intellectual Humility Is Essential in Preparing Collaborative Future Pharmacists

What Is Intellectual Humility?

Intellectual humility is fundamentally a cognitive phenomenon that involves “recognizing that one’s beliefs and opinions might be incorrect.”⁸ Showing intellectual humility, however, does not mean being uncertain about one’s beliefs or viewpoints. Contrastingly, it demonstrates awareness that one’s ideas might be flawed and acknowledgment that one may not have sufficient information and expertise to understand and evaluate aspects of the evidence.⁸ Nevertheless, an associated feature of intellectual humility is engagement, ie, engaging in and enjoying cognitive activities.⁸ While fundamentally an assessment of one’s own beliefs and knowledge, intellectual humility also manifests through openness to other peoples’ ideas and viewpoints.⁸ Moreover, it is characterized by flexibility and lack of conceit with regard to one’s beliefs and opinions.^8,9 As Krumrei-Mancuso and Rouse put it, intellectual humility is a “healthy independence between intellect and ego.”⁹ Furthermore, intellectual humility is associated with having low defensiveness or showing emotional resilience when one’s beliefs are questioned or challenged.^8,10

Alfano and colleagues, who recently developed and validated a tool to measure intellectual humility, proposed four core dimensions of the behavior: open-mindedness, intellectual modesty, corrigibility, and engagement (Table 1).¹⁰ Recent research has identified significant implications and benefits of applying intellectual humility in various domains, for instance, sociopolitics, religion, education, business and leadership.^7,11,12 Based on the above conceptualization of intellectual humility, we propose that the trait is also beneficial in promoting interdisciplinary collaboration. As discussed below, the core dimensions of intellectual humility may facilitate effective collaborations among members of a health care team.

Facilitating Role of Intellectual Humility in Interprofessional Collaboration

Mapping the core dimensions of intellectual humility to the corresponding core competency domains proposed by IPEC brings to light a potential facilitating role of intellectual humility in interdisciplinary collaboration (Table 1). Within the interprofessional setting, each team member yields unique knowledge, experiences, and skills. Cultivating open-mindedness could result in team members respecting the individual contributions and expertise of other health professionals. Disagreements on the course of care is inevitable because of the variation in training and experience of team members. Open-mindedness could promote willingness to listen to and learn from a variety of viewpoints and thereby prevent or resolve disagreements.

Training on intellectual modesty could encourage team members to recognize their limitations, and thus prevent them from exuding superiority and overconfidence in their knowledge. It could also keep them “grounded” (to not think about their “status” on the team), and thus promote willingness to work with others. Corrigibility could enhance interprofessional interactions, with team members responding respectfully to feedback from fellow health care providers. It could also eliminate defensiveness when one’s clinical decisions are challenged, and openness to revising one’s clinical decisions when warranted. Finally, engagement could result in health professionals continuously learning from each other; to be actively involved in resolving issues that may arise within the team, and to seek opportunities for lifelong professional and interprofessional development. Team members who demonstrate intellectual humility would listen to and learn from one another to develop the best clinical plan based on the evidence provided. Eventually, this will break down the silo mentality, positively influence the dynamics of the interprofessional team, and lead to the ultimate benefit: the provision of better care for patients.

Strategies to Teach Intellectual Humility to Student Pharmacists

In view of the potential collaboration-promoting role of intellectual humility, teaching this trait to student pharmacists is critical in preparing them for interdisciplinary practice. Trainings in intellectual humility could be offered through an elective course within the pharmacy curriculum. The University of Edinburgh, for example, has recently offered an online course on the science and applications of intellectual humility.¹³ However, we believe that the IPE introduced throughout the core curriculum is the most appropriate venue for teaching intellectual humility. Within this setting, students from the different health professional tracks could be informed about the benefits of intellectual humility in interprofessional collaboration. Prior to IPE sessions, all students could take assessments (eg, validated surveys) to determine the degree of their intellectual humility. If need be, students could be taught the core dimensions of the behavior and specific strategies to apply them during the IPE sessions. Furthermore, the students’ biases or stereotypes of their own profession and that of others could also be addressed, in view of health care students’ (including student pharmacists) inclination towards “ingroup favoritism,” or the tendency to favor members of one’s own group over those in other groups.^14,15 Such in-group bias, which is often driven by an effort to seek higher self-esteem,¹⁵ does not conform to the principles of intellectual humility and could potentially hinder interprofessional collaboration.

During the IPE sessions, students could be given comprehensive patient cases that would harness their individual skill sets and expertise. These cases could be designed with the addition of simulation or standardized patient involvement. The case development process should involve all faculty members representing the trainees’ fields of study. Case problems must be crafted such that their completion is contingent upon the entire team communicating effectively, showing openness to different ideas, accepting one another’s limitations, and responding respectfully to feedback and alternative ideas. Thus, students would be evaluated not only on successfully completing the patient cases, but also with regard to their application of intellectual humility to solve the case problems.

Teaching intellectual humility could also be implemented as students gain experiences through introductory and advanced pharmacy practice experiences (IPPEs and APPEs). Pharmacy preceptors could intentionally instruct students on intellectual humility by referring them to the core dimensions of the behavior and their application in an interprofessional care setting. As mentioned above, encouraging student pharmacists to be open to ideas, to admit that they are wrong, to be engaged, and to respond with resilience to feedback, will promote adoption of intellectual humility as students complete their IPPEs and APPEs. Incorporation of such behaviors would also serve as a model for other team members and learners (further discussed below). Preceptors can also evaluate students’ application of intellectual humility and instruct them on strategies to increase intellectual humility as they move toward a more autonomous role.

In order to evaluate the effectiveness of intellectual humility training, self-assessments through reflective writing could be employed, which could also serve as a tool to reinforce teaching and for students to document their commitment toward fostering intellectual humility. Reflective writing could be structured to allow students to articulate and analyze the factors that promoted or hindered meaningful interactions with others during the IPE sessions and experiential learning.¹⁶ Through reflective writing, students could be asked to ponder on the instances wherein the application of intellectual humility was crucial, and contemplate strategies to address the barriers that prevented them or others from demonstrating this trait.

Research on the effectiveness of intellectual humility trainings within IPE, IPPE/APPE frameworks are crucial to establish the above-proposed collaboration-promoting role of intellectual humility. Such work will also determine whether IPE, IPPE, and APPE settings are the ideal venues for providing such training. Furthermore, follow-up studies should also be conducted to determine whether students trained in intellectual humility really work better with others in a multidisciplinary team.

Although it might be challenging to teach intellectual humility given the contemporary society’s incentivization of arrogance and assertiveness,¹⁷ pharmacy educators can increase student’s adoption of intellectual humility by informing them of the personal benefits of being intellectually humble. Intellectual humility has been associated with better learning, and curiosity, which is a desired academic and professional outcome.⁷ In the context of diversity, equity, and inclusion, intellectual humility could help foster respect and openness to the diverse backgrounds and lived experiences of others, and motivate individuals to work toward equity and inclusion both in professional as well as personal contexts.

Role Modeling Intellectual Humility

“We must acknowledge … that the most important, indeed the only, thing we have to offer our students is ourselves. Everything else they can read in a book.”

In the above statement, the influential educator, Dr. D.C. Tosteson, emphasizes the significance of role modeling in medical education.¹⁸ Pharmacy educators and preceptors must embody intellectual humility in order for them to become effective trainers of this trait to student pharmacists. Intellectual humility is demonstrated when one admits that he/she does not know the answer to a question posed by a student or a colleague. This act does not make one appear unintelligent or indecisive. It does not compromise one’s integrity; rather, it sets an example for learners to be honest as well about the gaps in their knowledge, which could enable teachers to address them more effectively. With the current expansion of knowledge and technology, and the rate by which new ideas are introduced, it is impossible to know all information. Furthermore, narrations of personal stories and experiences¹⁹ that demonstrate intellectual humility are also effective ways to inculcate this virtue to student pharmacists.

Another way to model intellectual humility is by becoming more open to overall collaborative education, given that one barrier to the implementation of IPE is the preference of some educators to work or teach within their established silos.²⁰ Because intellectual humility leads to openness to new ideas and epistemic curiosity (the desire to obtain new knowledge), embracing it could also increase one’s openness to explore the essence and value of collaboration across new disciplines.

Consciously modelling positive behaviors can transform health professions education.¹⁸ Educators and preceptors need to be explicit and intentional about role modeling intellectual humility in order for this strategy to work.¹⁸ Showing intellectual humility at all times may be difficult to achieve. However, educators and preceptors can strive to become consistently good models of this trait to their students.