To date there is no agreed definition of what pharmacy professionalism is and this has not been discussed by the profession. The Royal Pharmaceutical Society (the professional body for Pharmacy) is now on a journey to address this. A recent meeting held at Lambeth involving all avenues of pharmacy (from grass-roots practitioners to companies/organisations, to regulators and government) started to address this, beginning a two-way conversation about professionalism and a no blame culture set within the context of recent findings regarding supervision and the responsible pharmacist regulations. Several organisations presented including the Civil Aviation Authority, the General Pharmaceutical Council (the GPhC) and the Crown Prosecution Service in order to set the scene for discussions.

A recent publication (New Medical Professionalism1) by the Health Foundation was then used as a basis for discussion. The paper was thought provoking and is well worth a read. It does not try to define professionalism, but rather to describe it through conversations at a range of levels – with those at the coal face, universities, Royal Colleges, employers and regulators. It reviews ‘the ways in which doctors’ relationships with evidence, society, patients, teams, regulators and employers have changed, are changing or may need to change and the implications for medical professionalism.’  It concluded that professionalism is changing all the time and there are a range of aspects that have led to this, including: how professionalism is viewed (tradition); the demographics of doctors; the growth of evidence-based medicine (with a trend towards specialisation); societal changes (an expectation of a cure and consumerism); changes in the doctor patient relationship (needing judgements and good communication); the evolution of medical teams (taking into account individual and team accountability and ensuring the unique contributions are in line with aptitudes and motivations); changes in how regulators carry out their role (as a participant in delivering healthcare with professionals); employers (ensuring acceptable compacts (agreements between parties; a covenant or contract) to provide health outputs). Much of this could also apply to pharmacy, indeed when Harry Cayton was interviewed in this research, he raised the question, “Why medical professionalism? It’s doctors, nurses, all the other people. You cannot treat the professionalism of doctors differently.” We would agree with that view and believe that the behaviours and values can span all healthcare professions. It is however important that each profession discusses this and determines what it thinks professionalism is (and is not) before moving onto a shared vision. That way we can come to a consensus view and hopefully take everyone with us.

At the end of the meeting we were all tasked with talking about professionalism (and a just culture) in our networks and helping the profession move forward on this. We have started this Blog with a view to helping with this and also provide further information and references below. We all need to engage with this area of development and push this agenda forward!

Background to professionalism

There are many definitions of professionalism/being a professional and they vary depending on the context. Within the healthcare sector, medicine has led the way in trying to define the term2-5. In recent years there has been a move away from defining the term to trying to classify the component parts. Many definitions are however vague and principle based having no clear description of what professional behaviours look like6.  We believe it is important to give examples of what good looks like and too often the bad examples are publicised, for example in the updates from the GPhC in the Pharmaceutical Journal. We all need to know what is expected of us and what to aspire to. This is especially true when in education and training and is key to the development of pre-registration trainee pharmacists in the pre-registration year.

The RPS have recently produced a definition of what ‘could be’ professionalism in its publication: Medicines, Ethics and Practice: The professional guide for pharmacists 2011,

 ‘Pharmacy professionalism could be defined as a set of values, behaviours and relationships that underpin the trust the public has in pharmacists’ 7.

This definition is based on work produced by the Royal College of Physicians 8. It however needs to be discussed and perhaps we should remove the words ‘could be’ and replace them with ‘is’?  The definition above was not used at the recent meeting at the RPS and therefore it seems that although it has appeared in a recent publication, the plan is to first discuss this with the profession and reach a consensus on its meaning before using it in all publications.

It is important to remember that when we are looking at an individual’s professionalism there is an overlap between socially acceptable behaviours (whether we are working or not) and professionalism (within the context of the specified discipline - pharmacy). This has made the definition of the concept and assessment of these professional components within medicine difficult9. This also applies to pharmacy. If we cannot produce an all encompassing definition then we need to set expectations in this area and these must be articulated to the profession (whether that be through the characterisation of individual components) so that we all know what we are aiming for. Once these expectations have been set in place then we can embed professionalism within the profession and measure outcomes (assess for professionalism).

We believe professionalism needs to be explicitly and consistently taught to all potential pharmacy registrants from day one of starting a pharmacy course as a student through to being a component part of revalidation. Medicine is starting to address issues within medical education and a recent report by The King’s Fund discusses this in more detail10. One other central aspect of learning professionalism is through the observation of role models11. This is especially important for pre-registration trainee pharmacists who have left the university environment and may be working with a sole pharmacist, their pre-registration tutor. If they do not have an appropriate professional tutor then this may shape how they practise themselves.

We should remember that professionalism is not a static concept and evolves over the career of being a pharmacist, so we all need to be engaged with this at whatever step in our careers. Professional behaviours are heavily influenced by the context of practice and it is essential to support and harness these. It is therefore essential that everyone (that means all of us) ensures that the right professional culture is set and maintained whether that be individuals, teams, employers, universities, professional bodies or regulators.

There are a number of groups undertaking research in the area of professionalism in pharmacy and these include looking at undergraduates, early career pharmacists and teaching and learning in general 12-14. What is important is that there is a foundation of professionalism and then adequate practice exposure and role models to ensure that this is embedded. We are focussed on the pre-registration year and we believe that we need to teach professionalism and develop good role models within pharmacy to ensure a professional workforce for the future!

 

REFERENCES

1   Christmas, S. & Millward, L. New Medical Professionalism: A Scoping Report for the Health Foundation. 2011. The Health Foundation. http://www.health.org.uk/public/cms/75/76/313/2733/New%20medical%20professionalism.pdf?realName=JOGEKF.pdf [last accessed 19/12/11].

2    Schafheutle E, Hassell K, Ashcroft D, Hall J, Harrison S. Professionalism in Pharmacy Education. 2010; Report published by the Pharmacy Practice Research Trust.

http://www.pprt.org.uk/Documents/Publications/Professionalism_in_pharmacy_education_final_report.pdf [last accessed 06/02/12].

3   Elvey R, Lewis R, Schafheutle E, Willis S, Harrison S, Hassell K. Patient-centred professionalism among newly registered pharmacists. 2011; Report published by the Pharmacy Practice Research Trust.

http://www.pprt.org.uk/Documents/Patient_centred_professionalism_in_newly_registered_pharmacists.pdf [last accessed 06/02/12].

4   Brown D, Ferrill MJ, Lloyd L. The Taxonomy of Professionalism: Reframing the Academic Pursuit of Professional Development. Am J Pharm Ed 2009; 73 (4) Article 68.

5   Wilson S, Tordoff A, Beckett G. Pharmacy professionalism: A systematic analysis of contemporary literature (1998-2009). Pharmacy Education. 2010; 10 (1): 26-30.

6   Lesser CS, Lucey CR, Egener B, Braddock CH 3rd, Linas SL, Levinson W. A behavioral and systems view of professionalism. JAMA. 2010; 304(24):2732-7.

7   Royal Pharmaceutical Society (RPS). Medicines, Ethics and Practice: The professional guide for pharmacists 2011; 35: London: RPS.

8   Royal College of Physicians (2010) Future Physician: Changing doctors in changing times. Report of a working party. London: Royal College of Physicians

9   Leinster S. Evaluation and assessment of social accountability in medical schools. Med Teach. 2011;33(8):673-6.

10 Levenson R, Atkinson S, Shepherd S. The 21st Century Doctor: Understanding the doctors of tomorrow. 2010; London; The King’s Fund.

11 Schafheutle E, Hassell K, Ashcroft DM, Hall J, Harrison S. Learning professionalism through practice exposure and role models. 2011 Pharm. Journal 285:164.

12 Wilson S, Gidman W, Becket G. Teaching appropriate behaviour to pharmacy students and assessing it. Pharm. Journal 2008; 280: 80.

13 Prescott J, Wilson, Becket G Factor analysis of the Jefferson Scale of Physician Empathy, student version. 2011; B.Psych.Soc. Assessment & Development Matters 3 (4): 18-21

14 Rutter PM, Khalid S. An exploration of how well final year pharmacy students understand professionalism.  Pharmaceutical Journal Online.2011 [accessed 11/05/2011].