The Journal of Continuing Education in the Health Professions, Volume 16, pp. 69-74. Printed in the U.S.A. Copyright 0 1996 The Alliance for Continuing Medical Education, the Society of Medical Coilege Directors of Continuing Medical Education, and the Council on CME, Association for Hospital Medical Education. All rights reserved.

Guest Editorial

Challenges and Opportunities in Lifelong Learning: Perspective of Pharmacist Employers

KENNETH W. KIRK, RPh, PhD Vice President of Academic Affairs National Association of Chain Drug Stores Alexandria, VA

ALAN L. HANSON, RPh, PhD Professor of Continuing Pharmacy Education Extension Services in Pharmacy University of Wisconsin Madison, WI

Abstract: What changes do pharmacist employers believe will have to occur to make lifelong learning a part of the underlying structure and framework of an individual pharmacist’s pro- fessional practice? Individual pharmacists should seek to develop a passion for their work and learn what to do with the autonomy granted to members of a profession. The pharmacy profession should develop a concept of pharmacy practice that focuses on what the public expects from a pharmacist rather than one that seeks to change the public’s perception of a pharmacist. Mandating certain behaviors on the part of pharmacists will not promote lifelong learning since regulations only prescribe minimums, while lifelong learning stresses maxi- mizing one S potential. Pharmacy educators should try to find ways to capitalize on the experience individual pharmacists have accumulated and move those pharmacists ahead to the next level of practice. This process begins with the perspective that educators should focus on enhancing a pharmacist ’s proficiency rather than trying toprevent obsolescence. The issue may not be whether pharmacists will participate in the learning process: rathel; it is likely to be what they will learn that is directly applicable to their pharmacy practice. Pharmacist employers should create a work environment where pharmacists can fully use what they have learned. Through the proper use of irtdividualized incentives, employers can promote self- directed and lifelong learning among their pharmacists.

Key Words: Continuing education, employers, incentives, pharmacy

Pharmacy education recently completed an exten- sive self-examination of curricular changes needed to prepare pharmacists to practice in the 21st cen- tury.’ The study addressed the importance of devel- oping an attitude of self-learning within phar- macy students and stated that, “A profession

Presented at the Second International Conference on Lifelong Learning in Pharmacy, August 26, 1994, Madison, WI.

Reprint requests: Kenneth W. Kirk, RPh, PhD, St. Louis College of Pharmacy, 4588 Parkview Place, St. Louis, MO 63110-1088.

dedicated to continued learning enhances the profession’s ability to serve the public.” The responsibility for such development does not lie solely with academia, nor should the focus be on students alone. Others with a stake in the profes- sion - pharmacist employees as well as phar- macist employers - have a role as well.

One method for pharmacists to foster such an attitude is by participating in some form of con- tinuing education on a regular basis. But while mandatory continuing education requirements for pharmacists are now commonplace across the country, it is questionable whether existing

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Lifelong Lenrriiiig: Perspectii~e of Phnrimcist Employers

continuing education offerings enhance a phar- macist‘s interest in lifelong learning. Pharmacy employers are interested in helping pharmacists develop a positive attitude toward lifelong learn- ing as part of the job enrichment process. How- ever. due to the episodic nature of most continu- ing education initiati\,es in pharmacy. employers cannot rely on the current system to ensure that their pharmacists are capable of meeting the chal- lenges that tomorrow‘s pharmacy practice will bring. As one pharmacy leader has so aptly stated. “Continuing education was a nice try but it does- n‘t work today: a half hour here and there answered the need two decades ago, but it no longer does.“’

Therefore. the basic question that this paper will try to answer is what changes do pharmacist employers believe will have to occur to make life- long learning a part of the underlying structure and framework of an individual pharmacist’s profes- sional practice? It is suggested that implementing these changes is the collective responsibility of four groups within pharmacy: 1 ) the individual phar- macist, (2) the pharmacy profession itself, (3) the pharmacy educator. and (4) the pharmacist employer. Each of these four groups will be addressed separately.

The Individual Pharmacist

Loolung at the evolving role of the pharmacist in today’s health care system, a case could be made that more “intelligent” pharmacists are needed. That statement is not intended to offend pharma- cists because adult educators define “intelligence” differently than most people. For example. Lin- deman described “intelligence” as “the ability to learn. the capacity to solve problems, to utilize knowledge in evolving continuing accommoda- tions to changing environments.”3

There are three important elements of Linde- man’s definition: ( 1 1 the ability to learn: (2) the capacity to solve problems. and (3) the ability to use knowledge to accommodate change. This ability to accommodate change is particularly important in the health care reform environment that exists

today. The development of managed care and the evolution in pharmacy toward becoming a more patient-oriented profession are two examples of changes that have both an immediate as well as future impact on pharmacists; those who adapt to such changes will prosper while those who do not may be faced with obsolescence. Lindeman also claimed that intelligent persons are teachable and adaptable; they know what they want to do and why.’ Seemingly, this also would describe self- directed learners. The environment in which life- long learning occurs is characterized by informal- ity and lack of rigid structure when compared to an undergraduate setting. Thus, self-direction is a key component to the lifelong learning process as learn- ers strive to determine their learning needs, develop learning plans, and evaluate learning outcomes.

One cannot overestimate the importance of a profession having autonomous, self-directed learn- ers. In fact, Rosinski has suggested that the bur- den of proof as to whether pharmacy remains a pro- fession will depend on the degree of dedication each individual member gives to professional growth.-‘ If having autonomy and knowing what to do with it is a key component of being a health professional, how does a pharmacist learn what to do with the autonomy that is inherent in an indi- vidual‘s efforts to be a self-learner?

A good place to start is to develop a passion for being a pharmacist. At a Career Development Conference for pharmacy educators, Banks sensed that a passion for pharmacy was missing in many pharmacists. She stated that most successful pro- fessionals with whom she was acquainted had chosen their particular career because of a com- mitment to a cause and through that commitment, they exhibited a passion in their w01-k.~

Evidence of such a passion may be exempli- fied by pharmacists who have a strong enough interest in their work to actively seek continuing education programs that they believe will make them better pharmacists. As documented by Han- son and De Muth, evidence shows that pharma- cists participate in a variety of professional and leisure learning activities, with varying frequency.6

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The issue may not be whether pharmacists con- tinue to participate in the learning process; rather it is likely to be what they will learn that is applic- able to pharmacy practice, per se. Will they learn new concepts in drug therapy or choose instead to pursue more recreational forms of education, totally unrelated to pharmacy practice? As adult educators know, the “competition” among con- tinuing education providers in pharmacy clearly extends beyond programs that seek to maintain a pharmacist’s competence. It includes many pro- grams for which the intent may be good but, in real- ity, do nothing more than raise awareness of an issue rather than impart an applicable skill and/or body of knowledge.

The pharmacist does not and should not func- tion alone in the pursuit of relevant (i.e., applica- ble) knowledge and skills. The provider of lifelong learning programs has a role as well. Some would argue that an emphasis should not be placed on what pharmacists need to do to become lifelong learners. Instead, they think that the focus should be on what providers of lifelong learning need to do to attract the learning audience. With a wide variety of programs from which to choose, phar- macists can be more discriminating in their learn- ing choices. The mere availability of an educational program is no guarantee that potential learners will participate. A provider who develops and offers programming without careful attention to such factors as learners’ needs, applicability of con- tent to practice, learning methods, and distance technology will likely have no audience. Today’s emphasis on accommodating change is a golden opportunity for continuing educators in pharmacy to develop programs that will attract pharmacists who are seeking to renew their passion for pharmacy.

The Pharmacy Profession Itself

One of the primary responsibilities of a profession is to develop and maintain its own standard^.^ Pharmacy today is trying to establish a standard of practice that is accepted by all practitioners. One

possible reason why standards or characteriza- tions of practice are laborious as well as difficult to develop and maintain is because present-day dis- cussions of pharmacy practice are often too con- ceptual. The profession seems to be embracing a concept called “pharmaceutical care,” although many define the term to suit their individual approaches to practice. Many pharmacists do not understand how to provide pharmaceutical care in their particular practice setting; therefore, they lack an awareness of what it is that they need to learn. The profession needs to provide such direc- tion if “pharmaceutical care” is to become the standard of practice for pharmacists.

Kami recently cautioned the business world against substituting vision for actually doing some- thing and warned that “Philosophy without action is hall~cination.”~ This has become a problem in pharmacy because, from an employer’s perspective, the gap between “theoretical concepts” and “mar- ketplace reality” has simply gotten too wide. Some believe that there are too many visionaries in phar- macy and not enough implementers. Too many people in pharmacy want to change those around them rather than seek to learn how they can better meet the existing needs of their constituencies.

For example, rather than develop a concept of pharmacy practice that seeks to change the pub- lic’s perception of a pharmacist, the profession might be better off simply asking itself what the public expects from a pharmacist. A profession should not ignore what its clientele want. Drucker has warned that the greatest danger for a business venture is to think it “knows better” than the cus- tomer. Drucker further states that “Businesses are not paid to reform customers, they are paid to sat- isfy customers.”8

One segment of any health profession is the regulatory side, exemplified by state licensing boards that determine the criteria that one must meet to practice a given occupation. There are those who believe that state boards of pharmacy can play a role in motivating pharmacists to update their knowledge and skills by instilling a fear of what will happen if they do not stay competent.

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L(fe1ong Lenixiiig: Pel-specti\-e of Phniwincist Employers

I &

Fear can be a strong moti\,ator to learn. Proponents of this philosophy would argue that. if the public expects too little from a pharmacist. "fear" needs to be instilled in pharmacists by resulations. For example. the majorit!, of state boards of phar- macy have replations stipulating that pharmacists must counsel all patients who receive prescrip- tions." These regulations ha\.e created a concern within the profession of pharmacy regarding enhanced liability for pharmacists: in turn. this has served as an impetus for increased participation by pharmacisth in continuing education programs designed to enhance their counseling skills."'

Histor! suggests. however. that regulatory "tear" is not effective in changing pharmacists' col- lective practice behavior. Mandatory continuing education requirements. for example. have existed in pharmacy for more than 25 years. However. no evidence exists to suggest that the standard of pharmacy practice today has been enhanced by these mandatory continuing education require- ments. In fact. as far back as 1984. an American Pharmaceutical Association Task Force on Pharmacy Education seriously questioned the validity of mandatory continuing education as a way to ensure the professional competency of pharmacists.'!

The basic problem of relying on regulations to promote lifelong learning is that regulations can only prescribe minimums while lifelong learn- ing stresses maximizing one's potential. Further, mandatory continuing education enhances atten- dance at continuing education programs. but not necessarily learning. Thus. while the pharmacy pro- fession needs to focus attention on establishing realistic standards of practice, i t should do so without creating more regulations designed to enforce those standards. If successful. the result could be a more autonomous pharmacy profession.

The Pharmacy Educator

An important question for pharmacy educators to answer is whether lifelong learning is something one "puts into" or "pulls out o f ' another person.

Just as the pharmacy profession has had a tendency to eyer-regulate pharmacists, a good argument can be made that pharmacy education has had a tendency to overeducate pharmacists. Educators have a tendency to view the learner as being defi- cient in something; their orientation is to identify what a person does not know. Adult educators, however, know that an adult learner has accumu- lated experience in life on the job. Thus, the role of educators is to make the adult learner aware of that experience, which occurs by focusing one's teaching efforts on "pulling out" that experience from the learner.

Unfortunately, pharmacists often underesti- mate the value of their practice experience. Inter- estingly, Lindeman has described adult education as a "process through which learners become aware of significant experience."3 Thus, continu- ing educators in pharmacy should try to find ways to move individual pharmacists ahead from the point where their experience has brought them to the next level of practice.

How can this be done? It could begin with the perspective that. rather than trying to prevent obsolescence, adult educators in pharmacy should focus on enhancing a pharmacist's proficiency. This is a concept promoted by Knox." Prevent- ing obsolescence merely maintains the status quo and that is not what lifelong learning strives for at all. Pharmacists joke about the patient who says. "If 2 tablets are good, 4 tablets must be twice as good." Yet, in too many continuing edu- cation programs, educators seem to be saying, "If 2 hours of lecture are good, 4 hours of lecture must be twice as good." Overdosing does not just hap- pen with medications; it happens in the classroom all too often.

The general status of continuing education (i.e.. episodic. emphasis on contact hours, content focus) in pharmacy today demonstrates. in some people's minds, that overeducation does not pro- mote lifelong learning. If pharmacists spend their entire career trying to figure out how to use what they already know, what is their motivation to learn more'? Putting more and more information

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Kirk and Hanson

into pharmacists via episodic continuing education programs is an easy way out for educators to take, but committing resources to create programmatic continuing education programs instead would help pharmacists develop their proficiency through- out their careers. This type of educational pro- gramming will be required to accommodate changes associated with the continuing evolution of pharmacy practice.

The Pharmacist Employer

For some time, it has been recognized that the cause of professional incompetence is seldom inadequate knowledge; rather, characteristics of the work environment often are the origin.13 Clearly, attitudes, character, and habits all strongly influ- ence a pharmacist’s competence. A recent doctoral dissertation study of pharmacist dispensing errors showed that the primary causes of errors were interruptions and distractions, lighting, and work- load. No mention was made in the study of phar- macists’ lack of kn0w1edge.I~

What can employers do, then, besides improve the work environment for pharmacists? The answer to this question could be tied closely to the ques- tion asked earlier (i.e., what does the public expect from a pharmacist?). This is particularly true if the public expects more than they are receiving. Employers could begin by creating an environment where pharmacists can fully use what they have learned. Over time, as some things are forgotten, new advancements are made, and, as practice changes, these pharmacists will find that they have not retained and/or acquired sufficient knowl- edge and skills to practice as they wish or to extend the limits of practice as it currently exists. Thus, eventually, they will sense a need to learn more. This is a critical step in becoming a self- directed learner.

Employers can promote self-directed and life- long learning among their pharmacists by center- ing attention around one key word: incentives. Indeed, the issue of lifelong learning is not about the availability of educational material; it is about

creating incentives for the learner to pursue what already is available. An employer’s goal should be to create a work environment where pharmacists are able to develop pride in their practice and pride in themselves.

Earlier, the question was asked: What can employers do besides improve the work environ- ment for pharmacists? Once the proper environ- ment has been created, an employer can begin focusing on what incentives motivate each phar- macist to perform at hisher best. Incentives are very individualized, just as adult education learn- ing experiences should be individualized. In fact, if one accepts Lindeman’s view that adult educa- tion is an attempt to create a new incentive for learning? then every employer has the opportunity, if not the responsibility, to become an adult educator.

Summary

This paper has segmented pharmacy into four groups: (1) the individual pharmacist, (2) the profession itself, (3) the pharmacy educator, and (4) the pharmacist employer. All four groups have a role to play in fostering lifelong learning activities. These roles may encompass setting expectations and professional standards, they may relate to teaching styles and facilitating the educational process, or they may involve pro- viding incentives that facilitate internal aspira- tions. While the ultimate responsibility rests with the individual pharmacist, who must decide whether to be a lifelong learner in pharmacy, the desire or motivation to pursue lifelong learning activities pertinent to the practice setting must be matched by the employer who affords an oppor- tunity to applyhse that which is acquired from the learning activity.

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