Cross-Validation of an Instrument for Measuring Professionalism Behaviors

By Kelley, Katherine A.; Stanke, Luke D. et al. | American Journal of Pharmaceutical Education, November 2011 | Go to article overview

Cross-Validation of an Instrument for Measuring Professionalism Behaviors


Kelley, Katherine A., Stanke, Luke D., Rabi, Suzanne M., Kuba, Sarah E., Janke, Kristin K., American Journal of Pharmaceutical Education


INTRODUCTION

A key component in the practice of pharmacy is the pharmacist's demonstration of professional attitudes and behaviors. Therefore, professionalism education should be a critical part of any doctor of pharmacy (PharmD) program. The Accreditation Council for Pharmacy Education (ACPE) lists professionalism as an area of emphasis in their accreditation standards and guidelines. (1)

Professionalism has been defined in contemporary pharmacy literature as possession and/or demonstration of structural, attitudinal and behavioral attributes of a profession and its members." (2) Professionalism also can be defined as a "set of core values that includes altruism/ service, caring, honor, integrity, duty and others." (3) While these definitions provide practitioners and educators a sense of the fundamental nature of professionalism, they are not methods for measuring professionalism in our students or practicing pharmacists.

Professionalism can be challenging to assess and there are numerous barriers to measuring it. (4) Definitions are more abstract than concrete. Furthermore, professionalism is somewhat specific to the context in which the pharmacist or trainee is practicing (eg, a student on a practice experience in a large, urban academic health center vs. a classroom setting). Also, there is reluctance to address unprofessional behaviors, however minor. (4) Finally, it can be difficult to garner accurate measures of concepts such as professionalism because survey takers tend to rate themselves at or near the top of the scale on every item. (5) This ceiling effect of measurement limits the usefulness of the instrument for measuring change over time. (6) Another difficulty associated with measuring professionalism is that professionalism is based on a set of internally held values that are exhibited and measured through behaviors; ie, professionalism can be viewed as both attitudinal (internal to the practitioner) and behavioral (externally exhibited to the world by the practitioner). Attitudinal measures of professionalism may not address outward behaviors, and behavioral measures may not address internally held values related to professionalism. (3)

While there are many publications on professionalism in pharmacy, relatively few papers report on the formal curriculum associated with teaching professionalism or assessing students' acquisition of professionalism. (7) Only 3 articles report on the development of tools to measure professionalism in pharmacy students. Hammer and colleagues developed an instrument to be used by preceptors to measure the behavioral aspects of professionalism based on items collected from student evaluation forms. (2) The instrument developed by Chisholm and colleagues is based on the American Board of Internal Medicine's (ABIM's) 6 tenets of professionalism and measures attitudinal aspects of professionalism by means of self-assessment. (8) Lerkiatbundit reported on the development of an attitudinal self-assessment of professionalism, (9) and on the validation of this instrument to measure change in professional attitudes over time. (10) This instrument contains 6 subscales and is based on earlier works by Schack and Helper that measured attitudinal professionalism in pharmacists. (11)

Lynch and colleagues reviewed the literature on professionalism in medicine and recommended a set of best practices for professionalism assessment. (12) The recommendations include formative assessment of learners early on and frequent in the curriculum, and conducting assessments in different settings and by multiple assessors using multiple methods. They also recommended that existing professionalism assessments should be improved rather than replaced by newly created instruments or tools. Veloski and colleagues reviewed the medical literature on professionalism instruments and reported that few published instruments address the 3 fundamental measurement properties: content validity, reliability, and practicality. …

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