INSTILLING PROFESSIONALISM AND CONFIDENCE IN

Transcription

1 INSTILLING PROFESSIONALISM AND CONFIDENCE IN STUDENT PHARMACISTS Renae Chesnut, RPh, MBA, EdD Associate Dean, Drake University College of Pharmacy and Health Sciences Why is confidence important? Professionals Competence knowledge, abilities, skills and attitudes Confidence belief that one has the ability to use that competence. ACPE Accreditation Standards, Appendix C active participation and patient care responsibilities, in a progressive fashion, designed to develop the practice skills, judgment, professional behavior, attitudes and values, confidence, and personal responsibility needed for each student to embark on an independent and collaborative practice. Balance of confidence is important for professionalism Under confident won t be able to portray knowledge Over confident may cause patient harm Pre-Assessment Questions Which of the following is not a source of selfefficacy? A. Vicarious Experiences B. Physiological States C. Goal-Setting with Challenging Standards D. Verbal Persuasion E. Mastery Experiences Pre-Assessment Questions Which of the following statements is false: A. Reflection questions allow for the development of selfefficacy. B. Over-confident behavior may be masking underlying self-esteem issues. C. Self-esteem leads to the development of self-efficacy. Pre-Assessment Questions T or F. Self-esteem is defined as the belief that one has the capability to initiate or sustain a desired behavior. T or F. Students should be expected to have the appropriate level of self-efficacy or confidence when they enter their experiential rotations. T or F. When a student makes a mistake on a task, it should be addressed immediately. Student Scenario #1 It is your first day with a new student and during the orientation discussion, you notice that the student does not say much. Furthermore, you notice that he doesn t look you in the eye when you are conversing with him. At one point, you even notice that he has a look of concern as you describe that you expect students to provide medication therapy management. Because of your early concerns, you contact t the experiential staff at the student s college to see if there is any background that you should be aware of. The experiential staff explain that the student is bright but has had a few experiences on rotations where his confidence level has dropped due to comments that had been made by the last preceptor. You quickly realize that your task as a preceptor will be to assist in developing a professional level of confidence in this student. 1

2 Student Scenario #2 It is the second week of a student s rotation and your rotation student has begun exhibiting behaviors that are not necessarily unprofessional, but ones that the you and your staff find annoying or frustrating. Specifically, the student appears overconfident in her abilities. You find yourself becoming irritated with that behavior and almost saying something publicly l or jumping in on a patient t counseling session. You realize that you need to communicate with the student directly rather than coming down on performance issues or jumping in on counseling sessions, but aren t sure how to broach the subject with the student in a way that will make a difference. Program Objectives Describe the role that concepts such as student development theory, self-efficacy and self-esteem play in the success of a student pharmacist. Define and describe the similarities, differences, and relationship between self-efficacy and self-esteem. Define and discuss the sources of self-efficacy efficacy and their use when coaching student pharmacists. Demonstrate a variety of positive psychology techniques to build self-esteem Flexibly utilize a wide variety of change strategies within a coaching session in order to assist professional program students to reach their desired future. Student Development Theory Marcia Baxter Magolda s Theory of Self-Authorship Three intertwined dimensions that answer 3 simple questions as the person moves toward selfauthorship. Epistemological which assists the individual to answer how do I know? Intrapersonal where the individual finds answer to the question of who am I? and lastly Interpersonal, the individual is able to master the how do I want to construct relationships with others? Self-authorship Four phases Following external formulas Reaching a crossroad Becoming the author of one s life Having an internal foundation Learning Model Self-reflection Clear interpretation of self beliefs Meaningful activities Student Development Theory Chickering s Theory of Identity Development 7 Vector and 7 Factors to assist institutions in enhancing students development. Sense of competence stemming from confidence that t can cope and be successful Teaching Recommendations Active Learning Student-faculty Interactions Timely feedback High Expectations Respect for individual learning differences Intellectual Competence Physical and Manual Skills Interpersonal Competence Social Cognitive Theory (SCT) Social Foundations of Thought and Action: A Social Cognitive Theory Albert Bandura, 1986 Self-efficacy and human behavior is determined by three factors which interact with each other in dynamic and reciprocal ways: Personal factors (what we believe and how we feel about what we can do), Environmental factors (our support networks and role models) Behavioral factors (what we ourselves experience and accomplish). Referred to as the Social Cognitive Theory because of the emphasis on cognitive processes being used in constructing reality and regulating behavior. 2

3 Self-Efficacy Whether you think you can or you think you can t, you are probably right. -- Henry Ford Motivates and moves people to action. The more mastery experiences clients have for themselves, the more confidence they gain and the more progress they make. It becomes an upward spiral. Self-efficacy allows a person to deal with and learn from setbacks and failures. Self-Esteem Self-esteem -- the belief that one has value and selfworth as a person. Before progress can occur, a student must have a secure foundation of self-esteem, believing that they have value and self-worth. Self-esteem impacts two areas Resilience Initiative Although self-esteem has been shown to be strongly related to happiness and well-being, it has not been shown to increase the likelihood of positive action or specific performance outcomes (Baumeister, et. al., 2003). Over-confident self-esteem can result in negative outcomes Differences between Self-Efficacy and Self-Esteem Self-Efficacy = the belief that one has the capability to initiate or sustain a desired behavior (the exercise of control) Motivational belief regarding specific tasks and/or accomplishments Question Can I do this activity/function? Self-Esteem = the belief that one has value and selfworth (the evaluation of self) Affective evaluation of the self Question How do I feel about myself? Self-efficacy impacts self-esteem When the behavior is highly desired or valued. The Sources of Self-Efficacy Physiological / affective states Stress Verbal persuasion Positive feedback Communicate confidence in the ability of clients Vicarious experiences Shadowing, Role Modeling sharing of situations and why behavior was taken. Sharing Stories of Success Mastery experiences Success The Sources of Self-Efficacy: Applications to Student Pharmacists Physiological / affective states Stress and anxiety effects Verbal persuasion Positive feedback Communicate confidence in the ability of student pharmacists Sources of Self-Efficacy: Vicarious Experiences Shadowing, Role Modeling sharing of situations and why behavior was taken. Sharing stories of failure and success Role Model Professional Behaviors Respect the patient/pharmacist relationship Promote the good of every patient in a caring and confidential way Respect the dignity of every patient Act with honesty and integrity in professional relationships Maintain professional competence Respect the value and abilities of colleagues Serve the community Strive for justice in the distribution of health care services 3

4 Sources of Self-Efficacy: Mastery Experiences Break activity into small pieces Take the task back down a level to a more simplified activity As confidence builds, step up the activity and add difficulty Show support and praise Continue to step up activity to move as much as possible in time at the site Denise Soltis, Drake University CPHS, Asst. Dean Change Strategies: Building Self-Efficacy and Self-Esteem Consider the four sources of self-efficacy using a case discussion Be proactive in discussions to set the stage for appropriate behaviors. Focus on behaviors and not the person Document the behavior(s) Consult with the experiential team sooner rather than later. When a failure occurs timing and location important Too soon may be based on emotions. Consider the surroundings seek privacy Change Strategies: Building Self-Efficacy and Self-Esteem Empathy - supporting self-efficacy by assisting students to quiet judgmental voices, the nay-saying internal voices that arise both from within and from some external influences. Determine whether the student has over-confidence or is possibly masking low self-esteem Use effective questioning techniques Questions to Facilitate Reflection What have you identified from this experience (specific skills, practices, etc.) that you will improve upon moving forward? What are the ramifications or implications (to pharmacists, to patients, to the pharmacy, to management, to the profession)? What other information do you need to make an informed comment or decision i (ideas and/or knowledge)? Which others, or the views of others are relevant to this issue, and in what way (pharmacists, technicians, patients, management, etc)? Questions to Facilitate Reflection What do you think the most important piece of information is in what I just told you, or if you had to summarize the case in 60 seconds, what would you say? What is the issue that needs to be addressed? What else do you need to consider at the moment as it relates to the issue? How does the issue make you feel? How will it change the way you practice in the future? Student Scenario #1 It is your first day with a new student and during the orientation discussion, you notice that the student does not say much. Furthermore, you notice that he doesn t look you in the eye when you are conversing with him. At one point, you even notice that he has a look of concern as you describe that you expect students to provide medication therapy management. Because of your early concerns, you contact t the experiential staff at the student s college to see if there is any background that you should be aware of. The experiential staff member explains that the student is bright but has had a few experiences on rotations where his confidence level has dropped due to comments that had been made by the last preceptor. You quickly realize that your task as a preceptor will be to assist in developing a professional level of confidence in this student. 4

5 Student Scenario #2 It is the second week of a student s rotation and your rotation student has begun exhibiting behaviors that are not necessarily unprofessional, but ones that the you and your staff find annoying or frustrating. Specifically, the student appears over-confident in her abilities and you notice that the student is plugged into an ipod when working on non-patient care activities. When approached about that behavior, the student responds that HR said that it was fine to do that. You find yourself becoming irritated with that behavior and almost saying something publicly or jumping in on a patient counseling session. You realize that you need to communicate with the student directly rather than coming down on performance issues or jumping in on counseling sessions, but aren t sure how to broach the subject with the student in a way that will make a difference. Which of the following is not a source of selfefficacy? A. Vicarious Experiences B. Physiological States C. Goal-Setting with Challenging Standards D. Verbal Persuasion E. Mastery Experiences Which of the following is not a source of selfefficacy? A. Vicarious Experiences B. Physiological States C. Goal-Setting with Challenging Standards D. Verbal Persuasion E. Mastery Experiences Which of the following statements is false: A. Reflection questions allow for the development of selfefficacy. B. Over-confident behavior may be masking underlying self-esteem issues. C. Self-esteem leads to the development of self-efficacy. Which of the following statements is false: A. Reflection questions allow for the development of selfefficacy. B. Over-confident behavior may be masking underlying self-esteem issues. C. Self-esteem leads to the development of selfefficacy. T or F. Self-esteem is defined as the belief that one has the capability to initiate or sustain a desired behavior T or F. Students should be expected to have the appropriate level of self-efficacy or confidence when they enter their experiential rotations. T or F. When a student makes a mistake on a task, it should be addressed immediately. 5

6 T or F. Self-esteem is defined as the belief that one has the capability to initiate or sustain a desired behavior T or F. Students should be expected to have the appropriate level of self-efficacy or confidence when they enter their experiential rotations. T or F. When a student makes a mistake on a task, it should be addressed immediately. Conclusion Self-confidence, or self-efficacy, plays an important role in the success of a student pharmacist. The four sources of self-efficacy can be used when coaching student pharmacists for greater success. A variety of positive psychology techniques to build self-efficacy, or confidence, are available to preceptors. References Accreditation Council for Pharmacy Education. Accreditation Standards and Guidelines for the Professional Program in Pharmacy Leading to the Doctor of Pharmacy Degree. The Accreditation Council for Pharmacy Education Inc. n pdf.accessed on July 8, Bandura, A. (1994). Self-efficacy. In V. S. Ramachaudran (Ed.), Encyclopedia of human behavior (Vol. 4, pp ). New York: Academic Press. (Reprinted in H. Friedman [Ed.], Encyclopedia of mental health. San Diego: Academic Press, 1998). Chapter 5: NVC & Motivational Interviewing in Coaching, Coaching Psychology Manual. Wellcoaches. American College of Sports Medicine Chapter 6: NVC & Motivational Interviewing in Coaching, Coaching Psychology Manual. Wellcoaches. American College of Sports Medicine References Baumeister,R.F., Campbell, J.D., Krueger, J.I., Vohs, K.D. (2003). Does high self-esteem cause better performance, interpersonal success, happiness, or healthier lifestyles? Psychological science in the public interest, Vol. 4(1). Hecimovich,M.D., Volet, S.E. Importance of Building Confidence in Patient Communication and Clinical Skills Among Chiropractic Students. The Journal of Chiropractic Education, Vol. 23, No. 2, Wongwiwatthananukit, S., Newton, G.D.. Popovich, N.G., Development and Validation of an Instrument to Assess the Self-Confidence of Students Enrolled in the Advanced Pharmacy Practice Experience AJPE Vol. 66, Spring 2002 Thank you for participating! This concludes the activity. To obtain your CPE credit, please return to the CEI website and go to My Portfolio. Scroll down to your list of activities and complete the evaluation and exam associated with this activity. it Your CPE statement t t will become available to you via a hyperlink. In addition, if you have recorded your CPE Monitor e-profile ID in your CEI profile prior to completing this activity, record of your successful participation will be sent to CPE Monitor. 6