Pharmacy student professional identity formation: a scoping review

Figures & data

Table 1 Summary of articles included in this scoping review on pharmacy student professional identity formation

Authors (year)	Country	Study aim	Study type	Data collection	Participants	Pharmacy student year level (sample size)	Intervention	Key findings related to PIF	Theoretical framing of PIF	Conclusions
Armstrong et al (2015)^Citation58	Canada	Compare and contrast the experience of a group of pharmacy students with access to this coaching program with that of a control group that did not receive coaching	Survey	Questionnaire	Pharmacy students	Final (n=10)	Pharmacy coaches randomly matched to pharmacy students and conducted two identical coaching sessions: 1) one-on-one, and 2) group meeting with all ten students	WIL combined with coaching can contribute to students’ career and PIF	Nil	WIL combined with coaching can contribute to students’ career and PIF
Bloom et al (2017)^Citation53	USA	Determine the benefit of pharmacy work experience in the development of student pharmacists’ professional identity	Survey	Questionnaire	Pharmacy students	All year groups (n=293)	Not applicable	Previous pharmacy experience facilitates earlier development of professional identity. Prior pharmacy experience can provide insight into the expectations as well as behavioral and cultural norms of the profession of pharmacy	Not stated	Pre-matriculation pharmacy experience may enhance development of professional identity early in the student experience but has limited influence on academic readiness
Bridges (2018)^Citation59	UK	Explore the potential mutual learning through group work to contribute to academic knowledge and understanding, and development of students’ professional values and selves	Qualitative	Interviews	Pharmacy students	First (n=17)	Not applicable	Facilitated group discussions promoted students to compare experiences of and views on professional roles (as perceived by themselves, other health care professionals, and patients) enabling students to explore elements of their developing professional identity through their conversations and reflections	Not stated	Opportunity for collaboration and exchange can positively influence development of students’ professional outlook and values
Burrows et al (2016)^Citation28	Australia	Explore how students understood pharmacy practice, nearing completion of an undergraduate program	Survey	Questionnaire	Pharmacy students	Final (n=104)	Not applicable	Lack of unified understanding of pharmacy students of what it means to be a pharmacist	Heidegger	Educators need to consider and address the variation in how students understand professional practice and influences on how practice is understood
Johnson and Chauvin (2016)^Citation29	USA	Examine the extent to which reflective essays written by graduating pharmacy students revealed PIF and self-authorship development	Description of curriculum development	Reflective essay	Pharmacy students	Final (n=41)	Developed a “learning partnerships model” based on self-authorship (Baxter-Magolda), and students completed a reflective essay	Analysis suggested relationships between self-authorship and PIF	Baxter-Magolda’s self-authorship theory	Results suggest that purposeful structuring of learning experiences can facilitate PIF
Mantzourani and Hughes (2016)^Citation60	UK	Evaluate students’ perceptions on the placement’s contribution to their professional development	Description of curriculum development	Focus groups	Pharmacy students	First (n=12)	Pilot of REPs to understand patient care issues and see the value of an MDT	REP created an opportunity for first-year students to start exploring their professional identities, and this was challenging especially given the short duration of the placement	Nil	Positive experiences when engaging in REP and contributed to professional development
McCartney and Boschmans (2018)^Citation50	South Africa	Describe and explore the lived experiences of final-year pharmacy students participating in hospital experiential learning program	Qualitative	Focus groups	Pharmacy students	Final (n=33)	15-Week placement	Lack of understanding of how pharmacist self- relates to other health care professional; further hampered by feelings of insecurity about professional role	Nil	South African pharmacy students lack a professional identity for the clinical role of the hospital pharmacist
Monrouxe et al (2014)^Citation30	UK	Examine dental, nursing, pharmacy, and physiotherapy students’ narratives of professionalism dilemmas: the types of events they encounter (“whats”) and the ways in which they narrate those events (“hows”)	Qualitative	Personal incident narratives	Interprofessional students (including pharmacy students)	All year groups (n=69)	Not applicable	Pharmacy students witness patient dignity breaches by non-health care professional, and these experiences crushed ideals	Labov’s structural perspective	Professionalism dilemmas experienced by health care students, including issues concerning whistle-blowing and challenging, have implications for interprofessional learning
Mylrea et al (2015)^Citation33	Australia	Examine implications of the decline in professionalism for health education programs and describe current approaches to professional education	Opinion	Opinion paper	Pharmacy students	Not stated	Not applicable	Pharmacy education needs to consider professionalization as it moves toward advanced practices and increasingly complex role Authentic activities; experiential learning and curriculum alignment with work practices	Merton; professional socialization	Curriculum design can exert a significant influence on student identity development
Mylrea et al (2018)^Citation34	Australia	Design and evaluate a PIP based on self-determination theory for commencing pharmacy students	Description of curriculum development	Questionnaire	Pharmacy students	First and second (n=44)	PIP – 10 workshops with opportunities to interact with pharmacists; group discussions; reflective writing and practice-related activities, eg, compounding and counseling	While students’ perceived professional identities remained unchanged, the “underlying motivation regulators governing identity formation are transitioning to a more autonomous state, which is increasingly intrinsic in nature”^Citation34	Self-determination theory	Students respond positively to the introduction of the PIP into their program of study
Mylrea et al (2018) ^Citation34	Australia	Develop a Pharmacy Motivation Scale (Pharm-S) to determine motivation regulators in undergraduate students and explore a possible link to professional identity development	Methodological	Questionnaire	Pharmacy students	All year groups (n=10)	Not applicable	Established the face, content, and construct validity of professional identity questionnaire tool and found possible links between motivation and professional identity	Self-determination theory	This is a potential role for the Pharm-S as a valid tool to measure pharmacy student professional identity development
Mylrea et al (2018)^Citation34	Australia	Examine conceptual frameworks aligned with professional identity development and explore the role for self-determination theory in pharmacy professional education	Opinion	Opinion paper	Pharmacy students	Not stated	Not applicable	Argues for self-determination theory as a theoretical framing to inform curricular initiatives and design	Self-determination theory	Proposes a role for self-determination theory as a theoretical framework for professional identity development in pharmacy education
Noble et al (2014)^Citation38	Australia	Understand how the formal curriculum experience of an Australian undergraduate pharmacy program supports students’ PIF	Qualitative	Participant observation	Pharmacy students	All year groups	Not applicable	Conventional curricular experience focusing on the provision of technical knowledge and enabling some opportunities for practical engagement. Limited opportunities for students to observe pharmacist role models, experiment with being a pharmacist, or evaluate their professional identities. While curricular learning activities were available for students to develop as pharmacists, eg, patient counseling, there was no contact with patients and pharmacist academic staff tended to role model as educators with little evidence of their pharmacist selves	Provisional selves and social theory of learning	Conventional approaches to pharmacy curriculum likely to make it challenging for students to develop strong professional identities
Noble et al (2014)^Citation38	Australia	Explore pharmacy educators’ perceptions of the purpose of the pharmacy curriculum and how they contribute to students’ development as pharmacists	Survey	Questionnaire	Pharmacy academics	Not applicable (n=34)	Not applicable	PIF is not a key consideration of pharmacy academics	Social theory of learning (Wenger)	Pharmacy educators may not consider how learning experiences contribute to PIF and the role they play in supporting this
Noble et al (2011)^Citation39	Australia	Explore a pharmacy school curriculum for opportunities for student engagement and to determine how these might shape student identity as pharmacists	Qualitative	Document analysis	Not applicable	All year groups	Not applicable		Social theory of learning (Wenger)	Curriculum emphasizes student acquisition of knowledge. The curriculum content was drug centered rather than patient centered, and the emergence of students’ identity as pharmacists may be fragmented as a result
Noble et al (2014)^Citation38	Australia	Examine pharmacy interns’ perception of transitioning from university to workplace and its influence on PIF	Qualitative	Interviews	Pharmacy interns	Intern (n=15)	Not applicable	The interplay between formal curricular experience and experiential placements left participants concluding that university had promoted idealist ways of being a pharmacist and students not equipped to reconcile this with the realities of practice	Social theory of learning (Wenger)	The realities of practice need to be acknowledged while equipping students, and then interns, to move beyond these realities so that they strengthen their professional identities as patient-centered pharmacists
Noble et al (2014)^Citation38	Australia	Examine how the pharmacy curriculum influences students’ formation of their professional identities	Qualitative	Focus groups	Pharmacy students	All year groups (n=82)	Not applicable	Pharmacy students struggled with their PIF. Many were entering the degree with little understanding of what being a pharmacist entailed. Once in the educational context, the nature of the role became both apparent and idealistic but not enacted. Students experienced dissonance between the idealistic notion of pharmacy practice and the realities of placements, and this may have been enhanced by a lack of patient-centered care role models. This struggle left them concluding that the role of the pharmacist was constrained and limited	Social theory of learning (Wenger)	PIF needs to be foreground in pharmacy curriculum enactment
Schafheutle et al (2012)^Citation52	UK	Understand and clarify how professionalism is learnt, cultivated, and facilitated in pharmacy education	Qualitative	Document analysis; focus groups; observation; interviews	Students and academics	Final (n=38)	Not applicable	Role modeling of preceptors influences professionalism. Key way to develop professionalism is through experiential learning	Not described	Professionalism learning is important and highlights approaches which appeared valuable within the constraints of university environment
van Huyssteen and Bheekie (2015)^Citation47	South Africa	Identify and describe first-year pharmacy students’ professional identity and determine whether it changed during the first semester of the “Introduction to pharmacy” course	Description of curriculum development	Reflective essay	Pharmacy students	First (not stated)	Sequential socialization activities including reflective critical incident reports	Curricula need to be designed to enable graduates to engage with constantly shifting professional identity rather than armoring up	Social identity theory	Students’ emergent professional identities were identified including an increasing sense of belonging to the professional
Welch et al (2017)^Citation54	USA	Design and implement a longitudinal course series focused on professional development and PIF in pharmacy students at Western New England University	Description of curriculum development	Assessment data	Pharmacy students	All year groups (not stated)	Development of a 4-year theme-based course series	4-Year program, evaluated by assessment pass rates, contributed to PIF Suggests that students take professional development seriously and achieved intended outcomes	Nil stated	Professional development course designed to enhance the PIF of students
Zaudke et al (2016)^Citation55	USA	Examine the impact of an interprofessional practice experience on students’ attitudes toward interprofessional learning	Description of curriculum development	Questionnaire	Interprofessional students (including pharmacy)	Fourth (n=252)	Development and evaluation (using RIPLS) of interprofessional practice experience with an intentional IPE curriculum to support experiential learning	Notes the difference between professions with respect to PIF	Nil stated	Attitudes toward teamwork and patient centeredness were more favorable for all respondents after the interprofessional practice experience
Zeeni et al (2016)^Citation56	Lebanon	Report students’ perceptions of their readiness for interprofessional learning before and after completing the IPE steps	Description of curriculum development	Questionnaire	Interprofessional students (including pharmacy)	All year groups (n=116 surveys completed)	IPE steps program – an extracurricular program (15 contact hours) and evaluated longitudinally using RIPLS	Professional identities were not different between professions at baseline or at the end. IPE does not interfere with development of distinct professional identities	Nil stated	Participants were satisfied with the learning experience, and assessment scores showed that all IPE learning outcomes were met

Abbreviations: IPE, interprofessional education; MDT, multidisciplinary team; PIF, professional identity formation; PIP, Professional Identity Program; REP, role-emerging placement; RIPLS, Readiness for Interprofessional Learning Scale; WIL, work-integrated learning.

Figure 1 Flow diagram of the search and selection process used for a 2018 literature search for articles on pharmacy students’ identity formation for a scoping review.

Table 2 Theories informing pharmacy student professional identity formation research

Theories informing pharmacy student professional identity formation	Studies using theory	Description of theory as described by study author(s)
Baxter-Magolda’s self-authorship theory^Citation41	29	“Self-authorship theory describes combined cognitive and affective development”^Citation29
Heidegger’s concept of being-in-the- world^Citation42	28	“This phenomenological approach involves explicating, interpreting, and describing the meaning of lived experience of a phenomenon”^Citation28
Provisional selves^Citation22	43	“The key factors influencing students’ professional identity formation include opportunities for imagination, observation, experiment and evaluation”^Citation36
Self-determination theory^Citation44	31–34	“Self-determination theory (SDT) … defined the role of motivation regulators in the formation and maintenance of identity”^Citation45
Social identity theory^Citation46	47	“According to the social identity theory, a person usually has a number of social identities (e.g. gender, age, language, culture, socioeconomic class, personality type, occupation) that contribute to the construction of an all-encompassing self-identity”^Citation47
Wenger’s theory of social learning^Citation48	35–39	“Learning, itself is a social and contextual experience, and results from an integration of meaning, practice, community and identity”^Citation36

Table 3 Professional identity formation as a curriculum priority

Rationale for professional identity formation as a curriculum priority	No. of articles (%)
Pharmacy curriculum influences students’ professional identity formation	2 (9)
Curriculum design and pharmacy academics tend to focus on knowledge and skills development	2 (9)
Risk of students’ professional identities being drug centered	1 (5)

Table 4 Current state of pharmacy students’ professional identities

Current state of pharmacy students’ professional identities	No. of articles (%)
Individualist perspectives	2 (9)
• Focus on traditional pharmacist roles •Aspirations to be patient centered, yet conclude role constrained and limited
Collective experience of identities	4 (18)
• Identities remain unresolved • Identities lack social recognition

Table 5 Curricular factors influencing professional identity formation

Curricular factors influencing professional identity formation
• Content silos with emphasis on acquisition of drug-centered knowledge • Pharmacists modeling professional capabilities • Opportunities to enact professional identities • Absence of patients and other health care professionals • Limited opportunities for feedback • Need to reconcile placement experiences

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