Description
Please write a reflection on how an understanding of professional identity formation and the development of a professional identity as a pharmacist will help you succeed as a student pharmacist in your fourth year (which is also known an the APPE year, when students do rotations all year long) based on the articles and videos you reviewed on professional identify formation and the APPE Readiness Guide from ACPE.Reflection assignment format: 4 to 5 pages in length, 12 point font, double space, and 1 inch margins.
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American Journal of Pharmaceutical Education 2021; 85 (10) Article 8714.
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AACP REPORT
A Pathway to Professional Identity Formation: Report of the 2020-2021
AACP Student Affairs Standing Committee
Kristin K. Janke, PhD,a Timothy J. Bloom, PhD,b Eric G. Boyce, PharmD,c Jessica L. Johnson, PharmD,d
Karen Kopacek, MS,e Teresa A. O’Sullivan, PharmD,f Heather M.W. Petrelli, MA, PhD,g David R. Steeb,
PharmD, MPH,h Libby J. Ross, MAi
a
University of Minnesota, College of Pharmacy, Minneapolis, Minnesota
Shenandoah University, Bernard J. Dunn School of Pharmacy, Winchester, Virginia
c
University of the Pacific, Thomas J. Long School of Pharmacy, Stockton, California
d
William Carey University, School of Pharmacy, Biloxi, Mississippi
e
University of Wisconsin-Madison, School of Pharmacy, Madison, Wisconsin
f
University of Washington, School of Pharmacy, Seattle, Washington
g
University of South Florida, Health Taneja College of Pharmacy, Tampa, Florida
h
University of North Carolina at Chapel Hill, Eshelman School of Pharmacy, Chapel Hill, North Carolina
i
American Association of Colleges of Pharmacy, Arlington, Virginia
b
EXECUTIVE SUMMARY Professional identity formation (PIF) involves internalizing and demonstrating the behavioral norms, standards, and values of a professional community, such that one comes to
“think, act and feel” like a member of that community. Professional identity influences how a professional perceives, explains, presents and conducts themselves. This report of the 2020-2021 AACP Student Affairs Standing Committee (SAC) describes the benefits of a strong professional identity,
including its importance in advancing practice transformation. Responding to a recommendation from
the 2019-2020 SAC, this report presents an illustrative and interpretative schema as an initial step
towards describing a pharmacist’s identity. However, the profession must further elucidate a universal
and distinctive pharmacist identity, in order to better support pharmacists and learners in explaining and
presenting the pharmacist’s scope of practice and opportunities for practice change. Additionally, the
report outlines recommendations for integrating intentional professional identity formation within professional curricula at colleges and schools of pharmacy. Although there is no standardized, single way to
facilitate PIF in students, the report explores possibilities for meeting the student support and faculty
development needs of an emerging new emphasis on PIF within the Academy.
Keywords: professional identity formation, practice transformation, professionalism
professional identity, the challenges of a universal pharmacist identity, and the importance of identity to practice
transformation. It presents an illustrative and interpretative
schema as an initial step towards describing a pharmacist’s
identity. It also explores the faculty development and student support needed to engage in intentional formation of
professional identity and implementation activities for colleges and schools to optimally engage in PIF.2
INTRODUCTION
Colleges and schools of pharmacy play a critical role
in professional identity formation (PIF) through design
of courses and experiential education, as well as co-curricular
requirements. Through the policies on professional education for the American Association of College of Pharmacy
(AACP) colleges and schools are encouraged “to advance
education that is aimed at the intentional formation of professional identity (ie, thinking, feeling and acting like a
pharmacist) and developed and implemented in cooperation with the professional pharmacy organizations within
the broader pharmacy profession.”1 This committee report
expands on the work of the 2019-2020 AACP Student
Affairs Committee by describing the benefits of a strong
COMMITTEE CHARGES AND HISTORY
President Anne Lin formed the 2020-2021 Student
Affairs Standing Committee (SAC) to continue the work
of the 2019-2020 SAC on professional identity formation
(PIF). With a year of research and discussion, some returning
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members and some new members, the 2020-2021 committee was uniquely positioned to dig deeper into the
issues and advance the former committee’s plans and recommendations. The charges were to examine: 1) strategies
to support PIF in our educational systems, 2) the use of
implementation science to support the advancement of
PIF and 3) PIF-supportive activities for the new Center to
Accelerate Pharmacy Practice Transformation and Academic Innovation (the Center). To address the charges,
members of the committee discussed the work of the preceding SAC in context of the other 2019-2020 AACP
standing committees, analyzed the documents of multiple
pharmacy professional organizations that describe aspects
of a pharmacist’s professional identity, and reviewed the
literature for approaches to develop student pharmacists’
professional identity. The SAC began by organizing
around two goals established by the 2019-2020 SAC: 1)
Develop a framework of essential values that describe the
professional identity of a pharmacist and 2) Integrate PIF
in pharmacy education, training, and practice. Biweekly
meetings were scheduled online for either the entire committee or two subgroups that each focused on one of the
goals. The SAC also met with members of the 2020-2021
Research and Graduate Affairs Standing Committee to
better understand the use of implementation science to
promote PIF in Doctor of Pharmacy (Pharm.D.) degree
programs.
Concurrent with its investigations and deliberations
on the charges, and in response to a recommendation in
the previous report related to faculty development and programming (Recommendation 3),2 the 2020-2021 SAC
worked with AACP to develop an 2021 Interim Meeting
session, “What’s the end goal? Professionalism or professional identity?” with Dr. Yvonne Steinert, Professor of
Family Medicine and Health Sciences Education at
McGill University.3 The programming followed on the
PIF microsessions during the 2020 AACP Interim Meeting, a PIF webinar by 2019-2020 SAC members in May
2020, and PIF posters at the 2020 AACP Annual Meeting.
The 2020-2021 SAC has also been advocating for the
inclusion of PIF in the 2021-2024 AACP Strategic Plan.
In brief, professional identity involves internalizing
and demonstrating the behavioral norms, standards, and
values of a professional community, such that one comes
to “think, act and feel” like a member of that community.4-6 PIF extends affective development beyond the
professionalism competencies well-known to pharmacy
educators. It begins when novices first learn the foundational knowledge of the profession and observe the actions
of members of the professional community they are joining. PIF continues when students practice acting like
a member of the profession, doing the work of the
profession under the observation and guidance of mentors,
and getting feedback on actions, attitudes, and behaviors
related to professional norms. By regularly demonstrating
competence in the roles and responsibilities of the profession and sufficient consistency in conforming to the professional expectations of colleagues, the individual begins
to feel like a member of the community and an initial professional identity is developed. The PIF process continues
indefinitely over the course of years, with identity evolving in response to additional experiences as a working
member of the professional community.5
Following our review of the literature and discussions
with experts, we contend that professional identity is too
important to leave to chance. While there is not one definitive path to identity, or a narrow set of activities or experiences that guarantee it, pharmacy educators must nonetheless
continue to collaborate in learning more about effective PIF
approaches and incorporating those approaches into the curriculum and co-curriculum in a systematic, progressive
manner. The benefits of a strong professional identity are
significant. Identity influences how a professional perceives, explains, presents and conducts themselves.7 Identity is also a key determinant of the scope and nature of an
individual’s work and prioritization of their roles.8 As such,
a strong professional identity is needed in this era of practice transformation and expansion of the pharmacist’s roles.
Furthermore, learners require guidance in developing a professional identity while also navigating amongst multiple
emerging identities. Student pharmacists are moving from
peripheral participant (ie, novice) to full member of the profession by gaining competency, yes, but also by learning
the language, the hierarchies within the healthcare system,
and the methods to manage the ambiguity that is inherent in
patient care.5 Pharmacy educators have the opportunity to
extend our work with professionalism into the identity
domain by making PIF an educational goal, engaging students in the work of identity formation and explicitly
attending to important factors impacting PIF, including role
modelling, mentoring, experiential learning, guided reflection and a welcoming community of practice.7 Pharmacy
educators are important in helping learners to navigate transitions, integrate personal and professional identities, manage emotions associated with this development (eg,
anxiety, frustration, satisfaction) and learning to “play the
role” on their way to being a pharmacist.5
PHARMACIST ROLES AS A COMPONENT
OF IDENTITY
As described by Cruess and Cruess, “It has long been
known that humans pass through recognizable developmental stages throughout their lives, during which their
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unique identity or identities are strongly linked to the roles
that they play.”7 Therefore, in considering identity, it is
important to understand the roles that pharmacists have
and are playing. Urick and Meggs summarize the evolution of community pharmacy practice, arguably the face
of the profession to the public, by dividing it up into four
eras based on the pharmacist’s primary role and/or responsibility.9 In the “Soda Fountain Era” from 1920-1949,
there was a transition away from the pharmacist’s traditional role of compounding medications toward dispensing manufactured proprietary medications. This led to the
second era of “Lick, Stick, Pour, and More,” from 19501979. During this era, individual pharmacy practitioners
and advocacy groups began to promote the idea that the
primary role of the pharmacist was to educate the patient
about their medications, a concept rapidly adopted by state
pharmacy practice acts and emphasized in pharmacy curricula. The “Pharmaceutical Care Era” between 19802009 saw major changes to pharmacy practice requiring
advanced education, such as expansion of medication
administration and medication therapy management; thus,
the Doctor of Pharmacy became the sole degree program
for pharmacists. In the present “Post-Pharmaceutical Care
Era,” acute and ambulatory care practice have largely
evolved into the role of clinical services provider. However, much of community pharmacy practice continues to
straddle the roles of the “Lick, Stick, Pour and More” and
“Pharmaceutical Care” eras. As stated by Cruess, Cruess,
and Steinert, “With time, the role comes to represent the
individual’s identity or identities.”6
Observing differing roles of the pharmacist, such as a
care provider in some settings and product dispenser in
other settings, can create confusion, frustration and/or
stress for pharmacy students as they navigate the tension
between ‘who they are’ and ‘who they wish to become.’
Understandably, the various roles may seem discordant or
even incompatible with each other. However, professional
identity involves more than just the tasks and functions
associated with one’s job. In assuming a professional identity, students are also internalizing the value systems of
the profession and its norms.7 Pharmacy educators are
critical in providing guided reflection and mentorship to
help students think beyond their observations of pharmacist roles and differences between settings. By clarifying
the distinctions between roles and the other elements of
identity, students will see that regardless of the practice
site, pharmacists share a common community of practice
based on a fundamental core set of values, characteristics
and norms. In addition, schools and colleges can facilitate
‘who students wish to become’ by offering early career
guidance and personalized education. Offering students
curricular and co-curricular opportunities that examine
emerging career opportunities will help them to see a pharmacist’s identity as including being a change agent in
healthcare.10
THE CHALLENGES OF A UNIVERSAL
PHARMACIST IDENTITY
There is evidence of five identity discourses in pharmacy, including apothecary, dispenser, merchandiser,
expert advisor and healthcare provider. Rather than shifting over time, newer identities have been added to existing
ones resulting in a “pile up.”11 Elvey, Hassell and Hall’s
research indicates nine role-based identities for pharmacists, including the scientist, clinical practitioner, medicines supplier and business person.12 As a result, the
2019-2020 SAC report recommended that “AACP should
initiate conversations within the profession of pharmacy
to develop a unified identity” (Recommendation 2).2
Not only do identities differ among practitioners, lack
of an agreed-upon identity is evident in stakeholder opinion on the content of educational programming. For example, a study examining European community pharmacists’
and pharmacy academics’ views on pharmacy practice
competencies found that academics emphasized the importance of research, pharmaceutical technology, and the regulatory aspects of quality, while community pharmacists
concentrated more on patient care competencies.13 Similarly, Nobel et al. reported that students noticed a disconnect between learning in the curriculum and observations
during experiential learning. For example, they were
taught by professors that pharmacists are more than dispensing agents for physicians, yet were told by many preceptors that being patient-focused was not efficient in
community pharmacy. This dissonance slowed professional identity formation in these students due to a lack of
reinforcement of theoretical and practical components.14
A Step Toward Describing A Universal Pharmacist’s
Identity
Professional organizations in pharmacy have identified the attributes of member pharmacists and represent
these identities in official papers and statements by the
organizations. Analysis of those official papers and statements was undertaken as a step toward defining a pharmacist’s professional identity. A subgroup of the SAC
searched the websites of the 13 member organizations of
the Joint Commission of Pharmacy Practitioners (JCPP) to
identify official papers or statements providing descriptions
or definitions of member pharmacist attributes, roles and
responsibilities. A total of 21 white papers, position statements, and other sources were identified for review. These
materials included the American Pharmacists Association
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(APhA) Oath of a Pharmacist,15 the American Society of
Health-System Pharmacists (ASHP) statements on Professionalism and the Pharmacist’s Role in Primary Care,16,17
the Center for the Advancement of Pharmacy Education
(CAPE) Educational Outcomes,18 the JCPP Pharmacists’
Patient Care Process,19 and the National Association of
Boards of Pharmacy (NABP) Model State Pharmacy Act
and Model Rules,20 among others.21-35 Two-thirds of the
sources reviewed either originated or were revised within
the past 10 years. Sources were reviewed for descriptions
of how pharmacists think, act, and feel. A total of 211
descriptors were identified (51 for Think, 143 for Act, and
17 for Feel) and were categorized into 23 areas, which were
then summarized into 13 domains (Table 1).
The domains (Table 1) were then discussed with the
entire SAC to develop professional identity items that
would fit into Think, Act, and Feel (Table 2), which is a
schema suggested by Cruess et al. in their discussion of
identity.4 While these items were not taken verbatim from
the 21 sources, they were derived from discussing the various points raised across the sources. This schema can be
used as a guide for pharmacy learners, educators, and
practitioners in considering the identity of a pharmacist.
The examples related to feeling like a pharmacist were
most difficult to identify and elucidate, and more work is
needed in this area.
While this schema provides some initial insight, there
is still a need for further description of the professional
identity of a pharmacist. As part of this clarification, the
profession should consider moving beyond roles, traits,
characteristics and attributes. Descriptions of the profession’s values, standards and norms that take into account
current and future practice would complement the work
presented in Tables 1 and 2 by elaborating on the principles
guiding behavior, especially in navigating difficult or
ambiguous situations in the increasing complexity of
practice.
Distinguishing a Pharmacist’s Identity from Other
Healthcare Professionals
Any work in describing the pharmacist’s identity cannot ignore the identities of other healthcare professionals.
According to Merriam Webster, the definition of identity
is “the distinguishing character or personality of an individual.”36 What distinguishes pharmacists from other
healthcare professionals and leads to acceptance of their
value to patient care? While profession-specific roles and
tasks may be easily distinguishable, how one thinks, acts,
and feels as a professional is to some extent shared among
healthcare professionals. For example, compassion, empathy, communication skills, and the ability to think critically, utilize sound judgment to solve problems, make
evidence-based decisions, and defend a point of view are
arguably traits that comprise professional identity for all
healthcare professions. One might conclude there is a
foundational shared identity of a healthcare professional
to which the identities of a specific profession are added.
Figure 1 provides an illustration of only a few examples of
many healthcare professions sharing common values,
characteristics and norms.
Given the assertion of a shared identity among healthcare professionals, Tables 1 and 2 can be interpreted in a
new way. Most of the elements listed could be considered
as representing any healthcare professional. It is the pharmacists’ role in optimizing medication use that distinguishes our profession from others. Pharmacists are
uniquely trained to identify medication therapy problems.
No other profession teaches medication-related skills,
such as comprehensive medication review and clinical
pharmacokinetics to the degree emphasized in pharmacy
education. Furthermore, colleges and schools are working
to prepare students to use a consistent thought process that
involves assessing each drug for indication, effectiveness,
safety and adherence.37 Additional work in elucidating the
distinctiveness of the pharmacist’s identity is needed to
support pharmacists and learners in explaining, presenting
and conducting themselves in a manner that positively
affects practice transformation.
Complicating the discussion is that values and norms
are further stratified and nuanced among different types of
roles and settings, making it more challenging to determine one universal professional identity for pharmacists.
For example, while it may be the norm for clinic-based,
ambulatory care pharmacists to follow up with patients to
determine the effectiveness of therapy, this may not be the
Table 1. Common Pharmacy Professional Domains Found
in Official Documents and Statements from Various Professional Pharmacy Organizations.
Collaboration, Teamwork
Collect Pertinent Information
Communication, Counseling, Education
Recommend, Prescribe, Order
Enhance Adherence
Prepare, Dispense, Provide Medications
Implementation of Plans, Therapy, Testing
Promote Health and Wellness
Patient Advocacy
Patient Care Focus
Evidence-Based Practice
Creativity, Innovation, Entrepreneurship
Medication Expertise
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Table 2. An Illustrative Schema to Help Describe A Pharmacists’ Professional Identity Based on the Domains Provided in
Table 1 and Organized into the Think, Act, and Feel Schema Proposed by Cruess.5
Examples of How Pharmacists Think:
Critically evaluating data and other information
Problem solving using pertinent information
Prioritizing analysis of medications and their use
Assessing a patient’s status to determine the presence of medication-related problems (adverse effects, drug interactions,
lack of adherence, duplicate therapy, inadequate therapy, etc.)
Creating therapeutic and monitoring plans focusing on pertinent drug and nondrug therapy
Continuing to learn about new drugs, disorders, practices, and technologies that impact patient care
Performing accurate and appropriate calculations related to drug therapy
Examples of How Pharmacists Act:
Participating as a team member and collaborating with the patient, caregivers, and other healthcare professionals
Collecting pertinent information as needed to make appropriate decisions
Communicating effectively with patients, caregivers, and other health professionals
Providing documentation of services and recommendations provided
Providing accurate information to patients, caregivers, and other healthcare professionals
Conducting health and wellness screening
Administering medications when appropriate
Promoting healthy lifestyles and preventive health behaviors
Protecting the confidentiality of patient information
Acquiring, preparing, dispensing, and providing medications and other healthcare products
Managing the medication use system
Providing pharmacy-based services that enhance patient care
Locating, summarizing, evaluating, and applying evidence from the primary literature
Examples of How Pharmacists Feel:
Responsible for providing accurate information to patients, caregivers, and other healthcare professionals
Responsible for following the laws, regulations, standards of practice when providing services to patients, caregivers, and
other healthcare professionals
Compelled to optimize patient care based on the patient’s needs and wishes
Compelled to advocate for the patient to meet the patient’s needs
Responsible for enhancing the health and wellbeing of patients and the community
Responsible to consider the accessibility, cost, and risks of therapy when making decisions or recommendations with
respect to patient care
Compelled to develop covenantal relationships with patients
Compelled to focus on patient care
Compelled to portray a professional image
Accountable for their actions and decisions
Confident in their ability to solve the problems that arise on a day-to-day basis as a pharmacist
Empathy and compassion for their patients and for those with whom they work.
norm in another practice setting. Additionally, norms also
vary by region within the United States and globally. For
example, the pharmacist functions permitted by law may
differ in California compared with New York, which may
impact professional identity. Clearly, discussion is needed
within the profession to determine the universal and distinctive norms and core values common to all pharmacist
professionals.
profession needs to be unified and accelerated. Perceptions of the scope and nature of a professional’s work and
prioritization of the professional’s roles is influenced by
professional identity.8 This conceptualization of “being a
pharmacist,” in turn, influences how the professional perceives, explains, presents and conducts themselves,7
which in turn influences their approach when engaging in
practice advancement and transformation.
To support the profession, a universal professional
identity is needed that would be readily recognized by
patients, caregivers, other healthcare professionals, payers,
governmental and private industry entities, and other stakeholders in healthcare. A universal professional identity
IDENTITY AND PRACTICE TRANSFORMATION
In order to fully capitalize on the current and future
abilities of pharmacists to meet societal needs and expectations, practice transformation within the pharmacy
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SUPPORTING PROFESSIONAL IDENTITY
FORMATION
PIF has become an important consideration in health
profession education programs, most notably in medicine,
nursing, and now pharmacy. Foundationally to the trend,
faculty must agree that formation of professional identity
and demonstration of professionalism are not the same. In
2000, the American Pharmaceutical Association Academy
of Student Pharmacists (APhA-ASP) and the American
Association of Colleges of Pharmacy Council of Deans
Task Force (AACP-COD) defined professionalism as
“active demonstration of traits of a professional.”41 Professionalism is described in the 2013 CAPE Outcomes as
the ability to “Exhibit behaviors and values that are consistent with the trust given to the profession by patients, other
healthcare providers, and society.”18 The 2014 AACPCOD Task Force on Professional Identity Formation later
moved beyond demonstration of professionalism to adopt
a definition of PIF: “Professional Identity Formation (PIF)
is the transformative process of identifying and internalizing the ways of being and relating within a professional
role.” 42
To illustrate the extension of PIF from professionalism, it is useful to imagine the addition of a new level atop
Miller’s Pyramid of Professional Competence (Figure 2)
as proposed by Cruess, et al.6 This imagery more easily
allows educators to envision the distinction between a student who can reliably “exhibit behaviors,” which demonstrate professionalism in an advanced pharmacy practice
experience (APPE) or objective structured clinical exam
(ie, checking all the boxes), and a student who has truly
“internalized” and relates to a professional role. This internalized identity includes professionalism, but extends to
include other beliefs, values, motives, core knowledge and
Figure 1. Common and Distinctive Values, Characteristics
and Norms of Healthcare Professionals.
should unify pharmacists by focusing on a set of common
attributes, values, and norms that contribute to the delivery
of high-quality pharmaceutical care, products, and services
that are needed to fulfill the Quadruple Aim.38
Similar to medicine, pharmacy does not consist of
just one community of practice. Physicians can demonstrate a multiplicity of professional identities as they join
various communities (eg, clinical care, academia,
research) with their global identity linked to their profession (medicine).39 A “landscape of communities” has
been forming within pharmacy with each community
developing their own unique identities.40 Practice expansion without a global identity has led to fragmentation
within pharmacy, where the focus is more on the roles and
attributes of pharmacists within the various communities,
rather than a shared set of values and norms. This fragmentation and lack of shared professional identity has hindered a unified approach to practice transformation. The
development of a universal professional identity is only
possible when pharmacists embody the professional identity through their own professional identity formation,
which begins in their Doctor of Pharmacy program and
extends through further education, training, and practice.
AACP and the Center can play a key role in establishing
the shared professional identity for pharmacists and supporting colleges and schools in promoting and enhancing
professional identity formation by learners, educators, and
practitioners.
Figure 2. The amended version of Miller’s Pyramid of Clinical Competence. Reprinted with permission from Wolters
Kluwer Health, Inc.6
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skills, attitudes, behaviors, and other attributes that students develop over time as they move from a nonprofessional lay person to a professional.43-45
There are a number of theories describing the development of professional identity, including SelfAuthorship Theory,46 Provisional Selves Theory,44 and
the Theory of Social Learning, more commonly known as
“Communities of Practice.”40 These example theories
describe similar supports for development of the identity,
including exposure to role models, active participation
and imitation, and immersion. These identified supports
naturally suggest pedagogical strategies faculty could use
to assist students in PIF, including experiential education,
guided reflection, symbolic and ceremonial events, and
strong mentoring programs. Each of the aforementioned
identity theories has been explored more deliberately in
terms of personal identity than professional identity,
though there are increasing reports of application of these
theories to pharmacy education.14
Pharmacy educators are encouraged to develop a
working knowledge of one or more identity theories to
assist in selecting pedagogies and approaches for PIF
support that align with their curricula. In particular, the
role of socialization has been described as a critical factor by which an individual learns to function in a particular society.5,7 This model may be particularly helpful
in assisting student services personnel, faculty and preceptors in understanding the process of identity formation (Figure 3). Factors that influence socialization
include self-assessment, the learning environment,
attitudes and treatment of the student by patients, peers
and health professionals, as well as conscious reflection
and unconscious acquisition of norms and values from
experiences, role models and mentors.5
It has been argued that, if PIF is an educational goal,
it must be explicitly included in the formal curriculum
as part of the cognitive base of the professional.7 To that
end, the SAC encourages faculty and institutions to prioritize the development of curricular, extracurricular, and
co-curricular opportunities for students to explore professional identity. PIF initiatives can find a fit within a nearly
endless array of possibilities from orientation day to graduation. Activities used and reported in pharmacy education have been summarized,47 including the effects of
autonomy-supportive teaching in a PIF workshop series
integrated into existing courses48 and embedded PIForiented activities in an APPE.49 Studies have also been
conducted on the influence of pharmacy employment50
and the overall curriculum on PIF.14 Periods of transition
(eg, entry into Introductory Pharmacy Practice Experiences) present opportunities and challenges for learners,
which can be viewed through the lens of identity formation.7 Pharmacy educators should be creative and flexible
in development and evaluation of activities, and responsive to the ongoing global conversation about pharmacist
identity in a time of practice transformation.
Self-assessment is critical in charting progress
towards the development of a professional identity.6,7 For
learners, positive feedback about progress is important to
both belonging within the pharmacy profession and
Figure 3. A schematic representation of professional identity formation. Reprinted with permission from Wolters Kluwer Health,
Inc.5
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American Journal of Pharmaceutical Education 2
