Pharmacy Needs Education & Training – Who will fill this need?

I recently read an article on leadership in the Harvard Business Review where a distinction was made between training and education and a view that educational establishments collectively over-invest in education and under-invest in training.
Typically, higher education prizes knowledge over skills.
This produces knowledgeable leaders and managers while training and skills go to those who do the actual work.

The author then went on to claim that a business with that sort of a bias is both dangerous and counter-productive because under pressure you don’t rise – you sink to the level of your training.

In other words, those organisations that commit to continual training will be more centred in their equilibrium, and therefore will not have a tendency to “sink”.
I believe that pharmacy currently fits that description.

The author further stated:

“When I see just how difficult and challenging it is for so many smart and talented organisations to innovate and adapt under pressure, I see people who are over-educated and under-trained.
That scares me.”

The quote above would seem to me to aptly describe the condition of pharmacy as it currently is.
And the few words above that quote would seem to hold the key to unlocking the problem.

Where pharmacists should be multi-talented “foot soldiers” delivering a range of skills for the betterment of patients, by forever advocating for them on health issues.
We have actually become a passive group of individuals trying to find a quiet niche in life.

This attitude has created a range of criticisms that mount in volume, not because we are actually doing anything “wrong” but more because our critics (including our patients) feel that we are more capable and could provide more in what we deliver.
We criticise each other for the same reasons but appear incapable of rectifying our position.

The author went on to describe how a similar problem had manifested within the US SEALS, acknowledged as one of the highest and best trained military forces in the world.
Brandon Webb, an innovative SEAL trainer/educator was assigned to make the transformation.

“A member of Seal Team 3, Webb became the Naval Special Warfare Command Sniper Course Manager in 2003. This was a precarious time. The SEALs leadership recognized that technical excellence—better shooting and better shots—didn’t go nearly far enough in addressing the complex environments and demands that would be made upon sniper teams in wartime deployments in multiple theatres. The wartime challenge demanded better collaboration, greater situational awareness and more strategic application of cutting edge technology for the war-fighter.
The post-9/11 environment demanded it.

In response, some of the radical changes that Webb designed are the following:
He broke the class into pairs, assigning mentors to boost support and accountability; he created classes that explore and explain technologies giving participants greater insight into the physics and underlying mechanics of their equipment; and he adopted the “mental management” techniques of Olympic world-champion marksmen, which we were at first reluctantly but then enthusiastically embraced. The results impressed the war-fighting community.”

In the above description we see that Brandon Webb began the process of transformation by creating special class formats to investigate and explain technologies to improve insights. He then broke the class into pairs and assigned mentors to each pair.

At i2P we have been periodically describing the use of mentoring as a method to train a complete pharmacy workplace and then adapt the mentoring style for patient mentoring.
We have also observed that education and training needs to be delivered by education providers as a mobile and decentralised platform that can move in close to a student’s work location as is possible.
Does it cost or does it pay?
By not addressing the full needs of the potential students of all ages, courses will not be adequately filled and will become costly.
By fully addressing needs, students will see value and would be in a position to support an innovative education/training platform.
That will pay.
And the same platform can embrace many non-traditional skills as well, that pharmacists may like to embrace e.g. cosmetics used for special dermal conditions.

Brandon Webb continued:

“Our instructors were teaching better, and our students were learning better,” Webb noted in The Red Circle, his 2012 SEAL memoir.
“The course standards got harder, if anything—but something fascinating happened: Instead of flunking higher numbers of students, we started graduating more.
Before we redid the course, SEAL sniper school had an average attrition rate of about 30 percent. By the time we had gone through the bulk of our overhaul, it had plummeted to less than 5 percent.” And this was accomplished by drawing from many diverse areas outside the military:

‘We took best practices from teaching, professional sports, and Olympic champions, and we made our course one of the best in the world in a very short period of time…”
Webb noted. “We re-wrote the entire curriculum and saw our graduation rate go from 70% to 98% instantly, and hold there…’ “

My immediate thoughts, as to the high increase in graduation rates, were twofold.
One was that interest was created in class content by exploring what was available technologically and how it could improve their work capabilities.
The second was the role of the mentor who could assist each student across the inevitable “potholes” of understanding, as each gap appeared.

This type of education has to be the starting point for a new and invigorated pharmacy profession.
It is a structure that could eventually have everyone marching to a similar (if not the same) tune.

This type of organisation could be the curator for pharmacy culture and its vision, and it must be capable of:

1. Producing Excellence, Not “Above Average”

Being very good is not good enough.
Training programs shouldn’t be designed to deliver competence; they must be dedicated to producing excellence.
Serious organisations don’t aspire to be comfortably above average.
In other words, training divorced from excellence is mere compliance.
It is more “box ticking” than human capital investment.
Is “above average” training really worth the time, energy and expense?
A kaizen—continuous improvement—ethos is one thing.
But customer service and leadership training that only enhances, rather than transforms capabilities and skills, doesn’t buy very much.
Do they really want training to empower and bring out the best in their people?
Or does everyone train with the tacit expectation that excellence matters less than being a bit better?
How do you think current pharmacist training rates?

2. Incentivise Excellence Not Competence

This links directly to a second theme around “getting the incentives right.”
Even if the training itself is world-class, organizations need recognition and rewards systems that explicitly acknowledge and promote excellence.
And, says Webb, also need the courage and integrity to reposition and replace those who can’t—or won’t—step up.

For training to work it has to be effective and incentives have to be in place (financial, personal growth, promotion, etc.), for training to be effective in the work place and in order to get employee ‘buy in’.

Brandon Webb says:
“I’m a big fan of economist Milton Freidman… it’s as simple as creating alignment through incentives and that’s what we did by creating an instructor/student mentor program.
The instructors had accountability (they would be evaluated on their student’s performance) which created the right incentive for them to pass.
This made a huge difference.
Plus we switched to a positive style of teaching and we saw our graduation rate rocket up.”

Should training overwhelmingly focus on skills enhancement?
Or must it be managed to build better bonds and relationships throughout the enterprise?
Webb unambiguously champions both.
The training transformation made the SEAL’s culture more open to innovation and exchange.
Incentives aligning and facilitating accountability improved the entire organization, not just the trainees..

3. Incorporate New Ideas from the Ground

Successful training must be dynamic, open and innovative.
Ongoing transformation—not just incremental improvement—is as important for trainers as trainees.
Brandon Webb asserts:
“It’s every teacher’s job to be rigorous about constantly being open to new ideas and innovation.
“It’s a huge edge, sometime life-saving, to adopt a good idea early and put it into practice…
As an instructor I learned that you are never done learning, and your students can be a wealth of information, especially when guys like Chris Kyle would come back from Iraq and make recommendations on how to better train students to the urban sniper environment.
We incorporated this type of mission brief back and actively sought out this knowledge from the SEAL sniper’s who were returning from places like Iraq, Afghanistan, Africa and other not so friendly places. Then we would take this knowledge and incorporate it into our yearly curriculum review; if important enough, we’d make the change within weeks.
That’s how fast we could adapt our course curriculum and get approvals.”
Thought leaders always work in future mode and invest in their own future.
Sharing this dynamic through a properly equipped educational structure would advance pharmacy’s cause quite rapidly, and with pride.

4. Lead by Example

Getting better at getting better is a vital organising principle for learning organizations.
The most important training behaviour a leader can demonstrate is leading by example.

Brandon Webb explains:

“Leading by example means never asking your team to do something you aren’t willing to do yourself.
This can’t be faked – do it right and your team will respect you and follow you.
Don’t do this, especially in a SEAL team, and you are doomed as a leader.
I’ve seen it happen, and careers ended when it did.
Lead by example and watch your team elevate you with their own accomplishments.

“I’ve seen small teams accomplish incredible things in training (my times at the sniper school) and combat (Afghanistan and Iraq).

“In Special Operations environments and top business environments, you have the privilege of working with people who just get the job done at all costs.
They are self-motivators.
Even if they don’t have the know-how, they will figure it out and just make it happen.
It’s amazing to have a whole team that thinks this way, and to see what they can accomplish.”

No one rightly doubts the vital role education plays in creating and sustaining economic competitiveness worldwide.
But it’s long past time that pharmacy leaders, regulating authorities, pharmacy schools and universities revisit what world-class training should mean.

The time is right for a complete revision and most pharmacists are waiting in expectation for the revolution to occur.
Most pharmacists would be willing to experience what they may term as “positive pain” that gives direction and understanding.
This would be seen as having value.
As distinct from the “negative pain” that has been experienced over the past 12-15 years currently providing gloom and depression.

Acceptance that the PBS, as a product, has reached the end of its life cycle, has not yet captured all of pharmacy awareness.
The type of education and training advocated in this article would have identified the problem, predicted the endpoint and would have mounted strategies to create direction, also overcome the big financial gaps that have emerged.
Collegiality between pharmacists would be maintained and expanded under such a mentoring system.
In such a positive environment you could only expect success, with slight downturns when industry trends created the need for adjustment.
Can we expect an education revolution?


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