Are We Producing Innovators and Leaders or Change Resisters and Followers

Education seems to be in America the only commodity of which the customer tries to get as little he can for his money. (1) The Scottish social philosopher Adam Smith, who gave us the concept of the "invisible hand" as a force in society, is often credited with articulating the importance of the unintended consequences of actions, especially those taken on a societal scale. History is replete with examples of public policy that, while intended to address a societal need, has given rise to long-term, unanticipated negative consequences. For example, the generous donation of clothing to certain regions of Africa has decimated the local textile industry, exacerbating rather than relieving poverty. (2) In the healthcare arena, 1 of the commonly cited unintended consequences of our educational and practice efforts is the lack of innovation in health care and healthcare delivery. The Institute of Medicine Roundtable on Value & Science-Driven Health Care, whose purpose is "the development of a learning healthcare system that is designed ... to drive the process of discovery as a natural outgrowth of patient care; and to ensure innovation, quality, safety, and value in health care," has noted that "although medical care in the United States has the capability to be the world's best, it currently falls short. Far too often, care that is important is not delivered, and care that is delivered is not important." (3) The Roundtable was referring to health care in general, but we believe that their concerns are especially applicable to pharmacy practice and education. Over the past 2 decades, pharmacy education has undergone a major transformation with the shift to a doctor of pharmacy degree for entry-level practice. This change was made because of the prevailing belief at the time that pharmacy practice and pharmaceutical science were advancing to the point where additional education was required to ensure that the pharmacy profession maintained its leadership role in medication therapy management and ensuring the safety of drug therapy. (4) The result of this educational shift was a number of changes in how we recruit, educate, and place our students. While each measure enacted has been intended to advance our education of new professionals, it is legitimate to ask if these well-intentioned actions are giving rise to inadvertent negative consequences. In particular, we suggest that pharmacy educational programs are at risk of producing not the leaders and innovators needed to change health care but rather followers who will inappropriately tend to preserve the status quo in health care and pharmacy practice. We believe there are several trends promoting this concern. These are widespread and affect our key processes: admissions/recruitment, curricular design, programmatic evaluation, and preparation/advising for career placement. Our concerns begin with how we select students for admission to our programs. There is significant research published on the various admission processes used in colleges and schools of pharmacy. The research indicates that our quantitative measures (eg, Pharmacy College Admissions Test scores, prepharmacy grade-point average [GPA], math/science grades) are good predictors of academic success, defined as professional program GPA, graduation rates, and success on national board examinations. (5-9) Although most schools use these measures as key predictors for admittance, there appears to be little research on how good these measures are at predicting applicants' future leadership potential or their likelihood of becoming change agents for the profession. Fortunately, the requirement of the Accreditation Council for Pharmacy Education (ACPE) that all potential enrollees be interviewed enables us to combine these quantitative criteria with qualitative assessments. Interview approaches appear to vary widely and the ability of these approaches to predict students' academic performance or, more importantly, their potential for leadership or innovation is not clear. …