跨越边界学习：荷兰药师向全科实践转型的专业身份形成。
Learning Through Boundary Crossing: Professional Identity Formation of Pharmacists Transitioning to General Practice in the Netherlands.
机构信息
A.C.M. Hazen is clinical pharmacist and researcher, Department of General Practice, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands. E. de Groot is assistant professor in the learning sciences, Department of General Practice, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands. A.A. de Bont is professor of sociology of innovation in health care, Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, the Netherlands. S. de Vocht is psychologist-supervisor, Department of General Practice, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands. J.J. de Gier is professor of pharmaceutical care, Department of Pharmacotherapy, Epidemiology and Economics, University of Groningen, Groningen, the Netherlands. M.L. Bouvy is professor of pharmaceutical care, Department of Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands. N.J. de Wit is professor of general practice, Department of General Practice, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, the Netherlands. D.L.M. Zwart is associate professor, Department of General Practice, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
出版信息
Acad Med. 2018 Oct;93(10):1531-1538. doi: 10.1097/ACM.0000000000002180.
PURPOSE
To unravel boundary crossing as it relates to professional identity formation in pharmacists transitioning from a community pharmacy to working as nondispensing clinical pharmacists in general practice, with the aim of optimizing their education.
METHOD
This was a multiple-case study, including two-stage interviews, peer feedback, and individual reflection, that collected data in 2014-2016 from eight clinical pharmacists working in general practice in the Netherlands. These pharmacists acted-without a workplace role model-as pharmaceutical care providers in general practices during a 15-month training program. In within-case and cross-case analysis, data were collected regarding pharmacists' role development in practice and perceptions of learning processes, and examined through the lens of professional identity formation and boundary crossing.
RESULTS
Analysis of data collected during and after the training program demonstrated that the clinical pharmacists who applied the learning mechanisms of reflection and transformation developed a patient-care-oriented professional identity. Some clinical pharmacists, who learned mainly through the mechanism of identification, did not integrate the new patient-care-oriented role into their professional identity. They felt that their workplace provided limited opportunities for reflection and transformation. Learning with peers on formal training days was seen as highly valuable for professional identity formation; it counterbalanced the lack of a role model in the workplace.
CONCLUSIONS
Professional identity formation in the transition from community pharmacist to clinical pharmacist in general practice benefited from reflective, on-the-job training. This permitted transformative, boundary-crossing learning with peers and supported professional identity formation oriented to providing practice-based pharmaceutical care.
目的
探讨药师从社区药房过渡到在全科医疗中担任非发药临床药师的职业认同形成过程中的边界跨越，目的是优化其教育。
方法
这是一项多案例研究，包括两阶段访谈、同行反馈和个人反思，于 2014 年至 2016 年期间从荷兰 8 名在全科医疗中工作的临床药师那里收集数据。这些药师在 15 个月的培训计划中，在没有工作场所角色模型的情况下，作为药物治疗提供方在全科医疗中执业。在案例内和跨案例分析中，收集了药师在实践中角色发展和学习过程感知方面的数据，并通过职业认同形成和边界跨越的视角进行了检验。
结果
对培训计划期间和之后收集的数据进行分析表明，应用反思和转变学习机制的临床药师发展出了以患者护理为导向的专业认同。一些临床药师主要通过认同学习机制学习，没有将新的以患者护理为导向的角色融入其职业认同。他们觉得工作场所提供的反思和转变机会有限。在正式培训日与同行一起学习被视为对职业认同形成非常有价值的，它弥补了工作场所缺乏角色模型的不足。
结论
从社区药剂师过渡到全科医疗中的临床药师的职业认同形成得益于在职的反思性培训。这允许与同行进行变革性的、跨越边界的学习，并支持以提供基于实践的药物治疗为导向的职业认同形成。
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