Moving beyond professionalism: Pharmacy students understanding of professionalism and professional identity.

INTRODUCTION: Professional identity is who we are in the context of our chosen profession, a complex and dynamic process. The purpose of this study was to describe pharmacy students' understanding of the terms professionalism and professional identity and the elements of formal and informal curricular activities that may contribute to professional identity formation. METHODS: This anonymous cross-sectional survey was administered to pharmacy students in years one through five at all 10 Canadian pharmacy schools with the help of local Canadian Association of Pharmacy Students and Interns representatives. Students were first asked to define professionalism and professional identity and then were provided with a definition of professional identity to support their statements as to what experiences were meaningful in its development. Both an inductive and deductive approach were used for thematic analysis of written responses alongside descriptive statistics. RESULTS: A total of 172 students responded. Most students were from the University of Alberta and were evenly distributed through years one through four of pharmacy. Key themes emerged of the traditional view of professionalism, expanding the six tenets defined by the American College of Clinical Pharmacy to include responsibility and accountability. Pharmacy students' definitions of professional identity more often included facets of professionalism, but when prompted acknowledged teaching related opportunities, professional development, and role-modelling as playing a key role in professional identity development. CONCLUSIONS: Most pharmacy students were unable to formally define professional identity; however when prompted they did understand what it was and which experiences nurtured its development.

The Problem With Predictions: A Cautionary Tale of Empirically Adjusting Apixaban Dosing With Carbamazepine.

Concomitant use of apixaban and carbamazepine (CBZ) is not recommended due to an anticipated reduction in apixaban concentration, although few case reports describe this interaction. We report a case of initiating apixaban 10 mg twice daily (BID), in a patient stabilized on CBZ 600 mg BID that was guided by prior experience. Apixaban concentrations were substantially elevated with initial empiric dosing; apixaban dosing of 7.5 mg BID was eventually implemented. This case highlights the fact that the degree of induction by CBZ can vary, regardless of the dose, and requires clinicians to be cautious when applying prior experiences with patients to new patients.

L'utilisation concomitante de l'apixaban et de la carbamazépine (CBZ) n'est pas recommandée puisqu'on l'attribue à la réduction anticipée des concentrations de l'apixaban, bien que peu d'observations décrivent cette interaction. Nous présentons un cas sur l'amorce de l'apixaban (10 mg deux fois par jour [BID]) chez un patient stabilisé par CBZ, 600 mg BID (en fonction d'expériences antérieures). La posologie empirique initiale a fait substantiellement augmenter les concentrations d'apixaban; la posologie de l'apixaban de 7,5 mg BID a finalement été mise en place. Ce cas illustre le fait que le degré d'induction par CBZ peut varier, indépendamment de la dose, et obliger les cli-niciens à être prudents lorsqu'ils transposent leurs expériences antérieures aux nouveaux patients.