Self-Care Takes Center Stage


Pharmacy schools and organizations—including AACP—shine the spotlight on well-being for faculty, students and staff. With a growing recognition that wellness is also intertwined with holistic patient care, lifestyle medicine could present new career paths for pharmacists.

By Jane E. Rooney

At AACP’s virtual Annual Meeting in July, at least a dozen sessions were directly focused on well-being, including the closing session by Dr. Sonja Lyubomirsky, author of The How of Happiness. Daily mindfulness sessions saw higher attendance than in past years. Wellness and well-being were certainly on the radar for pharmacy schools prior to the pandemic (AACP released policy statements in 2017 and 2018 promoting a culture of wellness in pharmacy education), but the past year and a half highlighted the urgent need to devote more resources to the topic, particularly for health professionals who have been under constant stress.

After being identified through surveys and listening sessions as a top area of interest and concern among members, “well-being for all” became a priority in AACP’s new strategic plan (see sidebar). AACP will provide resources and guidance to member schools to support faculty, staff and students. “We want to look at the kinds of evidence-based approaches that have been shown to improve a person’s sense of well-being. It’s not just about physical health—we have to consider well-being in a holistic manner,” said Dr. Stuart Haines, president of AACP and professor and director, Pharmacy Professional Development at the University of Mississippi School of Pharmacy. “We need to create a culture of well-being, and in addition, individual faculty and students need to build awareness about the areas in their own lives causing stress. At a structural level, we have to take a look at workload and how technology is affecting stress. There are constant demands, so we don’t get a chance to disconnect. It’s easy to pile on more and more work in our electronic age. There’s not a thoughtful approach to managing work. The amount of work people do today is significantly more than 20 or 30 years ago and the way we manage work has placed increased demands on our time and attention.”

Haines pointed out that while the pharmacy community will be AACP’s initial focus, this strategic priority extends to other health professionals as well as patients. “AACP will likely work in collaboration with other health profession organizations and patient advocacy groups. It’s not something we can tackle alone as an association.”

Wellness and well-being are also likely to become more integrated into pharmacy school curricula, which means greater opportunity for student pharmacists to explore how patients can benefit from lifestyle medicine. The American College of Lifestyle Medicine defines this as “the use of evidence-based lifestyle therapeutic intervention—including a whole-food, plant-predominant eating pattern, regular physical activity, restorative sleep, stress management, avoidance of risky substances, and positive social connection—as a primary modality, delivered by clinicians trained and certified in this specialty, to prevent, treat, and often reverse chronic disease.”

Faculty and pharmacists discuss how colleges of pharmacy are taking more deliberate steps to improve well-being for their own communities as well as to ensure that it becomes a routine part of patient care.

A Sustained Focus on Wellness

In 2019, while undertaking her own wellness journey and adding more content to the curriculum, Dr. Elizabeth Buckley, professor of pharmacy practice, Concordia University Wisconsin School of Pharmacy, discovered that pharmacy schools had an overwhelming interest in well-being content. She worked with Dr. Eleanor Vogt, professor emerita, University of California San Francisco School of Pharmacy, to create the AACP Connect Community for Well-Being and Resiliency. More recently, Buckley initiated a survey of pharmacy schools in the U.S. and Canada that explored well-being content in terms of overall curricular inclusion, experiential learning and faculty development. The overall curricular survey included responses from 10 Canadian schools and 89 U.S. schools.

The survey data is being prepared for publication at this time. Preliminary results from the data collected from January through May 2021 indicate that schools and colleges of pharmacy are devoting more resources and personnel to improve focus toward well-being. However, less than half of respondent schools include well-being in the school of pharmacy’s strategic plan or have a dedicated person or group working on initiatives. “Overall, the majority of programs were covering topics within intellectual (self-awareness, mindfulness) and emotional (self-care, stress management) well-being,” she said. “Some schools were covering occupational wellness (resiliency, burnout prevention), but many other wellness topics are not being addressed, indicating that we have a ton of room to grow.”

More schools reported that well-being was covered by co-curricular offerings rather than through electives or required courses and the most robust offerings came from student organizations. “The intellectual and emotional pillars of wellness house a lot of the future of well-being and self-care,” she continued. “Things like coping and kindness give you the lifelong skills. The occupational pillars of wellness are also vital to learning lifelong skills so we are equipped to not burn out when we become pharmacists.”

Buckley noted that the University of North Carolina Eshelman School of Pharmacy stood out for having a task force, a committee and a director devoted to wellness, as well as robust curricular offerings. Dr. Suzanne Harris, an assistant professor and the school’s director of well-being and resilience, said that the senior leadership recognized the importance of making well-being a priority in the strategic plan for the entire school community. Leadership buy-in and involvement were critical, as was building the infrastructure to have a sustained program. Evidence of rising mental health concerns in college-aged students and a student’s suicide four years ago opened their eyes to the need to better support students, faculty and staff. Harris’s own work in psychiatric pharmacy already focused on mental health, including stigma and barriers to seeking help.

“Our interim dean at the time [in 2018] had interest in this and we had a task force for looking at well-being and resilience in pharmacy. It was all volunteers; we had over 70 people who wanted to learn more about what can be done,” Harris recalled. “One of the top recommendations by the task force was that a standing committee should be formed. We now have a well-being and resilience committee that includes faculty, staff, students and some of our hospital partners to leverage and integrate systemwide changes. Another recommendation was to create a position for a director to oversee the schoolwide efforts around well-being and resiliency. I’ve been in that position since June 2020 to move forward our initiatives.” One of those initiatives was a well-being website that launched in September 2020, which promotes wellness events and provides resources for students, faculty, staff and post-graduate trainees.

Recognizing that if we invest in well-being, it’s not just for our own personal and professional growth but thinking about how that translates into improved patient outcomes.

Dr. Suzanne Harris

Rather than devoting one course or elective to wellness, the school incorporates it throughout the curriculum and in the co-curriculum. Mental health first aid training is part of a required third-year core course, Patient Care Experience, which emphasizes communication with patients, including those who are struggling with mental health issues. An elective in the third year examines pharmacotherapy and mental health. Before students go on rotations, they take an immersion prep course that includes sessions on well-being and resilience. Several courses throughout the curriculum address work/life integration, time management and healthy coping skills.

“Survey results show that 61 percent of pharmacists reporting high levels of burnout in practice,” Harris said. “We need to address it at the pharmacist level. We know it does impact and factor into the work they do. It affects interactions with patients—you see an increase in medical errors and it can have an impact on relationships with patients as well as teammates. Recognizing that if we invest in well-being, it’s not just for our own personal and professional growth but thinking about how that translates into improved patient outcomes.”

Harris said that while the pandemic highlighted burnout in the profession from frontline workers to educators, she did see a silver lining. “As a profession we really united in wanting to bring attention to this. Another focus that will continue is checking in more with students, and supervisors understanding to check in with employees and each other,” she said. “I hope pharmacy has an opportunity to learn from these challenges. Even on a personal level I think many of us were able to connect more with our families and build in self-care. As an educator I really saw how much the students appreciated that connection that faculty made with them and creating spaces for promoting wellness. I hope faculty continue to do that and holistically this will continue to promote a culture that supports the well-being of our people.”

Leaning into Lifestyle Medicine

Practicing pharmacists and student pharmacists need to attend to their own well-being as well as ensure that wellness is routinely addressed in patient care. Buckley noted that she would love to see academic institutions create director-level positions focused on wellness. “We need to embrace whole care and have pharmacists partnering with the alternative medicine path and looking at whole health,” she said. “If a pharmacist is involved, we can talk about how that matches your meds and whether something is safe and including all of it instead of being so siloed. I would love to see that as a career path for pharmacists.”

Lifestyle medicine may present an opportunity for pharmacists to expand their career options. “Pharmacists get trained in so many areas—we’re like the Swiss Army knives of healthcare. There are so many opportunities for pharmacists to advance the health of the country in many different roles,” explained Dr. Ed Stein, a retiring USPHS pharmacy officer with the Indian Health Service. “A lot of times when we’re recommending therapies for folks, there’s a lifestyle intervention that’s going to help. Sometimes it’s an add on and saying, clean up your diet, do more exercise. What I’ve learned through the American College of Lifestyle Medicine (ACLM) is that lifestyle medicine is a primary intervention. It’s not complementary and it’s not an alternative to conventional medicine. It’s a foundation for conventional medicine. For pharmacists, if we can think about lifestyle medicine intervention as a beginning place to start with patients, then the impact we can have with preventing, treating and reversing some diseases could be huge.”

The six pillars of lifestyle medicine are eating whole foods; getting regular exercise; reducing stress; avoiding risky substances; getting restorative sleep; and having positive social relationships. Stein added that lifestyle medicine is well-suited to interprofessional collaborations. “As pharmacists are being integrated into healthcare teams, the lifestyle medicine approach helps support that. We’re seeing this a bit already with pharmacists involved in motivational interviewing with patients. Lifestyle medicine is a modality that emphasizes and encourages that team-based approach to working with the patient. It brings in patients as well; it puts the choices in front of them and they become active team members in their healthcare.”

Pharmacists get trained in so many areas—we’re like the Swiss Army knives of healthcare. There are so many opportunities for pharmacists to advance the health of the country in many different roles. A lot of times when we’re recommending therapies for folks, there’s a lifestyle intervention that’s going to help.

Dr. Ed Stein

Stein became interested in lifestyle medicine when he began exploring how nutrition relates to chronic diseases. His studies on how lifestyle interventions can have an impact on patients with chronic diseases led him to his current role as the chair of the pharmacists’ member interest group at ACLM. “As we move away from an isolated drug distribution model and toward a more holistic component, it would be appropriate for pharmacists to be recommending those sorts of interventions to help patient management,” he said. “What I would like to see is people in a traditional mode of pharmacy who are recommending therapeutics and managing patients—whether in a community pharmacy setting or in a hospital or a healthcare organization—adopt lifestyle medicine practices as part of the foundation. If we’re talking about a patient with hypertension, we should be incorporating lifestyle medicine interventions. I would like to see that become integrated within the practice of pharmacy.”

Dr. Seena Haines, professor and chair, Department of Pharmacy Practice, University of Mississippi School of Pharmacy, is lead faculty, well-being and resilience champion, for the Office of Well-Being at the University of Mississippi Medical Center. She previously spent 16 years in clinical practice as an ambulatory care practitioner working alongside other healthcare professions. “Our diverse training and expertise provided comprehensive care to help delay and/or prevent disease progression. We worked with culturally diverse special populations to build intrinsic motivation and patient empowerment in patients who were at risk for chronic disease,” Haines noted. “Lifestyle medicine was and remains a cornerstone of treatment even when pharmacotherapy is warranted. Having been a dietitian before becoming a pharmacist, I knew well the value and importance of lifestyle and behavioral medicine.”

Haines agrees with Stein that pharmacists are uniquely positioned to practice lifestyle medicine to help slow or prevent the progression of chronic diseases. She said this is absolutely an area of growth for the profession. “Opportunities in lifestyle medicine beyond residency training can include the institute of integrative health training in mind-body medicine, becoming a credentialed health and wellness coach, pursuing credentials in lifestyle medicine by ACLM and a variety of mindfulness-based stress reduction course offerings and trainings to provide meditation and mindfulness-based practices as credentialed teachers,” she explained.

Stein pointed out that individuals who were not in good health fared worse with COVID-19, and the pandemic underscored the need to address the overall health and rising level of obesity among the U.S. population. Therefore, equipping student pharmacists with every possible tool to treat patients is vital. “We want to mitigate and prevent chronic diseases. We want to bring lifestyle medicine into students’ lexicon; it would be very valuable for them and for patients,” he emphasized. “There are a lot of ways to do that. ACLM has put together curriculums for medical residency programs. How can we get lifestyle medicine into the pharmacy students’ experience? It can be integrated into existing courses, it could be an elective or a required component or within the therapeutic realm. It could be part of pharmacy residency with standards built around that.”

UNC’s Harris sees opportunity particularly for community and ambulatory care pharmacists who work with chronic care management. “What we think about is traditional medication therapy management, but having this integrated lifestyle approach is useful as well,” she said. “A lot of chronic illness is focused on the prevention piece and I think that’s where lifestyle medicine fits in. Sometimes you do both [medication and non-medication preventive strategies], but it’s the combination that will support sustained change.”

Jane E. Rooney is managing editor of Academic Pharmacy Now.