福岡大学薬学部では，調剤実習に処方解析をテーマとしたグループワークを取り入れている．調剤実習で実臨床に近い調剤を体験することで，単なる手技の習得にとどまらず，学修者の様々な気付きを促すこと目標とした．今回，2024年度の調剤実習の効果を確認した．調剤に関する理解度は，全ての項目において実習後に有意に高まっていた．これまでの学修を調剤実習で活かせたと感じたことでは ｢計算｣，｢薬｣，｢調剤｣，｢添付文書」等の語句が抽出語として確認できた．このうち｢計算｣，｢薬｣，｢添付文書｣は，勉強不足だと感じたこととしても頻出していた．今後調剤する際に意識したいことでは｢患者｣が頻出上位の1つであった．実践した調剤実習により，手技の習得に加え，個別最適化のための処方解析の重要性や，調剤を含めた薬剤師業務の中心には｢患者｣が存在することを，非臨床の空間にて経験してもらう機会となったことが確認された．
At the Faculty of Pharmaceutical Sciences, Fukuoka University, group work focused on prescription analysis is incorporated into the dispensing practicum program as part of the pre-study of clinical practice. This approach is aimed at offering students a dispensing experience that closely mirrors actual clinical settings, to foster not only technical proficiency but also diverse forms of critical awareness and reflection. This study aimed to assess the effectiveness of the dispensing practicum for the 2024 academic year. Understanding of dispensing techniques markedly improved across all evaluated items after the practicum. Regarding the learners’ perceptions of applying their prior knowledge in the dispensing practicum, the frequently extracted terms included “calculation,” “medicine,” “dispensing,” and “package inserts.” Among these, “calculation,” “medicine,” and “package inserts” were frequently mentioned as areas where learners felt insufficiently prepared. Regarding what students intended to be mindful of when engaging in dispensing in the future, the frequently mentioned terms included “patient.” Through the dispensing practicum, students not only acquired technical skills but also developed awareness by gaining insights with a focus on actual clinical settings. This provided participants with an opportunity to experience, even in a non-clinical setting, the importance of prescription analysis for individualized optimization, as well as the central role of the patient in pharmacists’ responsibilities, including dispensing.
In the Model Core Curriculum for Pharmacy Education 2022 Revision, a new item titled “Dispensing as the Basis for Individual Optimization” was included1) . Thus, when learning about “Dispensing Based on Prescriptions,” the necessity of cultivating the ability to evaluate prescription appropriateness from multiple perspectives, including patient background and the pharmaceutical characteristics of medications, has become increasingly emphasized. Furthermore, in actual clinical settings, the important role of pharmacists in dispensing has shifted from simply preparing medications to actively contributing to patient-centered, individualized pharmacotherapy through prescription evaluation and other activities based on pharmaceutical expertise. This is also clearly demonstrated by the findings of Inoue et al., who confirmed the conceptual shift in “dispensing” through text mining of dispensing guidelines2) . Given this background, a comprehensive pre-study of clinical practice (hereafter referred to as “pre-training”) that enables learners to become more aware of a dispensing practicum that closely resembles actual clinical settings is essential. In the traditional pre-training at the Faculty of Pharmaceutical Sciences, Fukuoka University (hereafter referred to as “our university”), the dispensing practicum has primarily focused on mastering dispensing techniques and medication preparation methods.
Therefore, since 2022, group work focused on prescription analysis has been incorporated into the dispensing practicum, and the training content has been refined and improved to allow learners to experience dispensing closely resembling that in actual clinical settings. In the dispensing practicum for the 2024 academic year, efforts were made to increase opportunities for students to evaluate prescription appropriateness, considering patient backgrounds, dosages, and administration methods, by applying the knowledge acquired in previous lectures before the start of clinical training. Through this, the goal of the dispensing practicum was to help students recognize pharmacists’ role in dispensing, become aware of how the medications they have studied are actually used in clinical settings, and promote various insights.
In recent years, pharmaceutical education has begun to incorporate approaches from psychology, such as metacognition and motivation, to encourage learner awareness and thereby enhance autonomous learning motivation3–5) . Therefore, in this study, we conducted a questionnaire survey during the dispensing practicum held in the 2024 academic year to examine whether students were able to apply the knowledge they had acquired until that time, and to identify areas in which they felt the need to further deepen their learning.
The pre-training at our university includes five core units: Dispensing, Communication, Pharmaceutical Care, Physical Assessment, and Aseptic Dispensing. For the pre-training, all participants are divided into six groups, and they rotate through each unit every 4 days. The dispensing practicum consists of sections on powdered medicines, liquid medicines, topical formulation preparations, and a practical dispensing session (Table 1). During days 1 to 3, the focus was on developing skills in dispensing techniques and medication preparation methods. This included reviewing knowledge such as appropriate medication dosages tailored to individual patient backgrounds, practicing calculations essential for accurate medication preparation, and engaging in pair work that simulated the entire dispensing process, from receiving a prescription to delivering the medication to the patient. The daily dispensing practicum comprised two separate sessions, each lasting 2 h, with students rotating between the sessions. On day 4 of the practical dispensing session, group work was conducted with a focus on prescription analysis, and sufficient time was allocated for this activity. In addition to the dispensing techniques acquired during days 1 to 3, students applied their previously gained knowledge to engage in a dispensing practicum session that more closely resembles actual clinical settings.
Program details of the dispensing practicum program
| Day 1 | Day 2 | Day 3 | Day 4 | |
|---|---|---|---|---|
| Content A | Topical formulations ･Selection and counting of ointments preparation. ･Weighing and filling of a single ointment preparation. |
Topical formulations ･Weighing, mixing, and filling of a combined two-ointment preparation. |
Topical formulations ･Role-play from prescription reception to medication counseling. The activity included prescription analysis conducted in pairs. |
Practical dispensing session ･One-dose packaging of tablets. ･Dispensing in a simulated dispensing room following prescription analysis. This activity was conducted in groups. |
| Content B | Powdered medicines ･Calculation practice for determining the amount of formulation. ･Dispensing (single-agent, excipient addition, two-agent mixing, generic prescriptions). |
Powdered medicines ･Dispensing (excipient addition, manual tablet packaging, and tablet crushing). ･Prescription audit training (verification of prescription details, dosage and administration, pediatric dosage and administration planning, dosage and administration planning for patients with renal impairment). |
Liquid medicines ･Dispensing (single-agent, mL dosing, graduated scale dosing) |
Liquid medicines ･Dispensing (excipient addition, two-agent mixing, generic prescriptions). Powdered medicines ･Dispensing using a V-MAS pouch packing machine. ･Dispensing after prescription audit for pediatric and patients with renal impairment. |
On the fourth and final day, the practical dispensing session was conducted, incorporating group work focused on prescription analysis. The daily dispensing practicum comprised two separate sessions (Content A and B), each lasting 2 h, with students rotating between the sessions.
The practical dispensing session was conducted in groups of four. Patient information, such as background and laboratory values, was pre-written in the margins of the simulated prescriptions, and each participant used a different simulated prescription. (1) Each student selected one simulated prescription and performed a prescription audit (individual work) using information from the package inserts of prescription medications published on the Pharmaceuticals and Medical Devices Agency website. Based on patient information, students assessed prescription appropriateness and recorded their findings on a worksheet. If inquiries about a prescription were deemed necessary, they noted the reason and proposed an alternative. (2) For each simulated prescription audited, students shared within their group the generic name, mechanism of action, dosage, and administration; key characteristics of the medication, and the points focused on by the students during the prescription audit. (3) A faculty member reviewed and provided feedback on the content of activity (2) in each group. Regarding simulated prescriptions that required changes following a prescription inquiry, the original prescription was replaced with a new simulated prescription containing the appropriate revisions. In cases where a prescription inquiry was deemed necessary, students assumed the inquiry had been made and recorded the necessary information to be included in the designated section of the worksheet. (4) In the simulated dispensing room, each student performed tablet selection and counting using the simulated prescription they had audited. (5) In each group, a student other than the one who performed the dispensing verified the dispensed medication. A faculty member reviewed the verification of the dispensed medication and the worksheet entries once again, providing feedback on key points as necessary.
2. Assessment of the impact of the dispensing trainingIn the 2024 academic year, 215 students participated in the pre-training, organized into groups of 35 to 36 students. To assess learners’ subjective understanding of dispensing, both a pre-survey and a post-survey were conducted. The pre-survey was conducted during the first week of the pre-training period (mid-September), while the post-survey was administered on the final day (day 4) of the dispensing practicum for each group, after the completion of the practical dispensing session. Both the pre- and post-surveys contained 15 common items (Q1–15), which were evaluated using a 4-point Likert scale. The responses of 36 students who began the dispensing practicum before completing the pre-survey were excluded from the analysis, because the practicum had already commenced before survey administration. Out of 179 students, data from 149 students (response rate: 83%) who completed both the pre- and post-surveys were used to analyze changes in their understanding of dispensing following the dispensing practicum. Statistical analysis was conducted using the Wilcoxon signed-rank test in the IBM SPSS Statistics software. Responses to the questionnaire items were scored as follows: “Can explain” = 4, “Probably can explain” = 3, “Probably cannot explain” = 2, and “Cannot explain” = 1. The statistical significance level was set at 5% for all analyses.
3. Identifying participants’ reflections and insights gained from the dispensing practicum programIn the post-survey only, additional open-ended questions (Q16–21) were included. To explore the insights prompted by the dispensing practicum among the learners, text mining was conducted on six open-ended survey items by using the KH Coder6,7) . The target words for analysis included nouns, verbal nouns (suru-nouns), adjectival verbs, negative adjectives, adverbial nouns, tags, interjections, verbs, adjectives, adverbs, and compound nouns that appeared five times or more. The terms Yakuzaishi (pharmacist), Tenpu Bunsho (package insert), Gigi Shokai (inquiry), and Kijo (action) were set as mandatory extraction keywords, and the responses of 212 participants in the post-survey (response rate: 99%) were analyzed.
4. Ethical considerationsAt the beginning of the survey, the participants were informed both verbally and in writing that their responses might be used for future research, and that declining to participate would not affect their academic performance or result in any other disadvantage. This study was approved by the ethics review committee of the Research Promotion Division at Fukuoka University (approval no. F25-09-002). Before the commencement of this study, information about the research was made publicly available on the website of the Research Promotion Division at Fukuoka University website, allowing potential participants the opportunity to opt out.
The participants showed a significant improvement in understanding across all multiple-choice items (Q1–15) following the dispensing practicum, compared to their pre-practicum levels (p < 0.001). In the pre-survey, over 65% of the respondents selected negative responses (“Probably cannot explain” or “Cannot explain”) for questions Q1–6, which focused on dispensing techniques. After the dispensing practicum, over 90% of the respondents selected positive responses (“Can explain” or “Probably can explain”) for all items (Table 2).
Results of a questionnaire assessing learners’ understanding of dispensing
| n (%) | Average | Variance | ||||||
|---|---|---|---|---|---|---|---|---|
| Can explain | Probably can explain | Probably cannot explain | Cannot explain | No response | ||||
| Q1. Procedure for dispensing tablets from blister packs (selection and counting) | pre | 10 (6.7) | 38 (25.5) | 80 (53.7) | 21 (14.1) | 0 (0.0) | 2.25 | 0.60 |
| post | 105 (70.5) | 44 (29.5) | 0 (0.0) | 0 (0.0) | 0 (0.0) | 3.70 | 0.21 | |
| Q2. Procedure for crushing tablets for dispensing | pre | 2 (1.3) | 30 (20.1) | 90 (60.4) | 27 (18.1) | 0 (0.0) | 2.05 | 0.43 |
| post | 105 (70.5) | 44 (29.5) | 0 (0.0) | 0 (0.0) | 0 (0.0) | 3.70 | 0.21 | |
| Q3. Procedure for performing one-dose packaging dispensing | pre | 3 (2.0) | 36 (24.2) | 81 (54.4) | 29 (19.5) | 0 (0.0) | 2.09 | 0.51 |
| post | 85 (57.0) | 62 (41.6) | 2 (1.3) | 0 (0.0) | 0 (0.0) | 3.56 | 0.27 | |
| Q4. Procedure for dispensing powdered medicines | pre | 2 (1.3) | 29 (19.5) | 93 (62.4) | 25 (16.8) | 0 (0.0) | 2.05 | 0.41 |
| post | 112 (75.2) | 37 (24.8) | 0 (0.0) | 0 (0.0) | 0 (0.0) | 3.75 | 0.19 | |
| Q5. Procedure for dispensing liquid medicines | pre | 2 (1.3) | 20 (13.4) | 97 (65.1) | 30 (20.1) | 0 (0.0) | 1.96 | 0.39 |
| post | 109 (73.2) | 38 (25.5) | 2 (1.3) | 0 (0.0) | 0 (0.0) | 3.72 | 0.23 | |
| Q6. Procedure for dispensing topical formulations | pre | 2 (1.3) | 49 (32.9) | 75 (50.3) | 23 (15.4) | 0 (0.0) | 2.20 | 0.50 |
| post | 112 (75.2) | 34 (22.8) | 3 (2.0) | 0 (0.0) | 0 (0.0) | 3.73 | 0.24 | |
| Q7. Required information on a prescription | pre | 24 (16.1) | 83 (55.7) | 37 (24.8) | 5 (3.4) | 0 (0.0) | 2.85 | 0.52 |
| post | 60 (40.3) | 85 (57.0) | 4 (2.7) | 0 (0.0) | 0 (0.0) | 3.38 | 0.29 | |
| Q8. Required information on a medication bag | pre | 27 (18.1) | 88 (59.1) | 31 (20.8) | 3 (2.0) | 0 (0.0) | 2.93 | 0.47 |
| post | 117 (78.5) | 30 (20.1) | 2 (1.3) | 0 (0.0) | 0 (0.0) | 3.77 | 0.20 | |
| Q9. Procedure for dispensing medications according to a prescription | pre | 13 (8.7) | 52 (34.9) | 74 (49.7) | 10 (6.7) | 0 (0.0) | 2.46 | 0.56 |
| post | 107 (71.8) | 40 (26.8) | 2 (1.3) | 0 (0.0) | 0 (0.0) | 3.70 | 0.23 | |
| Q10. Workflow from prescription reception to medication delivery to the patient | pre | 13 (8.7) | 74 (49.7) | 50 (33.6) | 12 (8.1) | 0 (0.0) | 2.59 | 0.58 |
| post | 62 (41.6) | 81 (54.4) | 6 (4.0) | 0 (0.0) | 0 (0.0) | 3.38 | 0.32 | |
| Q11. Key points to check when reviewing a prescription (during prescription audit) | pre | 13 (8.7) | 70 (47.0) | 57 (38.3) | 9 (6.0) | 0 (0.0) | 2.58 | 0.54 |
| post | 65 (43.6) | 79 (53.0) | 5 (3.4) | 0 (0.0) | 0 (0.0) | 3.40 | 0.31 | |
| Q12. Methods for adjusting dosage according to patient conditions (e.g., age, body weight, and renal function) | pre | 4 (2.7) | 60 (40.3) | 71 (47.7) | 14 (9.4) | 0 (0.0) | 2.36 | 0.47 |
| post | 59 (39.6) | 79 (53.0) | 11 (7.4) | 0 (0.0) | 0 (0.0) | 3.32 | 0.37 | |
| Q13. The significance of prescription review by pharmacists | pre | 41 (27.5) | 86 (57.7) | 18 (12.1) | 4 (2.7) | 0 (0.0) | 3.10 | 0.49 |
| post | 103 (69.1) | 46 (30.9) | 0 (0.0) | 0 (0.0) | 0 (0.0) | 3.69 | 0.21 | |
| Q14. Actions to take when conducting a prescription inquiry about prescription contents | pre | 47 (31.5) | 72 (48.3) | 24 (16.1) | 5 (3.4) | 1 (0.7) | 3.09 | 0.61 |
| post | 90 (60.4) | 55 (36.9) | 4 (2.7) | 0 (0.0) | 0 (0.0) | 3.58 | 0.30 | |
| Q15. Key points to focus on when verifying prescriptions and medications dispensed by another pharmacist | pre | 17 (11.4) | 64 (43.0) | 56 (37.6) | 11 (7.4) | 1 (0.7) | 2.59 | 0.62 |
| post | 80 (53.7) | 69 (46.3) | 0 (0.0) | 0 (0.0) | 0 (0.0) | 3.54 | 0.25 | |
The survey was conducted before and after the dispensing practicum (n = 149, response rate 83%). For Questions 1 to 15, p < 0.001.
Text mining the free-text responses to “Q16. In the practical dispensing session, which aspects of what you learned from 4 years of lecture-based learning did you feel you were able to apply?”, revealed the most frequently extracted terms were “calculation” (45 times), “medicine” (39 times), “dispensing” (31 times), and “package insert” (31 times) (Table 3a). Terms such as knowledge–pharmacology–learning, class–learn–dispensing, calculation–method–formulation, interpretation–package insert–confirmation, and kinetics–drug–renal were found to co-occur (Fig. 1a). In response to “Q17. In the practical dispensing session, what did you feel you were able to apply from what you learned during days 1 to 3 of the dispensing practicum?”, the most frequently occurring terms were “confirmation” (123 times), “medication” (47 times), and “dispensing” (45 times) (Table 3b). Co-occurrences of terms such as confirmation–medication–prescription, finger–voice–let out, caution–specification–form, interpretation–package insert–prescription, and dispensing–counting–procedure were observed. In response to “Q18. In the practical dispensing session, what areas did you feel you still need to study further?”, co-occurrences of terms such as calculation–administration–renal, knowledge–medicine–action, and interpretation–package insert–confirmation were observed (Fig. 1b). The most frequently appearing terms were “medicine” (83 times), “action” (27 times), “prescribe” (26 times), and “package insert” (26 times) (Table 3c). In response to Q19, “What did you find difficult in the dispensing practicum?”, the words “prescribe” (44 times), “medicine” (37 times), and “audit” (36 times) appeared frequently (Table 3d). The comments included statements such as, “Even with reference to the package insert during prescription auditing, some aspects were difficult to evaluate, which made me realize the need to gain more experience by reviewing more prescriptions.”
Survey results pertaining to the insights gained during the dispensing practicum
| (a) Q16 | (b) Q17 | (c) Q18 | (d) Q19 | (e) Q20 | (f) Q21 | ||||||
|---|---|---|---|---|---|---|---|---|---|---|---|
| Extracted terms | Frequency of occurrence | Extracted terms | Frequency of occurrence | Extracted terms | Frequency of occurrence | Extracted terms | Frequency of occurrence | Extracted terms | Frequency of occurrence | Extracted terms | Frequency of occurrence |
| Calculation | 45 | Confirmation | 123 | Medicine | 83 | Difficult | 52 | Dispensing | 41 | Confirmation | 82 |
| Medicine | 39 | Medication | 47 | Think | 33 | Prescribe | 44 | Medicine | 36 | Think | 80 |
| Dispensing | 31 | Dispensing | 45 | Feel | 29 | Medicine | 37 | Audit | 29 | Dispensing | 71 |
| Package insert | 31 | Medicine | 41 | Action | 27 | Audit | 36 | Actually | 28 | Patient | 62 |
| Learn | 28 | Prescription | 32 | Prescribe | 26 | Confirmation | 34 | Think | 27 | Medicine | 50 |
| Prescribe | 27 | Voice | 31 | Package insert | 26 | Package insert | 34 | Prescription | 23 | Perform | 44 |
| Medication | 25 | Specification | 27 | Check | 24 | Prescription | 27 | Prescribe | 22 | Awareness | 41 |
| Audit | 23 | Times | 20 | Inquiry | 23 | Feel | 21 | Feel | 20 | Medication | 39 |
| Confirmation | 20 | Calculation | 19 | Calculation | 22 | Inquiry | 21 | Difficult | 19 | Error | 25 |
| Class | 20 | Perform | 18 | Learning | 21 | Find | 19 | Confirmation | 18 | Attention | 24 |
| Prescription | 19 | Form | 15 | Knowledge | 18 | Consider | 17 | Perform | 17 | Prescribe | 24 |
| Patient | 16 | Check | 15 | Understand | 18 | Judgment | 16 | Time | 17 | Audit | 21 |
| Feel | 15 | Take | 15 | Enough | 17 | Query | 15 | Shelf | 15 | Prescription | 20 |
| Check | 15 | Name | 16 | Perform | 15 | Accurately | 20 | ||||
| Perform | 15 | Memorize | 15 | Make a mistake | 18 | ||||||
| Consider | 18 | ||||||||||
| Specification | 16 | ||||||||||
| Careful | 16 | ||||||||||
List of frequently occurring extracted words from free-text responses in the post-survey (Q16–21), including words that appeared 15 times or more.
Co-occurrence network diagram of insights gained during the practical dispensing session, based on free-text responses to the two questions. (a) Q16. In the practical dispensing session, which aspects of what you learned from 4 years of lecture-based learning did you feel you were able to apply? (b) Q18. In the practical dispensing session, what areas did you feel you still need to study further? The diagram was generated using the top 50 words that appeared five times or more. The Jaccard coefficient was used as the measure of co-occurrence. To enhance the interpretability of the co-occurring terms, only the minimum spanning tree was depicted in the figure.
In response to Q20, “New realizations gained during the practical dispensing session compared to that during days 1 to 3 of the dispensing practicum,” students made comments, such as “When I actually tried picking medicines from a dispensing shelf with many medications, it took much longer than expected just to find the correct medicine”; “By actually selecting and auditing medicines, I realized how significantly dispensing is connected to patients’ lives and became aware of the importance of making prescription inquiries.”; and “When I was only performing dispensing tasks, I did not go as far as to question the accuracy of the prescription itself. Therefore, I was surprised by how much more needs to be considered when actually working in a pharmacy.” Additionally, the words “dispensing” (41 times), “medicine” (36 times), and “audit” (29 times) were among the most frequently mentioned keywords (Table 3e).
In response to Q21, “Which aspects of dispensing do you intend to be mindful of during clinical practice or after becoming a pharmacist?”, the most frequently extracted keywords were “confirmation” (82 times), “dispensing” (71 times), and “patient” (62 times) (Table 3f). The terms medicine–patient–think, times–confirmation–awareness, and audit–prescription–package insert, as well as adjust–administration–necessity, co-occurred (Fig. 2).
Co-occurrence network diagram of what students intend to be mindful of regarding future dispensing. Q21. Which aspects of dispensing do you intend to be mindful of during clinical practice or after becoming a pharmacist? Co-occurrence network diagram based on free-text responses to this question. The diagram was generated using the top 50 words that appeared five times or more.
We continuously improved the implementation methods of the dispensing practicum in the pre-training phase. Hence, by the fourth year, students were given opportunities to experience simulated dispensing that closely resembled the pharmacist’s duties in clinical settings, i.e., duties they would encounter for the first time during their fifth year of clinical practice. In this study, through the dispensing practicum, learners were encouraged to reflect on how the knowledge they had acquired during 4 years of lecture-based learning could be applied, and to consider what skills and knowledge they wished to further develop during their clinical practice. By fostering such awareness, the aim was to foster proactive learning going forward. Analysis of the questionnaire responses administered to participants showed that fundamental dispensing techniques, such as tablet selection and counting; tablet crushing; one-dose packaging of tablets, and the preparation of powdered medicines, liquid medicines, and topical formulation preparations, were properly understood through the dispensing practicum (Q1–6). The learners were encouraged to gain various insights with an awareness of actual clinical settings.
In response to Q17, many students reported that they were able to apply what they had learned during days 1 to 3 of the dispensing practicum, which mainly focused on mastering basic dispensing techniques, to the practical dispensing sessions. Notably, there were 123 times related to “confirmation,” including comments such as: “By carefully confirming the medication three times against the prescription and paying attention to the specifications, I was able to dispense accurately without making any mistakes.” Analysis of the multiple-choice items (Q1–9) revealed an increase in students’ understanding following the practicum. In addition, keyword extraction indicated that students had successfully acquired basic dispensing techniques and recognized the importance of verification. These skills were effectively applied on the final day of the dispensing practicum. Furthermore, the fact that all participants passed the practical skill assessment conducted after the pre-training indicates not only the objective effectiveness reflected in their responses to questions Q1–9, but also confirms that they had appropriately acquired the dispensing techniques in practice.
In the practical dispensing sessions, analysis of responses to Q16 (concerning the application of 4 years of lecture-based learning) and Q18 (concerning areas where students felt their knowledge was still insufficient) revealed that the terms “medicine” and “package insert” were frequently mentioned in relation to both. In response to Q16, students wrote comments such as, “I was able to understand the effects and indications of a medicine based on its name, which made me realize I was applying what I had learned,” “Since I had a basic understanding of how to read package inserts, I could identify the relevant sections,” and “I was able to apply the method for calculating creatinine clearance.” Subjects cited included pharmacology, dispensing, pharmacokinetics, and pharmaceutics. Analysis of the multiple-choice items (Q10–15) suggested that the learning content covered in these subjects contributed effectively to the dispensing practicum. This was evidenced by the fact that many students had already selected positive responses in the pre-practicum questionnaire, indicating a solid foundational understanding prior to the practical dispensing session. On the other hand, in Q18, many students felt they lacked sufficient knowledge in the same subject areas mentioned in Q16. For example, some commented, “I couldn’t immediately recall which disease the medicine was used for, so I felt I needed to study more,” and “I realized I need to review how to calculate dosage adjustments based on renal function, age, and body weight.” Although students demonstrated an understanding of how to read package inserts, the concept of “dose adjustment as needed,” which is commonly encountered in actual clinical settings, was still unfamiliar to many of them. Therefore, many students conducted prescription audits based strictly on the dosage and administration guidelines provided in the package inserts, and they often felt uncertain when judging the appropriateness of the prescriptions. Among the responses to Q19 regarding what students found difficult, some noted uncertainty about “to what extent prescription content falls within acceptable limits and at what point a prescription should be inquiries.” This suggests that many students found it challenging to make judgments based solely on the information provided in the prescription and the package insert. The finding indicated that students were able to recognize how the knowledge acquired through 4 years of lecture-based learning could be applied. They also became aware of the necessity and difficulty of prescription auditing that takes into account the patient’s condition in actual clinical settings, which led to recognition of areas needing further improvement.
During the first three days of the dispensing practicum, the dispensing shelf was stocked only with the medications that the students would handle on that day (approximately 10 types). In contrast, the simulated dispensing room used in the practical dispensing session contained more than 100 medications, including those with different formulations and strengths. Consequently, in response to Q20, which asked about different realizations between days 1 to 3 of the dispensing practicum and the practical dispensing session, students noted challenges specific to the simulated dispensing room used in the latter. Some students commented that “Selecting medications from a large shelf was more error-prone and time-consuming than retrieving them from the small shelf in front of me, as we did on days 1 to 3.” In addition, some students commented that “I realized the importance of working quickly, with not only focusing on the dispensing itself, but also including the auditing process, so as not to keep patients waiting.” Such responses indicate that students gained an understanding of the overall dispensing workflow, recognizing both the number of steps involved and the need to complete them within a limited amount of time. In response to Q21, which asked what students would like to be more mindful of regarding dispensing in the future, one student commented, “I felt that it is important to conduct prescription audits quickly and accurately, conduct smooth inquiries with physicians, and then dispense the appropriate medicine in the correct dosage to the patient efficiently. This made me aware of the need to improve my technical skills, knowledge, and communication abilities. The co-occurrence of the terms adjust–administration–necessity suggests that students became aware of the importance of individualized optimization of drug administration, which is a key objective of the dispensing practicum.
The “Pharmacy Vision for Patients” established in 20158) anticipates a shift in pharmacists’ roles from primarily dispensing tasks to more patient-centered services by fiscal year 2025. Additionally, since fiscal year 2019, pharmacy technicians have been allowed to assist with dispensing operations9) . In 2025, pharmacists are expected to be involved in patient-centered “individualized optimization of pharmacotherapy.” Results from a questionnaire survey conducted at our university, revealed that students tend to perceive the role of their profession primarily in terms of the “substance (medicine)”10) . Since students in the Faculty of Nursing at our university tend to focus on “people (patients),” a key challenge in the Faculty of Pharmacy is how to effectively increase learners’ awareness of patient-centered healthcare within the undergraduate curriculum. Although the dispensing practicum was conducted in a simulated environment different from actual clinical settings, the term “patient” was confirmed as one of the frequently extracted keywords in Q21. Based on the responses to Q20 and 21, it is suggested that students were able to understand the current meaning and expectations of “dispensing” for pharmacists before their clinical practice.
A limitation of this study is that it has not been confirmed how the various insights gained by learners through the dispensing practicum were applied during their clinical practice in actual clinical settings, nor whether recognizing areas of insufficiency led to increased motivation for proactive learning. In the future, it will be necessary to conduct a questionnaire survey among students who have completed their clinical practice after experiencing the dispensing practicum for the 2024 academic year, in order to verify whether the results of this study are not merely temporary immediately after the pre-training, but have a lasting effect on learners’ subsequent motivation and learning.
The role expected of pharmacists is constantly evolving, and accordingly, the approach to undergraduate education must also be renewed. We repeatedly improved the content of the dispensing practicum to enable students to better focus on actual clinical settings, and then implemented it. As a result, the learners had the opportunity not only to acquire dispensing techniques but also to experience, even in a non-clinical setting, the importance of prescription analysis for individualized optimization and the central role of the “patient” in pharmacists’ roles, including dispensing. Going forward, we aim to continuously update the practicum content in response to the evolving needs of actual clinical settings and to train pharmacists who can contribute to patient-centered pharmacotherapy.
We would like to thank Editage (www.editage.jp) for English language editing.
The authors declare no conflict of interest.
