Future Doctors, Pharmacists and Nurses Feel Ready to Tackle Overtreatment, National Survey Finds

Medicine has long been celebrated for its power to prescribe, but one of the most pressing challenges in modern healthcare is knowing when to stop. Deprescribing, the planned and supervised process of tapering or stopping medications whose harms may outweigh their benefits, has emerged as a critical counterweight to overprescribing, particularly among older adults living with multiple chronic conditions and long medication lists. Yet for all the evidence that deprescribing can reduce inappropriate polypharmacy and improve patient outcomes, it remains strikingly underused in routine clinical practice. A new national survey from Belgium, published in the Journal of General Internal Medicine, offers one of the most detailed portraits to date of how the next generation of healthcare professionals is being prepared, or in some cases not prepared, to take on this responsibility, and the results carry important lessons for medical, pharmacy and nursing education worldwide.

The study, led by Laudine Ackermans and Anne Spinewine of UCLouvain together with a broad consortium of researchers across Belgian universities and university hospitals, set out to evaluate the extent to which current education equips future healthcare professionals to deprescribe. Between April and June 2024, the team administered a cross-sectional online survey to undergraduate and postgraduate students in medicine, pharmacy and nursing enrolled at Belgian universities and nursing schools. The response was remarkable in scale: 1,777 students completed the questionnaire, including 509 medical students, 792 pharmacy students and 476 nursing students. This large, multi-disciplinary sample allowed the investigators to compare how different professional programs address deprescribing and to identify the factors most strongly associated with students feeling competent to carry it out.

The survey instrument was carefully grounded in established behavioral and educational science. Self-perceived competencies were assessed through seven items, while knowledge and skills were measured with nineteen items drawn from Farrell’s framework for deprescribing education. Attitudes were captured using twenty-five items from a questionnaire based on the Theoretical Domains Framework, a widely used model for understanding the psychological determinants of professional behavior, originally developed by Michie and colleagues and later validated by Cane and coworkers. The researchers analyzed the data using descriptive statistics and linear regression models, in which composite competency scores served as outcomes and curriculum level, clinical experience and exposure to deprescribing education acted as predictors. Open-ended responses were also thematically coded, giving students a voice in shaping the conclusions.

One of the most consequential findings concerns the sheer asymmetry of educational exposure across disciplines. Deprescribing featured commonly within the curricula of medicine and pharmacy programs, but it was rare in nursing education. This gap matters because nurses are frequently the professionals closest to patients, monitoring their day-to-day responses to medications and often best positioned to notice when a drug is causing harm or no longer serving a purpose. Previous work, including a 2026 scoping review in the International Journal of Nursing Studies on nurses’ role in deprescribing for older adults, has argued that nurses are underutilized in this domain. The Belgian survey now provides quantitative confirmation that the preparation of nursing students in deprescribing lags substantially behind that of their medical and pharmacy peers.

Among medicine and pharmacy students, the regression analyses revealed a clear and statistically robust pattern: greater self-reported exposure to deprescribing within the curriculum and a more advanced academic level were both significantly associated with higher self-perceived competency scores, with p values below 0.001. In other words, students who had encountered deprescribing more often, and those further along in their training, felt markedly more capable of engaging in it. While self-perceived competence is not the same as demonstrated skill, self-efficacy is a well-established predictor of whether professionals actually adopt new practices, making this finding a meaningful signal about which educational ingredients drive readiness. The dose-response relationship between exposure and confidence suggests that simply embedding deprescribing more deeply and repeatedly into curricula could pay dividends.

Perhaps the most technically revealing insight concerns where in the deprescribing process students feel confident and where they falter. Across all three disciplines, students reported higher confidence in the early steps of the deprescribing process, such as recognizing when a medication might be a candidate for withdrawal, but markedly lower confidence in assessing the deprescribing potential of individual medications and in implementing and monitoring actual deprescribing plans. This is a critical distinction. The early steps rely on general awareness and attitude, while the later steps demand specific pharmacological knowledge, familiarity with tapering schedules, and the clinical judgment to manage withdrawal effects and relapse risk. Evidence-based deprescribing frameworks, such as the patient-centered process described by Reeve and colleagues in the British Journal of Clinical Pharmacology and the GRADE-based methodology of Farrell and coworkers, emphasize exactly these later stages. The survey suggests that current education tends to cover the concept of deprescribing well but the operational mechanics of it poorly.

The attitudinal data offer a genuinely encouraging counterpoint. Students across all groups expressed generally positive attitudes, with strong intentions to deprescribe in their future practice, clear perceptions of its benefits, and a sense that deprescribing aligns with their emerging professional identity. This is significant because attitude and identity are powerful levers for behavior change; a workforce that enters practice already viewing deprescribing as part of its professional role is far more likely to sustain the behavior than one that must be persuaded later. At the same time, the students identified barriers that practicing clinicians will find intimately familiar: patient reluctance to stop medications, competing clinical priorities, and time constraints. These barriers echo those documented in systematic reviews of prescriber behavior and in surveys of European physicians regarding benzodiazepine deprescribing, underscoring that education alone, however well designed, will need to be complemented by system-level support if deprescribing is to become routine.

The students themselves did not stop at identifying problems; they offered a prescription of their own. In the open-ended responses, they called for more practical and interprofessional education on deprescribing, introduced earlier in the curriculum and delivered more broadly across disciplines. This aligns closely with a proposed curricular framework for interprofessional deprescribing education published by Farrell and colleagues in Medical Science Education in 2023, and with earlier work by Zimmerman and coworkers showing that trainees in medicine, pharmacy and nursing perceive gaps in their preparation and want clearer guidance on each other’s roles in the deprescribing process. Interprofessional education is particularly relevant because successful deprescribing in real-world settings is almost never a solo act; it typically requires a physician willing to revise a prescription, a pharmacist able to design a tapering plan, and a nurse monitoring the patient’s response, all coordinated around the patient’s own goals and preferences.

The Belgian context makes these findings especially timely. Belgium faces the same demographic pressures as much of Europe, with a growing population of older adults exposed to potentially inappropriate prescribing, a problem documented in national studies of nursing homes and community-dwelling patients with polypharmacy. National initiatives, including a reimbursed program to support withdrawal from benzodiazepines and related Z-drugs, have signaled policy-level commitment to tackling overmedication, and international deprescribing networks have been working to translate guidelines into practice. Yet interrupted time-series analyses have shown that the publication of international deprescribing guidelines alone does not automatically change prescribing behavior in nursing homes. The new survey points to a plausible missing link: if the professionals of tomorrow are not systematically trained in the later, operational stages of deprescribing, guidelines will continue to underperform in the clinic.

The authors are careful to acknowledge the limits of self-reported data. Self-perceived competency can be inflated, a phenomenon famously described in the psychological literature on the Dunning-Kruger effect, and the survey’s cross-sectional design captures a snapshot rather than a trajectory. Nevertheless, the scale of the sample, the grounding of the instruments in validated frameworks, and the consistency of the patterns across disciplines lend the findings considerable weight. The practical implications are clear: nursing curricula urgently need to incorporate deprescribing; all three disciplines need more emphasis on assessing the deprescribing potential of specific drugs and on implementing tapering plans; and education should be practical, interprofessional and introduced early. If educators act on these findings, the generation of clinicians now in training may be the first to treat deprescribing not as an afterthought to prescribing, but as an equally core clinical skill, one that could meaningfully reduce the hidden burden of overmedication that millions of older patients carry every day.

Subject of Research: A national survey of self-perceived deprescribing competencies, knowledge, skills and attitudes among healthcare professional students in Belgium.

Article Title: Self-Perceived Competencies, Knowledge, Skills, and Attitudes of Healthcare Professional Students in Deprescribing: A National Survey

Article References: Ackermans, L., Van Durme, T., de Saint-Hubert, M., Guisset, S., Van Leeuwen, E., Coteur, K., Tommelein, E., Philippe, G., Dilles, T., Verschuren, S., De Vriese, C., Patris, S., Siriez, R., Vanpee, D., & Spinewine, A. (2026). Self-Perceived Competencies, Knowledge, Skills, and Attitudes of Healthcare Professional Students in Deprescribing: A National Survey. Journal of General Internal Medicine. https://doi.org/10.1007/s11606-026-10724-9

Image Credits: AI Generated

DOI: 10.1007/s11606-026-10724-9

Keywords: deprescribing, polypharmacy, health professional education, medical students, pharmacy students, nursing students, self-perceived competency, interprofessional education, medication safety, older adults, attitudes, Belgium