How Do You Measure a Pharmacist’s Skills? A Massive Review Maps the Assessment Toolbox

How do you actually prove that a pharmacy student can think like a clinician? That deceptively simple question sits at the heart of a new scoping review published in BMC Medical Education, in which a team led by Sara Luengo and Jérémy Jost of the University of Limoges systematically mapped how health professions education measures the competencies behind pharmaceutical care. The answer, drawn from 3,625 screened records and 34 included studies, is both encouraging and sobering: there is a rich toolbox of assessment methods, but almost none of it was built for pharmacy, and very little of it has been validated for the digital, asynchronous learning environments that increasingly define modern training.

The review emerges from a concrete educational challenge. Competency-based education has become the dominant philosophy in health professional training, replacing time-served models with frameworks that specify what learners must demonstrably be able to do. In clinical pharmacy, this means competencies such as communicating with patients and prescribers, applying evidence-based medicine, exercising clinical reasoning, and solving medication-related problems. Yet the field lacks standardized assessment frameworks that are adaptable to digital learning. The researchers anchored their search to the ANEPC framework, developed by the French national association of clinical pharmacy educators, and asked which existing tools across medicine, nursing, and pharmacy could measure those competencies, how well validated they were, and whether they could function in e-learning settings.

Methodologically, the study followed the PRISMA-ScR reporting guideline and the Joanna Briggs Institute methodology for scoping reviews. Between January and April 2025, the team searched PubMed, Scopus, Cochrane, ScienceDirect, and SciELO with no language or date restrictions. Eligible studies had to describe or validate assessment tools targeting competencies aligned with the ANEPC framework and had to be evaluated in, or plausibly adaptable to, e-learning environments. The authors extracted data on study design, tool characteristics, targeted competencies, validation approaches, and psychometric reliability, synthesizing the findings qualitatively. Crucially, they categorized each tool’s adaptability to digital environments in clear tiers, explicitly separating empirical evidence from author-inferred proposed applications, a transparency move that guards against overclaiming.

The numbers tell a striking story about where assessment research actually lives. Of the 34 included studies, 53.0 percent originated in medicine, while only five studies, or 14.7 percent, focused specifically on pharmacy. The field is also young: 76.5 percent of the included publications appeared from 2017 onwards, suggesting that competency assessment in this space has accelerated sharply in the past decade. The domains assessed across the literature clustered around communication, evidence-based medicine, clinical reasoning, and problem-solving, which map closely onto the core of pharmaceutical care but were overwhelmingly developed and tested in other professions.

Four methodological families dominated the landscape. Objective Structured Clinical Examinations, or OSCEs, remain the gold standard for performance-based assessment, stationing learners through standardized clinical encounters scored with structured checklists. Evidence-based medicine instruments, such as validated tests of literature appraisal skills, probe whether learners can critically evaluate research. Clinical reasoning tests measure diagnostic and therapeutic thinking, often through scripted vignettes. Finally, structured rating scales allow examiners to quantify observed behaviors along defined dimensions. Each family carries distinct strengths: OSCEs capture authentic performance, written instruments offer scalability, and rating scales provide granularity, but each also carries distinct logistical burdens.

The psychometric picture is where the review delivers its most pointed critique. Validation evidence varied substantially across the 34 studies, and Cronbach’s alpha, a measure of internal consistency, was the most common reliability indicator reported. While internal consistency tells you whether items on a test hang together, it is only one thread in a modern validity argument. Evidence for response processes, meaning whether test-takers actually engage with items as intended, was sparse. Evidence for the consequences of testing, whether assessments drive beneficial or harmful learning behaviors, was likewise thin. Longitudinal validity, the demonstration that scores remain meaningful over time or predict later performance, was rarely examined. In practical terms, many widely used tools rest on a narrower evidentiary base than their popularity suggests.

The adaptability analysis is the review’s most forward-looking contribution. The qualitative synthesis revealed that written, structured tools, including EBM tests, clinical reasoning assessments, and rating scales, offer high adaptability for asynchronous digital delivery, since they can be migrated to online platforms with relatively minor redesign. Performance-based methods that require standardized patients or live examiners demonstrated only moderate adaptability without digital modifications. This distinction matters enormously as pharmacy education expands into remote and resource-limited settings. An OSCE requiring trained simulated patients and in-person examiners is expensive and geographically bound; a validated written reasoning assessment can, in principle, reach a learner anywhere with an internet connection.

The international composition of the research team hints at why this matters beyond the methodological literature. Alongside the Limoges-based epidemiology and clinical pharmacy groups, the author list includes clinicians from Calmette Hospital in Phnom Penh, Cambodia, spanning neurology, endocrinology, cardiology, and pharmacy. The work was supported by the French National Research Agency under the France 2030 investment framework, and the authors acknowledge the University of Limoges and the Calmette collaborations as part of a broader educational initiative. For health systems building clinical pharmacy capacity from the ground up, the ability to assess competencies remotely and consistently is not a convenience but a prerequisite for scalable training.

The review’s conclusions are carefully hedged, and appropriately so. The authors state that although several tools offer stronger potential for adaptation to clinical pharmacy and asynchronous e-learning, findings from other disciplines cannot be assumed valid for pharmaceutical care. This is a critical caveat: a clinical reasoning test validated in medical students measures overlapping but not identical constructs to those a pharmacist deploys when reconciling a medication list or resolving a drug interaction. Adapting borrowed instruments, the authors argue, requires rigorous content validation, contextual validation within pharmacy cohorts, and psychometric validation before scores can be trusted. The review therefore functions as an evidence map, a structured starting point rather than a set of ready-made answers.

What comes next, according to the authors, is the development of a standardized, pharmacy-specific competency assessment framework, and this review supplies its foundation. For educators, the immediate lessons are concrete: prioritize written structured tools when asynchronous delivery is the goal, but invest in the validation studies, particularly for response processes and longitudinal performance, that the current literature conspicuously lacks. For the profession at large, the review is a reminder that measuring competence is itself a competency, one that pharmacy education has quietly underinvested in. As medication-related care grows more central to patient safety worldwide, the tools that certify who is ready to provide it can no longer remain borrowed from other disciplines.

Subject of Research: Assessment methods and validation evidence for pharmaceutical care competencies in health professions education

Article Title: Methods for assessing the acquisition of pharmaceutical care skills among students and pharmacists: a scoping review

Article References: Luengo, S., Marcellaud, E., Ros, S., Aon, C., Sum, S., Vorn, M., Sarsrey, T., Lach, S., Polin, S., Chamroeun, H., Toniolo, J., & Jost, J. (2026). Methods for assessing the acquisition of pharmaceutical care skills among students and pharmacists: a scoping review. BMC Medical Education. https://doi.org/10.1186/s12909-026-10402-8

Image Credits: AI Generated

DOI: 10.1186/s12909-026-10402-8

Keywords: pharmaceutical care, clinical pharmacy education, competency assessment, scoping review, OSCE, e-learning, psychometric validation, health professions education, evidence-based medicine, clinical reasoning, BMC Medical Education, pharmacy students