The World Health Organization defines self-medication as the selection and use of medicines by individuals to treat symptoms they have recognized themselves, or the intermittent reuse of a prescribed drug for a chronic condition, all without professional oversight. When practiced responsibly for minor ailments, it can relieve pressure on overstretched health systems and support personal autonomy. But irresponsible self-medication carries serious consequences: misdiagnosis, delayed treatment of serious disease, adverse drug reactions, and—perhaps most dangerously—the acceleration of antimicrobial resistance, which the WHO ranks among the gravest threats to global health. A 2022 systematic review cited in the study put the worldwide prevalence of self-medication at up to 67 percent, with Southeast Asia topping the table at 74 percent, and prior research has found rates approaching 97 percent among health sciences students, far above the general population.

Vietnam presents a particularly fertile environment for the practice. Roughly half the population bought at least one medicine or supplement in the preceding three months according to recent national data, and antibiotics can reportedly be purchased without a prescription at 97 percent of community pharmacies. Earlier Vietnamese studies among university-level health students reported six-month self-medication rates ranging from 32 percent among pharmacy students to 52.7 percent among health sciences students who relied on personal experience. Yet the country’s associate-degree pharmacy and nursing students—the backbone of the primary healthcare workforce in rural and provincial facilities—had never been systematically compared within a single institution.

The research team, working from November to December 2025, surveyed essentially the entire final-year cohort: 365 eligible students, of whom 363 provided valid responses, a 99.5 percent response rate. The sample comprised 223 pharmacy students and 140 nursing students, nearly all aged 20 to 25 and predominantly female. The questionnaire, adapted from a validated instrument developed in Penang, Malaysia, went through a rigorous six-stage translation and cross-cultural adaptation process, including independent forward and back translation, expert committee review, pretesting, and a pilot with 30 separate students. Reliability was high: the knowledge section scored 0.85 on the Kuder–Richardson 20 coefficient and the attitude scale reached a Cronbach’s alpha of 0.92, both comfortably above the conventional 0.70 threshold.

The instrument measured four domains. Ten binary items assessed knowledge of drug interactions, contraindications, and safe-use principles, scored against the modified Bloom’s cutoff in which 80 percent or higher counts as good. Ten five-point Likert items gauged attitudes, operationalized as the propensity to self-medicate—so a higher score signals a stronger inclination toward the behavior, not a safer mindset. Nine further items captured actual practice over the preceding six months, including where students obtained medicines, what they treated, and why. Statistical analysis combined chi-squared and Mann–Whitney U tests with multivariable logistic regression, controlling for multicollinearity and verified for calibration with the Hosmer–Lemeshow test.

The knowledge results were broadly reassuring. Overall, 80.1 percent of students demonstrated good knowledge, with pharmacy students outperforming nursing students, 84.3 percent to 73.2 percent. Pharmacy students scored significantly higher on drug–alcohol interactions, drug–food interactions, and contraindications in children, reflecting the deeper pharmacology content of their curriculum. But a troubling detail lurked in the data: 61.7 percent of all students admitted having previously discontinued a medicine without consulting a healthcare professional—a habit with direct relevance to antimicrobial resistance and treatment failure, and one that was equally common in both disciplines.

Attitudes told a different story. Nearly 80 percent of students showed a moderate propensity toward self-medication, and 12.3 percent showed a high propensity. Nursing students were 5.5 times more likely than pharmacy students to fall into the high-propensity category, 24.6 percent versus 4.5 percent, despite scoring similarly on knowledge. Encouragingly, most students rejected the notion that professional training is unnecessary for safe self-medication, and majorities declined to recommend self-medication to others or to claim they could self-treat many diseases simply because of their health sciences background. Married students also expressed more caution than their single peers.

Practice data revealed what the researchers call a pharmacy–nursing paradox. Pharmacy students, armed with better knowledge and more cautious attitudes, nonetheless self-medicated more often: 61.0 percent versus 40.0 percent among nursing students. They cited emergency situations more frequently as a justification and self-treated gastrointestinal complaints—abdominal pain, diarrhea, constipation—at substantially higher rates. Nursing students, by contrast, leaned on prior treatment experience and the internet for information, and showed a striking reliance on unconventional supply channels: 46.2 percent of nursing students who self-medicated obtained medicines online, and 26.9 percent bought them at supermarkets, compared with 5.1 percent and 1.5 percent respectively among pharmacy students. The authors flag this as a pharmaceutical-law literacy gap, particularly urgent given Vietnam’s new e-commerce provisions under Law No. 44/2024/QH15.

The multivariable regression, fitted on 299 complete cases, distilled the picture into three independent predictors of self-medication. Being a nursing student roughly halved the odds compared with pharmacy students, an adjusted odds ratio of 0.43. Each one-point increase in the attitude score—greater propensity toward self-medication—raised the odds by 5 percent. And students with a grade point average between 2.00 and 2.49 faced nearly four times the odds of self-medicating compared with those in the excellent range, a finding that remained stable across sensitivity analyses including a Firth penalized-likelihood model. Knowledge score, notably, was not significant in any model, and the weak bivariate correlation between knowledge and attitudes dissolved after adjustment. The authors interpret this through the lens of the Theory of Planned Behavior: attitudes and internalized professional norms, not factual recall, drive behavior. Nursing training, with its emphasis on following medical orders, may itself act as a protective barrier, while pharmacological depth may breed a subtle overconfidence among pharmacy students—a hypothesis the cross-sectional design cannot confirm.

The implications reach beyond one college. Because knowledge alone demonstrably fails to shape safe behavior, the authors argue that health professional curricula should embed attitude-oriented interventions that stress the limits of professional competence and the clinical risks of unsupervised medication use, including arbitrary discontinuation. Nursing programs need explicit content on pharmaceutical law and online medicine purchasing; regulators, meanwhile, should strengthen Good Pharmacy Practice inspections and publish lists of licensed e-pharmacies. The study also positions cumulative GPA as a potentially modifiable risk marker worth screening for targeted support. Its limitations are real—single-institution scope, self-reported data vulnerable to recall and social desirability bias, and no capacity for causal inference—but the message is hard to dismiss. In a region where antibiotics sit behind no prescription counter, the people who will soon staff the front line of primary care are learning, before graduation, that knowing the risks of self-medication and acting on them are two very different skills.

Subject of Research: Self-medication knowledge, attitudes, and practices among Vietnamese healthcare college students

Article Title: Knowledge, attitudes, and practices regarding self-medication among healthcare college students in Vietnam: a cross-sectional study

Article References: Vo-Ho, T.-D., Vo, H. B. T., Huynh, H. V., Le, P.-Y. T., Nguyen, N.-N. T., & Vo, T. Q. (2026). Knowledge, attitudes, and practices regarding self-medication among healthcare college students in Vietnam: a cross-sectional study. Pharmacia, 73, Article e204360. https://doi.org/10.3897/pharmacia.73.e204360

Image Credits: AI Generated

DOI: 10.3897/pharmacia.73.e204360

Keywords: self-medication, Vietnam, pharmacy students, nursing students, knowledge attitudes practices, antimicrobial resistance, cross-sectional study, health sciences education, over-the-counter medicines, pharmacology training, Binh Duong Medical College, drug safety

The research team, led by Theophilus Ehidiamen Oamen of Obafemi Awolowo University together with colleagues at the University of Benin and the University of Ibadan, recruited 688 undergraduate pharmacy students across the three public universities. The sample was nearly gender balanced, comprising 354 males and 334 females with a mean age of 22.33 years and a standard deviation of 3.31 years. Participants completed an online cross-sectional survey containing the Smartphone Addiction Scale Short Version and the Bergen Social Media Addiction Scale, a well-established six-item measure of problematic social media use built around components of addiction such as salience, tolerance, mood modification, and conflict.

What makes this investigation stand out is its methodological design. Rather than fitting a single model and declaring victory, the researchers split their dataset into two equal halves of 344 participants each. The first half was subjected to exploratory factor analysis, a data-driven technique that lets the underlying structure of the items emerge without preconceptions. The second half was reserved for confirmatory factor analysis, which tests whether theoretically specified models reproduce the observed patterns of responses. This split-sample strategy guards against the common pitfall of overfitting, in which a model looks impressive on the same data used to build it but fails on fresh observations.

The team then pitted four competing structural architectures against one another. The simplest was a general one-factor model, which assumes all ten items tap a single latent trait of smartphone addiction. The correlated-factors model instead treats the scale’s subdomains as distinct but related dimensions. The second-order model proposes that several first-order factors converge on a higher-order general factor. Finally, the bifactor model, the most statistically demanding of the four, allows every item to load simultaneously on a general factor and on its own specific subdomain factor, thereby quantifying how much of the scale’s signal is genuinely global.

The bifactor model emerged as the clear winner on fit statistics. It achieved a chi-square to degrees-of-freedom ratio of 3.67, a comparative fit index of 0.949, a Tucker-Lewis index of 0.911, and a standardized root mean residual of 0.043, all indicating strong model-data correspondence. The root mean square error of approximation was elevated at 0.088 with a ninety percent confidence interval spanning 0.070 to 0.108, a caveat the authors acknowledge, but the overall pattern of indices favored the bifactor solution over its rivals.

Fit indices alone, however, can be misleading in bifactor modeling, which is why the researchers computed a battery of ancillary indices that scrutinize whether the general factor is substantive enough to justify a total score. The explained common variance reached 0.697, meaning nearly seventy percent of the reliable common variance among the items was attributable to the general factor. Hierarchical omega stood at 0.752, indicating that the general factor alone accounts for a substantial share of total score reliability. Construct replicability was 0.862, comfortably above the threshold conventionally associated with a well-defined latent variable, and factor determinacy reached 0.891, signifying that the general factor can be predicted with high fidelity from observed item scores. Together these indices strongly support the predominance of a single general smartphone addiction factor.

Equally important for real-world application is the question of measurement invariance: does the scale function identically across different groups? If not, apparent gender or institutional differences in scores might reflect measurement artifacts rather than genuine behavioral disparities. The study tested configural, metric, and scalar invariance across gender and across the three universities. Configural invariance confirms the same factor structure holds in each group, metric invariance establishes that items relate to the latent construct with equivalent strength, and scalar invariance ensures that individuals with identical levels of the underlying trait receive identical observed scores regardless of group membership. The Smartphone Addiction Scale Short Version passed all three levels in both comparisons, meaning researchers can meaningfully compare total scores between men and women and across the participating institutions.

The scale also demonstrated strong convergent validity, the degree to which it correlates with a theoretically related measure as expected. Scores correlated at 0.781 with the Bergen Social Media Addiction Scale, with a p-value below 0.001 and a ninety-five percent confidence interval from 0.743 to 0.813. This large association makes conceptual sense, since smartphone use and social media use are deeply intertwined behaviors, and it aligns the Nigerian findings with an international literature linking problematic smartphone use to problematic social media engagement. For a scale whose construct validity has been debated across sociocultural contexts, such convergence in a West African student population is a meaningful endorsement.

The practical upshot is that although the bifactor solution reveals multidimensional subthemes within the instrument, these specific factors are not strong enough to warrant separate interpretation or subscore use. The authors conclude that the scale functions primarily as a robust unidimensional measure in this population, and that researchers and clinicians can confidently rely on the total composite score to assess problematic smartphone use, provided they remain aware of the underlying subscale variance that the bifactor decomposition exposed. This recommendation carries weight for screening programs, epidemiological surveys, and intervention studies that depend on a single interpretable index of smartphone-related risk.

Beyond its immediate psychometric contribution, the study speaks to a broader scientific concern: behavioral addiction measures developed in one cultural context do not automatically transfer to others. By combining split-sample validation, competing-model comparison, bifactor diagnostics, invariance testing, and convergent validation in a single design, the researchers have produced a template for how scale evaluation should proceed in underrepresented populations. As smartphone penetration accelerates across Africa and young professionals in health disciplines face distinctive pressures of connectivity and study demands, having measurement tools whose structure, comparability, and validity have been verified locally becomes not a statistical nicety but a prerequisite for sound research and effective clinical practice.

Subject of Research: Psychometric validation of the Smartphone Addiction Scale Short Version among Nigerian pharmacy students

Article Title: Dimensionality and measurement invariance of the smartphone addiction scale among pharmacy students using general, correlated, second-order, and bifactor models; association with the bergen social media addiction scale: a multi-university study

Article References: OAMEN, T. E., Jegede, A. O., Idiake, J. O., & Irenitemi, E. O. (2026). Dimensionality and measurement invariance of the smartphone addiction scale among pharmacy students using general, correlated, second-order, and bifactor models; association with the bergen social media addiction scale: a multi-university study. BMC Psychology. https://doi.org/10.1186/s40359-026-05809-3

Image Credits: AI Generated

DOI: 10.1186/s40359-026-05809-3

Keywords: smartphone addiction, psychometrics, bifactor model, measurement invariance, confirmatory factor analysis, Bergen Social Media Addiction Scale, pharmacy students, Nigeria, scale validation, problematic smartphone use, convergent validity, BMC Psychology

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

The headline numbers frame the problem clearly. Overall, 71.95 percent of participants reported that HIV risk had been discussed during their training, and 64.42 percent said the same about PrEP. On the surface, those figures might seem encouraging, given that PrEP is a relatively recent addition to the prevention toolkit compared with decades of HIV education. But the study’s authors argue that the roughly one in three students who reported no PrEP discussion represents a missed opportunity at scale, because these are precisely the clinicians and pharmacists who will soon be prescribing, dispensing, and counseling patients about the medication that can reduce the risk of acquiring HIV through sex by about 99 percent when taken as directed.

The most eye-catching contrast in the data emerged between the two professional programs. After adjusting for other variables in multivariable ordinal regression models, pharmacy students had roughly twice the odds of medical students of reporting greater perceived HIV education, with an adjusted odds ratio of 2.03 and a 95 percent confidence interval of 1.35 to 3.04. The gap widened further for PrEP: pharmacy students had 3.41 times the odds of their medical counterparts of reporting greater perceived PrEP education, with a confidence interval of 2.23 to 5.22. That pharmacy trainees outpace medical trainees on PrEP awareness is notable, because physicians are often the ones expected to initiate PrEP prescriptions, while pharmacists increasingly serve as accessible touchpoints for medication counseling and, in many jurisdictions, direct pharmacy-based PrEP access.

The researchers also found that perceived education climbed steeply with academic seniority. Compared with first-year students, second-year students had nearly five times the odds of reporting greater perceived HIV education, with an adjusted odds ratio of 4.97, and more than five times the odds for PrEP education, at 5.42. Third-year students showed the strongest HIV signal in the entire analysis, with an adjusted odds ratio of 10.23, and fourth-year and beyond students reported the highest perceived PrEP education of all, with an adjusted odds ratio of 10.87. The trajectory makes intuitive sense: clinical content typically intensifies as students move from foundational coursework into rotations and experiential training. Yet the authors note that the pattern also implies first-year students, a group that includes many trainees who may already be interacting with peers and communities at risk, are largely entering professional school without meaningful PrEP literacy.

One of the more unexpected findings concerned gender. Cisgender women had lower odds than cisgender men of reporting greater perceived HIV education, with an adjusted odds ratio of 0.62, and lower odds of reporting greater perceived PrEP education, with an adjusted odds ratio of 0.51. In other words, even after accounting for program type and year of study, women in these cohorts consistently perceived less HIV and PrEP content in their training. The study did not test explanations for this disparity, but the finding raises questions about whether curricula, case materials, or classroom dynamics differ in ways that shape how students absorb and recall prevention content, and it flags a potential equity issue within the training environment itself.

Methodologically, the study relied on a cross-sectional survey design, which captures a snapshot of perceptions at a single point in time rather than tracking students longitudinally. The outcome measure was perceived education, meaning students’ own recollection and assessment of how much HIV and PrEP content they had encountered, not an objective audit of curriculum hours or a test of knowledge. Perception-based measures are valuable because they reflect what students feel prepared to act on, which influences whether future clinicians will raise prevention topics with patients. At the same time, the authors acknowledge that perception may not perfectly mirror actual curricular content, and the single-state sample of 385 students limits generalizability to other regions or professional programs.

The statistical approach deserves attention for readers who follow epidemiological methods. The team first used bivariate analyses to examine group differences in perceived education, then built multivariable ordinal regression models to estimate adjusted odds ratios with 95 percent confidence intervals. Ordinal regression is appropriate here because the perceived education outcome is ordered rather than binary, allowing the models to estimate how each predictor shifts a student’s position along a graded scale of reported educational exposure. The confidence intervals reported throughout the results exclude the null value of one, indicating that the associations between program type, academic year, gender, and perceived education were statistically reliable in this sample.

Why does this matter for public health? PrEP has been available in the United States since 2012, and federal initiatives have set ambitious targets for expanding its uptake, particularly among communities most likely to benefit, including gay and bisexual men, Black and Latino communities, people who inject drugs, and individuals in the American South and other high-burden regions. Yet uptake has lagged far behind eligibility, and a frequently cited barrier is that potential prescribers themselves feel unprepared to discuss or initiate PrEP. Studies like this one point to the upstream end of that pipeline: if a third of medical and pharmacy students report never discussing PrEP during training, the shortfall in confident prescribers and counselors is being manufactured years before those graduates see their first patients.

The pharmacy finding cuts both ways. On one hand, it suggests pharmacy curricula have integrated HIV prevention content relatively well, perhaps reflecting the profession’s central role in medication management and the growth of pharmacist-delivered preventive services. On the other hand, it highlights an asymmetry in which the professionals most likely to write initial PrEP prescriptions report less preparation than those most likely to fill and monitor them. Expanding pharmacy-based PrEP access, which several states now permit, could partially compensate, but the study’s authors argue that medical education also needs strengthening so that the two professions can function as a coordinated prevention workforce rather than an unevenly trained one.

The research team, led by Jacob Bleasdale and Emily Carter of the University of Central Florida, with colleagues at the University at Buffalo including Amy Hequembourg, Gene D. Morse, and Sarahmona Przybyla, framed their conclusions as an invitation to curriculum designers rather than an indictment of any single program. Their stated goal is to address the variability in educational experiences they documented and to better prepare future health professionals to care for the communities most likely to benefit from PrEP. The work was supported by the National Center for Advancing Translational Sciences of the National Institutes of Health, with additional support to the lead author from the National Institute on Alcohol Abuse and Alcoholism. As PrEP formulations expand from daily oral tablets to longer-acting injectables, the educational demands on trainees will only grow, making the gaps identified here a moving target that curricula will need to chase deliberately rather than assume will close on its own.

Subject of Research: Perceived HIV and PrEP education among medical and pharmacy students

Article Title: Perceived HIV and PrEP education among medical and pharmacy students: a cross-sectional study

Article References: Bleasdale, J., Carter, E., Hequembourg, A., Morse, G. D., & Przybyla, S. (2026). Perceived HIV and PrEP education among medical and pharmacy students: a cross-sectional study. BMC Medical Education. https://doi.org/10.1186/s12909-026-10526-x

Image Credits: AI Generated

DOI: 10.1186/s12909-026-10526-x

Keywords: HIV prevention, PrEP, medical education, pharmacy students, medical students, cross-sectional study, health professions education, pre-exposure prophylaxis, curriculum, New York State, ordinal regression, health communication

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