Less than one year ago, I was a foundation trainee myself. Now, I’m back in the teaching room as an educator, standing in front of the next cohort as students prepare to qualify as independent prescribers in a way that I never had to. Seeing this shift from both sides of the transition has shown me just how significant a change it is for early-career pharmacists.
The foundation year has always required a rapid transition from student to professional; however, the addition of prescribing demands even more. Trainees must develop clinical judgement and decision-making much earlier than previous generations. Prescribing at registration requires clinical competence but also the confidence to use that competence in a culturally sensitive and person-centred way. These two qualities do not always develop at the same pace and that tension appears frequently in the classroom.
This shift places new expectations on foundation programmes. Trainees need opportunities to build not only prescribing skills but the professional identity and cultural awareness needed to apply them safely. Cultural competence sits at the heart of prescribing — decisions are shaped by patients’ beliefs, values and lived experiences. Many trainees say that working in these “grey areas” is the most daunting part of becoming a prescriber. Concerns about mistakes can limit their willingness to test and apply their skills. Understanding this transition is essential if training is to provide meaningful support.
The evolving foundation training landscape
In response to these changes, a national training offer introduced by NHS England brings trainees from all sectors together for structured study days. These sessions focus on areas that are difficult to deliver consistently in practice, including professionalism, clinical reasoning, prescribing practice and cultural competence. In reality, the most meaningful learning often emerges through case discussions, peer learning and communities of practice, where trainees encounter real-life complexities and can talk openly about uncertainty.
Alongside adapting to new workplaces and preparing for assessments, trainees must now prepare to become autonomous prescribers
However, this shift also adds pressure. Alongside adapting to new workplaces and preparing for assessments, trainees must now prepare to become autonomous prescribers. How we frame this support influences engagement and confidence. As someone who recently moved from trainee to educator, I often think about what helped me, what I wish I had known and how these new expectations feel for today’s trainees.
A near-peer educator perspective
My reflections come from delivering study days in the north west of England, as part of a multidisciplinary educator team. I joined less than one year after completing my own foundation year and that closeness gives me a perspective slightly different from my senior colleagues. I still remember the pace, pressure and uncertainty and trainees often sense that.
Trainees frequently share worries about prescribing readiness, decision-making and managing culturally sensitive consultations. These conversations arise informally and reflect the realities of early practice more than any competency list. Working alongside more experienced clinicians adds balance as my recent experience brings relatability, while their insight provides perspective. Together, we create an environment where uncertainty feels normal rather than concerning.
I recognise parts of my own journey in the trainees. I remember not knowing where I fitted in or which path to pursue. I try to reassure them that pharmacy is broader than the familiar three routes many of us were told to choose between. They frequently ask how I revised, how I handled difficult situations or how I ended up in education. Those moments remind me why my near-peer role matters — it lets me share the things I wish I’d known.
These reflections draw on that vantage point, tutor discussions and anonymised trainee feedback to explore how confidence, competence and cultural awareness develop during the foundation year.
Emerging tensions in developing foundation prescribers
Prescribing confidence and the value of applied complexity
A consistent theme across trainee feedback is the value placed on learning that mirrors real-life prescribing. Case-based discussions felt “relevant to practice” and “made you think of scenarios you could be faced with and ethical dilemmas”. Trainees want support not just in finding the right answer but in navigating ambiguity.
Situational judgement questions helped reinforce that prescribing decisions “can’t be seen in black and white”
Group discussions were also valued. Trainees described gaining confidence by hearing “different ways of thinking” and perspectives they “hadn’t previously considered”. Situational judgement questions helped reinforce that prescribing decisions “can’t be seen in black and white”. These reflections echo what I see in that confidence grows through shared reasoning not instruction.
Learning through interaction, not instruction
Interactive learning formats were particularly appreciated. Team-based activities encouraged “problem solving… communication and learning from others”, suggesting that prescribing competence develops socially as well as cognitively. Open discussions, especially those without a single correct answer, provided safe spaces to express uncertainty.
Trainees also liked hearing from qualified professionals sharing their own learning, including mistakes, so “we can learn from them to do better next time”. This transparency supports confidence by normalising imperfection.
Cultural competence and identity formation
Some trainees described becoming more mindful of “safety and confidentiality when sharing information with other HCPs”, while others said clinical cases helped them understand “what is required of me professionally as a future prescribing pharmacist”. Many also emphasised the value of reflection and teamwork in building confidence, showing they’re not just thinking about decisions they make now, but the pharmacists they will become.
Engagement, cognitive load and the realities of the foundation year
A few trainees asked for sessions to be “shorter and more succinct”, likely reflecting the wider pressure of workplace learning and assessments. Yet even with time pressures, case discussions remained the most valued elements. Trainees highlighted the importance of peer connection, with some noting they “don’t regularly see any other pre-regs… only on these training days”. This sense of community seems to support confidence and reduce isolation, something I remember feeling myself.
Reflection summary
These insights point to a training experience where authenticity, interaction and reflection matter deeply. Trainees want space to explore uncertainty, hear real stories and feel part of a community. They respond to teaching that helps them understand not just how to prescribe but who they are becoming as prescribers.
As someone who was a trainee not long ago, I’m struck by … how much the landscape has changed around them
As someone who was a trainee not long ago, I’m struck by how familiar many of their worries feel and how much the landscape has changed around them. The gap between competence and confidence is not a sign of weakness; it is a natural part of professional growth. The way we frame prescribing, as something you grow into rather than switch on at registration, can be as important as delivering the content itself.
Conclusion
Foundation training is changing and so are the expectations placed on new pharmacists. Trainees must leave the year able to prescribe safely but also learn to trust their judgement, understand their values and build an identity that will evolve throughout their careers. As someone who has only just made this transition myself, I can see how much it matters that training environments allow room for uncertainty, reflection and cultural complexity.
Supporting this first cohort of pharmacist prescribers has made me realise that confidence does not arrive all at once. It grows through conversations, shared experiences and the reassurance that uncertainty is part of prescribing, not a barrier to it. Creating these spaces may help narrow the gap between what trainees can do and what they feel ready to do. This gap has become more significant now that prescribing is an expectation at the point of registration.
We are only beginning to understand how learning to prescribe during the foundation year will shape the professional identity of newly qualified pharmacists. The impact of this shift will unfold over the coming years, but what feels clear already is that confidence, cultural competence and connection will play a central part in how prepared trainees feel to step into this new version of the profession.
