Is pharmacy education preparing pharmacists for the cognitive demands of modern practice?

In the UK, pharmacy practice is evolving rapidly. Pharmacists are increasingly involved in prescribing, structured consultations and complex clinical decision-making across community, hospital and primary care settings. 

The General Pharmaceutical Council’s 2021 ‘Standards for the initial education and training of pharmacists’ reflect this shift, placing greater emphasis on person-centred care, leadership, self-reflection, clinical reasoning, professional judgement, prescribing and risk management^​1​. In addition, from September 2026, all newly qualified pharmacists in England will register as independent prescribers^​2​. These roles require not only strong clinical knowledge, but also sustained attention, emotional resilience, sound judgement and the ability to navigate uncertainty, interruptions, time pressure and competing demands.

Pharmacy education already provides strong foundations in pharmacology, therapeutics, ethics and clinical reasoning. Case-based learning, objective structured clinical examinations (OSCEs), placements and supervised practice all help students and trainees develop judgement and decision-making skills. The issue is not that schools of pharmacy are failing, nor that the standards are pointing in the wrong direction, but whether an important professional question is being addressed — as pharmacy roles become more clinically autonomous and cognitively demanding, are the cognitive aspects of safe practice being addressed across the educational continuum? 

Beyond knowledge: the cognitive work of practice 

Many aspects of clinical work are still learned largely through experience: how to remain oriented when interrupted repeatedly; how to recognise when fatigue, stress or emotion are narrowing one’s thinking; how to tolerate uncertainty while still making sound decisions; how to prioritise when several risks compete for attention; or how to sustain safe judgement over time.

These are not abstract concerns. In 2025, a scoping review revealed that pharmacists and pharmacy technicians experience interruptions and distractions at rates ranging from fewer than 5 to more than 20 times per hour, with consequences for workload, performance, wellbeing and waiting times^​3​. It also identified a shortage of educational initiatives at university level and limited workplace interventions to mitigate the impact of distractions^​3​. Recent research on pharmacists’ clinical decision-making likewise describes it as dynamic and cognitively complex, rather than purely linear or technical^​4​.

This matters because the pharmacist’s role increasingly depends on judgement in real-world environments. Safe prescribing, medicines optimisation and structured clinical assessment all happen within busy systems shaped by noise, shifting priorities, competing demands, incomplete information, frequent task-switching and the complexity of human interactions. 

It is therefore unsurprising that patient safety thinking has increasingly turned towards human factors and the conditions in which clinical decisions are made. The World Health Organization’s Global Patient Safety Action Plan emphasises the importance of human factors and ergonomics in building safer, more resilient healthcare systems, and NHS England’s primary care patient safety strategy expects staff and students to have access to training that includes safety culture, human factors and ergonomics^​5,6​.

Wider pressures, but still a role for education 

At the same time, this should not be framed as a problem of individual inadequacy, or as though education alone can solve what are clearly system-level pressures. Pharmacists are working within wider structural constraints, including staffing shortages, service expansion, funding pressure and high workload. In 2024, 87% of respondents to the then Royal Pharmaceutical Society’s ‘Workforce wellbeing survey’ reported that they were at high risk of burnout, while 70% reported inadequate staffing as a factor negatively affecting their mental health and wellbeing^​7,8​. Better educational preparation cannot fully compensate for unsafe workloads or under-resourced systems. Any serious discussion must take this into consideration. 

Still, recognising those wider pressures should not stop pharmacy from asking what it can strengthen on its own side. If pharmacists are expected to prescribe at registration and take on increasingly complex clinical roles, then it is worth considering whether some of the cognitive aspects of practice that are currently learned implicitly could be addressed more explicitly during undergraduate education, foundation training and continuing professional development. 

This is not a call to replace scientific rigour with softer concepts. It is a call to make more visible some of the often hidden capabilities that support safe judgement in practice, such as situational awareness, metacognition, emotional regulation, recognising and mitigating cognitive bias, tolerating uncertainty, maintaining attention amid interruptions, and knowing when to pause, seek support or escalate concerns. As pharmacy education is already being reshaped into a more integrated five-year pathway, this is a timely moment to consider whether the cognitive demands of practice are being taught explicitly enough^​9​.

What might this look like in practice? 

One area that could address this is human factors education, which helps learners understand how external factors (such as environment, workload, interruptions and system pressure) and internal factors (such as stress, fatigue, emotion and cognitive load) influence human performance. 

Another is simulation that reflects more realistic conditions, including ambiguity, task-switching, competing priorities and communication under pressure. Recent systematic reviews in pharmacy education suggest that simulation-based education can improve communication-related outcomes and learners’ confidence in performing clinical pharmacy activities^​10,11​. Recent work in undergraduate medicine and pharmacy education also identifies perceived gaps in human factors and patient safety teaching, suggesting that this remains a live area for development rather than a settled one^​12​.

A further area is metacognitive development. Pharmacy already values reflection, but retrospective reflection is not quite the same as awareness of one’s own reasoning in action. As clinical roles expand, there may be value in helping pharmacists become more aware of how decisions are made under pressure; how assumptions form; how cognitive bias may influence reasoning; how attention becomes fragmented; and how fatigue, emotion or stress can affect judgement. Emerging evidence from nursing education suggests that metacognitive processes, such as monitoring, evaluation and regulation, are closely linked to the development of clinical decision-making, while also indicating that educational approaches may need to be tailored to situational pressures and individual differences^​13​. Mindfulness-based approaches are also available within NHS educational resources and may support wellbeing, although further research is needed^​14,15​.

This does not necessarily require a wholly new stand-alone curriculum. In many educational and workplace settings, elements of simulation, feedback, reflection and guided discussion may already be present. The stronger case is that these approaches should become more explicitly and consistently directed towards the cognitive realities of practice. 

It should also be considered that not every learner needs the same level of education at the same stage. If this is to become the norm, it will need to be practical, integrated into existing teaching and supervision, and grounded in real practice rather than treated as an optional extra.

Towards a more inclusive and explicit model of preparation

There is also a case for thinking more carefully about cognitive diversity. As awareness of neurodiversity grows across healthcare education, pharmacy may need to consider how learning and training environments across the educational continuum can support practitioners with different cognitive styles while maintaining professional standards. Discussion within pharmacy is beginning to engage more openly with neurodivergence and cognitive diversity^​16​.

Of course, there are counterarguments. Many schools of pharmacy may already be doing some of this work well. Provision is likely to be variable and it would be unfair to suggest total absence across the sector. It is also true that not every aspect of professional judgement can be formalised; some capabilities mature only through supervised experience. But that does not weaken the case for greater explicitness — it strengthens it. If these abilities are important, students and trainees should not have to rely solely on a hidden curriculum to begin developing them.

Pharmacy teams are already living this new reality. As the profession enters the era of prescribing at registration, pharmacy has an opportunity to lead a thoughtful conversation about what modern practice really asks of clinicians: not only scientific expertise and professionalism, but also attention, awareness, judgement, the ability to keep thinking clearly under pressure, and the capacity to sustain safe practice amid personal and emotional demands. 

Alongside urgent system reforms, pharmacy education and professional development can continue evolving to make the cognitive reality of practice more visible, more discussable and more teachable.