Exploring the Challenges Student Pharmacists Confront when Learning to Detect Medication-Related Problems in Electronic Health Records: Implications for Instructional Design

Objective

This study aimed to explore the challenges pharmacy students face when learning to detect medication-related problems (MRPs) in electronic health records (EHRs) during simulated patient work-ups and offer implications for instructional design in pharmacy education.

Methods

A qualitative research design was employed to analyze responses from 120 third-year pharmacy students enrolled in a required course. The students completed open-ended surveys at the end of the semester, describing the difficulties they encountered while working on patient cases in a simulated EHR. Inductive thematic analysis was used to identify recurring themes related to the students’ challenges.

Results

The analysis revealed 3 macro-categories of challenges: (1) Work-up Process, including rushing through tasks and overlooking information; (2) Interpreting Cues, such as failing to understand the relevance of data and information overload; and (3) Perceived Ambiguity, including difficulty defining MRPs and conflicting information in the EHR. Ten specific themes were discovered within these macro-categories, providing a comprehensive view of the challenges students confronted.

Conclusion

Learners experienced significant challenges in detecting MRPs. These challenges were primarily rooted in managing the work-up process, interpreting clinical cues, and handling ambiguous information. The findings suggest a need for more structured scaffolding, repeated case-based practice focused on key cues and new strategies for modeling how to address ambiguity in clinical settings. These modifications may enhance students’ clinical reasoning and problem-detection abilities, improving their preparedness for real-world pharmacy practice.