A graphical model to make explicit pharmacist clinical reasoning during medication review

Abstract

Pharmacists’ roles have evolved substantially from traditional drug compounding and dispensing to encompass patient-centred clinical services. Pharmacist clinical reasoning, though fundamental to these new roles, generally remains implicit and understudied, particularly compared with that of other healthcare professionals, such as physicians. However, teaching and supervising the clinical services provided by pharmacists require a thorough understanding of the reasoning process involved. Several models describing pharmacist clinical reasoning have been developed, but they lack unified mapping.

Here, we used an instrumental case study approach to develop a model of pharmacist clinical reasoning during medication review. Our model is adapted from a previously published modelling-using-typified-objects model of physician clinical reasoning in all its cognitive complexity. Our pharmacist model, validated after iterative development and expert consultation, aligns components of pharmacist clinical reasoning with those of physician clinical reasoning. The clinical case contains drug-related problems of variable clinical relevance, as well as numerous key elements (e.g., laboratory results, vital signs) necessary for conducting a medication review. The case serves both as the foundation for model development and as an illustrative step-by-step example within this article.

Our model delineates the subprocesses of pharmacist clinical reasoning during medication review, offering a flexible, multipath structure that underscores the dynamic, nonlinear nature of the reasoning. The model might be able to clarify implicit cognitive processes, thus furthering the overarching objective of promoting reflective skill development among learners rather than relying solely on tacit knowledge gained through practice experience.