Bridging the gap between theory and practice: clinical pharmacists’ perspectives on pharmacokinetics in Sudan

Abstract

Background

Pharmacokinetics (PK) is vital for optimizing patient care, yet a gap remains between education and clinical application. This study aimed to evaluate clinical pharmacists’ perspectives on the educational, practical and implementation barriers to PK.

Methods

This cross-sectional analytical study conveniently surveyed practicing clinical pharmacists in Sudanese hospitals using a self-administered online google form questionnaire. The survey assessed perceptions of PK education, utilization in clinical practice, perceived skill adequacy, difficulty of application, and barriers to PK implementation.

Results

A total of 129 clinical pharmacists participated; 118 (91.5%) were female, 58 (45%) were aged 36–40 years, 122 (94.6%) held an MSc in Clinical Pharmacy, and 58 (45%) had under five years of experience. Regarding PK education, 79 (61.2%) reported taking both basic and clinical courses, and 28 (21.7%) received continuing education. The overall median rating of perspectives on PK education was 53% (IQR: 43–60%), with low agreement in terms of importance 13 (10.1%) and relevance 35 (27.1%). Only the nature of the PK course was significantly associated with these perspectives (p = 0.043). Barriers to PK implementation were strongly reflected in participants’ perspectives (median 84%, IQR 76–92%), mainly due to a lack of practical knowledge 110 (85.3%), the absence of role models 99 (76.7%), and poor understanding among clinical pharmacists 112 (86.8%). In practice, 59 (45.7%) used PKs occasionally, 72 (55.8%) reported skill gaps, and the median difficulty rating was 5 (IQR: 2–6).

Conclusion

This study reveals a critical gap between PK education and clinical application among Sudanese clinical pharmacists. From the perspective of clinical pharmacists, these findings highlight an urgent need for improved educational approaches and targeted professional development to better integrate PK into patient care.

Introduction

Pharmacokinetics (PK) is a vital tool for enhancing pharmaceutical care services for hospitalized patients, allowing for optimized treatment strategies tailored to individual needs [1]. Through drug concentration modeling, dose optimization, and therapeutic drug monitoring (TDM), PK data can support clinicians in tailoring treatments on the basis of patient-specific factors such as renal or hepatic function, age, weight, and comorbidities to ensure safer and more effective therapy [2–5].

Special attention must be given to optimizing medication use, as several factors have been identified that can prevent clinical pharmacy services and increase harm from medication errors during hospital stays [6]. Despite the recognized value of PK in patient care, a persistent gap exists between what is taught in academic settings and how PK is applied in the clinical environment [5, 7]. Pharmacists often report strong theoretical foundations in PK from their education but encounter challenges when translating this knowledge into practice [8]. These challenges include insufficient training in real-world applications, a lack of integration into clinical workflows, limited access to supportive tools such as TDM, and a healthcare culture that may undervalue or misunderstand PK’s role in clinical decisions [9]. This gap may result in missed opportunities to optimize therapy and improve patient safety [10, 11]. These challenges highlight the need to assess pharmacists’ perspectives on their education and training in PK, as understanding their preparedness and confidence can inform strategies to bridge the gap between academic knowledge and clinical practice. Although different studies worldwide have examined pharmacist perspectives on PK education and practice [5, 7, 11–13], no studies addressing this issue among clinical pharmacists in Sudan have been published. Therefore, this study aimed to evaluate clinical pharmacists’ perspectives on the educational, practical, and implementation barriers of PK to bridge gaps in practice and contribute to the advancement of clinical pharmacy practice.

Methods

Study design

This was a cross-sectional analytical study design that incorporated the use of a survey questionnaire among clinical pharmacists in Sudan.

Study population

All practicing clinical pharmacists in Sudanese hospitals were invited to participate in this study. A clinical pharmacist refers to a pharmacist who has completed at least a Master’s degree in Clinical Pharmacy and is formally registered with the Sudan Medical Council as a Clinical Pharmacy Specialist.

Sample size

The sample size was determined via the population survey tool in Epi Info version 7.2.5.0.

Study population size: 195 practicing clinical pharmacists in different Sudanese hospitals. As clinical pharmacy practice in Sudan is limited to major urban centers and no national registry of clinical pharmacists exists, the total number of practicing clinical pharmacists (n = 195) was estimated through direct contact with clinical pharmacy departments in hospitals where clinical pharmacy services are established. All identified clinical pharmacists were approached for participation.

Confidence level: A confidence level of 95% was chosen, which was aligned with a significance level (α) of 0.05. This is a typical cutoff to reduce the likelihood of Type I errors (false positives).

Expected frequency: We select a frequency of 50% to calculate the required minimum sample size, ensuring the most conservative estimate.

Margin of error: A 5% value was chosen to ensure that the study’s estimates would be precise enough to allow for meaningful interpretation.

The minimum sample size calculated was 129 clinical pharmacists.

Sampling technique

A convenient sampling technique was used.

Data collection process

The data were gathered from May to June 2025 via a self-administered questionnaire that was conveniently shared via an online Google Form. The survey link was distributed through established professional WhatsApp groups that are restricted to practicing clinical pharmacists working in Sudanese hospitals. Membership in these groups is typically based on professional verification (i.e., holding a clinical pharmacy qualification and active employment in a hospital setting), which helped ensure that only eligible participants received the survey link. To minimize selection and nonresponse bias, all identified practicing clinical pharmacists (n = 195) were invited to participate through group distribution and individual WhatsApp reminders. Data collection was discontinued once the minimum required sample size was achieved, as determined a priori through sample size calculation. A total of 129 pharmacists responded (66.2% response rate), meeting the required sample size and representing diverse locations and practice settings. Participation was voluntary, and no incentives were provided.

The study questionnaire

A previously validated English questionnaire developed by Shawahna et al. was used in this study [12]. The questionnaire comprises seven sections. Section I was used to gather demographic and professional information about clinical pharmacists; section II examined the nature and delivery of PK courses received during clinical pharmacy degrees; section III included six statements assessing the PK courses, including relevance, importance, adequacy, effectiveness, and depth, via a 5-point Likert scale (1 = strongly disagree, 5 = strongly agree); section IV evaluated how often clinical pharmacists apply PK knowledge in practice via a 5-point Likert scale (1 = none of the time, 5 = all or most of the time); section V assessed self-reported perspectives on PK skill adequacy via a 5-point Likert scale (1 = completely inadequate, 5 = completely adequate); section VI measured participants’ perspectives on the difficulty of applying PK in clinical settings via a 10-point scale (1 = least, 10 = most difficult); and section VII identified participants’ perspectives on barriers to PK implementation via five statements rated on a 5-point Likert scale. (1 = extremely unimportant, 5 = extremely important).

Questionnaire validity and reliability

A structured validation process was undertaken. The questionnaire was reviewed by two academic experts from the Department of Clinical Pharmacy and Pharmacy Practice, Faculty of Pharmacy, University of Gezira. The experts evaluated the instrument for clarity, relevance, and appropriateness within the local clinical pharmacy context, and no substantial modifications were required.

Construct validity was assessed using exploratory factor analysis, which demonstrated that all items had factor loadings greater than 0.4. The internal consistency of the questionnaire was evaluated using Cronbach’s alpha, which yielded a coefficient of 0.62.

Ethics approval

This study was performed in accordance with the principles of the Helsinki Declaration. Ethical approval was acquired from the Ethical Committee of the University of Gezira, Sudan (No: 57/2025). Written informed consent was acquired from every participating clinical pharmacist.

Data analysis

The data were analyzed with the Statistical Package for the Social Sciences version 27.0. (IBM, Armonk, NY, United States). Qualitative variables were summarized using frequencies and percentages. The Kolmogorov‒Smirnov test was used to assess the normality of the continuous data (item-rating percentage scores and overall perspective percentage scores). Data that did not follow a normal distribution are represented as medians with interquartile ranges (IQRs). The total item rating was calculated as a percentage by dividing the total item rating for all participants on a Likert scale by the maximum possible rating for all participants (5 × 129 = 645) and then multiplied by 100 to obtain the final item rating as a percentage. The overall clinical pharmacists’ perspective rating was calculated as a percentage by dividing the sum of individual Likert-scale ratings by the maximum possible score and multiplying by 100. For example, Section III consisted of six questions rated on a five-point Likert scale, yielding a maximum possible score of 6 × 5 = 30. The sum of individual ratings was divided by 30 and multiplied by 100 to obtain the percentage score. These percentage scores were treated as continuous data, assessed for normality, and summarized as medians with IQRs. To examine factors associated with clinical pharmacist perspective, the Mann–Whitney U test was used for categorical variables with two independent groups, while the Kruskal–Wallis test was applied for variables with more than two comparison groups.

Results

Demographic characteristics, professional and practice information of the clinical pharmacists

A total of 129 clinical pharmacists participated; most were female 118 (91.5%), aged 36–40 years 58 (45%), and worked primarily in Khartoum 67 (51.9%) and Omdurman 25 (19.4%) (Table 1). With respect to education, 122 (94.6%) held an MSc in Clinical Pharmacy, mainly from Khartoum University 65 (50.4%) and the University of Medical Science and Technology 35 (27.1%), with three from outside Sudan (2.3%) (Table 2).

Table 1.

Demographic characteristics of the clinical pharmacists

Characteristic	N (%)
Gender
Male	11 (8.5)
Female	118 (91.5)
Age
25–30	4 (3.1)
31–35	27 (20.7)
36–40	58 (45.0)
41–45	28 (21.7)
46–50	8 (6.2)
> 50	4 (3.1)
City
Khartoum	67 (51.9)
Omdurman	25 (19.4)
Bahri	18 (14.0)
Wad medani	16 (12.4)
Port Sudan	3 (2.3)

Table 2.

Professional and practice information of the clinical pharmacists

Characteristic	N (%)
Professional degree
MSc in pharmacy	122 (94.6)
PhD in pharmacy	7 (5.4)
Year of experience
< 5	58 (45.0)
5–10	52 (40.0)
> 10	19 (14.7)
University of degree
University of Khartoum	65 (50.4)
University of Gezira	11 (8.5)
Omdurman Islamic University	15 (11.6)
University of Medical science and technology	35 (27.1)
University Sains Malaysia	2 (1.6)
University of Jordan	1 (0.8)
Are you American Board of Pharmacy Specialty (BPS) certified clinical pharmacist?
Yes	51 (39.5)
No	78 (60.5)
Are you an academic contributor at any College/University?
Yes	54 (41.9)
No	75 (58.1)
Hospital
Governmental	116 (89.9)
Private	13 (10.1)
Hospital department
Cardiology	13 (10.1)
Medicine	42 (32.6)
Pediatric	24 (18.6)
Oncology	12 (9.3)
Renal	4 (3.1)
ICU	16 (12.4)
Surgery	9 (7.0)
OBS	5 (3.9)
Others	4 (3.1)

Abbreviations: MSc Master of Science,  PhD Doctor of Philosophy,  ICU  intensive care unit

In terms of professional experience, 58 (45%) had less than five years of experience, 51 (39.5%) were board-certified, and 54 (41.9%) had academic roles. Most 116 (89.9%) worked in government hospitals, 42 (32.6%) in medicine, 24 (18.6%) in pediatrics, 16 (12.4%) in intensive care units (ICUs) and 13 (10.1%) in cardiology (Table 2).

Nature and delivery of PK courses

Most participants 79 (61.2%) had taken both basic and clinical PK courses; 79 (61.2%) had integrated into other courses, such as pharmacotherapy, pharmacology and/or pharmaceutics; and only 28 (21.7%) had received PK-focused continuing education (Table 3).

Table 3.

Nature and teaching methods of Pharmacokinetic courses

Item	N (%)
Nature of pharmacokinetic courses
Basic pharmacokinetic	36 (27.9)
Clinical pharmacokinetic	14 (10.9)
Both	79 (61.2)
How pharmacokinetic courses were taught
Standalone courses	50 (38.8)
Incorporated as part of other course such as pharmacotherapy, pharmacology and/or pharmaceutics	79 (61.2)
Received continuing education courses related to pharmacokinetic
Yes	28 (21.7)
No	101 (78.3)

Perspectives on PK education

Overall, the median rating of clinical pharmacists’ perspectives on the importance, relevance, effectiveness, teaching methods, adequacy, and depth of PK courses was 53% (IQR: 43%–60%).

In this study, only 13 (10.1%) clinical pharmacists agreed that the PK courses they received were important to their current practice, with an overall rating of 39.7%. Additionally, 35 (27.1%) considered these courses relevant, reflecting an overall rating of 59.2%, 20 (16.5%) considered the teaching methods effective, with a corresponding rating of 51.8%, and 33 (25.6%) considered the course content adequate, reflecting an overall rating of 54.1%. The nature of the PK course was the only factor significantly associated with overall perspectives on PK education as shown by the Kruskal–Wallis test (H = 6.289, p = 0.043). The direction of the association indicated that students who had taken basic PK courses only reported the most favorable perspectives (mean rank = 77.40), followed by those who had taken clinical PK courses only (mean rank = 68.11), while students who had taken both basic and clinical PK courses had comparatively lower perspective scores (mean rank = 58.80). The detailed responses are presented in Table 4.

Table 4.

Perspectives of clinical pharmacists regarding the PK courses received in clinical pharmacy education

	Strongly disagree	Disagree	Neutral	Agree	Strongly agree
Item	N (%)	N (%)	N (%)	N (%)	N (%)	Rating percentages	Median (IQR)
1. The PK courses I received during my clinical pharmacy education were important to my current practice	49 (38)	53 (41.1)	14 (10.9)	6 (4.7)	7 (5.4)	39.7%	2 (1,2)
2. The PK courses I received during my clinical pharmacy education were relevant to my current practice.	1 (0.8)	65 (50.4)	28 (21.7)	8 (6.2)	27 (20.9)	59.2%	2 (2,4)
3. The PK courses I received during my clinical pharmacy education could have been taught better	1 (0.8)	59 (45.7)	27 (20.9)	12 (9.3)	30 (23.3)	61.7%	3 (2,3)
4. The method used to teach the PK courses during my clinical pharmacy education were effective	16 (12.4)	47 (36.3)	46 (35.7)	14 (10.9)	6 (4.7)	51.8%	3 (2,3)
5. The contents of the PK courses I received during my clinical pharmacy education were adequate	8 (6.2)	59 (45.7)	29 (22.5)	29 (22.5)	4 (3.1)	54.1%	2 (2,4)
6. The depth of the PK courses I received during my clinical pharmacy education was appropriate to prepare me for my future clinical roles	10 (7.8)	52 (40.3)	31 (24)	30 (23.3)	6 (4.7)	55.3%	3 (2,4)
Overall perspective on PK education {Median (IQR)}						53% (43% −60%)

Abbreviations: PK pharmacokinetics, IQR interquartile range

Barriers to PK implementation in clinical practice

Overall, clinical pharmacists’ perspectives on barriers to PK implementation had a median rating of 84% (IQR: 76%–92%). Clinical pharmacists identified key barriers to PK implementation, including a lack of practical knowledge 110 (85.3%), with an 83.1% overall rating; an absence of role models 99 (76.7%), with an 81.2% overall rating; and poor PK understanding among clinical pharmacists 112 (86.8%), which received the highest overall rating of 87.1%. Table 5 provides detailed insights into these perceived barriers.

Table 5.

Perspectives of clinical pharmacists regarding the barriers restricting the implementation of PK in optimizing patient outcomes

	Extremely unimportant barrier	Unimportant barrier	Neutral	Important barrier	Extremely important barrier
# Item	N (%)	N (%)	N (%)	N (%)	N (%)	Rating percentage	Median (IQR)
1. Lack of practical knowledge	2 (1.6)	2 (1.6)	15 (11.6)	65 (50.4)	45(34.9)	83.1%	4 (4,5)
2. Lack of continuing education relevant to PK	2 (1.6)	3 (2.3)	12 (9.3)	67 (51.9)	45 (34.9)	83.3%	4 (4,5)
3. Lack of role model at work place who knows and applies PK	3 (2.3)	0	27 (20.9)	55 (42.6)	44 (34.1)	81.2%	4 (4,5)
4. Poor understanding of PK by the health care professionals other than clinical pharmacists	0	15 (11.6)	20 (15.5)	60 (46.5)	34 (26.4)	77.5%	4 (3,5)
5. Poor understanding of PK by clinical pharmacists	0	5 (3.9)	12 (9.3)	44 (34.1)	68 (52.7)	87.1%	5 (1,5)

Abbreviations: PK pharmacokinetics, IQR interquartile range

Utilization, skill adequacy, and difficulty of PK in practice

In terms of PK utilization, 59 (45.7%) clinical pharmacists used PK knowledge some time in their practice, 24 (18.6%) used it all or most of the time, and 6 (4.7%) never used it (Fig. 1). In terms of skills adequacy, 72 (55.8%) reported a gap in their PK skills, whereas 33 (25.6%) considered their skills to be completely adequate, with none rating their skills as completely inadequate (Fig. 2). When rating the difficulty of applying PK knowledge on a 1–10 scale, most clinical pharmacists 31 (24%) chose 5, and the overall median rating was 5 (IQR: 2–6%). Associations between clinical pharmacists’ demographic, professional, and practice characteristics and their reported PK utilization, perceived skill adequacy, and difficulty in applying PK were examined using the Mann–Whitney U test (for two-group factors) and the Kruskal–Wallis test (for factors with more than two groups). No statistically significant associations were observed (all p > 0.05). 

Fig. 1.

Clinical pharmacists’ utilization of pharmacokinetic knowledge in current practice

Fig. 2.

Adequacy of clinical pharmacists’ pharmacokinetic skills for providing optimal patient care

Discussion

This study assessed clinical pharmacists’ perspectives on PK education, its clinical utilization, and barriers to effective implementation in Sudanese hospitals. The findings demonstrate a substantial gap between PK education and its practical implementation. Clinical Pharmacists reported low perceived importance and relevance of PK courses, limited routine utilization, and substantial gaps in skill adequacy. In contrast, barriers to PK implementation were strongly recognized, particularly insufficient practical training, lack of role models, poor PK understanding among pharmacists, and limited continuing education. Notably, the nature of PK course delivery was the only factor significantly associated with perspectives on PK education, highlighting the need for better-integrated, practice-oriented PK training.

Nature and delivery of PK courses

In this study, 38.8% of the participants received PKs as standalone courses. In comparison, a study conducted among hospital pharmacists in Palestine reported that 45.5% had standalone PK courses, suggesting better curricular attention [12]. Similarly, a study conducted in Libya evaluating undergraduate education reported that 37.0% of participants reported that PK was taught as a separate course [11]. In contrast, a previous study in Qatar and two studies from the USA reported that the majority of participants had received or delivered standalone PK courses [5, 7, 13]. These differences highlight the regional disparities in PK education and stress the necessity of enhancing and standardizing PK training worldwide. Improved PK education, particularly in clinical pharmacy programs, is crucial for assisting pharmacists in making knowledgeable, evidence-based clinical decisions and effectively contributing to patient care.

Perspectives on PK education

In this study, the overall perspective score of participants regarding the importance, adequacy, relevance and depth of PK courses was 53%, highlighting a significant educational gap. Notably, the nature of the PK courses was the only factor significantly associated with clinical pharmacists’ perspectives (p = 0.043). Further examination of this association showed that clinical pharmacists who had taken basic PK courses only reported more favorable perspectives than those who had taken clinical PK courses only, while those exposed to both basic and clinical PK courses demonstrated the lowest perspective scores. This unexpected gradient may reflect suboptimal integration between basic and clinical PK content, potential repetition without reinforcement, or increased cognitive burden when theoretical and clinical components are not well aligned. These findings suggest that merely offering both basic and clinical PK courses is insufficient unless they are coherently structured to reinforce clinical relevance and practical implementation, emphasizing the need for well-structured, standalone PK courses tailored to clinical practice. Similar concerns have been reported elsewhere, such as in Palestine, where hospital pharmacists expressed a lack of confidence in their PK skills due to insufficient hands-on training, whereas clinical PK courses were associated with higher ratings of adequacy and preparedness [12]. This study, together with findings from the study conducted in Palestine, highlights the need for CPD programs and enhancements in educational and training approaches. The low perceived importance and relevance of PK education likely reflect limited clinical integration and broader educational gaps rather than insufficient theoretical exposure alone. The significant association with the nature of PK course delivery, together with reported deficiencies in practical training, mentorship, and continuing education, suggests that PK is not adequately reinforced in clinical practice, which may reduce its perceived relevance among practicing pharmacists. These findings reinforce a global call for the horizontal and vertical integration of PK into pharmacy education.

In particular, the percentage of clinical pharmacists’ perspectives on the relevance of PK courses in this study was 27.1%, which was significantly lower than the 57.9% reported by Palestinian hospital pharmacists [12]. Dissatisfaction with teaching methods was evident in both studies but more pronounced in Sudan, where only 15.6% found the methods effective, whereas 44.8% of the Palestinian hospital pharmacists did [12]. In both contexts, the pharmacists expressed a clear need for better structured, clinically integrated, and practice-oriented PK training. These findings highlight the urgent need to improve both the content and delivery of PK education in Sudan’s clinical pharmacy programs, emphasizing interactive, clinically relevant, and application-focused teaching methods to enhance learning.

Alarmingly, only 10.1% of the clinical pharmacists in this study viewed PK courses as important to their current practice, whereas 64.8% of the hospital pharmacists in Palestine did [12]. Moreover, a study conducted in Qatar reported that 70–80% of hospital pharmacists agreed that their undergraduate PK courses were important and relevant to their current practice [5]. These findings are worrisome given that PK underpins drug dosing, TDM, and individualized patient care core responsibilities of clinical pharmacists [14, 15]. Such disparities may reflect differences in curriculum design, clinical exposure, or the practical application of PK concepts in everyday practice. These findings, reflecting clinical pharmacists’ perspectives and practice experiences, highlight the need to strengthen the clinical orientation and practical alignment of PK education to better support pharmacists’ confidence and competence in applying PK knowledge in real-world settings.

Barriers to PK implementation in clinical practice

The successful application of PK knowledge has been hindered by several key factors; a lack of practical knowledge is one of the most commonly identified barriers, with 85.3% of the participants in our study and 71.0% in the Palestinian study recognizing it as a critical concern [12]. Notably, a significantly greater proportion of Sudanese clinical pharmacists (76.7%) reported a lack of role models, compared to only 20.0% of their Palestinian hospital pharmacists [12]. Additionally, 86.8% of the participants in this study identified poor understanding of PK by a clinical pharmacist as a major barrier. Furthermore, the lack of continuing education relevant to PK was a key barrier to PK application in both studies, cited by 86.8% of Sudanese and 75.9% of Palestinian hospital pharmacists [12]. These findings may reflect differences between the pharmacy sectors of the two countries in terms of leadership development and clinical integration, and they align with the existing literature, which emphasizes the critical role of mentoring, practical experience, and continuing education in bridging the gap between theory and practice, particularly in essential courses such as clinical PK [16, 17].

Utilization, skill adequacy, and difficulty of PK in practice

The actual use of PK principles in clinical practice was alarmingly low, with only 18.6% of Sudanese clinical pharmacists in this study reporting frequent application, closely mirroring the 17.2% reported among hospital pharmacists in Palestine [12]. These figures underscore the disconnect between education and practical utility. Additionally, while only 25.6% of the participants considered their PK skills to be completely adequate, more than half acknowledged gaps in their PK skills. In comparison, 36.6% of the respondents in the Palestinian study believed their skills were sufficient [12], which is consistent with findings from earlier research conducted among hospital pharmacists in Qatar [5]. These findings raises some important concerns, highlighting a critical need for improved PK training. In line with suggestions from international studies, this finding confirms the critical need for organized CPD programs for clinical pharmacists to increase their professional growth and provide patients with the highest level of care [18, 19].

Notably, 24% of the participants in this study reported difficulty scores of 5 or higher on a 10-point scale. In contrast, 74.5% of Palestinian pharmacists reported scores of 5 or more on a similar scale [12]. This comparison indicates that although both groups face challenges, perceived difficulty is significantly greater among Palestinian pharmacists, suggesting that clinical settings may hinder effective PK implementation, even among those with some level of competence. This challenge may stem from institutional limitations such as interdisciplinary resistance, reluctance to adopt change, lack of clinical decision-making tools, and insufficient supportive infrastructure factors commonly observed in low- and middle-income countries [6]. The situation is further complicated by the high percentage of government-employed pharmacists (89.9%), as advanced clinical services such as TDM and PK-driven dosing are often limited by resource constraints in public institutions. This notable disparity may reflect a lower perceived challenge among Sudanese pharmacists, potentially due to differences in clinical expectations, educational standards, or limited experience with PK-related responsibilities. However, it could also indicate a lack of understanding of the complexities involved in applying clinical PK, suggesting a possible undervaluation of its importance. These findings highlight the need for improved, hands-on PK training and more effective assessment methods to accurately evaluate clinical pharmacists’ confidence and competence in clinical settings.

Improving PK education and clinical practice

Academic institutions and healthcare policymakers must take prompt action in response to these findings. The low perceived effectiveness and relevance of PK courses signal a clear call for pedagogy reform. PK education should be restructured to emphasize case-based learning, TDM, and integration with clinical rotations. Furthermore, establishing partnerships with teaching hospitals to embed clinical pharmacists within multidisciplinary teams can enhance experiential learning and mentorship, both of which are essential for professional development [20, 21]. It is also essential to establish national or institutional continuing education programs in clinical PK, which are specifically tailored for practicing clinical pharmacists in high-demand departments such as internal medicine, pediatric, ICU, and cardiology areas where the majority of respondents are currently employed.

Strengths and limitations

This study offers a comprehensive evaluation of PK education and its application in the daily practice of Sudanese clinical pharmacists. Its findings are strengthened by the use of a previously validated questionnaire. To enhance national representativeness and the generalizability of the results, clinical pharmacists from various cities across Sudan were included. By exploring multiple relevant domains, such as perceptions, utilization, implementation barriers, and skills adequacy, the study provides a well-rounded understanding of the issue. However, this study is not without limitations. The use of a convenience sampling technique introduces potential selection bias, which may affect the overall representativeness of the findings. However, participants were recruited from multiple major cities, hospital types, clinical departments, and experience levels, which supports a reasonable degree of diversity within the sample. Additionally, the predominance of female participants (91.5%) may affect the generalizability of the findings; however, comparable female predominance has been reported in studies using stratified, systematic random sampling (85.9%) and convenience sampling (75.9%), respectively, suggesting that this pattern reflects the demographic profile of the pharmacy profession rather than sampling bias [22, 23]. Thus, while the sample composition reflects the actual workforce structure, some degree of gender-related bias cannot be entirely excluded. The reliance on self-reported data presents another limitation, as it may lead to overestimation of abilities and is subject to recall bias. The cross-sectional design inherently restricts the ability to draw causal inferences or assess changes over time. Finally, multiple subgroup analyses were conducted without formal adjustment for multiple comparisons; therefore, the findings should be interpreted cautiously, as the possibility of type I error cannot be excluded.

Conclusion

This study reveals a critical gap between PK education and its clinical application among Sudanese clinical pharmacists. Despite their theoretical exposure to PK, most clinical pharmacists have shown limited clinical application due to poor understanding, inadequate training, a lack of continuing education, limited course relevance, and insufficient mentorship. The nature of PK courses was the only factor significantly associated with perspectives on PK education. From the perspective of clinical pharmacists, these findings indicate an urgent need to strengthen the clinical integration of PK education and expand targeted professional development initiatives to better support the effective application of PK knowledge in routine clinical practice.

Authors’ contributions

YBH: contributed to the work by participating in conceptualization, data curation, formal analysis, investigation, methodology, supervision, validation, visualization, writing original draft, and writing review and editing. SB: contributed to the work by participating in writing original draft. HASE: contributed to the work by participating in data curation, and writing original draft. MME: contributed to the work by participating in data curation, and writing original draft. KOA: contributed to the work by participating in supervision, and writing review and editing. All authors reviewed the manuscript.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Data availability

The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.

Declarations

Ethics approval and consent to participate

This study was performed in accordance with the principles of the Helsinki Declaration. Ethical approval was acquired from the Ethical Committee of the University of Gezira, Sudan (No: 57/2025). Written informed consent was acquired from every participating clinical pharmacist.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.