Feasibility of peer-assisted interprofessional learning between pharmacy and exercise physiology students in providing integrated care

Abstract

Background

Physical inactivity is a major contributor to chronic disease burden, and promoting physical activity has become a national priority in China’s primary healthcare system. Community pharmacists, who are highly accessible and increasingly involved in chronic disease management, are well positioned to support exercise-related care; however, formal training in exercise prescription remains limited within pharmacy education. Given the multidisciplinary nature of exercise prescription, this pilot study adopted an interprofessional education (IPE)–peer-assisted learning (PAL) framework to engage pharmacy and exercise physiology undergraduates in collaboratively developing integrated care plans combining medication management and exercise. The study aimed to evaluate the feasibility and educational value of this interprofessional training approach.

Methods

We implemented multi-modal interprofessional PAL activities involving self-directed readings, lectures, peer-assisted interaction and simulations. This project emphasized collaboration between pharmacy and exercise physiology students in designing care plans integrating medications and exercise. We employed SPICE-R2 instruments and open-ended reflection questions to assess the project’s effectiveness and analyzed reflection texts to inform future course design.

Results

Sixty pharmacy students and ten exercise physiology students completed all activities by June 2025. The total SPICE-R2 scores increased significantly following the interprofessional PAL activity. Domain-level analyses showed particularly notable improvements in “Roles/Responsibility” and “Outcome-based Education.” Case-based simulation was the most preferred learning method, whereas self-directed learning was the least preferred. Students recommended enhancing interprofessional communication through more frequent case-based simulations, accessible online platforms, and opportunities for collaborative research. They also revealed limited understanding of referral criteria and insufficient strategies for managing medication–exercise interactions.

Conclusion

In summary, this study indicated effectiveness of interprofessional PAL activity between pharmacy and exercise physiology undergraduates from different institutions, which improved the students’ perception in IPE and competency in exercise prescription. Future curricula should prioritize interprofessional simulation and integrated care planning, expand the number and diversity of simulation cases with brief preparatory teaching, and integrate medication–exercise interactions, special populations, and referral considerations to strengthen interprofessional teamwork.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12909-026-08745-3.

Background

According to the World Health Organization, physical inactivity is recognized as one of the leading risk factors for global mortality and contributes substantially to premature death through its association with chronic non-communicable diseases (NCDs), including cardiovascular disease, type 2 diabetes, and certain cancers [1, 2]. In response, the Exercise is Medicine (EIM) initiative was launched in 2007 by the American Medical Association (AMA) and the American College of Sports Medicine (ACSM) to promote physical activity as a standard component of healthcare. The initiative emphasizes the integration of physical activity assessment and counseling into routine care, particularly for patients with NCDs. [2]

Pharmacists play a critical role in chronic disease management and are among the most frequently encountered healthcare professionals in many health systems, particularly in community settings. [3] Beyond medication dispensing, accumulating evidence indicates that pharmacists are increasingly involved in health promotion and lifestyle management, including medication review combined with lifestyle counseling. Community pharmacy–based interventions targeting physical activity and other health behaviors have also been shown to be feasible and effective [4], [5]. Since the 2009 healthcare reform, China has substantially increased its investment in primary healthcare, leading to the rapid establishment of a nationwide network of community health service centers that now serve as the primary platform for chronic disease management [6]. Despite this expansion, the growing burden of chronic conditions has placed considerable pressure on the primary care workforce, highlighting the need to better utilize available healthcare professionals beyond traditional physician-only models [7], [8]. Community pharmacists, who are highly accessible and already embedded within primary care settings, have therefore been increasingly recognized as a potential workforce to support chronic disease management beyond pharmacotherapy [9].

Under China’s national 14th Five-Year Plan and the National Fitness Plan (2021–2025), physical activity has been positioned as a central component of national strategies for chronic disease prevention and control, with most interventions expected to be implemented within community healthcare settings [10]. Importantly, in China, pharmacists have already been involved in non-pharmacologic services, including diabetes self-management education and pharmacist-supported community management of hypertension and other chronic conditions, demonstrating both feasibility and early effectiveness in real-world practice [11], [12]. Together, these structural, policy, and practice-based factors underscore the relevance of educational initiatives that prepare pharmacy students to recognize medication–exercise considerations, reinforce general physical activity guidance during medication counseling, and appropriately refer or consult with exercise professionals within interprofessional primary care teams.

To enhance healthcare providers’ readiness to integrate physical activity into prevention and treatment, a range of training, curricular, and interprofessional programs have been implemented internationally[13–17]. These programs have demonstrated improvements in confidence, knowledge, and exercise counseling behaviors, primarily among physicians, highlighting the effectiveness of structured training and underscoring the need to extend such educational models to pharmacists. However, comparable training opportunities for pharmacists remain limited, despite their frequent patient contact and expanding role in lifestyle counseling. Early efforts, such as the development of elective courses in exercise prescription in U.S. pharmacy programs, demonstrated improvements in students’ knowledge and confidence [18]. Meanwhile, reviews of pharmacy curricula have consistently shown that exercise-related education is sparse, and that pharmacy students often overestimate their preparedness to counsel patients on physical activity despite limited objective knowledge [19], [20] Although recent initiatives, including asynchronous elective courses, have begun to address this gap, structured and scalable training models remain scarce [21]. 

Given the multidisciplinary nature of exercise prescription and chronic disease management, integrating exercise-related training within a multidisciplinary team (MDT) context is increasingly necessary. Interprofessional education (IPE) and peer-assisted learning (PAL) jointly form the conceptual framework of this feasibility study. IPE is defined by the World Health Organization as learning that occurs when students from two or more professions learn about, from, and with each other to enable effective collaboration and improve health outcomes [22]. PAL refers to a structured approach in which learners at comparable educational levels support each other’s learning through reciprocal interaction and shared responsibility [23]. When embedded within IPE, PAL operationalizes interprofessional learning by creating peer-based interactions through which professional roles, expertise, and authority are actively negotiated rather than passively received [24], [25]. This IPE–PAL framework provides an analytical lens to examine social learning processes, including reciprocity, professional identity formation, and power dynamics between pharmacy and exercise physiology students, thereby enabling a theory-informed exploration of how and why interprofessional peer learning occurs beyond a descriptive account of feasibility. [24, 26]. Previous interprofessional peer-assisted learning (PAL) activities involving pharmacy and physical therapy students have primarily focused on profession-anchored, problem-specific activities, such as teaching assistive device use, medication-related techniques, or fall risk reduction, while also fostering willingness to engage in multiprofessional teamwork [27–30]. In contrast, the present pilot study employed a non-parallel, integrative IPE–PAL design, in which pharmacy and exercise physiology students collaboratively discussed and operationalized integrated care plans, with explicit attention to how medication- and exercise-related recommendations are coordinated and communicated to patients. To date, few IPE initiatives have explicitly examined this co-constructive approach to interprofessional learning.

This pilot study was therefore designed to evaluate the feasibility of an interprofessional PAL activity engaging pharmacy and exercise physiology undergraduates in the co-development of integrated care plans incorporating medications and exercise. In addition to reporting educational outcomes, this pilot feasibility study has identified practical strengths, challenges, and areas for improvement to inform the design, refinement, and future development of interprofessional curricula.

Methods

Peer-assisted learning activity context

In China, pharmacists are trained through undergraduate clinical pharmacy programs. At China Pharmaceutical University, this interprofessional PAL activity was embedded in the required Ambulatory Care Practice course and involved all 60 fourth-year pharmacy students enrolled in the course. As China does not have a distinct physical therapy profession, exercise physiology represents the closest comparable discipline for exercise-based interventions. Because our university does not offer an exercise physiology program, we collaborated with Nanjing Sport Institute to involve exercise physiology students. Ten academically prepared fourth-year exercise physiology students with prior experience in exercise prescription were recommended by program coordinators and invited to participate. Diabetes cases were selected because they offer a shared clinical context in which both medication and exercise are central to care, facilitating reciprocal peer learning [31].

This study was conducted as a pilot investigation using a pragmatic convenience sampling approach. Participation in this study was voluntary, and informed consent was obtained from all participants prior to data collection. Students were explicitly informed that their decision to participate or not would have no impact on their course grades, academic standing, or evaluation outcomes.

For clinical pharmacy students, the interprofessional PAL activity was embedded within the required Ambulatory Care Practice course as part of its IPE module. Participation contributed 40% of their course grade, based on attendance and completion of assigned tasks. In contrast, participation for the exercise physiology students was voluntary, as their program does not include an IPE-related course, and therefore no course credit or scores were assigned.

Study design

This pilot study aimed to examine the feasibility of engaging undergraduate pharmacy and exercise physiology students in the joint delivery of integrated care plans, to assess changes in students’ readiness for interprofessional learning, and to use reflective analyses to inform the design and refinement of future interprofessional curricula. Quantitative data (SPICE-R2) were used to assess changes in interprofessional readiness, while qualitative data from reflective papers were used to contextualize these changes and to elicit student feedback relevant to course improvement.

The educators provide a structure of interprofessional PAL learning activities (Fig. 1). It consists of four steps, which are described in Fig. 1. Overall, it comprised 17 h, including 5 h of online preparatory learning and three face-to-face half-day sessions (4 h each). The first two face-to-face sessions were held on the same day (16 June 2025), with content instruction in the morning and interprofessional group discussion in the afternoon. Students then had one week to develop the integrated care plan and prepare presentations. The final face-to-face session took place one week later (23 June 2025) and included student presentations, the simulation activity, and structured feedback. It is important to note that all patient cases addressed diabetes and were comparable in terms of core patient characteristics. However, individual clinical parameters varied, as the cases were based on real patient scenarios to reflect authentic clinical variation. For clarity, additional details regarding the simulation component are provided below. Each team jointly met with a standardized patient to present an integrated care plan incorporating medication and exercise. The pharmacy students provided medication-related education, while the exercise physiology student assessed physical activity capacity and delivered exercise guidance. Importantly, all students jointly discussed with the standardized patient how medications and exercise may interact, including considerations for exercising while taking specific medications (e.g., timing of physical activity relative to medication administration, potential effects on glycemic control and safety precautions). They collaboratively addressed patient questions, reinforced consistent messages across disciplines, and provided integrated follow-up recommendations that aligned pharmacotherapy with individualized exercise advice. Each simulation session lasted approximately 30 min. The standardized patient provided structured feedback focused on students’ communication skills, including clarity, empathy, and responsiveness to patient concerns related to both medication use and physical activity.

Fig. 1.

Our interprofessional PAL multi-modal learning activities were divided into four steps. First, the educators created a self-directed online learning module, which included reading materials, such as IPEC core competencies for interprofessional collaborative practice (version 3), The Exercise Prescription Doctor’s Handbook, and The Standards of Care in Diabetes from ADA. The second step is the didactic lectures from experts in pharmacotherapy and exercise prescription, as well as interprofessional case examples presented by clinicians. The third step involved peer-assisted interaction groups consisting of six pharmacy students and one exercise physiology student. Each session began with an ice-breaking activity, followed by peer teaching on diabetic topics. Pharmacy students instructed exercise physiology students on medication management for general diabetic patients, while the exercise physiology students guided pharmacy students in designing individualized exercise prescriptions. The instructors from two professions served as consultants, providing support and recommendations as needed. Each team developed a peer-assisted integrated medication and exercise care plan for their assigned patient case during or following the class sessions. The last step included the simulations with standardized patients in teams (feedback from standardized patients) and presentation of integrated care plan from the whole class (feedback from instructors)

The SPICE-R2 (Student Perceptions of Interprofessional Clinical Education–Revised Version 2) questionnaire (Table 1), a validated measure of interprofessional education outcomes, was used to the whole cohort [32]. It employed a five-point Likert scale (1 = strongly disagree to 5 = strongly agree). A Chinese version was adapted using forward–backward translation and pilot tested for clarity. The questionnaire was administered at two time points: before interprofessional interaction (just before didactic lectures) and within 48 h after completion of the last session, step 4. An additional multiple-choice item was included in the post-SPICE-R2 survey to identify the learning activity perceived as most helpful. (Table 1)

Table 1.

SPICE-R2 questionnaire and the post-PAL multiple question

Instructions: Please be candid as you indicate disagreement/agreement with each statement.			Strongly Disagree		Disagree	Neutral		Agree		Strongly Agree
Q1 [T]	Working with students from different disciplines enhances my education		1		2	3		4		5
Q2 [R]	My role within an interprofessional team is clearly defined		1		2	3		4		5
Q3 [O]	Patient/client satisfaction is improved when care is delivered by an interprofessional team		1		2	3		4		5
Q4 [T]	Participating in educational experiences with students from different disciplines enhances my ability to work on an interprofessional team		1		2	3		4		5
Q5 [R]	I have an understanding of the courses taken by, and training requirements of, other health professionals		1		2	3		4		5
Q6 [O]	Healthcare costs are reduced when patients/clients are treated by an interprofessional team		1		2	3		4		5
Q7 [T]	Health professional students from different disciplines should be educated to establish collaborative relationships with one another		1		2	3		4		5
Q8 [R]	I understand the roles of other health professionals within an interprofessional team		1		2	3		4		5
Q9 [O]	Patient/client-centeredness increases when care is delivered by an interprofessional team		1		2	3		4		5
Q10 [T]	During their education, health professional students should be involved in teamwork with students from different disciplines in order to understand their respective roles		1		2	3		4		5
Post-PAL multiple choice:
Please select what type of the learning activity was most helpful for you		A Self-Directed Reading		B Lectures			C Peer-assisted Interaction		D Peer-assisted Simulation

T = Interprofessional Teamwork and Team-based Practice; R = Roles/responsibilities for Collaborative Practice; O = Patient Outcomes from Collaborative Practice

A reflection paper with five open-ended questions was administered alongside the post-class SPICE-R2 questionnaire. Each question required a minimum of three substantive sentences. The reflection questions are listed in Table 2. The reflection was formative and ungraded, with individualized feedback provided.

Table 2.

Five open-ended questions of the reflection paper

Reflection paper with open-ended questions
1.	Please give an example on what kind of professional knowledge you integrated into the development of the care plan. Are you clear about the responsibilities and tasks that different professional students need to undertake, respectively?
2.	Did you feel recognized or respected by other professional students during team collaboration? Please provide an example. In turn, did you acknowledge and appreciate students from the other profession?
3.	Could you give an example of something you learned from students of other professions that helped enhance your professional skills? In your opinion, what aspects could be improved to achieve better integration of knowledge and skills between the different professions?
4.	What was the atmosphere like when working with students from the other profession? What measures do you think could improve your communication skills with students from the other profession?
5.	As a pharmacy student/physiology student, after reflecting on this interprofessional peer-assisted learning activity, what extra questions would you like to ask?

Data collection and analysis

All materials were distributed and collected through the university’s e-class learning management system. Descriptive data related to participants’ demographic characteristics and SPICE-R2 responses were recorded using Microsoft Excel, and statistical analyses were subsequently performed using STATA version 16.0 (StataCorp LLC, College Station, TX, USA). Continuous variables were presented as means ± standard deviations (SD), and categorical variables as frequencies and percentages. To compare the pre- and post-intervention SPICE R2 scores, statistical tests were selected based on assessing data distribution, as determined by the skewness/kurtosis test with a significance level of 0.05. For normally distributed data, a paired t-test would be employed; otherwise, a Wilcoxon signed-rank test would be utilized.

Student identification numbers were collected only for the purpose of verifying that no duplicate survey responses were analyzed. Importantly, the instructor (Dr. Jiang) responsible for data collection and analysis was not involved in teaching the course or administering the survey and had no access to information linking identification numbers to individual students. Survey administration and data handling were conducted in a manner that ensured separation between teaching responsibilities and research activities. The final dataset used for analysis consisted exclusively of anonymized and aggregated data. These procedures were implemented to minimize potential power-related bias and social desirability bias, and to encourage honest and candid responses from students.

The open-ended reflective texts were analyzed using a manual qualitative approach complemented by application of the large language model ChatGPT-4.5 (OpenAI, San Francisco, CA, USA). Given the exploratory and pilot nature of the study, ChatGPT was used to support efficient summarization of frequently mentioned keywords, phrases, and explicit student perspectives across a large volume of free-text responses, rather than to replace human qualitative judgment. Two reviewers independently analyzed and synthesized responses to the open-ended questions and summarized prominent content relevant to each question. In parallel, the same reflective texts were independently analyzed using ChatGPT-4.5 to generate comparable summaries. Outputs from the human reviewers and the language model were then manually compared, synthesized, and integrated through discussion to formulate the final summarized results, with all interpretations determined by the research team.

Results

Baseline characteristics of participants

A total of 60 pharmacy students and 10 exercise physiology students completed all the activities by June 2025. Of the 60 pharmacy students who consented, 52 (87%) completed both the pre- and post-intervention SPICE-R2 questionnaires; all 10 exercise physiology students (100%) completed both. Participant characteristics are presented in Table 3. The majority were female, comprising around 60% of both groups. All students had prior professional internship or rotation experience, but none had experience in the IPE learning activities.

Table 3.

Participant characteristics of pharmacy students and exercise physiology students

	Pharmacy Students participated the questionnaires (60 students)	Pharmacy students completed all the questionnaires (52 students)	Exercise physiology Students (10 students)
Age(years), Mean SD	22(0)	22(0)	22(0)
Gender(female), n (%)	40(60%)	32(62%)	6(60%)
Years at University	4	4	4
Past Experience in the Professional Setting	60(100%)	52(100%)	10(100%)
Past Experience in the IPE Learning Activities	0(0%)	0(0%)	0(0%)

Quantitative analysis - SPICE-R2 scores

The pre- and post-intervention SPICE-R2 scores of all participants were displayed in Table 4. Overall, the whole cohort demonstrated improvements in their perceptions of interprofessional clinical education, as reflected in total scores (mean [SD] = 38.7[0.7] vs. 41.3[0.6], p < 0.001). Similar improvements were also observed within each subgroup, including pharmacy students (mean [SD] = 39.1[0.8] vs. 41.2[0.7], p = 0.003) and exercise physiology students (mean [SD] = 37.1[0.4] vs. 41.5[0.8], p < 0.001). Statistical comparisons revealed significant increases in the total scores in the “Roles/Responsibility” (mean [SD] = 10.7 [0.3] vs. 11.9[0.2], p < 0.001) and “Outcome-based education” (mean [SD] = 11.2 [0.2] vs. 12.3[0.2], p < 0.001) domains. Consistent improvements were also detected within each subgroup, including pharmacy students (Roles/Responsibility: mean [SD] = 10.9 [0.3] vs. 11.8[0.3], p = 0.001; Outcome-based education: mean [SD] = 11.4 [0.3] vs. 12.3[0.2], p = 0.02) and exercise physiology students (Roles/Responsibility: mean [SD] = 9.8 [0.4] vs. 12.3[0.4], p = 0.002; Outcome-based education: mean [SD] = 10.4 [0.3] vs. 11.8[0.4], p = 0.004). A significant increase in the total score of the “Teamwork and Team-based Practice” domain was also observed among exercise physiology students (mean [SD] = 16.7[0.4] vs. 17.4 [0.5], p = 0.02), whereas no meaningful change was detected in the overall cohort or among pharmacy students.

Table 4.

Pre- and Post-PAL SPICE R2 scores from students

Domain	Item	Pharmacy Students (N = 52)			Exercise Physiology Students (N = 10)			Total Students (N = 62)
		Pre-PAL Score Mean (SD)	Post-PAL Score Mean (SD)	p-value	Pre-PAL Score Mean (SD)	Post-PAL Score Mean (SD)	p-value	Pre-PAL Score Mean (SD)	Post-PAL Score Mean (SD)	p-value
Total		39.1(0.8)	41.2(0.7)	0.003**	37.1(0.4)	41.5(0.8)	< 0.001*	38.7(0.7)	41.3(0.6)	< 0.001**
T	Total	16.8(0.4)	17.1(0.3)	0.58**	16.7(0.4)	17.4(0.5)	0.02*	16.8(0.3)	17.1(0.3)	0.22**
	Q1	4.2(0.1)	4.2(0.1)	0.69**	4.4(0.2)	4.5(0.2)	1.000**	4.2(0.1)	4.3(0.1)	0.86**
	Q4	4.2(0.1)	4.3(0.1)	0.56**	4(0.2)	4.1(0.2)	0.343*	4.1(0.1)	4.3(0.1)	0.44**
	Q7	4.2(0.1)	4.3(0.1)	0.74**	4.3(0.2)	4.4(0.2)	0.343*	4.23(0.1)	4.3(0.1)	0.58**
	Q10	4.2(0.1)	4.3(0.1)	0.58**	4(0.1)	4.4(0.2)	0.123**	4.2(0.1)	4.3(0.1)	0.18**
R	Total	10.9(0.3)	11.8(0.3)	0.001**	9.8(0.4)	12.3(0.4)	0.002**	10.7(0.3)	11.9(0.2)	< 0.001**
	Q2	3.8(0.1)	4.1(0.1)	0.008**	3.5(0.2)	4.3(0.2)	0.008**	3.7(0.1)	4.1(0.1)	< 0.001**
	Q5	3.5(0.1)	3.7(0.1)	0.039**	3(0.1)	3.9(0.2)	0.004**	3.4(0.1)	3.8(0.1)	0.004*
	Q8	3.6(0.1)	4.1(0.1)	0.001**	3.3(0.2)	4.1(0.2)	< 0.001*	3.6(0.1)	4(0.1)	0.000**
O	Total	11.4(0.3)	12.3(0.2)	0.002**	10.4(0.3)	11.8(0.4)	0.004*	11.2(0.2)	12.3(0.2)	< 0.001**
	Q3	4.1(0.1)	4.3(0.1)	0.12**	3.7(0.2)	4(0.1)	0.25**	4(0.1)	4.3(0.1)	0.04**
	Q6	3.2(0.2)	3.8(0.1)	0.003*	2.9(0.2)	3.6(0.3)	0.01*	3.2(0.1)	3.7(0.1)	< 0.001*
	Q9	4.1(0.1)	4.3(0.1)	0.25*	3.8(0.2)	4.2(0.2)	0.04*	4(0.1)	4.3(0.1)	0.08**

T represents interprofessional Teamwork and Team-based Practice, R represents Roles/responsibilities for Collaborative Practice, and O represents Patient Outcomes from Collaborative Practice.

The symbol “*” represents paired-test was employed; "**" represents Wilcoxon signed rank test was employed; bold p-values represent statistically significant results (p < 0.05)

For the multiple-choice question on the most helpful learning activity, 27 students (44%) chose peer-assisted simulation, 16 students (26%) chose lectures, 12 students (19%) chose peer-assisted interaction, and 7 students (11%) chose self-directed reading.

Qualitative Analysis - Reflection texts

All 60 consenting pharmacy students completed the reflection paper. Educators at Nanjing Sport Institute summarized feedback from participating exercise physiology students. Table 5 shows the synthesized responses.

Table 5.

Summarized and synthesized answers to each question of the reflection paper

No.	Summarized and Synthesized Answers
1	-Professional knowledge integrated to the care plan: gave evidence-based medication recommendations; wrote SOAP note including evaluation of indication, effectiveness, safety, and adherence of medications and counseled patients on these aspects -Responsibilities to each profession: Pharmacy: provided pharmaceutical care, patient education, and design of follow-up; monitored adverse events related to medications; Exercise physiology: assess patients’ physical activity and mobility condition; prescribed exercise prescription and provided related professional guidance; monitored adverse events related exercise
2	-Feel recognized: suggestions and Recommendations were appropriately adopted; team roles were clearly defined, with mutual respect for each member’s responsibilities; within the team, active communication was encouraged -Appreciation: became aware of their own knowledge gaps in non-pharmacological treatments such as exercise; clearly recognized the importance of diverse professional knowledge and perspectives in providing integrated patient care; desired to apply these interprofessional insights in their future practice
3	-Learning from physical therapy students: assessed a patient’s physical fitness and health status through simple physical evaluations (such as InBody analysis, 1RM testing, and functional fitness tests) in order to develop a personalized exercise plan, including exercise type, intensity, frequency, and duration; gained a deeper understanding of the specific benefits and mechanisms of exercise in the management of chronic diseases; enhanced knowledge on exercise management, including dietary advice based on exercise demands, sugar supplementation during exercise and stretching techniques. -Aspects for improvement: to conduct IPE trainings and case-based simulations between different professions on a regular basis; to develop an online platform or forum that to carry out interdisciplinary collaborative research projects for students from these two professions to explore innovative approaches that integrate medication with exercise.
4	-Feelings for discussion atmosphere: most students felt it harmonious, friendly, and constructive; a few students felt it awkward initially, but become more comfortable as the discussions continued; very few students felt it polite but somewhat formal and reserved -Measures to improve communication: to provide more organized and specific tasks; to offer joint curricula or modules designed to foster cross-disciplinary engagement by allowing students to select electives from other professional fields
5	How to deal with the interaction between medications and exercise? How to prevent and manage risks during exercise, as well as address potential safety concerns arising from interactions between medications and physical activity? What alternative options are available when patients are unable or unwilling to engage in professional exercise training or use specialized equipment? What is a perfect time for referral?

Concerning “Teamwork and Team-based Practice”, most pharmacy students’ texts revealed mutual recognition and appreciation in the collaboration between the two professional students. To illustrate these themes, students noted: “In our team, we trusted each other and everyone fulfilled their responsibilities. For example, when we worked on developing a pharmaceutical care plan, the students from Nanjing Sport Institute acknowledged my professional input. Likewise, we respected and valued their expertise in areas beyond our scope, and fully supported the plans they contributed.” (Participant P06, Pharmacy) Another student commented: “When I shared the SOAP note I had written in our group chat; I received recognition and positive feedback from my teammates. I truly appreciated the exercise plan developed by the exercise physiology students-it was detailed, highly personalized, and their instruction sheet provided the patient with clear guidance, which greatly enhanced the feasibility of the plan.” (Participant P10, Pharmacy).

Regarding “Roles/Responsibilities”, students’ reflections indicated that pharmacy students applied their professional training when contributing to the integrated care plan and recognized the complementary responsibilities of exercise physiology students. As one pharmacy student described: “I assessed the patient case through SOAP model, which I have learned in the pharmacotherapy class, and designed the care plan based on the most recent guideline by Chinese Medical Association.” (Participant P12, Pharmacy) Another student noted: “The exercise physiology students assessed a patient’s physical fitness and health status through simple physical evaluations (such as InBody analysis, 1RM testing, and functional fitness tests), and then made the exercise prescription involving exercise type, intensity, frequency, and duration.” (Participant P16, Pharmacy).

Regarding “Outcomes-based Education,” students’ reflections commonly emphasized patient-centeredness and perceived benefits for patient care. For example, one student wrote: “By improving interprofessional collaboration, we can ensure patients receive more comprehensive and consistent care, ultimately enhancing treatment outcomes and patient satisfaction.” (Participant P09, Pharmacy) Another student noted: “With clear roles and teamwork, we can make sure patients receive complete care, including both medication treatment and an exercise plan, helping them achieve better health and quality of life.” (Participant P05, Pharmacy) Reflections also mentioned treatment efficiency, such as: “A personalized treatment plan that integrates medication therapy and exercise means fewer repeated interventions and improved treatment efficiency.” (Participant P15, Pharmacy).

Concerning their favorite peer-assisted simulation, students frequently highlighted the simulation component as a key opportunity to apply integrated medication and exercise recommendations in a patient-facing context, allowing real-time clarification, demonstration, and interprofessional coordination. One student mentioned “When exercise physiology students demonstrated exercises using actual equipment, the patient education became much more concrete and left a stronger impression on the patient.” (Participant P 21, Pharmacy) while summarized text from exercise physiology students mentioned “For some special medication formulations, actually demonstrating them in a simulated setting was much more effective than simply explaining them verbally.” Another student mentioned “During patient education, we were able to immediately notice key points that the other profession had overlooked and supplement them in real time. For example, It was only when explaining the care plan to the patient that I realized I could not clearly explain the exercise component, and the exercise physiology student provided very helpful clarification at that point.” (Participant P 36, Pharmacy). Standardized patients reported generally strong communication skills, particularly in clarity, empathy, and responsiveness to patient concerns. They also observed that, while interprofessional collaboration was evident, opportunities remained to further improve the smoothness of transitions between professional contributions, coordination during shared explanations, and overall time management.

Comparison of ChatGPT-assisted summaries and human reviewer analyses showed substantial agreement in the identification of core themes and frequently mentioned content across all open-ended questions. ChatGPT reliably captured explicit student statements, recurring keywords, and commonly expressed perspectives that were also identified through manual review. Differences were observed primarily in the level of abstraction and interpretation. Whereas ChatGPT-generated summaries focused on descriptive and surface-level content, human reviewers further synthesized these findings by explicitly linking student statements to competency-related constructs and by refining overlapping or broadly stated ideas. As a result, the final reported themes retained the content identified by ChatGPT while incorporating additional interpretive clarification derived from human review.

Discussion

Key findings

This pilot study achieved its primary aims by demonstrating that engaging pharmacy and exercise physiology undergraduates in the joint delivery of integrated care plans was feasible in terms of improving students’ interprofessional perceptions and core competencies, thereby enhancing their readiness for interprofessional learning.

For the Roles/Responsibility and the Outcome-based Education domains, significant post-intervention improvements were observed across the cohort. Within the IPE–PAL framework, these patterns can be understood as reflecting enhanced role clarification and outcome-oriented reasoning through reciprocal peer interaction. Qualitative reflections indicated that students initially had limited understanding of how the professional responsibilities were distributed across exercise-based and medication-based care. Through reciprocal peer interactions, the students from both professions developed clearer understanding of their respective and complementary roles, with exercise physiology students defining their responsibilities in exercise assessment and planning, and pharmacy students clarifying how medication management and counseling should be integrated into exercise-based care. Further, the students described applying newly acquired interprofessional knowledge directly to patient-centered care planning, such as incorporating exercise considerations into medication counseling, adjusting dietary advice based on exercise demands, and translating exercise prescriptions into patient-friendly formats. These peer exchanges required learners to articulate their own professional contributions while integrating those of their counterparts, which signifies a core PAL mechanism that supports role negotiation and shared problem-solving. Together, the convergence of quantitative and qualitative findings suggests that interprofessional PAL promoted both role clarity and outcome-focused competencies by linking professional knowledge to coordinated, patient-relevant care planning.

For the Teamwork and Team-based Practice domain, improvement was observed only among the exercise physiology students. Within the IPE–PAL framework, this pattern may be related to the differences in professional role orientation rather than the unequal exposure to teamwork. The pharmacy students scored high on this domain at baseline as well as post activity, which can be attributable to the emphasis on their collaborative and supportive role alongside physicians in their curriculum. It is also reflected in the qualitative results where they described the mutual trust with the exercise physiology students, clear role understanding, and recognition of complementary expertise. In contrast, the exercise physiology training in Chinese universities encompasses both supportive roles in patient rehabilitation and more independent or leading roles in athletic performance contexts [33], [34]. Participating in a coordinated, team-based clinical task with pharmacy students may therefore have prompted a clearer shift toward interprofessional teamwork perceptions among the exercise physiology students.

This pilot study innovated upon the current body of interprofessional PAL approaches by engaging students in collaboratively discussing and operationalizing integrated care plans, with an emphasis on how medication- and exercise-related recommendations are delivered, coordinated, and communicated to patients. In doing so, this study advances prior PAL models by moving beyond unidirectional teaching or parallel task completion toward shared reasoning about care integration. Applying an innovative training approach, our findings are consistent with prior interprofessional PAL studies involving pharmacy and physical therapy students with varied training focuses and depth of professional interactions, which reported improvements in knowledge, confidence, and interprofessional perceptions [27–30]. Several earlier initiatives emphasized profession-led, problem-specific teaching activities. For example, pharmacy-student–led pharmacology courses and pharmacy-led inhaler instruction primarily positioned the pharmacy students as content experts, with outcomes centered on the enhanced knowledge and teaching confidence among the pharmacy students and the appreciation of pharmacist’s roles among physical therapy students. Similarly, physical-therapy–led instruction on ambulatory devices effectively improved the pharmacy students’ procedural knowledge and skills, but the interprofessional interaction was largely structured around one profession teaching another without collaboration in problem-solving. In these models, interprofessional learning was achieved through unidirectional teaching and role clarification, with limited emphasis on how contributions are coordinated during patient-facing care [27–29]. A more integrative teaching/training approach was pioneered in the pro bono fall risk reduction setting, where pharmacy and physical therapy students contributed complementary assessments and developed profession-specific recommendations for older adults [30]. Qualitative findings from that study highlighted gains across IPEC competencies, particularly mutual respect, understanding of scope of practice, and the perceived value of collaborative care. This study was limited by the fact that professional contributions largely remained parallel, with each discipline generating recommendations within its own professional before sharing findings with the other profession. This pilot differs in promoting shared decision making and patient care delivery among the pharmacy and exercise physiology students. The observed gains in roles/responsibility clarification and outcome-oriented learning suggest that this interactional focus may represent a meaningful educational progression within interprofessional PAL, particularly for preparing students to function effectively within physician-led, team-based chronic disease care in the current healthcare settings.

Taken together, these findings suggest that interprofessional PAL can serve as an effective learning module when learning activities are designed to foster interprofessional interactions and dialogues rather than siloed parallel task completion. Future IPE–PAL curricula may therefore benefit from integrated care planning tasks that encourage students to present profession-specific input, integrate different professional recommendations, and develop coordinated advice for patients within a shared learning space.

Educational strategies and insights for future IPE

Among the four steps of learning activities in this study, the peer-assisted simulation (Step 4) was rated as the most helpful learning activity. Qualitative findings indicated that simulations enabled students to identify gaps in their own explanations, reinforce the need for consistent and complementary messaging, and align their recommendations with those of another profession during patient education. The students also perceived simulations as providing a realistic and immersive learning context that facilitated active interactions and shared reasoning between professions, consistent with prior evidence on the value of interprofessional simulation-based education [35], [36]. Standardized patient actors reported generally strong communication performance among the students, while also noting challenges in transitions between professional contributions and time management. Together, these findings suggest that simulation served as a practical setting for interprofessional coordination, supporting role clarification and patient-oriented communication, consistent with improvements observed in the Roles/Responsibility and Outcome-based Education domains. In contrast, self-directed readings (Step1) were rated least favorably, likely because students initially struggled to independently engage with unfamiliar, cross-disciplinary content. Future curricula should place interprofessional simulation at the core of learning design, with brief didactic input to prepare students for simulation-based activities. More scenarios and cases allow repeated interprofessional practice and support the gradual development of role coordination and coherent delivery of medication and exercise advice to patients.

Through the patient case simulation (Step 4), a key educational insight emerging from this IPE–PAL activity was students’ growing awareness that medication–exercise interactions are often complex and cannot be assumed to be uniformly synergistic. This finding aligns with the observed gains in the Outcome-based Education domain in that students became better able to link professional knowledge to practical, patient-centered advice. Through interprofessional dialogues, pharmacy students began to recognize that concurrent medication use and prescribed exercises may, given their frequent combination in disease management, introduce unanticipated interactions and considerations that influence both pharmacotherapy and exercise planning. The pharmacy students reflected on the evidence gaps in common diabetic drug therapies and their unclear interactions with exercise. For example, GLP-1 receptor agonists combined with exercise may result in unknown changes in body composition; concurrent metformin use and exercise training could lead to attenuated metabolic responses [37], [38]. Notably, these insights were most often prompted by the interactions with exercise physiology peers and obtained from subsequent literature searches, indicating that interprofessional PAL served as a catalyst for identifying knowledge limitations that may not be apparent within single-discipline training. Such interprofessional interactions may enhance students’ readiness for interprofessional discussion while promoting early research interest in underexplored intersections between pharmacotherapy and exercise-based interventions. From an educational perspective, these findings indicate that pharmacy curricula should incorporate medication–exercise interaction content and use clinical cases to help students reflect on how interdisciplinary input may impact their original profession-specific recommendations.

Another important student insight from the patient case simulation (Step 4) was that exercise-related guidance is often too general to apply in specific clinical contexts. Qualitative accounts showed the students’ hesitancy in recommending exercise when guidance lacked sufficient detail for particular conditions or populations, as well as their uncertainty about the appropriate timing for referral to another profession when managing patients independently. These concerns are consistent with broader evidence that exercise interventions are frequently insufficiently specified in the literature, limiting their translation into practice [39]. From an educational perspective, interprofessional learning activities should explicitly address these uncertainties through case-based discussions of exercise-related pharmacotherapy considerations, including those for special populations, as well as professional boundaries and referral decisions, in order to support more advanced development of interprofessional teamwork.

Future curricula should prioritize interprofessional simulation as a core learning strategy within the IPE-PAL framework, supported by brief preparatory teaching and a broader range of clinical cases to enable repeated interprofessional practice. Greater educational gains may be expected through multiple well-designed simulation cases. Pharmacy programs should incorporate medication–exercise interaction content and use case-based learning to help students examine how interdisciplinary input reshapes profession-specific recommendations. Interprofessional activities should also address exercise-related considerations, including those for special populations, as well as professional boundaries and referral decisions, to strengthen the development of interprofessional teamwork.

Barriers, limitations, and future directions

This study has several limitations. First, the pilot was conducted only with clinical pharmacy students from a single university, which may limit its generalizability to other pharmacy programs in China and abroad, as no prior studies have reported exercise prescription education among Chinese pharmacy students. The authors are willing to share more insights should a program is interested in establishing their own IPE-PAL coursework. Second, the sample size was constrained by the cohort size at our institution (60 students per year). Participation from ten exercise physiology students from Nanjing Sport Institute created an imbalance between professions; however, institutional leadership has expressed interest in establishing a formal inter-institutional agreement to support course development and data sharing in interprofessional education. In the future, we expect an increase in the number of exercise physiology students locally. We would also recommend other educators to approach their interprofessional network armed with evidence-based designs to secure the buy-in from other professional programs. Third, the evaluation relied on subjective self-reported questionnaires and reflective texts. Nevertheless, the findings demonstrated improved appreciation of IPE, particularly regarding roles and outcomes of interdisciplinary collaboration, and were supported by student reflections. Although instructors assessed students’ performance and provided feedback after simulation, objective scoring was not feasible because of the pilot nature of the course and potential conflicts of interest. The open-ended guiding questions showed consistency with the SPICE-R2 answers. Educators should consider using them in conjunction to obtain useful feedback from the learners.

For future curricula design, interprofessional simulation should be positioned as a core learning strategy, supported by brief preparatory teaching and multiple clinical cases to allow repeated practice. Interprofessional PAL curricula should incorporate medication–exercise interaction content, and use case-based activities to guide students in examining how input from different professions modifies their own discipline-specific recommendations. Learning tasks should also explicitly address exercise considerations for special populations, professional boundaries, and referral decisions to strengthen the development of interprofessional teamwork.

Conclusions

In summary, this study indicated effectiveness of interprofessional PAL activity between pharmacy and exercise physiology undergraduates from different institutions, which improved the students’ perception in IPE and competency in exercise prescription. Future curricula should prioritize interprofessional simulation and integrated care planning, expand the number and diversity of simulation cases with brief preparatory teaching, and integrate medication–exercise interactions, special populations, and referral considerations to strengthen interprofessional teamwork.

Abbreviations

PAL

Peer-assisted learning

NCDs

Non-communicable diseases

EIM

Exercise is medicine

AMA

American medical association

ACSM

American college of sports Medicine

HCPs

Healthcare providers

MDT

Multidisciplinary team

IPE

Interprofessional education

IPEC

Interprofessional education collaborative

Authors’ contributions

WZ designed the study and drafted the manuscript.QD delivered the pharmacotherapy-related teaching content and contributed to case design and care plan development.YZ delivered the exercise-related teaching content and contributed to case design and care plan development.LJ collected the data, conducted the statistical analyses, and prepared the data presentation.ZJ supervised the study design, coordinated scheduling and arrangements among all participants, and proofread the manuscript.All authors read and approved the final manuscript.

Funding

This work was supported by the Educational Reform Research Projects in China Pharmaceutical University, Nanjing, China (grant numbers 2025XJYB064).

Data availability

All data generated or analysed during this study are available from the corresponding author on reasonable request.

Declarations

Ethics approval and consent to participate

This study was reviewed and approved by the Institutional Review Board at Nanjing Hospital of Chinese Medicine, (IRB approval number: KY2025055, approval date: May 30th, 2025). If you have any questions, please contact 86-02586369034.

All participants were informed of the study purpose and procedures, and written informed consent was obtained prior to participation.

This study adhered to the Declaration of Helsinki.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.