Characterization of the learning environment for teaching pharmaceutical care: a scoping review

Abstract

Objective

Learning environments encompass aspects related to personal, social, organizational, physical, and virtual components and can affect not only academic performance but also the physical and emotional well-being of students, which in turn impacts the quality of services offered to society. Therefore, this study aimed to characterize the learning environment for pharmaceutical care teaching in the literature.

Findings

A scoping review was conducted the databases: Pubmed (Medline), Embase, Web of Science, Scopus and ERIC. The search was conducted in July 2025, without restrictions of year or language. The methodological quality of studies was verified using the Mixed Methods Appraisal Tool (MMAT). 11 studies met the eligibility criteria and were included in this scoping review. They were published between 2010 and 2025, in the United States (n = 4), Malaysia (n = 2; 18.18%), Netherlands, Australia, United Kingdom, Kuwait, and Canada (n = 1; 9.09%). The target population was Pharmacy students. Physical and virtual environments were described, highlighting innovative approaches centered on the student, as follows: experience-based learning (EBL), problem-based learning (PBL), simulation, team-based learning, blended learning and online learning (e-learning). Personal, social, and organizational components were also identified.

Summary

Innovative strategies have proven effective in the learning process of pharmaceutical care. However, it is important that these findings be reproducible in settings both inside and outside the university. Future research should deepen the understanding of learning environments for teaching Pharmaceutical Care to strengthen scientific production and guide the training of future pharmacists better prepared for patient-centered practices.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12909-026-08876-7.

Introduction

In the past 60 years, due to the increased use of medications and related morbidity and mortality, medications have been among the leading causes of preventable adverse events, hospitalizations, and deaths, with social effects and a strong economic impact [1, 2]. In response to these demands, Hepler and Strand (1990) defined Pharmaceutical Care as “the responsible provision of pharmacotherapy with the goal of achieving measurable outcomes that improve the patient’s quality of life.” [3].

Thus, institutions, professors, and pharmacists have understood the importance of transforming secular pharmaceutical education. Pharmaceutical Care has served as a benchmark for the advancement of pharmaceutical curricula, shifting from a product-oriented approach to a person-centered approach [3–7].

In the training process for the development of clinical skills, Higher Education Institutions seek to adjust their teaching and learning strategies, as well as analyze the objective and subjective aspects of the environments necessary for patient care practices [4, 8, 9]. The quality of learning environments can affect not only academic performance but also the physical and emotional well-being of students, which reverberates in the quality of services offered to society [9–12].

Some studies suggest that inserting students into practice scenarios from the beginning of graduation can make them active and participatory subjects in the teaching and learning process [13–15]. Such insertion amplifies the subjective experiences of the labor market, may strengthen the socioemotional aspects of students, and consolidate their competences to act as a pharmacist [16]. Nevertheless, there is a lack of studies that discuss the learning environment for teaching [17–19].

Before that, literature may identify the points of improvement of formative processes to deepen and support the transformation process of pharmaceutical education. Therefore, it is needed to consider that learning environments can be a facilitator to teaching patient care, in a systematized and reproducible way, as it promotes real or almost real interactions adapted to culture and physical and virtual scenarios of practice [20, 21]. Thus, the present study aimed to characterize in literature the learning environment for teaching Pharmaceutical Care.

Methods

This scooping review was conducted based on the methodological processes proposed by the Joanna Briggs Institute Reviewer’s Manual and using the Rayyan QRCI (www.rayyan.qrci.org/reviews) as a supporting tool to answer the following question: “How learning environments are structured for teaching Pharmaceutical Care?”. In addition, the secondary question were: “What are the organizational attributes of learning environments for teaching Pharmaceutical Care?”. Therefore, the databases EMBASE, ERIC, PUBMED/Medline, Scopus and Web of Science were used with the descriptors: “learning environment”; “pharmaceutical care”; “pharmacy education”; “pharmacy students”; “teaching” and their combinations and synonyms [22].

Study selection

After the search in July 2025, two researchers conducted the process of selection (M.A.L.R. e D.W.A.H.) and, when necessary, a third researcher facilitated the consensus (T.M.A.T.). Selection followed the stages: excluding duplicates, screening titles and abstracts, and evaluating full text. There were no restrictions on language or year of publication to evaluate full text. The following were excluded: other literature reviews, abstracts published in conference proceedings, expended abstracts, letters to editor, conference articles, studies in which the learning environment was not characterized clearly, and studies that characterized the learning environment for teaching healthcare to professions of other fields or in a multiprofessional perspective, once results were reported all together and not separately by profession.

Studies were included that focus on the learning environment for Pharmaceutical Care as a central theme, describing this environment considering aspects such as: physical structure, equipment, standardization of procedures, teaching methodology used, information system and service delivery. The concept of learning environment that was used, and its components are shown in Table 1.

Table 1.

Concept of learning environment and the components adopted by this scoping review

Concept	Definition
Learning environment	Refers to experiences and personal perceptions, social interactions, culture, and organizational practice, and the physical and virtual settings in which learning occurs [10].
Personal component	Describes how students interact with the learning environment, develop perceptions about it, engage in personal growth, and develop professional identity [21].
Social component	Characterizes the interactions and social relationships with others, adding to personal dimension. These relationships include elements such as shared values and culture of students, the relationship of students with faculty and administration, and the relationship between students and patients [21].
Organizational component	Highlights how individuals interact with policies, navigate through organizational performance measures, and answer to culture and/or specific actions of leadership. Organizations provide structure, guidance, and/or support for learning. This support can take the form of curriculum resources, geographic positioning and accreditation rules, as well as practice, culture, and organizational policies (such as workload, regulatory setting, faculty control, and curriculum) [21].
Physical component	Settings in which learning and practice happen. Physical setting includes physical buildings for teaching and learning in campuses, hospitals and clinics, and community settings [21].
Virtual component	Virtual setting includes curriculum management tools and digital assistants that provide students with content and interaction and learning forums [21].

Source: author

Data extraction

Data were extracted from studies included in this review by two independent reviewers: author, year, country, design, characteristics of participants (number, level – e.g., BPharM., MPharm., PharmD. –, semester/school year, university), characteristics of learning environment for Pharmaceutical Care (scenario, teaching method, content), as well as methods of collecting and evaluating results, influence of environment in the academic educational process, study limitations, and main conclusions.

Methodological quality evaluation

The methodological quality evaluation of included studies was conducted independently by two researchers and discrepancies were resolved by consensus. The Mixed Methods Appraisal Tool (MMAT) was used as it approaches different study designs. This tool consists of five sections, one for each type of study, with five items in each section. Each item was marked as “Yes” if the study met the item criteria; “no” if it does not meet the criteria; “I don’t know” if it missed enough information to judge [23].

Results

General characteristics

Out of the 1,511 records identified in the search, 887 were excluded for being duplicates. Therefore, 899 titles and abstracts were screened. 31 studies were selected for full-text reading and 11 were included in this review. Figure 1 shows the flowchart adopted by researchers for searching and selecting studies.

Fig. 1.

Flowchart used to search and select studies

All studies that met the eligibility criteria were published between 2010 and 2025 [24–34]. Studies were conducted in different countries as described in Table 2. About study design, three (27.27%) were descriptive studies, three (27.27%) were longitudinal studies, two (18.18%) were cross-sectional studies, two (18.18%) were experimental, and one (9.09%) was action research. The target population were mainly Pharmacy students in different phases of the course, although two studies also included faculty and one included internship supervisors in a stratified way [32, 34].

Table 2.

Countries of the studies included in the review

Country	Number of studies
United States	n = 4; 36.36%
Malaysia	n = 2; 18.18%
Netherlands	n = 1; 9.09%
Australia	n = 1; 9.09%
United Kingdom	n = 1; 9.09%
Kuwait	n = 1; 9.09%
Canada	n = 1; 9.09%

Personal, social, and organizational components of learning environment

Personal components were identified through factors such as learning goals, prior experience, dedication, and ability to manage expectations [32]. Besides, subjective elements such as empowerment, motivation, strengthening of professional identity, satisfaction, and autonomy, reinforce engagement and student accountability for their own learning which can be observed in other studies [25, 28, 29, 33, 34]. Confidence and development of professional competence were highlighted in alignment with previous studies [26, 30].

Regarding the social component, confidence relationships, feedback, and supervision built a safe and exciting environment [32, 33]. Team-based learning, peer review, and reflexive discussion promoted knowledge construction [24, 28, 29, 31]. Moreover, they improved communication with patients, colleagues, and other health professionals [25, 30]. Organizational component, identified in all studies, included curriculum, pedagogical strategies, accreditation rules, practices, policies, regulatory setting, guidance, and learning support [24–34].

Characteristics physical and virtual of learning environments described in studies

Physical environment

Five studies included in this review highlighted the importance of the physical environment in the learning experiences of Pharmacy students, underscoring variations among real contexts (hospitals, outpatient clinics, and community pharmacies), ability labs [25, 29–32]. Skills labs were scenario for dispensing activities [29, 31]. Experiences in outpatient clinic environments were based on measuring blood pressure of elderly patients [30]. Hybrid model revealed the relevance of face-to-face activities, with evaluation of cardiovascular risk in community pharmacies, complementing the virtual learning environment [25]. The learning experiences described in the latest study occurred in hospital pharmacies and community pharmacies, highlighting the need for a safe environment with essential conditions for the learning success [32]. The Table 3 details the characterization of the scenarios, services, disciplines, and year of study of the courses included in this review.

Table 3.

Characterization of scenarios, services, disciplines, and year of course

Author, year	Scenario (real or simulated)	Service	Discipline	Year of course
Ge, Planas & Er, 2010 [24]	Simulated outpatient clinic scenario	NR*	Clinical communication	NR*
Brown & Vosper, 2013 [25]	NR*	Cardiovascular risk evaluation	Pharmacology and Clinical Therapeutics	2º year of MPharm
Eukel et al., 2014 [26]	Simulated lab of pharmaceutical care	Pharmacotherapy management, Dispensing, among others	Pharmaceutical care	3º year of PharmD
Leong, 2016 [27]	Community clinic	Blood pressure assessment, health promotion and referral to specialists	Physical evaluation skills	3º year of PharmD
McDowell et al., 2016 [28]	Community pharmacy	Dispensing	Pharmacy, Health, and Society 1 and 2	1º year of undergraduate
Pick, Begley & Augustine, 2017 [29]	NR*	Dispensing and pain management	Pharmacotherapy and Dispensing, and Pharmaceutical Care	3º year of undergraduate
Azhari et al., 2020 [30]	NR*	NR*	Principles of Pathology and Pharmaceutical Care	2º and 3 º year of undergraduate
Al-Taweel et al., 2024 [31]	NR*	NR*	NR*	2º and 3º year of PharmD
Caldas et al., 2025 [32]	Community pharmacy	Dispensing	Pharmaceutical abilities lab	1º year of undergraduate
Maharajan, Sivapalan & Rajiah, 2025 [33]	NR*	NR*	NR*	1º year of PharmD
Raeni, de Beaufort & Pranger, 2025 [34]	Community and hospital pharmacy	Dispensing, pharmacotherapy review, work in cases (projects, policies, and protocols)	Internship	2º and 3º year of master’s degree

*NR = not reported

Virtual environment

The virtual component found in five studies seeks to improve learning experience of Pharmacy students, although they have different approaches and technologies [24–28]. One study developed an online cognitive support system to Problem Based Learning (PBL) structured in five steps of problem solving, recording and sharing the reasoning of students among colleagues, instructors, and evaluators [24].

Problem-Based Learning (PBL) was used in the study, which focused on cardiovascular risk assessment, as the basis for a blended learning environment, combining face-to-face simulation with asynchronous online activities and including digital resources such as interactive e-handouts, questionnaires with feedback, links to guidelines and practical tutorials, among others [25]. MyDispense simulated a community pharmacy offering representations of patients, prescriptions, products on shelves, and a high-fidelity interface to prescription processing [26].

Another study developed an interactive case scenario based on video to teach pain management, with different software integration and turned into a lively and interactive package [27]. The environment shows multiple choice questions integrated into the clinical case and provides immediate feedback, valuing interactivity, engagement, and instant gratification. In the last study, an i-Learn system was used, which is a virtual environment that enables sharing materials, online questionnaire applications, and interactive forum participation (i-Discuss), which stimulates collaboration, exchange of ideas and critical reflection with other students and tutors [28].

Effectiveness of learning environments

Learning environments such as internships, labs, community clinics, online simulations, and blended learning scenarios showed positive effect in developing competences in students [24–34]. Experience in virtual environments favor clinical reasoning, self-regulation, and peer collaboration [24–28].

Physical environments, on the other hand, engaged critical reasoning, professionalism, and communication abilities [25, 29–32]. Tools such as MyDispense, PBL cognitive support systems, and video interactive scenarios improved performance, confidence, and learning, complementing online activities with formative feedback [24–27]. Finally, teaching strategies including PBL, TBL, students as partners, and Experience-based learning promoted engagement, reflection, and decrease of failure rates [25, 30–33].

Learning theories

The included studies based their learning environment on different learning theories, which highlights a transition from traditional models of teaching, teacher-centered, to student-centered pedagogical approaches, which shown in Table 4.

Table 4.

Theoretical references and components of learning environment adopted by included studies

Author, year	Theoretical reference adopted	Components of learning environment*
Ge, Planas & Er, 2010 [24]	Sociocultural theory of Vygotsky (Vygotsky, 1978)	Social, Organizational, and Virtual
Brown & Vosper, 2013 [25]	Constructivist Theory (Vygotsky, 1978; Honebein, Duffy & Fishman, 1993)	Personal, Social, Organizational, Physical, and Virtual
Eukel et al., 2014 [26]	Not reported	Personal, Social, Organizational, and Physical
Leong, 2016 [27]	Not reported	Personal, Social, Organizational, and Physical
McDowell et al., 2016 [28]	Not reported	Personal, Social, Organizational, and Virtual
Pick, Begley & Augustine, 2017 [29]	Not reported	Organizational and Virtual
Azhari et al., 2020 [30]	Social Constructivism Theory (Wink & Putney, 2002)	Personal, Social, Organizational, and Virtual
Al-Taweel et al., 2024 [31]	Not reported	Personal and Organizational
Caldas et al., 2025 [32]	Not reported	Social, Organizational, and Physical
Maharajan, Sivapalan & Rajiah, 2025 [33]	Relational pedagogy – patterns of partnership model (Fielding, 2011)	Personal, Social, and Organizational
Raeni, de Beaufort & Pranger, 2025 [34]	Kolb’s Experiential Learning Theory (Kolb, 1984; McLeod, 2024)	Personal, Social, Organizational, and Physical

*The components identified in studies were classified following Gruppen et al. (2018) [10]. Source: author

Strategies for teaching pharmaceutical Care

Teaching and learning strategies reported by studies are consistent with a teaching model change, demanding students to be more active, besides using technological resources and active methods. Different methods were observed, and the most used were PBL (n = 2) and experience-based learning (n = 2). Table 5 shows the strategies and main results of each study.

Table 5.

Teaching strategies and main results of included studies

Author, year	Strategy	Main results
Ge, Planas & Er, 2010 [24]	Problem-based learning (PBL)	Prompts group overcame control group in all phases of problem solving
Brown & Vosper, 2013 [25]	Problem-based learning (PBL)	Reduction in failure rates from 50% to 2% and improved performance
Eukel et al., 2014 [26]	Real simulated activities	Students scored above the average in all activities and reported being prepared to patient care
Leong, 2016 [27]	Experience-based learning	Improved confidence when measuring vital signs after in-person experience
McDowell et al., 2016 [28]	Virtual simulated activities	The tool was considered effective for developing dispensing abilities
Pick, Begley & Augustine, 2017 [29]	Interactive case (video) and standard cases	High engagement and reinforcement of critical thinking through immediate feedback
Azhari et al., 2020 [30]	E-learning	Challenges in meeting the expectations of advanced students and the need for continuous innovation
Al-Taweel et al., 2024 [31]	Competence-based learning	Improvement of students’ satisfaction (5.4–7.4 to 7.8–8.7)
Caldas et al., 2025 [32]	Team-Based Learning (TBL)	Performance equity achieved between students with and without prior experience
Maharajan, Sivapalan & Rajiah, 2025 [33]	Students as partners	Students reported empowerment, sense of belonging, and development of leadership
Raeni, de Beaufort & Pranger, 2025 [34]	Experience-based learning	Positive environment and tutoring were determinants to learning experience

Source: author

Evaluation of methodological quality of studies

All studies were evaluated through MMAT tool (2008) and had clear resource questions (Appendix A). Two qualitative studies included in this review met al.l evaluation criteria [32, 33], whereas the quantitative studies (n = 4) partially met these criteria [28–31]. Out of the five mixed method studies, one met al.l criteria [34], and four partially met them [24–27].

Discussion

The need for transition from a teaching model product-centered to a patient care approach has been discussed [35]. However, the observed predominance of studies conducted in the United States can be justified by its pioneering work in Pharmaceutical Care, in creating PharmD, and in increasing workload of disciplines centered on patient care [3, 4]. It is important to highlight that accreditation standards of PharmD programs in the USA that articulate the expectations of academia and practice were updated, serving as reference to other countries [36].

Personal, social, and organizational component of learning environments

This study verified the presence of diverse personal and social components that influence learning and its application to qualified provision of Pharmaceutical Care. Such finds reinforce the necessity of a holistic approach that integrate the subjective elements as part of the teaching process [37] Furthermore, motivation, autonomy, and self-confidence influence learning since students report greater engagement, academic performance, and satisfaction with the acquired competences [34, 38].

Another important aspect stands out that organization, sense of usefulness, and belonging to the pharmaceutical profession were associated with acquiring patient-centered personal and social competences [39]. Another study showed that participation in peer-assisted practices (students, teachers, and supervisors) not only strengthened the development and consolidation of personal competences, but also organizational and social ones [40, 41]. Thus, building a curriculum must be a collaborative process that involves teachers, professionals, and students to create learning environments that train pharmacists to be more autonomous, confident, and engaged with the well-being of patients.

Different learning environments and their effectiveness

Data obtained from this review shows diverse virtual learning environments, and the selection of them must be guided by specific learning objectives, so the results are effective [42]. Some studies show that virtual reality is motivating, engaging, and interacting, besides it promotes cognitive, physical, customized, collaborative, and socioemotional development [43, 44]. Therefore, teaching based on virtual models is effective, adaptable, and sustainable [45]. Moreover, it allows immediate feedback and multiple user profiles, developing competences in a convenient, ethical, and safe context since it does not require specific physical environment or real patients which enable it to be used any time of undergraduate or continuing education.

In this review, it was found different learning environments inside (ability labs) and outside the university (hospitals, outpatient clinics, and community pharmacies), that contribute to the development of professional skills when promoting early contact with patients [27, 32]. These environments showed positive results in academic performance and decreasing failure rates, reinforcing their formative potential [46]. Thus, combing environments increases social engagement and facilitates learning from medication management until patient-centered care, meeting social and work labor demands [11, 47, 48].

Learning theories

A scoping review suggested that the absence of consensus about the definition of “learning environment” in the healthcare field limits the possibility of conducting multicenter research to evaluate the impact of different curriculum contexts as well as their improvement and adaptation to national realities [8, 10, 49]. Although concept differences, it is important to highlight that the studies analyzed were based on different learning theories which strengthen the person-centered educational process [26, 27, 30, 34, 35].

No theory isolated is sufficient to explain the complexity of learning, therefore it is necessary to consider them in a complementary way [50, 51]. Thus, using these theories in areas such as Medicine and Nursing has been the basis for structuring these environments and applying them in real world, allowing mediation through language and culture (Vygotsky) [52, 53], social interaction (Constructivism) [54–56], shared decision-making among students and teachers (Students as Partners) [35, 57–62], and combining real experience, simulation, and case discussions (Kolb) [63]. In summary, the agreed definition of learning environment and the use of complementary theories can facilitate curricular changes and training of pharmacists that are caregivers.

Strategies for teaching pharmaceutical care

The teaching and learning strategies reported in studies emphasize more active participation of students. Using active methods such as PBL can stimulate the teaching of Pharmaceutical Care through problem-solving, self-directed learning, critical thinking, and communication [46]. A metanalysis pointed out that Pharmacy students enrolled in PBL presented higher performance in middle and final exams compared to traditional methods [64]. In different contexts, such as in Japan and Norway, PBL applied to pharmaceutical technology and clinical activities showed improvements in confidence, thinking, and practical applications [65, 66].

A curriculum planning that adopts different methods of complementary education, goes beyond the traditional theoretical model by increasing exposure in clinical, technological, and collaborative scenarios [28, 30, 35, 36]. These experiences contribute to valuation of different learning styles and deepen the educational process, aligning educational results with real world demands [27, 33, 34]. Therefore, the curricular update must understand not only the content changes but also the characteristics of student generations and their interrelationships with professional practice [37, 67, 68].

Limitation

The present study shows strengths and limitations. As strengths, it is highlighted how different components of learning environments complement each other to develop the required competencies for patient-centered acting. As for limitations, the research revealed a lack of studies about developing learning environments for teaching Pharmaceutical Care. In addition, the absence of concept consensus on these environments could have limited the identification and inclusion of relevant studies in this review.

Conclusion

Although the relevance of the theme, publication about learning environments for teaching Pharmaceutical Care is yet scarce and heterogeneous, without a clearly defined concept and with diverse variables related to physical, virtual or hybrid components that influence personal, social, and organizational aspects during educational process. While the findings suggest the effectiveness of innovative strategies, it is important that these environments explore the use of active methods, be reproducible in scenarios both inside and outside the university and have the capability to be adapted to different learning styles, organizational models, and social and cultural contexts. Future research should deepen understanding of learning environments for teaching Pharmaceutical Care to strengthen scientific production and guide training of future pharmacists who are better prepared for patient-centered practices.

Authors’ contributions

Mayara de Almeida Lima Ribeiro: Conceptualization, Methodology, Formal analysis, Investigation, Visualization, Writing - Original Draft and Writing - Review & Editing. Dennis Wesley Andrade Hohenfeld: Methodology, Formal analysis, Investigation, Visualization, Writing - Original Draft and Writing - Review & Editing. Thaís Maria Araújo Tavares: Methodology, Formal analysis, Investigation, Visualization, Writing - Original Draft and Writing - Review & Editing. Fernando de Castro Araújo Neto: Methodology, Formal analysis, Visualization, Writing - Original Draft and Writing - Review & Editing. Alessandra Rezende Mesquita: Methodology, Formal analysis, Visualization, Writing - Original Draft and Writing - Review & Editing. Giselle de Carvalho Brito: Methodology, Formal analysis, Visualization, Writing - Original Draft and Writing - Review & Editing. Divaldo Pereira de Lyra Jr.: Conceptualization, Methodology, Visualization, Writing - Original Draft and Writing - Review & Editing, Supervision and Project administration.

Funding

This study was financed in part by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior—Brasil (CAPES)—Finance Code 001. The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. In addition, the authors (MALR and TMAT) received financial support of the Coordination of Superior Level Staff Improvement (CAPES).

Data availability

All data generated or analysed during this study are included in this published article and its supplementary information files.

Declarations

Ethics approval and consent to participate

Ethical approval and informed consent were not required.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.