Abstract
Background
The rapid expansion of available pharmacotherapies and increasingly complex medication regimens has increased the risk of medication-related complications in clinical practice. Concerns have been raised that physicians’ pharmaceutical competencies may not fully meet the demands for safe and rational medication use. Existing assessments of physicians’ pharmaceutical competency have largely focused on theoretical pharmacology, with limited multidimensional evaluations incorporating medication monitoring, guidance, and interprofessional collaboration.
Aim
This study aimed to comprehensively assess pharmaceutical competency among Chinese physicians during the continuing medical education phase and examine its association with professional titles, presence of clinical pharmacists, hospital-provided pharmaceutical training, and implementation of rational drug use systems.
Method
A cross-sectional survey was conducted using purposive sampling among physicians from public Grade A tertiary hospitals in 11 provinces, autonomous regions, and municipalities in China. Pharmaceutical competency was assessed using the combined approach of subjective self-assessment and objective testing. Descriptive statistics and subgroup analyses were performed to evaluate differences across professional titles, departmental allocation of clinical pharmacists, hospital pharmaceutical training, and rational drug use system implementation.
Results
In total, 1,044 valid questionnaires were included in the analysis. The median (Q1, Q3) subjective self-assessment score for pharmaceutical competency (maximum score = 5) was 3.92 (3.72, 4.28), while the median (Q1, Q3) objective accuracy rate (maximum = 100%) was 51.11% (41.11%, 61.11%). No significant differences in pharmaceutical competency were observed across professional titles (all P > 0.05). With the exception of self-directed pharmaceutical learning, clinicians working in departments with clinical pharmacists and those receiving hospital-provided pharmaceutical training reported significantly higher subjective competency scores (P < 0.05). In addition, hospital pharmaceutical training and the implementation of rational drug use systems were associated with significantly higher objective assessment scores across multiple competency domains (P < 0.05).
Conclusion
Physicians demonstrated relatively high self-assessed pharmaceutical competency, but comparatively low objective performance, suggesting a tendency to overestimate pharmaceutical competency. These findings highlight the need to strengthen the pharmaceutical education and medication management support for physicians. Pharmacist involvement, pharmacist-led training, and rational drug use systems may play important roles in supporting physicians’ pharmaceutical competency and promoting safer and more rational medication use.
Supplementary Information
The online version contains supplementary material available at 10.1007/s11096-026-02110-6.
Keywords: Clinical pharmacy, Continuing medical education, Drug utilization, Pharmaceutical services, Physicians
Impact statements
Clinical pharmacists play a critical role in supporting physicians’ medication-related competencies, highlighting the importance of integrating pharmacists into routine clinical teams to enhance prescribing confidence, medication monitoring, and interprofessional collaboration.
Pharmacist-led pharmaceutical training in continuing medical education may improve physicians’ applied medication knowledge and support safer and more rational drug use in complex clinical settings.
Institutional rational drug use systems, when implemented with active pharmacist involvement, can reinforce physicians’ practical application of pharmaceutical knowledge, suggesting that system-level medication management strategies are essential for improving real-world prescription practices.
Introduction
With the rapid advancement of medical technology and continuous expansion of available pharmacotherapies, physicians are required to manage increasingly complex medication regimens. However, in routine clinical practice, physicians’ pharmaceutical knowledge and prescribing experience may not always keep pace with the growing diversity of drugs, evolving indications, contraindications, and clinically relevant drug–drug interactions [1]. The increasing complexity of medication use substantially increases the risk of inappropriate prescriptions and medication-related harm, posing a persistent threat to patient safety [2]. In this context, pharmaceutical competency, which encompasses not only pharmacological knowledge but also medication monitoring, guidance, and interprofessional collaboration, has become an essential component of high-quality clinical care.
Continuing medical education (CME) plays a critical role in maintaining and updating physicians’ competencies following formal medical training. Beyond knowledge acquisition, CME increasingly emphasizes performance improvement, patient safety, and rational medication use [3, 4]. National health authorities have explicitly highlighted rational drug use as a core element of CME, encouraging healthcare institutions to strengthen pharmaceutical training and system-level interventions aimed at improving medication safety and effectiveness [5]. These policies demonstrate the growing recognition that safe medication use cannot rely solely on individual clinical experience, but requires structured educational and organizational support.
In China, current competency assessments for clinical physicians largely emphasize medical competency, with comparatively limited attention paid to pharmaceutical competency. Numerous studies have shown that physicians often demonstrate insufficient knowledge in key areas such as pharmacology, clinical pharmacotherapy, rational use of antimicrobial agents, and identification and reporting of adverse drug reactions (ADRs) [6–8].
Internationally, assessments of physicians’ pharmaceutical competency have tended to focus on theoretical pharmacology knowledge or selected aspects of medication monitoring. Surveys across diverse healthcare settings have consistently identified gaps in physicians’ understanding of pharmacology, applied pharmacotherapy, and ADR reporting [9–14].
However, pharmaceutical care in contemporary healthcare systems extends beyond the isolated knowledge domains. Safe and effective medication use also relies on physicians’ ability to provide appropriate medication guidance to patients, engage in self-directed pharmaceutical learning, and effectively collaborate with clinical pharmacists. These competency domains, which are critical to real-world prescribing practices, have received limited empirical evaluations. Moreover, no universally accepted framework currently exists for the comprehensive assessment of physicians’ pharmaceutical competency across multiple dimensions [10].
Clinical pharmacists play a pivotal role in bridging these gaps by supporting rational prescribing, conducting medication reviews, monitoring therapy outcomes, and facilitating inter-professional collaboration. Evidence from diverse healthcare settings indicates that pharmacist involvement in clinical teams is associated with improved medication safety, optimization of drug therapy, and enhanced prescription quality [15, 16]. Despite this, limited data are available on how institutional factors such as the presence of clinical pharmacists, hospital-based pharmaceutical training, and rational drug use systems are associated with physicians’ pharmaceutical competency, particularly within the Chinese healthcare context.
Aim
This study aimed to assess pharmaceutical competency among Chinese physicians during the continuing medical education phase using combined subjective self-assessment and objective testing, and to examine the association of pharmacist-related and institutional factors with physicians’ pharmaceutical competency.
Method
Study design and participants
This cross-sectional study assessed pharmaceutical competency among physicians undergoing CME in public Grade A tertiary hospitals in China between October 2024 and February 2025. A purposive sampling strategy was adopted to target physicians working in high-level hospitals, where complex medication uses and interprofessional collaboration with clinical pharmacists are routine. The questionnaire was administered online and distributed to the target cohort of clinicians through the department heads of participating medical institutions. Prior to the survey, small gifts were offered to the respondents as an incentive and a token of appreciation. During the data collection period, reminder messages were sent every three days, depending on the response rate, to facilitate timely completion of the survey. Participation in the study was voluntary.
Eligible participants met the following inclusion criteria: (1) willingness to participate, (2) holding the professional title of attending physician or associate chief physician, and (3) employment at a public Grade A tertiary hospital. Exclusion criteria included: (1) failure to complete the full questionnaire and (2) questionnaires with missing key variables or responses showing clear patterned irregularity, which were considered indicative of poor data quality.
Questionnaire development
To ensure content relevance and clarity, preliminary face-to-face interviews were conducted with 18 clinicians from a Grade A tertiary hospital prior to the formal survey. The participants represented multiple clinical specialties, including internal medicine, surgery, obstetrics and gynecology, and pediatrics. Feedback from these interviews was used to refine item wording and ensure alignment with routine clinical practice.
Based on literature review and expert consultation, two complementary instruments were developed to assess physicians’ pharmaceutical competency: a subjective self-assessment questionnaire and an objective knowledge-based test [17–21]. The conceptual framework for questionnaire development was informed by competency theory, particularly the Onion Competency Model, which conceptualizes competency as a multidimensional construct encompassing motivation, attitudes, knowledge, and skills [22]. In this study, self-directed learning in pharmaceutical knowledge and collaboration with clinical pharmacists was mapped to the motivational dimension, reflecting physicians’ capacity for self-directed and lifelong learning. These competencies emphasize the need for physicians to continuously update their pharmaceutical knowledge and skills and collaborate effectively with clinical pharmacists in medication therapy to ensure patient safety.
Medication guidance capability was aligned with the attitudinal dimension, requiring physicians to recognize their professional responsibilities, actively respond to patients’ medication-related concerns, and provide appropriate guidance regarding medication use.
Pharmaceutical theoretical knowledge corresponded to the knowledge dimension, representing physicians’ mastery of fundamental pharmaceutical principles, whereas medication monitoring capability was linked to the skill dimension, highlighting the ability to acquire and apply medication monitoring skills in routine clinical practice.
Based on this framework and informed by expert consensus, pharmaceutical competency in physicians was defined as a multidimensional construct encompassing pharmaceutical theoretical knowledge, medication monitoring capability, medication guidance capability, collaboration with clinical pharmacists, and self-directed learning in pharmaceutical knowledge.
Subjective pharmaceutical competency assessment
The subjective self-assessment questionnaire consisted of five dimensions: (1) theoretical pharmaceutical knowledge, (2) medication monitoring capability, (3) medication guidance capability, (4) collaboration with clinical pharmacists, and (5) self-directed pharmaceutical learning capability. A total of 23 items were used to assess the first four dimensions using a five-point Likert scale (1 = strongly disagree to 5 = strongly agree). The self-directed learning dimension comprises five items assessing the frequency of independent pharmaceutical learning activities, scored from 1 (“0 times”) to 5 (“ > 10 times”). Higher scores indicate higher perceived pharmaceutical competency.
Internal consistency and construct validity were evaluated prior to analysis. Cronbach’s alpha coefficients were 0.860 for pharmaceutical theoretical knowledge, 0.925 for medication monitoring, 0.938 for collaboration with clinical pharmacists, and 0.938 for medication guidance. The corresponding Kaiser–Meyer–Olkin (KMO) values ranged from 0.807 to 0.929. The questionnaire demonstrated excellent reliability (Cronbach’s alpha = 0.967) and adequate sampling (KMO = 0.967). Exploratory factor analysis indicated that the five extracted factors explained 78.75% of the total variance after rotation, thus supporting the construct validity of the instrument.
Objective pharmaceutical competency assessment
The objective assessment focused on three dimensions considered amenable to standardized knowledge testing: pharmaceutical theoretical knowledge, medication monitoring capability, and collaboration with clinical pharmacists. Medication guidance and self-directed learning were excluded because of their strong reliance on behavioral practices and contextual factors that are difficult to capture using objective test items.
The objective test items were adapted from the National Medical Licensing Examination and authoritative pharmaceutical textbooks, and were designed to reflect clinical medication scenarios, core principles of clinical pharmacology, and interdisciplinary collaboration practices. During questionnaire development, all items underwent independent expert review to evaluate the clinical relevance and appropriateness of difficulty, ensuring alignment with physicians’ CME content and prescribing responsibilities.
The objective assessment consisted of a 30-item multiple-choice test covering three dimensions: pharmaceutical theoretical knowledge (15 items), medication monitoring capability (10 items), and collaboration with clinical pharmacists (five items). Scoring was based on the proportion of correct responses, with higher accuracy indicating stronger pharmaceutical competence.
Sample size calculation
The minimum required sample size was calculated using the formula.
n = (t2 × σ2) / e2 [23], where t represents the standard normal value at the 95% confidence level (t = 1.96), σ is the estimated population standard deviation, and e is the margin of error. Based on prior unpublished research on pharmaceutical competency among Chinese clinical medicine students, σ was set at 0.72, with e fixed at 0.05. The minimum sample size was 796. With an anticipated attrition rate of 20%, the target sample size was increased to 955.
Statistical analysis
Data were analyzed using the Statistical Package for the Social Sciences (SPSS). Descriptive statistics are reported as medians with interquartile ranges (IQRs) for continuous variables and as frequencies and percentages for categorical variables. The Kolmogorov–Smirnov test indicated non-normal data distributions; therefore, non-parametric methods were applied.
The Mann–Whitney U test was used to compare subjective and objective pharmaceutical competency scores across subgroups defined by professional title, presence of clinical pharmacists in departments, hospital-provided pharmaceutical training, and implementation of rational drug use systems. Mean rank values were reported to reflect between-group differences. To control for Type I errors due to multiple comparisons, Bonferroni correction was applied. The adjusted significance thresholds were set at α = 0.0083 for the subjective scores (six dimensions), and α = 0.0125 for the objective scores (four dimensions). Statistical significance was defined as a two-sided P value below the adjusted threshold.
Ethics approval
The study was approved by the Ethics Committee of China Pharmaceutical University (CPU2024-11–152).
Results
Socio-demographic characteristics
A total of 1,300 questionnaires were distributed, of which 1,044 valid responses were included in the final analysis after excluding questionnaires with missing key variables, yielding a response rate of 80.31%. Among the respondents, 402 (38.5%) were male and 642 (61.5%) were female clinicians. Attending physicians accounted for 57.6% of the participants, whereas associate chief physicians accounted for 42.4%.
Clinical pharmacists were present in 76.2% of respondents’ departments. Hospital-provided pharmaceutical knowledge training was reported by 83.3% of physicians and 89.6% indicated that a rational drug use system had been implemented in their hospitals. The detailed sociodemographic characteristics are presented in Table 1.
Table 1.
Socio-demographic characteristics of surveyed clinicians (N = 1,044)
| Characteristic | Category | n (%) |
|---|---|---|
| Sex | Male | 402 (38.5) |
| Female | 642 (61.5) | |
| Professional title | Attending physician | 601 (57.6) |
| Associate chief physician | 443 (42.4) | |
| Hospital-provided pharmaceutical training | Yes | 870 (83.3) |
| No | 174 (16.7) | |
| Presence of clinical pharmacists in departments | Yes | 796 (76.2) |
| No | 248 (23.8) | |
| Implementation of rational drug use system | Yes | 935 (89.6) |
| No | 109 (10.4) |
Subjective and objective pharmaceutical competency scores
The median (Q1, Q3) overall subjective self-assessment scores for pharmaceutical competency were 3.92 (3.72, 4.28). Among the five subjective dimensions, the highest median scores were observed for medication monitoring capability and medication guidance capability, both with a median score of 4.17 (4.00, 4.83) and 4.17 (4.00, 4.83), respectively. The lowest median score was observed for self-directed pharmaceutical learning capability at 3.00 (2.20, 3.40).
The median (Q1, Q3) overall objective accuracy rates were 51.11% (41.11%, 61.11%, respectively). The highest median accuracy rate was observed for collaboration with clinical pharmacists at 60.00% (60.00%, 80.00%), whereas the lowest accuracy rate was observed for pharmaceutical theoretical knowledge at 46.67% (33.33%, 60.00%). The detailed subjective and objective scores across all dimensions are presented in Table 2.
Table 2.
Subjective and objective scores for clinicians’ pharmaceutical competency
| Dimension | Subjective score, median | IQR (Q1–Q3) | Objective accuracy, median (%) | IQR (Q1–Q3) |
|---|---|---|---|---|
| Theoretical knowledge in pharmacy | 4.00 | 1.00 (4.00–5.00) | 46.67 | 26.67 (33.33–60.00) |
| Medication monitoring | 4.17 | 0.83 (4.00–4.83) | 50.00 | 30.00 (30.00–60.00) |
| Collaboration with clinical pharmacists | 4.14 | 0.86 (4.00–4.86) | 60.00 | 20.00 (60.00–80.00) |
| Medication guidance | 4.17 | 1.00 (4.00–5.00) | — | — |
| Self-directed pharmaceutical learning | 3.00 | 1.20 (2.20–3.40) | — | — |
| Overall pharmaceutical competency | 3.92 | 0.56 (3.72–4.28) | 51.11 | 20.00 (41.11–61.11) |
IQR, interquartile range; Q1, first quartile; Q3, third quartile
Subgroup analyses of pharmaceutical competency
Subgroup analyses were conducted to examine differences in pharmaceutical competency across professional titles, presence of clinical pharmacists in departments, hospital-provided pharmaceutical training, and implementation of rational drug use systems.
No statistically significant differences were observed in either subjective self-assessment scores or objective test scores between attending physicians and associate chief physicians across any pharmaceutical competency dimension (all P > 0.05; Table 3).
Table 3.
Subgroup analysis of pharmaceutical competency by professional title
| Dimension | Professional title | Subjective score (mean rank) | P value | Objective score (mean rank) | P value |
|---|---|---|---|---|---|
| Theoretical knowledge in pharmacy | Attending physician | 510.92 | 0.140 | 531.41 | 0.263 |
| Associate chief physician | 538.20 | 510.42 | |||
| Medication monitoring | Attending physician | 512.76 | 0.214 | 531.46 | 0.259 |
| Associate chief physician | 535.71 | 510.34 | |||
| Collaboration with clinical pharmacists | Attending physician | 508.79 | 0.082 | 531.99 | 0.208 |
| Associate chief physician | 541.10 | 509.62 | |||
| Medication guidance | Attending physician | 516.97 | 0.476 | — | — |
| Associate chief physician | 530.00 | — | |||
| Self-directed pharmaceutical learning | Attending physician | 517.12 | 0.501 | — | — |
| Associate chief physician | 529.79 | — | |||
| Overall pharmaceutical competency | Attending physician | 507.13 | 0.055 | 535.66 | 0.100 |
| Associate chief physician | 543.35 | 504.65 |
—, not assessed. P values were derived from Mann–Whitney U tests
Clinicians working in departments with clinical pharmacists demonstrated significantly higher subjective self-assessment scores for theoretical pharmaceutical knowledge, medication monitoring capability, collaboration with clinical pharmacists, medication guidance capability, and overall pharmaceutical competency (P < 0.05). No statistically significant differences were observed in the objective test scores between clinicians with and without clinical pharmacists in their departments, after Bonferroni correction for multiple comparisons (Table 4).
Table 4.
Subgroup analysis of pharmaceutical competency by presence of clinical pharmacists in departments
| Dimension | Clinical pharmacists in department | Subjective score (mean rank) | P value | Objective score (mean rank) | P value |
|---|---|---|---|---|---|
| Theoretical knowledge in pharmacy | Yes | 542.25 | < 0.001 | 530.43 | 0.125 |
| No | 459.10 | 497.06 | |||
| Medication monitoring | Yes | 542.98 | < 0.001 | 531.50 | 0.081 |
| No | 456.77 | 493.61 | |||
| Collaboration with clinical pharmacists | Yes | 550.11 | < 0.001 | 525.27 | 0.571 |
| No | 433.89 | 513.60 | |||
| Medication guidance | Yes | 537.93 | 0.002 | — | — |
| No | 472.97 | — | |||
| Self-directed pharmaceutical learning | Yes | 506.59 | 0.002 | — | — |
| No | 573.57 | — | |||
| Overall pharmaceutical competency | Yes | 545.23 | < 0.001 | 531.66 | 0.079 |
| No | 449.56 | 493.11 |
—, not assessed. P values were derived from Mann–Whitney U tests. All significant results remained significant after Bonferroni adjustment
Clinicians who reported receiving hospital-provided pharmaceutical training showed significantly higher subjective self-assessment scores across all dimensions, except self-directed pharmaceutical learning (P < 0.05). In addition, these clinicians demonstrated significantly higher objective test scores across all assessed dimensions and overall composite scores (P < 0.05; Table 5).
Table 5.
Subgroup analysis of pharmaceutical competency by hospital pharmaceutical training status
| Dimension | Hospital pharmaceutical training | Subjective score (mean rank) | P value | Objective score (mean rank) | P value |
|---|---|---|---|---|---|
| Theoretical knowledge in pharmacy | Yes | 537.89 | < 0.001 | 553.99 | < 0.001 |
| No | 445.55 | 365.04 | |||
| Medication monitoring | Yes | 538.64 | < 0.001 | 553.86 | < 0.001 |
| No | 441.80 | 365.69 | |||
| Collaboration with clinical pharmacists | Yes | 538.73 | < 0.001 | 539.73 | < 0.001 |
| No | 441.33 | 436.35 | |||
| Medication guidance | Yes | 536.14 | < 0.001 | — | — |
| No | 454.30 | — | |||
| Self-directed pharmaceutical learning | Yes | 508.86 | 0.001 | — | — |
| No | 590.68 | — | |||
| Overall pharmaceutical competency | Yes | 533.49 | 0.008 | 557.14 | < 0.001 |
| No | 467.57 | 349.32 |
—, not assessed. P values were derived from Mann–Whitney U tests. All significant results remained significant after Bonferroni adjustment
Clinicians working in hospitals with an implemented rational drug use system demonstrated significantly higher subjective self-assessment scores for theoretical pharmaceutical knowledge, medication guidance capability, and overall pharmaceutical competency (P < 0.05). After Bonferroni correction for multiple comparisons, the differences in the subjective scores for medication monitoring and collaboration with clinical pharmacists were no longer statistically significant. Objective test scores were significantly higher across all assessed dimensions among clinicians in hospitals with rational drug use systems (P < 0.05; Table 6).
Table 6.
Subgroup analysis of pharmaceutical competency by implementation of a rational drug use system
| Dimension | Rational drug use system | Subjective score (mean rank) | P value | Objective score (mean rank) | P value |
|---|---|---|---|---|---|
| Theoretical knowledge in pharmacy | Yes | 530.81 | 0.008 | 535.91 | < 0.001 |
| No | 451.24 | 407.50 | |||
| Medication monitoring | Yes | 530.36 | 0.012 | 535.53 | < 0.001 |
| No | 455.06 | 410.72 | |||
| Collaboration with clinical pharmacists | Yes | 530.40 | 0.012 | 530.55 | 0.007 |
| No | 454.72 | 453.47 | |||
| Medication guidance | Yes | 530.65 | 0.008 | — | — |
| No | 452.56 | — | |||
| Self-directed pharmaceutical learning | Yes | 526.66 | 0.190 | — | — |
| No | 486.81 | — | |||
| Overall pharmaceutical competency | Yes | 532.19 | 0.002 | 537.10 | < 0.001 |
| No | 439.38 | 397.25 |
—, not assessed. P values were derived from Mann–Whitney U tests. After Bonferroni correction, differences in subjective scores for medication monitoring and collaboration with clinical pharmacists were no longer statistically significant
Discussion
Interpretation of main findings
This study provided a comprehensive assessment of pharmaceutical competency among Chinese physicians during CME by integrating subjective self-assessment with objective testing. A central finding was the clear discrepancy between the relatively high self-assessed pharmaceutical competency and comparatively low objective test performance. The study population consisted of physicians working in Grade A tertiary hospitals, which represent the highest level of the Chinese healthcare system. Clinicians in these settings are typically exposed to complex cases and advanced medical technology, which may contribute to greater professional confidence. Within the current Chinese medical education and licensing framework, pharmacology remains the primary pharmaceutical discipline formally assessed in physician-qualification examinations and professional advancement processes. In contrast, broader competencies, including clinical pharmacotherapy, medication monitoring, medication guidance, and interprofessional collaboration, have been evaluated less systematically. This structural emphasis may partially explain why physicians reported relatively high self-assessed pharmaceutical competency, while demonstrating more modest performance in objective assessments.
Differences in assessment approaches may further contribute to this discrepancy. Self-assessment tends to reflect professional confidence within familiar clinical contexts, whereas objective testing captures gaps in foundational pharmaceutical knowledge and applied competencies more directly. In addition, response bias cannot be excluded, as clinicians may unconsciously align their self-reports with professional role expectations and present themselves as competent practitioners, thereby inflating their self-assessment scores.
Role of clinical pharmacists
The presence of clinical pharmacists within departments was associated with higher self-assessed pharmaceutical competency across most domains, except for self-directed pharmaceutical learning. Clinical pharmacists contribute specialized expertise in pharmacology, pharmacokinetics, drug–drug interactions, ADRs, and individualized pharmacotherapy. Their involvement in clinical teams may support clinicians in optimizing medication selection, dosage adjustment, and monitoring strategies, thereby reinforcing confidence in rational medication use [24, 25]. However, this increased confidence may primarily reflect the availability of external support and established teamwork mechanisms, rather than a structural strengthening of physicians’ individual pharmaceutical knowledge systems. The presence of clinical pharmacists may reduce the immediate need for physicians to independently update pharmaceutical knowledge, potentially contributing to the gap between elevated subjective confidence and relatively unchanged objective knowledge levels. These findings suggest that while current pharmacist–physician collaboration models enhance confidence in medication-related decision-making and interprofessional interactions, they may not consistently translate into measurable gains in individual pharmaceutical cognitive competency.
Collaborative practice models, such as joint ward rounds, case discussions, and pharmaceutical consultations, may further enhance clinicians’ perceived ability to provide medication guidance and engage effectively in interdisciplinary decision making. Evidence from chronic disease management, including hypertension care, has shown that pharmacist–physician collaboration is associated with improved therapeutic outcomes, highlighting the practical value of such teamwork in routine clinical practice [26]. Increased recognition of the professional role of clinical pharmacists may facilitate more effective collaboration and shared learning [27].
Institutional and system-level factors
Hospital-provided pharmaceutical training is associated with higher pharmaceutical competencies, particularly in objective assessments. Structured training programs can facilitate the systematic transfer of clinically relevant pharmaceutical knowledge, including the identification of medication-related risks and the management of high-alert medications. Previous studies have demonstrated that targeted medication-related training improves healthcare professionals’ understanding of safe medication practices and enhances their risk awareness [28]. Moreover, pharmaceutical training is often delivered by experienced clinical pharmacists, which may simultaneously strengthen physicians’ pharmaceutical knowledge and promote closer inter-professional collaboration.
The implementation of rational drug use systems was also associated with higher objective pharmaceutical competency across all the assessed domains. Such systems typically incorporate standardized prescription review processes, clinical decision support, therapeutic drug monitoring, and ADR surveillance [29]. Repeated engagement with these structured processes may reinforce physicians’ application of pharmaceutical knowledge through routine practice and feedback. In addition, clearly defined collaborative workflows between physicians and clinical pharmacists within these systems may support consistent and effective medication management, helping align pharmaceutical knowledge with day-to-day clinical decision-making. It should be noted that after Bonferroni correction, the differences in self-assessment scores for medication monitoring ability and self-directed pharmaceutical learning were no longer statistically significant. This finding suggests that although rational drug use policy may be associated with more favorable self-perceptions in these dimensions, the magnitude of this association is likely modest and insufficiently robust to remain significant after adjustment for multiple comparisons.
Professional title and pharmaceutical competency
Notably, no significant differences in pharmaceutical competency were observed between clinicians with different professional titles. This finding suggests that professional seniority may not necessarily reflect up-to-date pharmaceutical competency, particularly in the rapidly evolving areas of pharmacotherapy. The standardization of CME requirements and overlapping clinical responsibilities across professional titles in tertiary hospitals may partially account for this observation. This result highlights the importance of continuous, practice-oriented pharmaceutical education for physicians at all career stages rather than relying on professional rank as a proxy for competency.
Study limitations
Several limitations of this study should be considered when interpreting these findings. First, the cross-sectional design precludes causal inferences regarding the relationships among pharmacist involvement, institutional factors, and physician pharmaceutical competency. Second, part of the assessment relied on self-reported data, which may have been subject to response and social desirability biases, although objective testing was incorporated to mitigate this limitation. Third, the study population was restricted to physicians working in public Grade A tertiary hospitals, which may limit the generalizability of the findings to other healthcare settings, including primary care, secondary hospitals, private institutions, and rural facilities. In addition, the use of purposive sampling may have introduced selection bias because the resulting sample may not be fully representative of the broader physician population, potentially leading to systematic deviations in participant characteristics. Fourth, the objective assessment excluded the dimensions of medication guidance and self-directed learning, and imbalances in the difficulty and number of test items across domains may have limited the coverage of real-world clinical behaviors and introduced assessment bias. Fifth, reliance on single-variable subgroup analyses (e.g., professional title) limits the ability to capture the combined effects of multiple determinants of pharmaceutical competency. Nevertheless, the consistency of the findings across several institutional variables suggests that the observed associations are reasonably robust at an exploratory level. Future studies should incorporate multivariable analytical approaches to adjust for potential confounding factors such as years of clinical experience and medical specialty. Sixth, in clinical departments without clinical pharmacists, physicians’ assessments of collaborative competency were largely based on theoretical understanding and perceived willingness, rather than direct collaborative experience. This may have resulted in differential measurement validity across subgroups and introduced a potential bias when comparing collaboration scores between departments. Accordingly, collaboration scores in departments without clinical pharmacists should be interpreted as reflecting clinicians’ attitudes toward and perceived readiness for collaboration rather than actual interprofessional practice. Finally, unmeasured factors, such as individual learning motivation, departmental culture, workload, and access to digital clinical decision support tools, may also have influenced pharmaceutical competency and were not captured in this study.
Overall implications
From a clinical pharmacy perspective, these findings highlight the importance of pharmacist-led education, effective pharmacist–physician collaboration, and system-level medication management strategies to support physicians’ pharmaceutical competency. Strengthening these elements within CME and routine clinical practice may help narrow the gap between perceived and actual pharmaceutical competence, and promote safer and more rational medication use.
Practical and policy recommendations
In clinical practice, medical institutions should optimize the allocation of clinical pharmacist positions, establish structured interprofessional collaboration mechanisms, such as joint ward rounds and case discussions between pharmacists and physicians, and strengthen end-to-end medication management through systematic rational drug use frameworks.
With CME, pharmacist-led pharmaceutical knowledge training and practice-oriented medication management programs should be integrated into the core curricula. In addition, a comprehensive competency assessment system that combines subjective self-assessment with objective evaluation should be developed to identify and address gaps in physicians’ pharmaceutical knowledge and skills more precisely.
At the health policy level, administrative authorities should promote the implementation of supportive systems for pharmaceutical competency development across medical institutions at all levels. Establishing evaluation frameworks centered on demonstrated pharmaceutical competency may help to systematically narrow the gap between perceived and actual competence, and ultimately enhance the safety and effectiveness of medication use in clinical practice.
Conclusion
This study provides a comprehensive assessment of pharmaceutical competency among Chinese physicians during the continuing medical education phase, by integrating subjective self-assessment with objective testing. The findings revealed a clear discrepancy between physicians perceived and objectively measured pharmaceutical competencies, suggesting that confidence in medication-related practice may not accurately reflect actual knowledge and skills. Institutional factors, including the presence of clinical pharmacists, hospital-provided pharmaceutical training, and the implementation of rational drug use systems, were associated with higher pharmaceutical competency, whereas professional titles were not. These results highlight the importance of pharmacist-led education, inter-professional collaboration, and system-level medication management strategies to support safe and effective medication use in clinical practice.
Supplementary Information
Below is the link to the electronic supplementary material.
Acknowledgements
None.
Author contributions
All authors contributed to the conception and design of the study. Chao Liu was responsible for literature retrieval and data collection. Chao Liu, Hanyang Guo, and Bingyi Li conducted questionnaire surveys. Hanyang Guo collected and analyzed the receipts and drafted the initial manuscript. All the authors critically reviewed and revised the manuscript for important intellectual content and approved the final version for publication.
Funding
None.
Data availability
The datasets generated and analyzed in the current study are available from the corresponding author upon reasonable request.
Declarations
Competing interests
The authors declare no competing interests.
Ethical approval
The study was approved by the Ethics Committee of China Pharmaceutical University (CPU2024-11–152).
Footnotes
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Hanyang Guo and Chao Liu are co-first authors and contributed equally to this work.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Supplementary Materials
Data Availability Statement
The datasets generated and analyzed in the current study are available from the corresponding author upon reasonable request.