How to feel more confident in making clinical decisions

While the GPhC learning outcomes cover the foundational clinical and professional aspects of pharmacy practice, they might not be enough to instill confidence in clinical decision making. This calls for an understanding of where this gap stems from in order to properly address it.

Is Miller’s pyramid sufficient for confidence building?

Miller’s pyramid outlines a logical progression from knowledge acquisition (“knows”) to real-world application (“does”). Pharmacy students typically move along this trajectory during their university years and training placements. What makes an efficient and safe pharmacist is the ability to integrate those skills as a whole into daily interactions, which is the ultimate goal of the training year. However, confidence is not merely the outcome of competence; it is also about learning from mistakes, acknowledging that “to err is human”, and building resilience around that.

A challenging balance 

While designated supervisors are tasked with evaluating trainee progress, their role should expand into mentorship, where trainees’ successes are acknowledged and mistakes are honestly shared, reflected on, and used to guide any additional training needs. This requires detailed learning needs analysis and customisation of the training to meet the specific needs of the trainee. This might be challenging, especially for the trainees who undergo multi-sector training or hospital training, where several practice supervisors are usually responsible for overseeing the trainee in different rotations. This also might create inconsistency in how the trainee is assessed and ultimately affect the quality and outcome of the training.

Do short rotations undermine confidence?

Medical doctors spend an average of four months, if not more, in each rotation during their foundation year, which allows them to understand the patient population, common medical conditions, and work dynamics in each rotation. On the other hand, trainee pharmacists rotate to several clinical and non-clinical areas for significantly shorter periods, which might come at the expense of being less confident in their practice and, ultimately, their decision-making ability. Moreover, many of the training elements are related to professional behaviour and collaboration with other practitioners, which necessitates spending enough time in their areas of training to be able to experience the dynamics of team building and collaboration aspects of their training.

Confidence through risk awareness

“First, do no harm” is the basic concept of safe medical practice. This is emphasised by many learning outcomes and especially those under the leadership and management domain of the GPhC standards for education and training of pharmacists. However, this might not always be addressed or emphasised efficiently during training. In addition to reflecting on errors or incidents, trainees need to be empowered to proactively analyse, identify, and reflect on the risks in their areas of practice and suggest strategies to mitigate them. 

In addition to reflecting on errors or incidents, trainees need to be empowered to proactively analyse, identify, and reflect on the risks in their areas of practice and suggest strategies to mitigate them.

For instance, understanding that venous thromboembolism is more likely in post-partum patients, or that paediatric dosing requires precise calculations, empowers trainee pharmacists to be able to assess and mitigate risks associated with their practice. Promoting the concept of risk assessment at every stage of the training can help trainees to proactively address risks, plan strategies to mitigate them, and ultimately gain confidence in their ability to effectively and safely make decisions related to their patients and practice.

A call for a paradigm shift

The aforementioned challenges barely touch on what would be a reason for the lack of confidence among newly qualified pharmacists; however, they might present a starting point to support the planned transformation of pharmacy practice to the independent prescribing model. 

This calls for:

• Supporting a growth mindset: Normalise mistakes as part of learning. Encourage reflective practice and resilience.
• Training supervisors as mentors: Provide them with the skills to guide, support, and empower trainees, not just assess them. 
• Prioritising depth in key rotations: Give trainees enough time in fewer settings to develop skills and build relationships that boost confidence. Moreover, addressing learning needs should be streamlined across different settings and practice supervisors.
• Assigning wards early: Let trainees integrate into teams from the outset. When they’re seen as contributors rather than observers, confidence grows.
• Making risk assessment routine: Integrate risk assessment into everyday tasks so trainees develop sound clinical judgement.

Building confidence and decision-making abilities are essential aspects of successful clinical training and, ultimately, safe and efficient practice. This would require a paradigm shift in the training programme structure, logistics, and expertise to guide, support, and empower trainees to be better prepared for their prescribing role.

The opinions expressed in this article are those of the author. They do not purport to reflect the opinions or views of the UKCPA or its members. We encourage readers to follow links and references to primary research papers and guidance.

Competing interest statement: 

The author declares: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.