Clinical reasoning by pharmacists: fostering clinical decision-making and interprofessional collaboration in pharmacy practice and education

Abstract

Clinical reasoning is a core competence for pharmacists and forms the foundation for effective clinical decision-making (CDM)–a complex interplay of cognitive processes and skills that enable pharmacists to make patient-centered clinical decisions in pharmacy practice. Yet, how pharmacists reason and make clinical decisions is less understood than in other health professions, posing teaching and learning challenges. This dissertation aims to enhance the understanding of clinical reasoning by pharmacists, identify the cognitive processes underlying CDM, examine factors influencing decision-making, and evaluate educational interventions that foster both CDM and interprofessional collaboration (IPC). Findings show that pharmacists use a combination of analytical and intuitive reasoning to interpret clinical data in context. Interviews identified 21 cognitive processes organized into eight CDM steps, highlighting challenges in contextual reasoning and limited attention to outcome evaluation and reflection. These insights informed the development of a pharmacy-specific CDM model and learning guide to support educators and learners across settings. Surveys indicated that both students and pharmacists found the model practical and supportive. Finally, an interprofessional pharmacotherapy program showed promise in enhancing IPC competencies. Collectively, this dissertation provides a comprehensive framework for understanding and teaching CDM, offering tools to foster more reflective, collaborative, and patient-centered pharmacy practice.