Why do competencies not always translate into practice? Evidence from Community Pharmacy setting
Despite high competency acquisition among Cuban community pharmacists, a significant implementation gap persists in translating these skills into routine patient-centred practice due to organizational and systemic barriers rather than educational deficiencies.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer
Imagine a world where your local pharmacy isn't just a place to pick up a bottle of pills, but a health hub where a pharmacist acts like a personal coach for your medicine. This is the dream of "pharmaceutical care." Instead of just handing over a product, the pharmacist checks if the medicine fits your body, explains how it works, and makes sure it doesn't clash with other things you're taking. To get ready for this big job, students go through "competency-based education." Think of this like a video game training level where you don't just read a manual; you actually practice the moves, solve puzzles, and learn the skills you'll need to beat the final boss: keeping patients safe and healthy.
But here's the tricky part: just because you've mastered the training level doesn't mean you can automatically play the game perfectly in the real world. Sometimes, the skills you learned in school get stuck in the classroom, and the real-life job ends up looking more like the old, boring version of the game. This paper asks a simple but important question: In Cuba, are pharmacists actually using all those fancy new skills they learned in school, or are they still mostly just counting pills and stocking shelves? The answer matters because if we spend years teaching new skills but never use them, patients might miss out on better care, and the whole system isn't working as hard as it could.
The Training vs. The Reality: A Pharmacy Story
In the sunny city of Santiago de Cuba, a researcher named Alina de las Mercedes Martínez Sánchez decided to play detective. She wanted to see if the pharmacy students of today were actually becoming the super-doctors-of-medicine they were trained to be. She looked at 42 pharmacists (that's almost everyone working in community pharmacies there) and asked them to fill out a checklist of 16 different tasks. Some tasks were like "organizing the shelves" (managerial), some were "handing over the medicine" (dispensing), and the most exciting ones were "checking if the medicine is right for the patient" (pharmaceutical care).
The Big Surprise: The "Manager" Wins, The "Doctor" Loses
The results were a bit like finding out that a student who studied hard for a science fair ended up spending all their time cleaning the lab instead of doing the experiments.
The study found that the pharmacists were absolutely crushing it at the "managerial" stuff. They got high scores for keeping the pharmacy looking professional, making sure the store was profitable, and keeping the medicines stored at the right temperature. It was like they were the best librarians in the world, keeping the books (or pills) in perfect order.
However, when it came to the "patient-centered" skills—the ones that require thinking, talking to doctors, and solving complex health puzzles—the scores dropped like a stone.
- The Average Score: The overall score for how well these skills were being used was 45.82 (out of a possible 80). This is below the middle point, meaning the "new way" of doing things isn't fully happening yet.
- The Gap: The "managerial" skills had a high average score of 4.22 (on a scale where 5 is "very frequent"). But the "dispensing" skills (like checking prescriptions) only averaged 2.47, and the "pharmaceutical care" skills (like finding drug problems) averaged just 2.62.
The "Missing Moves"
The paper points out specific moves that the pharmacists just aren't making very often. Imagine a soccer player who is great at tying their shoelaces but rarely kicks the ball. The biggest gaps were:
- Finding Drug Problems: Only 1.54 on the scale. This is the skill of spotting when a medicine might cause a bad reaction or isn't working.
- Joining Community Health Committees: Only 1.47. This is about working with local health groups to help the whole neighborhood.
- Checking if Patients Can Afford Medicine: Only 1.97.
- Double-Checking Prescriptions: Only 2.28.
In fact, the very highest scores went to things like "Professional pharmacy environment" (4.40) and "Pharmacy profitability" (4.20). The paper suggests that the pharmacists are doing the job they've always done (managing the shop) but haven't fully switched to the new job they were trained for (caring for the patient's health journey).
Why Isn't the New Stuff Happening?
The author suggests that the problem isn't that the pharmacists forgot what they learned in school. It's more like they have a Ferrari engine (the skills) but are stuck in traffic (the system). The paper argues that the "competency-based education" worked fine—the students learned the skills. But the real-world environment isn't set up to let them use those skills.
It's like teaching someone to be a race car driver but then making them drive a slow, heavy truck on a dirt road. The driver has the skills, but the truck and the road won't let them race. The paper points out that things like lack of time, not having the right tools to write down what they do, and not working closely enough with doctors are the barriers. The system is still set up for "product-oriented" pharmacy (selling boxes) rather than "patient-oriented" care (saving lives).
What Does This Mean?
The study concludes that while the education system is doing its part, the real-world practice hasn't caught up yet. The transition from "pill counter" to "health coach" is happening, but it's slow and uneven. The author suggests that to fix this, we need more than just better schools. We need better rules, more support from the hospital system, and a change in how the pharmacies are run so that pharmacists actually have the time and space to use their super-skills.
In short, the pharmacists in Cuba are ready to play the new game, but the game board itself needs to be redesigned to let them win.
Drowning in papers in your field?
Get daily digests of the most novel papers matching your research keywords — with technical summaries, in your language.