{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T02:39:24Z","timestamp":1792550364730,"version":"4.5.0"},"reference-count":26,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T00:00:00Z","timestamp":1787011200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T00:00:00Z","timestamp":1792540800000},"content-version":"vor","delay-in-days":64,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"the Soft Science Research Project of Henan Province Medical Science and Technology Research Plan","award":["Grant No. RKX202402021"],"award-info":[{"award-number":["Grant No. RKX202402021"]}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Med Educ"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Prescription review training programs are widely implemented in China to meet increasingly stringent policy requirements for rational drug use. However, evidence on the effectiveness of these programs and the specific needs for their optimization, particularly from the knowledge, attitude, and practice (KAP) perspective of returning pharmacists, remains limited. This gap constrains efforts to refine training systems and support the implementation of national pharmaceutical policies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>An exploratory sequential mixed-methods design grounded in the KAP model was employed. Phase I involved semi-structured interviews with 15 returning trainees, with thematic analysis adopted for data coding and thematising; Phase II administered a KAP questionnaire to trainees, quantitative data were analyzed using descriptive statistics, Pearson correlation, and binary logistic regression.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Qualitative interview revealed that trainees reported good knowledge acquisition and positive attitude transformation, but also faced practice barriers (limited pre\u2011review platform support, physician communication difficulties, and specialty misalignment). Quantitative survey of 394 trainees showed mean knowledge scores of 32.6\u00b13.2, attitude scores of 28.7\u00b12.4, and practice scores of 32.3\u00b13.6, with significant positive correlations among them. Regression analysis identified low usefulness of role\u2011playing and insufficient communication training demand were independent associated factors for poor practice translation (P&lt;0.05), while workplace contextual factors(e.g. pre\u2011review platform) were not significant. Both qualitative and quantitative findings consistently indicated strong trainee demand for extended training, specialty focused content, communication practice, and post-training support.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Prescription review training effectively improves pharmacists\u2019 knowledge and professional attitude. However, despite high knowledge and practice scores, qualitative findings revealed persistent self reported difficulties in applying training to practice, indicating a discrepancy between measured outcomes and perceived challenges. The two finding are complementary rather than contradictory. Addressing this discrepancy requires integrated interventions, including strengthened communication skills training, specialty-adapted content, improved institutional support platforms, and sustainable post-training follow-up.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12909-026-10186-x","type":"journal-article","created":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T10:24:31Z","timestamp":1787048671000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["A mixed-methods study on the effectiveness and optimization needs of a prescription review training program: from the KAP perspective of returning trainees"],"prefix":"10.1186","volume":"26","author":[{"given":"Xiangfen","family":"Shi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhao","family":"Yin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoxu","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoyue","family":"Bao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaojing","family":"Lu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,8,18]]},"reference":[{"issue":"1","key":"10186_CR1","doi-asserted-by":"publisher","first-page":"37","DOI":"10.1186\/s40545-022-00431-1","volume":"15","author":"S Shrestha","year":"2022","unstructured":"Shrestha S, Shrestha R, Ahmed A, Sapkota B, Khatiwada AP, Christopher CM, et al. Impact of pharmacist services on economic, clinical, and humanistic outcome (ECHO) of South Asian patients: a systematic review. J Pharm Policy Pract. 2022;15(1):37.","journal-title":"J Pharm Policy Pract"},{"issue":"3","key":"10186_CR2","first-page":"CD010418","volume":"2019","author":"C Ryan","year":"2019","unstructured":"Ryan C, McCullough A, Elborn S, Hughes C. Pharmacist-led interventions for adults with asthma or COPD. Cochrane Database Syst Rev. 2019;2019(3):CD010418.","journal-title":"Cochrane Database Syst Rev"},{"key":"10186_CR3","unstructured":"Ministry of Health of the People\u2019s Republic of China. Prescription Management Measures (Order No. 53 of the Ministry of Health). 2007 Feb 14. https:\/\/www.gov.cn\/zhengce\/2007-02\/14\/content_5713779.htm. Accessed 23 Feb 2026."},{"key":"10186_CR4","unstructured":"Ministry of Health of the People\u2019s Republic of China, State Administration of Traditional Chinese Medicine of the People\u2019s Republic of China, Health Department of the General Logistics Department of the People\u2019s Liberation Army. Notice on Issuing the. Provisions on Pharmaceutical Administration in Medical Institutions (No. 11, 2011) [in Chinese]. 2011 Mar 30. https:\/\/www.nhc.gov.cn\/zwgk\/wtwj\/201304\/0149ba1f66bd483995bb0ea51a354de1.shtml. Accessed 23 Feb 2026."},{"key":"10186_CR5","unstructured":"General Office of the National Health Commission. Office of the state administration of Traditional Chinese Medicine, general office of logistics support department of the central military commission. Notice on the issuance of prescription audit standards for medical institutions. Bullet Nat Health Comm People\u2019s Repub China. 2018;07:35\u20138."},{"key":"10186_CR6","unstructured":"National Health Commission of the People\u2019s Republic of China, Ministry of Education of the People\u2019s Republic of China, Ministry of Finance of the People\u2019s Republic of China, Ministry of Human Resources and Social Security of the People\u2019s Republic of China, National Healthcare Security Administration, National Medical Products Administration., Notice on Issuing the Opinions on Strengthening Pharmaceutical Administration in Medical Institutions and Promoting Rational Drug Use (No. 2, 2020). 2020 Feb 21. https:\/\/www.gov.cn\/gongbao\/content\/2020\/content_5522549.htm. Accessed 23 Feb 2026."},{"key":"10186_CR7","unstructured":"National Health Commission of the People\u2019s Republic of China, National Administration of Traditional Chinese Medicine of the People\u2019s Republic of China, National Disease Control and Prevention Administration of the People\u2019s Republic of China. Notice on Issuing the Functional Guidelines for Informatization of Compact County Medical Communities (No. 63, 2025). 2025 Feb 20. https:\/\/www.gov.cn\/zhengce\/zhengceku\/202503\/content_7013125.htm. Accessed 23 Feb 2026."},{"key":"10186_CR8","unstructured":"Science and Education Department, National Health Commission of the People\u2019s Republic of China. Notice on Issuing the Implementation Plan for the Shortage Talent Training Program and the County-Level Hospital Backbone Specialist Physician Training Program (No. 125, 2024). 2024. https:\/\/wsjkw.zj.gov.cn\/art\/2024\/10\/11\/art_1229560650_2530825.html. Accessed 23 Feb 2026."},{"key":"10186_CR9","unstructured":"Liupanshui Municipal Health Bureau. Notice on Holding the 2025 Primary Medical Institution Prescription Review Competency Training Course. https:\/\/gzcme.yiboshi.com\/ProjectNoticeView.aspx?ID=46e8f115-564a-4587-bfe9-1fae1dba4ca7&pid=0daa0c25-ea70-4ff3-ac61-d30dd65399f6. Accessed 23 Feb 2026."},{"key":"10186_CR10","unstructured":"Henan Pharmaceutical Association. Notice on Issuing the Enrollment Guide for the Sixth Hospital Pharmacist Prescription Review Skills Improvement Training Course of Henan Pharmaceutical Association. Henan Pharmaceutical Association. 2025 Jul 18. http:\/\/www.hnsyxh.cn\/view.jsp?id=1645. Accessed 23 Feb 2026."},{"issue":"8","key":"10186_CR11","first-page":"2328","volume":"23","author":"J Zhou","year":"2025","unstructured":"Zhou J, Deng Z, Liu L, Zhu Y, Li X, Zhang C, et al. Logistic regression of pharmacist position and satisfaction with prescription review training in Hunan [in Chinese]. Cent South Pharm. 2025;23(8):2328\u201333.","journal-title":"Cent South Pharm"},{"issue":"8","key":"10186_CR12","first-page":"2315","volume":"23","author":"L Liu","year":"2025","unstructured":"Liu L, Deng Z, Zhou J, Zhang C, Li X, Zhu Y, et al. Effectiveness of PHARMD training model by Hunan Pharmaceutical Association [in Chinese]. Cent South Pharm. 2025;23(8):2315\u201320.","journal-title":"Cent South Pharm"},{"key":"10186_CR13","first-page":"100677","volume":"20","author":"M Lea","year":"2025","unstructured":"Lea M, Trapnes E, Steen H, \u00d8degaard NB. Design and evaluation of a comprehensive training program for hospital-based clinical pharmacists - various, active, and work-integrated learning. Explor Res Clin Soc Pharm. 2025;20:100677.","journal-title":"Explor Res Clin Soc Pharm"},{"issue":"1","key":"10186_CR14","doi-asserted-by":"publisher","first-page":"460","DOI":"10.21873\/invivo.13460","volume":"38","author":"Y Aimiya","year":"2024","unstructured":"Aimiya Y, Mizuno T, Sakakibara M, Matsumoto N, Sugiura SY, Mizokami F, et al. Effectiveness of Online Team-based Learning for Pharmacists on How to Conduct Clinical Medication Reviews for Old Patients in Japan: A Randomized Controlled Trial. Vivo. 2024;38(1):460\u20136.","journal-title":"Vivo"},{"key":"10186_CR15","doi-asserted-by":"crossref","unstructured":"Leiman K, Westerholm A, Vahlberg T, Lias N, Lindholm T, Airaksinen M. Fostering medication review competence of pharmacy students: An assessment by students and their preceptors after advanced-level practical internship. Br J Clin Pharmacol. 2026;92(8):2549\u201360.","DOI":"10.1002\/bcp.70329"},{"key":"10186_CR16","doi-asserted-by":"publisher","first-page":"1521","DOI":"10.3389\/fphar.2019.01521","volume":"10","author":"NE Ismail","year":"2020","unstructured":"Ismail NE, Jimam NS, Dapar MLP, Ahmad S. Validation and Reliability of Healthcare Workers\u2019 Knowledge, Attitude, and Practice Instrument for Uncomplicated Malaria by Rasch Measurement Model. Front Pharmacol. 2020;10:1521.","journal-title":"Front Pharmacol"},{"key":"10186_CR17","unstructured":"World Health Organization. Knowledge, attitudes, and practices (KAP) surveys during cholera vaccination campaigns: guidance for oral cholera vaccine stockpile campaigns, World Health Organization Working Group on Monitoring & Evaluation. 2014 Jun 5. 41 p. https:\/\/www.who.int\/publications\/m\/item\/knowledge-attitudes-and-practices-(kap)-surveys-during-cholera-vaccination-campaigns-guidance-for-oral-cholera-vaccine-stockpile-campaigns. Accessed 23 Feb 2026."},{"issue":"9","key":"10186_CR18","doi-asserted-by":"publisher","first-page":"1316","DOI":"10.3390\/nu10091316","volume":"10","author":"J Nanayakkara","year":"2018","unstructured":"Nanayakkara J, Margerison C, Worsley A. Senior Secondary School Food Literacy Education: Importance, Challenges, and Ways of Improving. Nutrients. 2018;10(9):1316.","journal-title":"Nutrients"},{"issue":"5","key":"10186_CR19","doi-asserted-by":"publisher","first-page":"311","DOI":"10.1007\/s40037-018-0449-2","volume":"7","author":"KE Hauer","year":"2018","unstructured":"Hauer KE, Iverson N, Quach A, Yuan P, Kaner S, Boscardin C. Fostering medical students\u2019 lifelong learning skills with a dashboard, coaching and learning planning. Perspect Med Educ. 2018;7(5):311\u20137.","journal-title":"Perspect Med Educ"},{"issue":"1","key":"10186_CR20","doi-asserted-by":"publisher","first-page":"69","DOI":"10.1186\/s12909-024-05032-x","volume":"24","author":"X Lu","year":"2024","unstructured":"Lu X, Zhang W, Jia X, Bao X, Zhang X, Kang J, et al. Exploring the problems and coping strategies of pharmacy internship in large general hospitals in China: from the perspective of preceptors. BMC Med Educ. 2024;24(1):69.","journal-title":"BMC Med Educ"},{"issue":"2","key":"10186_CR21","doi-asserted-by":"publisher","first-page":"77","DOI":"10.1191\/1478088706qp063oa","volume":"3","author":"V Braun","year":"2006","unstructured":"Braun V, Clarke V. Using thematic analysis in psychology. Qualitative Res Psychol. 2006;3(2):77\u2013101.","journal-title":"Qualitative Res Psychol"},{"issue":"6","key":"10186_CR22","doi-asserted-by":"publisher","first-page":"349","DOI":"10.1093\/intqhc\/mzm042","volume":"19","author":"A Tong","year":"2007","unstructured":"Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care. 2007;19(6):349\u201357.","journal-title":"Int J Qual Health Care"},{"issue":"6","key":"10186_CR23","doi-asserted-by":"publisher","first-page":"382","DOI":"10.1097\/00006199-198611000-00017","volume":"35","author":"MR Lynn","year":"1986","unstructured":"Lynn MR. Determination and quantification of content validity. Nurs Res. 1986;35(6):382\u20135.","journal-title":"Nurs Res"},{"issue":"4","key":"10186_CR24","doi-asserted-by":"publisher","first-page":"459","DOI":"10.1002\/nur.20199","volume":"30","author":"DF Polit","year":"2007","unstructured":"Polit DF, Beck CT, Owen SV. Is the CVI an acceptable indicator of content validity? Appraisal and recommendations. Res Nurs Health. 2007;30(4):459\u201367.","journal-title":"Res Nurs Health"},{"issue":"5","key":"10186_CR25","doi-asserted-by":"publisher","first-page":"489","DOI":"10.1002\/nur.20147","volume":"29","author":"DF Polit","year":"2006","unstructured":"Polit DF, Beck CT. The content validity index: are you sure you know what\u2019s being reported? Critique and recommendations. Res Nurs Health. 2006;29(5):489\u201397.","journal-title":"Res Nurs Health"},{"issue":"1","key":"10186_CR26","doi-asserted-by":"publisher","first-page":"528","DOI":"10.1186\/s12909-022-03591-5","volume":"22","author":"X Yao","year":"2022","unstructured":"Yao X, Jia X, Shi X, Liu G, Li Y, Zhang X, et al. Exploring the experiences and expectations of pharmacist interns in large general hospitals in China: from the perspective of interns. BMC Med Educ. 2022;22(1):528.","journal-title":"BMC Med Educ"}],"container-title":["BMC Medical Education"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12909-026-10186-x","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12909-026-10186-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12909-026-10186-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T02:08:01Z","timestamp":1792548481000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12909-026-10186-x"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,18]]},"references-count":26,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["10186"],"URL":"https:\/\/doi.org\/10.1186\/s12909-026-10186-x","relation":{},"ISSN":["1472-6920"],"issn-type":[{"value":"1472-6920","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,18]]},"assertion":[{"value":"3 March 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"13 August 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"18 August 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"Ethics was approved by the First Affiliated Hospital of Zhengzhou University Institutional Review Board approved the protocol (Protocol\u2019s reference number: No.2026-KY-0053). For the qualitative research component, written informed consent to participate was obtained from each participant. For the quantitative research component, electronic informed consent was obtained from all participants. Prior to the survey, an electronic information page detailing the study purpose, procedures, and data anonymity was presented to all participants. Participants were required to actively indicate their consent by selecting the option stating, \u201cI have read and understood the above information and voluntarily agree to participate in this study\u201d before proceeding to the questionnaire items. The research was conducted following standards in accordance with the Declaration of Helsinki.","order":1,"name":"Ethics","label":"Ethics approval and consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":2,"name":"Ethics","label":"Consent for publication","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":3,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"1689"}}