An evaluation of ‘entrustment’ decisions on pharmacy undergraduates made during hospital experiential learning in 2024–25

Abstract Introduction The General Pharmaceutical Council (GPhC) standards for initial education and training of pharmacists recognise the role of experiential learning (EL) in enhancing preparedness for practice.1 In Northern Ireland (NI), the Clinical Education Pharmacy Team work with both Schools of Pharmacy to develop Entrustable Professional Activities (EPAs), based on authentic practice tasks, to evaluate student competence in hospital-based practice activities.2 The retrospective entrustment scale developed for pharmacy undergraduate context in NI has been adapted from the literature, and offers five choices; 2a, 2b, 3a, 3b, and 3c, which offer incrementally increased independence, e.g. if the activity was not completely independently: 2a Practice Supervisor (PS) had to intervene throughout, completely independently: 3c (PS ready to step in if needed).2 PSs completed training in 2024 including how to formulate an entrustment decision for a student. All pharmacy undergraduate students in NI in 2024–25 completed hospital-based EL for three days in Year 2, two weeks in Year 3, and three weeks in Year 4. PSs assign an entrustment decision to student performance after observing the activity and discuss areas of improvement during a feedback conversation. Aim To evaluate pharmacy students’ ability to complete authentic pharmacist tasks in secondary care with increasing independence and responsibility, as judged by entrustment decisions by PSs on EPAs. Methods An evaluation of entrustment decisions made by PSs in secondary care using the NI Entrustment Scale was undertaken in May 2025.2 Each entrustment decision for each EPA (2a, 2b, 3a, 3b or 3c) was recorded and counted. All EPAs completed by pharmacy undergraduates attending EL in hospital in 2024–25 were included. Where EPAs were completed in two academic years, the results were compared using descriptive statistics. Results A total of 3753 entrustment decisions made on 692 pharmacy students from Year 2 (n = 259), Year 3 (n = 244) and Year 4 (n = 189) were reviewed. Seventeen percent of Year 2 students received an entrustment level of 3c when completing a medication history, compared to 21% of Year 3 students. Thirteen percent of Year 3 students received an entrustment level of 3c when completing medication review compared to 23% of Year 4. Nineteen percent of Year 2 received an entrustment level of 3c when evaluating and managing clinical improvement or worsening compared to 31% of Year 4. Sixty percent of Year 4 students received 3b for their prescribing skills, a further 26% received 3c. Conclusion This study shows that as NI pharmacy students’ progress through the MPharm, acquiring knowledge, skills and engaging in more EL, they are more likely to achieve a higher entrustment rating from a PS. Limitations include the need to further develop PSs’ understanding of entrustment, and the comparison between academic years may be due to differing academic ability and not solely evolving competence. In future studies, we can compare third year performance in 2024–25 to fourth year performance in 2025–26.