Evaluating pharmacist prescribing education programs: A realist synthesis

Background/Introduction Pharmacist prescribing has evolved to meet healthcare system needs, but the effectiveness, mechanisms, and contextual factors influencing pharmacist prescribing education programs across undergraduate, postgraduate, and continuing professional development (CPD) contexts remains poorly understood. Objectives/Aim This realist synthesis explores how pharmacy prescribing education programs work (or not), for whom, under what circumstances, and why. Methods After developing an initial program theory from grey literature, a realist synthesis using Pawson’s key stages were followed: (i) clarifying the scope; (ii) determining the search strategy; (iii) study selection and appraisal of documents; (iv) data extraction; and (v) analysis and synthesis processes. The RAMESES I (Realist And Meta-narrative Evidence Syntheses – Evolving Standards) publication standards were followed. Context-mechanism-outcomes configurations (CMOC) of varied pharmacy prescribing education programs were extracted and recurring patterns were synthesised to refine the initial program theory. Results Twenty-three articles were included. One recurring CMOC pattern was identified for undergraduate prescribing programs, nine for postgraduate programs, and four for continuing professional development (CPD) programs. While all three educational settings could generate positive outcomes, cross-category analysis revealed several shared patterns: Experiential learning could generate confidence in both undergraduate and postgraduate programs; social learning could generate satisfaction in postgraduate and CPD programs; and positive student–educator relationships could generate satisfaction in postgraduate and CPD programs. Conclusion Pharmacist prescribing education programs seem to be most effective when designed to trigger mechanisms producing desired outcomes (knowledge, skills, confidence, and satisfaction) within their specific contexts. Experiential and social learning emerged as key drivers of successful programs. These findings offer practical guidance for educators and policymakers to optimize prescribing education and inform future realist evaluations exploring contextual influences with greater clarity. Registration ROSPERO: CRD420251056576Protocol reference: Xenos K, Rees CE, Heslop IM, Benrimoj SI, Dineen-Griffin S. Evaluating pharmacist prescribing education programmes: a realist synthesis protocol. BMJ Open. 2025;15(8):e105951.