The Hidden Architecture of Inertia: Stakeholder Perspectives on the Most Pressing Challenges in Pharmacy Education

OBJECTIVE: The objectives of this study were to (1) identify convergent/divergent challenges in pharmacy education, (2) develop a model to demonstrate how these challenges lead to stagnation in pharmacy education, (3) identify systemic drivers/restraining forces that influence change, and (4) explore perceived advantages/disadvantages of educational transformation. METHODS: This qualitative study used grounded theory and thematic analysis to analyze data from 27 focus groups comprising 8 stakeholder groups: students, faculty, preceptors, deans, health care professionals, payors, professional organization leaders, and practice transformation leaders. Discussions were transcribed, coded, and analyzed iteratively to identify themes, stakeholder convergence/divergence, and perceived trade-offs related to educational reform. RESULTS: Four interconnected themes were identified: a persistent competency-practice gap; a fragmented professional identity; rising resource and sustainability challenges; and strong resistance to change. These themes were mapped into 2 reinforcing cycles, the Educational Inertia Cycle and the Professional Identity Cycle, showing how outdated curricula, unclear role definitions, and institutional obstacles continue to create misalignment. Cross-stakeholder analysis revealed shared concerns but varied priorities, with students and preceptors emphasizing practice readiness, while faculty and deans highlighted burnout and resource constraints. A qualitative force field analysis identified key driving and restraining forces, while an advantage-disadvantage matrix outlined perceived trade-offs of proposed reforms, including competency-based education, experiential expansion, and curricular redesign. CONCLUSION: Despite widespread recognition of necessary reforms, pharmacy education faces systemic inertia. Stakeholder insights affirm the urgent need for coordinated, strategic efforts to realign curricula, support faculty, foster identity formation, and modernize assessment. These findings offer a grounded framework for transforming pharmacy education to be more responsive today and ready for tomorrow.