Association of Clinical Pharmacy Training and Workload of Clinical Pharmacists in Tertiary Hospitals of China | BMC medical training

Study design and participants

The healthcare system in China follows a 3-tier hierarchical structure. This study only considered clinical pharmacists in tertiary hospitals because clinical pharmacy services are underdeveloped in most primary and secondary health care settings. [38, 39].

The inclusion criteria were: (1) working as full-time clinical pharmacists in the sampled hospitals; (2) undertake specific tasks involving the management of pharmaceuticals, patients, or medical information; (3) be available to participate in the study by completing the questionnaire which would take approximately 15 to 30 minutes; and (4) be prepared to sign the informed consent document. Clinical pharmacists in training (students in externship or internship) and visiting clinical pharmacists were excluded.

A stratified sampling strategy was adopted. First, all 31 provincial administrative regions (including provinces, autonomous regions and municipalities) of mainland China were covered by the sample. Then, the cities in each provincial administrative region were equally divided into 3 groups based on their gross domestic product per capita in 2018, thus generating 93 groups. Within each group, 1 city or district was selected using the random number method; thus, 93 cities or districts were selected. In each selected city or district, 2-4 tertiary hospitals were interviewed for convenience based on the permission of hospital administrators. In each surveyed hospital, 2 participants were referred by the hospital administrator(s) or another participant who completed the survey [40]. A total of 744 questionnaires were distributed.


A panel of experts consisting of 2 administrators and 2 teaching clinical pharmacists from tertiary hospitals, as well as 3 university experts in clinical pharmacy training, were consulted for the design of the questionnaire. The questionnaire consisted of the following 3 sections:


Sociodemographic data (gender, age, marital status), technical title, years of practice, specialty area and hospital characteristics were included.

Education background

The training system for clinical pharmacists in China consists of three components: medical and pharmaceutical education with a formal education record, basic training, individualized training provided by training or academic organizations [41]. Therefore, this study identified the level of education of pharmacists through the following three indicators: level of higher education, qualification of practice and training experience.

For higher education, this section collected information on whether respondents graduated from a certain level of education and the type of degree. Considering that the types of degrees of clinical pharmacists are diverse [20], this question was defined as a question to be filled in according to the suggestions of the experts. The researchers divided the degree types into seven groups based on the expert panel’s recommendations, namely Pharmacy (General), Clinical Pharmacy, Chinese Materia Medica, (excluding the three above) the other pharmacy, clinical medicine, (except clinical medicine) the other medical specialties, (except the six above) other specialties. Practice qualifications include nationally and provincially standardized training in specialty and general medicine. Training experience includes Ministry of Health Clinician Pharmacist Training Completion Certificate, Clinical Pharmacist Advanced Training Certificate, National Health Commission Clinical Pharmacist Faculty Training Certificate and of family planning, any training abroad as a clinical pharmacist and (except the above) other training.


There was no suitable instrument to measure the workload of clinical pharmacists in tertiary hospitals in China [42, 43]. This study measured this based on the extent of their clinical work developed. The Standards of Practice for Clinical Pharmacists (SPCP) was originally in English and translated by a native English speaker who is fluent in Chinese and a Chinese translator proficient in Chinese-English translation separately. Subsequently, the 2 versions were reviewed, synthesized and revised by the 2 translators and the panel of experts until they reached a consensus on all the translations. The final scale was formed with reference to the SPCP and Arrangements for the administration of pharmaceutical affairs of medical institutions. A total of 12 questions that mainly covered the routine tasks of clinical pharmacists in tertiary hospitals in China were used to measure the scope of clinical work developed by clinical pharmacists. Each question was provided in the form of a full description and presented to participants as follows: “Have you undertaken the task yet? with a response on a 5-level Likert scale, ranging from 1 (strongly disagree) to 5 (strongly agree). It is the total score that was included in the regression analysis.


A pre-test of the questionnaire was conducted among 47 clinical pharmacists from 24 tertiary hospitals in 6 cities in Jiangsu Province, China in April 2019 by convenience sampling. The reliability of the workload instrument was acceptable (Cronbach’s alpha 0.63 for the workload instrument). The final questionnaire is available online as Supplementary File 1: Annex 1.

Data gathering

A total of 46 undergraduate students majoring in general pharmacy or clinical pharmacy were recruited as data collectors. They have been trained to be able to access the potential participant and familiarize themselves with the procedure for conducting the survey and the standardized explanations for potential participant questions. All 2 data collectors surveyed 1 set of geographically neighboring cities or districts in July and August 2019. After obtaining consent from hospital administrators, data collectors asked potential participants for their background information to determine if they meet the inclusion criteria for the study. . Then, they informed eligible participants of the objectives, content and requirements of the survey and confirmed their willingness to participate again. Those who were willing to participate signed the consent form and decided on a time and a quiet location for the survey with the data collectors.

Data collectors verbally interviewed participants with each item of the questionnaire and recorded their responses via an online survey system on mobile phones or tablets. Which would convert the data into electronic documents. Data collectors were not permitted to comment on the questionnaire except for requirements or instructions for completing the questionnaire. The survey system allowed users to set restrictions on the format of responses and ensured data quality. A total of 5 postgraduate students were recruited and trained to review uploaded documents and immediately return those with data entry errors or damaged data, which were corrected during return visits by data collectors when necessary. was possible. [40].

Data analysis

Descriptive statistics were used to account for the characteristics of the sample. Ordinary least squares regression was used to assess the association of each independent variable with clinical pharmacy workload. Multicollinearity was assessed by examining the variance inflation factor (VIF). An independent variable with a VIF value greater than 10 means that it exhibits collinearity with the other independent variables and should be deleted. The VIF was examined again when an independent variable with the highest VIF greater than 10 was removed. This was repeated until multicollinearity was no longer suspected. Three levels of statistical significance were established in this study, namely ppp

To assess the robustness of the results, clinical pharmacist job satisfaction was included in the regression model as a covariate. The similarity of the results of the two models could support the relative robustness of the final model. Stata 15.0 was used for data analysis.

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