International Journal of Clinical Pharmacy

, Volume 41, Issue 6, pp 1471–1482 | Cite as

Community pharmacists’ clinical reasoning: a protocol analysis

  • Mohammad B. Nusair
  • M. Ken Cor
  • Mary Roduta Roberts
  • Lisa M. GuirguisEmail author
Research Article


Background There are two fundamental approaches to clinical reasoning, intuitive and analytical. These approaches have yet to be well explored to describe how pharmacists make decisions to determine medication appropriateness. Objective (1) to identify the cognitive actions (i.e., operators) that pharmacists employ when they move from one cue (i.e., concept) to another, and (2) to describe the overall clinical reasoning approach taken by pharmacists when checking for medication appropriateness. Setting Pharmacists from a chain pharmacy in Canada were invited to participate in this study. Method Data was collected in private rooms using video recordings to capture simulated patient–pharmacist interactions of a new prescription medication. A simulated case scenario was used to gather two types of verbal reports, concurrent think-aloud and structured retrospective think-aloud from pharmacists. All verbal reports were video-recorded, transcribed verbatim, and analyzed using protocol analysis. Main outcome measure Pharmacists’ reasoning approaches when making medication appropriateness decisions. Results A total of 17 pharmacists participated. Pharmacists were most likely to use analytical clinical reasoning approaches when checking prescriptions and three used no clinical reasoning. When the pharmacists were asked specific questions regarding the decision-making model for pharmacy (i.e., check for indication, efficacy, safety, and adherence), 50% reported using analytical decision-making approaches, with a third of the decisions being made in hindsight. Conclusion The majority of the pharmacists followed an analytical decision-making approach to clinical reasoning. When the pharmacists were asked prompting questions about their medication-related decisions, they employed a combination of intuitive and analytical approaches. The pharmacists had the competency to check for medication appropriateness; though this knowledge was mostly restructured during the process of hindsight reasoning.


Clinical decision making Community pharmacy services Observation Patient simulation Pharmacist 



The authors express gratitude to the pharmacists who participated in the study.


This project was funded by a grant with a Pharmacy Chain in Canada. The funding agreement ensured the authors’ independence in designing the study, interpreting the data, writing, and publishing the report.

Conflicts of interest

The authors declare no conflicts of interest or financial interests specific to the content of this manuscript.


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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Faculty of PharmacyYarmouk UniversityIrbidJordan
  2. 2.Faculty of Pharmacy and Pharmaceutical SciencesUniversity of AlbertaEdmontonCanada
  3. 3.Faculty of Rehabilitation MedicineUniversity of AlbertaEdmontonCanada
  4. 4.Faculty of Pharmacy and Pharmaceutical Sciences, Edmonton Clinic Health AcademyUniversity of AlbertaEdmontonCanada

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