The main results of this study demonstrate nearly all European countries (95.2%) include CP as part of the undergraduate curriculum, which goes along with increasing clinical activities provided by pharmacists.  Previous literature shows an increased uptake of clinical courses related to medical sciences in pharmacy curricula of European countries. 
Three countries did not include practical teaching of CP in their undergraduate curriculum, possibly entailing that students in those countries are not acquiring full clinical competence as the combination with practical training is deemed necessary according to Miller’s educational model.  In fact, this finding was reiterated by EPSA students’ perceptions where all respondents considered they should have more practice-based learning in CP. The variety of reported contact hours and ECTS may have implications on mobility programmes (e.g., Erasmus +) and on early career capacities of recent graduates to engage in CP activities.  The analysis of the impact of different levels of CP education and practice within countries justifies further studies. The European legislation provides general guidance into the areas to be included in pharmaceutical sciences education  but is then transposed nationally with room for the development of varied curricula, demonstrated through various studies. [12–13;21] Previous research has shown that the proportion of patient-centred courses in pharmacy curricula across Europe varied from 20 to 54%, leaving clear that recent graduates from e.g., Malta or the Netherlands, with a higher load of patient-centred care courses, are probably better prepared to engage in CP compared to those graduating in e.g., Greece or Macedonia, with a lower load of such courses.  Student representatives expressed a general lack of confidence in their preparedness to engage and deliver CP activities, possibly explained by their maturity at this stage but also by the perceived unfitness of education for CP practice. Only students from the UK perceived their undergraduate education to be totally fit for practice. Conversely, only Serbian students perceived it as totally unfit for practice. Fitness for practice does not solely result from the amount of time devoted to specific topics but also from the adequacy of learning methods used and, in this aspect, there was a mismatch between the existing methods and the desired ones. There was a perception of excessive lecture-based learning and insufficient practice-based learning. However, the use of problem-based learning or team-based learning was aligned with students’ desires and needs.
Postgraduate education in CP was widely disseminated, although with varying models of delivery in terms of the extent and structure of the courses available in each country. Various courses were reported in the domain of CP, many of which named in alignment with daily clinical activities.
More than half of the countries have CP as a recognized specialty. Specialization may not be a prerequisite for advanced CP practice, as in fact, some countries deliver high quality CP services in the absence of a specialization in CP, including the UK and Malta. [7;19] Notwithstanding, 60% of respondents stated that this specialization was solely applicable to the hospital setting, which suggests a need for greater investment in the development of CP in the ambulatory setting for better alignment with the Astana declaration. 
Although some European countries referred to specific areas of specialization within CP, these were less varied in scope and less structured according to areas of practice, compared to the 14 areas adopted in the US. 
Clinical pharmacists’ career paths vary widely between European countries, with some needing a specific postgraduate specialization and others providing clinical activities in various settings based on undergraduate education and CPD courses. This finding suggests a unified and structured career path for clinical pharmacists across Europe is needed. A minority of countries reported to have competency frameworks, and those that have such frameworks tend to include CP. Such frameworks are essential to identify a career path and levels of advanced practice and expertise in a certain area. 
Most European countries have pharmacy education and training quality assurance systems but seldom focused on CP. [26–27] The implementation of common training quality standards for CP education and practice can further support and standardize education and practice across Europe. There was no association between the extent of CP education and the recognition of CP as a specialization, suggesting that such recognition does not necessarily reflect a higher quality of CP education and training. This fact may also compromise mutual recognition of CP specialization between member states. Therefore, recognition of CP as a speciality domain calls for a standardised pan-European approach.
This study also highlighted that the currently approved ESCP definition is supported and accepted widely in European countries. Even though this finding is reassuring, most respondents were ESCP members, thus external validation by other clinical pharmacists not affiliated with ESCP will be worth exploring in the future.
This study has strengths, including the high representation of European countries and the robust approach to data validation. For most countries (n = 28, 70%), level 2 evidence was obtained, and for seven countries, level 3 evidence was ensured. Only in five countries (Albania, Finland, Kosovo, North Macedonia, and Slovenia), evidence was limited to level 1.
Although this mapping exercise was open to contribution by all CP academics and practitioners, the dissemination process led to a self-selected sample, where most participants were likely ESCP members or associates of the EAFP. The inability to identify the best respondent per country led to multiple responses and the need to resort to participatory methods and extra data validation steps. Time between the dissemination of the survey, data analysis and publication may have led to outdated information due to the dynamic nature of education and professional practices. The sample used to illustrate students’ perceptions did not span all European countries for which responses have been obtained in the primary survey. The views may not necessarily reflect final year students or all students, and perceptions are not necessarily evidence based. Nonetheless, the information collected was useful to supplement the main study findings and not used for validation purposes.