This study addressed a few major issues related to MCs including perceptions towards MCs and its relationship with CPD/CE, the role of universities with regards to the provision of MC courses, the need for such courses, and, finally, foreseeable challenges with regards to its implementation. Recruiting participants from a range of countries was meant to provide us with a wider cross-section through sampling countries (and practices) that would allow us to compare and contrast possibilities and challenges as expressed by our selected individuals, and how these differ between countries. We feel this information would be valuable to readers in different locations in the world.
Most of the participants acknowledged the unique features MCs had to offer, such as being less costly, more flexible and easily accessible. This was in line with findings from the literature search that was conducted which explored MCs and its use in other professions [17–23]. Participants expressed interest in utilising MC courses tailored to their own field in pharmacy which provides the opportunity to acquire the required level of skills necessary to specialise within a certain area. Practitioners may be attracted to this trainee-centered approach, which would allow them to better invest their time to fulfil their own learning and training needs. Equally attractive to participants was that MCs offer the chance to pursue topics according to their own interests and desires which can be interpreted as the freedom and power to direct their own professional development. Indeed, the literature on MCs suggested these courses helped students’ exercise full autonomy while identifying the courses appropriate to their needs in various settings .
The interest expressed towards MCs shows pharmacists wanting to improve their professional skills, provided they could integrate the training easily into their daily schedules. This has been found in earlier research where a survey revealed that 34% (n = 1,239) of PharmD students in the US exhibited the desire to pursue additional training after graduation . Additionally, throughout the last few years there has been a clear shift of pharmacists from a traditional dispensing role to a more clinical patient-centered role . The shift to a more clinical role requires synthesising and linking the pharmacist’s clinical knowledge together. As some pharmacists may have been in the traditional dispensing role for a long time, small MC courses may be what is required to boost the pharmacist’s confidence and offer an accredited set of skills and knowledge to fulfil the growing expectations in their profession.
Doubts around the recognition and acceptance by the relevant stakeholders were expressed. MCs are a relatively new concept, and many people are still unfamiliar with what they are and how they can help a pharmacist progress. However, some participants in this study argued that digital badging (DB) linked to MCs offer enough transparency and are self-explanatory by nature. This is in accordance with the current literature, which agrees DBs are an enriched symbol that houses valuable information with regards to one's skills and accomplishments [27, 28]. Similar concerns were also reflected in previous studies that explored the effect of DB systems amongst the workforce [29–31]. Thus, lack of recognition and acceptance is a potential issue that may be remedied over time, as MCs begin to flourish more within the healthcare setting and subsequently raise more awareness.
Other notable challenge perceived by participants related to the nature of MC courses being short and discrete components of learning. The growing complexity of patient’s medical health needs have been highlighted by numerous studies [32–34]. As people live longer, healthcare professionals are dealing with increasingly complex cases and MCs may lack the ability to reflect real life practice. Some participants questioned if MCs would be able to approach learning in an integrated and holistic manner. MCs might be more suited to address basic and foundational skills/knowledge required in pharmacy but whether they will be able to address deeper content remains an area to be explored through research. It is possible to create MC courses dedicated to specialised and complex cases, however, such courses will require specialist knowledge and will only target a small audience as it may not be relevant to most healthcare professionals in their everyday practice.
Overall, participants seemed to advocate for the idea that MCs could offer an alternative pathway to fulfilling CE/CPD requirements, with the added benefit of enhanced flexibility, accessibility, and convenience. This comes from the participant’s personal experiences with the more traditional ways of fulfilling CE/CPD requirements such as via conferences, seminars, workshops - all of which demand physical attendance and substantial time and money. Current literature recognises such factors are major barriers toward the participation of these activities [35, 36]. MCs are perceived as having the potential to dismantle some of these barriers. As mentioned in the literature, MCs break learning into small chunks, allowing busy professionals to continue learning, whilst quantifying and documenting their development in a verified manner . Our results support this finding and it is a highly attractive quality for the pharmacy profession. Research did show how the underlying principles of MCs align closely with the core values of CE/CPD in healthcare, i.e. self-directed, based on learning needs and having defined outcomes . Seeing traditional CE/CPD are deemed ineffective, it may be worthwhile to trial MCs . There is also concern some CE/CPD providers are unable to identify and respond to individual pharmacy needs . Participants generally shared the insight that MCs would enable pharmacists to get the most out of their CE/CPD requirements, making their learning more valuable and applicable to their own practice.
Our study highlighted some concerns around the practical design, quality and assessment of MC courses. Many participants highlighted that if such a system were to be implemented, it must be robust and challenging enough to match the academic standards of traditional CE/CPD programmes. Despite MCs being relatively shorter, it should not compromise the strict academic expectations. A certain degree of apprehension exists with regards to the possibility MCs could prevent pharmacists from pursuing higher education such as postgraduate studies but further research is needed to make this conclusion.
To date, no MCs have been studied within the context of pharmacy CPD/CE although they appear promising in other settings such as the teaching and medical field [17, 18, 23]. This study reveals practitioners see MCs as a viable option to help pharmacists fulfil their CE/CPD requirements. These results also confirm the ideas present in previous papers, which state MCs can address the gap for those who need continuous skill/knowledge updates, such as those who work in a highly transformative healthcare setting .
There was consensus that universities are well placed to create and deliver MC courses for the pharmacy profession. A number of MCs are already provided by leading universities, such as MIT and Harvard [39–41]. Participants offered various reasons for their views: universities’ expertise in academia, being a great addition to the training/education they already provide and its reputation in delivering quality education. It was noted the rankings of those that provided such courses were important, suggesting participants placed an emphasis on the prestige and reputation of the provider. Ultimately, this implies the driving force for pursuing MCs is the desire to obtain quality education and such achievements need to be recognised by others.
Other participants built upon the idea by highlighting the need for universities to collaborate with local practitioners to ensure courses reflect current, real life practice. A couple of participants indicated the explicit need for universities to implement such courses for the ongoing training of pharmacists as many of the external organisations have been regarded as less cultivating and operate heavily in the interests of business profit.
Participants also affirmed the idea MCs and its DBs were an innovative way to showcase to peers or other HCPs the skills/knowledge they have. An earlier paper found pharmacists who earned DBs reported elevated feelings of self-worth and increased recognition by other HCPs . Other studies also found DBs a great way to illuminate one's skills/knowledge for employers. In light of these results, it seems fair to suggest verification/acknowledgement of one's competencies is highly desirable. Thus, within the context of pharmacy, DBs allow more transparency of the individual pharmacist’s expanding skill sets, translating into better utilisation of their skills and expertise.
In agreement with other research [6, 43, 44], our findings suggest the length of time an MC course takes to complete is a major determinant of whether it will be considered. Although time constraints are well known to researchers , the aspects of cost have been largely unexplored. Different countries offer pharmacists different salaries, therefore cost is relative to each situation and depends on factors such as who will pay for the costs, who will fund the courses and who will run the courses. Some pharmacists aren’t required to participate in CE/CPD and for those, any cost associated with the courses may not be popular. Limitations aside, this study revealed the concept of cost is more complex than previous studies suggest . Adding directly to cost is technology, which is expected by participants to be advanced and affordable with MC courses. Another point to consider is if participants do not have the technology at home which places them at an instant disadvantage and provides even greater time constraints for completing these MC courses.
Participants described individual motivation as a potential challenge. This stems from the worry of the time and effort spent pursuing these courses which may not be recognised by others and the fear of exploring something beyond traditional learning methods. Considerable effort seems to be required to promote and advertise MCs to pharmacy practitioners and show the positive impact it can have on one’s career. In line with other research, there is concern regarding the lack of applicability of MCs to each and every practicing environment , ultimately hinting each MC must be tailored to that specific country to provide value that can serve the profession.
These findings advance our understanding and provide further insight into the need for legislation and regulation around MC courses so standards of care are kept and competencies are made. Previous studies have discussed the fact that legislation is more difficult to change than regulations .
Participants suggested formal recognition of MCs so they could contribute to the development of pharmacy practice and to the advancement of the profession. This aligns with finding from earlier studies outlining that addressed the issue of recognition and relevance of MC courses especially when compared to more traditional degrees [46, 47].