Antimicrobial stewardship programs (ASPs) are pivotal in limiting the spread of antimicrobial resistance. Pharmacists are key members of healthcare teams, and to effectively participate in ASPs as antimicrobial stewards, they must receive proper training during pharmacy education before entering professional practice. Although ASP-related curricula have been introduced in entry-to-practice programs globally, there is limited understanding of how students analyze antimicrobial stewardship (AMS) data and make clinical decisions. This study aimed to investigate students’ cognitive strategies and how they develop therapeutic decisions when handling AMS cases. A qualitative case study design was employed, recruiting a sample of pharmacy students (n=20) to interpret AMS scenarios. Individual semi-structured interviews were conducted with each participant. A think-aloud method with verbal protocol analysis was used to explore students’ decision-making approaches. Thematic analysis was applied to identify patterns and themes in the interview responses. Two main themes emerged: students’ focus and their case interpretation strategies. The focus theme captured the external factors students considered when analyzing AMS case data and justifying therapeutic decisions, including patient-centered considerations, drug-related elements, AMS interventions, and pharmacists’ roles. The clinical reasoning theme described the approaches students used to process the data and reach decisions, distinguishing between systematic and non-systematic strategies. Students demonstrate variation in both the focus and cognitive strategies used to interpret AMS cases. The findings highlight the importance of explicitly teaching clinical reasoning and decision-making in pharmacy programs to enhance students’ awareness of their cognitive processes and decision-making skills.
