TY  - JOUR
T1  - From Simulated Medication Errors to Safer Pharmacy Practice: A Systematic Review of Instructional Design, Assessment Validity, and Evidence of Learning Transfer
A1  - Julia Berg
A1  - Hassan Al-Rashid
A1  - Maria Santos
JF  - Annals of Pharmacy Education, Safety, and Public Health Advocacy
JO  - Ann Pharm Educ Saf Public Health Advocacy
SN  - 3108-4850
Y1  - 2023
VL  - 3
IS  - 2
DO  - 10.51847/xI7Qt9FLVS
SP  - 152
EP  - 166
N2  - To examine how medication-error simulations in pharmacy education and practice are designed and assessed, the extent to which resulting assessments support valid interpretations of learner performance, and whether improvements demonstrated in simulated settings transfer to clinically relevant behavior or safer pharmacy practice. A systematic review was conducted using PRISMA 2020 reporting principles. Searches captured pharmacy-focused medication-error, medication-safety, error-disclosure, medication-reconciliation, order-verification, root-cause-analysis, dispensing, and related simulation studies. Candidate records were screened against prespecified population, simulation, outcome, and empirical-design criteria. Instructional designs were coded separately from assessment characteristics and from learning-transfer level. Assessment evidence was examined according to construct alignment, scoring processes, reproducibility or assessor agreement, external relationships, and the strength of inference permitted. Transfer was classified from reaction or confidence outcomes through immediate learning, delayed or changed-context performance, workplace behavior, and patient- or safety-level outcomes. Twenty-seven unique candidate records entered the screening process. Seven were excluded during title/abstract or concept screening, leaving 20 for detailed eligibility assessment; three were excluded at that stage, yielding 17 included evidence units. Simulations included root-cause analysis, medication reconciliation, electronic order verification, error disclosure, dispensing and virtual-pharmacy tasks, clinical decision-support scenarios, and error-rich environments. Objective performance measures were present in several studies, but confidence, attitudes, self-assessment, and immediate simulated performance remained common outcomes. Most evidence was confined to proximal educational outcomes or repeated performance in simulated contexts. Direct evidence of workplace transfer was exceptionally limited and vulnerable to attrition and self-report bias. No included evidence established a patient- or medication-safety effect attributable to simulation. Medication-error simulation can support measurable learning and performance within pharmacy education, but the strength of the resulting claims depends on both assessment quality and outcome distance from practice. Current evidence supports educational value more strongly than it supports generalized claims that simulation improves routine-practice medication safety.
UR  - https://smerpub.com/article/from-simulated-medication-errors-to-safer-pharmacy-practice-a-systematic-review-of-instructional-de-yppaalqxvvgpxmr
ER  -