In pharmacy education, experiential learning through standardised patients, Observed Structured Clinical Examinations (OSCEs), and classroom-based simulations has been essential for developing practical skills and bridging theoretical knowledge with real-world application (Gharib et al., 2023a). However, the increasing number of pharmacy students and associated logistical and financial constraints have strained traditional placement opportunities, highlighting the need for alternative, scalable methods to complement experiential learning (Hall et al., 2012; Mai et al., 2019).

Computer-based simulation (CBS) represents a promising solution in healthcare education, offering virtual simulations of clinical scenarios that allow users to replicate the roles and responsibilities of healthcare professionals in a controlled, risk-free environment (Mai et al., 2019; Cook et al., 2011; Benedict and Schonder, 2011; Duff et al., 2016; Seybert et al., 2019). This technology not only provides a scalable and interactive platform for repeated practice and immediate feedback to students (Gharib et al., 2023a; Jabbur-Lopes et al., 2012), but also aligns with Kolb’s experiential learning theory by fostering critical thinking and clinical reasoning through active problem-solving and decision-making (Ried et al., 2002; Looyestyn et al., 2017; Jaber and Al-worafi, 2023). Additionally, CBS enhances communication and teamwork skills by simulating interdisciplinary interactions and patient counselling (Rash et al., 2024; Phanudulkitti et al., 2023).

Despite the availability of various CBS solutions in the market, their utilisation in pharmacy education remains relatively low. There is a significant gap in the literature concerning the perspectives of key educational stakeholders, including educational institutions, educators, and students, on the barriers and facilitators to CBS implementation in pharmacy education. Distinct stakeholders may have varying needs, which could directly or indirectly influence the success of the implementation process (DiVall et al., 2014). While the benefits of CBS in healthcare education are well-documented, comprehensive global data on its use in pharmacy education remain scarce. Most of the existing research focuses on individual institutions or specific tools, lacking a broader perspective on the challenge and enablers of CBS adoption across different global regions.

This study aims to fill the gap by exploring the global views of both students and educators on CBS usage across six WHO regions. The insights gained are expected to provide valuable guidance to stakeholders in pharmacy education, potentially influencing future practices and policies related to CBS. By addressing this research gap, the study seeks to contribute to the advancement of pharmacy education through the adoption of innovative and effective teaching methods.

Between March and September 2023, two parallel, cross-sectional, mixed-methods online surveys were conducted to explore global perspectives on CBS in pharmacy education. One survey targeted pharmacy practice educator, and the other targeted students. The surveys followed an exploratory approach to align with the study’s objectives (Watling and Lingard, 2012; Jansen, 2010; Guetterman et al., 2019), as described in Figure 1.

The surveys captured a comprehensive global perspective, gathering insights from 152 educators across 38 countries and 392 students from 46 countries (see Figures 2, 3). The largest group of educator participants was from (AMRO) with (33.6%, n = 51), while (AFRO) had the lowest representation of (5.9%, n = 9). Among students, EMRO had the highest participation of 100 students (25.5%), while the AFRO again underrepresented with 21 students (5.4%), see Table 1.

The educators’ teaching experience was fairly balanced, with (51.3%, n = 78) having more than 5 years of teaching experience, and (48.7%, n = 74) having 5 years or less. Students tended to be more experienced, with (73.5%, n = 288) having less than 2 years remaining in their pharmacy program, and only (26.5%, n = 104) having more than 2 years left.

This study explored the perceptions and experiences of pharmacy educators and students across various global regions regarding the integration and utilisation of CBS in pharmacy practice education. The findings provide significant insights into the current state of CBS adoption, and the barriers impacting its widespread implementation.

The findings indicate a significant gap between the recognised value of CBS and its practical application within pharmacy curricula, with 81 educators (53.5%) and 156 students (63.7%) reporting insufficient usage. Similar to findings in broader healthcare education, educational technologies are often underutilised despite their proven benefits (Unsworth, 2020). These results suggest initiatives to improve adoption of these technologies may be well received by students and educators alike, especially if the solution is capable of training students in their prioritised skills (clinical problem-solving and communication skills) and can model both community and hospital practice.

Educators also indicated overwhelmingly that workload factors were one of their main priorities. They indicated a desire for ready-made scenarios, and solutions which reduce workloads. This is likely a significant issue for most of the existing CBS solutions which require educators to undertake works to both author new case-based scenarios and integrate these scenarios into their curriculum. Based on this feedback solutions which include features to minimise or reduce overall workload, such as off the shelf scenarios and curriculum content, automated assessments/grading, and those that leverage generative artificial intelligence, are likely to be well received by educators.

The barriers to CBS implementation are multifaceted, encompassing technical, financial, and institutional challenges. While major technical issues were not reported as significant barriers, the presence of minor technical problems that were encountered by 130 students (53%) and 53 educators (53.5%), suggests ongoing challenges that can disrupt the learning experience.

Financial constraints and insufficient technical support (reported by 86 educators (56.6%) and 81 educators (53.3%), respectively), requires targeted resource allocation. While the results indicate that a majority of educators who had experience with using CBS, view CBS as both affordable (53.5%, n = 53) and cost-efficient (75.8%, n = 75), there are still underlying concerns among some educators regarding the initial costs and time investment required for its integration into the curriculum. These concerns may stem from the broader context of budget constraints and inadequate infrastructure, challenges that are well-documented in the literature when integrating new educational tools into academic settings (Haleem et al., 2022; Graham, 2013) and, where the upfront costs of new technology can deter its adoption (O’Doherty et al., 2018).

Research to demonstrate the long-term benefits and cost-effectiveness of CBS could help alleviate the above concerns and foster broader acceptance among educators. Additionally, investing in robust IT support systems and adequately funding computer resources to mitigate minor technical issues is likely to improve uptake and student acceptance within institutions.

Both educators and students reported high levels of comfort with using CBS, which aligns with existing studies indicating a general positive attitude toward technology-enhanced learning in healthcare education (Bennett and Maton, 2010). However, it is noteworthy that a small but significant proportion of both groups expressed neutrality or disagreement regarding their comfort with CBS. This variation may be due to differing levels of digital literacy, as suggested by previous research highlighting the impact of digital competence on the adoption of educational technologies (Bennett and Maton, 2010). Tailored training and support to address these differences, and CBS features which help to support and onboard new users, could enhance the effectiveness and acceptance of CBS across the board.

There was a slight divide in perceived likelihood of CBS integration initiatives being supported–students generally believed educators and institutions were less likely to lend their support, while educators were a little more optimistic, with a greater percentage of “Very Likely” responses and fewer “Not Likely” responses. This student scepticism may stem from past experiences where new initiatives were introduced without sufficient follow-through, a common issue in educational reform efforts (Rogers et al., 2019). This gap also may reflect a communication barrier between students and faculty or a lack of transparency in institutional decision-making processes (Chen et al., 2020). On balance however, both students and educators tended to agree that such initiatives were at least “Somewhat Likely” to be supported across the board, with no clear trend to suggest that any particular stakeholder group would be in firm opposition.

Although this study was not designed to capture this data, we do note that a number of educators indicated they make use of professional software systems like PioneerRx, FredDispense, and Oracle as CBS substitutes. While offering practical benefits by helping to produce practice ready graduates, we would note some minor concerns with this approach. These tools, designed for specific industry tasks (e.g., dispensing, stock management, record keeping), risk narrowing students’ learning by focusing on procedural skills, rather than fostering a patient focus. Unlike tools designed for educational purposes, such as MyDispense, Pharmacy Simulator and SimPharm, dispensing software are also not designed to provide user-friendly assessment and feedback suitable for students. Proper use of these tools should be scaffolded with sufficient instructional guidance and other exercises, such as patient counselling role-plays, to be utilised effectively. This approach presents its own set of logistical and resourcing challenges. We would suggest that educational institutions critically assess this balance to ensure that these tools complement rather than dominate the curriculum, preserving the core aim of developing well-rounded, adaptable pharmacists.

It is unsurprising that in developing regions such as Southeast Asia (SEARO) and Africa (AFRO), access to technical and financial support presents a greater concern. These findings align with broader trends in the literature that highlight the ongoing challenges faced by educational institutions in low- and middle-income regions, where limited infrastructure and resources often impede the integration of advanced educational technologies like CBS (Naresh and Reddy, 2015). The concern raised by respondents in the Western Pacific region (WPRO) likely reflects the constrained higher education landscape in Australia, where many universities have been grappling with financial difficulties due to reduced international student numbers following the COVID-19 pandemic (Almaiah et al., 2020; Carnegie et al., 2022). This financial strain has led to widespread budget cuts, staffing reductions, and the scaling back of technological investments in teaching and learning (Carnegie et al., 2022). Such factors may have contributed to the concerns around financial and technical support for CBS integration in this region.

This study builds on previous research by providing a more comprehensive, global perspective on CBS adoption in pharmacy education. Unlike earlier studies that primarily focused on specific tool integration and specific institutions, this research captured insights from 152 educators from 38 countries, and 392 students from 46 countries, spanning six WHO regions (AFRO, AMRO, EMRO, EURO, SEARO, and WPRO). Moreover, the widespread support for CBS from both educators and students suggests that greater inclusion of CBS in daily pharmacy education practice could enhance student skills in areas such as communication and problem-solving, while also addressing educator concerns about workload.

The reliance on self-reported data from surveys may introduce bias, since the topic may have primarily attracted individuals who are already interested in CBS or supportive of its use. This self-selection bias could potentially impact the results towards more positive perceptions of CBS, limiting the generalisability of the findings.

We also acknowledge that participants’ knowledge and experience with CBS does vary. Some participants may have only a passing interest in the technology, while others may have extensive experience using it. This variability in familiarity could impact the depth of their perspectives, with those who have limited experience potentially offering narrower or unsubstantiated views. Many participants were also found to have only used a single CBS tool, which restricts their ability to provide a comprehensive assessment of CBS technology more generally.

A key limitation of this study is the regional imbalance, especially the low participation from the African Region (AFRO), with only 5.9% of educators and 5.4% of students represented. This limits the reliability and generalisability of the data for those areas. While this study analysed data at the regional level, significant country-level differences within regions may exist, particularly in regions like Europe or the Americas where economic and educational development varies considerably. It is worth noting that certain countries dominated regional responses. For instance, in the educators’ survey, the USA contributed 82.4% of AMRO responses, India 60% of SEARO, Egypt 26.7% of EMRO, Ireland 32% of EURO, and Australia 50% of WPRO. This made it difficult to compare between countries in the same region, as sample sizes were diminished at this level of granularity. Future research should aim for more balanced regional representation through targeted recruitment in underrepresented regions to offer more granular insights.

We also attempted to complement the quantitative data with qualitative insights by asking participants to voluntarily share additional comments. However, the response rate for these qualitative inputs was very low, limiting our ability to explore more in-depth perspectives (Andrade, 2020). The scarcity of qualitative feedback highlights the challenges of relying on voluntary responses in survey-based research, particularly with global recruitment. Future research could benefit from employing dedicated qualitative methods, such as interviews or focus groups with educators and leaders, to gain further insights to complement the results of our surveys. This research could potentially explore socio-cultural factors affecting CBS adoption across different educational settings. Understanding these influences may be crucial for developing effective, inclusive strategies tailored to the diverse needs of global educational environments and help guide the future development of CBS systems.

This study provides valuable insights into the global perceptions of CBS implementation in pharmacy education, highlighting its potential and the barriers to broader adoption. Both educators and students expressed comfort with CBS and recognised its value in developing essential skills, such as communication and problem-solving. However, significant gaps in its utilisation were identified, with educators particularly highlighting workload concerns and a desire for CBS to help reduce this. Financial constraints and limited technical support were also notable barriers, especially in SEARO, AFRO, and WPRO.

The regional disparities in CBS adoption suggest that, while there is strong support for integrating CBS into pharmacy curricula, targeted efforts are needed to address the unique challenges in different regions. Based on our study’s findings, educators, policymakers and institutions seeking to implement CBS should ensure they have adequate resources, including appropriate computer hardware, technical support, and training, to increase the chances of success. CBS developers should focus on creating tools that support students in practising problem-solving and communication skills in both community and hospital settings, and prioritise features which might reduce educators’ workloads.

By addressing these barriers, pharmacy education can fully harness the potential of CBS to enhance empirical learning and better prepare students for real-world clinical practice.