Barriers And Facilitators Of Using MyDispenseTM From The Student Perspective : A Systematic Review

1. Introduction

Pharmacy students need to complete a curriculum aligned with accreditation standards to ensure they demonstrate the competencies required as a pharmacist[1,2]. Pharmacy practice can be simulated through a wide range of pedagogical methods e.g.) workshops, experiential learning opportunities and using standardised patients in observed structured clinical examinations (OSCEs). Logistical challenges associated with incorporating actors as patients to simulate clinical practice, however, may limit their applications and novel approaches are required to meet pharmacy curricular outcomes[3].

Pharmacy education has evolved with technological advancements. The COVID-19 pandemic drove a shift for educators to implement virtual pedagogical methods into pharmacy curricula e.g.) computer-based simulations (CBS), which enhance digital literacy and provide engaging learning experiences[4,5,6,7]. CBS can be defined as an interactive computer simulation model of patient-clinician interactions, that allow learners to emulate healthcare professional roles to obtain a full patient history, conduct physical health check-ups and to make appropriate diagnostic and therapeutic decisions[8]. Active learning methods e.g.) CBS can be more effective at improving student performance in formal assessments relative to passive learning methods[9]. Alternative learning methods are particularly important for Generation Z (those born between 1997 and 2012[10]) who are currently the primary demographic cohort of students within third-level education. This digitally literate generation tends to benefit from blended learning approaches[11].

MyDispense^TM is a high-fidelity, low-stakes, web-based, community pharmacy simulation developed by the Faculty of Pharmacy and Pharmaceutical Sciences at Monash University in Queensland, Australia[12]. MyDispense^TM has a global reach, being implemented in over 200 institutions across 30 countries worldwide[12]. MyDispense^TM allows students to develop their dispensing and counselling skills without the risk of patient harm in a virtual pharmacy sandbox environment[13,14]. MyDispense^TM can also be used in senior years of pharmacy programs as a supplementary learning resource to prepare students for OSCEs and pre-registration assessments[6].

Virtual patients act as a novel nexus between clinical theory and practical applications for students, acting as an accessible alternative to standardised patient actors and experiential learning opportunities, whereby recruitment and scarce placements can pose logistical challenges[15]. MyDispense^TM supports active self-learning by providing instant feedback and repeat exercises, reinforcing critical thinking, clinical reasoning and problem solving skills[16]. These skills align with Kolb’s learning model and Miller’s learning framework, meeting pharmacy program outcomes[16]. Despite these advantages, the use of virtual patients in pharmacy education appears to be relatively low, possibly due to implementation barriers[17].

A gap in the literature is present exploring the student perspective on barriers and facilitators of MyDispense^TM in pharmacy education. Therefore, to guide future research and implementation strategies for educators the aim of this systematic review is to synthesize relevant literature to identify students’ views regarding the barriers and facilitators of MyDispense^TM in pharmacy education.

2. Materials and Methods

2.1. Search Strategy

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used to conduct this systematic review (Appendix A) [18]. The PICO (P: Population; I: Intervention; C: Comparisons; O: Outcomes;) framework was applied to further define our research question and identify relevant search terms (Table 1).

A systematic search of PubMed, CINAHL and EMBASE from 2015-2025 was performed in January 2025 using combined keywords, indexing terms and proximity searching. Boolean operators (AND, OR) were used to refine the search, as were Medical Subject Headings (MeSH) terms in PubMed and CINAHL plus Emtree terms in Embase. Common search terms used across all three databases in this systematic review were “MyDispense”, “computer simulation”, “patient simulation”, “pharmacy students”, “perceptions”, “facilitators”, “enablers”, “barriers”, and “pharmacy education”. Examples of the search strategy used across all the databases can be found in Appendix B. Manual hand-searching of included studies reference lists, identified from database searching was performed to seek out any further additional relevant studies to be included for review.

2.2. Eligibility Criteria

Articles were included if they were:

• primary research sources
• published between January 2015 and January 2025
• qualitative, quantitative and/or mixed methods articles examining pharmacy students’ perceptions of MyDispense^TM
• published in English.

Articles were excluded if they were:

• reviews, conference abstracts, meta-analyses, commentary studies, grey literature
• not published in English
• not investigating the use of MyDispense^TM
• did not include a pharmacy student population.

2.3. Study Selection

References from all three databases were imported into Rayyan [19]. Any duplicate articles were removed. Title/abstract screening was conducted by two independent reviewers (OC & LS) against the pre-determined inclusion and exclusion criteria. Thereafter, full text articles were retrieved for screening by two independent reviewers (OC & LS) for inclusion. Any identified articles from reference list searching were imported to Rayyan and subject to full-text screening by the reviewers (OC & LS) for inclusion. Any conflicts that arose were resolved through a third party (RMcC) with discussions being held until consensus was reached.

2.4. Data Extraction and Synthesis:

Thematic analysis by the specific approach outlined by Braun and Clarke was performed to identify barrier and facilitator themes to provide further insight on student perceptions[20]. Full texts were imported into NVivo 15.1.1 to facilitate thematic analysis. Data extraction was conducted by OC on all included studies. This was cross-checked, on a specified sample of 20%, by LS for accuracy. Qualitative and quantitative results (with a degree of qualitative insight) from included articles were coded to identify possible barrier/facilitator themes. All study characteristics (author(s), year of publication; jurisdiction; study design; outcomes; participants; data collection methods; facilitators; barriers) were collected and presented in Table 2 for summary and comparison purposes.

3. Results

3.1. Articles Eligible for Inclusion

Initial database searches yielded 153 records, following duplication removal. 18 studies met eligibility criteria and were included for full-text screening. Following independent review, seven of the 18 full texts were excluded. 17 papers were identified from manual hand-searching of included full-text citation lists and four papers were included in the review. A diagram outlining the flow of studies within this review can be seen in Figure 1.

3.2. Characteristics of Included Studies

Fifteen studies were included in this review. Seven of the fifteen studies were conducted in USA[21,22,23,24,25,26,27], six in Asia[28,29,30,31,32,33], one in UK[34], and one in Australia[16]. All studies used purposive sampling. Sample sizes ranged from 33[33] to 322[31] students. The average number of participants across all studies was 121 students. Nine papers employed a mixed-methods approach[16,21,26,28,30,31,32,33,34], five papers used a quantitative methodology[22,23,25,27,29] and one paper was qualitative in nature[24]. All studies were questionnaire–based using closed-ended, open-ended and Likert-scale questions to gather student perceptions. Other data collection methods included semi-structured interviews[29] and focus group discussions[33]. Seven studies were longitudinal[22,23,25,27,28,29,30] and eight studies were cross-sectional in nature[16,21,24,26,31,32,33,34]. All studies included pharmacy students. One study included pharmacy instructors[28] and another included pharmacists with one year experience[30] in the study population. An overview of study characteristics can be found in Table 2.

3.3. Summary of Identified Facilitators

Facilitators identified include improved dispensing and counselling skills and a deeper understanding of pharmacy legislation. MyDispense^TM is an accessible, interactive and engaging learning environment for students. Instant feedback at the end of exercises promotes active learning. Students appreciated the risk free environment of MyDispense^TM. The outlined facilitators identified in this review were mapped to the four themes; 1) Develops Competency 2) Accessibility 3) Engaging Learning Experience 4) Safe Learning Environment. These themes are presented alongside supporting quotations in Table 3.

3.3.1. Facilitator Theme I: Develops Competency

Students recognised MyDispense^TM enabled them to practice skills needed to correctly and safely dispense medications e.g.) appropriate labelling[21,22], verifying patient identities[21,22,23,24,25,26,27,28,29,30], identifying prescription errors and omissions[21,25,26] and referencing appropriate information sources[24,30,31]. MyDispense^TM helps students systematically organise their thoughts when dispensing, which fosters best practice habits[32]. Most students (97.1%) agreed/strongly agreed MyDispense^TM helped them better understand steps required to dispense prescriptions safely[16].

MyDispense^TM develops patient communication skills[22,23,28,30,31,34]. A majority (71.1%) of first year students reported increased OTC knowledge and counselling skills upon completing MyDispense^TM exercises[34]. Positive perceptions were also observed in senior years of pharmacy programs as 70.1% of fourth and fifth year students felt it was effective for counselling skills development [30].

Four articles implemented MyDispense^TM to support pharmacy law skill development[21,24,26,34]. The vast majority (86.9%) of students across two years of a PharmD program agreed MyDispense^TM helped active recall of pharmacy laws from didactic lectures and most (73.2%) felt this application of MyDispense^TM enabled them to enhance their understanding of pharmacy law[24]. MyDispense^TM allows students to become familiar with brand-names of medicines encountered frequently in practice within their jurisdiction [23,30,34], which may provide a smoother transition to practice.

3.3.2. Facilitator Theme II: Accessibility

MyDispense^TM is widely accessible, allowing students to practice exercises in their own time and from any location [22,29,31,33]. Three papers highlighted its remote accessibility and use during COVID-19[28,31,34]. One third of students in one study felt able to practice dispensing at any place or time was one of its most useful features [27]. MyDispense^TM can be accessed from mobile devices which further facilitates its remote use in students [30,31].

3.3.3. Facilitator Theme III: Engaging Learning Experience

Pharmacy students expressed appreciation for the realism of the simulation experience[32]. MyDispense^TM offers a high-fidelity, virtual pharmacy learning environment to support students, particularly for those with no prior pharmacy experience[24,25,26,28,30,31]. Nearly three in four PharmD students across three US institutions agreed/strongly agreed MyDispense^TM was more realistic than paper-based cases[26]. Additionally, 84.4% of students in one study reported MyDispense^TM was a stimulating learning environment[16].

Students can actively learn from the instant feedback feature of MyDispense^TM [16,21,27,28,30,33]. This increases student confidence as they can use such feedback to change their approach in subsequent exercises[16]. Most (83.4%) students expressed agreement that prompt feedback was helpful for improving their understanding[16]. Likewise, 83.6% of students in another survey reported prompt feedback provided by MyDispense^TM as one of its most useful features[29].

3.3.4. Facilitator Theme IV: Safe Learning Environment

Seven papers reported students felt that MyDispense^TM provided a controlled learning environment whereby they can make mistakes[16,23,26,27,28,30,31]. Two studies reported that providing a safe environment to practice was one of the commonly cited facilitators by students, particularly for novice students prone to mistake[27,29]. Students also reported appreciation for the ability to repeat exercises, which can facilitate active learning from mistakes and reinforce learning from exercises[16,30,31,34]

3.4. Summary of Identified Barriers

Barriers identified include the initial difficulties of navigating MyDispense^TM and some students felt the user interface (UI) could be improved to provide a more interactive experience. Technical issues also caused student frustration. MyDispense^TM only replicates community pharmacy practice and students felt patient-prescriber interactions were not authentic because oral communication is not a platform feature. The outlined barriers highlighted in the review were aligned to three themes; 1) Learning Curve 2) IT issues 3) Limited Realism and Applications. These themes are presented alongside supporting quotations in Table 4.

3.4.1. Barrier Theme I: Learning Curve

Eight articles reported students felt MyDispense ^TM was difficult to use initially[21,25,26,28,30,31,32,34]. Students highlighted the need for training on the platform to facilitate its use[26]. In one study, a third of students (33.8%) felt more instructions were required prior to use. Similarly, only a half of Vietnamese pharmacy students agreed/strongly agreed MyDispense^TM was straightforward to use[30,34].

Students highlighted the design and appearance of the user interface (UI) could be improved to provide a more learner-friendly experience[16,30,31,34]. Label fonts were reportedly difficult to read and product images were occasionally of poor resolution, negatively impacting simulation fidelity[28,30,31]. The UI was not optimised for Thai and Vietnamese learners, as English was the only available language in MyDispense^TM [28,30].

3.4.2. Barrier Theme II: IT Issues

Three studies highlighted students had limited MyDispense^TM access due to internet connectivity issues[16,28,31]. One study reported a significant relationship between internet connectivity and MyDispense^TM use (p=0.000), whereby an increase in internet connectivity is associated with a higher percentage of student MyDispense^TM participation[31]. Students also faced minor technical issues and highlighted MyDispense^TM was incompatible with certain devices and web browsers, limiting its use and negatively impacting the overall learning experience of the simulation[16,21,25,31,33].

3.4.3. Barrier Theme III: Limited Realism & Applications

Within four articles, students felt MyDispense^TM was limited as it only simulates community pharmacy practice[27,29,31,34]. Two studies identified this feature as one of the least useful design aspects, as reported by students[27,29]. Students also wanted more varied exercises e.g.) veterinary prescription exercises, for a more comprehensive and integrated learning experience[34]. Students suggested MyDispense^TM could be more relevant to practice by including a commercially available dispensing software within the simulation[16,34].

Four studies revealed students felt patient and prescriber interactions within MyDispense^TM were limited in nature[27,29,32,34]. Students felt interactions did not feel authentic , as oral communication is not a feature of MyDispense^TM [32]. 38% of students felt limited interactions were one of the least useful features of MyDispense^TM [27]. Likewise, nearly three in five students in another survey agreed MyDispense^TM has limited interactions[29].

4. Discussion

This review identified multiple facilitators to MyDispense^TM use which were categorized into four themes; 1) Develops Competency, 2) Accessibility, 3) Engaging Learning Experience and 4) Safe Learning Environment. Identified barriers were encompassed by three themes; 1) Learning Curve, 2) IT issues and 3) Limited Realism and Applications.

This review explored MyDispense^TM across a range of areas e.g.) pharmacotherapy and pharmacy law courses[16,21,22,23,24,25,26,27,28,29,30,31,32,33,34]. One facilitator which emerged was that MyDispense^TM developed the required competencies for practice. Previous reviews also identified CBS can support competency and practical skill development in pharmacy students[17,28,35]. Pharmacy simulations act as low-demand alternatives to OSCEs, as they facilitate knowledge acquisition (“Knows How”) and knowledge applications (“Shows How”) in realistic scenarios, aligning with Millers educational framework[36,37]. Students can struggle to apply counselling skills in real-life scenarios when not provided with opportunities to practice in a high-fidelity environments[38], however, the use of MyDispense ^TM can possibly overcome these issues to improve overall confidence in practice[39].

MyDispense^TM provides an engaging, realistic learning experience with immediate feedback[16,28,30,31]. MyDispense^TM is more engaging for students relative to didactic teaching methods[26]. In a global survey, 72.4% and 77.6% of expressed agreement, respectively, that simulation provides both an enjoyable and engaging learning experience[40]. Evidence also suggests active learning methods can increase student engagement with lecture materials and performance in assessments[9]. Prompt feedback which is a MyDispense^TM feature, does not appear to increase student assessment performance, relative to traditional delayed feedback[41]. However, receiving such feedback in a timely manner can enhance student self-learning and metacognition, thereby promoting productive failure[16,42].

MyDispense^TM was commonly employed during COVID-19, as educators explored innovative methods to substitute for traditional face-to-face teaching[28,31,34]. Virtual patients enable educators to provide a flexible, accessible, remote learning environment for students[43]. However, pharmacy students can feel socially isolated when online pedagogy is used and usually preference in-person learning, suggesting a balance needs to be struck by pharmacy educators and a blended learning approach should be employed when implementing MyDispense^TM to meet student needs[44].

MyDispense^TM provides a safe-learning environment for students where they can make mistakes and repeat exercises without facing real-world repercussions[16,23,26,28,30,31]. This may be a useful feature for pharmacy students, who tend to be self-orientated perfectionists, as it provides them with ample opportunity to repeat exercises and correct mistakes[39,45]. This theme echoes the findings of a past review, concluding high-fidelity simulations must provide a controlled environment to allow learners to focus on clinical skills without distraction whilst also having the opportunity for repetition to learn from mistakes to ensure an effective learning experience[46].

The initial learning curve of the simulation and IT issues were two barrier themes identified in this review. Initial difficulties appear to be common for other simulations used in pharmacy education[47]. Platform learning curves may be associated with inadequate digital literacy, as research underlined that enhanced digital competencies, improve student adaptability and assessment performance in blended-learning environments[48]. Internet connection issues were most commonly reported by Vietnamese and Filipino students, suggesting this may be a sociodemographic barrier to MyDispense^TM [30,31]. This is supported by a recent survey reporting that only half of educators in the Western Pacific Region (WPRO) agree that their institution provides adequate technical support[40]. This indicates students in such regions may have limited resources. Minor technical issues however, appear to be universal to simulations used in pharmacy education[49,50]. Four in five pharmacy students consider ease of use and bug free experiences as essential features for simulations, emphasising how technical issues can serve as prominent barriers[17]. Institutions should employ technicians for platform troubleshooting and provide user guides for students to overcome such initial learning curve barriers, however, the establishment of such infrastructure can be costly and demanding for educators[40].

MyDispense^TM only simulates community practice and limited aspects of hospital practice e.g.) discharge prescriptions, which is a barrier for student engagement and educational applications[16]. Other simulations e.g.) SimPharm^TM can simulate hospital pharmacy and can facilitate interprofessional learning (IPL) activities[6,51,52]. A previous review on CBS used in pharmacy education found interaction elements of multiple simulations do have limited realism capabilities[15]. Despite this, MyDispense^TM was purpose-designed to simulate community pharmacy[16] and to support teaching of communication skills, therefore, educators should make students aware of its intended uses in pharmacy education prior to implementation.

4.1. Limitations

A critical appraisal was not performed on articles in this review. However, appraisal of qualitative research is inherently biased and subjective in nature with certain appraisal tools placing more weight on different aspects of qualitative methodology over others[53]. Another limitation of this review was articles published prior to 2015 were not included, however, it is unlikely these articles would add significantly our findings as MyDispense^TM is a novel simulation developed by Monash University in 2011[16].

4.2. Future Implications

The findings of this review suggest while pharmacy students perceive facilitators to using MyDispense^TM, various factors can act as barriers to its adoption. The UI requires further work to provide a more-learner friendly experience. Opportunities could be explored by stakeholders to adapt MyDispense^TM to wider cultural contexts and ensure its sustainability as a platform, by expanding the language database for international learners. Further research is warranted to explore stakeholders’ views on the barriers and facilitators to implementing simulations e.g.) MyDispense^TM into pharmacy curricula. Identifying such challenges is the first step to inform future educators on successful implementation strategies to promote technology-enriched, diverse learning experiences for pharmacy students.

5. Conclusions

This review identified the barriers and facilitators to MyDispense^TM use in students. MyDispense™ provides a novel, accessible approach by which pharmacy students can develop competency in an engaging high-fidelity, low-stakes learning environment. MyDispense^TM allows for mistakes without facing real-life consequences which facilitates its use in pharmacy education. Barriers to its use however, included the initial learning curve necessary to navigate the platform, technical issues and the limited realism of some of the content and applications of the platform. Suggested improvements for MyDispense^TM identified from this review were highlighted, and further development of the software is encouraged to enhance student engagement in future pharmacy education. The outcome of this review provides an understanding to educators of key factors to consider from the students’ perspective when implementing MyDispense^TM into pharmacy curricula globally and may be useful for stakeholders in education when considering implementation and use of MyDispense^TM in the future.