Which Links Have Been Tested? An Evidence Map of Continuing Education and Continuing Professional Development for Pharmacists and Pharmacy Technicians

Background. Most pharmacy regulators now mandate continuing professional development, replacing or adding to traditional ongoing education. However, the broad evidence supporting this change has not been well characterized. Objective. This mapping aims to explore the scope, design, geography, and impact of research on continuing education and professional development for practicing pharmacists and pharmacy technicians. It also seeks to identify which links in the implicit chain, from requirement to patient outcome, have been examined. We distinguish three often-overlapping dimensions: the mechanism (what practitioners are asked to do, such as accrual or documented cycles), the requirement (whether participation is mandatory), and the warrant (the record's claimed proof). Five research questions are posed to address the determinants of map, mechanism, mandate, warrant, and engagement. Methods. An evidence map of PubMed was created using eight structured queries that focused on fundamentals, effectiveness, reviews, revalidation, barriers, settings in low- and middle-income countries, digital delivery, and the technician workforce. These queries retrieved a total of 1,145 records over two rounds. Of these, 743 were unique entries, and 724 were eligible for screening. The screening process involved reviewing titles and abstracts, and each selected study was categorized by topic, design, country, sample size, and the highest Kirkpatrick level of evidence for outcomes. Both screening and data extraction were completed in a single step using a language model for classification, while design and outcome coding were verified by a single author. When multiple publications reported the same study, they were linked, ensuring that counts reflect individual studies rather than reports. Results. Following an extensive search and a detailed audit, 359 studies met the inclusion criteria, of which 201 (56.0%) were published after 2020. The majority were surveys conducted at a single time point (129, 35.9%) or evaluations of a single group before and after an intervention (63, 17.5%). Only 12 studies (4.6%) included a comparison group, of which six were randomized trials. Outcome measurements mainly focused on knowledge, skills, and attitudes (161, 44.8%). Fifty-two studies (14.5%) examined behavior change, and just 3 (0.8%, 95% CI 0.3 to 2.4) assessed patient or system outcomes. All three were uncontrolled, and no controlled study measured outcomes beyond behavior. Only 4 of the 12 comparative studies considered the cycle itself; the remaining 8 compared different continuing education formats. No study evaluated the impact of introducing, removing, or varying a requirement against any outcome. One study independently measured engagement and competence over a single register and found that every pharmacist who failed the external competence review had previously passed the engagement review. Conclusions. Among the four links in the field’s implicit chain from requirement to patient outcome, one has not been tested in pharmacists at all, while another has been examined by four studies. The warrant claim based on this chain is challenged where it has been tested. The strongest positive claim, supported by evidence, is that the cycle influences pharmacists' actions more than accrual-based education does. This conclusion relies on self-reported behavior from a single, unblinded trial involving 100 pharmacists, reported across three papers, with effects diminishing over three years. No pharmacy trial has directly compared these approaches against patient outcomes, and the closest relevant research in medicine has been conducted twice without showing a signal. Therefore, the most valuable questions in the field are narrower than replication. They are whether the cycle offers additional benefits beyond any educational intervention, whether that effect can be sustained, and whether employer-led levers, such as protected time, are effective.