The training of hospital pharmacy residents (farmacéuticos internos residentes, FIR in Spanish) began in 1977 with the first call for specialised training positions for pharmacists in Spain.1,2 Since then, this process has been essential for the evolution of the specialty. However, since the last update of the programme in 19993, the profession has undergone significant changes in the scientific, technological, and healthcare fields.4,5

The 4-year programme defines competencies across 12 training areas, including drug information, compounding, oncology pharmacy, clinical pharmacokinetics, outpatient care, and overall management of the pharmacy service. There are also permanent and transversal activities such as research, teaching, and quality improvement. Although the duration of rotations is established at between 3 and 6 months, the programme does not specify their temporal distribution, except for a basic rotation of 6 months in the first year and clinical rotations in the fourth year, which must include inpatient pharmaceutical care, surgical areas, and outpatient areas, without detailing specific departments.3 Under these premises, each hospital accredited for teaching designs their own standard training programme, and the tutor adapts it to an individualised training plan for each resident. This lack of clear guidelines on time schedules provides tutors and centres with the flexibility to adjust the programme, but it can also generate variability in the residents' training.

In addition, the lack of updates in the official programme, excludes key areas that have gained importance in today's hospital pharmacy services. Areas such as transversal skills, pharmaceutical care in advanced therapies (CAR-T, gene therapies), pharmacogenomics, and the management of chronic conditions are not included in the current official programme of the specialty.3,6 Moreover, the need for on-call duty is not described. This lack of updating in the training programmes may also lead to variability in resident education across accredited hospitals.

Given such a flexible structure, the ongoing professional developments, and potentially outdated training programmes, it has become necessary to evaluate the current design of hospital pharmacy residency rotations in Spanish hospitals. This study aimed to collect current data on the organisation of rotations within hospital pharmacy departments across Spanish hospitals. The resulting mapping of resident pharmacist training structures will serve as a practical reference framework for hospital pharmacy tutors.

A descriptive, cross-sectional, multicentre study was conducted by the Tutors' Working Group of the Spanish Society of Hospital Pharmacy (SEFH) using a voluntary online survey to evaluate the organisation of hospital pharmacy residency rotations.

Study population: hospital pharmacy services (HPS) accredited for specialised healthcare training in Spain. This is a finite and well-defined sample with a total population of 114 teaching units.

From the 114 hospitals with accredited teaching units, 99 responses were received, representing an 86.8% response rate. Tables 1 and 2 show the response rate by autonomous community and the characteristics of the responding HPSs. Among the accredited HPSs, 79.8% had between 251 and 1000 beds, 84.8% were accredited for 1 to 2 positions annually, and 54.5% had 2 tutors.

This is the first study to comprehensively map the organisation of hospital pharmacy residency training programmes in Spain. The high response rate (87%), with representation from all autonomous communities, provides a broad and reliable overview of the current training of hospital pharmacy residents. We did not analyse potential non-response bias (13% of the population), as we considered that there were no substantial differences between respondents and non-respondents. This assumption is supported by the descriptive nature of the study and the fact that it involved a finite population clearly defined by the Spanish Ministry of Health's teaching accreditation.

Our findings reveal considerable variability in the duration and organisation of rotations across hospitals, ranging from 1 to 12 months. Additionally, some hospitals do not define a fixed rotation schedule; instead, some training is spread across the residency period. This heterogeneity can be partly attributed to the use of shared or part-time rotations in many centres, which enables residents to train in multiple areas concurrently during the 4-year programme. The introduction of new fields5 such as pharmacogenetics and digital health, alongside the increase of accredited residency positions in some hospitals, may also be contributing to this variability.

The high proportion of part-time rotations—reported in over 60% of hospitals—reflects an evolution in HPSs towards a more integrated model of care. This contrasts with the traditional departmental structure,7 where, for instance, a pharmacist might have been exclusively assigned to parenteral nutrition. At present, many departments operate through teams that manage a patient's entire pharmacological treatment, promoting a more integrative model of care that may influence the organisation of rotations.7 Future research should investigate how this model affects both resident training outcomes and satisfaction, particularly when comparing full-time and part-time rotations.

In some hospitals, responses to questions about specific rotations were incomplete, or indicated that certain areas—such as prescription validation and drug dispensing for inpatients, or drug evaluation—are delivered longitudinally across the training period rather than within specific timeframes. In these cases, training is integrated into day-to-day clinical activities without a formally defined rotation. This is due to the decentralisation of these activities, and the training being organized across the 4-year residency period. Nonetheless, we believe that the acquisition of skills requires clearly defined objectives and a structured evaluation process to ensure consistent educational standards.8

The organisation of clinical rotations includes common areas such as infectious diseases, haematology, and oncology, but considerable variability exists in other areas. Similarly, although the training programme stipulates that clinical rotations should be carried out in the fourth year3, an increasing number of hospitals are distributing them across the entire residency period. This allows us to integrate them with non-clinical rotations, offering a more ongoing and cohesive learning experience. This reorganisation may be related to the growing involvement of hospital pharmacists in patient care teams,9–11 which facilitates residents' participation in clinical activities from the early stages of training. Such early engagement can help reinforce previously acquired knowledge and contribute to a more sustained and integrated development of clinical competencies.

Despite the fact that nearly 33% of hospitals currently provide pharmaceutical care in long-term care centres,9 the low rate of rotations in these settings is noteworthy. This is a particularly relevant issue, because regional pharmaceutical regulations are increasingly addressing the provision of care in long-term care centres in response to the growing needs of institutionalised patients.12–14

Rotation in primary care is already included in the training programme of nearly 80% of hospitals in Spain. This reflects ongoing changes in the role of hospital pharmacists, due to the increasing demand for pharmaceutical care able to support continuity of care across different levels of the healthcare system.15,16 It is essential to clearly define the skills to be acquired during primary care rotation and to formally incorporate it into the next version of the official specialty training programme.17

The considerable variability observed in our study highlights the urgent need to revise and update the hospital pharmacy training programme. Such a revision should reflect current professional practice and promote more consistent training that aligns with both present and future healthcare needs. The fact that 93% of hospitals offer rotations not included in the official programme underscores the relevance of incorporating emerging fields18 and transversal skills19 into the formal curriculum. To address this variability, the Tutors' Working Group is collaborating with other working groups within the SEFH to develop standardised, competency-based training models. These models will include recommendations on content, duration, and the appropriate year of residency for each rotation.20–24 These models aim to assist tutors in structuring resident training and minimising variability in rotation organisation.

Among the strengths of this study are a high participation rate and broad geographic representation, which together provide a reliable overview of the Spanish national scenario. One limitation, however, is that transversal skills were not assessed. These may already be incorporated in some hospitals and should be examined in future research to gain a more comprehensive understanding of current training practices. Furthermore, this study focused on the organisation and duration of rotations, without exploring how these are structured in each HPS in terms of defined competencies and the educational methods used to achieve them. Investigating these aspects could offer valuable insights and support greater consistency across training programmes.

In conclusion, this study highlights considerable variability in the organisation of training programmes across hospital pharmacy teaching units in Spain. Moving towards greater standardisation of rotations, the incorporation of transversal skills, and the revision of the national training programme are essential steps to ensure high-quality, equitable training that meets the demands of today's healthcare landscape.

This is the first study to describe the organisation of the training rotations of hospital pharmacy intern pharmacist residents (FIR) in Spain, providing a comprehensive view of the current situation in hospitals accredited for specialised health training.

The results obtained should be of great interest for hospital pharmacy tutors, since they can serve as a guide and reference for the organisation of the specific training itineraries of each HPS. This will contribute to promote a more homogeneous training aligned with the current needs of the specialty. Furthermore, our results show the need to update the training programme of the specialty and to move towards the standardisation of rotations, guaranteeing equitable training adapted to the current demands of hospital pharmacy.

Claudia Colomer Aguilar: Writing - review & editing, Methodology, Formal analysis, Data curation, Conceptualization. Eva Negro-Vega: Writing - review & editing, Writing - original draft, Supervision, Project administration, Methodology, Investigation, Data curation, Conceptualization. Edurne Fernández de Gamarra-Martínez: Writing - review & editing, Methodology, Formal analysis, Data curation, Conceptualization. Beatriz Martínez Castro: Writing - review & editing, Supervision, Methodology, Conceptualization. María Pérez Abánades: Writing - review & editing, Supervision, Methodology, Conceptualization. Susana Redondo Capafons: Writing - review & editing, Supervision, Methodology, Conceptualization. Covadonga Pérez Menéndez Conde: Writing - review & editing, Writing - original draft, Supervision, Project administration, Methodology, Investigation, Data curation, Conceptualization.

None declared.