The hospital pharmacy residency program (known as POE) was officially approved in Spain in 1999.1 However, pharmacy residency currently involves a substantially broader scope of practice of increasing complexity. Building upon the foundations established by previous generations in areas such as the safe and effective use of medicines, medication preparation and selection, pharmacotherapeutic information, education, and research, hospital pharmacy has undergone a significant evolution, expanding its role in therapeutic decision-making, participation in multidisciplinary teams, personalized medicine, advanced therapies, digital health, and continuity of care.2,3 These evolving contributions have led to advances in the specialty, but pose a core question: How can hospital pharmacy residency education be structured to ensure consistency, the progressive development of competencies, and reliable assessment of learning outcomes?

POE is the national competency development framework for hospital pharmacy residents. As it occurs in other health sciences specialties, training departments implement POE through local standard residency pathways approved by the education committee and tailored to the characteristics of each healthcare institution.4 These practices ensure a real-world residency experience. However, in the last 25 years, hospital pharmacy practice has increased in complexity, thereby requiring a collective effort to organize and update residency programs and standardize the evaluation of educational outcomes.

These needs were clearly identified in a study published by the Spanish Society of Hospital Pharmacy’s (SEFH) Mentorship Working Group in 2025 titled Mapa de las rotaciones de los farmacéuticos internos residentes de farmacia hospitalaria en España (Mapping hospital pharmacy residency rotations in Spain).5 The study demonstrated substantial inconsistencies in rotation programs across pharmacy units, with differences in timing, duration, modality and contents. The most striking finding was that 93.3% of hospitals included rotations that were not established in POE. While this finding shows an evolving educational framework designed to meet real-world pharmacy practice needs, it also uncovers the lack of a standardized education framework. Residency programs should be adapted to the specific characteristics of each center; however, such contextualization should not result in inequalities in residency educational opportunities.

To address disparities in the development of competencies, the SEFH Mentorship Working Group, in collaboration with different working groups and SEFH experts, has designed a range of residency pathways and established the competencies to be acquired in each.6 These pathways do not replace POE or local education programs, but provide a supplementary framework for competency-based education. The main contribution of SEFH's residency pathways lies in the organization of each training domain around a clearly defined set of competencies, learning activities, levels of responsibility, and evaluation strategies. The ultimate purpose is to foster a more consistent and progressive education framework aligned with the evolving demands of contemporary hospital pharmacy practice.

This initiative represents a deeper shift than may be apparent at first glance. For many years, residency programs have predominantly focused on the location, timing and duration of rotations. This approach is necessary but insufficient. The key question is not only where residents should rotate, but rather which competencies they should acquire, which skills they should master, which professional behaviors they should demonstrate, and the level of autonomy and responsibility they should progressively attain across different clinical settings.7

This is not an exclusive concern in hospital pharmacy. Advanced clinical practice is shifting toward educational models that define the expected on-the-job performance.8 The international literature has demonstrated that the use of competency-based education frameworks helps standardize practice, identify educational and training needs, tailor learning activities and appraise performance.9 In our environment, competency-based education is especially relevant, since it raises the following questions: What professional profile should residents develop? How can we assess learning outcomes?

SEFH's training pathways are intended to serve as a practice-focused tool that provides definitions for specific competencies and determines training activities, levels of supervision, and evaluation methods.7 These pathways provide guidance for tutors to plan rotations, teachers to supervise residents, and residents to understand what is expected from them. This framework provides a clear picture of the educational process for tutors to focus on specific competencies, objectively assess learning outcomes, and improve rotation programs.

It provides an organized but flexible approach. Each hospital offers its own portfolio of services, resources, priorities and learning opportunities.10 This heterogeneity embodies the diversity of hospital pharmacy units in Spain and should be preserved. To this end, residency pathways distinguish basic from advanced competencies. This framework establishes a core educational curriculum while allowing different levels of specialization, according to the singularities of each center and the resident's stage of professional development. These competency-based pathways feature a clear and flexible structure that guides training and enables residency programs to be tailored to local hospital pharmacy demands.

The updated residency pathways recognize the broad scope of hospital pharmacy practice without losing sight of the areas that represent the identity of this specialty. Pharmacological technology, clinical nutrition, clinical safety, medication evaluation and selection, together with clinical trials, to name a few, are key areas in hospital pharmacy and are defined in POE. The aim of defining competencies related to these areas is not to discover them but to update, organize and evaluate performance according to contemporary pharmacy practice.

In the clinical setting, novel residency pathways define pharmacy practice in units such as emergency departments, intensive care, surgical care, oncology, hematology, solid organ transplantation, and neuropsychiatry, along with the management of complex polypharmacy patients. This new approach reflects the increasing integration of hospital pharmacists into multidisciplinary care teams across diverse clinical specialties. The competencies required for pharmacists to integrate into multidisciplinary care teams go beyond demonstrating a deep understanding of drug therapies or disease; they include the ability to cooperate with other healthcare providers, provide effective advice, prioritize problems, cope with incomplete data, monitor clinical outcomes, ensure the continuity of care, and demonstrate a commitment to patient clinical outcomes.11 The residency period should prepare future specialists to deal with these scenarios efficiently.12 The novel residency pathways define the clinical, communication and organizational competencies that residents should attain, the training activities required, and the duties that residents should progressively assume.

These pathways include new areas that have gained significant relevance in recent years. This evolution is exemplified by personalized pharmacotherapy, where therapeutic drug monitoring and clinical pharmacogenetics are increasingly integrated to optimize individualized therapeutic decisions. Other novel areas include advanced drug therapies, which demand a broad competency set encompassing access, reimbursement and funding processes; logistics, preparation and handling; manufacturing; biosafety; traceability; drug therapy monitoring; research; and quality assurance. The new education approach provides a structured framework for residents to acquire competencies in emerging pharmacy areas.

Additionally, research residency pathways, digital skills, and bioethics strengthen key cross-curricular areas. The research pathway organizes skills related to the generation of knowledge, from the identification of relevant research questions through methodological design, project management, data analysis, interpretation of results, and science engagement. The digital skill pathway introduces digital health by including digital literacy skills, scientific-clinical data processing, health communication 2.0, copywriting, networked cooperation, data analysis, and involvement in digital health projects. The bioethics pathway incorporates ethics as an integral component of clinical, organizational, and professional decision-making. Together, these pathways mirror the role of pharmacy in increasingly complex clinical, organizational, ethics, technological and research processes.

This approach is especially relevant in a volatile, uncertain, complex and ambiguous healthcare system. Pharmacy residency programs should not be constrained to consolidated practice models, but it should be aimed at training skills that enable pharmacists to solve unexpected problems, interpret changing information, adapt to emerging technologies, cooperate in multidisciplinary teams and make decisions in a context of growing healthcare demands in a context of reduced trust in foundational science, and resource limitations.13

Not only residents but also tutors and teaching associates must take on the challenge of acquiring and teaching ever-changing skills to adapt to an evolving context.14,15 Educational pathways do not replace tutors but provide a structured educational framework that enables self-guided learning.

The release of new educational pathways opens a new era. The next step involves effectively implementing new competencies in educational programs, performing competency-based supervision, assessing their utility, and updating them in alignment with advances in the specialty. In the future, hospital pharmacy professionals will be required to display clinical, critical, digital, research, teaching, and communication skills to be able to lead innovative actions in challenging environments.3 To date, residency programs had been limited to a sequence of rotations and relied on each unit's interest in providing training. The new educational pathways integrate purposeful and standardized programs based on a shared vision. Updating POE is necessary for it to reflect the evolving landscape of hospital pharmacy practice, while preserving the continuity of core services.

Novel educational pathways are proof of a shared commitment to enhancing pharmacy education and training. These training programs anticipate POE updates and demonstrate the specialty's capacity to adapt to and address emerging challenges.