As a PharmD student in Ghana, I entered clinical practice thinking that being prepared meant knowing my drugs well. I studied mechanisms of action, pharmacokinetics, adverse effects, interactions, and indications. I expected that when I entered the hospital, I would have enough time to think through what I had learned and apply it.
I quickly realized that real practice does not work that way. The patient is standing in front of you. Another patient is waiting. A prescription needs to be checked, a dose calculated, a label written, and a medication prepared. At the same time, the patient may need counseling and the pharmacist may be asking you a question. There is no pause button.
Knowing the drug is not always enough
One of the biggest differences I noticed was how clinical practice changes the way you think about medications. At university, I may learn that caffeine is a central nervous system stimulant. In clinical practice, however, I encountered caffeine citrate in a much more specific context: its use in neonatal care for apnea of prematurity. The mechanism was still important, but the practical question was different: What is this medicine doing for this particular patient?
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I experienced something similar with morphine and lactulose. I already knew morphine and its adverse effects, but seeing the two medicines together made the relationship more practical. Morphine can reduce gastrointestinal motility and contribute to constipation, while a laxative may be used to manage constipation when appropriate.
Hydroxyurea taught me something similar about clinical recall. It is not enough to remember its pharmacology. In the right clinical context, you need to quickly connect it with sickle cell disease and know the relevant dosing, monitoring, and counseling considerations.
Clinical practice taught me that sometimes the most useful knowledge is not the longest answer in a textbook. It is the specific piece of information you need at that moment.
Speed matters more than I expected
I also underestimated how important speed would be. In pediatric practice especially, calculations became part of almost everything: milligram-per-kilogram dosing, converting concentrations, determining volumes, checking prescribed doses, and calculating quantities to dispense. The patient’s weight matters. The formulation strength matters. The final dose has to be accurate.
After performing similar calculations repeatedly, some concentrations and formulas started becoming almost automatic. Information I never expected to remember off the top of my head began coming naturally because I had repeatedly used it.
But speed cannot come at the expense of accuracy. Patients may already have spent hours moving through registration, consultation, and laboratory services before reaching the pharmacy. You have to work efficiently while still getting the answer right.
Real patients do not come with perfect case-study information
Classroom cases are usually well organized. The age is provided. The weight is provided. The diagnosis is clear. The prescription is legible.
Real patients do not always arrive that way. A caregiver may forget the child’s weight. A prescription may be difficult to read. An important record may have been left at home. A caregiver may have traveled a long distance and cannot simply be sent home to retrieve missing information.
I remember being asked how we would handle a prescription with missing or unclear information when the patient had traveled a long way from another facility. My mind went blank.
I knew what a valid prescription was. I had studied prescription requirements. But suddenly, the question was no longer, “What are the components of a valid prescription?” It was, “What do you actually do now?”
That experience showed me that pharmacy requires reasoning. You have to find a safe and practical way forward while considering the patient, the prescriber, the available information, and the realities of the health care system.
Every patient has a different story
Clinical practice has also made me appreciate how individual patients are. Two patients can have the same diagnosis and take the same medication but have completely different circumstances. One child may vomit after taking medicine. Another may struggle to take it because of school. Another may have a caregiver who has difficulty understanding the instructions.
The pharmacist cannot simply apply the same script to everyone. You have to ask questions, listen carefully, identify what is missing, and work with the information the patient gives you.
Communication is part of the job
Clinical practice also exposed my weakness in communication. I found myself more comfortable doing calculations, preparing medications, and writing labels than standing in front of a patient and starting a conversation. Then I watched a friend ask a patient simple questions such as, “Have you taken this medication before?” The conversation developed naturally. I wondered how she made it look so easy.
That experience made me realize that communication is not something pharmacists can simply add at the end of their training. It is part of the job.
Knowing the pharmacology of sickle cell disease does not mean a patient will understand an explanation filled with technical terms. A pharmacist has to take complicated knowledge and bring it down to a level the patient can understand.
Language can make this even more difficult. I encountered a patient who spoke French, but the variety she spoke was difficult for the available people to understand. Knowing French from textbooks was not enough to guarantee meaningful communication. The patient eventually returned with someone who could help bridge the language gap.
That experience reminded me that communication in health care is not simply about knowing a language. It is about being understood.
What my experience made me question about pharmacy education
My experience in Ghana has made me think differently about how pharmacy students are prepared for the transition from the classroom to patient care. I do not think the answer is less theory. The theory is essential.
But students also need opportunities to practice using that knowledge before a real patient is standing in front of them. Patient-facing skills, calculations, prescription assessment, counseling, and clinical reasoning should be introduced and repeatedly practiced throughout pharmacy education.
Pharmacy education is structured differently across countries and institutions, so my experience should not be taken as a description of every program. But clinical practice has shown me how important it is for students to repeatedly connect classroom knowledge with realistic patient situations before they are expected to do so in practice.
If I could advise myself before starting clinical practice, I would say: Take calculations seriously. Learn the guidelines. Practice being quick without sacrificing accuracy. Practice communicating. And do not underestimate the value of language skills.
Clinical practice has not made me think that what I learned in the classroom was useless. It has made me understand why I learned it.
The goal of pharmacy education should not simply be to produce students who can remember information for an examination. It should help produce students who can retrieve the right information, reason through an unfamiliar situation, communicate it clearly, and apply it safely when a real patient is waiting.
Because when the textbook meets the patient, knowing the medicine is only the beginning.
Kirsty Affam is a pharmacy student in Ghana.
