Evaluation of Pharmacy and Nursing Interprofessional Undergraduate Learning in a High-Fidelity Simulated Hospital, Supported with a Virtual Online Environment

Abstract

Pharmacy and nursing professions collaborate closely in healthcare settings. Effective interprofessional practice is now widely recognised as essential for achieving optimal patient care outcomes. Little has been published on nursing-pharmacy Interprofessional learning (IPL) in a simulated environment in Australian contexts. This study aimed to evaluate whether an IPL activity improved participants’ communication confidence, role understanding, clinical knowledge, and preparedness for hospital placement, while also assessing student satisfaction and identifying areas for improvement. A pedagogically structured teaching and learning model was developed, involving a high-fidelity on-campus simulated hospital ward, supplemented with a virtual online environment to immerse nursing and pharmacy students in a realistic clinical environment to achieve deep learning in preparation for safe practice. An online anonymous survey was conducted to evaluate participants’ experience and preparedness following the simulation. 280 students participated and 52 completed the evaluation. Most students reported that the experience boosted their confidence in communicating with other healthcare professionals (82%), increased clinical/therapeutic knowledge (86%), gave them a better understanding of the roles of nurses/pharmacists within the hospital setting (88%) and left them feeling better prepared for hospital placement (85%). Student free-text responses from the evaluation survey further supported the expansion of the IPL sessions in the future. IPL involving nursing and pharmacy students in a simulated hospital builds confidence in communicating and increases self-reported preparedness for placement.

1. Introduction

Interprofessional learning (IPL) occurs “when students from two or more professions learn about, from and with each other to enable effective collaboration and improve health outcomes” [1]. IPL provides a platform for healthcare undergraduates to collaborate as a multidisciplinary team to optimise consumer health outcomes [2]. It cultivates core standards and competencies such as respect, effective communication, and shared decision-making, and promotes development of professional identity [3], equipping students to integrate these elements into their future practice [2,4].

Increasing demand for ‘work-ready’ health professionals has led to a growing emphasis on interprofessional practice in tertiary education [5]. In Australia, the accreditation standards for all degrees leading to registration as health professionals with the Australian Health Practitioner Regulation Agency now reference IPL, and most are explicit regarding the requirement to demonstrate IPL [6]. Recognising the importance of interprofessional practice, the International Pharmaceutical Federation has also advocated for pharmacy academic institutions to embed opportunities for interprofessional socialisation and learning experiences that transcend traditional hierarchical structures [7]. Moreover, the World Health Organisation has called all health professional educators to embed IPL as an innovative approach to interprofessional practice [8].

Collaboration between pharmacy and nursing professions is paramount to enhance medication safety and improve patient outcomes [9]. Effective interprofessional teamwork relies on mutual understanding and appreciation of each other’s roles and professional expertise, which is essential for achieving a shared vision for patient care [10,11]. Evidence from multiple settings highlights interprofessional practice as a key strategy for delivering high-quality, coordinated, person-centred care [12,13,14].

IPL at the university level can take various forms, each designed to enhance collaboration and teamwork among health professionals in training. Formats for IPL trialled between pharmacy and nursing students range from asynchronous online activities [15] and case-based workshops in the classroom setting [16] to simulation-based activities [17] and concurrent placements in various clinical environments [18,19]. While many IPL models have been trialled, evaluations suggest face-to-face, scenario-based IPL is associated with greater student satisfaction, compared to other formats [20]. International studies involving nursing and pharmacy students indicate a positive attitude towards most forms of IPL [21,22,23,24], although few have explored this in the Australian context. Australian pharmacy and nursing students have expressed support for more interactive and innovative IPL undergraduate experiences [25,26].

The University of South Australia conducted a pilot study in a simulated hospital environment involving nursing and pharmacy students. The nursing and pharmacy curricula are grounded in constructivist and experiential learning philosophies that position the student at the centre of the learning process. Students are expected to build knowledge through positive interdependent experiences such simulations. This approach reflects both Kolb’s experiential learning theory, where students cycle between active participation, reflection, and application, and Social Interdependence Theory, which emphasises collaboration and mutual reliance to achieve shared goals [27,28]. The curricula are designed to encourage social interaction and teamwork enabling a deeper understanding and the development of professional competence.

The primary aim of this study was to develop and evaluate an IPL experience involving nursing and pharmacy students in a virtual and physical high-fidelity simulated hospital environment. The study explored if this interprofessional activity increased participants’ self-reported (1) confidence in communicating with other members of the healthcare team, (2) understanding of the roles performed by the counterpart profession, (3) clinical and therapeutic knowledge and (4) preparedness for hospital placement. The secondary aims were to quantify overall student satisfaction with the IPL activity and to explore student perceptions through qualitative feedback, identifying perceived strengths, areas for improvement, and insights into the interprofessional learning experience.

2. Materials and Methods

The IPL sessions were conducted on campus within the Simulated Hospital and Health Service high-fidelity hospital wards. The Simulated Hospital and Health Service consists of an online platform and a series of purpose-built, on-campus simulated clinical areas, set up to emulate hospital wards [29]. The simulation patients were duplicated in a virtual hospital (custom build for the University of South Australia by Novus software developers) which could be accessed online through the university’s ‘learnOnline’ Learning Management System. The participants were allocated into two cohorts by their profession. The nursing cohort consisted of 260 nursing students in the third and final year of their undergraduate degree (93% of the enrolled cohort); another 20 enrolled nursing students were unavailable to participate. Pharmacy students in the fourth and final year of their undergraduate pharmacy degree were recruited via an open expression of interest process, and the first 20 pharmacy students (approximately 20% of the enrolled student cohort) who submitted an expression of interest were invited to form the participating pharmacy cohort.

The interprofessional activity took place in a high-fidelity simulated hospital and health service. Situated across one metropolitan and two regional university campuses, this purpose-built facility is designed to replicate a wide range of hospital and community healthcare settings. The facility within the metropolitan campus where the IPL activity took place comprised seven distinct clinical areas across three levels. These included specialised spaces such as medical, surgical, paediatric, emergency, critical care, and recovery units, as well as a community clinic and home-care environment. Additional functional spaces, including clean and dirty utility rooms, helped sustain the authenticity of the simulated environment [29].

The simulated hospital and health service supports interprofessional and inquiry-based learning through its use of high-fidelity manikins programmed with scenarios that represent diverse patient groups across the lifespan and a wide range of health conditions. Each acute care bed is fitted with a touch screen linked to the central network, providing access to online resources and live patient data, allowing students to monitor and respond to simulated physiological changes. An integrated audio-visual system also facilitates recording of care episodes and team interactions, enhancing opportunities for self-reflection, feedback, and skill development—particularly in communication, cultural competence, empathy and compassionate care [29].

A particular strength of this simulation facility is its clinician-led model. The simulated hospital is staffed by postgraduate-qualified registered nurse lecturers and sessional clinical staff (also registered nurses), with a typical ratio of one staff member to eight nursing students. For the IPL activity, the team also included one registered hospital pharmacist for every two pharmacy students. These practitioners are not academic staff but practising clinicians, many of whom also supervise students in real hospital placements. This structure allows students to engage in authentic, contemporary, and high-quality clinical learning experiences under the guidance of experienced professionals [29].

The IPL activity was structured around Kolb’s Experiential Learning cycle [27]. Students engaged in concrete experiences through high-fidelity on-campus simulation, followed by reflective observation during facilitator-led debriefs and peer observation. These reflections informed abstract conceptualisation, allowing students to connect their experiences to interprofessional competencies. The activity also prepared students for active experimentation, allowing them to apply their interprofessional skills in subsequent clinical placements. The design further drew on Social Interdependence Theory [28], emphasising positive interdependence among team members to achieve shared goals and foster collaboration and mutual support.

Participating students received information via email, detailing the aims of the IPL activity and their allocated learning time in the simulated hospital and health service. Prior to their allocated IPL session, students within both professions were given access to a virtual online version of the simulated hospital and health service. This access allowed students to review the admission notes, medication chart and other bedside documents for the patients they would be caring for in the simulation hospital wards, in addition to the ward’s spatial orientation, prior to attending the on-campus IPL session. The virtual hospital was designed as a preparatory tool to support students’ engagement in the subsequent face-to-face session. By allowing students to familiarise themselves with the clinical documentation and physical layout in advance, the virtual component reduced cognitive load during the on-campus simulation and enabled participants to focus more fully on interprofessional communication, collaboration, and decision-making. While not evaluated as a stand-alone outcome, the virtual hospital formed an integral part of the overall IPL strategy by ensuring students commenced the activity with a shared baseline of patient information and ward orientation.

In the simulated hospital and health service, students were divided into groups comprising approximately 24 nursing students with two pharmacy students, and each group was supervised by one pharmacist and two nurse clinical facilitators and a nursing academic. This group structure was designed to approximate real-world ward dynamics, with more nursing students than pharmacy students to reflect how wards are typically staffed with many nurses and a single clinical pharmacist. Facilitators guided interactions to ensure all students had an opportunity to participate in collaborative interprofessional care, using flexible approaches tailored to the situation rather than specific prompts, scripts or checklists.

Prior to the session, students received a concise briefing regarding the session objectives, expectations of conduct, and simulation space protocols. The IPL activity was designed with specific interprofessional learning objectives, aligned with the Interprofessional Education Collaborative (IPEC) Core Competencies [30], which were reinforced during the briefing. These included developing students’ confidence and skill in interprofessional communication, and enhancing their understanding of the roles and responsibilities of other health professions to support coordinated patient care.

During the IPL session, under the guidance of the clinical facilitators, students reviewed and provided collaborative care for the simulated patients over a 90 to 120 min period, engaging in authentic peer-interactions mirroring real-world hospital practice. In providing care to the simulated patients, students participated in activities such as reviewing medication charts and progress notes, simulated conversations with the patient (via microphones and speakers with facilitators voicing patients remotely through headsets), performing observations, determining and responding to acute clinical deterioration, administering medications and conducting interprofessional case-based discussions. Clinical facilitators led a short debrief conversation which included informal feedback and an opportunity for student reflection at the end of the session. An overview of the IPL activity structure and key details is provided in Figure 1.

Following the participation in the interprofessional activity in the simulated hospital and health service, all nursing and pharmacy student participants were invited to complete an anonymous online evaluation. The evaluation survey was developed in-house by the study investigators to address the specific aims of the study and was piloted with a convenience sample of students, and pharmacists and nurses with academic experience (n = 6). Feedback from piloting led to minor modifications to survey wording, structure and response options to improve clarity and flow, supporting its face and content validity. The survey comprised both quantitative and qualitative components, designed to capture participants’ demographics, perceptions, and reflections regarding the experience. It included multiple-choice, ordinal rating-scale, and Likert-scale items, as well as open-ended questions. The content of the survey is summarised in Box 1 below:

Box 1. Overview of the survey content.

Q1

Previous experience with IPL (Nil; In classroom; In simulated practice environment; and/or In clinical practice; tick all that apply);

Q2

Agreement with the following statements (5-point Likert-scale from 5-Strongly Agree to 1-Strongly Disagree) describing the impact of IPL on their:

• confidence in communicating with other professions;
• anticipated increase in confidence if further IPL sessions were facilitated;
• clinical and/or therapeutic knowledge;
• understanding of counterpart professionals’ roles;
• sense of preparedness for clinical placement;

Q3

Rating of the educational quality of the IPL experience (5-point scale from 5-Very Good to 1-Very Poor)

Q4

Rating of the facilitation method of the IPL experience (5-point scale from 5-Very Good to 1-Very Poor)

Q5

Rating of the relevance of the IPL activity to their future practice (Entirely Relevant; Partially Relevant; Not Relevant);

Q6

Feedback on the most enjoyable part of the activity (free text)

Q7

Areas of improvement (free text)

Quantitative results from the evaluation survey were summarised using descriptive statistics (mean, proportion) calculated in Microsoft Excel version 16.0. Any partial or non-responses were classified as missing values, and the denominators were adjusted accordingly when calculating proportions.

Free-text responses underwent qualitative analysis using NVivo software (Version 14, QSR International). Similar to other qualitative methods, qualitative description is an ‘empirical method of investigation aiming to describe the informant’s perception and experience of the world and its phenomena’ [31]. Unlike more interpretive methods, qualitative description adopts a pragmatic lens, prioritising clear and direct accounts of events or experiences [31]. A flexible coding framework was developed based on the content of the data. Two researchers independently analysed the free-text responses, then reviewed and refined the coding structure through discussion until consensus was achieved.

This project was reviewed by the University of South Australia Human Research Ethics Committee (ID: 202457) and deemed exempt from requiring ethics approval as a quality assurance activity.

3. Results

Twenty pharmacy students and 260 nursing students participated in the IPL experience. Of these, 15 pharmacy and 37 nursing students submitted responses to the evaluation survey, giving overall response rates of 75% and 14%, respectively.

3.1. Quantitative Survey Findings

Previous experience in IPL was reported by 40 out of 52 (77%) students. Several types of IPL experiences were undertaken before participating in the IPL activity in the Simulated Hospital and Health Service. Fourteen of 52 (27%) had participated in a ‘classroom’ style IPL activity and n = 22/52 (42%) had participated in IPL as a part of practical activities. Only four of 52 students (8%) had previously taken part in IPL within a simulated practice environment.

Forty-four students answered the 5-point scale survey questions asking degree of agreement with statements regarding the impact of the IPL activity (Figure 2). Most respondents (n = 36/44, 82%) reported the IPL experience increased their confidence in communicating with other members of the healthcare team. Almost all (n = 43/44, 98%) respondents ‘Agree’ or ‘Strongly Agree’ that this confidence would further increase through the provision of more IPL in the future. In addition, n = 38/44 (86%) responded ‘Agree’ or ‘Strongly Agree’ that the IPL experience increased their clinical/therapeutic knowledge. The majority (n = 39/44, 89%) of respondents ‘Agreed’ or ‘Strongly Agreed’ that they had a better understanding of the roles of their counterpart cohorts after the experience. Thirty-seven of 44 respondents (84%) reported they felt better prepared for their upcoming hospital placement.

The majority of participating students positively rated the general quality and facilitation of IPL. 81% of respondents (39 out of 48) reported the IPL activity facilitated by the clinical educators as ‘Good’ or ‘Very Good’ and 87% of students (45 out of 52) rated the educational quality of IPL as ‘Good’ or ‘Very Good’. When asked about the relevance of IPL activity to their future practice, 98% of respondents (45 out of 46) indicated that the interprofessional activity was ‘Very Relevant’ to their learning.

3.2. Qualitative Survey Findings

Among the 52 participants who responded to the evaluation survey, 30 students (58%) submitted free text responses. Analysis of free-text responses identified two overarching thematic categories: (1) Strengths of the IPL activity and (2) Opportunities for improvement, each comprising multiple subthemes, as presented in

Table 1. Qualitative analysis of student free-text survey responses (n = 30), summarising reflections on their experiences with the IPL activity, including subthemes, descriptive summaries, and illustrative quotes.

Theme	Sub-Theme	Sub-Theme Description	Example Quotes
Strengths of the IPL activity	Interprofessional collaboration and relationships	Engaging with peers from another profession allowed to share their own knowledge while gaining insight into the roles, responsibilities and expertise of other health professionals. This highly valued exchange enhanced understanding of each profession’s contributions to patient care and supported recognition of the value of different professional perspectives.	‘I really enjoyed talking to them and helping answer some of their questions about the patients’ (Student 3, nursing) ‘As a group we collaborated and shared our knowledge, improving our understanding (and appreciation) for each other’s roles within a multi-disciplinary healthcare team, and thus fostering the relationship between nurses and pharmacists.’ (Student 1, pharmacy) ‘Opportunity to speak to the nursing students and understand what their knowledge is and what nurses actually do.’ (Student 24, pharmacy). ‘Think it is a great opportunity see how both sides work, and being exposed to the role of each profession in the administration of medications.’ (Student 10, nursing)
	Practical application in a safe environment	Actively applying their theoretical knowledge in realistic clinical scenarios enabled students to translate classroom learning into practice. The simulation provided a safe, low-risk environment to observe patient care, practise clinical skills, communication, teamwork, and interprofessional interaction, enhancing practical understanding and readiness for real-world clinical situations.	‘seeing theory applied to a realistic situation’ (Student 19, pharmacy) ‘To actually get the chance to practice what a pharmacist would do in the hospital and how to communicate with nurses. I found it a lot more useful than the field visits…’ (Student 28, pharmacy) ‘Realistic clinical suite has potential to simulate genuine interprofessional interactions’ (Student 26, pharmacy) ‘[The simulated hospital ward] makes me have the feeling of reality with less stress of the bad outcome, which is a fantastic way to practice, and gets me better prepared for the hospital environment’ (Student 27, pharmacy). ‘[...]it was such a good and safe way of learning how to communicate between other professions.’ (Student 18, pharmacy)
	Personal and professional growth	Reflecting on their own skills and knowledge helped students recognise their professional contributions and identify areas for further development. Participating in the interprofessional activity enhanced self-awareness, reinforced motivation for ongoing learning, and encouraged students to take initiative in their professional development.	‘surprised on how much medical knowledge I had even if I felt I was put on the spot it was nice that while I felt under pressure I was able to answer their questions correctly’ (Student 5, nursing) ‘The opportunity to review patients in a real-time setting. Highlights areas of study that may need improvement.’ (Student 29, pharmacy) ‘I feel my learning is finally useful in practice, rather than just learned ‘from the book’. I became more motivated as I felt the application of knowledge in real fields and observed within a clinical setting’ (Student 27, pharmacy).
Opportunities to improve the IPL activity	Optimising frequency, duration and integration	Extending and increasing the frequency of IPL sessions throughout the curriculum would reinforce learning and provide ongoing opportunities to consolidate interprofessional communication and collaboration skills. Some students also suggested integrating such activities earlier within their programme could maximise preparation and confidence ahead of activities like field visits.	‘I really enjoyed it, I wish we had more sessions like this to attend.’ (Student 26, pharmacy) ‘I think the session might be improved with the opportunity for more time to interact.’ (Student 9, pharmacy) ‘I think this activity could be improved by engaging more often, I enjoyed talking to them [the pharmacy students] in a professional way which I had never experienced before so having them contribute more often, in more classes would be great.’ (Student 16, nursing) “It would be nice to have longer sessions! I personally really enjoyed it and would have loved it even more if the session was longer—the 1.5 h passed really quickly and I feel we could have covered things in greater depth in a longer session as well” (Student 18, pharmacy) “Introduce it earlier in the Pharmacy degree, potentially to coincide with what we learnt in Pharmacotherapeutics Theory prior to doing the Pharmacotherapeutics Practice field visits.” (Student 22, pharmacy)
	Enhancing case design and scope	Structuring IPL cases to support more student-led communication, with facilitators taking a less directive role, could enhance engagement and learning. Some students perceived that scenarios were weighted toward one profession and expressed a preference for cases that reflected content that was equally valuable to professions. Students also identified opportunities to broaden the scenarios to include other health disciplines, to further enrich IPL.	“Students to take more of a lead in the communication and have a structure during activity” (Student 8, nursing) “More related to pharmacy rather than focus largely on nursing student content” (Student 23, pharmacy) “..having more sessions with different students from different health professions” (Student 14, nursing)
	Pre-session preparation	Providing more detailed pre-session information and clear guidance on roles and expectations would enable students to prepare effectively and optimise participation to gain maximum benefit from the activity.	“Perhaps having a clearer idea of how the pharmacist undertakes their role on the ward round prior to going into the simulation (i.e., what are their step-by-step procedures for that ward round)” (Student 20, nursing) “have scheduled times made available to nursing students so they can benefit for spending time with pharmacy students, can prepare questions etc” (Student 5, nursing)

. These thematic categories capture students’ perspectives on what aspects of the session were most valuable and where enhancements could be made.

Students particularly valued opportunities to learn from and with peers from another profession, enhancing understanding of roles and professional contributions. Students commented on the benefits of practising their skills based on a clinical scenario within a simulated hospital environment. Actively applying theoretical knowledge in realistic clinical scenarios enabled students to translate classroom learning into practice within a low-risk environment. Students also highlighted that the simulated hospital provided a safe space for them to develop communication skills. The experience prompted students to self-reflect on their own skills and knowledge and helped students to recognise their own capabilities and areas for development.

Students also suggested opportunities for improvement regarding the IPL experience. Three key areas for improvement included extending and integrating sessions, optimising case design and scope and enhancing pre-session preparation.

4. Discussion

The findings of this study contribute to the growing body of literature describing the value that nursing and pharmacy students place on IPL [21,23,32,33,34], and their relevance to the Australian context. Specifically, students reported that the experience enhanced their understanding of respective professional roles, increased confidence in interprofessional communication, strengthened their sense of preparedness for hospital placements, and deepened their clinical/therapeutic knowledge. Participants were consistently generally satisfied with the relevance of the IPL activity to their professional learning.

The results of this study align with several studies investigating the benefits of simulation-based interprofessional education in undergraduate curricula. In a study with nursing and pharmacy students in the United States in a simulated emergency department setting [35], the attitude of students about IPL improved following the interprofessional education in a simulation setting as well as the self-confidence of students. In a U.K. study of nursing and pharmacy students participating in simulated hospital and general practice settings [36], students’ understanding of each other’s professional roles increased, and their confidence in communication with other health professionals and patients were both enhanced.

Beyond the educational outcomes, it is also important to consider the unique affordances of simulation as a learning environment. Students in this study described the combined virtual/physical simulated hospital ward as a ‘safe’ environment in which they could practise interprofessional communication without the pressure of real-world consequences. As in prior research, participants highlighted the value of engaging in realistic tasks without the risk that mistakes would result in patient harm [37]. This sense of safety aligns with existing literature, which identifies simulation as a low-stakes environment that fosters risk-taking and active participation [38]. Such environments have been shown to support learner confidence, enhance interprofessional engagement and promote deeper reflection, ultimately strengthening preparedness for clinical collaboration [37].

Students reported that participating in the simulation broadened their understanding of their peers’ professional roles and contributions, while the opportunity to observe and engage with one another during realistic clinical tasks clarified role boundaries and revealed previously underappreciated aspects of day-to-day practice. These findings are consistent with prior studies demonstrating that simulation fosters role clarity and shared understanding through authentic interprofessional interactions. In one United Kingdom study, nursing and pharmacy students reported greater understanding of interprofessional roles following a mental health IPL workshop [32]. A United States study conducted an IPL activity as a clinical simulation, finding pharmacy and nursing students felt the activity increased their understanding of their own role in the team and the role of other health professionals, and the activity improved their confidence in collaboration [39].

This study has several limitations that should be acknowledged. First, the sample size was not sufficient to allow robust analysis of the responses of individual pharmacy and nursing student cohorts. Study participation was voluntary which likely introduced self-selection bias, particularly given the low response rate from nursing students (14%), raising the possibility that respondents may have held different views from non-respondents. The use of self-reported data could introduce recall bias. These limitations were mitigated by integrating qualitative analysis of free-text responses alongside the quantitative data. The study was conducted at a single institution, this, along with the low nursing student response rate may limit the generalisability of the findings to other educational settings. Significantly, it was beyond the scope of the study to assess improvements in observed performance or longer-term outcomes, which are crucial to understanding the sustained impact and broader benefits of IPL. There remains a need for further high-quality research into IPL’s influence on behaviour, clinical practice, and patient outcomes [40].

Building on the current findings, future research could explore the long-term impacts of this IPL activity by incorporating objective measures of student performance, such as pre- and post-assessments during subsequent clinical placements or in early professional practice. Further investigation is warranted to clarify the specific value of the virtual simulation component—both as a standalone modality and in combination with the physical simulation experience. It would also be valuable to determine the most appropriate timing within the curriculum to introduce this type of IPL activity, as well as the optimal frequency for its delivery, to maximise student engagement and learning outcomes. These insights will support the design of evidence-based IPL strategies that are both pedagogically sound and responsive to the realities of clinical education.

5. Conclusions

This study confirmed interprofessional learning between pharmacy and nursing students when implemented in a simulated setting, is beneficial from the student perspective. It fosters self-confidence in interprofessional communication, strengthens self-reported therapeutic knowledge, improves perceived preparedness for placements, and is valued by students. Future research should focus on strategies to evaluate the long-term impact of such IPL on practice and clinical outcomes.