Evidence to Action: Using Implementation Science to Make CBE a Reality in Pharmacy

By: Aleda M. H. Chen and Denise H. Rhoney

Every profession has its own unique approaches and characteristics to education and training. Within pharmacy, we are taught to have all of our answers rooted in scientific evidence. When we answer a patient or provider question or are asked to evaluate a medication therapy problem, evidence is first in our minds. Sometimes, this means using tertiary resources when the answer is well-known, or using a combination of the guidelines and primary evidence when knowledge is not quite so evident for a specific patient problem. This evidence-first mindset strengthens our credibility as medication experts but presents a unique challenge when introducing innovation into pharmacy education.

A few years ago, we were challenged to evaluate whether all U.S. pharmacy programs should transition to competency-based education (CBE). As we navigated this question, we quickly realized that moving from theory to practice required more than just compelling evidence—it demanded a way to turn existing evidence into actionable steps. The challenge wasn’t just proving why we should shift to CBE, but rather figuring out how to make it happen successfully and sustainably. The key? Implementation science —a structured approach that ensures innovations are not only evidence-based but also feasible in real-world settings. This approach allowed us to bridge the gap between research and real-world application, ensuring that CBE wasn’t just a concept but a feasible and effective model for pharmacy education.

What is implementation science?

Implementation science is a systematic approach to translating evidence into practice ensuring innovations are effectively adopted, adapted, and sustained to create lasting change across various fields. There are numerous implementation science frameworks and models.¹ Some help assess fidelity—ensuring an intervention is implemented as intended. Others guide translation—helping tailor evidence-based strategies to unique settings. Regardless of the model, implementation science is essential at every phase of change, promoting fidelty, sustainability, and adoption across stakeholders.

Researchers describe science as a behavioral change intervention,² requiring the identification and addressing of behaviors necessary for adopting new evidence into practice or education.³ Behavior is driven by an interplay of capability (knowledge and skills), opportunity (environmental and social support), and motivation (beliefs and intentions). Even well-evidenced interventions may fail to take root or achieve their intended impact without intentionally assessing and targeting these factors. By embedding behavior change principles into implementation science, we can identify barriers, design targeted interventions, and create sustainable change in complex systems, ensuring that evidence-based innovations are effectively translated into real-world outcomes.

How pharmacy education is using implementation science in our pursuit of CBE?

Pharmacy education is using implementation science proactively – before launching CBE- to ensure a smooth transition.

Step 1: Understand the Landscape – The Active Implementation Framework. (Exploration Phase)

After studying and reviewing models and the pros and cons of each, we chose the Active Implementation Model from the National Implementation Research Network (NIRN), which breaks down all of the elements needed for moving science into practice. We used the model as part of a systematic review framework to examine implementations of CBE internationally.⁴ This model helped us understand:

Key components of CBE that drive success
Common facilitators and barriers in different settings across all stakeholders
How to structure implementation to fit pharmacy education

By applying implementation science at the evidence review stage we ensure that our transition to CBE was not just theoretical but also grounded in real-world lessons at the start.

Step 2: Assessing Readiness – The Behavior Change Wheel (Exploration Phase)

The next challenge was not what CBE should look like but rather HOW ready we were for this shift. The Behavior Change Wheel (BCW)³ provided a framework for evaluating readiness in individual stakeholders based on three key factors:

Capability: Do pharmacy education stakeholders have the knowledge and skills needed for CBE (such as how to develop outcome competencies, sequence them progressively, tailor learning experiences, engage in competency-focused instruction, and programmatically assess outcomes))?⁷
Opportunity: Are there supports to facilitate CBE for all stakeholders?
Motivation: Are stakeholders willing to embrace the shift?

By using the BCW framework, we can identify gaps in stakeholder preparedness, institutional support, and stakeholder buy-in that could hinder CBE implementation. By pinpointing these areas before rollout we are now designing targeted interventions to build readiness and minimize resistance.⁵ We will also assess organizational readiness to change using pre-existing tools.⁶

Next Steps (Installation and Initial Implementation Phases)

After completing the pre-implementation phase and assessing readiness to change, the next critical step is ensuring that structured efforts translate this readiness into actionable implementation strategies. This requires targeted interventions, aligned teams, and validated tools to drive behavior change effectively.

Establish Implementation Teams – Use readiness to change data to design interventions within the BCW framework. Engage key stakeholders to ensure buy-in, pilot, collect feedback, and refine strategies before full-scale implementation.
Develop Structured Implementation Strategies – Identify early adopters to lead change, adapt interventions based on real-time feedback, and establish monitoring mechanisms to track adoption, fidelity, and sustainability. Implement change management strategies to address resistance.
Ensure Long-Term Sustainability – Align implementation efforts with policies, accreditation standards, and institutional priorities., Develop scalability plans and foster a culture of continuous evaluation to sustain and refine interventions over time.

Bridging the Gap Between Evidence and Action

U.S. pharmacy education is progressing toward full implementation, embedding implementation science across all phases to ensure that CBPE is both evidence-based and practical. Just as pharmacists rely on evidence to guide patient care, we must apply the same rigor to pharmacy education. The question is no longer if we transition to CBE but how to do so effectively. With implementation science as our guide, we move closer to ensuring that pharmacy education evolves to meet the needs of future practitioners, patients, and society.

About the Author:

Aleda M. H. Chen, PharmD, PhD, FAPhA is the Associate Dean (Assessment, Research) and Professor of Pharmacy Practice at Cedarville University School of Pharmacy. With Dr. Rhoney, she is engaged in the scholarly efforts within AACP committees and workgroups to move pharmacy to CBE.

Denise H. Rhoney, PharmD, FCCP, FNCS, MCCM is the Ron and Nancy McFarlane Distinguished Professor at the UNC Eshelman School of Pharmacy. With Dr. Chen, she has been leading the AACP efforts in a movement towards CBE in the Doctor of Pharmacy degree.

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