In this study, the experts who participated in the Delphi correspondence were from seven hospitals and two universities in four different provinces and cities in China. In addition, the consulting experts were teachers engaged in teaching and experienced hospital instructors, and the expert authority coefficient was 0.779, which ensured the objectivity and robustness of the results. The Kendall consistency coefficient of the two rounds of correspondence was statistically significant, proving that the constructed self-assessment tool for internship teaching in pharmacy departments of healthcare organizations is reliable. However, experts' ratings of readiness for various aspects of internship teaching varied, indicating that our healthcare organizations need improvement in two areas: the internship teaching model and the assessment of the effectiveness of internship teaching.
The results of this study show that the organizational structure of internship teaching includes the infrastructure and hardware of the internship teaching department, systems related to internship teaching, and the selection and training of teachers. The pharmacy department of a healthcare institution should be well prepared in terms of organizational structure concerning these aspects, providing a sound infrastructure and system for teaching internships, as well as selection criteria and training for teachers. In terms of the organizational structure of internship teaching, the ratings were low for “Availability of job descriptions for lead teachers” and “Whether the lead teacher receives regular training in relevant teaching and pharmacy service training”. Our pharmacy graduates lack a clinical rotation training system for residents, legal safeguards and guidelines for action, qualified clinical practice lead teachers, and accredited internship sites[25]. In Japan[26], the government has established accreditation standards for internship sites to guarantee effective internships: basic hardware facilities, standardized teacher qualification requirements, and defined training guidelines and assessment programs. In Korea[27-29], universities and hospital pharmacies have cooperated to establish and improve a set of education and assessment models - the hospital pharmacy department and the school pharmacy program work closely together, the hospital pharmacy department is mainly on the students' internship management, and the school supports the hospital pharmacy department, both sides collaborate, and develop together. At present, some large hospitals and large pharmacy chains in China have set up internship bases with schools to receive a large number of interns majoring in pharmacy from higher vocational colleges and universities; However, there is no unified certification standard for the construction of internship bases, and there are no detailed requirements for the hardware of the internship conditions and the experience of the supervising teachers, which makes it difficult to guarantee the effect of internship[30]. there is no unified standard for the selection and training of internship instructors in China, and instructors lack assessment indicators and incentives[31]. Based on the above analysis, in the future, we need to strengthen the position awareness of the teachers in the ideology; at the ability level, we need to improve the comprehensive ability and level of the teachers; at the system level, we need to improve the access system of the teachers, the evaluation mechanism of the effect of teaching and the construction of the guarantee mechanism. At the institutional level, it is necessary to improve the access system, the evaluation mechanism of the teaching effect, and the construction of the guarantee mechanism[32].
According to the results of this study, the content of internship teaching includes professional orientation and ethics training, pre-service training, training in the dispensing department, and practical training in the clinical department. Regarding the teaching content of internship teaching, the interns were rated low in terms of professional orientation and ethics training and pharmacist core competency training as well as the learning of pharmacy information technology operating system. Internship is a critical period for most graduates' career decision-making, and graduation internship is an important way for students to fully understand the content of the work and the current situation of employment, so that they can better choose employment and further education reasonably according to their actual situation, In addition, internship can provide better preparation for future clinical work. Therefore, during the internship period, we should enhance the interns' awareness of the pharmacy profession and their career planning for the future[33, 34]. The core competencies of hospital pharmacists refer to the knowledge, skills, judgment, and personal attributes required for pharmacists to provide safe, effective, cost-effective, and ethical patient-centered pharmacy services, including professional practice, coordination and communication, management, professional development, and critical thinking[35-37]. Training interns in core pharmacist competencies can enhance pharmacy services. China's hospital pharmacy services are gradually changing from purely "drug-centered" to "patient-centered"[38]. The development of "patient-centered" pharmacy service is still facing the change of service concept, the lack of patients' awareness of pharmacy service, the business level of pharmacy personnel needs to be improved, the establishment of clinical pharmacists, and other issues. Therefore, there is an urgent need for relevant regulations and policies to clearly define the contents of the work and guide the hospital pharmacy services to be perfected towards systematization, standardization, and rationalization[39].
The research results show that internship teaching modes include diversified teaching modes, theory and practice teaching modes, and arranging teaching contents according to the length of internship and different levels of interns. In terms of the teaching mode, the ratings of whether to adopt diversified teaching modes and whether to arrange the teaching contents according to the interns' needs and learning abilities were low. The traditional internship teaching mode is mostly led by the teacher, and the interns are in a passive acceptance state, which weakens the students' motivation to learn and reduces the interns' initiative[40]. New teaching methods such as Problem-Based Learning (PBL)[41] and Case Based Learning (CBL) can help improve the effectiveness of internships[42]. The use of diversified teaching methods stimulates students' motivation and enhances their independent learning and research abilities, giving them good clinical and communication skills, thus improving the effectiveness of the internship[43].The level of interns in China's pharmacy program varies, and teachers should rationally arrange the content of teaching according to the interns' needs and learning abilities.
The results of this study show that the assessment of the effectiveness of internship teaching should include access assessment, process assessment, outcome assessment, and bidirectional assessment; however, the overall scores in the aspect of the assessment of the effectiveness of internship teaching in China are low, indicating that there is a difference between China's internship teaching system and that of the developed countries in these aspects:(1) Lack of access assessment. Because of the late start of pharmacy internship teaching in China, the pharmacy departments of medical institutions accept interns at different levels of specialties, undergraduate and master's degrees, and there is a lack of criteria for access assessment of interns. In Japan, students are required to pass the Pharmacy Common Achievement Test (CBT: Computer-Based Testing and OSCE: Objective Structured Clinical Examination) before participating in pharmacy internships, which prevents students without pharmacist licenses from participating in training site pharmacy internships[26, 44]. In the United States, a pharmacist can only become a clinical pharmacist after obtaining a doctor of pharmacy degree, passing the national standardized examination, and then undergoing 1-2 years of residency pharmacist training[45]. (2) Defects in process evaluation and result evaluation. China's pharmacy graduates are generally poor in practical ability, the reason is that the practice education system is not perfect, the domestic teaching hospitals mostly use the traditional written and operational examinations, and there is a lack of perfect assessment and evaluation system when assessing the results of internship[6]. Foreign pharmacy internships need to participate in several practical courses, and throughout the entire period of professional learning, the assessment includes daily attendance, network testing, meetings and discussion performance, mentors and classmates evaluation, and other forms of assessment, each part of the results multiplied by the weighting of the final results[46]. (3) Look forward to establishing a two-way assessment scheme. Two-way assessment includes the evaluation of the teaching staff and the interns, and the evaluation of the teaching staff is mainly from the interns and the teaching team to make a comprehensive evaluation of the teaching attitude, teaching content, and teaching effect of the teaching staff.
Strengths and limitations
The strengths of this paper are mainly in the following aspects: 1) This study used a mixed-methods approach, which allowed the indicators of the assessment tool to be derived primarily from the first-hand experiences of interns and lead teachers, enhancing the validity of the tool. 2) The experts participating in this study are from the pharmacy departments of several large comprehensive medical institutions across the country, which guarantees the representativeness and rigor of the study. Of course, several limitations are worth mentioning. First, the self-assessment tool for internship teaching readiness is a dynamic system that will change with the development of hospital pharmacy and the national healthcare reform, and It still needs to be improved and the relevant indexes to make the self-assessment tool more specific and practical in practice. Secondly, this study has not conducted a large-scale empirical study on the self-assessment tool; the next step will be to continue to conduct empirical studies nationwide to test the reliability and operability of the self-assessment tool, and to further improve the index system so that it will be more valuable for application.