Identifying Foundational Drug Knowledge in Pharmacy Education Using a Structured Consensus Framework

Foundational drug knowledge is a central expectation for pharmacy practice-readiness, yet programs lack consensus-based guidance on which medications to prioritize or how intensively to assess them. Programs often use volume-derived drug lists as a pragmatic starting point, but such lists may not fully reflect the breadth of medications encountered across diverse practice settings. The purpose of the study is to identify a consensus-based foundational drug list reflective of the breadth of pharmacy practice.

A multi-phase consensus study was conducted using the Lawshe method to establish content validity of essential drugs for a pharmacy curriculum. An initial inventory of 1381 drugs taught across an integrated therapeutics curriculum was reviewed by a nine-member academic expert panel, followed by evaluation of the refined list by 10 practicing pharmacists representing diverse clinical settings. Responses were merged to form a 19-member consensus panel. Drugs meeting statistical thresholds for essentiality were grouped by strength of expert agreement. The resulting list was compared with a commercially available Top 300 Drugs list using the Jaccard Similarity index.

A total of 218 drugs achieved consensus inclusion: 78 reached unanimous consensus with a content validity ratio (CVR) = 1.0, 83 reached near-complete consensus (CVR = 0.895), and 57 met the minimum consensus threshold (CVR = 0.789). Cardiovascular and hematology, central nervous system, and anti-infective classes were most heavily represented among drugs with the strongest consensus. Comparison with the commercial list yielded a Jaccard Similarity index of 0.408 and an overlap coefficient of 0.697. Concordance with the commercial list declined as consensus strength decreased, from 85% among unanimously endorsed drugs to 65% at near-complete consensus and 56% at the minimum threshold, with systematic gaps in opioid analgesics, intravenous antibiotics, and emergency and critical care medications.

This study provides a validated, consensus-derived framework of 218 foundational drugs and a replicable methodology that programs may use or adapt. The primary curricular application operates through focused, longitudinal assessment rather than changes to taught content.