Objective To understand how pharmacists develop patient-pharmacist communication skills. Methods A realist synthesis approach was used to understand how educational interventions work to improve patient-pharmacist communication. Initial programme theories were developed through a scoping search and stakeholder focus groups (faculty, students, patients and public). A systematic search was then conducted for evidence to test initial theories. Included papers were assessed for relevance and rigour. Extracted data was synthesised to refine the initial programme theories and develop modified programme theories. Results Forty-seven papers were included in the final synthesis. Role-play with simulated patients and peers, video recording and lectures were the most widely reported interventions. Repeated practice, feedback, reflection and confidence were among the mechanisms by which interventions work. Modified programme theories relating to interactions of role-play, experiential learning, video recording, self-assessment and workshops were developed. Conclusions Outcomes of communication education interventions are influenced by the level of learner. Educational interventions that promote reflection are particularly useful. Practical implications There are a wide range of theory-informed interventions, which should be used in a programmatic approach to communications education. A longitudinal programme of communication skills training, with intervention choice based on level of learning, is important.
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