Table 1 Summary of the subthemes identified in relation to the two prominent threads of TL

Phase 1: A disorientating dilemma

Phase 2: Self-examination with emotional disturbance

Value in an acute situation

“I was quite apprehensive…I didn't really know what value I could add to that situation in such an acute setting.” [PRP12]

Frustration at lack of information

“I thought it was quite difficult… making decisions quickly and reading guidelines quickly and trying to find the best evidence and then relaying that.” [PRP9]

Pressure of concurrent assessment

“I suppose normally I would go away and look at a patient myself before coming to a medic rather than do it both at the same time, almost like a car crash…. I felt quite stressed out to be honest. I came out in a bit of a cold sweat.” [PRP5]

Concern about causing harm

“..there wasn’t a diagnosis, the bloods weren’t there.. all the stuff that I would normally look at before recommending any interventions… if we missed something in the diagnosis, if we missed something, like, in such an acute setting.” [PRP10]

Phase 3: A critical assessment of assumptions

Transferrable skills

“You’re working directly together, communicating constantly… very rapidly changing your plan of action and communicating that to people and coming up with an idea of what you’re going to do next and delegating small tasks to each other...” [PRP8]

Decisions made with incomplete information

“I like knowing the answer and having a specific answer, but I am aware that’s not always the case and it’s kind of risk and benefit, judging it. And so it was putting me out of my comfort zone in that sense because there is no right or wrong answer… not everything’s going to be 100 per cent safe, but it’s weighing it up.” [PRP1]

Problem-solving

“I have never really had that problem- solving part in my job really, usually they have already been diagnosed by the time I've seen them, so it really kind of switched me back into that kind of helping to diagnose them as well, which was nice.” [PRP6]

Prioritisation of urgent issues

“It was interesting to, sort of, consider what is a problem that we needed to solve then, and what would be a problem that would be further downstream in the wards… I did find I had to really balance that and think, no, that’s a future problem. That’s not something we’re sorting right this second.” [PRP3]

Phase 4: Recognition that one’s discontent and process of transformation are shared

Value realised by others

“I think every single time I’ve had interaction with, particularly medics, it’s felt as though, the biggest surprise to them is how much I can offer in terms of helping them, with these kind of situations.” [PRP8]

Self-doubt and fear of causing harm

“I think we were both kind of, a bit worried by it.. I think we shared the same kind of nerves for it… during the actual scenario, I thought he [medical student] was just getting on with everything and I didn’t really notice the nerves drumming in that situation, it was just when we discussed it afterwards.” [PRP10]

Phase 5: Exploration of options for new roles, relationships and actions

Growing in confidence as a pharmacist

“I did feel like I was making decisions, which I feel like is what a pharmacist does… I think I actually felt as close to a pharmacist as I’ve felt.” [PRP5]

Sharing knowledge

“The knowledge, kind of, just came back to me, if that makes sense. I just wasn’t really thinking about it. I was just, kind of, doing it… I think the, sort of, working together part helped with that. If I was making a quicker decision, working with someone else who’s also a different profession made you feel a bit more comfortable in your decisions.” [PRP4]

Value in the team

“More towards the end, the doctor was like ‘is there anything I can do to help you?’ I suppose it made me realise that it is that team, you are just one small part of trying to fix this problem for the patient.” [PRP6]

Shared decision-making

“So, it’s good to know that we’re all, kind of, on the same page and actually that’s why it’s so important to make decisions together.” [PRP3]

Phase 6: Planning a course of action

Approaching medical staff

“…being more comfortable communicating with the doctors and just, maybe if they don’t ask me questions, if they’re not too sure what my role is, I could maybe, do you know, speak to

them… So, if I’m going in to speak to them, I could tell them what I’ve done and what I’ve looked up and, yeah, just building relationships with the doctors.” [PRP9]

Prioritising information

“I could probably find quite a lot of information, but it’s not always as easy for the medics to do that, and they may not need all the information that I’ve found. So, it’s just trying to then approach it, and give them the concise information.” [PRP1]

Education of medical staff

“I suppose not seeing doctors as, they don't know everything… they might be like the boss of the ward but they still make mistakes, so not to be afraid to call them out on the mistakes and help them.” [PRP7]

Speaking up

“I think maybe [I will] be more vocal when I think that input is needed, because I was able to see quite clearly how the knowledge that I could bring to the scenario changed the path that it went down… I think speaking up and actioning things and then maybe just taking on more of a role and responsibility if there’s something that needs to be done, just being like ‘oh I’m from pharmacy, I can do that’.” [PRP10]

Building professional relationships more generally

“I’d definitely be quite confident with speaking to doctors, speaking to other health professionals about things I wasn’t sure of, as well as other pharmacists, just everyone really, if I wasn’t sure about something. And I’d have maybe a slightly better understanding of what they know that I may not.” [PRP4]