Students’ perceptions on the examined factors affecting their intentions for postgraduate training in PGx and PM

Students assessed the teaching tools used in PGx modules to be moderately to rather useful (Fig. 2 and Table 3). Lectures and supplementary material in e-class were perceived as the most useful tools (mean around 5.2), followed by laboratory training (mean 4.7). Books and formative assignments were considered as moderately helpful (mean around 4.2). Study year was the only demographic variable to influence students’ evaluation of lectures, laboratory training, e-class material and optional assignments (Additional file 1: Tables S1–S5). Indeed, second-year students were indicated to be the most pleased with available teaching tools in contrast to fifth-year students. Second-year students were very satisfied with lectures, laboratory training and e-class material (means from 5.3 to 5.9), while third-year students found lectures and e-class material quite valuable (means around 5.6).

Fig. 2

Descriptive statistics (mean and standard error of means) of student answers

Table 3 Frequencies (valid %) of student answers

Students’ satisfaction related to training received in PGx clinical implementation is in line with their evaluation of teaching tools. They appear to be moderately to rather satisfied with theoretical and laboratory training along with department’s curriculum, as 45% to 50% of participants agreed with the relevant statements and means ranged from 4.3 to 4.6 (Fig. 2 and Table 3). Again, study year was the only demographic variable affecting students’ views (Additional file 1: Tables S1–S5), with second-year students being the most satisfied (mean 5.3) and fifth-year the least (mean 4.0). Third-year students were rather satisfied with their theoretical training (mean 4.8), but moderately with their laboratory training (mean 3.7), which is attributed mainly to the special circumstances that laboratory exercises were conducted during the last two years because of COVID-19 restrictions. Students claimed to be moderately confident in implementing PGx in clinical practice, as the means of all relevant statements ranged from 3.5 to 3.9 (Fig. 2 and Table 3). Study year only affected students’ self-confidence, mainly due to significant divergences between first and second-year students (Additional file 1: Tables S1–S5).

Students shared very positive attitudes towards PGx and its implementation in clinical practice. Around 80% agreed that PGx should be an important part of pharmacy students’ curriculum and they would recommend PGx testing to patients or a family member (Fig. 2 and Table 3). Moreover, almost 60% agreed that they intended to keep up with future updates in the field of PGx and incorporate PGx testing in patient care. Female students were more positive than their male classmates concerning the significance of PGx in their curriculum, while female students intended to be updated about future advances in the field and to integrate PGx in patient care. Students (or a family member of theirs) receiving chronic medication were more inclined to recommend PGx testing to patients or a family member, whereas those holding another BSc degree were less willing to undergo a PGx testing in the future. First-year, closely followed by second-year, students held more positive attitudes and were more disposed to adopt PGx in clinical practice and keep up with future updates.

Individuals’ level of knowledge on PGx and PM was measured by an index, (0 to 10), concerning the total number of correct answers given at the 10 relevant statements (Fig. 3). Students’ level of knowledge in PGx and PM was found moderately satisfactory (Figs. 2, 3 and 4). Approximately 75% of them gave 4 to 7 correct answers, whereas only 4% of the respondents got a score of 9 out of 10 (mean = 5.7, median = mode = 6). Students (or a family member of theirs) receiving chronic medication scored on average 0.5 units higher than others. Moreover, students of the last three study years presented an almost equal level of knowledge in PGx and PM, but much higher than those of the first and second year (Additional file 1: Tables S1–S5).

Fig. 3

Students’ overall level of knowledge in PGx and PM (Valid %, N = 346)

Fig. 4

Percentage of students answering correctly and wrongly to each statement of knowledge about PGx and PM (Valid %, N = 346)

Students claimed to be moderately willing to pursue postgraduate studies related to PGx and PM, Almost 45% of them agreed with the pertinent clause and one-quarter of them were neutral (mean 4.2). However, they were quite disposed to attend relevant certified training or information programmes, since about two-thirds of them agreed with the relevant statement and only 17% disagreed (mean 5.03) (Fig. 2 and Table 3). Female students were more inclined to improve their knowledge and skills on PGx and PM, while those possessing another BSc degree stated a lower interest. Students’ interest for postgraduate training in PGx and PM declined as they ascended the study year. Thus, while students of the first 3 years appeared quite willing for postgraduate training, fourth- and, especially, fifth-year students were, to some extent, reluctant, particularly to attend a relevant MSc course (Additional file 1: Tables S1–S5).

SEM analysis of key determinants on student intentions for postgraduate training in PGx and PM

The measurement model of the four factors (Training Satisfaction, Self-Confidence, Attitudes and Intentions) was tested by Confirmatory Factor Analysis (CFA). The level of knowledge on PGx and PM was measured by an index, of a scale from 0 to 10; therefore, it was not considered in the measurement model analysis. All values of the model-fit measures calculated to assess the model’s overall goodness of fit were within the corresponding acceptance levels. Specifically, the values computed by AMOS were: CMIN/DF = 1.512 < 3–5, CFI = 0.986 ≥ 0.90, TLI = 0.981 ≥ 0.90, NFI = 0.960 ≥ 0.90, IFI = 0.986 ≥ 0.90, RFI = 0.945 ≥ 0.90, RMSEA = 0.39 (0.023 – 0.052) < 0.08 and SRMR = 0.041 < 0.08 (Collier 2020; Kline, 2016). According to Table 4, the factor loadings of each item on the respective constructs are well above the suggested threshold of 0.5; therefore, all items were eligible for the next stages of analysis. However, ATT6 item (I would recommend pharmacogenomic testing to a family member) was removed from the analysis because of its high correlation with ATT5 item (0.848).

Table 4 Factor loadings, reliability and convergent validity of measurement model

Cronbach’s alpha and composite reliability (CR) verified the construct reliability of each model construct (Table 4). All Cronbach’s alpha values were quite higher than the acceptance level of 0.70 [34], and CRs, ranging from 0.81 to 0.86, were well above the threshold value of 0.70 [35]. The average variance extracted (AVE) for all constructs was found higher than the benchmark of 0.50 (Table 4), indicating the convergent validity of the factors included in model [36]. The discriminant validity was confirmed by the heterotrait-monotrait ratio of correlations (HTMT) method, as all ratios ranged between 0.202 and 0.797 (Table 5), below the suggested critical value of 0.85 [37]. Finally, in our measurement model the Harman’s single factor test showed that the total variance for a single factor was 36.77%, considerably lower than the recommended threshold of 50%, and hence, we assumed that the common method bias did not constitute a significant threat to the validity of our research findings [38, 39].

Table 5 HTMT ratios for discriminant validity

Mann–Whitney and Kruskal–Wallis tests revealed significant differences on some of students’ answers according to gender, study year, possession of another BSc degree and receiving chronic medication. Thus, these demographics were included in SEM analysis as control variables. A binary variable was used for “study year” (1st–3rd: 0; 4th–5th: 1) to simplify the SEM analysis. Third-year students were grouped together with their first- and second-year classmates, as they expressed relatively similar intentions for postgraduate training in PGx and PM. This may be explained by the fact that fourth and fifth-year students are approaching to the completion of their studies, and consequently they are more settled regarding their intentions for postgraduate training including PGx and PM.

Figure 5 outlines the statistically significant effects of key determinants on student intentions. More details are presented in Figure S1 and Tables 6 and 7. The values of the global fit statistics (CMIN/DF < 2–5, CFI ≥ 0.90, TLI ≥ 0.90, NFI ≥ 0.90, IFI ≥ 0.90, RFI ≥ 0.90, RMSEA < 0.08, SRMR < 0.08) indicated a good model fit [32, 33]. Moreover, the coefficient of determination (R2) was 0.70 signifying, as well, a good model fit. Attitudes towards PGx implementation were the only factor which directly influenced students’ intentions to pursue postgraduate training in PGx and PM. The high value of the pertinent standardised regression weight, 0.76, indicated a very strong positive impact of attitudes on intentions for postgraduate training.

Fig. 5

Synoptic SEM diagram of the factors influencing students’ intention to pursue postgraduate training in PGx and PM

Table 6 Regression weights and covariances for the SEM modelTable 7 Standardised direct, indirect and total effects for the SEM model

Self-confidence and training satisfaction affected students’ intentions only indirectly, as they exhibited a moderate positive influence on attitudes (total effects: 0.35 and 0.31, respectively). Furthermore, training satisfaction exerted a relatively low (0.25) positive effect on self-confidence. However, self-confidence was found to have a rather low negative (−0.11), but still significant, impact solely on students’ intentions to attend certified training or information programmes related to PGx and PM (INT2). Therefore, the positive total, and indirect, effects of both self-confidence and training satisfaction on intentions for postgraduate training were relatively low: 0.26 and 0.24, respectively.

The level of knowledge was the only examined factor of the proposed research model that had neither direct nor indirect impact on students’ intentions for postgraduate training, in general. However, it appeared to have a quite low positive impact (0.11) on students’ intentions to attend certified training or information programmes related to PGx and PM (INT2). Although no significant relationship was established between the level of knowledge and the training satisfaction construct, a low negative relationship was found between the level of knowledge and the satisfaction with both the laboratory training (STF2) and the departments’ curriculum (STF3) (−0.19 and −0.11, respectively).

Concerning control variables, study year, primarily, and gender, to a less degree, influenced students’ intentions for postgraduate training both directly and indirectly. Specifically, in line with the Kruskal–Wallis test results, students of the last two study years appeared to be considerably less willing to pursue postgraduate training in PGx and PM, less zealous to implement PGx and PM in clinical practice and less satisfied with their training than their classmates of the first 3 years. Female students were more disposed to pursue postgraduate training and hold more favourable attitudes towards PGx and PM than their male classmates.