**5. Conclusions**

The integration of regulated pharmacy technicians in community pharmacy practice continues to be a vexing issue in many di fferent jurisdictions. This study has helped identify potential areas for curricular quality improvement in pharmacy technician education programs that may enhance the quality and extent of integration. Most of these areas fall into a broad category of "soft-skills" training needs; further work is required to verify the results of this study and determine the feasibility of teaching, learning, and assessment of these soft skills as a method for enhancing the impact that regulated pharmacy technicians may have on community practice and their patients. Particular areas for curricular attention include interpersonal communication skills appropriate for clinical/care workplaces, conflict managemen<sup>t</sup> and negotiation, intraprofessional collaboration skills, and practice managemen<sup>t</sup> competencies. There may also be opportunities to consider joint pharmacy/pharmacy technician student education workshops or events in order to start to build a more intraprofessionally collaborative culture at the student level. Another important insight from this study is the need for further work to identify financially viable and sustainable practice models that integrate regulated technicians into the workforce. In recognition of their advanced education, qualifications, and scope of practice, it is reasonable that regulated pharmacy technicians expect and deserve a wage premium compared to unregulated technicians: Understanding how to accommodate this wage premium within an existing business and financial structure, and leveraging the advanced education, qualifications, and scope of practice to generate additional revenue to support paymen<sup>t</sup> of higher wages has not been clearly determined within most practices in this study, and this further limits workplace integration. Educators and researchers have an important potential role in working with individual practices and the profession as a whole to provide business plan templates that can support employers in making decisions to hire and retain regulated technicians in a fiscally responsible and sustainable manner.

In a recent study by Anderson et al. [23], the lack of standardization in pharmacy technician education and training programs was identified as a potential barrier to fuller utilization of technicians and integration in practice. Similarly, Wheeler et al. have noted that "(w)ith ongoing pharmacist practice transformation, an approach that ensures uniform technician education ... is vital to support a practice model designed to transform medication managemen<sup>t</sup> across the continuum of care [24]". This research has potentially contributed valuable information regarding specific areas for focus in enhancing the quality, rigor, and impact of the educational programs, which form the foundation of regulated pharmacy technician practice.

**Author Contributions:** Conceptualization, D.A. and Z.A. methodology: A.W., M.J., and P.G.; software P.G.; validation, A.W., M.J., P.G., and Z.A.; formal analysis, P.G.; investigation, A.W., M.J., and P.G.; writing—original draft preparation, A.W. and M.J.; writing—review and editing, P.G. and Z.A.; supervision, D.A. and Z.A.; project administration, D.A. and Z.A.; funding acquisition, Z.A. All authors have read and agreed to the published version of the manuscript.

**Funding:** This research was funded by an unrestricted gran<sup>t</sup> from the Ontario College of Pharmacists, the regulatory body for pharmacy practice in Ontario Canada Grant Number 21374.

**Conflicts of Interest:** The authors declare no conflict of interest.
