The art and challenges of teaching calculations in clinical courses
I have been leading on the teaching and assessment of calculations in my pharmacy course for many years, yet I still find calculations to be uniquely challenging to teach. Designing and teaching these sessions requires a different skill set from other types of clinical teaching. But why is that, and is teaching numeracy in clinically oriented courses genuinely different from teaching it elsewhere?
The main challenge is the abstract-to-clinical leap. Students must translate raw mathematics into high-stakes scenarios such as drug dosing, intravenous infusion drip rates, or compounding. Some can handle the arithmetic in isolation or grasp the clinical context on its own, but struggle when the two must be integrated. The true skill is applying numbers to patient care, which goes far beyond a pure mathematical question.
I have found this particularly prominent with rounding. On the surface, it seems to be a simple mathematical operation we are all familiar with, but in a clinical context it requires careful judgment. Deciding whether to round up, down, or to a specific decimal place demands the ability to link numbers to real-world application, for example, to ensure feasibility of administration, to determine how many insulin prefilled pens to supply a patient, or to interpret statistical measures such the number needed to treat, among other examples.
Precision is a requisite in pharmacy calculations. In other subjects possibly a margin of error may be tolerated, however in this field students are expected to produce one correct answer with no room for deviation. Our aim is never to make the subject unnecessarily difficult, but to maintain patient safety, which is what ultimately matters. A 10% dosing error could mean overdosing, underdosing, or toxicity, particularly in paediatrics or with drugs that have a narrow window between effective and toxic doses. The need for accuracy and consistent checking at each step adds another layer of cognitive pressure.
Complications increase with unit conversions. Switching between different metric expressions, or between systems such as micrograms, percentages, and millimoles is cognitively demanding and could be easily confused without meticulous approach. These conversions may seem routine, but small mistakes in conversion can cascade into major errors.
Another point to add is the pedagogy gap, when we assume students already have solid numeracy foundation. For some, gaps in basic skills such as handling ratios, fractions, or unit conversions still exist, and these often resurface once layered with the clinical context. Therefore, tutors must break problems down and guide students step by step. Without strong conceptual scaffolding, students are more likely to disengage and lose confidence in the learning process.
One more note to add: we are “wired differently,” and what works for one student may not work for another. Background education and prior exposure to mathematics can vary, affecting how students approach calculations. A tutor needs to craft multiple teaching strategies to meet these diverse learning styles. Tools that aid explanation, such as simple sketches, digital tools and quizzes, videos, and simulations can help students to “visualise” the problem in context, bridging the gap between abstract numbers and reality. Additionally, small group teaching can facilitate an interactive environment, test student comprehension, and provide immediate feedback. Investing in these resources is essential to ensure that calculations are made understandable, rather than simply theoretical.
To further provide students with a more authentic experience, recent calculation teaching has also been framed within a simulated hospital environment involving incorporating patient-actors and high-fidelity mannequins. This reinforces the direct impact on patient care. For example, students might receive a case brief with resources and be asked to assess renal function to determine an appropriate dosage adjustment, be provided with a hospital drug chart for a patient with unmanaged pain to calculate an opioid dose or calculate a life-saving dose in a critical medical emergency.
Therefore, for all the reasons and examples mentioned above, teaching calculations is challenging, but preparing safe practitioners makes it highly rewarding. Tutors need to be creative, resourceful, and use a variety of methods to reach the diverse learning needs of their students, ensuring that they can grasp key concepts, apply skills accurately and with confidence.
Heba Ghazal, a Senior Lecturer in Pharmacy who has recently obtained her Senior Fellowship, has been nominated multiple times by her students for excellence in support and supervision.