ObjectiveHealth advocacy competency roles are found in the educational outcomes of many health disciplines, yet their development is neglected in the professional curriculum and clinical learning environment. We explored how pharmacy students conceptualize health advocacy through their practice in workplace-based learning and any feedback they receive. MethodsWe conducted a longitudinal diary study of Canadian pharmacy students completing Advanced Pharmacy Practice Experiences in hospital and community practices in their graduating year. At pre-determined intervals, 25 students recorded workplace-based activities they recognized as health advocacy and any feedback they received from supervisors, patients, or other staff. Written diary data from 180 records were analyzed by 5 researchers according to inductive content analysis steps and principles. ResultsPharmacy student records reflecting health advocacy roles were organized into 5 categories including, (1) disease prevention; (2) health promotion; (3) seamless care; (4) usual pharmacist care; and (5) professional advocacy. Although many activities were consistent with current competency role descriptions, they do not reflect educational outcomes associated with patient- or systems-level support necessary to address socio-political determinants of health. Although Advanced Pharmacy Practice Experience in training evaluation reports included scores for items related to health advocacy competency, few students confirmed receiving specific written or verbal feedback. ConclusionPharmacy students construct health advocacy roles in workplace-based training through biomedical-oriented practices with little direct input offered by supervisors. Pharmacy educational outcomes require contemporary updates to health advocacy competency descriptions which offer examples for practical enactment at system-level and recommendations for feedback and assessment.