The safe and effective use of medicines relies not only on an in-depth knowledge of clinical pharmacology and therapeutics (CPT), but also on clinical judgement and the application of prescription writing skills in practice. Clinical judgement is partially underpinned by experience, however medical graduates do not feel that undergraduate curricula adequately prepare them to prescribe safely and effectively.
The aim of this PhD research project was to gain an understanding of the current teaching and learning practices for practical prescribing in the UK by using a mixed methods approach. Questionnaires were used to capture quantitative data regarding current provisions. No validated questionnaires existed. Those used in this research followed a similar format to a study investigating CPT teaching provisions, and were subsequently validated internally at Brighton and Sussex Medical School. Focus groups were used to capture qualitative data to further explore views of students regarding practical prescribing skill acquisition.
Views from over 1000 medical students, from 24 medical schools are presented. The majority (94.3%) of final year medical students reported that there was teaching and learning in practical prescribing on their course (n=396, 95% Confidence Interval [CI] = 92-97%), with 86.8% of fourth years (n=328, CI=83-90%) and 73.8% of third years (n=166. CI=67-80%) reporting the same. Almost 6% of final year students (n=24) reported that they did not get taught any practical prescribing on their course or did not know if it would be provided. Self-directed learning was the most frequently reported mode of delivery (90.9%, n=809), followed by tutorials (n=786, 79 88.3%), and pre-prescribing seminars (n=725, 81.5%). Validated pre-prescribing, simulation and pre-prescribing seminars were perceived by each year group as the three most effective methods.
Three medical schools reported students do not practice practical prescribing. There was a lack of emphasis on feedback on prescribing, with 7 medical schools reporting they do not provide validated prescribing sessions to their students. The final stage of the research project involved the assembly of a panel of experts in safe prescribing to achieve consensus on the core content, learning outcomes and potential modes of delivery of teaching and learning for a focused programme of study in practical prescribing for medical students, to supplement current undergraduate curricula. A two round modified Delphi method was used to seek consensus (>75% panel agreement). This method has been used previously in other areas of curricular development in UK medical education.
Thirty four out of 47 experts invited responded to round 1 (72.3% response rate) and reached consensus on all 17 core content items, and 22 of the 25 proposed learning outcomes. None were rejected outright. Twenty-eight of the 34 experts responded to round 2 (82.4% retention), and achieved consensus on 17 of the 25 proposed core content items, and all additional 16 learning outcomes. The panel also advised on the suitability of possible teaching and learning methods for practical prescribing at various stages of the undergraduate medical degree.
Implementing such a programme of study might optimise the acquisition of practical prescribing skills and reduce prescribing errors. Ultimately, patient safety might be improved.
|Date of Award
|Michael Okorie (Supervisor), Sian Williams (Supervisor), Inam Haq (Supervisor) & Gordon Ferns (Supervisor)