Prepare for the PSA : An e-Learning Tutorial for Final-Year Medical Students

Finneas Catling1, Robert Baker1,2. 1University of Bristol, Bristol, Avon, UK, 2Musgrove Park Hospital, Taunton, Somerset, UK

BACKGROUND: It is essential to patient safety that junior doctors prescribe appropriately, yet errors were identified in 8.4% of 50016 prescriptions written by first-year foundation doctors during 2009.1 Qualitative data from the same study suggested that undergraduate medical education programmes had failed to provide adequate training in practical prescribing. In addition, only 27% of medical students surveyed during 2006-2008 felt that their training would enable them to achieve the core prescribing competencies outlined by the GMC.2,3 The Prescribing Skills Assessment (PSA) is a computer-based examination aimed at ensuring prescribing competence in final-year medical students. The PSA will soon be introduced nationally but few specific preparatory resources are currently available whereby prospective candidates can test their knowledge and familiarise themselves with the exam format.4

METHODS: Forty five penultimate-year medical students (representing 18% of their year group) responded to an open email invitation and were surveyed regarding the prescribing teaching they had received, their perceived competence in the skills examined by the PSA, and their preferences relating to e-learning resources. An online tutorial (Prepare for the PSA) was designed in response to the results obtained and was moderated by clinicians with experience of the PSA. The tutorial consists mainly of a practice exam which closely mirrors the format of the PSA itself. After completing each question the user receives personalised feedback and is given the opportunity to further their knowledge using interactive learning activities. A facility for users to contribute their own questions to the tutorial is included and integration with social media encourages student involvement, with the aim of establishing the tutorial as a platform for collaborative prescribing and therapeutics education. The tutorial also explains the rationale underlying the PSA and directs users to further learning resources. Six students responded to an open invitation to evaluate a draft version of the tutorial and rated their confidence in their ability to perform each skill examined by the PSA, before and after completion of the tutorial, using a 5-point scale. .

RESULTS: In the group surveyed initially, 82% of students felt their teaching had prepared them “slightly well” or “not at all well” for prescribing duties as a foundation doctor. When asked which features would be most helpful to include in an e-learning tutorial, almost all students requested practice examination questions and self-test quizzes. In the evaluation group, the majority of students initially felt “slightly confident” or “moderately confident” in their ability to perform PSA-assessed prescribing skills. After completion of the draft tutorial, average confidence increased in each of these abilities, with a mean increase of 0.69 points on the 5-point rating scale and with “moderately confident” and “very confident” being the most common responses.

CONCLUSION: Medical students in our study felt poorly prepared for prescribing skills. A trend of increased confidence following completion of the Prepare for the PSA was identified but requires investigation with a larger-scale evaluation. Further studies are in process which explore the association between completion of the tutorial, student confidence and performance in the PSA itself.

1. Dornan T, Ashcroft D, Heathfield H, Lewis P, Miles J, Taylor D, et al. An in depth investigation into causes of prescribing errors by foundation trainees in relation to their medical education. EQUIP study. Manchester: General Medical Council, 2009.

2. Heaton A, Webb DJ, Maxwell SR. Undergraduate preparation for prescribing: the views of 2413 UK medical students and recent graduates. British journal of clinical pharmacology 2008;66(1):128-34.

3. Rubin P. Tomorrow\'s Doctors. London: General Medical Council, 2009.

4. British Pharmacological Society, Medical Schools Council. About the PSA Internet. Available at http