To What Extent Can Prescribing Skills Be Learnt And Developed In Undergraduate Training: The Perspectives Of Newly Qualified Doctors

D Burrage. St George's, University of London, London, UK

Introduction: Prescribing is an essential skill but evidence suggests newly qualified doctors are unprepared to do it. Teachers of clinical pharmacology need more information about the educational needs of newly qualified doctors to ensure they are better prepared to prescribe. But to what extent can prescribing skills be learnt and developed in undergraduate training? This study sought the perspectives of newly qualified doctors.

Methods: The research sample was taken from newly qualified doctors at a London teaching hospital during 2014, who were sampled by convenience. The study was conducted in two phases. Quantitative data was collected using a questionnaire. The majority of questions invited answers on a five-point Likert scale. Qualitative data was collected from (i) an open question in the questionnaire, and (ii) triangulated with a sample of doctors who volunteered to participate in semi-structured interviews. UCL ethics screening advised that the study was exempt from ethical approval.

Results: The questionnaire response rate was 59% (n=24/41). Four doctors took part in semistructured interviews.

1. Preparedness for prescribing: 29% disagreed that their experience at medical school prepared them for prescribing, and 63% would have liked more teaching. Twenty-one % agreed they were anxious/ embarrassed about their lack of pharmacology knowledge.

2. How newly qualified doctor have learnt to prescribe: Only 46% felt teaching in clinical pharmacology was equivalent or better than training in other areas; 92% had had dedicated teaching on clinical pharmacology and 88% on prescribing. Doctors delivered the majority of clinical pharmacology and prescribing teaching, in large group and small group settings, respectively. Seventy-five per cent had formative, but only 58% had a summative, prescribing assessments.

3. Perceptions on how undergraduate training could be improved: 67% felt clinical pharmacology would be best taught in small groups, whilst 58% felt prescribing teaching is best taught in the workplace.

Themes that emerged from qualitative analysis included:

1. Preparedness for prescribing: (i) key role as prescriber of common medications under supervision, (ii) preparedness associated with undergraduate teaching.

2. How the F1 doctor has learnt to prescribe: (i) motivated by necessity and assessment, (ii) learning is self-directed and experiential, (iii) role modelling from 'near peers' in the work place is common.

3. Perceptions on how undergraduate training could be improved: (i) should be content and process focused, (ii) taught through practice and (iii) assessment should be practical.

Conclusion: Undergraduate teaching of prescribing helps newly qualified doctors feel more prepared. However exposure to prescribing is poor and newly qualified doctors lack confidence to prescribe common medications independently. They prefer a more experiential, apprenticeship-style, approach to learning.