Towards Better Prescribing Education for Medical Students

Background and Aims: Prescribing represents ‘the greatest challenge in modern undergraduate medical education’, [1]. Prescribing errors are a major health system concern worldwide. The current study aims to improve prescribing skills for final year medical students through piloting implementation of a 7-day training course.

Summary of work: The training course was developed via collaboration of clinical pharmacologists and clinicians. Online surveys (n=31) and semi-structured interviews (n=4) were used for need assessment and exploring driving and restraining forces. Online case-scenario-based tests were prepared and the course was conducted through blended methods of learning including face-to-face sessions and online activities over one week. Students got immediate feedback through a testing website. Podcasts were uploaded for further annotations. The course was evaluated through comparing pre- and post- tests and a paper-based surveys (n=22).

Outcomes: Students’ confidence in different elements of prescribing was evaluated before and after the training course. Achieving highest degree of confidence, through the course, included overall prescription writing (75 vs 10%, p <0.05), and using the British National Formulary (45 vs 2%, p<0.05). As a result, training on prescribing is planned to be incorporated in the curriculum.

Discussion: The study is an action research that emphasizes the collaboration among academics and clinicians. Immediate feedback (formative assessment) and case-scenarios from everyday practice (authentic learning) helped in enhancing the learning activities. A framework for enhancing training on prescribing was formulated.Previous studies showed that workshops as short as few hours and extended courses of three years, can improve prescribing skills [2]. Choice usually depends on the context, the educational strategies used, and the type of the programme, whether discipline- or problem- based. Such courses should improve clinical reasoning and critical thinking skills.

Conclusions: The study involved the implementation of a short training course on prescribing skills using blended learning methods, through collaborative work among pharmacologists and clinicians. The feedback of the main stakeholders; the clinicians and the students was the key driving force for planning and implementation. The model of prescribing education can be useful to other Medical Colleges with a similar educational context.

References:

(1) Maxwell S (2012). How should teaching of undergraduates in clinical pharmacology and therapeutics be delivered and assessed? Br J Clin Pharmacol 73(6): 893–899.

(2) Kamarudin G, Penm J, Chaar B, Moles R (2013). Educational interventions to improve prescribing competency: a systematic review. BMJ 3(8): e003291.