Preparedness for Prescribing: Final Year medical students’ self-evaluation of and attitudes towards prescribing education.

Background: Awareness of the harms arising from prescribing errors and recognition that Foundation Year 1(FY1) and 2 doctors write the majority of in-patient prescriptions have seen increased focus on ensuring that medical graduates possess the knowledge and skills required to be safe prescribers on their first day of work. This has included the introduction nationally of the Prescribing Safety Assessment (PSA) as well as specific interventions by individual medical schools (1). Providing knowledge and experience, maintaining patient safety, and integrating prescribing within the overall curriculum are challenging goals for educators. Few studies have evaluated students’ views of these goals, or their perspectives on prescribing teaching since the introduction of the PSA. At Barts and The London School of Medicine and Dentistry, the PSA became a summative component of Finals examinations in 2015. Over several years, we have developed multi-modal prescribing training for finalists including lectures, practical workshops, SCRIPT® e-learning(2), pharmacist-led small group tutorials and junior doctor shadowing. Here, we sought to evaluate the students’ perceptions of their training and their resulting prescribing skills and to understand their perspective on how to develop competent and safe FY1 prescribers.

Summary of work: We surveyed final year medical students prior to graduation (June 2015) using a questionnaire circulated in both online and paper formats. A combination of Likert scales, ranking and free text questions was developed with reference to previously validated tools and piloted before use. The questionnaire was completed by 41% of the final year cohort (137 students). Data were entered onto an Excel® spreadsheet for analysis; thematic analysis of free text answers was performed.

Outcomes: A small majority of students felt prepared for FY1prescribing (58%), with 30% being unsure, and 10% stating they were not prepared. Almost all students surveyed (97%) felt their prescribing had improved over the previous twelve months. With regard to specific prescribing competencies, students expressed confidence in their ability to write a legally correct prescription and perform calculations, and knew where to seek advice about medicines. Reviewing and amending medications, undertaking drug monitoring and recognition and management of adverse drug events emerged as areas of self-perceived weakness. Students expressed a strong preference for a multi-modal approach to prescribing education and highly valued opportunities to write their own prescriptions. Interactive workshops and the SCRIPT® e-learning platform were the most useful individual resources. Students clearly asked for an even greater emphasis on practical prescribing, starting early and integrated throughout the curriculum.

Discussion and conclusion: Students understand the importance of safe prescribing and are motivated gain the required competencies for FY1. Compared with national data for 2006-8, self-assessment of competence suggests improvement since the introduction of the PSA and local curriculum development (3). Whilst e-learning is highly valued, this should be integrated with practical opportunities to prescribe – either simulation or supervised prescriptions. Drug monitoring and adverse drug reactions are areas for further intervention. Work is now needed to examine how medical students’ self-evaluations translate into prescribing behaviours and error rates as FY1prescribers.

1. Ross S and Maxwell S (2012). British Journal of Clinical Pharmacology 74: 644-661.

2. Standard Computerised Revalidation Instrument for Prescribing and Therapeutics (SCRIPT®)(2015) http://wm.hee.nhs.uk/files/2015/01/SCRIPT-brochure-Final.pdf

3. Heaton A et al (2008). British Journal of Clinical Pharmacology 66: 128-134