A pilot study of a pharmacist-led prescribing program for final-year medical students

Implementation and evaluation of an interprofessional prescription writing workshop with a simulated electronic prescribing activity for preclerkship medical students

BACKGROUND

Prescription writing skills are essential for physician practice. This study describes the development and implementation of a curricular intervention focused on improving the knowledge and confidence of preclerkship medical students' prescription writing practices utilizing an interprofessional education model, with a focus on electronic prescribing.

METHODS

Medicine and Pharmacy Faculty from a large, urban university collaborated to develop the content of the workshop and a simulation platform was used for the e-prescribing activity. Second-year medical students attended a mandatory in-person workshop facilitated by fourth-year pharmacy students. A pre and post knowledge test and confidence survey were used to assess students' knowledge, confidence, and satisfaction. Outcomes from the knowledge test were evaluated with paired-samples proportions tests, and confidence survey data was evaluated with paired t-tests and Wilcoxon signed-rank tests in a pre-post study design.

RESULTS

Students demonstrated a significant increase in prescription writing knowledge and confidence after completing the workshop. On the pre-test, 7% of students (21/284) completed the electronic prescribing assessment correctly and 51% of students (149/295) completed it correctly on the post-test. All items on the confidence survey showed a significant increase in pre- versus post-survey comparisons (p < 0.001).

CONCLUSIONS

This interprofessional prescription writing workshop facilitated by pharmacy students shows promise for improving the knowledge and confidence of prescription writing and electronic prescribing practices in preclerkship medical students.

Educational Interventions for Medical Students to Improve Pharmacological Knowledge and Prescribing Skills: A Scoping Review

Introduction

Medication-related errors place a heavy financial burden on healthcare systems worldwide, and mistakes are most likely to occur at the stage of prescribing. Junior doctors are more likely to make prescribing errors, and medical graduates also lack confidence and preparedness towards prescribing. Thus, this review aimed to evaluate the existing educational approaches to improve pharmacological knowledge and prescribing skills among medical students.

Methods

CENTRAL, CINAHL, ERIC, Ovid Embase, Ovid MEDLINE, Ovid PsycINFO, and Scopus were searched with keywords related to "pharmacological knowledge", "prescribing skills", "educational interventions" for articles published since 2016.

Results

3595 records were identified, and 115 full-text articles were assessed for eligibility. Eighty full-text articles were eligible and included in this review. Thirty-seven studies focused on improving prescribing skills, whilst 43 targeted pharmacological knowledge. A broad range of interventions was implemented, including e-learning, case-based, interprofessional, and experiential learning. Pharmacological knowledge and prescribing skills were measured in various ways, and all studies reported one or more positive findings at Kirkpatrick level 1 or 2. No study reported outcomes at Kirkpatrick levels 3 and 4.

Discussion

The World Health Organisation's Good Guide to Prescribing was the foundation of the development of prescribing educational interventions. Emerging interventions such as experiential and interprofessional learning should be incorporated into the prescribing curriculum. Innovative approaches such as game-based learning can be considered for clinical pharmacology teaching. However, there was a lack of outcomes at Kirkpatrick levels 3 and 4. Robust methodology and reliable outcome measures are also needed in future studies.

Teaching rational prescribing in undergraduate medical education: a systematic search and review

AIM

This study aimed to reveal the current status of the literature on rational prescribing training in undergraduate medical education.

METHODS

This study followed the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. An online search using 50 keywords in four databases was performed to access the studies published between 2008 and 2020. Specific features of the training such as aims or objectives of teaching, methods or model, and evaluation of effectiveness were extracted. Kirkpatrick levels were used to evaluate the effectiveness of teaching.

RESULTS

Of 74 studies included in the full review, 16 (21.6%) of them reported the use of WHO 6-Step Model for Rational Prescribing in their educational interventions. In terms of effectiveness, only two of the studies investigated changes in learner behavior in the context for which they are being trained, and only one study showed the effect of training on patient outcomes.

CONCLUSION

The evidence on the effectiveness of rational prescribing training has been presented mostly by using student satisfaction surveys and test of knowledge and skills. A higher level of evidence such as patient outcomes of the training needs to be reported.

What do physician associates think about independent prescribing?

Physician associates (PAs) are currently unable to prescribe in the UK due to the absence of statutory regulation and prescribing legislation. This is likely to change with the introduction of regulation by the General Medical Council (GMC) set to start from 2023. Currently, there are working groups looking into what needs to be done to enable them to prescribe. In this paper, we explored the views of PAs that qualified in the UK on prescribing and ordering investigations via an online questionnaire. Almost all PAs would prefer to be able to prescribe and request radiological investigations. Inability to perform these basic duties has a negative impact on patient care, patient flow, PAs' contribution to healthcare and career progression.

Pharmacist-Led Education for Final Year Medical Students: A Pilot Study

Background: Prescribing is a core skillset for medical officers. Prescribing errors or deficiencies can lead to patient harm and increased healthcare costs. There is an undefined role for pharmacist-led education to final year medical students to improve prescribing skills.

Aim: Assess if pharmacist-led education on prescription writing improves the quality and safety of final year medical students' prescribing skills.

Method: 

Participants and Intervention: Final year medical students were randomised into tutorial (TG) or non-tutorial groups (NTG) and assessed pre- and post- intervention. TG received education by a clinical pharmacist and pharmacy educator using case-based learning. NTG received no additional training as per usual practice. Following the pre-test, all students completed a 3-week tertiary hospital medical ward placement. Students completed the post-test following placement and after the TG participated in the intervention.

Student Assessment: Assessment included writing Schedule 4 (S4, prescription only), Schedule 8 (S8, controlled drug), S4 streamline (S4SL), and Mixed case (S4 and S8) prescriptions.

Results: At baseline, there were no significant differences between TG and NTG for overall scores or proportion of passes. Post intervention scores significantly improved in TG (p = 0.012) whereas scores significantly decreased in the NTG (p = 0.004). The overall proportion of passes was significantly higher in the TG than NTG (p < 0.001).

Conclusion: Education by a clinical pharmacist improved short-term prescribing skills of final year medical students in this study. Students learning primarily experientially from peers and rotational supervisors showed decreased prescribing skills. We propose pharmacist-led education on prescription writing should be further evaluated in larger studies across more student cohorts and for longer periods of follow up time to clarify whether such an educational model could be included in future medical school curricula.

A Rapid Review of Prescribing Education Interventions

INTRODUCTION

Many studies conducted on the causes and nature of prescribing errors have highlighted the inadequacy of teaching and training of prescribers. Subsequently, a rapid review was undertaken to update on the nature and effectiveness of educational interventions aimed at improving the prescribing skills and competencies.

METHODS

Twenty-two studies taking place between 2009 and 2019 were identified across nine databases.

RESULTS AND DISCUSSION

This review reinforced the importance of the WHO Guide to Good Prescribing to prescribing curriculum design as well as the effectiveness of small group teaching. However, it also highlighted the lack of innovation in prescribing education and lack of longitudinal follow-up regarding the effectiveness of prescribing education interventions.

The Effectiveness of a Foundation Year 1 Doctor Preparation Course for Final Year Medical Students

BACKGROUND

Starting work as a junior doctor can be daunting for any medical student. There are numerous aspects of the hidden curriculum which many students fail to acquire during their training.

OBJECTIVES

To evaluate the effectiveness of a novel foundation year one (FY1) doctor preparation course focusing on certain core topics, practical tips and components of the hidden curriculum. The primary objective was to improve the confidence level and knowledge of final year medical students transitioning to FY1 doctors.

METHOD

A 2-day, practical course titled 'Preparation 2 Practice' delivering hands-on, small-group and lecture-based teaching, covering core medical student undergraduate curriculum topics in medicine and surgery. The course content spanned therapeutics, documentation skills and managing acute clinical tasks encountered by FY1 doctors during an on-call shift. A pre- and post-course survey and knowledge assessment were carried out to assess the effectiveness of the course. The assessment was MCQ-based, derived from topics covered within our course. The 20-question test and a short survey were administered electronically.

RESULTS

Twenty students from a single UK medical school attended the course. 100% participation was observed in the pre- and post-course test and survey. The median post-course test result was 22 (IQR 20.25-23.75) which was higher than the median pre-course test score of 18.75 (IQR 17-21.75). A Wilcoxon sign rank test revealed a statistically significant difference between the pre- and post-course test results (P = .0003). The self-reported confidence score of delegates on starting work as a junior doctor was also significantly higher following the course (P = .004).

CONCLUSION

The results show a significant improvement in perceived confidence and knowledge on core curriculum topics amongst final year medical students having attended our FY1 doctor preparation course. We conclude that there is scope for similar supplementary courses as an adjunct to the undergraduate medical curriculum.

Twelve tips for facilitating medical students prescribing learning on clinical placement

Prescribing is a complex clinical skill requiring mastery by the end of basic medical training. Prescribing errors are common in newly qualified doctors, aligned with expressed anxiety about prescribing, particularly with high-risk medications. Learning about prescribing needs to start early in medical training, underpinned by regular opportunities for reflective practice. Authentic learning within the clinical work environment is more effective than lecture based learning and allows potential immediate feedback. Educational strategies should support prescribing learning underpinned by appropriate formative and summative assessments. Students should routinely be expected to use resources including an online formulary, sustained through tracking individual progress through use of their own personal formulary or 'p' drugs. Regular prescribing practice with embedded feedback during undergraduate training will help to ensure newly qualified doctors are more confident and competent prescribers.

Pharmacist-led teaching as a longitudinal theme for medical school curriculums - a solution for reducing prescribing errors in junior doctors?

Medication errors are a significant problem faced by health services internationally.Prescribing errors are a common preventable source of morbidity and mortality, and as such it is our duty as healthcare professionals to minimise them as much as possible.Many prescriptions, and errors, are written by junior doctors. Which raises the question of whether the medical school curriculum could be changed to better prepare students for prescribing.There is a great deal of evidence in the literature describing how pharmacist-led teaching in later years of medical school has a beneficial effect on the quality of prescriptions written by junior doctors. In addition, this style of teaching leads to a reduction in the number of prescribing errors that occur. However, many of these papers still reported that students were still apprehensive about their prescriptions after the teaching programmes, and a number of their prescriptions still contained some inaccuracies.The University of Liverpool organises 'Safe Prescribing' teaching sessions during years 3-5 of the undergraduate medical curriculum. This programme consistently receives positive feedback and results in students feeling more comfortable and confident in a variety of prescribing scenarios.Incorporating pharmacist-led teaching as a longitudinal theme from the early stages of medical school is one way positive habits can be built and reinforced. This may in turn reduce the number of prescribing errors that occur, both in junior doctors and more senior doctors as these clinicians progress through their training armed with an effective skill set.