The performance of junior doctors in applying clinical pharmacology knowledge and prescribing skills to standardized clinical cases

Abstract

WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT• Safe prescribing is a core competency in undergraduate medical education.• A large proportion of undergraduate medical students and recently graduated doctors in the UK are not confident in their ability to prescribe effectively and safely.• Errors are common in all healthcare settings and prescribing errors are the most common type. WHAT THIS STUDY ADDS• This study produced twelve valid and statistically reliable assessments of clinical pharmacology and therapeutics (CPT) knowledge and prescribing skills in areas that pose a high risk to patient safety. • The findings show that a large proportion of foundation year 1 (FY1) doctors fail to demonstrate the level of CPT knowledge and prescribing ability judged by a subject matter expert (SME) panel to be required at this stage of their careers.• We suggest strategies and areas where teaching can be focused to improve the safety and effectiveness of prescribing by FY1 doctors. AIMSRecent studies suggest a worryingly high proportion of final year medical students and new doctors feel unprepared for effective and safe prescribing. Little research has been undertaken on UK junior doctors to see if these perceptions translate into unsafe prescribing practice. We aimed to measure the performance of foundation year 1 (FY1) doctors in applying clinical pharmacology and therapeutics (CPT) knowledge and prescribing skills using standardized clinical cases. METHODSA subject matter expert (SME) panel constructed a blueprint, and from these, twelve assessments focusing on areas posing high risk to patient safety and deemed as essential for FY1 doctors to know were chosen. Assessments comprised six extended matching questions (EMQs) and six written unobserved structured clinical examinations (WUSCEs) covering seven CPT domains. Two of each assessment types were administered over three time points to 128 FY1 doctors. RESULTSThe twelve assessments were valid and statistically reliable. Across seven CPT areas tested 51-75% of FY1 doctors failed EMQs and 27-70% failed WUSCEs. The WUSCEs showed three performance trends; 30% of FY1 doctors consistently performing poorly, 50% performing around the passing score, and 20% performing consistently well. Categorical rating of the WUSCEs revealed 5% (8/161) of scripts contained errors deemed as potentially lethal. CONCLUSIONSThis study showed that a large proportion of FY1 doctors failed to demonstrate the level of CPT knowledge and prescribing ability required at this stage of their careers. We identified areas of performance weakness that posed high risk to patient safety and suggested ways to improve the prescribing by FY1 doctors.

How prepared are UK medical graduates for practice? A rapid review of the literature 2009–2014

“…For example, understanding how the clinical environment works and clinical handover (sometimes called handoff) do not appear in the outcomes. Once again the pattern of preparedness shows far more studies, providing evidence that graduates are unprepared11 13 27 36–39 42 47 51 63–65 67 than those providing evidence they are prepared,36–38 42 51 with no studies purely contributing to the latter.…”

Formulary compliance and pharmacy labor costs associated with systematic formulary management strategy

“…Inexperienced prescribers require more training in safe and rational prescribing when starting clinical practice. 10,11 More medications on a formulary could lead to more medication errors, as prescribers have to become familiar with more medications. In addition, a broader formulary leads to a larger inventory.…”

Evaluating an undergraduate interprofessional education session for medical and pharmacy undergraduates on therapeutics and prescribing: the medical student perspective

“…The GMC requires undergraduate medical curricula to be designed to ensure that graduates are competent in prescribing 30. Reasons in part were due to findings showing that some junior doctors lacked the clinical pharmacology and therapeutics knowledge required of them 31,32. Hospital medication error rates of 8%–10% were made by doctors in the first 2 years after their initial medical degree 33.…”