What Should Junior Doctors Know about the Drugs they Frequently Prescribe? A Delphi Study among Physicians in the Netherlands

Abstract

The aim of this study was to identify the information about commonly prescribed drugs that junior doctors should know in order to prescribe rationally in daily practice, defined as essential drug knowledge (EDK). A two-round Internet Delphi study was carried out involving general practitioners from one practice cluster, and registrars and consultants from two Dutch academic and eight teaching hospitals. A preliminary list of 377 potential EDK items for three commonly prescribed drugs was assessed on a dichotomous scale; an item was considered EDK if at least 80% consensus was reached. The consensus list of EDK items was discussed by the research team to identify similarities between the three drugs, with a view to forming a list of general EDK items applicable to other commonly prescribed drugs. Sixty experts considered 93 of the 377 items (25%) as EDK. These items were then used to form a list of 10 general EDK items. The list of EDK items identified by primary and secondary care doctors could be used in medical curricula and training programmes and for assessing the prescribing competence of future junior doctors. Further research is needed to evaluate the generalizability of this list for other commonly prescribed drugs.Rational prescribing (i.e. effectively, safely and at low cost) is an essential skill for medical doctors to reduce the frequency of avoidable adverse drugs reactions and prescribing errors [1,2]. Unfortunately, numerous studies have revealed that the prescribing performance of junior doctors is inadequate and that they make many avoidable prescribing errors, resulting in inefficiencies in patient care and even patient harm [1][2][3][4][5]. There is considerable evidence that a major factor contributing to prescribing errors is a lack of basic knowledge of pharmacology and pharmacotherapy among recent graduates [6][7][8][9][10][11][12][13][14][15][16]. Thus, improving the pharmacology and pharmacotherapy knowledge of medical students might prevent or reduce the number of these errors in the future [1,6].In order to prescribe adequately, it is important to identify which information about individual drugs should be ready knowledge and which can be looked up (e.g. by using a mobile app or electronic prescribing system). Some studies suggest that medical students should use, and have a thorough knowledge of, a core list of commonly prescribed drugs, such as the essential drug list [17] or the student formulary [18][19][20][21], so that they can prescribe these drugs appropriately, under the supervision of a senior doctor. This knowledge of drug information and prescribing competence should be tested in an examination before graduation. Until now, there has been no clear and robust definition of what graduates should know about commonly prescribed drugs (e.g. doses, contraindications, etc.) to prescribe rationally. Therefore, the aim of this study was to identify which information about commonly prescribed drugs junior doctors should have acquired in order to prescribe rationally in dail...

Essential competencies in prescribing: A first european cross‐sectional study among 895 final‐year medical students

“…This poor knowledge could be because the quantity and quality of undergraduate clinical pharmacology teaching is inadequate, as implied by the students. Despite the growing digital support (e.g., apps, websites), clinical pharmacology remains a target for educational improvement, because an adequate knowledge of drug interactions and contraindications, especially of commonly prescribed drugs, remains crucial to prescribe safely and to minimize the risk of harm to patients …”

“…The MCQs covered basic pharmacological mechanisms of action ( n = 8), drug side effects ( n = 8), drug–drug interactions, and drug–disease contraindications ( n = 8) of essential drug(s), as listed in the World Health Organization (WHO) list of essential medicines . The questions about the clinical case scenarios assessed essential CPT knowledge, that is, ready knowledge in CPT that every medical graduate should have acquired before graduation (example: Supplemental Figure 1 ) …”

“…interactions and contraindications, especially of commonly prescribed drugs, remains crucial to prescribe safely and to minimize the risk of harm to patients. 14 Nearly half of the therapies (46%) were inappropriate, with a substantial proportion of these being potentially harmful (15%) or potentially lethal (4%). This is worrying because the clinical cases were based on common diseases that European graduates will encounter regularly in daily practice.…”

“…21 The questions about the clinical case scenarios assessed essential CPT knowledge, that is, ready knowledge in CPT that every medical graduate should have acquired before graduation (example: Supplemental Figure 1). 14 The scenarios described diseases selected from the list of 40 core diseases that European medical graduates should know how to treat, namely, acute bronchitis, gastroesophageal reflux disease, community-acquired pneumonia, osteoarthritis, essential hypertension (example: Supplemental Figure 2). 8 Scenarios were presented in the same format, 22 but differed in complexity (disease severity and complicating factors, such as age, comorbidity, and comedication).…”

The Dutch list of essential drugs for undergraduate medical education: A modified Delphi study

“…Used alongside the list of essential diseases and the Dutch National Pharmacotherapy Assessment, 19,25,26 this list will provide a solid framework for CP&T education in medical curricula in the Netherlands. This will enable students to become acquainted with these drugs in their preclinical years, 28 thereby forming a sound basis on which their prescribing skills and knowledge can be developed further during clinical training and clerkships.…”