Junior doctors prescribing: enhancing their learning in practice

Authors


  • Author's contributions: CR, GM, JI, BCB, CD, BB and JM contributed to the designing of the interview schedules, collecting, analyzing and writing of the qualitative data. JS, EP, NJ, MA commented on the interview schedules, analysis and the writing up of the qualitative data.

  • BCB, CR, JI, GM, CD and BB contributed to the design of the triangulating questionnaire with clinical expertise and comments from JS, JM, EP, NJ, MA.

  • The triangulating questionnaire was distributed and collected by CR, GM, JI, BCB, CD, BB, MA and JM and analyzed by BCB.

  • Prescribing assessment data were provided at Newcastle by BCB and at Warwick by MA.

  • All authors contributed to earlier drafts of this paper and to the final draft of the paper. All authors had full access to all the data. JI is guarantor of the study.

Ms Charlotte Rothwell, Durham University, Medical Education Research Group, Burdon House, Leazes Road, Durham DH1 1TA, UK. Tel.: +44 19 1334 8197, Fax: +44 19 1334 8352. E-mail: c.r.rothwell@durham.ac.uk

Abstract

WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT

• A large proportion of medical graduates do not feel prepared for practice.

• Prescribing is one of the biggest steps up from being a student to practising as a doctor.

WHAT THIS STUDY ADDS

• The lack of preparedness of graduates for practice is related to a lack of exposure and preparation for clinical practice. Preparedness may be improved by increasing the number of opportunities to develop the skill-based, applied aspects of prescribing in a controlled, ‘real’ environment. Simulated activity could provide this experience to undergraduates, or writing prescriptions and drug charts to be checked and signed by a doctor on clinical placements.

AIM This aim of this paper was to explore new doctors' preparedness for prescribing.

METHODS This was a multiple methods study including face-to-face and telephone interviews, questionnaires and secondary data from a safe prescribing assessment (n= 284). Three medical schools with differing curricula and cohorts were included: Newcastle (systems-based, integrated curriculum); Warwick (graduate entry) and Glasgow [problem-based learning (PBL)], with graduates entering F1 in their local deanery. The primary sample consisted of final year medical students, stratified by academic quartile (n= 65) from each of the three UK medical schools. In addition an anonymous cohort questionnaire was distributed at each site (n= 480), triangulating interviews were conducted with 92 clinicians and questionnaire data were collected from 80 clinicians who had worked with F1s.

RESULTS Data from the primary sample and cohort data highlighted that graduates entering F1 felt under-prepared for prescribing. However there was improvement over the F1 year through practical experience and support. Triangulating data reinforced the primary sample findings. Participants reported that learning in an applied setting would be helpful and increase confidence in prescribing. No clear differences were found in preparedness to prescribe between graduates of the three medical schools.

CONCLUSION The results form part of a larger study ‘Are medical graduates fully prepared for practice?’. Prescribing was found to be the weakest area of practice in all sources of data. There is a need for more applied learning to develop skill-based, applied aspects of prescribing which would help to improve preparedness for prescribing.

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