I have recently submitted a thesis for a masters of philosphy, entitled: The Design and Validation of assessment tools for use with Junior Doctors in Applying Clinical Pharmacology. Part of this work has been written up and will be published in the next edition (June 2010) of the peer reviewed academic journal British Journal of Clinical Pharmacology.
Entitled: The performance of junior doctors in applying clinical pharmacology knowledge and prescribing skills to standardised clinical cases. This paper builds on the fact that safe prescribing is a core competency in undergraduate medical education. That a large proportion of undergraduate medical students and recently graduated doctors in the UK are not confident in their ability to effectively and safely prescribe and that errors are common in all healthcare settings and prescribing errors are the most common type.
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. My co-authors (Prof Nicky Britten & Dr David Bristow) suggest strategies and areas where teaching can be focused to improve the safety and effectiveness of FY1 doctors’ prescribing.
If this is an area of interest then below is the abstract related to the article and a link to the journal.
Recent 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 standardised clinical cases.
A subject matter expert (SME) panel constructed a blueprint and from this twelve assessments focussing on areas posing high risk to patient safety and deemed as essential for FY1 doctors to know. Assessments comprised six Extended Matching Questions (EMQ) and six Written Unobserved Structured Clinical Examinations (WUSCE) covering seven CPT domains. Two of each assessment types were administered over three time points to 128 FY1 doctors.
The 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.
This study shows that a large proportion of FY1 doctors fail to demonstrate the level of CPT knowledge and prescribing ability required at this stage of their careers. We identify areas of performance weakness that pose high risk to patient safety and suggest ways to improve FY1 doctors’ prescribing.