The Performance of junior doctors in applying clinical pharmacology knowledge and prescribing skills to standardised cases

TitleThe Performance of junior doctors in applying clinical pharmacology knowledge and prescribing skills to standardised cases
Publication TypeJournal Article
Year of Publication2010
AuthorsHarding, S, Britten, N, Bristow, D
JournalBritish Journal of Clinical Pharmacology
Volume69
Issue6
Start Page598
Number of Pages606
Abstract

AIMS 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 standardized clinical cases. METHODS A 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. RESULTS 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. CONCLUSIONS This 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.

Practical Implications

A large proportion of the FY1 doctors are unable to perform at an appropriate level of ability in relation to clinical pharmacology and therapeutics.
Areas of performance weakness that pose high risk to patient safety are identified. Training and Assessments are suggested to improve the prescribing by FY1 doctors.

Lay Summary

Errors are common in all healthcare settings. Over 9% of patients admitted to hospital are harmed by error. Whilst error can occur at any stage of the medicine-use process, prescribing errors by GPs are the most common type.
Studies suggest that a worryingly high proportion of final year medical students and new doctors feel unprepared for effective and safe prescribing. Little research has been undertaken with UK junior doctors to see if these perceptions are connected to unsafe prescribing. We aimed to measure the performance of foundation year 1 (FY1) doctors in safe prescribing.
With the help of a pharmacological and medicine expert panel, twelve assessments on of areas high risk to patient safety and deemed as essential for FY1 doctors to know were created. Assessments consisted of six extended matching questions (EMQs) (choosing the write prescription from a list) and written unobserved structured clinical examinations (WUSCEs). These assessments were given at three time points over the course of a year to 128 FY1 doctors.
Of the students tested, 51–75% of FY1 doctors failed EMQs and 27–70% failed WUSCEs. The WUSCEs showed three main things; 30% of the FY1 doctors consistently performing poorly, 50% performing around the passing score, and 20% performing consistently well. The WUSCEs revealed 5% (8/161) of the assessments contained errors deemed as potentially lethal if a patient were to be prescribed what the students had put down in their assessment.
This study showed that a large proportion of the FY1 doctors failed to demonstrate the level of clinical pharmacology and therapeutics (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.

Keywordspending
URLhttp://onlinelibrary.wiley.com/doi/10.1111/j.1365-2125.2010.03645.x/full