DOI: http://dx.doi.org/10.18203/2319-2003.ijbcp20171078

Acquisition of prescribing skill by medical students in a problem-based learning curriculum: preclerkship to clerkship phase transition

Khalid A.J. Al Khaja, Henry James, Reginald P. Sequeira

Abstract


Background: Medical school training for students in pharmacotherapy is sub-optimal and junior doctors are not confident to prescribe drugs. This study was conducted to assess the prescribing competency of students in preclerkship and clerkship phases at a medical school that implements problem-based learning curriculum.

Methods: Objective structured practical examination was used to assess prescribing competency of students in both phases. The prescribing performance was empirically categorized into poor, moderate and good competency.

Results: The prescription writing skills achieved by the clerkship students did not significantly differ from that attained by students in preclerkship phase. Good prescribing competency was attained by approximately 20% of the students at the end of both phases. Preclerkship students performed better on therapeutic reasoning than those in clerkship phase. Cognitive skill that involves choosing the superior drug(s) among several alternatives as achieved less satisfactorily by majority of students from both phases of the program.

Conclusions: Acquisition and further development of the prescribing competency during the clerkship phase was sub-optimal. The continuation of pharmacotherapeutic context-learning program during clerkship phase is recommended.


Keywords


Antihypertensives, Bahrain, Context-learning pharmacotherapy program, Prescribing skill assessment, Prescribing competency, Therapeutic reasoning

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References


Aronson JK. Medication errors: definitions and classification. Br J Clin Pharmacol. 2006;67:599-604.

Aronson JK. A prescription for better prescribing. Br J Clin Pharmacol. 2006;6:487-91.

Al Khaja KA, Handu SS, James H, Mathur VS, Sequeira RP. Assessing prescription writing skills of pre-clerkship medical students in a problem-based learning curriculum. Int J Clin Pharmacol Ther. 2005;43:429-35.

Al Khaja KAJ, James H, Sequeira RP. Effectiveness of an educational intervention on prescription writing skill of preclerkship medical students in a problem-based curriculum. J Clin Pharmacol. 2013;53(5):483-90.

Rauniar GP, Roy RK, Das BP, Bhandari G, Bhattacharya SK. Prescription writing skills of pre-clinical medical and dental undergraduate students. J Nepal Med Assoc. 2008;47:197-200.

Kumar J, Shaik MM, Kathi MC, Chetty MS, Deka A. Appraisal of prescription writing skills of preclinical undergraduate students in a medical institute of Nepal. JCMS-Nepal. 2010;6:7-13.

Coombes ID, Stowasser DA, Coombes JA, Mitchell C. Why do interns make prescribing error? A quantitative study. Med J Aust. 2008;188:89-94.

Likic R, Maxwell SRJ. Prevention of medication errors: teaching and training. Br J Clin Pharmacol. 2009;67:656-61.

Dean B, Schachter M, Vincent C, Barber N. Prescribing errors in hospital inpatients: their incidence and clinical significance. Qual Saf Health Care. 2002;11:340-44.

Ross S, Bond C, Rothnie H, Thomas S, Macleod MJ. What is the scale of prescribing errors committed by junior doctors? A systematic review. Br J Clin Pharmacol. 2009;67:629-40.

Mathur VS, Sequeira RP, Jassim KA. Promoting rational prescribing in problem-based curriculum. In: Scherpier AJJA, van der Vleuten CPM, Rethans RJ, van der Steig AFW, eds. Advances in Medical Education. Dordrecht: Kluwer Academic Publishers; 1997:516-18.

Lofholm PW, Katzung BG. Rational prescribing and prescription writing. In: Katzung BG, ed. Basic and Clinical Pharmacology. 11th Ed. New York, NY: McGraw-Hill; 2009:1127-1139.

Al Khaja KAJ, Sequeira RP, Al-Ansari T, Damanhori AH, James H, Handu SS. Paediatric iron preparations for infants in Bahrain: Some therapeutic concerns. Int J Clin Pharmacol Ther. 2010;48:200-5.

Norman G. Research in Clinical Reasoning: Past history and current trends. Med Edu. 2005;39:418-27.

Richir MC, Tichelaar J, Geijteman ECT, de Vries TP. Teaching Clinical Pharmacology and therapeutics with emphasis on the therapeutic reasoning of undergraduate medical students. Eur J Clin Pharmacol. 2008;64:217-24.

Richir MC, Tichelaar J, Stanm F, Thijs A, Danner SA, Schneider AJ, et al. A context-learning pharmacotherapy program for preclinical medical students leads to more rational drug prescribing during their clinical clerkship in internal medicine. Clin Pharmacol Ther. 2008;84:513-6.

Vollebregt JA, Oldenrijk JV, Kox D, van Galen SR, Sturm B, Metz JC, et al. Evaluation of a pharmacotherapy context-learning program for preclinical medical students. Br J Clin Pharmacol. 2006;62:666-72.

Zgheib NK, Simaan JA, Sabra R. Using team-based learning to teach clinical pharmacology in medical school: Student satisfaction and improved performance. J Clin Pharmacol. 2011;51:1101-11.

Celebi N, Wagner R, Weyrich P, Heine D, Fenik Y, Holderried F, et al. Medical clerkships do not reduce common prescription errors among medical students. Naunyn Schmiedebergs Arch Pharmacol. 2010;382:171-6.

Miller GE. The assessment of clinical skills, competence, performance. Acad Med. 1990;65:63-7.

Wass V, Van der Vleuten C, Shatzer J, Jones R. Assessment of clinical competence. Lancet. 2001;357(9260):445-9.

National Institute for Health and Clinical Excellence (NICE) [homepage on internet]. Hypertension in adults: diagnosis and management. NICE guidelines [CG127]. Available from: https://www.nice.org.uk/guidance/cg127/chapter/1-Guidance. Accessed 6 February 2017.

James PA, Oparil S, Carter BL, Cushman WC, Dennison-Himmelfarb C, Handler J, Lackland DT, et al. Evidence-based guidelines for the management of high blood pressure in adults Report from the panel members appointed to the eighth joint National Committee (JNC8). JAMA. 2014;311:507-20.

Tziomalos K, Athyros VG, Karagiannis A, Mikhailidis DP. Dyslipidemia induced by drugs used for the prevention and treatment of vascular diseases. Open cardiovasc Med J. 2011;5:85-9.

Deshmukh M, Lee HW, McFarlane SI, Whaley-Connell A. Antihypertensive medications and their effects on lipid metabolism. Curr Diab Rep. 2008;8:214-20.

Carella AM, Antonucci G, Conte M, Di Pumpo M, Giancola A, Antonucci E. Antihypertensive treatment with beta-blockers in the metabolic syndrome: a review. Curr Diabetes Rev. 2010;6:215-21.

Mancia G, Gassi G, Zanchetti A. A new onset diabetes and antihypertensive drugs. J Hypertens. 2006;24:3-10.

Opie LH, Schall R. Old antihypertensives and new diabetes. J Hypertens. 2004;22:1453-8.

European Heart Journal [homepage on internet]. 2013 ESH/ESC Guidelines for the management of arterial hypertension. Available from: http://eurheartj.oxfordjournals.org/content/34/28/2159. Accessed 6 February 2017.

Salvetti A, Chiadoni L. Thiazide diuretics in the treatment of hypertension: an update. J AM Soc Nephrol. 2006;17:S25-9.

World Health Organization, International Society of Hypertension Writing Group. World Health Organization (WHO) / International Society of Hypertension (ISH) Statement on management of hypertension. J Hypertens. 2003;21:983-92.