Assessing prescribing competence

Abstract

Prescribing of medicines is the key clinical activity in the working life of most doctors. In recent years, a broad consensus regarding the necessary competencies has been achieved. Each of these is a complex mix of knowledge, judgement and skills. Surveys of those on the threshold of their medical careers have revealed widespread lack of confidence in writing prescriptions. A valid and reliable assessment of prescribing competence, separate from an overall assessment of medical knowledge and skill, would have many benefits for clinical governance and patient safety, and would provide a measure of the success of training programmes in therapeutics. Delivering such an assessment presents many challenges, not least of which are the difficulty in identifying a surrogate marker for competent prescribing in clinical practice and the challenge of ensuring that competence assessed in a controlled environment predicts performance in clinical practice. This review makes the case for an on-line OSCE as the most valid form of assessment and sets out the requirements for its development, scope, composition and delivery. It describes an on-going attempt to develop a national assessment of prescribing skills towards the end of undergraduate medical training in the UK.

Prescribing and the core curriculum for tomorrow's doctors: BPS curriculum in clinical pharmacology and prescribing for medical students

“…For the first time, all agreed about the outcomes that should be expected of medical graduates in relation to safe use of medicines and these, together with some others, were incorporated into the most recent version of Tomorrow's Doctors [11] ( Table 2). The group also recommended that there should be a national e-Learning programme to support education in this area of the curriculum [12] and development of assessments that might enable medical students (and medical schools) to demonstrate that the required learning outcomes had been met [13].…”

“…For the first time, all agreed about the outcomes that should be expected of medical graduates in relation to safe use of medicines and these, together with some others, were incorporated into the most recent version of Tomorrow's Doctors [11] ( Table 2). The group also recommended that there should be a national e-Learning programme to support education in this area of the curriculum [12] and development of assessments that might enable medical students (and medical schools) to demonstrate that the required learning outcomes had been met [13].The challenge for medical schools now will be to achieve the required outcomes given that they represent a significantly more ambitious target. The available data suggest that there is currently a marked variation in the learning provided by different schools [14] and some are likely to find the targets set by the GMC more difficult to meet than others.…”

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“…More than 53,000 final year medical students have completed the exam over the last few years, with a high pass rate. [18][19][20] Student feedback was very positive highlighting the fairness, comprehensiveness. and widely recognized need for such an assessment.…”

GPs, nurses and pharmacists as prescribers in primary care: an exploration using the social identity approach / Hausärzte/-innen, Diplomierte Pflegefachpersonen und Apotheker/-innen als Arzneimittelverschreiber/-innen: eine Exploration mit dem Ansatz der Sozialen Identität

“…Although core competencies for nurse and pharmacist prescribers were originally devised by the National Prescribing Centre (now part of the National Institute for Health & Care Excellence), prescribing competence is now part of medical training as well (Maxwell & Whalley, 2003;Mucklow, Bollington & Maxwell, 2011). However, while these initiatives describe the generic core competencies to become safe and effective prescribers, the term 'competence' was used by our nurse and pharmacist prescribers to describe the clinical areas in which they felt they had the clinical knowledge and confidence to prescribe.…”