Essential competencies in prescribing: A first european cross‐sectional study among 895 final‐year medical students

Abstract

European medical students should have acquired adequate prescribing competencies before graduation, but it is not known whether this is the case. In this international multicenter study, we evaluated the essential knowledge, skills, and attitudes in clinical pharmacology and therapeutics (CPT) of final‐year medical students across Europe. In a cross‐sectional design, 26 medical schools from 17 European countries were asked to administer a standardized assessment and questionnaire to 50 final‐year students. Although there were differences between schools, our results show an overall lack of essential prescribing competencies among final‐year students in Europe. Students had a poor knowledge of drug interactions and contraindications, and chose inappropriate therapies for common diseases or made prescribing errors. Our results suggest that undergraduate teaching in CPT is inadequate in many European schools, leading to incompetent prescribers and potentially unsafe patient care. A European core curriculum with clear learning outcomes and assessments should be urgently developed.

Pharmacology and Therapeutics Education in the European Union Needs Harmonization and Modernization: A Cross‐sectional Survey Among 185 Medical Schools in 27 Countries

“…Curriculum designers tend to place more emphasis on diagnostic rather than therapeutic reasoning, with the former being perceived as more challenging and difficult 14. Consistent with the views of final‐year students in Europe,6 CPT education was mainly based on traditional learning methods such as lectures and written examinations, rather than on context‐based learning methods, such as patient simulation and workplace assessments. In fact, a large proportion (39%) of schools used solely traditional learning methods, which could in part explain why respondents indicated that students were not well prepared for rational prescribing.…”

“…Rational prescribing is a complex skill that requires various high‐level cognitive processes,16 and thus attending lectures and passing written examinations probably do not prepare students sufficiently for this task. A recent study showed that students taught with mainly traditional learning curricula have significantly weaker prescribing competencies than students taught with mainly problem‐based learning curricula 6. The WHO Guide to Good Prescribing model has been shown to be the only effective method to teach rational prescribing in a wide variety of international settings,17, 18, 19 yet fewer than 20% of the respondents used this model in their teaching program.…”

“…In the UK, recently graduated doctors were found to be responsible for a large number of prescribing errors and reported not feeling adequately prepared for their prescribing responsibilities 4, 5. Furthermore, a recent multicenter study involving 17 European medical schools showed a general lack of essential prescribing competencies among 895 final‐year students, which has potential consequences for patient safety 6. Poor undergraduate teaching in pharmacology and clinical pharmacology and therapeutics (CPT) may underlie this lack of prescribing competencies 5.…”

Do final‐year medical students have sufficient prescribing competencies? A systematic literature review

“…In terms of CPT topics, most articles (32%) evaluated competencies in antimicrobial prescribing and resistance, and in general prescribing (26%). Most studies (85%) used a cross‐sectional survey as the primary evaluation method; other evaluation methods comprised clinical cases ( n = 3) 10, 21, 22, clinical vignettes ( n = 3) 23, 24, 25, multiple‐choice exams ( n = 2) 10, 26, therapeutic consultations with patients in general practice ( n = 1) 27, drug prescriptions during internship ( n = 1) 28 and a mixture of quantitative and qualitative methods ( n = 1) 29. In total, 10 339 final‐year medical students were involved.…”

“…knowledge, skills and attitudes) among junior doctors is frequently mentioned 7, 9, which might be due to inadequate undergraduate education and training in clinical pharmacology and therapeutics (CPT). Indeed, a recent study showed that European final‐year medical students lacked essential prescribing competencies and felt that their medical curriculum had not adequately prepared them for safe prescribing 10. Another recent study showed that CPT education across Europe is still mainly based on traditional learning methods (e.g.…”