Foundation year 1 doctors and clinical pharmacology and therapeutics teaching. A retrospective view in light of experience

Abstract

What is already known about this subject • In the UK prescribing-related errors are common.• Poor prescribing and prescribing errors result in significant patient morbidity and mortality.• In hospital, junior doctors are responsible for a significant number of prescribing errors. AimsTo determine whether, in retrospect, first year foundation (FY1) programme doctors believe that their undergraduate education in Clinical Pharmacology and Therapeutics (CPT) has prepared them to prescribe safely and rationally. MethodsThis was a prospective questionnaire survey. Ninety FY1 doctors, employed in the Aberdeen Teaching Hospitals, participated. ResultsSeventy-one percent of FY1 doctors completed the survey. Thirty percent of respondents rated their knowledge of CPT as poor or worse and only 8% as good; 74% reported having witnessed an adverse drug reaction (ADR) and 55% a drug-drug interaction, a number of which had resulted in patient morbidity or mortality. Many of these events were reported to have been avoidable or predictable with more extensive undergraduate and postgraduate training. Forty-two percent of respondents stated that they had not been taught enough about avoiding ADRs and 60% about avoiding drug-drug interactions during their undergraduate years. Over 75% of respondents reported high levels of confidence for the unsupervised use of warfarin, nonsteroidal analgesics and opiate analgesics. In retrospect, FY1 doctors would like more undergraduate teaching in prescribing for special patient groups, ADRs, drug interactions, together with CPT in their postgraduate teaching programme. ConclusionsFY1 doctors believe that their undergraduate and postgraduate training in CPT is insufficient to prescribe safely and rationally. This study adds further weight to the call for an increase in the training of junior doctors in the rational and safe use of medicines.

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

“…While students should not be expected to remember exact drug doses, except perhaps for a small number of emergency drugs, they should know where to find information quickly and easily and understand the principles that underlie rational dose selection. This is an aspect that students and new doctors are often particularly concerned about and seek further guidance [3]. Students should also have a clear understanding of their responsibilities as prescribers and the limits of their competence.…”

“…While there remain concerns from some that a return to allowing unqualified staff to write on official documentation constitutes an unnecessary risk we believe that this represents an illogical and short-sighted approach to risk management.The final year medical students of this month may be next month's busiest hospital prescribers, competence assumed, and often poorly supervised. Various studies have highlighted that this transition currently involves an unreasonable jump in responsibility [2,3,5,6]. Pre-prescribing offers the opportunity to bring the steepest part of the 'learning curve' into undergraduate training where there is less time pressure and better supervision for the novice prescriber.…”

“…It is perhaps not surprising that new doctors consider prescribing to be the most difficult aspect of their job and the one for which they feel least prepared [2]. A number of reports have highlighted that, once they have been exposed to the workplace, junior doctors retrospectively consider that there was insufficient emphasis on the practical aspects of prescribing in the undergraduate curriculum [3], and that is a view shared by Table 1 Sub-competencies involved in the prescribing process many medical students [4]. The need for a careful review of the way medical students are trained to be prescribers has been brought into sharper focus by recent data showing that the 7-10% of the prescriptions written by this group contain errors [5,6].…”

A cross sectional survey of the views of newly registered pharmacists in Great Britain on their potential prescribing role: a cautious approach

“…Survey data of Foundation Year 1 doctors at a teaching hospital in Scotland identified that undergraduate and postgraduate training in clinical pharmacology and therapeutics was considered by them to be insufficient to promote rational and safe use of medicines [17]. In an attempt to meet some of these learning needs, the British Pharmacological Society has recently launched e-Prescribe, which aims to provide e-learning materials to help medical students (and students from other healthcare professions) develop a firm grounding in the principles of basic and clinical pharmacology and hence promote safe and effective prescribing [18].This is one of many initiatives available to develop and improve prescribing skills.…”

Do educational interventions improve prescribing by medical students and junior doctors? A systematic review

“…First-year doctors are neither confident nor competent when prescribing, by their own assessment and that of their supervisors [5,6]. New prescribers have also highlighted a lack of undergraduate and postgraduate education in prescribing [7,8].…”