Preparing to prescribe: How do clerkship students learn in the midst of complexity?

Abstract

Prescribing tasks, which involve pharmacological knowledge, clinical decision-making and practical skill, take place within unpredictable social environments and involve interactions within and between endlessly changing health care teams. Despite this, curriculum designers commonly assume them to be simple to learn and perform. This research used mixed methods to explore how undergraduate medical students learn to prescribe in the ‘real world’. It was informed by cognitive psychology, sociocultural theory, and systems thinking. We found that learning to prescribe occurs as a dynamic series of socially negotiated interactions within and between individuals, communities and environments. As well as a thematic analysis, we developed a framework of three conceptual spaces in which learning opportunities for prescribing occur. This illustrates a complex systems view of prescribing education and defines three major system components: the “social space”, where the environmental conditions influence or bring about a learning experience; the “process space”, describing what happens during the learning experience; and the intra-personal “cognitive space”, where the learner may develop aspects of prescribing expertise. This conceptualisation broadens the scope of inquiry of prescribing education research by highlighting the complex interplay between individual and social dimensions of learning. This perspective is also likely to be relevant to students’ learning of other clinical competencies.

What causes prescribing errors in children? Scoping review

“…This study shows how these fundamental differences in children—including growth, development, physiology and drug handling—caused additional errors. While publications generally consider these paediatric-specific factors in isolation from one another, a multidisciplinary group of stakeholders agreed that, like in adults,6 60 errors occur when multiple factors collide. Within a single prescription, an inexperienced prescriber might have to establish a child’s correct weight, reconcile conflicting information about an unlicensed product, interpret a complex dosing regimen, calculate an accurate dose and communicate this to parents.…”

Why nutrition education is inadequate in the medical curriculum: a qualitative study of students’ perspectives on barriers and strategies

“…In constructivism, knowledge is socially constructed and realities are generated by the interaction of social, cultural and interpersonal factors [ 32 , 33 ]. Accordingly, there are multiple accounts of realities and meaning is realised through mutual interactions between the researcher and participants and the context of the research [ 34 ]. In this research approach, identification of the background and assumptions of the researcher and how they may influence the data collection and analysis is important and should be reflected upon by the researcher and shared with readers to facilitate interpretation of the research findings [ 35 , 36 ].…”

Embracing standardisation and contextualisation in medical education

“…We understand context to be a complex and unpredictable emergent property of these specific patterns, inseparable from any single health care interaction. Medical students, clinicians and patients are all situated within this ever‐changing and unpredictable matrix, whose only constant defining characteristics are its fluidity and individuality . This view of context provides a productive lens for health professions education and enables us to examine the interaction of contextual diversity with standardisation more closely.…”