Junior Doctors prescribing: enhancing their learning in practice

Abstract

What is already known on this topic: A large proportion of medical graduates do not feel prepared for practice. Prescribing is one of the biggest steps up from being a student to practising as a doctor. What this study adds: Graduates lack of preparedness for practice is related to a lack of exposure and preparation for clinical practice. Preparedness may be improved by increasing the number of opportunities to develop the skill-based, applied aspects of prescribing in a controlled, ‘real’ environment. Simulated activity could provide this experience to undergraduates, or writing prescriptions and drug charts to be checked and signed by a doctor on clinical placements. Aim: This aim of this paper was to explore new doctors’ preparedness for prescribing. Methods: Multiple methods study including face-to-face and telephone interviews, questionnaires, and secondary data from a safe prescribing assessment (n = 284). Three medical schools with differing curricula and cohorts: Newcastle (systems-based, integrated curriculum); Warwick (graduate entry) and Glasgow (problem-based learning (PBL)), with graduates entering F1 in their local deanery. The primary sample consisted of final year medical students, stratified by academic quartile (n = 65) from each of the three UK medical schools. In addition an anonymous cohort questionnaire was distributed at each site (n = 480), triangulating interviews were conducted with 92 clinicians and questionnaire data was collected from 80 clinicians who had worked with F1s. Results: Data from the primary sample and cohort data highlighted that graduates entering F1 felt under-prepared for prescribing. However there was improvement over the F1 year through practical experience and support. Triangulating data reinforced the primary sample findings. Participants reported that learning in an applied setting would be helpful and increase confidence in prescribing. No clear differences were found in preparedness to prescribe between graduates of the three medical schools. Conclusion: The results form part of a larger study ‘Are medical graduates fully prepared for practice?’ Prescribing was found to be the weakest area of practice in all sources of data. There is a need for more applied learning to develop skill-based, applied aspects of prescribing which would help to improve preparedness for prescribing.