Medical students are to be tested on prescribingBMJ 2009; 339 doi: https://doi.org/10.1136/bmj.b5504 (Published 16 December 2009) Cite this as: BMJ 2009;339:b5504
All rapid responses
Medical schools provide the basis of medical learning after which
pupils should be ready to train and work as doctors. One of the
requirements is to train students in prescribing drugs with safety and
efficacy. This is essential for safe patient care.
Thirty-one Foundation Year One (FY1) doctors at University College
London Hospital (UCLH) started their FY1 year in August 2010. In the week
prior to starting work as FY1 Doctors, there was a prescribing
examination for which a pass mark of eighty percent was set; Those who
failed had to re-sit the examination until they achieved the pass mark,
and until then, they were not allowed to prescribe. A significant
proportion of FY1 doctors were unable to obtain 80% and had to retake the
examination. We postulated that this was a reflection on the prescribing
teaching taught at Medical School, and undertook an investigatory survey
A questionnaire regarding the details of the duration, method and
content of prescribing teaching conducted at the doctors' respective
medical schools were collected. There were twenty-two responses (71%)
Twenty out of twenty-two respondents reported that their medical
schools had provided prescribing teaching to its medical students at some
point during their respective five or six year medical degree. Lectures
was the most popular mode of teaching with fifteen medical schools
providing it (68%), followed by small group teaching provided by twelve
medical schools (54%) and the next most popular were practical sessions
and e-learning both being provided by eight medical schools each (36%).
Seminars and experience by shadowing pharmacists were in the minority with
only four medical schools providing them. University College London (UCL)
and Birmingham Medical School were the only faculties to provide four
different modalities of teaching.
The largest subset of medical schools offered prescribing teaching in
the final year; twelve out of the twenty-two. Seven of the twenty-two
medical schools had prescribing teaching starting in third year. Liverpool
Medical School was the only medical school to offer teaching throughout
the duration of its medical degree.
Six out of twenty-two medical schools offered prescribing teaching
for less than seven days in total. These included Cambridge University, St
George's Medical School and Barts and the London. Five Universities
offered prescribing teaching for a duration of one to three weeks. Seven
Universities offered it for a length of one month to one year. Only
Liverpool Medical School offered prescribing teaching for more than one
year in total.
FY1 doctors rated the usefulness of prescribing teaching at their
respective medical schools with ratings ranging from one to five whereby
one represented 'not very useful at all' and five represented 'very
useful'. UCL, Bristol and Birmingham Medical Schools were given ratings of
five, whilst Barts and The London was the only medical school given the
rating of one out of five.
FY1 doctors rated how prepared they felt for prescribing as an FY1
with ratings ranging from one to five whereby one represented 'not very
prepared at all' and 5 represented 'very prepared'. Thirteen out of twenty
(65%) junior doctors felt less than sufficiently prepared for prescribing,
out of which two doctors, from The Barts London and Oxford Medical School
respectively, were not prepared 'at all'. The one junior doctor that felt
'very' prepared for prescribing studied at UCL Medical School.
There were two junior doctors reporting not having had any
prescribing teaching during their medical training; they studied at Oxford
University and Imperial College of London. The two doctors reported that
they would be more prepared for prescribing as a junior doctor had they
had prescribing teaching during their training. However, there is a
discrepancy in this; there were other doctors from both of these medical
schools reporting having had prescribing teaching. These discrepancies may
be accounted for because some students undertake a BSc degree in the
middle of their medical degree, and some transfer to London for clinical
years, which could cause differences in their teaching programme.
Increasing emphasis on student selected learning in the latter part of the
medical course may also impact on this issue.
The fitness to practice of Medical Graduates is an important issue
and clearly ability to prescribe safely, accurately and legally is an
important aspect. From our preliminary small survery we have demonstrated
very wide variation in the current type, duration and effectiveness of the
teaching of prescribing. As many Trusts are now undertaking a prescribing
examination before the commencement of work as described at UCLH the
question arises of whether there should be a nation wide standard of
performance in prescribing, that all medical graduates would undertake. An
equivalent of a 'prescribing driving license'. If such a system were
introduced it would contribute greatly to patient safety and give greater
confidence to those setting out on their Medical Careers.
Our survey suggests that at the very least prescribing teaching at
medical school needs to be altered in such a way that it is longer in
duration, encompasses a greater variety of teaching methods in order to be
targeted at a greater audience, and has the need to provide students with
the confidence to prescribe correctly and safely for their patients.
Competing interests: No competing interests