University challengeBMJ 2006; 333 doi: https://doi.org/10.1136/bmj.333.7576.s176-b (Published 11 November 2006) Cite this as: BMJ 2006;333:s176
Less of a win-win situation in Middlesbrough, where South Tees NHS Trust asked F1 doctors to take a test to assess their knowledge of drug prescribing in their first months on the wards. Given that most medical students have no prescribing experience (they will learn most of it in training posts), and that these F1 doctors had not prepared for the exam, it came as no surprise that all of them failed, says the BMA. Tom Dolphin, deputy chairman of the BMA's Junior Doctors Committee, says the doctors at James Cook University Hospital were given 13 questions to complete in an hour. “It was rather complicated stuff that you wouldn't have expected a house officer to know,” he says. One question, for example, was about the appropriate dose of a dopamine infusion—something a junior doctor wouldn't prescribe on their own. “Most of them didn't even finish the test in the time available. These guys are only three months out of medical school. But failing the test meant they were not considered safe to prescribe.” The trust withdrew prescribing rights— placing all the responsibility back on the F2 trainees and senior registrars. Although Tom accepts that errors in drug prescribing do occur, and that these measures are in the best interests of the patients, expecting doctors in training to pass a test for which they are not prepared is stupid, he argues.
But Mike Bramble, medical director for South Tees, stands by his decision. Trainees could take in a British National Formulary and a calculator, so should, in theory, have been able to work the dosage out, he says. Despite that, some trainees only got two answers right out of 13. “I was very surprised—and disappointed,” he said. “Legally we were in a pretty sticky position. If a mistake happens and a patient dies, where does the doctor— and the trust—stand?”
Professor Bramble assures Newshound that the trainees have since retaken their test and most of them got at least 10 of the 13 questions right, so prescribing rights have been reinstated. But you can bet the deans in the northern deanery are asking themselves about what is happening on their degree courses (the trainees included people from medical schools in Newcastle, Sheffield, and Leeds). Newshound understands that a similar test has been in place for three years at King's College Hospital in London. One wonders what the pass rate is like there? The General Medical Council has been aware of this potential problem for some time: it issued a press release in July 2005 stating that medical students must be taught to prescribe safely and effectively, and adding “we regularly check medical schools to ensure they are following our guidance.” Makes you wonder, doesn't it?