Abstract

Assessing the prescribing skills of trainee medical staff: implementation of a routine assessment and remedial training strategy

Author(s): Dr Deborah J F Mayne,Professor Anthony J Hildreth,Dr Janice E O�Connell,Mr Leslie Boobis,Professor Christopher S Gray,Dr Deborah Mayne

Introduction: There is increasing recognition that newly qualified doctors often feel unprepared for employment, particularly with regards to prescribing. This lack of preparedness undoubtedly contributes to clinical error and decreases patient safety.
Methods: Trainees attending induction in a large NHS foundation hospital participated in a compulsory clinical assessment of prescribing skills. Trainees were presented with a clinical scenario from which they were required to prescribe specified drugs on a hospital prescription chart. A consensus panel marked the station according to pre-specified ‘critical’ errors or omissions. Candidates who made critical errors or omissions were invited to remedial training and reassessment.
Results: In total 120 trainees were assessed, of whom 72.5% (87/120) made critical errors or omissions. Subsequently, 79.3% (69/87) of trainees were reassessed; 79.7% (55/69) of whom passed on 2nd attempt, and 78.6% (11/14) passed on 3rd attempt; 3 doctors did not attend further reassessment. The most common critical errors were: prescription of the wrong dose of warfarin (59.2%); failure to stop aspirin (44.6%); and inappropriate abbreviation of ‘units’ when prescribing insulin (39.8%). 47 candidates (38.8%) prescribed amoxicillin in a penicillin allergic patient. Foundation Year 1 doctors performed worse than Senior House Officer (SHO) and Specialist Registrar (SPR) doctors (Mann-Whitney test, p<0.001, p=0.12 respectively) and made more critical errors (p=0.003 and p=0.32).

Discussion: It cannot be assumed that newly appointed doctors prescribe safely. Critical errors or omissions were made by all grades of medical staff, but particularly Foundation Year 1 doctors. Steps to improve exposure to prescribing practice in the undergraduate curriculum should be encouraged and linked to ongoing development of skills throughout practice.