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Standardised assessment to monitor prescribing skills

A new study describes a standardised assessment that ensures that students who graduate from UK medical schools have achieved a minimum standard of knowledge and skill related to prescribing medications. Following the introduction of the Prescribing Safety Assessment, the vast majority of final-year medical students are able to accurately prescribe medications, but a small proportion require further training or supervision before being able to prescribe independently.

Prescription medicines are one of the most frequent interventions used by doctors to alleviate symptoms, treat illnesses, and prevent future disease. Because newly-graduated doctors write a large proportion of prescriptions in hospitals, it is important to assess their competence at prescribing medications before graduation. This is a complex skill to assess, however, due to the large number of prescribing scenarios that might be tested, the variety of documentation used, and the challenge of marking large numbers of prescriptions in a standardised way.

Dr Simon Maxwell, of the University of Edinburgh and his colleagues from the British Pharmacological Society and Medical Schools Council sought to tackle these issues by creating a national assessment that would identify graduates who need more training and supervision in prescribing, and in the future might also highlight which training methods are most successful in developing competent practitioners.

Over a period of 5 years, the investigators developed the Prescribing Safety Assessment as a 2-hour online assessment of competence. With the development of an online delivery system and a unique approach to automated online marking of large numbers of prescriptions, the team was able to overcome the practical difficulties of assessing prescribing.

"Our paper demonstrates the feasibility of delivering a standard national prescribing assessment involving around 200 assessment events at academic centres around the UK each year and enabling tens of thousands of prescriptions to be instantaneously assessed against a standardised marking scheme," said Maxwell.

For the study, 7,343 final-year medical students in 31 UK medical schools took the Prescribing Safety Assessment. The overall pass rate was 95 percent with the pass rates for the individual papers ranging from 93% to 97%. The Prescribing Safety Assessment was re-taken by 261 students who had failed, and 80% of those candidates passed. There was significant variation in performance between students from different medical schools.

"We believe that this is the first example of a large-scale nationally applied assessment of prescribing competence anywhere in the world," said Maxwell. "We have now participation by medical schools in Ireland and Malta, with growing interest about building on this assessment from educators in Australia, New Zealand, Canada and India. Also, in the UK, we are exploring whether the Prescribing Safety Assessment and its associated training modules might have utility as an assessment for more senior doctors and pharmacists."

Abstract
Aim(s): Newly graduated doctors write a large proportion of prescriptions in UK hospitals but recent studies have shown that they frequently make prescribing errors. The Prescribing Safety Assessment (PSA) has been developed as an assessment of competence in relation to prescribing and supervising the use of medicines. This report describes the delivery of the PSA to all UK final-year medical students in 2016 (PSA2016).
Methods: The PSA is a 2-hour online assessment comprising eight sections which cover various aspects of prescribing defined within the outcomes of undergraduate education identified by the UK General Medical Council. Students sat one of four PSA ‘papers’ which had been standard-set using a modified Angoff process.
Results: A total of 7,343 final-year medical students in all 31 UK medical schools sat the PSA. The overall pass rate was 95% with the pass rates for the individual papers ranging from 93 to 97%. The PSA was re-sat by 261 students who had failed and 80% of those candidates passed. The internal consistency (Cronbach's alpha) of the four papers ranged from 0.74 to 0.77 (standard error of measurement 4.13 to 4.24%). There was a statistically significant variation in performance between medical school cohorts (F = 32.6, p < 0.001) and a strongly positive correlation in performance for individual schools between PSA2015 and PSA2016 (r = 0.79, 95% CI 0.61 to 0.90; p < 0.01).
Conclusions: PSA2016 demonstrated the feasibility of delivering a standardised national prescribing assessment online. The vast majority of UK final-year medical students were able to meet a pre-specified standard of prescribing competence.

Authors
Simon RJ Maxwell, Jamie J Coleman, Lynne Bollington, Celia Taylor, David J Webb

[link url="https://www.sciencedaily.com/releases/2017/05/170522080815.htm"]Wiley material[/link]
[link url="http://onlinelibrary.wiley.com/doi/10.1111/bcp.13319/abstract;jsessionid=6C6B892F4F21B4C1B314BBF376BDF956.f04t01"]British Journal of Clinical Pharmacology abstract[/link]

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