Prescribing
Practical prescribing course: a student evaluation Vicky Tittle, David Randall, Vidhya Maheswaran, Andrew Webb, Simon Quantrill and Michael Roberts, Department of Respiratory Medicine, Whipps Cross University Hospital, Barts Health NHS Trust, London, UK
Medical students feel underprepared for the challenges of prescribing
SUMMARY Background: Prescribing errors occur in up to 10 per cent of junior doctor prescriptions, and medical students feel underprepared for the challenges of prescribing once qualified. A number of studies have looked into the effectiveness of new interventions, in particular pharmacist-taught prescribing courses, but there is little data on how students perceive these new strategies. The aim of this project was to evaluate a teaching programme of practical prescribing skills, conducted by hospital pharmacists, via a series of focus groups. Methods: A pharmacist-taught course in practical prescribing
was introduced to final-year medical students during clinical placements at five different hospitals. A focus group was conducted at each participating hospital and emerging themes were identified. Results: Key emerging themes from the focus group analysis showed that students felt more confident in prescribing after completing the course. Students valued the opportunity to gain practical prescribing experience by using problem-based exercises, which encouraged them to prescribe on real drug charts, or to spot prescribing errors or drug interactions on charts constructed by pharmacists. Pharmacists
were felt to be knowledgeable and approachable teachers. Students highlighted controlled drug prescriptions and familiarity with the British National Formulary (BNF) as key topics that hadn’t been covered in conventional pharmacology teaching. Discussion: A practical prescribing course can help prepare medical students by giving them the tools to tackle complex prescribing scenarios. Pharmacists as teachers were well received, and specific topics, including controlled drug prescribing and using sample drug charts, should be the focus of these types of courses.
38 © 2014 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2014; 11: 38–42
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1/6/2014 10:58:10 AM
INTRODUCTION
There is little evidence focusing on student evaluation of these courses
R
educing prescribing errors remains a key challenge in medical education. Studies have shown that 8–10 per cent of all prescriptions by junior doctors contain a drug error,1 and medical students report a lack of confidence in prescribing.2,3 Various strategies and interventions have been suggested to help medical students with prescribing skills, although the evidence base for most is restricted, with studies being limited by methodological difficulties and small sample sizes.4 Successfully implemented strategies trialed at various institutions have focused on context-driven prescribing, a review of prescriptions created by students and problem-based prescribing scenarios, each with positive outcomes.5–7 Amongst these interventions, a number of studies have highlighted the efficacy of pharmacist-led prescribing programmes.8,9 Despite the increasing use of these interventions, there is little evidence focusing on student evaluation of these courses and which key learning points should be extracted. In order to address these issues within Barts and The London School of Medicine and Dentistry, a prescribing course taught by hospital pharmacists was designed for final-year medical students that emphasised the development of practical prescribing skills, bridging the gap between theoretical pharmacology and the reality of clinical prescribing. The aims of this study were to understand how students perceived pharmacist-taught courses, to identify the key topics that students found most useful, and to ascertain the impact of the course on the students’ confidence. This was achieved by gathering student feedback using a series of focus groups.
Figure 1. Drug charts and the British National Formulary: key prescribing resources students were taught how to use
METHODS Final-year students complete placements in general medicine and surgery in one of 10 associate teaching hospitals. Logistically, these modules were the best opportunity to deliver a practical prescribing course. The course comprised a 2–hour teaching session each week for 4 weeks. Five hospitals agreed to provide pharmacist time to teach the course and 110 students took part in the prescribing course, funded by Barts and The London Centre for Excellence in Teaching and Learning (CETL). A focus group was conducted at the end of the course at each of the participating hospitals.
Participating pharmacists attended a central teaching skills study day at the beginning of the year, and were provided with teaching materials, including sample drug charts, prescribing scenarios and practise questions, and were encouraged on how to teach practical prescribing skills. A variety of teaching methods were used, including small group tutorials, pharmacist ward rounds and time spent shadowing ward pharmacists. An informal prescribing skills assessment was provided at the beginning and end of the course (Figure 1), with constructive feedback. Results from these assessments were not included in this study, as the assessments themselves were not validated for research purposes.
© 2014 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2014; 11: 38–42 39
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1/6/2014 10:58:12 AM
confidence in prescribing, but felt that they still had limitations; however, the course provided tools, such as knowledge of the British National Formulary (BNF), to help them in the future.
Students found pharmacists to be practical, capable, knowledgeable and approachable teachers
Figure 2. Sample scenarios used in the formative prescribing assessments at the beginning and end of the course
The course aimed to address the following topics. • Prescriptions for acute medical emergencies, including writing up immediate (stat), regular and as-required medications. • Discharge prescriptions and controlled drugs. • Taking a drug history; highlighting errors in drug transcriptions and interactions. • Therapeutic drug monitoring and dose adjustment. Focus groups A focus group was conducted at each of the five participating hospitals. A total of 18 students were involved in the focus groups; participation was voluntary, and written consent, for use of information, was obtained. Focus groups were led by one of three researchers trained in facilitation. They were recorded digitally and transcribed by a professional transcriber. The transcripts were reviewed independently by two researchers who identified emerging themes (Box 1). A third researcher synthesised the recurring themes into the analysis presented here. The local Research and Development Department approved
the project protocol, and confirmed that as a service evaluation project, formal ethics committee approval was not required.
RESULTS Practicality of the course The dominant theme to emerge from focus group analysis was the recognition of the importance of practical prescribing and the benefits of having practical prescribing experience.
There’s a significant difference between pharmacology knowledge and prescribing experience. And that’s actually pharmacology teaching, that’s totally different to actual prescribing skills. Site 3 (Having the) opportunity to sit and write charts…has been really useful. Site 3 …we don’t really have any pharmacy teaching, for example, prescribing charts and things. Site 1 Students’ confidence The students found the course helped to improve their
(The teaching has been) useful with regard to drug charts, because you sort of know your way around it now and you’re more confident prescribing anything because before you were obviously just watching the junior doctors doing it and you don’t get to do it. Site 1 I think the best thing about this is that I thought to myself, where would I be as an F1 if we didn’t have this? Site 4 The key to getting good at prescribing I think is to make as many mistakes as possible before you get on the ward. Then you can be so much more confident about it. Site 4 The things we’ve gone over, I think I’d be better at. And if I’d forgotten, I’d know where to look in the BNF to find the answers. Site 5 Emerging themes on the style of teaching or specific aspects of teaching Students found pharmacists to be practical, capable, knowledgeable and approachable teachers.
Pharmacists were quite good at just saying: ‘OK, it’s fine, don’t worry. Ask the silly questions, make the mistakes and we’ll rectify them here.’ Site 4
40 © 2014 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2014; 11: 38–42
tct_12106.indd 40
1/6/2014 10:58:16 AM
They brought these props as well. They brought in things like blister packs. They’d bring in drug charts where there had been obvious mistakes made and show us examples. Site 3 Pharmacist-led (teaching) is best. Site 2 The use of sample drug charts was a strong positive factor in the teaching course (Figure 2).
…none of us knew how to actually write on a drug chart to begin with. Site 2 …until now we would have probably not even looked at a drug chart. Site 3
Box 1. Summary of the emerging focus group themes • Having a practical prescribing experience was the most beneficial aspect of the course • The course improved confidence and competence • Pharmacists were highly regarded as teachers • Key topics were controlled drug prescribing and using the British National Formulary • Small group and interactive teaching styles were the best methods to deliver the course • Validated assessments for prescribing would be useful in future courses
Box 2. Key points in providing practical prescribing courses • Provide prescribing scenarios • Use sample drug charts and allow students the opportunity to prescribe • The best teaching method was small interactive teaching groups, compared with lectures and shadowing pharmacists • Use pharmacists to teach and facilitate teaching sessions
DISCUSSION Students found the small group teaching and interactive sessions to be stimulating and enjoyable.
I think here, where there’s smaller groups, it definitely, definitely works better. Site 3 When you think in that 2 hours, you would eventually get bored, but you don’t because it’s so interactive. Site 3 Negative feedback revolved around the assessments. Students found the informal prescribing assessments to be difficult because of time constraints, and as a result didn’t feel their scores reflected their learning.
I mean, I haven’t really found much hard throughout medical school, this is the first one that I thought, oh, my god, I’m actually struggling here! Site 4
The emphasis on practical prescribing skills left students feeling more confident in prescribing
The overwhelming message from the focus group data was that the emphasis on practical prescribing skills left students feeling more confident in prescribing, both by gaining practical experience and also by showing them the tools that can aid prescribing in real-life scenarios. Students developed a way of approaching prescribing dilemmas, including understanding how to use the BNF and how ward pharmacists could support them. Such an approach directly addresses many of the issues identified in the studies of prescribing competence amongst newly qualified doctors.2,3 This article reinforces previously published reports of the benefits of using pharmacists to deliver a practical prescribing course.8 Students highly rated pharmacists as teachers, as they were found to be knowledgeable and approachable. Students actively engaged with pharmacists and came to better understand their roles as health care professional colleagues.
Students participating in the focus groups identified a lack of knowledge in prescribing as a key issue in their readiness to practise medicine, and recognised the importance of these skills as junior doctors. The prescription of controlled drugs and understanding the use of the BNF are examples of key topics that are lacking in traditional pharmacology teaching. Feedback on teaching styles has led to improvements on the delivery of the course, focusing on casebased teaching and interactive styles. Students were most negative about the prescribing assessments carried out as part of the course, because of the perception that they were too difficult; however, the assessments exemplified the realistic difficulties of practical prescribing, where perhaps students had previously lacked insight. Nevertheless, the use of validated assessments would be beneficial in future courses. Limitations of this study include the inability to
© 2014 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2014; 11: 38–42 41
tct_12106.indd 41
1/6/2014 10:58:18 AM
[Pharmacists] working with medical undergraduates may foster interprofessional working relationships
demonstrate the transferability of skills, and although it wasn’t viable in this study, the ability to demonstrate the long-term impact of prescribing courses, especially as it is difficult to recreate within a classroom the demanding work environment that may affect a doctor’s concentration and skill. Although this article aimed to concentrate on the focus group results, we appreciate the limitation of not being able to demonstrate prescribing competence through prescribing assessments, and future correlations of qualitative and quantitative data would be beneficial. Practical prescribing could be replicated in other settings where pharmacists are closely involved in clinical practice and are willing to be involved in education. Working with medical undergraduates may foster interprofessional working
relationships. Key aspects of this course, which could be replicated in other centres, have been highlighted in Box 2.
pharmacotherapy program for preclinical medical students leads to more rational drug prescribing during their clinical clerkship in internal medicine. Clin Pharmacol Ther 2008;84:513–516.
REFERENCES 1.
General Medical Council. An in depth investigation into the causes of prescribing errors by foundation trainees in relation to their medical education – EQUIP study. London: General Medical Council; 2009.
2.
Heaton A, Webb DJ, Maxwell SR. Undergraduate preparation for prescribing: the views of 2413 UK medical students and recent graduates. Br J Clin Pharmacol 2008;66:128–134.
3.
Evans D, Roberts CM. What can we do to better prepare medical students for life as a PRHO? Med Teach 2006;28:549–552.
4.
5.
Ross S, Loke YK. Do educational interventions improve prescribing by medical students and junior doctors? A systematic review. Br J Clin Pharmacol 2009;67:662–670. Richir MC, Tichelaar J, Stanm F, Thijs A, Danner SA, Schneider AJ, deVries TP. A context-learning
6.
Akici A, Gören MZ, Aypak C, Terziog˘ lu B, Oktay S. Prescription audit adjunct to rational pharmacotherapy education improves prescribing skills of medical students. Eur J Clin Pharmacol 2005;61:643–650.
7.
Celebi N, Weyrich P, Riessen R, Kirchhoff K, Lammerding-Köppel M. Problem-based training for medical students reduces common prescription errors: a randomised controlled trial. Med Educ 2009;43: 1010–1018.
8.
Webbe D, Dhillon S, Roberts CM. Improving junior doctor prescribing – the positive impact of a pharmacist intervention. Pharm J 2007;278:136–139.
9.
Sandilands EA, Reid K, Shaw L, Bateman DN, Webb DJ, Dhaun N, Kluth DC. Impact of a focussed teaching programme on practical prescribing skills among final year medical students. Br J Clin Pharmacol 2011;71:29–30.
Corresponding author’s contact details: Vicky Tittle, 178 Albion Road, London, N16 9JR, UK. E–mail: [email protected]
Funding: Centre for Excellence in Teaching and Learning at Barts and The London School of Medicine and Dentistry, Queen Mary, University of London. Conflict of interest: None. Ethical approval: The Research and Development office at Whipps Cross Hospital confirmed no formal ethics approval was required for the study. doi: 10.1111/tct.12106
42 © 2014 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2014; 11: 38–42
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Practical prescribing course: a student evaluation Vicky Tittle, David Randall, Vidhya Maheswaran, Andrew Webb, Simon Quantrill and Michael Roberts, Department of Respiratory Medicine, Whipps Cross University Hospital, Barts Health NHS Trust, London, UK
Medical students feel underprepared for the challenges of prescribing
SUMMARY Background: Prescribing errors occur in up to 10 per cent of junior doctor prescriptions, and medical students feel underprepared for the challenges of prescribing once qualified. A number of studies have looked into the effectiveness of new interventions, in particular pharmacist-taught prescribing courses, but there is little data on how students perceive these new strategies. The aim of this project was to evaluate a teaching programme of practical prescribing skills, conducted by hospital pharmacists, via a series of focus groups. Methods: A pharmacist-taught course in practical prescribing
was introduced to final-year medical students during clinical placements at five different hospitals. A focus group was conducted at each participating hospital and emerging themes were identified. Results: Key emerging themes from the focus group analysis showed that students felt more confident in prescribing after completing the course. Students valued the opportunity to gain practical prescribing experience by using problem-based exercises, which encouraged them to prescribe on real drug charts, or to spot prescribing errors or drug interactions on charts constructed by pharmacists. Pharmacists
were felt to be knowledgeable and approachable teachers. Students highlighted controlled drug prescriptions and familiarity with the British National Formulary (BNF) as key topics that hadn’t been covered in conventional pharmacology teaching. Discussion: A practical prescribing course can help prepare medical students by giving them the tools to tackle complex prescribing scenarios. Pharmacists as teachers were well received, and specific topics, including controlled drug prescribing and using sample drug charts, should be the focus of these types of courses.
38 © 2014 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2014; 11: 38–42
tct_12106.indd 38
1/6/2014 10:58:10 AM
INTRODUCTION
There is little evidence focusing on student evaluation of these courses
R
educing prescribing errors remains a key challenge in medical education. Studies have shown that 8–10 per cent of all prescriptions by junior doctors contain a drug error,1 and medical students report a lack of confidence in prescribing.2,3 Various strategies and interventions have been suggested to help medical students with prescribing skills, although the evidence base for most is restricted, with studies being limited by methodological difficulties and small sample sizes.4 Successfully implemented strategies trialed at various institutions have focused on context-driven prescribing, a review of prescriptions created by students and problem-based prescribing scenarios, each with positive outcomes.5–7 Amongst these interventions, a number of studies have highlighted the efficacy of pharmacist-led prescribing programmes.8,9 Despite the increasing use of these interventions, there is little evidence focusing on student evaluation of these courses and which key learning points should be extracted. In order to address these issues within Barts and The London School of Medicine and Dentistry, a prescribing course taught by hospital pharmacists was designed for final-year medical students that emphasised the development of practical prescribing skills, bridging the gap between theoretical pharmacology and the reality of clinical prescribing. The aims of this study were to understand how students perceived pharmacist-taught courses, to identify the key topics that students found most useful, and to ascertain the impact of the course on the students’ confidence. This was achieved by gathering student feedback using a series of focus groups.
Figure 1. Drug charts and the British National Formulary: key prescribing resources students were taught how to use
METHODS Final-year students complete placements in general medicine and surgery in one of 10 associate teaching hospitals. Logistically, these modules were the best opportunity to deliver a practical prescribing course. The course comprised a 2–hour teaching session each week for 4 weeks. Five hospitals agreed to provide pharmacist time to teach the course and 110 students took part in the prescribing course, funded by Barts and The London Centre for Excellence in Teaching and Learning (CETL). A focus group was conducted at the end of the course at each of the participating hospitals.
Participating pharmacists attended a central teaching skills study day at the beginning of the year, and were provided with teaching materials, including sample drug charts, prescribing scenarios and practise questions, and were encouraged on how to teach practical prescribing skills. A variety of teaching methods were used, including small group tutorials, pharmacist ward rounds and time spent shadowing ward pharmacists. An informal prescribing skills assessment was provided at the beginning and end of the course (Figure 1), with constructive feedback. Results from these assessments were not included in this study, as the assessments themselves were not validated for research purposes.
© 2014 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2014; 11: 38–42 39
tct_12106.indd 39
1/6/2014 10:58:12 AM
confidence in prescribing, but felt that they still had limitations; however, the course provided tools, such as knowledge of the British National Formulary (BNF), to help them in the future.
Students found pharmacists to be practical, capable, knowledgeable and approachable teachers
Figure 2. Sample scenarios used in the formative prescribing assessments at the beginning and end of the course
The course aimed to address the following topics. • Prescriptions for acute medical emergencies, including writing up immediate (stat), regular and as-required medications. • Discharge prescriptions and controlled drugs. • Taking a drug history; highlighting errors in drug transcriptions and interactions. • Therapeutic drug monitoring and dose adjustment. Focus groups A focus group was conducted at each of the five participating hospitals. A total of 18 students were involved in the focus groups; participation was voluntary, and written consent, for use of information, was obtained. Focus groups were led by one of three researchers trained in facilitation. They were recorded digitally and transcribed by a professional transcriber. The transcripts were reviewed independently by two researchers who identified emerging themes (Box 1). A third researcher synthesised the recurring themes into the analysis presented here. The local Research and Development Department approved
the project protocol, and confirmed that as a service evaluation project, formal ethics committee approval was not required.
RESULTS Practicality of the course The dominant theme to emerge from focus group analysis was the recognition of the importance of practical prescribing and the benefits of having practical prescribing experience.
There’s a significant difference between pharmacology knowledge and prescribing experience. And that’s actually pharmacology teaching, that’s totally different to actual prescribing skills. Site 3 (Having the) opportunity to sit and write charts…has been really useful. Site 3 …we don’t really have any pharmacy teaching, for example, prescribing charts and things. Site 1 Students’ confidence The students found the course helped to improve their
(The teaching has been) useful with regard to drug charts, because you sort of know your way around it now and you’re more confident prescribing anything because before you were obviously just watching the junior doctors doing it and you don’t get to do it. Site 1 I think the best thing about this is that I thought to myself, where would I be as an F1 if we didn’t have this? Site 4 The key to getting good at prescribing I think is to make as many mistakes as possible before you get on the ward. Then you can be so much more confident about it. Site 4 The things we’ve gone over, I think I’d be better at. And if I’d forgotten, I’d know where to look in the BNF to find the answers. Site 5 Emerging themes on the style of teaching or specific aspects of teaching Students found pharmacists to be practical, capable, knowledgeable and approachable teachers.
Pharmacists were quite good at just saying: ‘OK, it’s fine, don’t worry. Ask the silly questions, make the mistakes and we’ll rectify them here.’ Site 4
40 © 2014 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2014; 11: 38–42
tct_12106.indd 40
1/6/2014 10:58:16 AM
They brought these props as well. They brought in things like blister packs. They’d bring in drug charts where there had been obvious mistakes made and show us examples. Site 3 Pharmacist-led (teaching) is best. Site 2 The use of sample drug charts was a strong positive factor in the teaching course (Figure 2).
…none of us knew how to actually write on a drug chart to begin with. Site 2 …until now we would have probably not even looked at a drug chart. Site 3
Box 1. Summary of the emerging focus group themes • Having a practical prescribing experience was the most beneficial aspect of the course • The course improved confidence and competence • Pharmacists were highly regarded as teachers • Key topics were controlled drug prescribing and using the British National Formulary • Small group and interactive teaching styles were the best methods to deliver the course • Validated assessments for prescribing would be useful in future courses
Box 2. Key points in providing practical prescribing courses • Provide prescribing scenarios • Use sample drug charts and allow students the opportunity to prescribe • The best teaching method was small interactive teaching groups, compared with lectures and shadowing pharmacists • Use pharmacists to teach and facilitate teaching sessions
DISCUSSION Students found the small group teaching and interactive sessions to be stimulating and enjoyable.
I think here, where there’s smaller groups, it definitely, definitely works better. Site 3 When you think in that 2 hours, you would eventually get bored, but you don’t because it’s so interactive. Site 3 Negative feedback revolved around the assessments. Students found the informal prescribing assessments to be difficult because of time constraints, and as a result didn’t feel their scores reflected their learning.
I mean, I haven’t really found much hard throughout medical school, this is the first one that I thought, oh, my god, I’m actually struggling here! Site 4
The emphasis on practical prescribing skills left students feeling more confident in prescribing
The overwhelming message from the focus group data was that the emphasis on practical prescribing skills left students feeling more confident in prescribing, both by gaining practical experience and also by showing them the tools that can aid prescribing in real-life scenarios. Students developed a way of approaching prescribing dilemmas, including understanding how to use the BNF and how ward pharmacists could support them. Such an approach directly addresses many of the issues identified in the studies of prescribing competence amongst newly qualified doctors.2,3 This article reinforces previously published reports of the benefits of using pharmacists to deliver a practical prescribing course.8 Students highly rated pharmacists as teachers, as they were found to be knowledgeable and approachable. Students actively engaged with pharmacists and came to better understand their roles as health care professional colleagues.
Students participating in the focus groups identified a lack of knowledge in prescribing as a key issue in their readiness to practise medicine, and recognised the importance of these skills as junior doctors. The prescription of controlled drugs and understanding the use of the BNF are examples of key topics that are lacking in traditional pharmacology teaching. Feedback on teaching styles has led to improvements on the delivery of the course, focusing on casebased teaching and interactive styles. Students were most negative about the prescribing assessments carried out as part of the course, because of the perception that they were too difficult; however, the assessments exemplified the realistic difficulties of practical prescribing, where perhaps students had previously lacked insight. Nevertheless, the use of validated assessments would be beneficial in future courses. Limitations of this study include the inability to
© 2014 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2014; 11: 38–42 41
tct_12106.indd 41
1/6/2014 10:58:18 AM
[Pharmacists] working with medical undergraduates may foster interprofessional working relationships
demonstrate the transferability of skills, and although it wasn’t viable in this study, the ability to demonstrate the long-term impact of prescribing courses, especially as it is difficult to recreate within a classroom the demanding work environment that may affect a doctor’s concentration and skill. Although this article aimed to concentrate on the focus group results, we appreciate the limitation of not being able to demonstrate prescribing competence through prescribing assessments, and future correlations of qualitative and quantitative data would be beneficial. Practical prescribing could be replicated in other settings where pharmacists are closely involved in clinical practice and are willing to be involved in education. Working with medical undergraduates may foster interprofessional working
relationships. Key aspects of this course, which could be replicated in other centres, have been highlighted in Box 2.
pharmacotherapy program for preclinical medical students leads to more rational drug prescribing during their clinical clerkship in internal medicine. Clin Pharmacol Ther 2008;84:513–516.
REFERENCES 1.
General Medical Council. An in depth investigation into the causes of prescribing errors by foundation trainees in relation to their medical education – EQUIP study. London: General Medical Council; 2009.
2.
Heaton A, Webb DJ, Maxwell SR. Undergraduate preparation for prescribing: the views of 2413 UK medical students and recent graduates. Br J Clin Pharmacol 2008;66:128–134.
3.
Evans D, Roberts CM. What can we do to better prepare medical students for life as a PRHO? Med Teach 2006;28:549–552.
4.
5.
Ross S, Loke YK. Do educational interventions improve prescribing by medical students and junior doctors? A systematic review. Br J Clin Pharmacol 2009;67:662–670. Richir MC, Tichelaar J, Stanm F, Thijs A, Danner SA, Schneider AJ, deVries TP. A context-learning
6.
Akici A, Gören MZ, Aypak C, Terziog˘ lu B, Oktay S. Prescription audit adjunct to rational pharmacotherapy education improves prescribing skills of medical students. Eur J Clin Pharmacol 2005;61:643–650.
7.
Celebi N, Weyrich P, Riessen R, Kirchhoff K, Lammerding-Köppel M. Problem-based training for medical students reduces common prescription errors: a randomised controlled trial. Med Educ 2009;43: 1010–1018.
8.
Webbe D, Dhillon S, Roberts CM. Improving junior doctor prescribing – the positive impact of a pharmacist intervention. Pharm J 2007;278:136–139.
9.
Sandilands EA, Reid K, Shaw L, Bateman DN, Webb DJ, Dhaun N, Kluth DC. Impact of a focussed teaching programme on practical prescribing skills among final year medical students. Br J Clin Pharmacol 2011;71:29–30.
Corresponding author’s contact details: Vicky Tittle, 178 Albion Road, London, N16 9JR, UK. E–mail: [email protected]
Funding: Centre for Excellence in Teaching and Learning at Barts and The London School of Medicine and Dentistry, Queen Mary, University of London. Conflict of interest: None. Ethical approval: The Research and Development office at Whipps Cross Hospital confirmed no formal ethics approval was required for the study. doi: 10.1111/tct.12106
42 © 2014 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2014; 11: 38–42
tct_12106.indd 42
1/6/2014 10:58:18 AM
