Prescribing safety assessment: Ensuring competency of new doctors to use medicines

抄録

Prescribing is a complex and challenging task requiring diagnostic skills, knowledge of medicines, communication skills, an understanding of the principles of clinical pharmacology, and an appreciation of risk and uncertainty. The demands on new prescribers have increased because of several important trends including more licensed medicines available, more indications for drug therapy, greater complexity of treatment regimens leading to ‘polypharmacy', and more elderly and vulnerable patients. The systems that prescribers work in are often complex and contribute to suboptimal performance. Medication errors and avoidable adverse reactions are common causes of harm to patients and many involve recently qualified doctors. There have been concerns expressed in various countries that the current approach to the training of junior prescribers may not be sufficient to meet the complex demands of the modern hospital environment. With these challenges in mind it is important that we have reliable assessments that enable us to demonstrate that our training programmes are effective and that all new medical graduates are competent to prescribe. This plenary lecture will (i) explore the evidence that prescribing training may be sub-optimal and that better training improves performance, (ii) identify some of the key challenges in delivering high quality assessment of prescribing, (iii) propose some general principles that should guide the assessment of prescribing, (iv) describe the development and implementation of the UK Prescribing Safety Assessment since 2014, (v) describe other approaches to assessing prescribing, (vi) explore whether a common international assessment of prescribing can be delivered, and (vii) propose how prescribing assessments might be utilised to explore the competence of other prescribing groups.

1. Maxwell SRJ, Coleman JJ, Bollington L, Taylor C, Webb DJ. Prescribing Safety Assessment 2016: Delivery of a national prescribing assessment to 7,343 UK final-year medical students. Br J Clin Pharmacol. 2017 Apr 27. doi: 10.1111/bcp.13319.

2. Maxwell S, Cameron IT, Webb DJ. Prescribing Safety Assessment. Lancet. 2015; 385: 579-581.