Prescribing skills assessment: ensuring the competency of doctors and other healthcare professionals to use medicines

抄録

Prescribing medicines is a core activity for all healthcare systems, both in hospitals and primary care. In the UK, an average of around 20 prescriptions are written for every member of the population each year. Prescribing is a challenging task for any healthcare professional. Prescribers have to select the correct medicine, dosage, route, and frequency of administration, sometimes in the face of diagnostic uncertainty, taking into account potential individual variability in pharmacokinetics and response as a consequence of co-morbidity, genetics, and interacting drugs. Given that individual patients have different ideas and expectations, and the outcome of any prescription is uncertain, the prescriber also needs to be able to counsel the patient and plan an appropriate strategy for monitoring and follow-up for evidence of benefit and/or harms. Given these complexities, it is perhaps not surprising that poor prescribing is common: around 5 to 10% of UK prescriptions contain an error. These errors result from a combination of poor performance of individual prescribers and the increasing demands of a pressurised healthcare system. In these circumstances it is important that undergraduate and continuing education provides the training to ensure that all prescribers meet minimum standards of prescribing competency. In response to these concerns, the British Pharmacological Society and UK Medical Schools have developed the Prescribing Safety Assessment (PSA) as a summative assessment of knowledge, judgement and skills related to prescribing and supervising the use of medicines in a modern healthcare system. The PSA is intended to enable final-year medical students at the end of their undergraduate training to demonstrate that they have achieved the necessary competence to prescribe, and supervise the use of, medicines in a modern healthcare system. This presentation will describe the development of the assessment items, the online system used to deliver of the PSA, the performance of the UK candidates and medical schools, and the basic psychometric properties of the assessment. It will go on to describe the various international collaborations that have developed and the opportunities that exist to create global standards of prescribing practice.