Prescribing
Using simulation for prescribing: an evaluation Georgia Woodfield, Marie O’Sullivan, Nicholas Haddington and Andrew Stanton, University of Bristol Academy at Great Western Hospital, Swindon, Wiltshire, UK
Drug errors are a major cause of patient morbidity
SUMMARY Background: Drug errors are a major cause of patient morbidity. The UK General Medical Council has highlighted that prescribing teaching should be prioritised. How should medical teachers best teach the practical aspects of prescribing? Method: We piloted a set of eight prescribing simulation tutorials for 35 final-year undergraduate medical students in Great Western Hospital, Swindon, UK. Students completed baseline questionnaires addressing confidence levels in prescribing. They then prescribed independently for simulated cases of common medical emergencies within tutor-led tutorials (n = 17)
or self-directed prescribing tutorials (n = 18). Confidence scores and numbers of drug errors were documented at baseline and following four tutorials. Drug errors were categorised according to potential harm. Students then swapped to receive the alternative tutorial type. Results: Both tutorial types resulted in a statistically significant decrease in the number of unsafe drug errors: from 57 to three in the tutor-led group (p = 0.003) and from 60 to 14 in the self-directed learning group (p = 0.001). Both tutorial types led to statistically significant increases in confidence scores for global prescribing, prescribing in
medical emergencies and managing medical emergencies (with a median increase of one point on a modified Likert scale). Confidence using the British National Formulary improved, but reached statistical significance for the self-directed group only. Discussion: Simulating cases and using real drug charts is an effective method for improving students’ prescribing ability and confidence in common medical emergencies. Tutorials like these, whether tutor-led or self-directed, could be incorporated into medical curricula. This could help prevent drug errors in practice, thereby improving patient care and safety.
24 © 2014 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2014; 11: 24–28
tct_12056.indd 24
1/6/2014 10:25:15 AM
INTRODUCTION
D
espite the immediate need for junior doctors to prescribe drugs safely upon qualification,1 there remains variation in how this is taught. Drug errors are a major cause of patient morbidity and mortality. In 2007, 32 per cent of the most serious UK drug error incidents were caused by errors in prescribing.2
In a 2009 UK General Medical Council (GMC) report, 9 per cent of hospital prescriptions contained errors, and 18.7 per cent of these were made by junior doctors in 19 UK hospitals over 7 days.3 The report concluded that ‘more could have been done during undergraduate education to link theory with practice, and develop medical students’ expertise in the complex context of clinical practice’.3 A 2008 GMC report of newly qualified UK doctors showed that prescribing was the ‘main area of practice in which errors were reported by respondents, indicating a significant potential risk’.4 Furthermore, a recent development in prescribing is the introduction of the prescribing skills assessment (PSA).5 Although this will not be a legal requirement in order to practise as a doctor, it is likely that many medical schools will use it as part of the final assessment. This is another pertinent reason for prioritising medical student teaching in prescribing. How should medical teachers help students prepare for final examinations, the PSA and for becoming a doctor? Are simulation-style tutorials effective for improving prescribing skill and confidence in fifth-year medical students?
OBJECTIVES We wanted to determine whether a structured tutorial programme
could deliver the following outcomes.
...9 per cent of hospital prescriptions contained errors
1. Reduction in number of drug errors and improvement in drug-chart safety for common medical emergencies. 2. Improvement in subjective confidence levels in four areas: • Global prescribing • Using the British National Formulary (BNF) • Managing common medical emergencies • Prescribing for common medical emergencies 3. Evaluation of the effectiveness of tutor-led and self-directed tutorials in the above measures, and exploration of student preferences between these two teaching approaches.
METHOD All 35 final-year students undertaking a 12-week clinical attachment in medicine and surgery at the Great Western Hospital in Swindon were informed about the study. All were from the University of Bristol, undertaking a 5–year UK medical undergraduate course, and attended the tutorials in September–December 2011. A total of 34 students completed a questionnaire (Appendix S1), grading their confidence on a five-point modified Likert scale from 0 (no confidence) to 4 (very confident) in four areas: • prescribing on a drug chart to the standard of a newly qualified doctor • using the BNF • managing common medical emergencies, e.g. hyperkalaemia • prescribing for common medical emergencies The questionnaire also explored students’ past experiences of learning about prescribing, and their opinions on the
relevance and usefulness of this. The data collected were identifiable by student number only. Students then received four prescribing tutorials (Appendix S2) involving them individually prescribing on drug charts for four ‘real-life’ medical emergency cases, using the BNF. All common emergencies cases were deemed equal in terms of difficulty and importance for a junior doctor. Group A (17 students) prescribed each week within four tutor-led tutorials, during which the completed drug charts were collected and the answers discussed. The answers included a discussion of the rationale for treatment, contraindications and common pitfalls. Tutorials were led by doctors who had graduated 2 years ago (authors G.W. and M.O.). Group B (18 students) prescribed in a self-directed manner using any resources they required, and in their own time. Drug charts were collected weekly, and written answers and model drug charts were provided afterwards, covering the same knowledge areas. After four sessions all students re-scored their confidence on a repeat questionnaire, and then swapped tutorial type for four further sessions with new scenarios. Tutorial preference was determined in a final
© 2014 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2014; 11: 24–28 25
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1/6/2014 10:25:20 AM
Tutor-led and self-directed simulation tutorials can significantly improve student prescribing skill
questionnaire after eight sessions. Other questions referred to students’ experiences during the tutorials and how useful they thought they were.
RESULTS
Drug errors and drug-chart safety were assessed from the drug charts collected for cases 1 and 4.
Group B: all 18 students partook in self-directed tutorials; the completion of these nonassessed tutorials was harder to ascertain.
Each drug chart was graded separately and agreed by consensus (among authors G.W., M.O., A.S. and N.H.). Red: one or more errors that are likely to cause serious patient harm or death. This included the omission of life-saving drugs. Orange: one or more potentially harmful errors. Blue: inappropriate or not indicated medication, but unlikely to cause harm. Main emergency medications prescribed adequately. Green: Appropriately prescribed medication to adequately treat the emergency presentation, with no inappropriate medication. ‘Unsafe’ drug errors were those graded orange or red. The data collected were analysed using spss 19 (IBM). Paired data, where available, were compared using the Wilcoxon signed-ranks test; p < 0.05 was considered to be statistically significant. Change in scores and p values could only be calculated from paired data (matched pre and post scores).
Group A: all 17 students attended either three (six students) or four tutorials (11 students).
A total of 35 students were therefore included in the data collection. Baseline data: prescribing teaching experience Four of 30 students (13.3%) believed prescribing had been previously taught well throughout university. Thirty of 31 students (96.8%) believed that practical prescribing should be a formal part of the curriculum. Thirty-one of 31 students (100%) wanted prescribing teaching to form part of the curriculum, as combined tutorled/self-directed tutorials (16/31; 52%), self-directed tutorials (2/31; 6%) or tutor-led tutorials (13/31; 42%). Twenty-six of 31 students (83.9%) generally preferred tutor-led to self-directed tutorials. Drug errors Charts completed before and after the tutorials were returned by 14 of 17 students in group A, and by 18 (pre) and 16 (post) students in group B.
Both tutorial types resulted in a statistically significant decrease in the number of unsafe drug errors made (Table 1). Confidence levels Questionnaires completed before and after the tutorials were returned by 15 (pre) and 17 (post) students in group A, and by 17 (pre and post) students in group B. Both tutorial types resulted in statistically significant confidence increases in global prescribing as a junior doctor, in managing common medical emergencies and in prescribing for common medical emergencies (Table 2). There was a significant increase in confidence in using the BNF in the self-directed group B only.
DISCUSSION This study has shown both tutorled and self-directed simulation tutorials can significantly improve student prescribing skill and confidence, within a prescribing teaching programme. However, the preference and opinion questions in the final questionnaire showed that students preferred the former style, and found it useful. Safe prescribing is a priority for passing final exams, the PSA and, most importantly, for becoming a doctor. As medical educators we must take positive steps to help students prepare adequately. Tutorials like these, whether tutor-led or self-directed, could in future be incorporated into medical school curricula.
Table 1. Unsafe drug errors made before and after the tutorials Median number of unsafe drug errors
p value for difference in errors
Before tutorials
After four tutorials
Group A Tutor-led tutorials
57 errors n = 14
3 errors n = 14
p = 0.003
Group B Self-directed tutorials
60 errors n = 18
14 errors n = 16
p = 0.001
26 © 2014 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2014; 11: 24–28
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1/6/2014 10:25:22 AM
Table 2. Confidence levels before and after tutorials Confidence area
Group A
Group B
Median confidence score Before tutorials n = 15
After four tutorials n = 17
Median confidence increase per student (Likert scale units) n = 15
p value n = 15
Median confidence score Before tutorials n = 17
After four tutorials n = 17
Median confidence increase per student (Likert scale units) n = 17
p value n = 17
Global 1 prescribing
2
1
0.001
2
2
1
0.025
Using the BNF
2
3
1
0.197
2
3
1
0.005
Managing common medical emergencies
1
2
2
0.003
1
2
1
0.002
Prescribing for common medical emergencies
0
2
2
0.001
1
2
1
0.001
Tutorials like these, could in future be incorporated into medical school curricula
n, number of students with available data.
They are a straightforward, easily deliverable and effective tool for improving prescribing ability and confidence. In turn, drug errors when the student enters the workplace could be prevented, improving patient care and safety. The authors strove to ensure that emergency cases were equal in terms of difficulty, but accept that this is a potential limitation to the study. We chose hyperkalaemia (case 1) and acute pulmonary oedema (case 4) for assessment, because the possible number of ‘unsafe errors’ for the scenarios was equivalent, and therefore the level of difficulty was deemed to be equal. Both cases had a potentially fatal drug: insulin and morphine, respectively. Students had to prescribe emergency medications, but also withhold exacerbating medications, for all eight cases.
A further limitation was the small study size, but this was determined by the number of students from the University of Bristol placed in Swindon. Student allocation was random and unrelated to the study. For timetabling reasons, group A were doing their medical attachment during the first four tutorials, whereas group B were doing surgery. We were concerned that this might influence performance, but this was not the case, probably because of the proximity of final examinations for all students. Although the initial sample size was small, we did achieve a reasonable return of before and after questionnaires and drug charts. There were enough paired data to allow the calculation of statistically significant improvements in both error rate and confidence scores in all but one domain for one group.
We used a modified Likert scale of 0–4 to reflect the possibility that some students may have had ‘no confidence’, reflected in a score of 0. The authors are unaware of any evidence that using such a 0–4 scale generates different data from a 1–5 scale, but accept that this is another potential limitation. We did, however, use the same scale throughout. It is possible that prescribing tutorials could influence confidence and drug errors in the work place. This could be investigated by following the students into clinical practice, which would be worthy of further study. A 2011 meta-analysis compared simulation-based medical education (SBME) with traditional clinical medical education.6 Some studies within the meta analysis linked SBME directly with better patient outcomes and improved patient care practices.6
© 2014 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2014; 11: 24–28 27
tct_12056.indd 27
1/6/2014 10:25:22 AM
Simulated prescribing tutorials are an effective way of reducing drug errors
In overall conclusion we have shown that simulated prescribing tutorials are an effective way of reducing drug errors and improving students’ confidence in prescribing.
3.
Dornan T, Ashcroft D, Heathfield H, Lewis P, Miles J, Taylor D, Tully M, Wass V for the General Medical Council. Final report. An in depth investigation into causes of prescribing errors by foundation trainees in relation to their medical education. EQUIP study. 2009. Available at http://www.gmc-uk.org/about/ research/research_commissioned_4. asp. Accessed on 13 February 2013.
4.
Illing J, Morrow G, Kergon C, Burford B, Spencer J for the General Medical Council. How prepared are medical graduates to begin practice? A comparison of three diverse UK medical schools. 2008. Available at http://www.gmc-uk. org/about/research/research_commissioned_1.asp. Accessed on 13 February 2013.
REFERENCES 1.
2.
General Medical Council. Tomorrow’s Doctors 2009. Available at http:// www.gmc-uk.org/education/undergraduate/tomorrows_doctors_ 2009_outcomes2.asp. Accessed on 13 February 2013. NHS National Patient Safety Agency, National Reporting and Learning Service. Safety in doses: improving the use of medicines in the NHS. Learning from national reporting 2007; published 2009. Available at http://www.gmc-uk. org/about/research/research_commissioned_1.asp. Accessed 13 February 2013.
5.
British Pharmacological Society. Prescribing Skills Assessment. 2011. Available at http://www.prescribe. ac.uk/psa/. Accessed on 13 February 2013.
6.
McGaghie W, Issenberg S, Cohen E, Barsuk J, Wayne D. Does Simulation-Based Medical Education With Deliberate Practice Yield Better Results Than Traditional Clinical Education? A Meta-Analytic Comparative Review of the Evidence. Acad Med 2011;86:706–711.
SUPPORTING INFORMATION Additional supporting information may be found in the online version of this article at http://onlinelibrary.wiley. com/doi/10.1111/tct.12056/ suppinfo Appendix S1 Questionnaire prior to prescribing tutorials Yr 5 Appendix S2 Case 1 Prescribing Tutorial Yr 5
Corresponding author’s contact details: Dr. Georgia Woodfield, University of Bristol Academy at Great Western Hospital, Marlborough Road, Swindon, Wiltshire, SN36 6BB, UK. E-mail: [email protected]
Funding: None. Conflict of Interest: None. Ethical approval: The article describes a simple evaluation exercise of teaching that was received as part of the student curriculum, rather than formal research on human subjects. There was no potential harm to patients. The student opinion data and prescribing data was collected by questionnaire and by collection of completed student drug charts. Students were aware of the project and gave consent to partake in data collection from the tutorials. Anonymity of participants was guaranteed. The parent institution (Great Western Hospital) was aware of the project and it was discussed with the Trust’s Director of Research and Development who advised that formal ethics approval was not required. doi: 10.1111/tct.12056
28 © 2014 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2014; 11: 24–28
tct_12056.indd 28
1/6/2014 10:25:22 AM
Using simulation for prescribing: an evaluation Georgia Woodfield, Marie O’Sullivan, Nicholas Haddington and Andrew Stanton, University of Bristol Academy at Great Western Hospital, Swindon, Wiltshire, UK
Drug errors are a major cause of patient morbidity
SUMMARY Background: Drug errors are a major cause of patient morbidity. The UK General Medical Council has highlighted that prescribing teaching should be prioritised. How should medical teachers best teach the practical aspects of prescribing? Method: We piloted a set of eight prescribing simulation tutorials for 35 final-year undergraduate medical students in Great Western Hospital, Swindon, UK. Students completed baseline questionnaires addressing confidence levels in prescribing. They then prescribed independently for simulated cases of common medical emergencies within tutor-led tutorials (n = 17)
or self-directed prescribing tutorials (n = 18). Confidence scores and numbers of drug errors were documented at baseline and following four tutorials. Drug errors were categorised according to potential harm. Students then swapped to receive the alternative tutorial type. Results: Both tutorial types resulted in a statistically significant decrease in the number of unsafe drug errors: from 57 to three in the tutor-led group (p = 0.003) and from 60 to 14 in the self-directed learning group (p = 0.001). Both tutorial types led to statistically significant increases in confidence scores for global prescribing, prescribing in
medical emergencies and managing medical emergencies (with a median increase of one point on a modified Likert scale). Confidence using the British National Formulary improved, but reached statistical significance for the self-directed group only. Discussion: Simulating cases and using real drug charts is an effective method for improving students’ prescribing ability and confidence in common medical emergencies. Tutorials like these, whether tutor-led or self-directed, could be incorporated into medical curricula. This could help prevent drug errors in practice, thereby improving patient care and safety.
24 © 2014 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2014; 11: 24–28
tct_12056.indd 24
1/6/2014 10:25:15 AM
INTRODUCTION
D
espite the immediate need for junior doctors to prescribe drugs safely upon qualification,1 there remains variation in how this is taught. Drug errors are a major cause of patient morbidity and mortality. In 2007, 32 per cent of the most serious UK drug error incidents were caused by errors in prescribing.2
In a 2009 UK General Medical Council (GMC) report, 9 per cent of hospital prescriptions contained errors, and 18.7 per cent of these were made by junior doctors in 19 UK hospitals over 7 days.3 The report concluded that ‘more could have been done during undergraduate education to link theory with practice, and develop medical students’ expertise in the complex context of clinical practice’.3 A 2008 GMC report of newly qualified UK doctors showed that prescribing was the ‘main area of practice in which errors were reported by respondents, indicating a significant potential risk’.4 Furthermore, a recent development in prescribing is the introduction of the prescribing skills assessment (PSA).5 Although this will not be a legal requirement in order to practise as a doctor, it is likely that many medical schools will use it as part of the final assessment. This is another pertinent reason for prioritising medical student teaching in prescribing. How should medical teachers help students prepare for final examinations, the PSA and for becoming a doctor? Are simulation-style tutorials effective for improving prescribing skill and confidence in fifth-year medical students?
OBJECTIVES We wanted to determine whether a structured tutorial programme
could deliver the following outcomes.
...9 per cent of hospital prescriptions contained errors
1. Reduction in number of drug errors and improvement in drug-chart safety for common medical emergencies. 2. Improvement in subjective confidence levels in four areas: • Global prescribing • Using the British National Formulary (BNF) • Managing common medical emergencies • Prescribing for common medical emergencies 3. Evaluation of the effectiveness of tutor-led and self-directed tutorials in the above measures, and exploration of student preferences between these two teaching approaches.
METHOD All 35 final-year students undertaking a 12-week clinical attachment in medicine and surgery at the Great Western Hospital in Swindon were informed about the study. All were from the University of Bristol, undertaking a 5–year UK medical undergraduate course, and attended the tutorials in September–December 2011. A total of 34 students completed a questionnaire (Appendix S1), grading their confidence on a five-point modified Likert scale from 0 (no confidence) to 4 (very confident) in four areas: • prescribing on a drug chart to the standard of a newly qualified doctor • using the BNF • managing common medical emergencies, e.g. hyperkalaemia • prescribing for common medical emergencies The questionnaire also explored students’ past experiences of learning about prescribing, and their opinions on the
relevance and usefulness of this. The data collected were identifiable by student number only. Students then received four prescribing tutorials (Appendix S2) involving them individually prescribing on drug charts for four ‘real-life’ medical emergency cases, using the BNF. All common emergencies cases were deemed equal in terms of difficulty and importance for a junior doctor. Group A (17 students) prescribed each week within four tutor-led tutorials, during which the completed drug charts were collected and the answers discussed. The answers included a discussion of the rationale for treatment, contraindications and common pitfalls. Tutorials were led by doctors who had graduated 2 years ago (authors G.W. and M.O.). Group B (18 students) prescribed in a self-directed manner using any resources they required, and in their own time. Drug charts were collected weekly, and written answers and model drug charts were provided afterwards, covering the same knowledge areas. After four sessions all students re-scored their confidence on a repeat questionnaire, and then swapped tutorial type for four further sessions with new scenarios. Tutorial preference was determined in a final
© 2014 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2014; 11: 24–28 25
tct_12056.indd 25
1/6/2014 10:25:20 AM
Tutor-led and self-directed simulation tutorials can significantly improve student prescribing skill
questionnaire after eight sessions. Other questions referred to students’ experiences during the tutorials and how useful they thought they were.
RESULTS
Drug errors and drug-chart safety were assessed from the drug charts collected for cases 1 and 4.
Group B: all 18 students partook in self-directed tutorials; the completion of these nonassessed tutorials was harder to ascertain.
Each drug chart was graded separately and agreed by consensus (among authors G.W., M.O., A.S. and N.H.). Red: one or more errors that are likely to cause serious patient harm or death. This included the omission of life-saving drugs. Orange: one or more potentially harmful errors. Blue: inappropriate or not indicated medication, but unlikely to cause harm. Main emergency medications prescribed adequately. Green: Appropriately prescribed medication to adequately treat the emergency presentation, with no inappropriate medication. ‘Unsafe’ drug errors were those graded orange or red. The data collected were analysed using spss 19 (IBM). Paired data, where available, were compared using the Wilcoxon signed-ranks test; p < 0.05 was considered to be statistically significant. Change in scores and p values could only be calculated from paired data (matched pre and post scores).
Group A: all 17 students attended either three (six students) or four tutorials (11 students).
A total of 35 students were therefore included in the data collection. Baseline data: prescribing teaching experience Four of 30 students (13.3%) believed prescribing had been previously taught well throughout university. Thirty of 31 students (96.8%) believed that practical prescribing should be a formal part of the curriculum. Thirty-one of 31 students (100%) wanted prescribing teaching to form part of the curriculum, as combined tutorled/self-directed tutorials (16/31; 52%), self-directed tutorials (2/31; 6%) or tutor-led tutorials (13/31; 42%). Twenty-six of 31 students (83.9%) generally preferred tutor-led to self-directed tutorials. Drug errors Charts completed before and after the tutorials were returned by 14 of 17 students in group A, and by 18 (pre) and 16 (post) students in group B.
Both tutorial types resulted in a statistically significant decrease in the number of unsafe drug errors made (Table 1). Confidence levels Questionnaires completed before and after the tutorials were returned by 15 (pre) and 17 (post) students in group A, and by 17 (pre and post) students in group B. Both tutorial types resulted in statistically significant confidence increases in global prescribing as a junior doctor, in managing common medical emergencies and in prescribing for common medical emergencies (Table 2). There was a significant increase in confidence in using the BNF in the self-directed group B only.
DISCUSSION This study has shown both tutorled and self-directed simulation tutorials can significantly improve student prescribing skill and confidence, within a prescribing teaching programme. However, the preference and opinion questions in the final questionnaire showed that students preferred the former style, and found it useful. Safe prescribing is a priority for passing final exams, the PSA and, most importantly, for becoming a doctor. As medical educators we must take positive steps to help students prepare adequately. Tutorials like these, whether tutor-led or self-directed, could in future be incorporated into medical school curricula.
Table 1. Unsafe drug errors made before and after the tutorials Median number of unsafe drug errors
p value for difference in errors
Before tutorials
After four tutorials
Group A Tutor-led tutorials
57 errors n = 14
3 errors n = 14
p = 0.003
Group B Self-directed tutorials
60 errors n = 18
14 errors n = 16
p = 0.001
26 © 2014 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2014; 11: 24–28
tct_12056.indd 26
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Table 2. Confidence levels before and after tutorials Confidence area
Group A
Group B
Median confidence score Before tutorials n = 15
After four tutorials n = 17
Median confidence increase per student (Likert scale units) n = 15
p value n = 15
Median confidence score Before tutorials n = 17
After four tutorials n = 17
Median confidence increase per student (Likert scale units) n = 17
p value n = 17
Global 1 prescribing
2
1
0.001
2
2
1
0.025
Using the BNF
2
3
1
0.197
2
3
1
0.005
Managing common medical emergencies
1
2
2
0.003
1
2
1
0.002
Prescribing for common medical emergencies
0
2
2
0.001
1
2
1
0.001
Tutorials like these, could in future be incorporated into medical school curricula
n, number of students with available data.
They are a straightforward, easily deliverable and effective tool for improving prescribing ability and confidence. In turn, drug errors when the student enters the workplace could be prevented, improving patient care and safety. The authors strove to ensure that emergency cases were equal in terms of difficulty, but accept that this is a potential limitation to the study. We chose hyperkalaemia (case 1) and acute pulmonary oedema (case 4) for assessment, because the possible number of ‘unsafe errors’ for the scenarios was equivalent, and therefore the level of difficulty was deemed to be equal. Both cases had a potentially fatal drug: insulin and morphine, respectively. Students had to prescribe emergency medications, but also withhold exacerbating medications, for all eight cases.
A further limitation was the small study size, but this was determined by the number of students from the University of Bristol placed in Swindon. Student allocation was random and unrelated to the study. For timetabling reasons, group A were doing their medical attachment during the first four tutorials, whereas group B were doing surgery. We were concerned that this might influence performance, but this was not the case, probably because of the proximity of final examinations for all students. Although the initial sample size was small, we did achieve a reasonable return of before and after questionnaires and drug charts. There were enough paired data to allow the calculation of statistically significant improvements in both error rate and confidence scores in all but one domain for one group.
We used a modified Likert scale of 0–4 to reflect the possibility that some students may have had ‘no confidence’, reflected in a score of 0. The authors are unaware of any evidence that using such a 0–4 scale generates different data from a 1–5 scale, but accept that this is another potential limitation. We did, however, use the same scale throughout. It is possible that prescribing tutorials could influence confidence and drug errors in the work place. This could be investigated by following the students into clinical practice, which would be worthy of further study. A 2011 meta-analysis compared simulation-based medical education (SBME) with traditional clinical medical education.6 Some studies within the meta analysis linked SBME directly with better patient outcomes and improved patient care practices.6
© 2014 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2014; 11: 24–28 27
tct_12056.indd 27
1/6/2014 10:25:22 AM
Simulated prescribing tutorials are an effective way of reducing drug errors
In overall conclusion we have shown that simulated prescribing tutorials are an effective way of reducing drug errors and improving students’ confidence in prescribing.
3.
Dornan T, Ashcroft D, Heathfield H, Lewis P, Miles J, Taylor D, Tully M, Wass V for the General Medical Council. Final report. An in depth investigation into causes of prescribing errors by foundation trainees in relation to their medical education. EQUIP study. 2009. Available at http://www.gmc-uk.org/about/ research/research_commissioned_4. asp. Accessed on 13 February 2013.
4.
Illing J, Morrow G, Kergon C, Burford B, Spencer J for the General Medical Council. How prepared are medical graduates to begin practice? A comparison of three diverse UK medical schools. 2008. Available at http://www.gmc-uk. org/about/research/research_commissioned_1.asp. Accessed on 13 February 2013.
REFERENCES 1.
2.
General Medical Council. Tomorrow’s Doctors 2009. Available at http:// www.gmc-uk.org/education/undergraduate/tomorrows_doctors_ 2009_outcomes2.asp. Accessed on 13 February 2013. NHS National Patient Safety Agency, National Reporting and Learning Service. Safety in doses: improving the use of medicines in the NHS. Learning from national reporting 2007; published 2009. Available at http://www.gmc-uk. org/about/research/research_commissioned_1.asp. Accessed 13 February 2013.
5.
British Pharmacological Society. Prescribing Skills Assessment. 2011. Available at http://www.prescribe. ac.uk/psa/. Accessed on 13 February 2013.
6.
McGaghie W, Issenberg S, Cohen E, Barsuk J, Wayne D. Does Simulation-Based Medical Education With Deliberate Practice Yield Better Results Than Traditional Clinical Education? A Meta-Analytic Comparative Review of the Evidence. Acad Med 2011;86:706–711.
SUPPORTING INFORMATION Additional supporting information may be found in the online version of this article at http://onlinelibrary.wiley. com/doi/10.1111/tct.12056/ suppinfo Appendix S1 Questionnaire prior to prescribing tutorials Yr 5 Appendix S2 Case 1 Prescribing Tutorial Yr 5
Corresponding author’s contact details: Dr. Georgia Woodfield, University of Bristol Academy at Great Western Hospital, Marlborough Road, Swindon, Wiltshire, SN36 6BB, UK. E-mail: [email protected]
Funding: None. Conflict of Interest: None. Ethical approval: The article describes a simple evaluation exercise of teaching that was received as part of the student curriculum, rather than formal research on human subjects. There was no potential harm to patients. The student opinion data and prescribing data was collected by questionnaire and by collection of completed student drug charts. Students were aware of the project and gave consent to partake in data collection from the tutorials. Anonymity of participants was guaranteed. The parent institution (Great Western Hospital) was aware of the project and it was discussed with the Trust’s Director of Research and Development who advised that formal ethics approval was not required. doi: 10.1111/tct.12056
28 © 2014 John Wiley & Sons Ltd. THE CLINICAL TEACHER 2014; 11: 24–28
tct_12056.indd 28
1/6/2014 10:25:22 AM
