Context / probleemstelling of aanleiding
Probleemstelling (inclusief theoretische onderbouwing en onderzoeksvraag/vragen):
Poor prescribing adversely affects the quality of care. However, many final-year medical students in Europe lack adequate prescribing knowledge and skills at graduation.1 Although never studied, it is widely assumed that prescribing knowledge and skills improve by learning in practice. Therefore, the aim of this study was to investigate how the prescribing knowledge and skills of junior doctors in the Netherlands and Belgium develop during the year after graduation. Moreover, the aim was investigate the impact of the Dutch National Pharmacotherapy Assessment (DNPA), and the type of curriculum, on the level and development.
Methode:
In this international, multicentre (n=11), longitudinal study, prescribing knowledge and skills, including learning curves, were analysed for junior doctors working in various specialties who completed three validated assessments at about the time of graduation (Assessment 1), and 6 months (Assessment 2) and 1 year (Assessment 3) after graduation. Each assessment contained 35 multiple choice questions on medication safety (passing grade ≥85%) and three clinical case scenarios. At the time of inclusion, one university had the DNPA in the educational program. The curriculum was either classified as theoretical (lectures, self-study), practical (bed-side teaching, clinics) or mixed, based on a previous cross-sectional survey.2
Resultaten (en conclusie):
In total, 556 junior doctors participated, 326 (58.6%) of whom completed the MCQs and 325 (58.5%) the clinical case scenarios of all three assessments. Five universities had only theoretical education, six a mixed type curriculum. Mean prescribing knowledge was stable in the year after graduation, with 69% (SD 13) correctly answered questions at assessment 1 and 71% (SD 14) at assessment 3, whereas prescribing skills decreased: 63% of treatment plans were considered adequate at assessment 1 but only 40% at assessment 3 (p<0.001). Junior doctors who graduated at the school with the DNPA, and those with a mixed type curriculum had higher prescribing knowledge in all assessments (all p<0.001), but the same learning curves. The DNPA had no impact on the prescribing skills, whereas the a mixed type curriculum improved it in all assessments.
Discussie (beschouwing resultaten en conclusie in het kader van de theorie):
This study showed that junior doctors’ prescribing knowledge and skills did not improve in the year after graduation while they were working in various clinical fields. While the prescribing knowledge remained stable but under the predefined passing grade, their prescribing skills even deteriorated. The DNPA and a mixed type curriculum have a positive impact, but not sufficient. Therefore, more educational interventions should be introduced in both the under- and postgraduate education to improve the prescribing competence of junior doctors.
Referenties:
1: Brinkman et al, 2016. PMID: 27648725
2: Brinkman et al, 2017. PMID:
28295236
