The impact of therapeutics tutorials on the reasoning of fourth year medical students with regard to the prescribing process.
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Date
2005
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Abstract
This research was initiated as a response to a request for assistance from a group of students
at the Nelson R Mandela School of Medicine who had reported feeling unprepared to
prescribe medicines. This led to an interest in the level of competence shown by students in
making prescribing decisions and the extent to which they were confident of their prescribing
judgments.
Student prescribing competence and confidence were assessed using quantitative and
qualitative methods. The quantitative assessment comprised a test where students were asked
to rate their confidence in some of their responses. A stratified sample of 10 of these student
interviewed, where they were asked to choose treatment for four paper cases. Prescribing
skills were found to be lacking, with test results averaging 47%. appropriate treatment
selected for only 4 of the total of 40 paper cases. Upon reviewing the literature, it became
apparent that poor prescribing skills, leading to the problem of irrational prescribing was a
worldwide phenomenon The study aimed to address areas of weak prescribing skill using a
short intense intervention comprising of several different learning strategies. Student change
in confidence following the course was assessed using an evaluation form where students
rated their perceived changes in key competences. Students showed improved confidence for
each of the prescribing abilities measured.
These findings have been compiled into 3 research publications, the texts of which are bound
together as they were submitted together to comply with the research requirement of an M.Ed.
The findings are reported in a paper titled Building successful therapeutics into a problembased
medical curriculum in Africa in the South African Journal of Higher Education (see
Appendices).
I was also interested in how prescribing ability builds as students develop new prescribing
skills. The student interviews provided an opportunity to explore the variation shown between
the students relating to the quality of the treatment they prescribed for a given paper case. A
sample of two sets of paper cases were assessed using a phenomenographic method, yielding
two different perspectives of student experience.
The research outlined above is the focus of the dissertation, which also includes an
exploration of the teaching and learning issues which guided the design of the intervention
and which I believe led to the positive finding of improved student prescribing confidence.
Also included in the dissertation is an analysis of the quantitative assessment according to the
cognitive categories of Bloom's Taxonomy, as well as qualitative data gathered from student
interviews which revealed an understanding about prescribing abilities which predominated at
differing Bloom cognitive levels for different students.
In the second paper titled Undergraduate medical students' reasoning with regard to the
prescribing process which has been submitted to Medical Teacher, (see Appendices) the
range of student cognition associated with prescribing is explored. Each question from the
quantitative assessment of prescribing abilities were grouped according to the Bloom
Category it had been assigned, student scores according to each Bloom category were
calculated. Students scored highest for the lowest cognitive category ('knowledge') and
lowest for the highest ranked cognitive categories( 'evaluation' and 'synthesis'). These
findings along with the qualitative findings and the phenomenographic assessment were
reported here.
Description
Thesis (M.Ed.)-University of KwaZulu-Natal, Pietermaritzburg, 2005.
Keywords
Drugs--Prescribing., Chemotherapy., Tutors and tutoring., Problem based learning., Theses--Higher education.