The impact of therapeutics tutorials on the reasoning of fourth year medical students with regard to the prescribing process.

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.