Do final‐year medical students have sufficient prescribing competencies? A systematic literature review

• Published in: British journal of clinical pharmacology Vol. 84; no. 4; pp. 615 - 635
• Main Authors: Brinkman, David J., Tichelaar, Jelle, Graaf, Sanne, Otten, René H. J., Richir, Milan C., Agtmael, Michiel A.
• Format: Journal Article
• Language: English
• Published: England John Wiley and Sons Inc 01-04-2018
• Subjects: Clinical Competence; clinical pharmacology; competence; Competency-Based Education; Drug Prescriptions - standards; Education, Medical - standards; Educational Measurement - methods; Health Knowledge, Attitudes, Practice; Humans; medical curriculum; medical student; Medication Errors - prevention & control; pharmacotherapy; Practice Patterns, Physicians' - standards; prescribing; Students, Medical; Systematic Review and Meta‐analysis; therapeutics; competence; therapeutics; medical curriculum; pharmacotherapy; clinical pharmacology; prescribing; medical student
• ISSN: 0306-5251; 1365-2125
• DOI: 10.1111/bcp.13491

Aims
Prescribing errors are an important cause of patient safety incidents and are frequently caused by junior doctors. This might be because the prescribing competence of final‐year medical students is poor as a result of inadequate clinical pharmacology and therapeutic (CPT) education. We reviewed the literature to investigate which prescribing competencies medical students should have acquired in order to prescribe safely and effectively, and whether these have been attained by the time they graduate.
Methods
PubMed, EMBASE and ERIC databases were searched from the earliest dates up to and including January 2017, using the terms ‘prescribing’, ‘competence’ and ‘medical students’ in combination. Articles describing or evaluating essential prescribing competencies of final‐year medical students were included.
Results
Twenty‐five articles describing, and 47 articles evaluating, the prescribing competencies of final‐year students were included. Although there seems to be some agreement, we found no clear consensus among CPT teachers on which prescribing competencies medical students should have when they graduate. Studies showed that students had a general lack of preparedness, self‐confidence, knowledge and skills, specifically regarding general and antimicrobial prescribing and pharmacovigilance. However, the results should be interpreted with caution, given the heterogeneity and methodological weaknesses of the included studies.
Conclusions
There is considerable evidence that final‐year students have insufficient competencies to prescribe safely and effectively, although there is a need for a greater consensus among CPT teachers on the required competencies. Changes in undergraduate CPT education are urgently required in order to improve the prescribing of future doctors.