Hospital Pharmacology (Jan 2018)
Prescribing assessment: Are final year medical students competent to prescribe antibiotics rationally?
Abstract
Introduction: The rational use of drugs, especially antibiotics, has been recognized as a serious problem worldwide. Aim: The purpose of this study was to evaluate the practical skills of Bulgarian medical students in their final year of education to prescribe antibiotics rationally as well as the impact of a training focused specifically on avoiding prescription errors. Materials/Methods: Medical students from the Medical University of Sofia in their 10th semester of education from two consecutive teaching cycles took part in this study. The students' participation was completely voluntary. The study was performed as academic study after having obtained a positive opinion from the Local Ethics Committee of the University Hospital 'Tsaritsa Joanna-ISUL', Medical University of Sofi a. The study was planned to be conducted in two separate parts: a pilot study aimed at receiving basic information about the self-assessment confidence of the medical students in prescribing drugs and especially antibiotics rationally and comparing this to their actual prescribing competence and a subsequent pivotal study after having performed a thorough analysis of the results of the pilot study with implementation of the respective corrective measures. The students' perception of their theoretical knowledge and practical skills to prescribe drugs and especially antibiotics rationally was assessed by means of a questionnaire containing 5 questions whereas their level of antibiotic prescribing competence was assessed by means of solving three simulated patient cases. The appropriateness of written therapeutic prescriptions was assessed independently by two clinical pharmacologists using a three-grade assessment scale: 'good', 'satisfactory' and 'unsatisfactory'. Results: The results of the pilot study showed that 50.35% of the prescriptions were rated as 'good', 21.64% as 'satisfactory' and 28.01% as 'unsatisfactory'. The results obtained from the subsequent pivotal study showed that 60.97% of the prescriptions were rated as 'good' (representing a 21.1% increase), 16.23% as 'satisfactory' (representing a 25% decrease) and 22.80% as 'unsatisfactory' (representing an 18.6% decrease). This was accompanied by an increase in the students' self-assessment confidence rated as 'good' - from 19.15% to 34.21%, while 'satisfactory' and 'unsatisfactory' ratings decreased - from 65.96% to 55.26% and from 14.89% to 10.53%, respectively. Conclusions: Medical students from the Medical University of Sofi a showed a level of competence to prescribe antibiotics rationally commensurable with the level report ed by foreign medical universities. Regardless of the observed discrepancy between the self-assessment rating and the practical antibiotic prescribing skills it was clearly shown that education specifically focused on prescription errors may contribute to the improvement of the students' antibiotic prescribing competence.
