Peninsula Medical School, University of Plymouth, Drakes Circus, Plymouth PL4 8 AA, UK.
Br J Clin Pharmacol. 2010 Jun;69(6):598-606. doi: 10.1111/j.1365-2125.2010.03645.x.
Recent studies suggest a worryingly high proportion of final year medical students and new doctors feel unprepared for effective and safe prescribing. Little research has been undertaken on UK junior doctors to see if these perceptions translate into unsafe prescribing practice. We aimed to measure the performance of foundation year 1 (FY1) doctors in applying clinical pharmacology and therapeutics (CPT) knowledge and prescribing skills using standardized clinical cases.
A subject matter expert (SME) panel constructed a blueprint, and from these, twelve assessments focusing on areas posing high risk to patient safety and deemed as essential for FY1 doctors to know were chosen. Assessments comprised six extended matching questions (EMQs) and six written unobserved structured clinical examinations (WUSCEs) covering seven CPT domains. Two of each assessment types were administered over three time points to 128 FY1 doctors.
The twelve assessments were valid and statistically reliable. Across seven CPT areas tested 51-75% of FY1 doctors failed EMQs and 27-70% failed WUSCEs. The WUSCEs showed three performance trends; 30% of FY1 doctors consistently performing poorly, 50% performing around the passing score, and 20% performing consistently well. Categorical rating of the WUSCEs revealed 5% (8/161) of scripts contained errors deemed as potentially lethal.
This study showed that a large proportion of FY1 doctors failed to demonstrate the level of CPT knowledge and prescribing ability required at this stage of their careers. We identified areas of performance weakness that posed high risk to patient safety and suggested ways to improve the prescribing by FY1 doctors.
最近的研究表明，相当大比例的医学专业应届毕业生和新医生感到自己对有效和安全的处方开具准备不足。针对英国初级医生的研究很少，以了解这些看法是否转化为不安全的处方实践。我们旨在使用标准化临床病例来衡量第一年住院医师（FY1）医生应用临床药理学和治疗学（CPT）知识和开具处方技能的能力。
一个主题专家（SME）小组构建了蓝图，从中选择了 12 项评估，重点关注对患者安全构成高风险且被认为 FY1 医生必须了解的领域。评估包括 6 个扩展匹配问题（EMQ）和 6 个涵盖 7 个 CPT 领域的书面非观察结构化临床考试（WUSCE）。每种评估类型的两个都在三个时间点上向 128 名 FY1 医生进行了管理。
这 12 项评估是有效的，并且具有统计学可靠性。在七个测试的 CPT 领域中，51-75%的 FY1 医生在 EMQ 中失败，27-70%在 WUSCE 中失败。WUSCE 显示了三种绩效趋势；30%的 FY1 医生表现持续不佳，50%的医生表现接近及格分数，20%的医生表现持续良好。WUSCE 的分类评分显示，5%（8/161）的脚本包含被认为可能致命的潜在错误。
这项研究表明，相当大比例的 FY1 医生未能表现出他们职业生涯这个阶段所需的 CPT 知识和处方能力水平。我们确定了对患者安全构成高风险的绩效弱点领域，并提出了提高 FY1 医生处方水平的方法。
