Division of Pharmacy and Optometry, Faculty of Biology, Medicine and Health, University of Manchester, Stopford Building, Oxford Road, Manchester, M13 9PT, United Kingdom.
Res Social Adm Pharm. 2018 Jan;14(1):6-17. doi: 10.1016/j.sapharm.2017.02.002. Epub 2017 Feb 7.
Prescribing is a complex and error-prone task that demands expertise. McLellan et al.'s theory of expertise development model ("the model"), developed to assess medical literature on prescribing by medical students, proposes that in order to develop, individuals should deliberately engage their knowledge, skills and attitudes within a social context. Its applicability to independent prescribers (IP) is unknown.
A systematic review was conducted to explore whether the model is applicable to non-medical independent prescribing and to assess the factors underpinning expertise development reported in the literature.
Six electronic databases (EMBASE, Medline, AMED, CINAHL, IPA and PsychInfo) were searched for articles published between 2006 and 2016, reporting empirical data on pharmacist and nurse IPs education or practice. Data were extracted using themes from the model and analysed using framework analysis.
Thirty-four studies met the inclusion criteria. Knowledge, pre-registration education, experience, support and confidence were some of the intrinsic and extrinsic factors influencing IPs. Difficulty in transferring theory to practice was attributed to lack of basic pharmacology and bioscience content in pre-registration nursing rather than the prescribing programme. Students saw interventions using virtual learning or learning in practice as more useful with long-term benefits e.g. students were able to use their skills in history taking following the virtual learning intervention 6-months after the programme. All studies demonstrated how engaging knowledge and skills affected individuals' attitude by, for example, increasing professional dignity. IPs were able to develop their expertise when integrating their competencies in a workplace context with support from colleagues and adherence to guidelines.
This is the first study to synthesize data systematically on expertise development from studies on IPs using the model. The model showed the need for stronger foundations in scientific knowledge amongst some IPs, where continuous workplace practice can improve skills and strengthen attitudes. This could facilitate a smoother transfer of learnt theory to practice, in order for IPs to be experts within their fields and not merely adequately competent.
开处方是一项复杂且容易出错的任务，需要专业知识。为了评估医学生在开处方方面的医学文献，McLellan 等人提出了专长发展模型理论（“该模型”），该理论提出，为了发展，个人应该在社会环境中刻意运用自己的知识、技能和态度。其在独立处方者（IP）中的适用性尚不清楚。
进行了系统评价，以探讨该模型是否适用于非医疗独立处方，并评估文献中报告的专长发展的基础因素。
检索了 2006 年至 2016 年期间发表的六大学术数据库（EMBASE、Medline、AMED、CINAHL、IPA 和 PsychInfo），报告了关于药师和护士 IP 教育或实践的实证数据。使用该模型中的主题提取数据，并使用框架分析进行分析。
34 项研究符合纳入标准。知识、预注册教育、经验、支持和信心是影响 IP 的一些内在和外在因素。由于缺乏预注册护理的基础药理学和生物科学内容，而不是处方计划，导致将理论转化为实践的困难。学生认为使用虚拟学习或实践中学习的干预措施更有用，具有长期效益，例如，在虚拟学习干预后 6 个月，学生能够在病史采集方面使用他们的技能。所有研究都表明，通过例如提高职业尊严，使知识和技能得到更好的应用，如何影响个人的态度。当 IP 以同事的支持和遵守准则为依托，在工作场所环境中整合他们的能力时，他们能够发展自己的专长。
这是第一项使用该模型系统地综合有关 IP 专长发展数据的研究。该模型表明，一些 IP 需要更坚实的科学知识基础，持续的工作实践可以提高技能并增强态度。这可以更顺利地将学到的理论转移到实践中，使 IP 成为他们领域的专家，而不仅仅是足够胜任。
