Holbrook Anne, Liu J Tiger, Rieder Michael, Gibson Michelle, Levine Mitchell, Foster Gary, Perri Dan, Maxwell Simon
Division of Clinical Pharmacology, St. Joseph's Healthcare Hamilton, Ontario, Canada.
Division of Clinical Pharmacology & Toxicology, Department of Medicine, McMaster University, Ontario, Canada.
Can Med Educ J. 2019 Mar 13;10(1):e103-e110. eCollection 2019 Mar.
The knowledge and ability to prescribe safely and effectively is a core competency for every graduating medical student. Our previous research suggested concerns about medical student prescribing abilities, and interest in a standardized assessment process.
A multi-year cross-sectional study evaluating the feasibility, acceptability, and discriminative ability of an online prescribing competency assessment for final year Canadian medical students was conducted. Students at nine sites of four Ontario medical schools were invited to participate in an online one-hour exam of eight domains related to prescribing safely. Student feedback on perceived fairness, clarity, and ease of use formed the primary outcome. Exam performance and parity between schools were the secondary outcome.
A total of 714 students completed the assessment during spring final review courses between 2016 and 2018. Student feedback was more favourable than not for appropriateness of content (53.5% agreement vs 18.3% disagreement), clarity of questions (65.5% agreement vs 11.6% disagreement), question layout and presentation (70.8% agreement vs 12.2% disagreement), and ease of use of online interface (67.1% agreement vs 13.6% disagreement). Few (23.6% believed their course work had prepared them for the assessment. Mean total exam score was 70.0% overall (SD 10.4%), with 47.6% scoring at or above the pass threshold of 70%. Our prescribing competency assessment proved feasible, acceptable, and discriminative, and indicated a need for better medical school training to improve prescribing competency. Further evaluation in a larger sample of medical schools is warranted.
安全有效地开具处方的知识和能力是每一位即将毕业的医学生的核心能力。我们之前的研究表明对医学生开具处方能力存在担忧，并且对标准化评估过程有兴趣。
开展了一项多年的横断面研究，评估针对加拿大最后一年医学生的在线处方能力评估的可行性、可接受性和区分能力。邀请了安大略省四所医学院九个地点的学生参加一场与安全开具处方相关的八个领域的在线一小时考试。学生对感知到的公平性、清晰度和易用性的反馈构成主要结果。考试成绩和学校之间的均等性是次要结果。
在2016年至2018年春季期末考试复习课程期间，共有714名学生完成了评估。学生对内容适当性（53.5%表示同意，18.3%表示不同意）、问题清晰度（65.5%表示同意，11.6%表示不同意）、问题布局和呈现方式（70.8%表示同意，12.2%表示不同意）以及在线界面易用性（67.1%表示同意，13.6%表示不同意）的反馈大多是积极的。很少有学生（23.6%）认为他们的课程作业使他们为评估做好了准备。总体平均考试成绩为70.0%（标准差10.4%），47.6%的学生得分达到或高于70%的及格线。我们的处方能力评估被证明是可行的、可接受的且具有区分能力，并表明需要更好的医学院培训来提高处方能力。有必要在更多医学院样本中进行进一步评估。
