An evaluation of a simulation-based training programme to support final-year medical students in their preparation for foundation-year prescribing practice
Authors: Lloyd M , Lea N , Zaman F , Bennett N 
Published: April 2024

Abstract

Introduction
Prescribing is a high-risk and error prone activity with doctors reporting a lack of preparedness for prescribing practice,[1] with potential for simulation-based training (SBT) to enhance prescribing skill development.[2] To support preparation for prescribing practice, a team-based SBT programme was developed for final-year medical students.

Aim
To determine the impact of the SBT on prescribing knowledge and student perceptions of SBT in supporting their prescribing practice.

Methods
An SBT event was designed to include three complex multi-morbid scenarios reflecting foundation practice. The scenarios were co-produced by a multidisciplinary team, with sessions facilitated by clinical pharmacists. Sessions focused on practical prescribing and authentic decision-making with a convenience sample of final-year medical students. Students worked in small groups to manage conditions including heart failure, atrial fibrillation, diabetic keto-acidosis and chronic obstructive pulmonary disease, all followed by a facilitated debrief.
Effectiveness of the SBT on understanding of the treatment of the topics was measured anonymously using ten multiple choice questions (MCQs). A 28-item survey was self-administered to students pre and post session, including demographic questions and prescribing confidence agreement statements using a 5-point Likert-scale (strongly disagreed to strongly agreed), with further open-ended questions used to evaluate views of the SBT, and the perceived impact on prescribing confidence.
Data were entered into a database and analysed using SPSS v29. Mann-Whitney U-tests were used to determine differences in unpaired agreement scores with independent t-tests used to explore change in unpaired MCQ test-scores.

Results
Thirty-seven students attended the SBT with 34 students completing post session surveys. Pre session, mean test scores were 4.5±2.0, and post session, mean test scores were 7.7±1.5, an improvement of 3.2 (CI 2.4 to 4.1) t(69)= 7.5, p&lt;0.0001 (d=1.8 large effect).
Self-rated prescribing confidence scores significantly increased post-teaching for ability to identify drug interactions (pre-median: 3 [neutral], post-median: 4 [agreed], p=0.019), monitoring of medications (pre-median: 3, post-median: 4, p&lt;0.001) and ordering of appropriate investigations (pre-median: 3, post-median: 4, p&lt;0.001), with significant differences in mean rank reported for all other self-rated confidence scores, except for completion of drug histories, and accessing of information resources.
The majority of participants strongly agreed/agreed that the training was valuable (99.1%), interactive (94.1%), practical and relevant (97.1%), contextualised prescribing (94.1 %), and helped preparation for practice (94.1%). Students also strongly agreed/agreed that they were more confident with their prescribing (82.3%), and that pharmacists were appropriate subject teachers (97.1%).
Open-ended responses suggested that students found the session challenging and tiring, but realistic, focusing on common prescribing scenarios they would likely encounter. The debrief and personalised feedback was valued, whilst students reported that more SBT was needed throughout their training for other topics including fluids and insulin prescribing.

Conclusion
Deficits were identified for self-rated prescribing confidence and knowledge-based competence on final-year medical students. A contextualised prescribing SBT programme is acceptable and valued by final-year medical students to prepare them for practice. Whilst it can improve medical student prescribing knowledge and confidence, impact on prescribing competence is unknown and further work is required to explore this educational modality on prescribing quality.

References
1. Brinkman DJ, Tichelaar J, Graaf S et al. Do final-year medical students have sufficient prescribing competencies? A systematic literature review. Br J Clin Pharmacol. 2018;84:615–635.
2. Lloyd M, Watmough S, Bennett N. Simulation-based training: applications in clinical pharmacy. Clinical Pharmacist, 2018;10(9):3–10.