Standardized assessment for students graduating from UK medical schools

Prescription medicines are one of the most frequent interventions used by doctors to alleviate symptoms, treat illnesses, and prevent future disease. Because newly-graduated doctors write a large proportion of prescriptions in hospitals, it is important to assess their competence at prescribing medications before graduation. This is a complex skill to assess, however, due to the large number of prescribing scenarios that might be tested, the variety of documentation used, and the challenge of marking large numbers of prescriptions in a standardised way.

Simon Maxwell, MD, PhD of the University of Edinburgh and his colleagues from the British Pharmacological Society and Medical Schools Council sought to tackle these issues by creating a national assessment that would identify graduates who need more training and supervision in prescribing, and in the future might also highlight which training methods are most successful in developing competent practitioners.

Over a period of 5 years, the investigators developed the Prescribing Safety Assessment as a 2-hour online assessment of competence. With the development of an online delivery system and a unique approach to automated online marking of large numbers of prescriptions, the team was able to overcome the practical difficulties of assessing prescribing.

"Our paper demonstrates the feasibility of delivering a standard national prescribing assessment involving around 200 assessment events at academic centres around the UK each year and enabling tens of thousands of prescriptions to be instantaneously assessed against a standardised marking scheme," said Prof. Maxwell.

For the study, 7343 final-year medical students in 31 UK medical schools took the Prescribing Safety Assessment. The overall pass rate was 95 percent with the pass rates for the individual papers ranging from 93 to 97 percent. The Prescribing Safety Assessment was re-taken by 261 students who had failed, and 80 percent of those candidates passed. There was significant variation in performance between students from different medical schools.

"We believe that this is the first example of a large-scale nationally applied assessment of prescribing competence anywhere in the world," said Prof. Maxwell. "We have now participation by medical schools in Ireland and Malta, with growing interest about building on this assessment from educators in Australia, New Zealand, Canada and India. Also, in the UK, we are exploring whether the Prescribing Safety Assessment and its associated training modules might have utility as an assessment for more senior doctors and pharmacists."