A service evaluation of an ‘edutainment’ safe prescribing programme to support year 5 student doctors in preparation for foundation year prescribing practice

Abstract Introduction Doctors report lack of preparedness for prescribing,1 with prescribing errors prevalent amongst Foundation doctors. Simulation based training (SBT) is widely used to support skill development with potential to support prescribing education.2 To support preparation for prescribing practice, a SBT programme was developed for Year 5 student doctors. Aim To determine the impact of SBT on prescribing confidence, knowledge, and student perceptions of SBT in supporting prescribing practice. Methods A SBT event was designed with five simulation exercises reflecting common clinical scenarios, challenging non-technical skills, clinical reasoning and justification of relevant investigations (e.g. ECG due to chest pain presentation). All students participated in tabletop exercises, with one student leading the high-fidelity SBT whilst others observed via live stream. A debrief, facilitated by a Safe Prescribing pharmacist discussed the case, including justification of diagnosis and treatment plans. Within the tabletop SBT, to ‘game-ify’ learning (based on the TV show ‘The Traitors’), two ‘Disruptors’ were selected and briefed in advance to provide common error provoking situations, including incorrect information handover, incorrect prescriptions and plausible differential diagnosis. This was a key feature to determine if the remainder of the group would challenge this and further justify their own clinical reasoning. Students worked in teams, presenting diagnosis and treatment plans to their colleagues and Safe Prescribing pharmacists. During the debrief, students were informed of the ‘Disruptors’ and challenged to identify them. A 27-item post-session survey was provided, including demographic questions and prescribing confidence agreement statements using a five-point Likert scale (5-strongly agreed to 1-strongly disagreed), with additional open-ended questions to evaluate how the event will influence future prescribing practice. The qualitative data were thematically analysed to determine preparedness for prescribing post-session. Results Eleven students attended and undertook all activities within the SBT event and invited to participate in the evaluation. Nine students completed the post-session evaluation (81.8%). Median post-session prescribing confidence scores were 5 (IQR 4–5) for ability to write inpatient prescriptions, formulate management plans, access appropriate guidelines and justify appropriate investigations. All students strongly agreed/agreed the event was useful, interactive, practical, relevant and prepared them for Foundation prescribing. All agreed that teaching had supported decision making and pharmacists were appropriate teachers for prescribing practice. Students described the SBT as tiring but realistic, with increased awareness of common prescribing errors and that they desire more SBT. The group presentation, ‘Disruptor’ identification and pharmacist-led debrief were highly valued. Conclusion A contextualised SBT provides a realistic, safe environment to support prescribing education and is an interactive and useful method to prepare for Foundation year. Utilising the ‘disruptor’ design appears to be a novel and engaging approach to learning. It is highly valued and positively reviewed by students for the interactive and enjoyable learning modality. Whilst this modality can improve student confidence and ability, the impact on preparedness for practice is unknown and therefore further work is required to explore this educational modality on prescribing quality. The small sample size was a study limitation, but this was reflective of the small final year cohort.