Incorporating prescription writing into a therapeutics examination

Dear Sir,

The Clinician Assessment for Practice Program has as a primary focus the determination of practice readiness of International Medical Graduates for direct entry, without additional residency training, into family practice. Along with an OSCE, candidates write a 3 hour, 50 item short answer therapeutics examination in which nearly all test items are based on a brief clinical scenario. The ability to write a prescription in a format consistent with accepted Canadian standards was considered as one important objective of the assessment.

To meet this objective several test items incorporated an actual prescription blank, printed in the examination booklet, as part of the item. Candidates are instructed to write the prescription for the drug indicated by the clinical scenario as they would to have it filled by a pharmacist. These items are scored for appropriate selection of drug, dose, route of administration, frequency, and duration. Marks are also awarded (usually 1/3 of the available total for the item) for completion of patient name, age, date, and physician signature. Marks are deducted for missing elements and for inappropriate or incorrect use of abbreviations and for illegibility. The guiding standard for scoring is whether the prescription, as written, could be efficiently and safely filled by a pharmacist. Clearly, the appropriate choice of medication, its dose, and administration are the critical elements; however, proper completion of the prescription form is also important.

Such test items have now been administered to 130 candidates. The first examination included only one prescription and the printed prescription blank lacked space for patient name, age, date, and signature. The subsequent two examinations each incorporated three prescriptions with a complete format. Candidates in the last two cohorts (N = 71) whose overall scores were below the mean for the entire examination tended to score lower on the prescription writing items than other candidates at or above the mean, but not invariably so. It did not appear that prescription writing scores had a clear predictive value of overall performance on the therapeutics examination. However, this does not detract from using this approach to assess an important competence of family practice.

Robert F. Maudsley, MD

Executive Director

Clinician Assessment for Practice Program

College of Physicians and Surgeons of Nova Scotia

Suite 200

1559 Brunswick St

Halifax, Nova Scotia, Canada, B3J 2G1

email: [email protected]

Admission to new medical schools

Dear Sir,

The paper on factors affecting applicant choice of medical school in the UK raised some interesting issues (Brown 2007), but the messages should be interpreted with caution. In particular, the comment that students ‘did not rate new medical schools highly’ does not appear to be based on a strong theme emerging from qualitative analysis, but rather based on perhaps only one or two of several quotes from a small number of participants about a wide range of issues relating to choice of one school over another. Readers should be aware that in any qualitative study, extrapolation beyond the views of the participants is difficult.

A number of additional factors likely to influence many prospective medical students did not arise in the interviews described in the paper. These include the establishment of new medical schools in areas with no previous provision (e.g. Devon & Cornwall, East Anglia) and the involvement of large numbers of applicants in peer-led online forums, such as newmediamedicine.com, medschoolsonline.co.uk and admissionsforum.net, where the frequency of individual students’ applying to a mixture of established and new schools is apparent. While other major factors identified in this study–the nature of the course, the type of location, the friendliness of staff, etc.–exert a major influence, the distinction between old and new schools might be less significant.

Indeed, there is little evidence that new medical schools in the UK are having difficulty filling admission quotas with high quality applicants. For example, the new medical school at Keele has admitted four cohorts, demand has risen a little each year, and the admissions office receives about 10 applicants for each place. Most of our students appear to be very happy with their choice of school.

While it is correct that new medical schools do not have a long track record of graduation of successful graduates, they may well offer other advantages: proximity to home; ‘fresher’ curricula; smaller, more student-friendly environment; broader clinical experience; and broader options for elective or selective experiences outside of the traditional biomedical sciences. Further, all new schools are under the supervision of the General Medical Councils Quality Assurance for Basic Medical Education (QABME) process, and should result in a degree that meets the same core professional requirements as are required of all medical schools. Still further, professional career development arguably depends more on what is done after medical school graduation than the name of the school.

The Australian experience of new medical schools has shown that new schools can not just survive, but thrive. What this paper demonstrates well is that medical students may make choices based on a complex mix of perception and reality, but that the friendliness of admissions processes can change those perceptions. There may be lessons in this for new medical schools.

Professor Richard Hays

Head of School

Gordon Dent

Director of Admissions,

Keele University

Keele ST5 5BG

Email: [email protected]