Arthur Chickering is Distinguished Professor of Higher Education at Memphis State University. On leave from the Directorship of the Center for the Study of Higher Education at Memphis State, he is Visiting Professor at George Mason University. Zelda Gamson is a sociologist who holds appointments at the John W. McCormack Institute of Public Affairs at the University of Massachusetts-Boston and in the Center for the Study of Higher and Postsecondary Education at the University of Michigan.

Seven Principles for Good Practice in Undergraduate Education: Faculty Inventory. Institutional Inventory.

Prescribing medicines is the primary intervention that most doctors offer to influence their patients’ health; however concerns have been expressed about the extent to which graduates are prepared by medical schools to assume prescribing responsibility. Both students and clinical teachers have identified a gap between workplace prescribing demands placed on newly qualified doctors and their preparation for this complex activity during undergraduate training. This study explored the exit-level prescribing performance of final-year students in the Graduate Entry Medical Programme at the University of the Witwatersrand compared with students’ perceptions of their prescribing competence. The results indicated a disparity between students’ competence and confidence. Examination marks showed that 83.6% of students were competent to prescribe according to the graduating standards of the University; however, questionnaire data revealed that 66% of students did not feel that their training had enabled them to prescribe rationally. This inconsistency was explored by analysis of the examination papers according to Bloom’s Revised and the SOLO Taxonomies. It was concluded that students score well on questions which test recall and application of knowledge, but some do not manage questions involving evaluation. Since prescribing is a complex skill that requires evaluative competence, this may explain why, despite high examination scores, students remain insecure. Exploration of the structure of knowledge through a Bernsteinian lens revealed that curricular components including problem-based learning and horizontal integration constrain epistemic access to the structure of rational prescribing knowledge for some students. It is recommended that rational prescribing skills should be taught as a synchronous strand within the curriculum, rather than in the current integrated mode. Learning could also be improved by innovative pedagogies associated with active learning and improved feedback.

https://wiredspace.wits.ac.za/bitstream/handle/10539/7601/Moch_MEd_Abstract.pdf?sequence=1

Developing rational prescribing competence in medical school : an investigation of the relation between student perceptions and examination performance.

A literature review to Examine the Validity and Reliability of group poster presentations as an assessment method of a module in an undergraduate nursing degree programme

The impact of therapeutics tutorials on the reasoning of fourth year medical students with regard to the prescribing process.

Medical students generally learn to calculate drug doses using paper problems containing numerical information. In contrast, once qualified, they have to extract the relevant information from treatment guidelines and use equipment, such as syringes, to dose patients. We compared students’ success in calculating drug doses using those different approaches. After receiving relevant training, 239 consenting first year students were randomised into four groups. Groups 1 and 2 had to calculate a dose, while groups 3 and 4 had to both calculate and then prepare a dose using a syringe and a labelled bottle of medicine. We gave groups 1 and 3 numerical dosage information. Groups 2 and 4 had to extract this information from guidelines. We compared success between groups using a chi-square test. Groups 1 and 3 outperformed groups 2 and 4. Availability of equipment seemed to be related to the improved success between groups 2 and 4, but this was not significant. Students who did not speak English at home were three times more likely to answer incorrectly than English-speaking students. Students who had equipment were more likely than students who did not have equipment to use appropriate units and propose realistic quantities. In light of these findings, we recommend that medical student training and assessment should include both extraction of embedded dosage information from guidelines and use of the equipment used in dosing.

Examining the role of contextual factors in dosage calculation

Irrational prescribing originates in undergraduate therapeutics education, where prescribing skills have been overlooked. P-drug, a rational prescribing approach, has been developed in response to poor prescribing. In 2004, the first cohort of PBL final year students at Nelson R. Mandela School of Medicine reported feeling unprepared to prescribe medicines and requested help. We aimed to assist students in improving their prescribing competence and confidence. Students were tested and asked to rate their confidence for some of their responses. A stratified sample of 10 of these students, were interviewed, where they prescribed treatment for 4 paper cases. A week-long intervention was designed, covering key areas of weakness and prescribing skills and employing several learning strategies. Students evaluated the course, rating how they felt key competences changed. Test results averaged 47 per cent. True/false questions were better answered (69 per cent) than short answer questions (21 per cent), the worst of these testing drug level interpretation (48 per cent) and dosage calculation (5 per cent) respectively. Students interviewed gave appropriate treatment for 4 of 40 cases and important patient information in only 1 case. Eight students gave an appropriate text for further information. The student evaluation showed an improvement for all prescribing abilities. South African Journal of Higher Education Vol. 20 (3) 2006: 426-441

Building successful therapeutics into a problem-based medical curriculum in Africa

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Building successful therapeutics into a problem-based medical curriculum in Africa