Amul&disciplinaryreviewoftheteachingandassessmentof...
Transcript of Amul&disciplinaryreviewoftheteachingandassessmentof...
A mul&disciplinary review of the teaching and assessment of prescribing: how do professions perform?
Lynda Cardiff1, Lisa M Nissen1, Paul BenneD2, Lloyd Reed2, Vivienne TippeD3, Peter Horrocks3, Andrew Carkeet4, Vincent Chan5, Sonya Osborne6, David Lim3
1-‐School of Clinical Sciences QUT, 2-‐Podiatry Discipline QUT, 3-‐Paramedic Science Discipline QUT, 4-‐Optometry Discipline QUT, 5-‐Pharmacy Discipline QUT, 6-‐School of Nursing QUT
Introduc&on Prescribing is a complex task, requiring specific knowledge and skills, combined with effec;ve, context-‐specific clinical reasoning. Errors associated with prescribing result in significant morbidity and mortality. Systema;c reviews indicate medical prescribing errors range from 7% to 10.3% of medica;on orders1. For both established and emerging professions with prescribing rights, there is a clear need to ensure graduates have well defined prescribing skills, to enable competent prescribing. Essen;al to this outcome is the applica;on of comprehensive, evidence-‐based assessment methods that effec;vely assess these skills. 1. Dornan T et al., An in depth inves5ga5on into causes of prescribing errors by founda5on trainees in rela5on to their medical educa5on. EQUIP study.
Prescribing is comprehensively taught and assessed across the five non-‐medical professions studied. Iden;fied gaps in the curriculum serve as a prompt for improvement in this area. Gaps exist in understanding what cons;tutes op;mal assessment of a diverse health workforce in rela;on to prescribing medicine. Currently, there is no single validated and reliable method for assessing all elements of prescribing performance. This project highlights difficul;es in the prescribing assessment process, par;cularly in the work integrated learning environment. In the interests of pa;ent safety, there remains a compelling need to develop comprehensive methods to assess the prescribing competence of students across disciplines in both the university and work integrated learning environments.
The NPS Prescribing Competencies Framework (PCF)2 was used as the accepted standard for prescribing skills, knowledge and behaviours. Review of the curriculum for five non-‐medical prescribing professions was undertaken to iden;fy whether the prescribing elements as ar;culated in the PCF were taught and assessed. 2. NPS: BeGer Choices BeGer Health, Competencies required to prescribe medicines: puKng quality use of medicines into prac5ce. 2012, Na5onal Prescribing Service Limited: Sydney.
Method
For each profession: § The context in which prescribing occurs was
reviewed § A detailed mapping of the curriculum was
undertaken to iden;fy where and how prescribing skills and knowledge are currently taught
§ The methods used to teach and assess prescribing skills and knowledge were iden;fied
§ Areas for improvement in the teaching and/or assessment of prescribing were iden;fied
Conclusion
Results
Clinical Lecture Tutorial Case Study SDR
Podiatry
Paramedicine
Pharmacy
Optometry
Nurse Practitioner
Most Frequent Methods Employed to Teach Prescribing
SDR = Self directed reading/research
Most frequent Methods Employed to Assess Prescribing
Clinical Appraisal
Case Study OSCE Written Exam
Oral Exam Written Reflection
Podiatry
Paramedicine
Pharmacy
Optometry
Nurse Practitioner
Challenges § Applying context to prescribing across
professions (acute care paramedic vs pharmacist vs podiatric surgeon)
§ Iden&fica&on of ffec&ve and robust assessment of prescribing in the work integrated learning environment which is suscep&ble to many uncontrollable factors (e.g. skills and knowledge of supervisor)
§ Determina;on of whether high level assessment translates to safe and effec;ve prescribing in prac;ce
Discipline)Mapping:))Bachelor)of)Pharmacy)Element)H2.5)Collaborates)with)other)health)professionals)to)achieve)optimal)health)outcomes)for)the)person)
Performance)Criteria) Teaching) Teaching)Method/s)
Assessment) Assessment)Method/s)
H2.5.1&Engages&in&open,&interactive&discussions&with&other&health&professionals&involved&in&caring&for&the&person&
CSB430)Pharmacy)Practice)1&Available&written&literature®arding&commonly&employed&medicines&and&strategies;&specific&counselling&points&for&medicines&and&non@medicine&therapies.)
L.GW& CSB430)Pharmacy)Practice)1&Oral&examination.)
OE&
CSB440)Pharmacy)Practice)2&Understanding&of&the&pharmacology,&indications,&potential&contraindications,&precautions&and&specific&counselling&points&for&commonly&used&medicines&for&cardiovascular,&respiratory,&thyroid&diseases;&eczema;&contraception.&&Provision&of&appropriate&written&and&verbal&advice.)
L.GW.CLP& CSB440)Pharmacy)Practice)2&Oral&examinations;&case&presentations&completed&during&placement;&preceptor&assessment&of&counselling&skills&during&placement.)
OE.CP.CPA&
CSB450)Pharmacy)Practice)3&Specific&counselling&and&questioning&requirements&for&medicines&used&for&severe&pain,&anxiety,&dementia,&Parkinson’s&disease,&depression,&diabetes,&epilepsy,&sleep&disorders,&glaucoma,&migraine.&&Understanding&of&addiction&and&its&management.)
L.GW.CLP& CSB450)Pharmacy)Practice)3&Oral&examinations;&case&presentations&completed&during&placement;&preceptor&assessment&of&counselling&skills&during&placement.)
OE.CP.CPA&
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