OBJECTIVES: This study analysed the errors made by 16 final-year medical students in a classroom prescribing exercise. The aim was to gain greater understanding of the reasons for non-optimal prescribing and of how to improve basic training in pharmacotherapeutics. METHODS: The task was to adjust a patient's phenytoin sodium dosage to achieve better control of seizures. It was based on a real-life case, and was presented as a written exercise. Process-tracing and think-aloud techniques were used to study the students' performance. RESULTS: The results suggest that the root cause of the errors was lack of a knowledge base which integrated scientific knowledge with clinical know-how. Three different clinical reasoning strategies were observed. Students who followed an incremental strategy demonstrated superior scientific knowledge and this resulted in less hazardous errors. Those who followed gambling or backward-reasoning strategies appeared to possess inferior scientific knowledge and this resulted in more hazardous errors. CONCLUSIONS: The results support current trends towards integrating basic medical science into a foundation of clinical know-how, as in the problem-based curriculum. They also emphasize the importance of a thorough grounding in medical science as a means of minimizing error.
OBJECTIVES: This study analysed the errors made by 16 final-year medical students in a classroom prescribing exercise. The aim was to gain greater understanding of the reasons for non-optimal prescribing and of how to improve basic training in pharmacotherapeutics. METHODS: The task was to adjust a patient's phenytoin sodium dosage to achieve better control of seizures. It was based on a real-life case, and was presented as a written exercise. Process-tracing and think-aloud techniques were used to study the students' performance. RESULTS: The results suggest that the root cause of the errors was lack of a knowledge base which integrated scientific knowledge with clinical know-how. Three different clinical reasoning strategies were observed. Students who followed an incremental strategy demonstrated superior scientific knowledge and this resulted in less hazardous errors. Those who followed gambling or backward-reasoning strategies appeared to possess inferior scientific knowledge and this resulted in more hazardous errors. CONCLUSIONS: The results support current trends towards integrating basic medical science into a foundation of clinical know-how, as in the problem-based curriculum. They also emphasize the importance of a thorough grounding in medical science as a means of minimizing error.
Authors: Carolina J P W Keijsers; Larissa van Hensbergen; Lotte Jacobs; Jacobus R B J Brouwers; Dick J de Wildt; Olle Th J ten Cate; Paul A F Jansen Journal: Br J Clin Pharmacol Date: 2012-11 Impact factor: 4.335
Authors: N Celebi; K Kirchhoff; M Lammerding-Köppel; R Riessen; Peter Weyrich Journal: Naunyn Schmiedebergs Arch Pharmacol Date: 2010-06-10 Impact factor: 3.000
Authors: Patrik Aronsson; Shirley Booth; Staffan Hägg; Karin Kjellgren; Ann Zetterqvist; Gunnar Tobin; Margareta Reis Journal: BMC Med Educ Date: 2015-12-29 Impact factor: 2.463