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      Development and validation of an instrument to assess the prescribing readiness of medical students in Malaysia

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          Abstract

          Background

          Prescribing incompetence is an important factor that contributes to prescribing error, and this is often due to inadequate training during medical schools. We therefore aimed to develop and validate an instrument to assess the prescribing readiness of medical students (PROMS) in Malaysia.

          Methods

          The PROMS comprised of 26 items with four domains: undergraduate learning opportunities; hands-on clinical skills practice; information gathering behaviour; and factors affecting the learning of prescribing skills. The first three domains were adapted from an existing questionnaire, while items from the last domain were formulated based on findings from a nominal group discussion. Face and content validity was determined by an expert panel, pilot tested in a class of final year (Year 5) medical students, and assessed using the Flesch reading ease. To assess the reliability of the PROMS, the internal consistency and test-retest (at baseline and 2 weeks later) were assessed using the Wilcoxon Signed Ranks test and Spearman’s rho. The discriminative validity of the PROMS was assessed using the Mann–Whitney U-test (to assess if the PROMS could discriminate between final year medical students from a public and a private university).

          Results

          A total of 119 medical students were recruited. Flesch reading ease was 46.9, indicating that the instrument was suitable for use in participants undergoing tertiary education. The overall Cronbach alpha value of the PROMS was 0.695, which was satisfactory. Test-retest showed no difference for 25/26 items, indicating that our instrument was reliable. Responses from the public and private university final year medical students were significantly different in 10/26 items, indicating that the PROMS was able to discriminate between these two groups. Medical students from the private university reported fewer learning opportunities and hands-on practice compared to those from the public university. On the other hand, medical students from the private university reported more frequent use of both web based and non-web-based resources compared to their public university counterparts.

          Conclusions

          The PROMS instrument was found to be a reliable and valid tool for assessing medical students’ readiness to prescribe in Malaysia. It may also inform on the adequacy of medical programmes in training prescribing skills.

          Electronic supplementary material

          The online version of this article (doi:10.1186/s12909-015-0433-z) contains supplementary material, which is available to authorized users.

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          Most cited references33

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          Coefficient alpha and the internal structure of tests

          Psychometrika, 16(3), 297-334
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            Chi-Square Tests for Goodness of Fit and Contingency Tables

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              Prescribing errors in hospital inpatients: their incidence and clinical significance.

              It has been estimated that 1-2% of US inpatients are harmed by medication errors, the majority of which are errors in prescribing. The UK Department of Health has recommended that serious errors in the use of prescribed drugs should be reduced by 40% by 2005; however, little is known about the current incidence of prescribing errors in the UK. This pilot study sought to investigate their incidence in one UK hospital. Pharmacists prospectively recorded details of all prescribing errors identified in non-obstetric inpatients during a 4 week period. The number of medication orders written was estimated from a 1 in 5 sample of inpatients. Potential clinical significance was assessed by a pharmacist and a clinical pharmacologist. About 36200 medication orders were written during the study period, and a prescribing error was identified in 1.5% (95% confidence interval (CI) 1.4 to 1.6). A potentially serious error occurred in 0.4% (95% CI 0.3 to 0.5). Most of the errors (54%) were associated with choice of dose. Error rates were significantly different for different stages of patient stay (p<0.0001) with a higher error rate for medication orders written during the inpatient stay than for those written on admission or discharge. While the majority of all errors (61%) originated in medication order writing, most serious errors (58%) originated in the prescribing decision. There were about 135 prescribing errors identified each week, of which 34 were potentially serious. Knowing where and when errors are most likely to occur will be helpful in designing initiatives to reduce them. The methods developed could be used to evaluate such initiatives.
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                Author and article information

                Contributors
                plai@ummc.edu.my
                debrasim@um.edu.my
                chuass@um.edu.my
                tchook@ummc.edu.my
                ngcj@um.edu.my
                achik1fi@cmich.edu
                cheonglieng_teng@imu.edu.my
                Journal
                BMC Med Educ
                BMC Med Educ
                BMC Medical Education
                BioMed Central (London )
                1472-6920
                21 September 2015
                21 September 2015
                2015
                : 15
                : 153
                Affiliations
                [ ]Department of Primary Care Medicine, University of Malaya Primary Care Research Group (UMPCRG), Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
                [ ]Department of Pharmacology, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
                [ ]Department of Pharmacy, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
                [ ]Division of Clinical Science, School of Medicine and Allied Health Sciences, International Medical University, 57000 Kuala Lumpur, Malaysia
                [ ]Central Michigan University College of Medicine, Mount Pleasant, MI 48859 USA
                Article
                433
                10.1186/s12909-015-0433-z
                4578793
                bcf6c11d-bf6b-4827-90da-220522954f42
                © Lai et al. 2015

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 12 January 2015
                : 4 September 2015
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                Research Article
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                © The Author(s) 2015

                Education
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