The question you raise is an interesting one. Is it possible to evaluate
whether training on rational prescribing has any effect on actual
prescribing. Despite the excellent work done in evaluating the WHO/Groningen
Guide to Good Prescribing I remain very sceptical that training in
undergraduate academic settings has any benefit though I would like to be
proved wrong. I believe that young medical students or student nurses learn
and know a great deal of relevant therapeutics. However, when they qualify
and become interns/residents or are posted out of their training hospital to
a health center they have to learn how to prescribe quickly. To do this they
identify a safe prescriber, a role model and copy that person's prescribing
So how could you prove me wrong in my assertion? While your idea of using
pooled data is attractive I suspect it would be difficult to do and might
not cleary distinguish. I would suggest that when young prescribers who have
had rational prescribing training are first placed in a prescribing choice
situation they should be compared with colleagues who have not received the
training in how closely they follow agreed Standard Treatment Guidelines.
You could choose a few conditions with clear agreement on optimum therapy
where guidelines are often neglected such as surgical antibiotic
prophylaxis, treatment of diarrhea or ARI or other such conditions. It would
be difficult to do but would be worth doing.
I would not want to stop the undergraduate rational prescribing training
though I am sceptical, as it may have a benefit and may sensitize students
for later training. My priority would be to focus on the residency
internship experience to ensure that rational prescribing is promoted there.
I would advocate identifying the opinion leaders, the role models (who may
not be the consultants) and study their prescribing. Where their are
deficiencies these should be aggressively addressed and where there is good
practice this should be reinforced. Such a study could be done be randomly
allocating wards or "firms" to different intervention groups and then
monitoring prescribing practices.
So I wonder if any E-Druggers have evidence that undergraduate prescribing
training improves prescribing practices of graduates later in their carriers?
I await comments!
Richard Laing Tel (617) 353-6630
Department of International Health Fax (617) 353-6330
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