Do we become better prescribers after graduation: A 1-year international follow-up study among junior doctors

Erik M. Donker*, David J. Brinkman, the Education committee of the Dutch Society for Clinical Pharmacology and Biopharmacy, Floor van Rosse, Ben Janssen, Wilma Knol, Glenn Dumont, Philippe G. Jorens, Alain Dupont, Thierry Christiaens, Jeroen van Smeden, Itte de Waard-Siebinga, Laura E.J. Peeters, Ronald Goorden, Marleen Hessel, Birgit Lissenberg-Witte, Milan Richir, Michiel A. van Agtmael, Cornelis Kramers, Jelle Tichelaar

*Corresponding author for this work

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Aim: The aim of this study was to investigate how the prescribing knowledge and skills of junior doctors in the Netherlands and Belgium develop in the year after graduation. We also analysed differences in knowledge and skills between surgical and nonsurgical junior doctors. Methods: This international, multicentre (n = 11), longitudinal study analysed the learning curves of junior doctors working in various specialties via three validated assessments at about the time of graduation, and 6 months and 1 year after graduation. Each assessment contained 35 multiple choice questions (MCQs) on medication safety (passing grade ≥85%) and three clinical scenarios. Results: In total, 556 junior doctors participated, 326 (58.6%) of whom completed the MCQs and 325 (58.5%) the clinical case scenarios of all three assessments. Mean prescribing knowledge was stable in the year after graduation, with 69% (SD 13) correctly answering questions at assessment 1 and 71% (SD 14) at assessment 3, whereas prescribing skills decreased: 63% of treatment plans were considered adequate at assessment 1 but only 40% at assessment 3 (P <.001). While nonsurgical doctors had similar learning curves for knowledge and skills as surgical doctors (P =.53 and P =.56 respectively), their overall level was higher at all three assessments (all P <.05). Conclusion: These results show that junior doctors' prescribing knowledge and skills did not improve while they were working in clinical practice. Moreover, their level was under the predefined passing grade. As this might adversely affect patient safety, educational interventions should be introduced to improve the prescribing competence of junior doctors.

Original languageEnglish
Pages (from-to)5218-5226
Number of pages9
JournalBritish Journal of Clinical Pharmacology
Issue number12
Early online date18 Jun 2022
Publication statusPublished - Dec 2022

Bibliographical note

Funding Information:
This study was funded by ZonMw, The Netherlands Organization for Health Research and Development, project number: 83600095004.

Publisher Copyright:
© 2022 The Authors. British Journal of Clinical Pharmacology published by John Wiley & Sons Ltd on behalf of British Pharmacological Society.


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