The Challenge
Prescribing is a fundamental part of the work of Foundation year one doctors, who write and review many prescriptions each day. It is a complex task requiring knowledge of medicines and the diseases they are used to treat, careful judgement of risks and benefits of treatment, and attention to detail. As well as offering the potential for improving health, it is an activity associated with potential hazards: a recent GMC-sponsored study found that 9% of hospital prescriptions contain errors ('An in depth investigation into causes of prescribing errors by foundation trainees in relation to their medical education - EQUIP study'). It is also apparent in other research that this is the area of the Foundation Doctor role that new graduates find the most challenging ('How prepared are medical graduates to begin practice?'). As a result, in Tomorrow’s Doctors (2009), the GMC defined prescribing competencies required of new medical school graduates.

Our Proposal
The aim is not to place any additional hurdles in front of UK medical students; rather it is to provide a reliable and validated assessment that will serve to ensure that the core prescribing competencies outlined in Tomorrow’s Doctors (2009) are achieved by all graduates.

The proposed assessment is pass/fail, and medical students will be required to pass the assessment prior to graduation. The ultimate goal is to create an online assessment, lasting around one hour, to be undertaken by final year medical students at a time to be decided by their medical school. This flexible timing will allow students who fail the assessment to undertake further training and retake the assessment prior to graduation.

How is the Assessment Being Developed?
The development of the Prescribing Skills Assessment is being driven by a cross sector Steering Group. The Steering Group has developed and piloted a paper based assessment in 11 medical schools involving over 1300 medical students.  Every student was given the opportunity to feedback on their experience. The overwhelming majority felt that the pilot assessment was an appropriate test of the prescribing skills expected of a final year medical student and supported the fact that the British National Formulary was available throughout the process. Moreover, many commented that they appreciated the focus that such an assessment would place on preparation for prescribing.

All stakeholders, including medical students, will be involved in the development of the assessment and the associated policies and processes. Piloting will continue over the coming year and decisions around implementation will be based on consensus and evidence.