TY - JOUR
T1 - Pre-prescribing
T2 - Creating a zone of proximal development where medical students can safely fail
AU - Gillespie, Hannah
AU - Reid, Helen
AU - Conn, Richard
AU - Dornan, Tim
N1 - Funding Information:
We thank Drs Samantha Smith and Effie Dearden, and Professor Helen Cameron of the University of Edinburgh for introducing us to pre-prescribing and Dr Ruth Kinston and Professor Andy Hassell for inspiring us to adopt it and supporting our implementation of it. This work would not have been possible without the active support of clinical and academic leaders, who are too numerous to name individually, but gave unstinting support to the process of change.
Publisher Copyright:
© 2022 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.
PY - 2022/12/2
Y1 - 2022/12/2
N2 - PURPOSE: Prescribing is a common task, often performed by junior clinicians, with potential for significant harm. Despite this, it is common for medical students to qualify having only prescribed in simulated scenarios or assessments. We implemented an alternative: students were given pens with purple ink, which permitted them to write prescriptions for real patients. We set out to understand how this intervention, pre-prescribing, created a zone of proximal development (ZPD) for learners.METHODS: An anonymous, mixed methods, evaluation questionnaire was distributed to all final-year medical students at one university in the United Kingdom. Analysis was guided by Experience Based Learning theory.RESULTS: Two hundred and eighteen students made 386 free-text comments. Most participants reported that pre- helped them become capable doctors (Strongly Agree n = 96, 45%; Agree: n = 110, 50%). Pre-prescribing created a ZPD in which participants could use the tools of practice in authentic contexts under conditions that made it safe to fail.CONCLUSIONS: This research shows how a theoretically informed intervention can create conditions to enhance learning. It encourages educators to identify aspects of routine practice that could be delegated, or co-performed, by learners. With appropriate support, educators can create 'safe-fails' which allow learners to participate safely in authentic, risky, and indeterminate situations they will be expected to navigate as newly qualified clinicians.
AB - PURPOSE: Prescribing is a common task, often performed by junior clinicians, with potential for significant harm. Despite this, it is common for medical students to qualify having only prescribed in simulated scenarios or assessments. We implemented an alternative: students were given pens with purple ink, which permitted them to write prescriptions for real patients. We set out to understand how this intervention, pre-prescribing, created a zone of proximal development (ZPD) for learners.METHODS: An anonymous, mixed methods, evaluation questionnaire was distributed to all final-year medical students at one university in the United Kingdom. Analysis was guided by Experience Based Learning theory.RESULTS: Two hundred and eighteen students made 386 free-text comments. Most participants reported that pre- helped them become capable doctors (Strongly Agree n = 96, 45%; Agree: n = 110, 50%). Pre-prescribing created a ZPD in which participants could use the tools of practice in authentic contexts under conditions that made it safe to fail.CONCLUSIONS: This research shows how a theoretically informed intervention can create conditions to enhance learning. It encourages educators to identify aspects of routine practice that could be delegated, or co-performed, by learners. With appropriate support, educators can create 'safe-fails' which allow learners to participate safely in authentic, risky, and indeterminate situations they will be expected to navigate as newly qualified clinicians.
KW - Prescribing education
KW - assistantship
KW - preparation for practice
KW - workplace learning
U2 - 10.1080/0142159X.2022.2098100
DO - 10.1080/0142159X.2022.2098100
M3 - Article
C2 - 35820063
SN - 0142-159X
VL - 44
SP - 1385
EP - 1391
JO - Medical Teacher
JF - Medical Teacher
IS - 12
ER -