The pen is mightier than the sword. Reinstating patient care as the object of prescribing education

H. Gillespie, E. McCrystal, H. Reid, R. Conn, N. Kennedy, T. Dornan*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

6 Citations (Web of Science)


Prescribing (writing medication orders) is one of residents' commonest tasks. Superficially, all they have to do is complete a form. Below this apparent simplicity, though, lies the complex task of framing patients' needs and navigating relationships with them and other clinicians. Mistakes, which compromise patient safety, commonly result. There is no evidence that competence-based education is preventing harm. We found a profound contradiction between medical students becoming competent, as defined by passing competence assessments, and becoming capable of safely caring for patients. We reinstated patients as the object of learning by allowing students to 'pre-prescribe' (complete, but not authorise prescriptions). This turned a disabling tension into a driver of curriculum improvement. Students 'knotworked' within interprofessional teams to the benefit of patients as well as themselves. Refocusing undergraduate medical education on patient care showed promise as a way of improving patient safety.
Original languageEnglish
Pages (from-to)50-57
Number of pages8
JournalMedical Teacher
Issue number1
Publication statusPublished - 2 Jan 2021


  • activity theory
  • preparation for practice
  • prescribing education
  • workplace learning
  • Activity theory

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