The impact of a preprescribing formative assessment on learning in final-year medical students using hospital inpatient electronic prescribing systems.

Aims: Graduating medical students consistently report being unprepared for the complexity of prescribing in clinical practice. Current clinical prescribing teaching and authentic assessment are limited due to patient safety concerns. We aimed to examine the educational utility of supervised preprescribing as a learning process and potential authentic workplace-based assessment.

Methods: Student preprescriptions and student-authorized prescriptions were extracted from electronic prescribing and administration system data. Patient clinical records were reviewed to identify outcomes of student-authorized prescriptions. All prescription data were analysed with descriptive statistics. Current students, recent graduates (post-graduate year 1 doctors) and supervisors were interviewed to explore of educational impact of supervised preprescribing by inductive reflexive thematic analysis.

Results: The live electronic prescribing and administration system was used by 355/370 students over 4 academic years (23 November 2020-19 November 2024). They created 25 324 preprescriptions in 3268 patients. Supervising doctors promoted/authorized 58% (14 684/25324) to live prescriptions. Of 296 student-authorized prescriptions, 33% (97/296) were administered to patients, and only 3% (8/296) were not potentially appropriate. No adverse drug reactions to these 8 prescriptions were documented. The preprescribing model was found to benefit student learning, confidence and identity through 5 themes: Practice, practice, practice, Prescribing with support, Conquering time, Safety protected and Becoming a real medical doctor.

Discussion: Supervised preprescribing within clinical settings is feasible and improves student prescribing confidence. Human and system mechanisms managed patient safety concerns and facilitated safe, authentic student preprescribing. This supports inclusion of formative assessment, in the form of supervised preprescribing as authentic workplace-based learning of prescribing.