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The effect of different levels of realism of context learning on the prescribing competencies of medical students during the clinical clerkship in internal medicine: an exploratory study

  • Pharmacoepidemiology and Prescription
  • Published:
European Journal of Clinical Pharmacology Aims and scope Submit manuscript

Abstract

Purpose

The aim of this study is to evaluate the effect of different levels of realism of context learning on the prescribing competencies of medical students during the clinical clerkship in internal medicine.

Methods

Between 2001 and 2007, 164 medical students took part in the prospective explorative study during their clinical clerkship in internal medicine at the VU University Medical Center, Amsterdam, The Netherlands. In a fixed order, each student had to formulate a treatment plan for a real patient in three situations of increasing realism: a minimal level (studying a patient record), medium level (preparing for a therapeutic consultation), and optimal level (preparing for and performing a therapeutic consultation with the patient).

Results

In comparison to studying a patient record (minimal context level), preparing a therapeutic consultation (medium context) improved four of the six steps of the WHO six-step plan. Preparing and performing a therapeutic consultation with a real patient (optimal context) further improved three essential prescribing competencies, namely checking for contraindications and interactions, prescription writing, and instructions to the patient.

Conclusion and recommendations

The results of this first explorative study suggest that enrichment of the learning context (responsibility for patient care) might be an important factor to improve the training of rational prescribing skills of medical students during their clinical clerkship in internal medicine. Clinical (pharmacology) teachers should be aware that seemingly small adaptations in the learning context of prescribing training during clinical clerkships (i.e., with or without involvement with and responsibility for patient care) may have relatively large impact on the development of prescribing competencies of our future doctors.

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Conflict of interest

The authors declare that they have no conflict of interest.

Author contributions

J. Tichelaar and C. van Kan contributed equally to this manuscript and are considered equal first authors and had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Dr. Richir and Professor Dr. De Vries are considered coequal senior authors. Tichelaar, Van Kan, Richir, and De Vries were responsible for the study concept and design; Tichelaar, Van Kan, and Schneider for the acquisition of data; Tichelaar, Van Kan, Van Unen, Van Agtmael, Richir, and De Vries for the analysis and interpretation of data; Tichelaar, Van Kan, Richir, Van Unen, Schneider, Van Agtmael, and De Vries for drafting the manuscript; Tichelaar, Van Kan, Richir, and De Vries for the statistical analysis; Tichelaar, Van Kan, Van Unen, and Schneider for the administrative, technical, or material support; Tichelaar, Richir, and De Vries for the study supervision. No grant or funding was obtained.

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Authors and Affiliations

  1. Department of Internal Medicine section Pharmacotherapy, VU University Medical Center, De Boelelaan 1118, PK1X74, 1081 HV, Amsterdam, The Netherlands

    Jelle Tichelaar, Coen van Kan, Robert J. van Unen, Anton J. Schneider, Michiel A. van Agtmael, Theo P. G. M. de Vries & Milan C. Richir

  2. RECIPE (Research and Expertise Center In Pharmacotherapy Education), VU University Medical Center, Amsterdam, The Netherlands

    Jelle Tichelaar, Michiel A. van Agtmael, Theo P. G. M. de Vries & Milan C. Richir

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  1. Jelle Tichelaar
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  2. Coen van Kan
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  6. Theo P. G. M. de Vries
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Correspondence to Jelle Tichelaar.

Additional information

Jelle Tichelaar and Coen van Kan contributed equally to this work.

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Tichelaar, J., van Kan, C., van Unen, R.J. et al. The effect of different levels of realism of context learning on the prescribing competencies of medical students during the clinical clerkship in internal medicine: an exploratory study. Eur J Clin Pharmacol 71, 237–242 (2015). https://doi.org/10.1007/s00228-014-1790-y

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  • DOI: https://doi.org/10.1007/s00228-014-1790-y

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