Home Analysis of self-reported confidence in independent prescribing among osteopathic medical graduating seniors
Article Open Access

Analysis of self-reported confidence in independent prescribing among osteopathic medical graduating seniors

  • Khalil Eldeeb EMAIL logo
Published/Copyright: August 23, 2024
Download Article (PDF)
Journal of Osteopathic Medicine
From the journal Journal of Osteopathic Medicine Volume 125 Issue 2

Abstract

Context

Prescribing medications is one of the physicians’ most important professional activities throughout their careers. Lack of confidence and competency to prescribe may lead to preventable medical errors. The prevalence of prescription errors among new graduate physicians has been widely studied. Studies have linked this to inadequate foundational pharmacology education and work environment, among other factors. Suggestions were made for different educational interventions to increase the physicians’ confidence and competency in prescribing to reduce the risk of medical errors. However, many of these studies were about students or graduates of medical schools other than osteopathic medical schools.

Objectives

This study analyzed the self-reported confidence of graduating seniors in the United States osteopathic medical schools in their current ability to prescribe safely and independently and the possible associated factors.

Methods

This study analyzed secondary data on the graduating seniors’ surveys published by the American Association of Colleges of Osteopathic Medicine (AACOM) from the 2012/2013 to 2020/2021 academic years. Data were analyzed utilizing SPSS version 26.0 and MedCalc version 22.009, and statistical inferences were considered significant whenever p≤0.05.

Results

The aggregated data show that 38,712 Doctor of Osteopathic Medicine (DO) seniors responded to the AACOM survey, representing 72.1 % of expected graduates during the study period. Most of the DO graduating seniors (70.8 %) reported feeling confident in their current abilities to independently write safe and indicated orders and to prescribe therapies or interventions in various settings. The percentage of respondents who perceived the time devoted to clinical pharmacology instruction as appropriate increased systematically over these reported years. A positive correlation was found between the percentage of students who reported the time dedicated to clinical pharmacology as excessive and the percentage of students who reported being confident in prescribing. A statistically significant positive correlation was found between the percentage of students who agreed that the first two years of medical school were well organized and the percentage of students who reported being confident in prescribing. A statistically significant correlation was found between the percentage of students who agreed with statements about frequent interactions with the attendee, testing at the end of each rotation, and being prepared for Comprehensive Osteopathic Medical Licensing Examination Level 2-Cognitive Evaluation (COMLEX Level 2-CE) during the required clerkships and the percentage of students who reported being confident in independent prescribing.

Conclusions

During this study period, most osteopathic medical graduating seniors (70.8 %) felt confident about their current prescribing abilities; the rest did not, which can increase the risk of preventable medical errors. The prescription confidence may be boosted by more organization for the first 2 years, increasing the time devoted to clinical pharmacology education, and developing more interactive courses during the required clerkships in clinical education.

Keywords: confidence; osteopathic; pharmacology education; prescribing

Prescribing medicines is one of most physicians’ most critical daily acts. However, it remains one of the tasks for which newly graduated physicians consistently feel less confident and underprepared [1], 2]. An efficient and safe medication prescription requires diagnostic skills, adequate pharmacological knowledge, and efficient interactions among the healthcare team members and patients [3].

With millions of drugs prescribed yearly, poor prescribing may impact patient safety and healthcare costs, and lead to significant public health problems such as antibiotic resistance [4]. Prescribing errors are a global issue among new physicians, and it was reported in studies from Europe [5], 6], Asia [7], 8], Australia [9], America [10], [11], [12], and Africa [13], 14]. In a review of 115,933 prescriptions written for patients who were discharged from the adult Emergency Department (ED) at an academic medical center [10], a total of 20,498 errors (16.5 %) were identified within 19,126 prescriptions, with the highest percentage of errors made by non-EM first-or second-year residents (30.6 %; n=6,278), followed by EM residents (27 %; n=5,535). In a study by Kalfsvel et al. [15] that involved an analysis of 1,502 prescriptions written by final-year medical students (n=381), 40 % of these prescriptions contained at least one error, and more than half of these errors (54 %) were inadequate information type.

While the underlying causes of poor prescribing may be related to the working environment and extensive workload, educational factors such as poor instruction in pharmacology and lack of self-confidence to prescribe have been proposed [5], 16]. Pharmacology curriculum varies in length, content, instructional methods, and assessment, even within similar health-related programs [17]. Studies about medical school students and newly graduated doctors’ preparations and self-perceived confidence to prescribe show varied results. In a study of the views of 2,413 medical students in the United Kingdom and recent graduates in 2006–2008 from 25 medical schools in the United Kingdom, only 38 % of respondents felt ‘confident’ about prescription writing [18]. In their study of prescribing skills among European final-year medical students (n=895), Brinkman et al. [5] reported that less than 50 % of the participants felt confident in their prescribing skills, according to the World Health Organization (WHO) 6-step method.

Medical education in the United States has two major paths: traditional allopathic schools, which grant MD degrees; and osteopathic medical schools, which grant Doctor of Osteopathic Medicine (DO) degrees and educate nearly 25 % of all US medical students [19]. Studies about the confidence to prescribe and prescription error included only MD students or graduates [1], 10], 16], 18], 20]. Studies examining the confidence of DO students/graduates to prescribe independently and the factors that may be associated with, it if at all available, are limited in the literature. Hence, this study was designed to gain insight into the self-reported level of confidence in independent prescribing of the final-year DO medical students, its relation to their self-reported evaluation of pharmacology education, the first two years of medical education, and clinical medical education during the required clerkships.

Methods

The American Association of Colleges of Osteopathic Medicine (AACOM) annually surveys the graduating seniors the nations’ colleges of osteopathic medicine (COMs). The survey queries graduating seniors on several topics and develops a comprehensive snapshot of the students’ self-reported education experiences and satisfaction with their medical education, among other areas of AACOM interest. This study reviewed and analyzed the secondary database of the graduating seniors’ survey published on the AACOM website (https://www.aacom.org) for graduating DO classes from the 2012–2013 to 2020–2021 academic years [21]. Data were presented as averages for the percentage of each factor over the study period. Correlations between the averages were assessed utilizing SPSS (version 26.0 for Windows, IBM Corporation, Armonk, NY). Pearson Correlation Sig. (2-tailed) was performed, and all statistical inferences were considered significant for the analysis whenever p≤0.05. Comparisons of proportions were calculated utilizing the MedCalc statistical software (version 22.009, MedCalc Software Ltd, Ostend, Belgium).

Results

Surveys participation

Between the 2012–2013 and 2020–2021 academic years, a total of 38,712 DO seniors responded to the AACOM graduating seniors’ surveys, representing an average of 72.4 % of the expected DO graduates during this period. The number of respondents gradually increased annually from the 2012–2013 to 2018–2019 academic years, with the highest number of respondents being 4,983 (response rate=75 %) during the 2018–2019 academic year. The respondent number then significantly decreased to 4,084, a 59 % response rate (X2 (1)=263.131, p<0.0001, 95 % CI [14.1–17.9 %]) in 2019–2020, before it rose again to 4,673 (63 % response rate) during the 2020–2021 academic year (Figure 1).

Figure 1: The numbers of DO seniors who responded to the AACOM graduating seniors’ surveys and the percentage of graduating seniors who reported being confident in their current ability to prescribe independently. (A) The respondents’ number gradually increased annually from the 2012–2013 to 2018–2019 academic years, with the highest number in the 2018–2019 academic year before it decreased in the 2019–2020 and 2020–2021 academic years. (B) The graduating seniors’ perception of how confident they are in prescribing utilizing a scale of 5, in which 5 is very confident and 1 is not confident at all. The data represent the percentage of students on levels 4 and 5. The average level of confidence over the years is 70.8 %.
Figure 1:

The numbers of DO seniors who responded to the AACOM graduating seniors’ surveys and the percentage of graduating seniors who reported being confident in their current ability to prescribe independently. (A) The respondents’ number gradually increased annually from the 2012–2013 to 2018–2019 academic years, with the highest number in the 2018–2019 academic year before it decreased in the 2019–2020 and 2020–2021 academic years. (B) The graduating seniors’ perception of how confident they are in prescribing utilizing a scale of 5, in which 5 is very confident and 1 is not confident at all. The data represent the percentage of students on levels 4 and 5. The average level of confidence over the years is 70.8 %.

Self-reported confidence in prescription

The graduating seniors’ perception of how confident they are in their current ability to write safe and indicated orders and to prescribe therapies or interventions in a variety of settings (e.g., inpatient, ambulatory, urgent, or emergent care), without direct supervision, was assessed on a scale from 1 to 5 (1=not at all confident, 5=very confident). The percentage of the DO graduating seniors who reported being confident (4) and very confident (5) in their current ability to prescribe independently from the 2013–2014 to 2018–2019 academic years ranged between 65 and 68 % over the period. Then it significantly increased from 67 % in 2018–2019 to 93 % in 2019–2020 (X2 (1)=905.36, p<0.0001, 95 % CI [24.5–27.5 %]) and dropped significantly from 93 to 77 % (X2 (1)=425.07, p<0.0001, 95 % CI [14.6–17.4 %]) in the 2020–2021 academic year, averaging 70.8 % over the years of interest (Figure 1). On the other hand, the percentage who reported a lack of confidence (1 + 2 + 3) from the 2013–2014 to 2018–2019 academic years ranged between 32 and 35 %. It then dropped to 7 % in 2019–2020 and rose to 23 % in the 2020–2021 academic year, averaging 29.3 % over the years of the interest.

Perception of time devoted to clinical pharmacology instruction

The graduating seniors were asked to evaluate the time devoted to various instruction areas as appropriate, inadequate, or excessive. In evaluating their perception of the time devoted to clinical pharmacology instruction, the percentage of graduating seniors who considered that time appropriate gradually increased over the academic years under review. It rose from 78 % in 2012–2013 to 87 % in 2020–2021, averaging 81.4 % over the study period. The percentage of students who perceived this time as inadequate decreased gradually over these years. It decreased from 20 % in 2012–2013 to 10 % in 2020–2021, averaging 16.3 %. At the same time, the percentage of students who perceived it as excessive ranged from 2 to 3 % over these years, averaging 2.2 % (Figure 2). A statistically significant positive correlation was found between the percentage of students who reported being confident in prescribing and the percentage of students who perceived time dedicated to pharmacology as excessive (r=0.894**, p=0.003). A statistically significant negative correlation was found between the percentage of students who reported not being confident in prescribing and the percentage of students who perceived the time dedicated to pharmacology as excessive (r=−0.894**, p=0.003) (Table 1).

Figure 2: The DO graduating seniors’ evaluation of time devoted to clinical pharmacology instruction from the 2012–2013 to 2020–2021 academic years. The percentage of graduating seniors reported that the time devoted to clinical pharmacology instruction as appropriate is gradually increasing over the years.
Figure 2:

The DO graduating seniors’ evaluation of time devoted to clinical pharmacology instruction from the 2012–2013 to 2020–2021 academic years. The percentage of graduating seniors reported that the time devoted to clinical pharmacology instruction as appropriate is gradually increasing over the years.

Table 1:

Correlation between different factors affecting self-reported confidence in prescription. Correlation analyses were run between the percentages of students who evaluated the time devoted to pharmacology education, students who agreed with the statements about their first 2 years of medical education, and students who reported being confident in their current ability for the independent prescription. Data show the factors that have significantly correlated.

Appropriate Inadequate Excessive Write safe and indicated orders and prescribe therapies An appropriate amount of training was provided in OMT Osteopathic principles were adequately integrated into coursework Basic science courses were sufficiently integrated with one another The first two years of medical school were well-organized There was adequate preparation for COMLEX Level I There was adequate exposure to patient care during the first two years
Appropriate Pearson correlation 1 −0.984b 0.677a 0.501 −0.894b 0.546 0.753a 0.660 0.145 −0.873b
Sig. (2-tailed) 0.000 0.045 0.206 0.001 0.128 0.019 0.053 0.710 0.002
n 9 9 9 8 9 9 9 9 9 9
Inadequate Pearson correlation −0.984b 1 −0.760a −0.588 0.883b −0.604 −0.767a −0.754a −0.261 0.833b
Sig. (2-tailed) 0.000 0.017 0.125 0.002 0.085 0.016 0.019 0.497 0.005
n 9 9 9 8 9 9 9 9 9 9
Excessive Pearson correlation 0.677a −0.760a 1 0.894b −0.735a 0.737a 0.747a 0.877b 0.356 −0.545
Sig. (2-tailed) 0.045 0.017 0.003 0.024 0.023 0.021 0.002 0.347 0.129
n 9 9 9 8 9 9 9 9 9 9
Write safe and indicated orders and prescribe therapies Pearson correlation 0.501 −0.588 0.894b 1 −0.554 0.532 0.526 0.784a 0.290 −0.573
Sig. (2-tailed) 0.206 0.125 0.003 0.154 0.175 0.180 0.021 0.486 0.138
n 8 8 8 8 8 8 8 8 8 8

  1. aCorrelation is significant at the 0.05 level (2-tailed). bCorrelation is significant at the 0.01 level (2-tailed).

Evaluation of the medical education in the first two years

The DO graduating seniors evaluated the first 2 years of their medical education on an agreement scale. The percentage of students who “agree” and “strongly agree” with statements about the preclinical years in the graduation surveys varied over the years (Table 2A).

Table 2:

DO graduating seniors’ evaluation of the first 2 years of medical education and clinical education – required clerkships. The percentage of DO graduating seniors from the 2012–2013 to 2020–2021 academic years who reported “Agree” and “Strongly Agree” with the statements regarding the first 2 years of their medical education (A), and with the statements regarding the clinical education – required clerkships (B).

(A)
Graduating seniors’ evaluation of first 2 years of medical education 2012–2013 2013–2014 2014–2015 2015–2016 2016–2017 2017–2018 2018–2019 2019–2020 2020–2021 Average
Basic and clinical science course objectives were made clear to students 89 90 88 88 88 87 87 89 88 88.2
An appropriate amount of training was provided in OMT 88 88 88 86 86 86 86 85 84 86.3
Osteopathic principles were adequately integrated into coursework 85 85 86 85 86 85 85 86 87 85.6
Basic science courses were sufficiently integrated with one another 78 78 78 80 79 79 79 80 81 79.1
Course objectives and examination content matched closely 78 79 76 76 78 78 77 78 79 77.7
Students were provided with timely feedback on performance 77 78 75 73 73 74 74 76 76 75.1
Coursework adequately prepared students for clerkships 75 75 73 73 72 71 72 72 73 72.9
Basic science courses were sufficiently integrated with clinical training 70 69 69 70 69 69 70 69 72 69.7
The first 2 years of medical school were well-organized 68 68 66 67 67 67 68 70 70 67.9
There was adequate preparation for COMLEX Level I 65 64 63 65 62 59 65 64 66 63.7
There was adequate exposure to patient care during the first 2 years 60 58 58 56 54 53 52 51 53 55.0
(B)
Graduating seniors’ evaluation of clinical education – required clerkships 2012–2013 2013–2014 2014–2015 2015–2016 2016–2017 2017–2018 2018–2019 2019–2020 2020–2021 Average
Able to work on a personal basis with patients 93 92 92 90 92 90 90 92 90 91.2
Felt free to ask questions 87 87 88 86 87 86 86 89 86 86.9
Was asked relevant and pertinent questions on patient diagnosis, treatment options, management, and follow-up care 85 85 85 85 86 85 86 88 86 85.7
Testing was provided at end of each rotation 79 81 82 83 84 85 89 91 91 85.0
Appropriate diversity of patients and their health issues 85 86 84 84 86 85 84 85 84 84.8
Was treated with respect 83 83 84 88 85 84 85 86 84 84.7
Appropriate technology usage for situation 81 80 81 84 83 83 82 85 83 82.4
Support staff was friendly and supportive 80 80 80 86 82 81 82 83 82 81.8
Attending modeled excellent patient relationship skills 78 78 80 88 82 80 81 82 81 81.1
Adequate preparation for COMLEX Level 2-PE 85 85 82 81 80 80 80 85 54 79.1
Able to discuss progress on rotation with attending 76 77 80 79 80 78 78 80 81 78.8
Appropriate number of inpatient experiences 79 79 78 77 80 79 78 77 76 78.1
Clear goals and objectives were set 74 74 74 75 78 77 77 79 78 76.2
Lived a reasonable distance from rotation sites 71 71 72 77 77 78 75 80 79 75.6
Attending critically evaluated me during rotation 72 73 76 75 76 75 76 78 78 75.4
Attending based the evaluation on direct observation 72 74 76 76 78 75 66 77 77 74.6
The attending seemed interested in my opinions 70 70 73 72 74 72 72 73 72 72.0
Personal concerns were addressed by the attending while on rotation 69 69 72 79 74 70 71 72 71 71.9
Coverage hours were set and finished on time 67 66 67 79 70 71 72 74 73 71.0
Rounds were conducted as scheduled 54 69 68 79 72 72 74 75 73 70.7
Clear performance objectives were set 68 67 67 67 71 69 71 71 71 69.1
Timely feedback was provided on performance 68 67 69 68 70 69 69 70 71 69.0
Adequate preparation for COMLEX Level 2-CE 63 67 64 65 67 65 67 72 71 66.8
Rotations prepared me for examinations 62 63 64 64 69 66 66 68 67 65.4
Able to design own goals and objectives 65 63 64 63 65 66 65 60 64 63.9
Clerkships were well-organized 65 55 55 77 63 64 64 63 63 63.2
Able to discuss the final rotation evaluation with the attending 62 61 66 64 66 63 64 60 63 63.2
Able to meet and discuss areas of concern with the attending outside of the clinical setting 55 54 58 68 60 58 64 56 59 59.1
Too large a role by residents in teaching and evaluation 27 28 30 32 34 33 35 33 30 31.3
OPP were well-integrated in each clerkship 22 23 24 35 29 28 32 29 30 28.0
Each clerkship had an osteopathic orientation 20 22 24 36 27 28 30 25 26 26.4

  1. COMLEX, comprehensive osteopathic medical licensing examination; DO, doctor of osteopathic medicine; OMT, osteopathic manipulative treatment. COMLEX Level 2-CE, comprehensive osteopathic medical licensing examination level 2-cognitive evaluation; DO, doctor of osteopathic medicine; OPP, osteopathic principles and practice.

A statistically significant positive correlation was found between the percentage of students who reported being confident in prescribing and the percentage of students who reported the perception of time devoted to pharmacology instruction as excessive (r=0.894***, p=0.003) and with the percentage of students who agreed with the statement “the first two years of medical school were well organized” (r=0.784*, p=0.021) (Table 1).

A statistically significant negative correlation was found between the percentage of students who reported not being confident in prescribing and the percentage of students who reported the perception of time devoted to pharmacology instruction as excessive (r=−0.894***, p=0.003) and the percentage of students who agreed with the statement “the first two years of medical school were well organized” (r=−0.784*, p=0.021).

Evaluation of the medical education in the clinical years (required clerkship)

Like the first 2 years, the medical education in the clinical years was evaluated on an agreement scale. The percentage of students who “agree” and “strongly agree” with statements about these years in the graduation surveys varied over the years (Table 2B).

A statistically significant positive correlation was found between the percentage of students who reported being confident in independent prescription and the percentage of students who agreed with the following statements “being asked relevant and pertinent questions on patient diagnosis, treatment options, management, and follow-up care” (r=0.905**, p=0.002), with providing adequate preparation for COMLEX Level 2-CE during clinical rotations (r=0.849**, p=0.006), with testing at the end of each rotation (r=0.734*, p=0.038) and with being critically evaluated during rotation by the attending (r=0.758*, p=0.029). On the other hand, a statistically significant negative correlation was found between the percentage of students who reported being confident in independent prescription and the percentage of students who agreed with the statement “Able to design their own goals and objectives” during the required clinical clerkships (r=−0.773*, p=0.025) (Table 3A).

Table 3:

Correlation between the DO graduating seniors’ evaluation of their clinical education – required clerkships and their self-rated confidence in their ability for the independent prescription. Correlation analyses were run between the percentages of students who agreed with the statements about their clinical education–required clerkships and students who reported being confident in their current ability for the independent prescription (A) or students who reported not being confident in independent prescription (B). Data show only the factors that have significant correlations.

(A)
Was asked relevant and pertinent questions on patient diagnosis, treatment options, management, and follow-up care Testing was provided at end of each rotation Attending critically evaluated me during rotation Adequate preparation for COMLEX Level 2-CE Able to design own goals and objectives
Write safe and indicated orders and prescribe therapies Pearson correlation 0.905b 0.734a 0.758a 0.849b −0.773a
Sig. (2-tailed) 0.002 0.038 0.029 0.008 0.025
n 8 8 8 8 8
(B)
Was asked relevant and pertinent questions on patient diagnosis, treatment options, management, and follow-up care Testing was provided at end of each rotation Attending critically evaluated me during rotation Adequate preparation for COMLEX Level 2-CE Able to design own goals and objectives
Not confident Pearson correlation −0.905b −0.734a −0.758a −0.849b 0.773a
Sig. (2-tailed) 0.002 0.038 0.029 0.008 0.025
n 8 8 8 8 8

  1. aCorrelation is significant at the 0.05 level (2-tailed). bCorrelation is significant at the 0.01 level (2-tailed). COMLEX Level 2-CE, comprehensive osteopathic medical licensing examination level 2-cognitive evaluation; DO, doctor of osteopathic medicine.

A statistically significant negative correlation was found between the percentage of students who reported not being confident in independent prescription with the percentage of students who agreed with the following statements “being asked relevant and pertinent questions on patient diagnosis, treatment options, management, and follow-up care (r=−0.905**, p=0.002), with testing at the end of each rotation (r=−0.734*, p=0.038),” and “Adequate preparation for COMLEX Level 2-CE (r=−0.849**,p=0.008).” On the other hand, a statistically significant positive correlation was found between the percentage of students who reported not being confident in independent prescription and the percentage of students who agreed with the statement “Able to design their own goals and objectives” during the required clinical clerkships (r=0.773*, p=0.025) (Table 3B).

Discussion

This study identified the level of self-reported confidence in prescribing medications independently by final-year DO medical students and factors that may be associated with it, including their perception of time devoted to pharmacology education, the first 2 years of medical education, and clinical education in the required clerkships. The number of survey respondents increased annually before it declined during the last 2 academic years of the study, which may be related to the COVID-19 global pandemic burden on the healthcare team members and the demand for the newly graduating physicians to serve. Analyzing the averages of responses from 38,712 DO seniors, who represent 72.1 % of the DO expected graduates during the study period, strengthen this study because we review this national-level aggregated data to obtain generalized interpretations.

Our finding that, on average, 70.8 % of DO graduating seniors feel confident in their current abilities to prescribe safely and independently demonstrates a higher confidence level than the percentages reported in earlier studies. For instance, Heaton et al. [18] found that only 38 % of their respondents felt confident about prescription writing, whereas Brinkman et al. [5] reported that less than 50 % of their participants felt confident in their prescribing skills.

This observation may be consistent with the following studies demonstrating that medical students and junior physicians are not competent in prescribing when they enter practice. In his survey of house officers employed at public health tertiary institutions throughout Trinidad and Tobago [11], only (56 %; n=42) stated that they were “confident” or “very confident” in prescribing. A study of 895 final-year students from 17 medical schools in 15 European countries [5] showed that 54.7 % (range 34–65) of the prescriptions contained one or more prescribing errors and concluded that there was a lack of essential prescribing competencies among final-year medical students.

With the paucity of studies that directly assess the DO graduate’s competency and confidence to prescribe safely and independently, the question is whether this is correlated with pharmacology education, the first 2 years of medical education, and clinical medical education during the required clerkships. The positive correlation between the percentage of graduating seniors who reported that the time devoted to clinical pharmacology instructions was excessive and confidence in prescribing may be consistent with [5] findings that inadequate undergraduate teaching in clinical pharmacology and therapeutics in many European schools leads to incompetent prescribers and potentially unsafe patient care. It is also consistent with a finding from a cross-sectional survey in 29 European countries (n=7,328) about medical students’ perception of their readiness to prescribe antibiotics responsibly, showing that most final-year European medical students feel that they still need more education on antibiotic use for their future practice as junior physicians [1]. It is also consistent with a study suggesting that switching the pharmacology curriculum to a problem-based curriculum is associated with an increase in students’ prescribing competence at the end of the medical curriculum [22].

Considering the importance of pharmacology education in developing prescribing confidence and that it is primarily taught in the first 2 years, we looked for the factors that correlate with pharmacology education during these years. Our data support moving to an efficient integrated curriculum in these years of medical education by showing the statistically significant positive correlation between the perception of time devoted to clinical pharmacology education as appropriate or excessive with sufficient integration of basic science courses with one another. The importance of the first 2 years of basic courses integration for pharmacology course perception is also supported by the negative correlation between the perceived pharmacology devoted time as inadequate and basic sciences courses integrations with one another. These suggestions are consistent with the finding that increased focus on pharmacotherapy during medical school and integration of clinical pharmacology in the internal medicine course can increase students’ confidence in basic prescribing skills [23]. This consistency also aligns with our observation of the positive correlation between adequate exposure to patient care during the first 2 years and the percentage of students who perceive this time as inadequate, which may indicate the need for more pharmacology-dedicated time as we move toward a more integrated curriculum with early and adequate clinical exposure.

While medical students learn basic pharmacological knowledge in their preclinical years, the exposure to clinical cases and application of these foundational pieces of knowledge take place more in the clinical years; as a result, we evaluated the DO seniors’ perceptions of clinical education during the required clerkships. This current study found that confidence in prescription positively correlates with active, planned clinical education during the required clerkships. This planned interactive clinical learning model aligns with studies about different structured educational interventions that can facilitate new physicians’ gain of professional confidence in prescribing [3], 20], 24]. The positive outcome of these organized interventions is consistent with our observation of a negative correlation between the DO graduating seniors’ confidence in their ability to prescribe safely and independently and their ability to design their own goals and objectives during their required clinical education clerkships. This finding is also consistent with data that show an association between increased professional confidence in prescribing and having clear learning outcomes for students’ training during their ward-based education [23]. It is also consistent with a study highlighting the need for utilizing relevant clinical cases and providing feedback in a well-structured small-group session to boost the prescribing skills of the new physicians [25].

This study has several limitations that should be considered when interpreting the findings. First, the reliance on aggregated data from AACOM graduating senior surveys introduces potential limitations due to the aggregation of data across multiple years. Assumptions are made that relationships and perceptions remain consistent over time, despite possible variations in the educational environment, assessment methods, and external factors such as the impact of the pandemic. Consequently, the precision of our findings may be affected by these assumptions. Furthermore, although the aggregated data provide a broad overview, they may not accurately capture the nuanced year-to-year variations in graduating seniors’ perceptions. Moreover, the study’s findings are based on graduating seniors’ participation and their perceptions of the survey questions. As with any survey-based study, there is a potential for response bias, and the findings may not necessarily extend to the entire cohort of graduating seniors. The level of participation and individual interpretations of the survey questions may introduce limitations regarding the generalizability of the results. Additionally, this study focuses on the perception of confidence rather than objectively assessing the risk for prescription errors among DO graduating students. Although confidence may be a relevant factor, it is important to recognize that it may not precisely reflect the likelihood of actual prescription errors. Other factors not explored in this study could contribute to the occurrence of prescription errors, and further research is needed to develop a comprehensive understanding of the level of confidence in independent prescription and its associated factors. Finally, the use of correlation analysis in this study helps identify factors related to prescription confidence; however, it is essential to note that correlation does not imply causation. Additional research employing more sophisticated study designs, such as longitudinal studies or experimental interventions, is warranted to better understand the factors influencing prescription confidence and to develop efficient interventions aimed at reducing the occurrence of prescription errors that may impact future patients.

In conclusion, while this study provides valuable insights into the perception of confidence in independent prescription among DO graduating students, it is crucial to acknowledge the limitations arising from the aggregation of data across multiple years and the potential variations in graduating seniors’ perceptions over time. Caution should be exercised when generalizing the findings, and further research should be conducted to address these limitations and obtain a more comprehensive understanding of the topic.

Conclusions

Although most of the respondent DO graduating seniors (70.8 %) felt confident in their ability to prescribe independently during the study period, the minority (29.2 %) do not. The confidence in prescribing may be enhanced by increasing the time devoted to clinical pharmacology education within the well-organized first 2 years of medical education. It may also be enhanced by developing more interactive clinical courses during the required clerkship. These clinical courses should encourage attendings’ and students’ interactions with clear pre-set objective goals to emphasize the development of prescription skills and to reduce the risk of medical prescription errors in order to improve patient health outcomes and safety.

Corresponding author: Khalil Eldeeb, PhD, Jerry M. Wallace School of Osteopathic Medicine, Campbell University, Smith Hall, 4350 US-421 S, Lillington, NC 27546, USA, E-mail:

Acknowledgments

The author would like to thank Godwin Dogbey, PhD, for his comments and suggestions, and edits.

  1. Research ethics: Not applicable.

  2. Informed consent: Not applicable.

  3. Author contributions: The author has accepted responsibility for the entire content of this manuscript and approved its submission.

  4. Competing interests: None declared.

  5. Research funding: None declared.

  6. Data availability: The raw data can be obtained on request from the corresponding author.

References

1. Dyar, OJ, Nathwani, D, Monnet, DL, Gyssens, IC, Stålsby Lundborg, C, Pulcini, C, et al.. Do medical students feel prepared to prescribe antibiotics responsibly? Results from a cross-sectional survey in 29 European countries. J Antimicrob Chemother 2018;73:2236–42. https://doi.org/10.1093/jac/dky150.Search in Google Scholar PubMed

2. Alexander, C, Millar, J, Szmidt, N, Hanlon, K, Cleland, J. Can new doctors be prepared for practice? A review. Clin Teach 2014;11:188–92. https://doi.org/10.1111/tct.12127.Search in Google Scholar PubMed

3. Lonnbro, J, Nylen, K, Wallerstedt, SM. Developing professional confidence in the art of prescribing – a randomized controlled study on structured collegial discussions during internship. Eur J Clin Pharmacol 2019;75:687–96. https://doi.org/10.1007/s00228-018-02619-4.Search in Google Scholar PubMed

4. Davey, P, Marwick, CA, Scott, CL, Charani, E, McNeil, K, Brown, E, et al.. Interventions to improve antibiotic prescribing practices for hospital inpatients. Cochrane Database Syst Rev 2017;2:CD003543. https://doi.org/10.1002/14651858.CD003543.pub4.Search in Google Scholar PubMed PubMed Central

5. Brinkman, DJ, Tichelaar, J, Schutte, T, Benemei, S, Böttiger, Y, Chamontin, B, et al.. Essential competencies in prescribing: a first European cross-sectional study among 895 final-year medical students. Clin Pharmacol Ther 2017;101:281–9. https://doi.org/10.1002/cpt.521.Search in Google Scholar PubMed PubMed Central

6. Ashcroft, DM, Lewis, PJ, Tully, MP, Farragher, TM, Taylor, D, Wass, V, et al.. Prevalence, nature, severity and risk factors for prescribing errors in hospital inpatients: prospective study in 20 UK hospitals. Drug Saf 2015;38:833–43. https://doi.org/10.1007/s40264-015-0320-x.Search in Google Scholar PubMed PubMed Central

7. Kamel, FO, Alwafi, HA, Alshaghab, MA, Almutawa, ZM, Alshawwa, LA, Hagras, MM, et al.. Prevalence of prescription errors in general practice in Jeddah, Saudi Arabia. Med Teach 2018;40(1 Suppl):S22–9. https://doi.org/10.1080/0142159X.2018.1464648.Search in Google Scholar PubMed

8. Ansari, M, Neupane, D. Study on determination of errors in prescription writing: a semi-electronic perspective. Kathmandu Univ Med J 2009;7:238–41. https://doi.org/10.3126/kumj.v7i3.2730.Search in Google Scholar PubMed

9. Weier, N, Thursky, K, Zaidi, STR. Antimicrobial knowledge and confidence amongst final year medical students in Australia. PLoS One 2017;12:e0182460. https://doi.org/10.1371/journal.pone.0182460.Search in Google Scholar PubMed PubMed Central

10. Gregory, H, Cantley, M, Calhoun, C, Hall, GA, Matuskowitz, AJ, Weant, KA. Incidence of prescription errors in patients discharged from the emergency department. Am J Emerg Med 2021;46:266–70. https://doi.org/10.1016/j.ajem.2020.07.061.Search in Google Scholar PubMed

11. Ignacio, D, Sealy, P, Clement, Y. Confidence in prescription writing among junior physicians in Trinidad and Tobago. West Indian Med J 2015;64:407–12. https://doi.org/10.7727/wimj.2014.087.Search in Google Scholar PubMed PubMed Central

12. LaScala, EC, Monroe, AK, Hall, GA, Weant, KA. Antibiotic prescribing errors in patients discharged from the pediatric emergency department. Pediatr Emerg Care 2022;38:e387–92. https://doi.org/10.1097/PEC.0000000000002296.Search in Google Scholar PubMed

13. Ajemigbitse, AA, Omole, MK, Erhun, WO. An assessment of the rate, types and severity of prescribing errors in a tertiary hospital in southwestern Nigeria. Afr J Med Med Sci 2013;42:339–46.Search in Google Scholar

14. Ajemigbitse, AA, Omole, MK, Osi-Ogbu, OF, Erhun, WO. A qualitative study of causes of prescribing errors among junior medical doctors in a Nigeria in-patient setting. Ann Afr Med 2013;12:223–31. https://doi.org/10.4103/1596-3519.122691.Search in Google Scholar PubMed

15. Kalfsvel, L, Hoek, K, Bethlehem, C, van der Kuy, H, van den Broek, WW, Versmissen, J, et al.. How would final-year medical students perform if their skill-based prescription assessment was real life? Br J Clin Pharmacol 2022;88:5202–17. https://doi.org/10.1111/bcp.15427.Search in Google Scholar PubMed PubMed Central

16. Ryan, C, Ross, S, Davey, P, Duncan, EM, Francis, JJ, Fielding, S, et al.. Prevalence and causes of prescribing errors: the prescribing outcomes for trainee doctors engaged in clinical training (PROTECT) study. PLoS One 2014;9:e79802. https://doi.org/10.1371/journal.pone.0079802.Search in Google Scholar PubMed PubMed Central

17. Quesnelle, KM, Zaveri, NT, Schneid, SD, Blumer, JB, Szarek, JL, Kruidering, M, et al.. Design of a foundational sciences curriculum: applying the ICAP framework to pharmacology education in integrated medical curricula. Pharmacol Res Perspect 2021;9:e00762. https://doi.org/10.1002/prp2.762.Search in Google Scholar PubMed PubMed Central

18. Heaton, A, Webb, DJ, Maxwell, SR. Undergraduate preparation for prescribing: the views of 2413 UK medical students and recent graduates. Br J Clin Pharmacol 2008;66:128–34. https://doi.org/10.1111/j.1365-2125.2008.03197.x.Search in Google Scholar PubMed PubMed Central

19. American Medical Association. DO vs. MD: how much does the medical school degree type matter? Available from: https://www.ama-assn.org/medical-students/preparing-medical-school/do-vs-md-how-much-does-medical-school-degree-type-matter.Search in Google Scholar

20. Ajemigbitse, AA, Omole, MK, Erhun, WO. Effect of providing feedback and prescribing education on prescription writing: an intervention study. Ann Afr Med 2016;15:1–6. https://doi.org/10.4103/1596-3519.161722.Search in Google Scholar PubMed PubMed Central

21. Medicine AAoCoO. AACOM reports: entering and graduating class surveys. Available from: https://www.aacom.org/reports-programs-initiatives/aacom-reports/entering-and-graduating-class-surveys.Search in Google Scholar

22. Brinkman, DJ, Monteiro, T, Monteiro, EC, Richir, MC, van Agtmael, MA, Tichelaar, J. Switching from a traditional undergraduate programme in (clinical) pharmacology and therapeutics to a problem-based learning programme. Eur J Clin Pharmacol 2021;77:421–9. https://doi.org/10.1007/s00228-020-03027-3.Search in Google Scholar PubMed PubMed Central

23. Eriksson, AL, Wallerstedt, SM. Developing confidence in basic prescribing skills during medical school: a longitudinal questionnaire study investigating the effects of a modified clinical pharmacology course. Eur J Clin Pharmacol 2018;74:1343–9. https://doi.org/10.1007/s00228-018-2508-3.Search in Google Scholar PubMed PubMed Central

24. Papanicolas, LE, Nelson, R, Warner, MS. Influence of antimicrobial susceptibility reporting on junior doctors’ decision to prescribe antimicrobials inappropriately. J Antimicrob Chemother 2017;72:1202–5. https://doi.org/10.1093/jac/dkw525.Search in Google Scholar PubMed

25. Lonnbro, J, Wallerstedt, SM. “It’s helpful to get the time and opportunity to discuss drug treatment; that’s what I think is the most important thing.” A qualitative study on prescribing education in junior physicians. Eur J Clin Pharmacol 2020;76:249–55. https://doi.org/10.1007/s00228-019-02764-4.Search in Google Scholar PubMed

Received: 2022-09-10
Accepted: 2024-05-17
Published Online: 2024-08-23

© 2024 the author(s), published by De Gruyter, Berlin/Boston

This work is licensed under the Creative Commons Attribution 4.0 International License.

Articles in the same Issue

  1. Frontmatter
  2. General
  3. Commentary
  4. Protecting the profession: lessons from the recent physician scandals
  5. Medical Education
  6. Original Articles
  7. Analysis of self-reported confidence in independent prescribing among osteopathic medical graduating seniors
  8. Perspectives of osteopathic medical students on preclinical urology exposure: a single institution cross-sectional survey
  9. Musculoskeletal Medicine and Pain
  10. Original Article
  11. Communication and empathy within the patient-physician relationship among patients with and without chronic pain
  12. Neuromusculoskeletal Medicine (OMT)
  13. Original Article
  14. Comparing cranial suture interdigitation in humans and non-human primates: unearthing links to osteopathic cranial concept
  15. Public Health and Primary Care
  16. Original Article
  17. Alcohol consumption among older adults in the United States amidst the COVID-19 pandemic: an analysis of the 2017–2021 Behavioral Risk Factor Surveillance System
  18. Letter to the Editor
  19. Investigating trends in orthopedic surgery match for osteopathic and allopathic graduates post-single accreditation transition
https://doi.org/10.1515/jom-2022-0187
Keywords for this article
confidence; osteopathic; pharmacology education; prescribing
Creative Commons
BY 4.0

Articles in the same Issue

  1. Frontmatter
  2. General
  3. Commentary
  4. Protecting the profession: lessons from the recent physician scandals
  5. Medical Education
  6. Original Articles
  7. Analysis of self-reported confidence in independent prescribing among osteopathic medical graduating seniors
  8. Perspectives of osteopathic medical students on preclinical urology exposure: a single institution cross-sectional survey
  9. Musculoskeletal Medicine and Pain
  10. Original Article
  11. Communication and empathy within the patient-physician relationship among patients with and without chronic pain
  12. Neuromusculoskeletal Medicine (OMT)
  13. Original Article
  14. Comparing cranial suture interdigitation in humans and non-human primates: unearthing links to osteopathic cranial concept
  15. Public Health and Primary Care
  16. Original Article
  17. Alcohol consumption among older adults in the United States amidst the COVID-19 pandemic: an analysis of the 2017–2021 Behavioral Risk Factor Surveillance System
  18. Letter to the Editor
  19. Investigating trends in orthopedic surgery match for osteopathic and allopathic graduates post-single accreditation transition
Sign up now to receive a 20% welcome discount
Institutional Access
How does access work?
Have an idea on how to improve our website?
Please write us.
© 2025 De Gruyter Brill
Downloaded on 7.9.2025 from https://www.degruyterbrill.com/document/doi/10.1515/jom-2022-0187/html
Scroll to top button