1. Formative Prescribing Assessment for Foundation Doctors on Induction Katie Reygate [kreygate@kss.hee.nhs.uk] Prescribing Lead, Health Education England working across Kent, Surrey & Sussex

2. Formative Prescribing Assessment for Foundation Doctors on Induction History of the prescribing assessment Lessons learnt from implementing the assessment Integration of Prescribing leads into Medical Education Feedback mechanisms Communication strategy Future work @NHS_HealthEdEng @KatieReygate kreygate@kss.hee.nhs.uk

3. History of the Prescribing Assessment Multidisciplinary group created an assessment –Long answer scenario using local charts (75mins) –Short answer MCQ assessment Objectives for the assessment were determined by: –examining other assessments used locally and nationally, –national standards e.g. NPSA alerts –local experience of serious prescribing errors made by doctors in training. @NHS_HealthEdEng @KatieReygate

4. History of the Prescribing Assessment Ethos: Formative assessment to identify weaker prescribers and provide developmental support. –There is no set pass mark for the long answer assessment; there are safety criteria Local implementation: –during induction week –local decision as to feedback methods and restrictions of prescribing rights for weaker prescribers. –Support mechanisms decided locally Multidisciplinary engagement required. Pharmacy Test @NHS_HealthEdEng @KatieReygate

5. Lessons learnt from implementing the assessment @NHS_HealthEdEng @KatieReygate ↓Pilot in 2011 – 4 trusts – 74 doctors ↓Long written scenario assessment was refined, more trusts joined the assessment group. Introduction of implementation guide. ↓2012 Assessment held in 10 Trusts, 422 doctors (38.2%> 1SE) ↓Refinement of the assessment, extended time for trainees who require it. MCQ made available online. Assessment (both Scenario and MCQ) mapped to NPA prescribing competency framework. ↓2013 Assessment held in 12 Trusts, 520 doctors (46.3% > 1SE) ↓Introduction of a marking criteria for prescribing leads ↓Introduction of SCRIPT to STFS (August 2014) ↓2014 Assessment held in 13 Trusts, 557 doctors (70% > 1 SE) ↓Introduction of an online pre-induction MCQ assessment to all STFS doctors ↓2015 Assessment held in 16 Trusts, 760 doctors (54.4% > 1 SE) ↓Feedback of results to medical schools

6. N attempted % correct Identification of the risk of hypokalaemia associated with the drugs prescribed. 90325.30 Significant interaction due to inappropriate administration times 91727.59 Monitoring of blood parameters91233.22 Appropriate use of analgesic ladder84438.39 Dose interval of opioids91545.14 Questions answered correctly by fewer than 50% of the candidates (2012/13 paper)

7. Example – pilot 2011 PC: Jemma Smith is a 39 year-old woman admitted with status epilepticus (first episode). Her weight is 50kg and her height 5’3”. PMH: Proximal DVT 10 weeks ago DH: Preadmission Jemma was taking warfarin only, stabilised on 4mg daily (target INR 2.5). On Admission, her INR was 2.3. A decision is made to administer phenytoin as an intravenous infusion at dose of 20mg/kg. Calculate and prescribe this in the section provided overleaf, ensuring that the concentration, rate and diluent are appropriate.

8. Lessons learnt from implementing the assessment @NHS_HealthEdEng @KatieReygate Refining the assessment: –Psychometric analysis –Review of results –Feedback from trainees –MDT review Planning is key Orientation to prescribing system is required Marking guide to aid consistency, second markers & benchmarking. Timely feedback and strategy –One to one –Group feedback –SCRIPT signposting –Fit local needs

9. Integration of Prescribing leads into Medical Education Leadership: Foundation Programme Director / Director of Medical Education –Provide direction for the prescribing leads –Develop feedback strategy and provide support when needed Prescribing leads feed into Local Faculty Groups: –Updates on the assessment and results –Plan for the year ahead –Communications @NHS_HealthEdEng @KatieReygate

10. Feedback mechanisms Variety of methods (capacity limited): –Group feedback Immediately after assessment After individual results received –Individual email with developmental points, including SCRIPT modules –One to one feedback Prescribing lead / TPD / DME –Feedback via educational supervisors –Feedback via ward pharmacists (friendly pharmacist scheme) @NHS_HealthEdEng @KatieReygate

11. Communication strategy Trainees: Advertise via trust, via STFS communications and website. Prescribing leads: Prescribing Assessment Group, feed into all aspects of communications. Medical Education Departments: informed via prescribing leads at LFG, STFS communications and website, STFS Advisory and Development Medical Schools: Report to be sent to medical schools >50 trainees (2012-2015). @NHS_HealthEdEng @KatieReygate

12. Future work E-Prescribing training and assessment Impact of the PSA on local prescribing assessments Feedback mechanisms Transition from F1 to F2 (including from EPMA – drug charts, and EPMA to EPMA) Continually review the need for the assessment. @NHS_HealthEdEng @KatieReygate