prescribing skills assessment prescribing skills assessment training workshop psa question item...

Prescribing Skills Assessment


Training Workshop

PSA Question item stylesPrescribing, Prescription Review, Planning

Management and Data Interpretation

John Mucklow

Slide compilation © 2011 The British Pharmacological Society & Medical Schools Council. All rights reserved.

http://www.chms.ac.uk/default.html


Station Description Marks Comments

1 Prescribing 1 10 1 question item of 10 marks


3 Prescription Review 1 8 2 question items of 4 marks each

4 Planning Management 8 2 question items of 4 marks each

5 Communicating Information 6 3 question items of 2 marks each

6 Drug Calculation Skills 8 4 question items of 2 marks each




10 Adverse Drug Reactions 8 4 question items of 2 marks each

11 Drug Monitoring 8 4 question items of 2 marks each

12 Data Interpretation 6 3 question items of 2 marks each

TOTAL MARKS 100

Prescribing Skills Assessment – Format




PRESCRIBING

Competencies• Reasoning and judgement

Deciding on the most appropriate prescription (drug, dose, route and frequency) to write, based on the clinical circumstances and supplementary information.

• Measurable actionWriting a safe, effective and legal prescription for a single medicine, using the documentation provided to tackle a specific indication highlighted by the question.




PRESCRIBING

This question type will present:• a clinical scenario• a request to write a prescription for a single appropriate

medicine or fluid on one of a variety of prescription charts

Typical scenarios will involve the treatment of:• acute conditions (e.g. acute asthma)• chronic conditions (e.g. reflux oesophagitis)• important symptoms (e.g. pain)




PRESCRIBING

The candidate will have to exercise judgement when deciding between different drugs, formulations, routes, doses and dose intervals

Typical medicines will include those that are high-risk (e.g. insulin) or in common use (e.g. antibiotics), and IV fluids

Prescriptions must be legible, unambiguous and complete • approved name written in upper case• appropriate form and route• correct dose appropriately written without abbreviation• necessary details and instructions, signed




PRESCRIBING

Items may involve prescriptions written into a variety of prescription forms, including:

• hospital once-only

• regular medicines

• fluid prescription charts

• general practice (FP10) forms




PRESCRIBING

Good Prescribing question items should:• be based on a clinical scenario that might be faced by a

Foundation doctor

• expect actions that might reasonably be expected of a Foundation doctor

• avoid using over-elaborate clinical scenarios – restrict content to what is required to answer question




PRESCRIBING

Case presentationA [age]-year-old [man/woman/child] presents to [location and situation] complaining of [symptom] etc. PMH. She/he has suffered from …. [describe any past medical history relevant to the scenario]. DH. She/he normally takes …. [list any current prescriptions]. SH. [include any relevant social history]

[Try to adhere to this general layout but there is room for flexibility]




PRESCRIBINGOn examinationTemperature xx.x°C, HR xx/min and regular, BP xxx/xx mmHg, JVP xxxxxx, RR xx/min, O2 sat xx% on air, HS xxxxxx, chest sounds xxxxxxx. Other important observations are…….

InvestigationsNa+ xxx mmol/L (137–144), K+ xxx mmol/L (3.5–4.9), U xxx mmol/L (2.5–7.0), Cr xxx µmol/L (60–110), eGFR etc.ECG shows ………CXR shows ………

[Provide sufficient information to enable the candidate to make a sound judgement about the need for and choice of treatment]




PRESCRIBING

Good Prescribing question items should:• state clearly the symptom or problem to be addressed by

the prescription within the ‘Prescribing Request’ box

• require only one prescription to be written

Prescribing requestWrite a prescription for ONE drug that will help to [treat/alleviate/prevent] [symptom or problem].




Prescribing Item

Case presentationA [age]-year-old [man/woman/child] presents to [location and situation] complaining of [symptom] etc. PMH. She/he has suffered from …. [describe any past medical history relevant to the scenario]. DH. She/he normally takes …. [list any current prescriptions]. SH. [include any relevant social history] [Authors should try to adhere to this general layout but there is room for flexibility] On examinationTemperature xx°C, HR xx/min and regular, BP xxx/xx mmHg, JVP xxxxxx, RR xx/min, O2 sat xx% on air, HS xxxxxx, chest sounds xxxxxxx. Other important observations are …….


[Authors should provide sufficient information from the clinical examination and investigations to enable the candidate to make a sound judgement about the need for and choice of treatment]

Prescribing requestWrite a prescription for ONE drug that will help to [treat/alleviate/prevent] [symptom or problem].(use the hospital ‘once-only medicines’ prescription chart provided)

Please paste any picture or other illustration that supports the clinical case into this box

PWS000ID This question item is worth 10 marks You may use the BNF at any time

ONCE ONLY MEDICINES

DateTim

e Medicine (Approved name) Dose Route Prescriber – sign + printTim

egiven

Given

by







Prescribing requestWrite a prescription for ONE drug that will help to [treat/alleviate/prevent] [symptom or problem].(use the hospital ‘regular medicines’ prescription chart provided)


PWS000ID This question item is worth 10 marks

Date

Time

Drug (Approved name)

68Dose Route

12Prescriber – sign + print Start date 14

18Notes Pharmacy

22

You may use the BNF at any time Prescribing Item






Prescribing requestWrite a prescription for ONE intravenous fluid that would be most appropriate for the patient at this point.(use the hospital fluid prescription chart provided)



INFUSION THERAPY

Date Start time

Infusion solution Medicine added Prescriber’s signature

Given by

Type/strength Volume Route Rate Duration Approved name Dose








Prescribing requestWrite a prescription for ONE drug that will help to [treat/alleviate/prevent] [symptom or problem].(use the general practice prescription form provided)



Pharmacy Stamp

Please don’t stamp over age box

Age0yr 0mths

D.o.B.00/00/0000

Title, Forename, Surname & AddressPatient NameAddress Line 1Address Line 2Town Postcode

Number of days’ treatmentN.B. Ensure dose is stated

Endorsements Drug nameDoseFrequency

Signature of PrescriberSignature

Date00/00/0000

ForDispenserNo. ofPrescns.on form

Xxxxx Health AuthorityDr AddressTown PostcodeTel: 00000 000 000

FP10NC0105





PRESCRIBING

Answer page

• Clinical scenarios seldom have only one correct answer

• Identify those answers that you believe to be optimal and those that are suboptimal but worthy of credit

• Enter these on the Answer page that follows the question template.




Marking guide for A and B. Candidates should be given 4 marks for an optimal answer that can’t be improved. They should get 3 marks for an answer that is good but is suboptimal on some grounds (e.g. cost-effectiveness, likely adherence). They should get 2 marks for an answer that is likely to provide benefit but is clearly suboptimal for more than one reason. They should get 1 mark for an answer that has some justification and deserves some credit.

PWS000ID This question item is worth 10 marks You may use the BNF at any time Answer Page

C. Timing. Candidates will also be given 1 mark for correctly dating (and timing) the prescription

D. Signature. Candidates will also be given 1 mark for signing the prescription

A. Drug choice Score Feedback/justification B. Dose and route Score Feedback/justification

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

Prescribing Item




PRESCRIBINGMarking guide for A and B. Candidates should be given 4 marks for an optimal answer.They should get 3 marks for an answer that is good but is suboptimal on some grounds (e.g. cost-effectiveness, likely adherence).They should get 2 marks for an answer that is likely to provide benefit but is clearly suboptimal for more than one reason.They should get 1 mark for an answer that has some justification and deserves some credit.

The mark achieved in A determines the maximum achievable mark in B.Candidates cannot compensate for a suboptimal choice of drug by correctly stating its dose and route.

C. Timing. Candidates will also be given 1 mark for correctly dating (and timing) the prescriptionD. Signature. Candidates will also be given 1 mark for signing the prescription




Please use the British National Formulary, to which the candidates will have access throughout, as the ultimate arbiter of dose ranges, routes, indications, contra-indications, etc.

















TOTAL MARKS 100





PRESCRIPTION REVIEWCompetencies• Reasoning and judgement

Deciding which components of the current prescription list are inappropriate, unsafe or ineffective for a patient, based on their clinical circumstances

• Measurable actionIdentifying prescriptions (drugs, doses or routes) that are inappropriate, unsafe or ineffective from amongst the current list of prescribed medicines




PRESCRIPTION REVIEWThis question type will present:• a scenario that requires review of a current list of prescribed

medicines

Typically this question type will involve:• interpreting the list of medicines in light of a clinical problem,

spotting important drug interactions• identifying obvious or serious dosing errors• noting suboptimal prescriptions




PRESCRIPTION REVIEW• The total list of medicines for each question item should range

from 4–10

• Some knowledge of common effects, adverse reactions and interactions of common medicines will be assumed

• Candidates should have time to consult the BNF for relevant information that might be considered beyond the core knowledge base of a minimally competent Foundation doctor




PRESCRIPTION REVIEWGood Prescription Review question items should:

• state clearly in each of two questions associated with each list the reason why between 1 and 3 items on the list of prescriptions need to be identified

• typically ask the candidate to identify medicines that contain dosing errors, or are causing symptoms, contra-indicated, likely to interact, etc.Question ASelect the [ONE/TWO/THREE prescription/prescriptions] that [is/are] [contra-indicated/most likely to be a cause of/contains a serious dosing error/interact/, etc.].(mark [it/them] with a tick in column A)



Prescribing Skills AssessmentPrescribing Skills Assessment – Prescription Review Question Item Example

Prescription Review Item REV000ID This question item is worth 4 marks You may use the BNF at any time

CURRENT PRESCRIPTIONS

Drug name Dose Route Freq. A B

Drug 1 xx mg IV daily ☐ ☐

Drug 2 xx mg ORAL 12-hrly ☐ ☐

Drug 3 xx mg ☐ ☐








Case presentationA [age]-year-old [man/woman/child] presents to [location and situation] complaining of [symptom that might be used as the focus for one of the questions] etc. PMH. She/he has suffered from …. [describe any past medical history relevant to the scenario]. DH. She/he normally takes …. [list any current prescriptions]. SH. [include any relevant social history] His current regular medicines are listed (right). [Authors should try to adhere to this general layout but there is room for flexibility – the presentations should be fairly brief]

Question ASelect the [ONE/TWO/THREE prescription/prescriptions] that [is/are] [contra-indicated/most likely to be a cause of/contains a serious dosing error/interact/, etc.].(mark [it/them] with a tick in column A)

Question BSelect the [ONE/TWO/THREE prescription/prescriptions] that [is/are] [contra-indicated/most likely to be a cause of/contains a serious dosing error/interact/, etc.].(mark [it/them] with a tick in column B)

Answer box

Question A Marks per correct tick [1 or 2]

Write a brief justification in this box

Question B Marks per correct tick [1 or 2]






PRESCRIPTION REVIEW CURRENT PRESCRIPTIONS

Drug name Dose Route Freq. A BDrug 1 xx mg IV daily ☐ ☐Drug 2 xx mg ORAL 12-hrly ☐ ☐Drug 3 xx mg ☐ ☐Drug 4 xx mg ☐ ☐Drug 5 xx mg ☐ ☐Drug 6 xx mg ☐ ☐Drug 7 xx mg ☐ ☐Drug 8 xx mg ☐ ☐Drug 9 xx mg ☐ ☐Drug 10 xx mg ☐ ☐




PRESCRIPTION REVIEW Answer boxQuestion A Marks per correct tick [1 or 2]Write a brief justification in this box

Question B Marks per correct tick [1 or 2]Write a brief justification in this box

















TOTAL MARKS 100





PLANNING MANAGEMENTCompetencies• Reasoning and judgement

Deciding which combination of therapies would be most appropriate to manage a particular clinical situation

• Measurable actionSelecting the most appropriate combination of treatment strategies based on individual patient circumstances




PLANNING MANAGEMENTThis question type will present:• a clinical scenario followed by a request to identify the

important therapeutic strategies for initial management

This will involve:• selecting between options (e.g. medicines, fluids) that would

be of real benefit and others that would be neutral or harmful

The candidate will have to decide on:• the two most appropriate prescriptions, based on symptoms,

signs and investigations, from a list of five




PLANNING MANAGEMENTThe treatment might be preventive, curative, symptomatic or palliative

The question tests the ability to plan treatment appropriate to individual patients. Candidates should be aware of situations where it is inappropriate to prescribe and also of the role of non-drug therapies. Some of these scenarios may relate to the management of clinical toxicological emergencies

The likely diagnosis (or differential diagnosis) will not necessarily be identified; planning management is sometimes necessary even when the diagnosis is not certain




PLANNING MANAGEMENTGood Planning Management question items should:

• be based on a list of 5 management options from which the candidate will be required to select the 2 most appropriate

• contain sufficient information to allow a competent candidate to select the 2 best options unambiguously

• contain 3 distracting options that, while plausible, are clearly less appropriate than the correct answers in relation to the clinical scenario

QuestionSelect the TWO most appropriate management options at this stage.(mark them with a tick)




Planning Management Item MAN000ID This question item is worth 4 marks You may use the BNF at any time

MANAGEMENT OPTIONS

A Option A ☐

B Option B ☐

C Option C ☐

D Option D ☐

E Option E ☐



[Authors should try to adhere to this general layout but there is room for flexibility – the presentations should contain sufficient information to allow candidates to select the 2 best options from the list you provide but should not be over-elaborate]

QuestionSelect the TWO most appropriate management options at this stage.(mark them with a tick)

Answer box

Option A Justification


Option B Justification


Option C Justification

Option D Justification

Option E Justification





PLANNING MANAGEMENTMANAGEMENT OPTIONS

A Option A ☐B Option B ☐C Option C ☐D Option D ☐E Option E ☐

List options in alphabetical order, starting with a lower case letter, unless option is a proper noun. Identify the 2 correct answers by placing a tick in the column on the right.




PLANNING MANAGEMENTAnswer boxOption A JustificationWrite a brief justification in this box

Option B JustificationWrite a brief justification in this box




















TOTAL MARKS 100





DATA INTERPRETATIONCompetencies• Reasoning and judgement

Deciding on the meaning of the results of investigations as they relate to decisions about ongoing drug therapy

• Measurable actionMaking an appropriate change to a prescription based on those data




DATA INTERPRETATIONThis question type will involve:• interpreting data in the light of a clinical scenario• deciding on the most appropriate course of action with regard

to prescribing

The correct course of action may involve:• withdrawing a medicine• reducing its dose• no change• increasing its dose• prescribing a new medicine




DATA INTERPRETATIONGood Data Interpretation question items should:

• be based on a clinical scenario where a treatment decision (e.g. choosing from a selection of treatment options, deciding on a dosage change) is based on interpreting data from an investigation (e.g. physiological measurement, blood test)

• be based on a list of 5 monitoring options relating to the treatment identified, from which the candidate will be required to select the most appropriate




DATA INTERPRETATIONGood Data Interpretation question items should:

• contain sufficient information to allow a competent candidate to select the best option unambiguously

• contain 4 distracting options that, while plausible, are clearly less appropriate in relation to responding to the data than the correct answer.

QuestionSelect the most appropriate decision option with regard to [the xxxx prescription/the treatment of xxxxxx] based on these data.(mark it with a tick)




Data Interpretation Item DAT000ID This question item is worth 2 marks You may use the BNF at any time

DECISION OPTIONS

A Option A ☐

B Option B ☐

C Option C ☐

D Option D ☐

E Option E ☐

Case presentationA [age]-year-old [man/woman/child] presents to [location and situation] complaining of [symptom that might be used as the focus for one of the questions] etc. PMH. She/he has suffered from …. [describe any past medical history relevant to the scenario]. DH. She/he normally takes …. [list any current prescriptions]. SH. [include any relevant social history][Authors should try to adhere to this general layout but there is room for flexibility – the presentations should be fairly brief but identify the treatment for which a decision is required, the therapeutic indication and sufficient information about the patient to for the candidate to be able to identify the best decision option]

QuestionSelect the most appropriate decision option with regard to [the xxxx prescription/the treatment of xxxxxx] based on these data.(mark it with a tick)

Answer boxOption A Justification


Option B Justification









DATA INTERPRETATIONMANAGEMENT OPTIONS

A Option A ☐B Option B ☐C Option C ☐D Option D ☐E Option E ☐

List options in alphabetical order, starting with a lower case letter, unless option is a proper noun. Identify the correct answer by placing a tick in the column on the right.




DATA INTERPRETATIONAnswer boxOption A JustificationWrite a brief justification in this box

Option B JustificationWrite a brief justification in this box







Station Description Marks Nature of task

1 Prescribing 1 10 Suggest 1 drug


3 Prescription Review 1 8 Choose 1–3 options from 4–10

4 Planning Management 8 Choose 2 options from 5

5 Communicating Information 6 Choose 2 options from 5

6 Drug Calculation Skills 8 Calculate 1 value



9 Prescription Review 2 8 Choose 1–3 options from 4–10

10 Adverse Drug Reactions 8 Choose 2 options from 5

11 Drug Monitoring 8 Choose 2 options from 5

12 Data Interpretation 6 Choose 1 option from 5

TOTAL MARKS 100





ONE/TWO BEST ANSWER QUESTIONS

Identify the topic Ensure it is important, and not trivial Draw material from encounters with students who

are not certain to pass, such as: unexpected ignorance misconceptions errors of judgement

What precise knowledge do you wish to test? Limit question to single testing point





Write down the correct answer(s) Identify three/four plausible alternative

options that are: incorrect/clearly less correct than agreed answer not widely divergent not worded as ‘all/none of the above’





Build the stem as a fictional scenario that includes all the information necessary to choose the correct answer (and no more)

Check that: stem is written economically lead-in and options follow logically



prescribing skills assessment prescribing skills assessment training workshop psa question item...

Documents

question slide compilation

prescribing request

signed slide compilation

pain slide compilation

flexibility slide compilation

information63 question

question type

prescription review