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Is a short e-learning course effective at improving paediatric prescribing skills among foundation doctors? An open label randomised controlled trial
  1. M A Gordon1,
  2. P Baker2,
  3. M Chandratilake3
  1. 1Department of Paediatric Gastroenterology, Royal Manchester Children's Hospital, Manchester, UK
  2. 2Foundation School, North Western Deanery, Manchester, UK
  3. 3Centre for Medical Education, Dundee, UK

Abstract

Aims Junior doctors make many prescribing errors and these are the single biggest cause of critical incident reports in UK hospitals, occurring in up to 8% of prescriptions. Mortality and morbidity are known to result, with up to 7000 deaths per year in the USA attributed to such errors. The GMC has recommended improved prescribing be achieved via educational resources, such as e-learning. We designed an e-learning resource for paediatric prescribing and evaluated its effectiveness in a non-blinded randomised controlled fashion.

Method Using Gagne's nine events instructions as the educational basis, we developed a self-contained, downloadable flash programme consisting of relevant content from the Foundation curriculum. Optional self-assessment exercises, taking 1–2 h for participants to complete, were included. The content was reviewed by two paediatric pharmacists and piloted before delivery. Volunteer trainees in the North Western Foundation School were randomised for the study, after informed consent, which resulted in 86 in the control and 76 in the intervention groups. All participants were assessed on basic prescribing tasks and completed a prescribing habits/confidence questionnaire. The intervention group completed the e-learning exercise. 4 weeks later all participants were assessed on similar basic prescribing tasks and with the same habits/confidence questionnaire. The intervention group also gave feedback on the package.

Results Both groups showed no pre-intervention differences in their ability to perform the basic prescribing tasks (66.5% vs 66.4%, p=0.56). Post-intervention, the e-learning group scored significantly higher (62.7% vs 78.2%, p<0.0001), with improved confidence scores (p<0.0001). Participants reported changed prescribing behaviour, with significant decreases in the time prescribing was completed without reference materials in the intervention group (38% vs 30.1% p<0.05). The feedback on the e-learning exercise was highly positive with 87% recommending it to be mandatory for Foundation doctors.

Conclusions A short, educationally sound self-administered e-learning intervention can significant enhance the paediatric prescribing ability, confidence and practice among junior doctors over a significant period. The use of such a resource to train doctors prior to commencement of paediatric placements should have positive impact on patient safety. We plan to evaluate the long-term impact of this intervention.

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