Prescribing medicines is the primary intervention that most doctors offer to influence their patients’ health; however concerns have been expressed about the extent to which graduates are prepared by medical schools to assume prescribing responsibility. Both students and clinical teachers have identified a gap between workplace prescribing demands placed on newly qualified doctors and their preparation for this complex activity during undergraduate training. This study explored the exit-level prescribing performance of final-year students in the Graduate Entry Medical Programme at the University of the Witwatersrand compared with students’ perceptions of their prescribing competence. The results indicated a disparity between students’ competence and confidence. Examination marks showed that 83.6% of students were competent to prescribe according to the graduating standards of the University; however, questionnaire data revealed that 66% of students did not feel that their training had enabled them to prescribe rationally. This inconsistency was explored by analysis of the examination papers according to Bloom’s Revised and the SOLO Taxonomies. It was concluded that students score well on questions which test recall and application of knowledge, but some do not manage questions involving evaluation. Since prescribing is a complex skill that requires evaluative competence, this may explain why, despite high examination scores, students remain insecure. Exploration of the structure of knowledge through a Bernsteinian lens revealed that curricular components including problem-based learning and horizontal integration constrain epistemic access to the structure of rational prescribing knowledge for some students. It is recommended that rational prescribing skills should be taught as a synchronous strand within the curriculum, rather than in the current integrated mode. Learning could also be improved by innovative pedagogies associated with active learning and improved feedback.

Prescribing of drugs is an integral component of health care. In ideal situations drug prescribing constitute safe, effective, and inexpensive treatment alternatives for many conditions. However, poor and inappropriate prescribing is associated with illness and increased costs that can have an important impact at population level. Therefore, evaluation of the quality of drug prescribing is an important part of the process to improve quality in health care delivery. "Drug Utilisation 90%" (DU90) is an innovative approach to assess drug prescribing. Using this approach the drugs that represent 90% of the drug prescription/sales volume are identified. The rationale behind the development of DU90 rests on an assumption that a low number of products prescribed is associated with more rational prescribing practices. Furthermore, the approach can be used to asses what proportion of the drugs that represent 90% of the volume is made up by drugs recommended by local drug committees. In this essay, a feasibility study of DU90 is presented. Furthermore, the usefulness of DU90 as an indicator for quality assessment is discussed. It is concluded that DU90 does not directly reflect the quality of prescribing but it seems to be an useful tool in the quality assessment process through indicating areas that need to be analysed in more depth. The approach can be used for exploring drug prescribing data in a rapid, effective and inexpensive way / Läkemedelsförskrivningen är en viktig komponent inom sjukvården. Använd på rätt sätt är den en relativt säker, effektiv och mindre kostsam form av behandling jämförd med andra terapeutiska åtgärder. Utvärderingen av kvaliteten på läkemedelsförskrivningen är en viktig insats eftersom dålig läkemedelsförskrivning kan leda till onödig sjuklighet för patienten och ökade kostnader för samhället. Drug Utilisation 90 % (DU90) är en ny metod för utvärderingen av läkemedelsförskrivningen. Med hjälp av denna metod identifieras de läkemedel som utgör 90 % av förskrivnings/försäljningsvolymen. Konceptet har utvecklats baserat på antagandet att användning av få produkter är associerat med en mer rationell läkemedelsförskrivning. Baserad på DU90 kan även följsamheten till listan på rekommenderade läkemedel som utfärdas periodvis av Läkemedelskommittéerna, utvärderas inom 90 % av förskrivnings-/försäljningsvolymen. I denna uppsats presenteras en pilotstudie av användbarheten av DU90. Vidare diskuteras DU90 som indikator för kvalitetsutvärdering. Sammanfattningsvis dras slutsatsen att DU90 inte direkt reflekterar kvaliteten på läkemedelsförskrivningen men verkar vara ett användbart verktyg eftersom det kan ge värdefull indikation på terapiområden som behöver vidare analys. DU90 förefaller vara ett snabbt, effektivt och billigt instrument för utvärdering av förskrivningsdata. / <p>ISBN 91-7997-105-9</p>

Introduction During the last decades, proportion of geriatric patients in the world population increases. This phenonemon is caused particularly by advances in medical science, social care and working conditions. However, the problem still lies in a very frequent polypharmacotherapy and polymorbidity in older patients. With the aim to reduce the frequent adverse drug events in seniors, the explicite criteria of PIMs (potentially inappropriate medications) have been created. The aim of this work was to determine the registration rates of PIMs in several Eastern and Central European countries using all until now published 22 explicit criteria of potentially inappropriate medications in older patients that are available in published scientific literature. Methods A set of 345 PIMs gained from all explicit criteria published in peer- reviewed or impact factor journals by 2015 year and summarized in diploma thesis of S . Grešákové, MSc (defended in June 2016) was used in this work. Every drug has been included in the list only once, disregarding the other conditions of inappropriateness (e.g. drug-disease interactions, dosing schedules, etc.). The exception were PIMs available in non-sustained and sustained-release forms, because each of this drug form can be identified under a specific ATC code....