Developing rational prescribing competence in medical school : an investigation of the relation between student perceptions and examination performance.

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

MEDICATION USE IN A SAMPLE OF COMMUNITY-DWELLING OLDER ADULTS

Objectives: To examine prevalence, changes and persistence of medication-use and potentially inappropriate medication-use at two time points in a sample of 176 participants of a falls-prevention program. Methods: Drug lists were formulated through in-person interviews. The Beers\u27 Criteria were used to categorize medications as potentially inappropriate. Results: Mean age of the sample was 79 (SD=6.3) years (range 47-100 years). Nearly two-thirds took at least one cardiac medication. Over 40% took an antithrombotic medication. One-quarter took a prescription central nervous system medication and about one in ten took an over-the- counter pain medication. At baseline, 17.6% reported the use of at least one inappropriate medication which decreased to 13.6% by the second assessment. Conclusions: This small study demonstrates varied prevalence and persistence among drug classes examined. Use of inappropriate medication decreased, but, since follow-up did not continue past one year, the persistence of these changes after the falls-prevention program ceased is unknown

Bard Observer, Vol. 10, No. 10

https://digitalcommons.bard.edu/observer/1491/thumbnail.jp

Face-to-face language learning at a distance? a study of a video conference try-out

Videoconferencing has been proposed as a technology which has an immediate and beneficial application to language learning, because it enables face-to-face communication at a distance. The costs remain high, however, and course providers need to be sure what additional 'pedagogical overheads' are involved, i.e. in the rethinking of teaching approaches and the preparation of material. This paper reports on a study of a videoconference tutorial carried out as part of the distance learning component of a course in Professional English. The study shows that the interaction between teacher, subject expert and students was characterised by the absence, as well as the presence, of important features of face-to-face communication, and that certain kinds of tutorial activity, such as individual correction, and the management of group discussion, were not especially well supported by the technology used. We discuss the implications of this for the pedagogy of language teaching by videoconference, and draw some lessons for the incorporation of the technology into the mainstream of distance language learning

Estimating the Irish public's willingness to pay for more sustainable salmon produced by integrated multi-trophic aquaculture

Integrated Multi-Trophic Aquaculture (IMTA) has been put forward as a potential sustainable alternative to single fin fish species aquaculture. In IMTA, several species are combined in the production process. Integrating species has a conceivable dual advantage; the environmental impact can be lowered through nutrient cycling and from an economic perspective there is potential for increased efficiency, product diversification and a higher willingness to pay for more environmentally friendly produced salmon. This paper presents the results from a choice experiment which examines whether the Irish public is willing to pay a premium for “sustainably produced” farmed salmon from an IMTA process. Uniquely, an ecolabel was used in the design, based on familiar energy rating labels, to communicate the environmental pressure of fish farming to respondents. The experiment demonstrates that the Irish public has a willingness to pay a price premium for sustainability in salmon farming and for locally produced salmon