Appraising the curricula of UK non-medical prescribing programmes and its role in producing high-level prescribers

Omer, Usmaan N.

Abstract

In recent years, healthcare systems have sought to decrease workload pressures on doctors by expanding the authority to prescribe medications to other healthcare professionals. This authority is most advanced in the UK, where healthcare professionals including pharmacists, nurses, physiotherapists, optometrists, chiropodists, podiatrists, radiographers and dietitians can prescribe. They are referred to as non-medical prescribers (NMPs). Before NMPs can prescribe, they are required to undertake a specific short prescribing programme to obtain an independent prescribing qualification. With the increasing number of healthcare professionals able to prescribe in practice, there are various prescribing practice guidelines, but no overall consensus on the core qualities of a high-level, safe and rational prescriber, regardless of healthcare background. Additionally, there is a gap in knowledge and understanding around the teaching and educational approaches used by prescribing programmes which non-medical healthcare professionals undertake to obtain their independent prescribing qualification.
A programme of research was conducted to define the core categories of a high-level prescriber and then explore and appraise the teaching and educational approaches of UK NMP programmes and how they facilitate the development of students into high-level independent prescribers. The research began with a rapid review exploring innovative teaching approaches introduced to prescribing education worldwide in the last ten years. The review highlighted and compared the myriad of approaches used to teach prescribing, but it also highlighted the gap in literature around the training of NMPs. Study One involved a documentary analysis of national and international prescribing practice guidelines aimed at various healthcare professionals to define a universal set of core categories around high-level prescribing for prescribers of all backgrounds. Study Two used the results of Study One to inform semi-structured interviews with 16 NMP programme leads spread across the UK to obtain an understanding around the taught content, teaching approaches and overall logistical functioning of the NMP programme. Participants were also afforded the opportunity to offer their appraisals pertaining to the teaching approaches of the programme. Programme leads were recruited via email and interviews were conducted virtually using Zoom due to the constraints of the COVID-19 pandemic. Study Three involved recruiting 18 graduates of various NMP programmes spread across the UK. These were recruited through a snowball sampling strategy with the aid of programme leads interviewed in Study Two. Graduates undertook a two-part interview, part one involved a vignette exercise, where participants were presented with prescribing case scenarios for which they would verbalise their prescribing decisions. This was an opportunity for participants to demonstrate the extent to which they displayed the qualities of high-level prescribing defined in Study One. Part Two of the interview involved a traditional semi-structured interview, where participants appraised the teaching approaches of the programme and how they helped or hindered development of their prescribing practice.
The core categories of high-level prescribing were defined as being knowledgeable, safe, communicative and contemporary. NMP programmes use a range of teaching approaches to inculcate these core qualities of prescribing into their students and utilise stringent assessment approaches to ensure prescribers qualify from the programme with these core qualities, however, despite certain differences in perspectives, both programme leads and graduates highlighted major areas where the teaching approaches and overall functioning of the NMP programme could be improved. Subsequently, these perspectives were used to inform a set of recommendations aimed at optimising the delivery of teaching on NMP programmes. Increasing innovative educational approaches such as flipped classroom, blended learning and simulation-based education will enhance the learning experiences of students on the programme and subsequently their skill and competency. Enhancing the roles of Practice Supervisors as teachers will increase the prescribing knowledge of students in their own area and fulfil the core category of being a knowledgeable prescriber. A widespread implementation of formative OSCEs would be an effective means for students to review and appraise their own prescribing practice before completing the programme. Finally, increasing continuing professional development post-qualification will ensure prescribers will be able to update and enhance their prescribing skills as they progress in their careers.
Future research aimed at comparing prescribing practices of NMPs before and after implementation of these recommended changes would be beneficial and additionally, this programme of study can serve as a starting point for countries looking to expand prescribing authority and subsequently develop a specific curriculum of study for these non-medical healthcare professionals.

Citation

Omer, U. N. Appraising the curricula of UK non-medical prescribing programmes and its role in producing high-level prescribers. (Thesis). Hull York Medical School, the University of Hull and the University of York. https://hull-repository.worktribe.com/output/4224134

• Thesis Type: Thesis
• Deposit Date: May 6, 2022
• Publicly Available Date: Feb 24, 2023
• Keywords: Medicine
• Public URL: https://hull-repository.worktribe.com/output/4224134
• Additional Information: Hull York Medical School, The University of Hull and the University of York
• Award Date: Jan 1, 2022