The role of purple pens in learning to prescribe

Medical doctors are required to prescribe drugs safely and effectively upon qualification, a skill that many feel poorly prepared to undertake. To better prepare doctors, a whole-task approach that develops knowledge and skills, but that also considers the effect of the complex clinical workplace on prescribing, is optimal. We describe an evaluation of an experiential learning programme that allows senior medical students to gain experience with inpatient prescribing during their hospital assistantship.

A standard operating procedure (SOP) for medical student transcribing was implemented by the teaching hospitals associated with a single medical school. This included medical student prescriptions being written in purple ink. The evaluation consisted of an audit of transcribing activity and a student survey. We evaluated the usage of the initiative, adherence to the SOP and the propensity for error.

The survey was completed by 38 out of a possible 108 fifth-year students. All respondents agreed that the programme was helpful in aiding them to learn about prescribing. A total of 247 prescriptions for 50 patients were audited: 25.1% of the prescriptions written by students required some form of amendment by the supervising doctor or pharmacist; three (1.2%) prescription errors remained unidentified; and none presented a patient safety risk.

The purple-pen scheme affords medical students the opportunity to prescribe in the workplace, where they face authentic challenges when safely contributing to patient care. The identification of prescribing errors, feedback and the learners' own reflections helped the learners to focus on areas for improvement in prescribing prior to qualification.