Main Article Content

Vincent Wu
Oscar Chan
Simon R. Maxwell
Mitchell A. Levine
Dan Perri
Rolf J. Sebaldt
Bandar Baw
Anne Holbrook


Prescribing, medical students, clinical pharmacology, competency, validation



Prescribing is an essential skill for all physicians, built on knowledge of clinical pharmacology, therapeutics and toxicology across the life cycle. The decline in organized clinical pharmacology training in medical schools, combined with an expanding pharmacopeia and increasing complexity of patient care, makes prescribing competency difficult for medical students to master.


To develop and validate the McMaster Prescribing Competency Assessment (MacPCA), an online tool suitable for evaluating clinical pharmacology knowledge and prescribing skills of medical trainees in Canada.


The MacPCA was developed using an online examination platform scalable to multiple sites across Canada. Questions represented 8 domains of safe and effective prescribing with level of difficulty aimed at a final year medical student. Validation assessment concentrated on face and construct validity.


58 participants ( 7, 12 and 21 medical students in Years 1, 2, and 3, respectively and 8 undergraduate controls) were recruited. Mean scores were 31 % (SD 13.6) , 46% (SD 14.9), 75% (SD 8.3) and 81% (SD 10.5) for the controls, Year 1, Year 2, and Year 3 (final year) students, respectively. Combined Year 2/ Year 3 scores were significantly better than control /Year 1 scores (p<0.0001). Final year student feedback indicated the test was fair, clear and unambiguous, aimed at the right level, with sufficient time for completion.


The MacPCA demonstrated good face validity and successfully discriminated between upper year medical students and their junior colleagues. Further expansion of testing and validation is warranted.

Abstract 247 | PDF Downloads 141


1. Association of American Medical Colleges. Contemporary Issues in Medicine: Education in Safe and Effective Prescribing Practices. Washington DC: Association of American Medical Colleges, 2008.
2. Reidenberg, MM. A new look at the profession of clinical pharmacology. Clin Pharmacol Ther 2008 Feb;83(2):213- 7.
3. Dornan T, Ashcroft D, Heathfield H, et al. An in depth investigation into causes of prescribing errors by foundation trainees in relation to their medical education. EQUIP Study Final Report. http://www.gmc - of_prescribing_errors.pdf_28935150.pdf (August 2015).
4. Cadieux G, Tamblyn R, Dauphinee D, Libman M. Predictors of inappropriate antibiotic prescribing among primary care physicians. CMAJ 2007 Oct 9;177(8):877 –83.
5. Ben -David MF, Klass DJ, Boulet J, et al. The performance of foreign medical graduates on the National Board of Medical Examiners (NBME) standardized patient examination prototype: a collaborative study of the NBME and the Educational Commission for Foreign Medical Graduates (ECFMG). Medical Education 1999 Jun;33(6):439 –46.
6. Qayyum F, Wright M, Lee M, Leung C, Sada A, Holbrook A. Medical Student Opinions On Their Training In Clinical Pharmacology And Therapeutics. McMaster University Medical Journal 2012; 9(1):4 -8.
7. Heaton A, Webb DJ, Maxwell SR. Undergraduate preparation for prescribing: the views of 2413 UK medical students and recent graduates. Br J Clin Pharmacol 2008 Jul;66(1):128- 34.
8. Oshikoya K, Senbanjo IO, Amole OO. Interns’ knowledge of clinical pharmacology and therapeutics after undergraduate and on-going internship training in Nigeria: a pilot study. BMC Medical Education 2009 Jan;9:50.
9. Ross S, Ryan C, Duncan EM, et al. Perceived causes of prescribing errors by junior doctors in hospital inpatients: a study from the PROTECT programme. BMJ Qual Saf 2013 Feb;22(2):97- 102.
10. Frank JR, editor. The CanMEDS 2005 physician competency framework. Better standards. Better physicians. Better care. Ottawa: The Royal College of Physicians and Surgeons of Canada; 2005.

Most read articles by the same author(s)