Medical students' errors in pharmacotherapeutics

Objectives This study analysed the errors made by 16 final‐year medical students in a classroom prescribing exercise. The aim was to gain greater understanding of the reasons for non‐optimal prescribing and of how to improve basic training in pharmacotherapeutics. Methods The task was to adjust a patient’s phenytoin sodium dosage to achieve better control of seizures. It was based on a real‐life case, and was presented as a written exercise. Process‐tracing and think‐aloud techniques were used to study the students’ performance. Results The results suggest that the root cause of the errors was lack of a knowledge base which integrated scientific knowledge with clinical know‐how. Three different clinical reasoning strategies were observed. Students who followed an incremental strategy demonstrated superior scientific knowledge and this resulted in less hazardous errors. Those who followed gambling or backward‐reasoning strategies appeared to possess inferior scientific knowledge and this resulted in more hazardous errors. Conclusions The results support current trends towards integrating basic medical science into a foundation of clinical know‐how, as in the problem‐based curriculum. They also emphasize the importance of a thorough grounding in medical science as a means of minimizing error.