Pharmacist-led prescription writing educational intervention to final-year medical students: A pre-post non-randomised longitudinal study

Sophie Mokrzecki; Tarun Sen Gupta; Tilley Pain; Stephen Perks; Andrew J. Mallett

doi:10.12688/f1000research.163920.1

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Study Protocol

Pharmacist-led prescription writing educational intervention to final-year medical students: A pre-post non-randomised longitudinal study

[version 1; peer review: 1 not approved]

Sophie Mokrzecki ^1,2, Tarun Sen Gupta², Tilley Pain^3,4, Stephen Perks¹, Andrew J. Mallett^2,5,6

Sophie Mokrzecki ^1,2, Tarun Sen Gupta², [...] Tilley Pain^3,4, Stephen Perks¹, Andrew J. Mallett^2,5,6

PUBLISHED 12 Jun 2025

Author details Author details

¹ Pharmacy Department, Townsville University Hospital, Townsville, Queensland, 4814, Australia
² College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
³ College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD, Australia
⁴ Allied Health Governance Office, Townsville University Hospital, Townsville, QLD, Australia
⁵ Department of Renal Medicine, Townsville University Hospital, Townsville, QLD, Australia
⁶ Institute for Molecular Bioscience and Faculty of Medicine, The University of Queensland, Saint Lucia, Queensland, Australia

Sophie Mokrzecki
Roles: Conceptualization, Funding Acquisition, Investigation, Methodology, Project Administration, Resources, Software, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing

Tarun Sen Gupta
Roles: Supervision, Validation, Visualization, Writing – Review & Editing

Tilley Pain
Roles: Supervision, Writing – Review & Editing

Stephen Perks
Roles: Investigation, Methodology, Resources, Software, Supervision, Validation, Visualization, Writing – Review & Editing

Andrew J. Mallett
Roles: Methodology, Supervision, Validation, Visualization, Writing – Review & Editing

OPEN PEER REVIEW

REVIEWER STATUS

Abstract

Background

Writing a medication prescription is a multifaceted skill expected of all junior doctors. However, many medical students feel a lack of preparedness and confidence after graduation. Separating the teaching of practical and clinical components may enhance understanding of the practical skills prior to integrating clinical knowledge to complete a prescription.

This study aimed to: (1) assess whether pharmacist-led multimodal education interventions change the prescribing skills of Australian final-year medical students, (2) evaluate knowledge retention a year later in the same participants as junior doctors, and (3) determine whether there is an association between self-perceived confidence to prescribe and their practical ability to write safe and legal prescriptions. This manuscript details the methods used in this novel longitudinal study.

Methods

This non-randomised pre-post longitudinal study will be conducted in two phases. The control group received standard curriculum-based education. The intervention was pharmacist-led multimodal education on prescription writing skills for final-year medical students. The intervention group completed the pre-post and follow-up tests.

This study was approved by the James Cook University Human Research Ethics Committee (approval number H9114).

Discussion

This paper presents the methods and protocol of an approved and funded non-randomised longitudinal study to investigate the potential of pharmacist educators to improve prescribing knowledge and skills among final-year medical students in Australia. Prescribing skills education for medical students may reduce the probability of potentially incorrect or unsafe prescribing habits as junior doctors. Education standards do not acknowledge adherence to local legal regulations when prescribing and do not recommend mandatory teaching or assessment criteria. This study will review the effectiveness of and need for additional education on the practical skill of writing a medication prescription. If positive, the findings of this study will have practical and policy impacts that may result in long-term improvement in safe medicine practice and ultimately benefit patient care.

Keywords

Medical students, Prescriptions, Pharmacists, Medical education

Corresponding author: Sophie Mokrzecki

Competing interests: No competing interests were disclosed.

Grant information: This study was funded by an approved and competitively awarded grant: 2023 and 2024 Townsville Hospital and Health Service (THHS) Study Education and Research Trust Account (SERTA) Grants. AJM was supported by a Queensland Health Advancing Clinical Research Fellowship.
The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Copyright: © 2025 Mokrzecki S et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

How to cite: Mokrzecki S, Sen Gupta T, Pain T et al. Pharmacist-led prescription writing educational intervention to final-year medical students: A pre-post non-randomised longitudinal study [version 1; peer review: 1 not approved]. F1000Research 2025, 14:581 (https://doi.org/10.12688/f1000research.163920.1) First published: 12 Jun 2025, 14:581 (https://doi.org/10.12688/f1000research.163920.1) Latest published: 12 Jun 2025, 14:581 (https://doi.org/10.12688/f1000research.163920.1)

Introduction

A medication prescription is a legal document that only approved prescribers may authorise, ensuring the safe use of medicines. Writing a medication prescription is a multifaceted skill incorporating multiple layers and dimensions (Figure 1). While it is a competency expected of all junior doctors, many medical students feel a lack of preparedness and confidence in completing a medication prescription after graduation.^1,2 Unpreparedness may occur because of an unclear definition of the term ‘prescribe’ resulting in medical education governing bodies and providers not developing clear strategic learning and assessment resources³ to teach the different aspects of prescribing.

Figure 1. Infographic describing the characteristics of what makes prescribing medication for the consumer multilayered and multidimensional (reproduced with permission)².

The definition of ‘to prescribe’ varies internationally based on local legislative or professional requirements.^4,5 Here, we describe a prospective research study and intervention that will be conducted in Australia where the Health Workforce Australia definition of prescribe will be used: ‘the process involving information gathering, clinical decision making, communication and evaluation, resulting in the initiation, continuation or cessation of a medicine’.⁴ This definition aligns with the steps within the medication management pathway⁶ as recommended by the Australian Commission on Safety and Quality in Health Care, ensuring the safe and quality use of medications. The medication management pathway describes prescribing as multilayered (Figure 1),⁶ grouping clinical and practical knowledge and calling the combined process “prescribing.” We previously proposed that education may be designed to teach the technical and practical skills of prescribing independently from clinical decision-making by separating the two components.² Separating the multilayered prescribing pathway allows education systems to restructure and develop specific learning objectives for the practical skill of writing medication prescriptions. Teaching the practical and clinical components separately may enhance the understanding of the practical skill of prescribing, prior to integrating the clinical knowledge of prescribing into the completed prescription.

Prescribing is also multidimensional (Figure 1), with differences between inpatient ordering and writing outpatient or discharge prescriptions. Targeted education on the practical skill of writing a discharge or outpatient prescription is less than that on inpatient medication ordering.^2,7 Education on one type of medication authorisation fails to prepare future prescribers across other contexts or scenarios of medication authorisation and prescription. It is critical for medical students to gain knowledge and skills in prescription writing throughout their medical training so that they understand, and can apply, the fundamentals of prescription and medication supply authorisation by the time of graduation.⁸ It is assumed that this knowledge and understanding will produce efficient, safe, and legal prescribers using all prescribing domains (electronic and handwritten). Sound awareness of the fundamentals of a prescription may reduce prescribing errors when using unfamiliar systems to prescribe.

Influencing early awareness of safe and legal prescribing can be challenging. Many educational interventions target junior doctors, with less emphasis on educating medical students. Differences in medical education curricula (e.g., postgraduate versus undergraduate courses and varying length of university degrees), and assessable criteria may contribute to inconsistent prescribing skills of graduates and thus, possible inadvertent medication errors or harm. These education shortfalls may increase medication misadventure, harm to patients and costs on health systems.^9,10 The World Health Organisation (WHO) Guide to Good Prescribing (GGP) is a well-known and well-utilised resource in medical education curricula worldwide. The GGP is a 6-step therapeutic problem-solving guide for teaching prescribing to medical students internationally but is not mandatory. It proposes that clinical training focuses on diagnostic rather than therapeutic skills and acknowledges that prescribing skills do not improve much after graduation.⁹ We recommend mandatory training on the practical skill of prescribing while acknowledging the importance of therapeutic knowledge. The identified gap in medical education is in teaching the skill of writing a discharge or outpatient medication prescription.

We have previously identified that Australian and New Zealand (NZ) final-year medical students prefer pharmacists to provide multimodal education on prescription writing.² Students in their final year of medical school training are likely motivated to actively engage in prescription education and training, given the proximate need to independently apply the knowledge in their subsequent first postgraduate or internship year. To our knowledge, no studies have investigated the incorporation of a pharmacist educator with multimodal learning resources for final-year medical students to improve multilayered and multidimensional prescribing skills across potential outpatient and discharge prescription settings.

In this study, we built upon previous pilot findings^2,11 to conduct a pre-post non-randomised longitudinal study of a pharmacist educator who developed prescription education interventions for final-year medical students in Australia. Our primary objective is to assess whether a pharmacist-led multimodal education intervention changes the discharge/outpatient prescribing skills of final-year medical students, at James Cook University (JCU), Australia. Our secondary aim was to review knowledge retention of prescribing skills in the same participants a year later as junior doctors. Thirdly, we aimed to determine if there is an association between participants’ self-perceived confidence in prescribing and their practical ability to write safe and legal discharge/outpatient prescriptions. This manuscript describes in detail the methods used in this novel longitudinal study.

Protocol

Study design

This non-randomised pre-post longitudinal study was conducted in two phases (Figure 2). The control group consisted of students who received curricula-based education throughout their medical degree. The intervention was pharmacist-led multimodal education on prescription writing skills for final-year medical students. This is a non-randomised study based on ethics, fairness, and logistics of conducting the intervention over vast geographical locations to ensure that information sharing did not contaminate the collected data.

Figure 2. Design structure of two-phase non-randomised pre-post longitudinal review study.

Phase 2A

Baseline data collected in 2023 assisted in the content validity of this two-phase study, informing phase 2B. This phase acted as the control, ensuring that students’ prescribing skills are comparable at similar time points, both between calendar years and prior to the educational intervention.

Phase 2B

This interventional phase formed the pre-post design of this study in 2024. The principal investigator is a pharmacist who developed and led the multimodal educational intervention conducted after the pre-test. Participants attended a 5-week placement block prior to completing the post-test.

Phase 3

Participants who acknowledged their participation in phase 3 will have voluntarily provided a contact email after completing phase 2B. A follow-up test in 2025 will result in the longitudinal design of this study.

Study setting

This study is developed and conducted in Queensland (QLD), Australia, through the Medical School Program of the JCU College of Medicine and Dentistry. Bachelor of Medicine, Bachelor of Surgery at JCU is a 6-year undergraduate course. The course includes face-to-face and case-based learning modalities with mandatory clinical placements. Like other Australian medical schools, it undergoes periodic review and accreditation by the Australian Medical Council.

Participants

As the recruited medical school, convenience sampling will be used to invite all JCU final-year medical students based in Townsville, Cairns, Mackay, rural and remote locations, and on their elective rotation. JCU medical students not in their final year of medical education or from other universities were excluded from this study. This study will also exclude junior doctors from 2025 who were not actively involved in phase 2B during 2024. All participants were required to provide written informed consent in each phase by completing a mandatory field when commencing the test and accepting to participate.

Phase 2A of this study was conducted in 2023 with JCU final-year medical students. This was the baseline data collection comparator for the phase 2B pre-test. Participation was voluntary and anonymous. This cohort will not be included in the interventional study.

Using G*Power version 3.1.9.4, this study will require 76 participants. However, factoring in a 25% dropout rate, a total of 95 students was an ideal sample size. Between 2023 and 2024, there will be approximately 170 year-6 (final-year) medical students enrolled at JCU. Our randomised controlled trial pilot study produced a difference in the total mean score of eight points between groups.¹¹ However, the pilot study involved a very small sample size, so the lower bound of the 95% confidence interval for the mean difference was substantially less (approximately 3); therefore, a conservative approach requires a sample size large enough to allow a difference as small as 3 to be detected. This was based on a two-tailed test with an alpha of 5% and power of 80%. This difference in prescribing scores is clinically meaningful and relevant to practice based on the literature.^11,12

We previously identified final-year medical student’s preference for prescription writing education is during the final year of medical education.² Phase 2B will include the JCU final-year medical student cohort of 2024 from July to August. The consenting Phase 2B cohort will form the participant group for phase 3 in 2025 as junior doctors (interns). In the Australian context, the intern year is the first postgraduate year (PGY1) after completion of medical school and is completed in accredited hospitals and health services in accredited programs with provisional registration from the national clinician registration body (Australian Health Practitioner Regulation Agency - AHPRA). Progression to general registration as a medical officer is conditional upon the successful completion of all the required rotations in an accredited intern program.

Voluntary participation in phase 2B and phase 3 will not be anonymous to ensure that data can be paired to assist with the analysis. Data from phase 2B and phase 3 will be presented in de-identified formats.

Intervention

Intervention and assessment criteria will hold specificities to local state legal regulation of the Medicines and Poisons (Medicine) Regulation (MPR) 2021. Some participants may have been on placement in other locations external to QLD at the time. However, as their medical degree is based through JCU QLD, all educational materials and assessable criteria will adhere to QLD regulations.

Education modalities

Mokrzecki et al. phase-1 study identified that final-year medical students’ preference would be a multimodal education package on the skill of prescription writing delivered by a pharmacist during placement with hands-on experiences and tutorials.² These preferences assisted in developing the intervention methods presented. Final-year medical students from 2023 (Phase 2A) completed only the online prescription writing test to ensure content validity during the intervention phase (phase 2B). Phase 2A testing was conducted in a whole cohort session, where participants were then offered the face-to-face education package to meet ethics criteria.

This study aims to cover all factors by providing face-to-face education with case-based learning and hands-on experiences (roughly 1.5 h), supported by an online learning module (roughly 30 min), implemented during a five-week placement block (Figure 2).

Education will be provided by a pharmacist regarding the skill of writing a prescription, separate from the clinical decision-making process within the medication management pathway. Education materials will be supported by resources such as the MPR, Pharmaceutical Benefits Scheme (PBS), and the Australian Medicines Handbook (AMH). To assess the content and remove bias from having one pharmacist educator, this intervention recruited two other pharmacists to deliver the intervention to the participants in Cairns and Online. All trainers underwent training by SM to ensure consistency in education delivery.

The effects of this multimodal education package on prescribing skills will be determined by assessing participants pre-post the intervention, and again as junior doctors (intern year).

Online learning module

The online education is an interactive learning module developed through Articulate^® by SM and launched online on LearnJCU^® (digital learning environment utilised by JCU) after students complete the pre-test. It is an overview of the face-to-face education that participants were encouraged to complete. Participants could engage with the content as many times as they wished during the five-week placement period. Access to the content closed immediately before completing the post-test.

Face-to-face education

Face-to-face education consisted of an interactive hands-on teaching model, first reviewing the legal requirements of a prescription from the Queensland MPR. This will guide case-based learning into training functionalities of the PBS and AMH, and how using these resources assist in writing medication prescriptions.

Hands-on opportunities

During face-to-face education, cases are used to assist participants in learning and practicing how to write various medication prescriptions. Participants will also engage with the interactive features of the online learning module to complete Schedule 4 (prescription-only medication) and Schedule 8 (controlled drug) medication prescriptions. All prescription writing cases used during the educational interventions and the pre-post and follow-up tests will differ.

Assessment and data collection methods

To our knowledge, no assessment tool has been developed that has the functionality to assess the skill of writing a complete discharge or outpatient medication prescription separate from making a clinical decision or inpatient medication ordering. The assessment tool developed for this study was conceptualised by the principal investigator (SM), based on the MPR requirements, and approved by all authors (Figure 3). A pilot study by Mokrzecki et al.¹¹ and some of the preliminary questions of Mokrzecki et al.² assisted in the development of all test questions in each phase. Qualtrics^® is a web-based software used by SM to roll out the online test, allowing participants to type and submit a complete medication prescription online without prompting through an online formulary. Qualtrics data can be imported into Microsoft Excel and an appropriate statistical software system for analysis.

Figure 3. Copy of phase 2A written case showing an example of similar Schedule four prescription cases in each phase.

Four other cases (complex S4, S4 streamline, S8 and mixed), are not displayed.

Online prescription writing assessment consists of preliminary questions and five cases yielding six prescriptions (Figure 3). All tests will have different cases used; however, each test will consist of Schedule 4 (S4), complex S4, S4 streamline, Schedule 8 (S8), and mixed (S4+S8) cases. After writing each prescription, participants were asked if they were confident that their prescription was legal and safe by stating ‘confident’ or ‘not confident’.

Each prescription is critiqued according to set criteria as per the legal MPR, which must be adhered to when prescribing in QLD. Within this criterion, four domains were established by the authors for the purposes of this study (DPSP – six drug factors, five prescriber factors, four safety factors, and three patient factors), which are listed in Table 1. To our knowledge, this is the first study to develop an assessment rubric or framework to critique discharge/outpatient prescriptions. This novel assessment framework will not require validation, as data collection is based on local legal regulations and guidelines of assessment rather than the establishment of a research tool.

Table 1. DPSP criteria.

Drug factors

Prescriber factors

Safety factors

Patient factors

1. Name
2. Strength
3. Dose/Form
4. Directions
5. Quantity
6. Repeats

1. Name (with unique identifier – prescriber number)
2. Signature
3. Place of practice address
4. Contact number
5. Qualifications

1. Prescription date
2. Legible and approved abbreviations
3. PBS/non-PBS eligible
4. Extra S8 prescription requirements (quantity in words and figures)

1. Name
2. Home address
3. Date of birth (if monitored medicine/S8 prescription)

Measuring the effectiveness - comparisons

Two control points were used for data collection. The first control will be the year 2023 phase 2A cohort. This phase established the usability and data extraction of the test. The second control will be the 2024 Phase 2B cohort pre-test, with comparison made to both phase 2A and phase 2B participants’ post-test data. This ensures that participants are comparable from 2023 to 2024 with similar baseline knowledge and tests the outcome of possible changes in prescribing skills after the intervention phase.

The analysis of knowledge retention involves a comparison of phase 2B data to phase 3 data. The three time points (pre-post-longitudinal, see Figure 2) will assist in the analysis and possible justification of the three factors: the educator, education modalities, and when the education is delivered during the medical degree.

Proposed data analysis

Identifiable data for phase 2B and phase 3 were collected to perform paired data analysis. All quantitative data analyses will be presented and published in a de-identified manner.

The following datasets will be compared and analysed, where a P value <0.05 is considered statistically significant in all cases:

- Dispensability: Phase 2A to phase 2B pre-data, phase 2B pre-post-data, and phase 2B pre-post-data to phase 3.
- Compare data within phase 2B.
- Compare phase 3 to phase 2B pre-post data.
A new numerical variable may be created in calculating the difference in scores (between and within pre-post phase 2B and phase 3). Therefore, this may also be tested to determine whether the results are normally distributed. Further analysis will be undertaken to seek specific insights into the relative confidence in prescribing abilities in relation to script correctness.

Ethics approval

This study was approved by the JCU Human Research Ethics Committee on June 15^th, 2023 (approval number H9114). JCU Medical School provided written support for the principal investigator to conduct this study. Medical Deans Australia and New Zealand were aware of this study and provided written support in conducting phase-1 (information not provided in this paper). No further site-specific approvals were required as each study location used JCU clinical medical school resources. Research carried out for this study adhered to the Declaration of Helsinki.

Dissemination

As the principal investigator, SM completed this study for the purposes of her Doctor of Philosophy (PhD). SM undertakes this as a PhD by publication; therefore, all results will be disseminated by publication and presentations in addition to the final thesis. Data sharing is not yet applicable, as no dataset has been generated or analysed during the publication of this current paper (excluding phase-1, not presented).² Future datasets that are generated and/or analysed will not be publicly available because of confidentiality but may be available from the corresponding author upon reasonable request.

Study status

Data collection for phase 3 of this study is currently ongoing and is expected to be completed by August 2025, at which point the study will conclude.

Discussion

Early prescribing skills education for medical students may reduce the probability of potentially incorrect or unsafe prescribing habits.^8,9 Australian medical education clinical practice standards explain prescribing as graduates’ ability to appropriately, effectively, and sustainably prescribe in line with quality and safety frameworks and clinical guidelines.¹³ This standard does not acknowledge adherence to local legal regulations when prescribing and does not recommend mandatory teaching or assessment criteria. In Australia, it is not yet mandatory for medical graduates to successfully complete a prescribing competency exam to gain conditional or general registration with the AHPRA. Unclear resources to guide the teaching and assessment of prescription writing can result in inconsistent and possibly unsafe prescribing practices among medical graduates.

A similar pilot study presented the risks and benefits of a randomised controlled trial.¹¹ The main limitation of this study was its small sample size. Owing to this and other identified risks, we have designed a longitudinal non-randomised study underpinned by high calibre methods to generate robust and generalisable data that will answer the study aims.

This study is the first to investigate whether pharmacist-led multimodal education interventions change the prescribing skills of JCU final-year medical students. In addition, we will determine the participants’ knowledge retention by following them up a year later as junior doctors in their intern year. Therefore, this study will review the effectiveness of and need for additional education on the practical skill of writing a discharge/outpatient medication prescription. Furthermore, this study will assess participants’ self-perceived confidence in relation to their prescribing skills. We will explore the Dunning-Kruger effect whereby participants pre-prescribing skill compared to their post-prescribing skill, and a self-assessment of confidence will determine the estimation of their abilities in relation to their competence.

The potential limitations of this study include the non-randomisation of participants, recruitment from one university within one state of Australia (QLD), and data collection at only one time point within the intervention year. The limitations of this study have been assessed, and justifications were made to assist in removing bias. Therefore, the strengths of this study include recruiting one university that has students enrolled and conducting placement over several locations (local, rural, remote, and elective rotations) across multiple hospitals and health services, and diverse geography. The educational interventions were offered face-to-face and online in a virtual setting, again removing bias by not excluding participants based on location and allowing for collection of this data through a questioning technique within the preliminary questions of the test. High-standard data collection methods adhering to QLD legal regulations ensures integrity. Non-randomisation and one time-point data collection after participants have undertaken a minimum of three final year medical school clinical rotations have been carefully considered and proposed as appropriate methodological factors given the participant cohort to ensure that information sharing will not contaminate the collected data. Review and approval by the Human Research Ethics Committee and grant review panel of the funder further supported this proposal.

Engagement with stakeholders has been key to the design of the proposed study. The research team consulted experts where appropriate to conduct and report on the topic. Support was provided by Medical Deans Australia and New Zealand, and JCU Medical Deans. The methodology of this study was strongly considered and evaluated by the investigator team, medical education experts, and statisticians to ensure rigor. Results from each phase of the study will be disseminated through appropriate presentations and publications and will inform any methodological modifications that might become unexpectedly indicated.

In summary, we presented the methods and protocol of an approved and funded non-randomised longitudinal study to investigate the potential of pharmacist educators to improve prescribing knowledge and skills among Australian final-year medical students. If positive, the findings of this study will have practical and policy impacts that may result in long-term improvement in safe medicine practice and ultimately benefit patient care.

Declarations

Consent

Participants partaking in this voluntary study provided informed consent. Additionally, before beginning each test, participants were required to provide consent to participate by completing a mandatory acknowledgment field. This process served as a form of written consent.

Participants were advised that de-identified data would be used in research publications and reports as outlined to them prior to consenting to start the voluntary test and interventions.

Clinical trial number

Not Applicable.

Pre-print

This paper has been accepted as a pre-print:¹⁴ Sophie Mokrzecki, Tarun Sen Gupta, Tilley Pain et al. Pharmacist-led prescription writing educational intervention to final-year medical students: A pre-post nonrandomised longitudinal study, 18 February 2025, PREPRINT (Version 1) available at Research Square [https://doi.org/10.21203/rs.3.rs-5823347/v1].

Data availability statement

No data is associated with this article.

Acknowledgements

The authors would like to acknowledge the contributions and assistance of Dr. Sarah Chalmers, Leanne Southgate, Associate Professor Zaf Smith, Ms. Bronwyn Howes, JCU Medical and Clinical School, TUH Pharmacy Department, participating JCU medical students, Haley Plaza, and Vaughan Schipplock. All those listed are aware and have granted permission to have their names and affiliations listed.

References

1. Australian Medical Council, Medical Board of Australia: Australian Medical Council and Medical Board of Australia’s Preparedness for Internship Survey.2019. Reference Source
2. Mokrzecki S, Perks S, Pain T, et al.: Australian and New Zealand medical students’ confidence and preparedness to prescribe. BMC Med. Educ. 2025; 25: 536. Publisher Full Text
3. Newble D, Dawson B, Dauphinee D, et al.: Guidelines for assessing clinical competence. Teach. Learn. Med. 1994; 6(3): 213–220. Publisher Full Text
4. Health Workforce Australia: Health Professionals Prescribing Pathway (HPPP) Project - Final Report.2013.
5. NPS MedicineWise: Prescribing Competencies Framework: Embedding quality use of medicines into practice. Sydney: 2nd ed. 2021.
6. Australian Commission on Safety and Quality in Health Care: Safety and Quality Improvement Guide Standard 4: Medication Safety (October 2012). Sydney: ACSQHC; 2012.
7. Mokrzecki S, Mallett AJ, Sen Gupta T, et al.: Do educational interventions improve prescribing skills of medical students compared to no additional learning? A systematic review. Med. Educ. Online. 2023; 28(1). PubMed Abstract | Publisher Full Text | Free Full Text
8. Malca CM, Siccha SC, Cardenas FE, et al.: Improvement in drug prescription skills in medical students through in-person and remote simulated interviews. Preprint. medRxiv. 2023. Publisher Full Text
9. De Vries TPGM, Henning RH, Hogerzeil HV, et al.: Guide to good prescribing: a practical manual.1994. Reference Source
10. Haque M: Good prescribing to maximize patient benefit. Int. J. Nutr. Pharmacol. Neurol. Dis. 2018; 8(3): 67–69. Publisher Full Text
11. Mokrzecki S, Pain T, Mallett AJ, et al.: Pharmacist-Led Education for Final Year Medical Students: A Pilot Study. Front. Med. 2021; 8(732054). PubMed Abstract | Publisher Full Text | Free Full Text
12. Garbutt JM, DeFer TM, Highstein G, et al.: Safe Prescribing: An Educational Intervention For Medical Students. Teach. Learn. Med. 2006; 18(3): 244–250. Publisher Full Text
13. Australian Medical Council: Standards for Assessment and Accreditation of Primary Medical Programs 2023.July 2023. Accessed September 2023. Reference Source
14. Mokrzecki S, Gupta TS, Pain T, et al.: Pharmacist-led prescription writing educational intervention to final-year medical students: A pre-post nonrandomised longitudinal study, 18 February 2025, PREPRINT (Version 1). Research Square. Publisher Full Text

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Version 1

VERSION 1 PUBLISHED 12 Jun 2025

Author details Author details

¹ Pharmacy Department, Townsville University Hospital, Townsville, Queensland, 4814, Australia
² College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
³ College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD, Australia
⁴ Allied Health Governance Office, Townsville University Hospital, Townsville, QLD, Australia
⁵ Department of Renal Medicine, Townsville University Hospital, Townsville, QLD, Australia
⁶ Institute for Molecular Bioscience and Faculty of Medicine, The University of Queensland, Saint Lucia, Queensland, Australia

Sophie Mokrzecki
Roles: Conceptualization, Funding Acquisition, Investigation, Methodology, Project Administration, Resources, Software, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing

Tarun Sen Gupta
Roles: Supervision, Validation, Visualization, Writing – Review & Editing

Tilley Pain
Roles: Supervision, Writing – Review & Editing

Stephen Perks
Roles: Investigation, Methodology, Resources, Software, Supervision, Validation, Visualization, Writing – Review & Editing

Andrew J. Mallett
Roles: Methodology, Supervision, Validation, Visualization, Writing – Review & Editing

Competing interests

No competing interests were disclosed.

Grant information

This study was funded by an approved and competitively awarded grant: 2023 and 2024 Townsville Hospital and Health Service (THHS) Study Education and Research Trust Account (SERTA) Grants. AJM was supported by a Queensland Health Advancing Clinical Research Fellowship.
The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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Published: 12 Jun 2025, 14:581

https://doi.org/10.12688/f1000research.163920.1

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© 2025 Mokrzecki S et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Mokrzecki S, Sen Gupta T, Pain T et al. Pharmacist-led prescription writing educational intervention to final-year medical students: A pre-post non-randomised longitudinal study [version 1; peer review: 1 not approved]. F1000Research 2025, 14:581 (https://doi.org/10.12688/f1000research.163920.1)

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Reviewer Report 05 Sep 2025

David Newby, University of Newcastle, Newcastle, New South Wales, Australia

Not Approved

https://doi.org/10.5256/f1000research.180341.r391881

This study addresses a meaningful gap in the literature, given the limited evidence on the effectiveness of pharmacy-led prescribing training—or prescribing education more broadly. Considering that prescribing is a routine yet high-stakes task for junior doctors, often performed independently and ... Continue reading

This study addresses a meaningful gap in the literature, given the limited evidence on the effectiveness of pharmacy-led prescribing training—or prescribing education more broadly. Considering that prescribing is a routine yet high-stakes task for junior doctors, often performed independently and under pressure (e.g., during night shifts with minimal support), the topic is clearly relevant. That said, I’m unsure whether the study design will allow for a clear demonstration of impact, particularly in the absence of a comparator group. Including such a group could strengthen the study’s ability to attribute outcomes directly to the intervention..

Background:
The study protocol effectively highlights the importance of prescribing training for undergraduate medical students, noting both the current gaps in formal education and the lack of confidence among new graduates in prescribing tasks. The authors also reference their own work to support the value of pharmacist-led prescribing training, which appears to be well-received by students. Additionally, the background insightfully points out that most prescribing education focuses on inpatient scenarios, with limited attention given to outpatient or discharge prescribing—an area that deserves more emphasis.

While the aims of the study are reasonably well-articulated, I have some concerns about whether the proposed methods will adequately address these aims.

Study design:
The protocol outlines a two-phase study: Phase 2A and 2B focus on the immediate impact of a pharmacist-led prescribing intervention on undergraduate medical students, while Phase 3 aims to assess retention of this impact one year post-graduation. However, the role of Phase 2A remains unclear. The authors describe it as contributing to ‘content validity’ and also refer to it as a ‘comparator’ group. Yet, based on the description and Figure 2, Phase 2A participants only complete a pre-test and are not followed up after their 5-week placement (unlike Phase 2B participants). This limits their utility as a true comparator group.

Moreover, the manuscript states that comparisons will be made between post-test data from both Phase 2A and 2B participants. However, Figure 2 shows that Phase 2A participants only complete a single test (equivalent to the pre-test I presume). As described, this appears to be a single-arm pre-post study, which limits the ability to attribute any observed changes in prescribing to the intervention itself. It remains possible that improvements are due to the placement experience rather than the intervention, given the absence of a comparable group that underwent the same placement without the intervention. This represents a significant limitation in the study design. It seems that Phase 2A data are primarily used to establish baseline equivalence with Phase 2B, but without follow-up, their relevance is questionable.

A broader concern is the inconsistent use of tense throughout the manuscript. For example, the methods section refers to the study in the past tense (“This non-randomised pre-post longitudinal study was conducted…” p.4), while later sections use the future tense (“Phase 2B will include the JCU final-year medical student cohort…” p.6). It is clear from the manuscript that this is not a proposed ‘protocol’ – rather it is a half-completed study (i.e. Phase 2A and 2B have been completed). This raises questions about the appropriateness of presenting this as a protocol. Typically, protocols are published prior to study commencement to allow transparency and pre-specification of methods. If Phases 2A and 2B are already complete, the rationale for publishing this as a protocol—beyond outlining Phase 3—is unclear.

The sample size calculation section would benefit from re-structuring. Currently, it begins with the final sample size and then discusses adjustments for attrition. It would be clearer to first explain the expected effect size and the assumptions underlying the power calculation, followed by how this informed the required sample size and any adjustments for dropout.

While the intervention is described in reasonable detail, replication would be difficult based on the current information. Only one example of a prescribing scenario is provided; including a broader sample or an appendix with all scenarios would enhance reproducibility.

The assessment of student prescribing is generally well-described. However, it is unclear whether assessments are conducted by a single assessor or multiple independent assessors. Although the criteria (referred to as the ‘DPSP’) appear to be somewhat objective, inter-rater reliability would be improved by having two or more assessors independently score the responses, with discrepancies resolved by consensus or a third reviewer. Additionally, the acronym ‘DPSP’ is not defined in the manuscript and should be clarified.

Discussion:
The Discussion section appropriately highlights the potential relevance of the study’s findings for informing future medical student training. However, a significant concern that is not addressed in the limitations section is the study’s ability to robustly evaluate the impact of the pharmacist-led prescribing intervention. Based on the protocol as described, the absence of a true comparator arm substantially weakens the study’s capacity to attribute observed changes in prescribing behavior to the intervention itself. This is particularly notable given that Phase 2A, conducted the year prior, could have served as a comparator group. The lack of follow-up for Phase 2A participants limits the ability to distinguish the effects of the intervention from other influences, such as the clinical placement experience. A more explicit discussion of this design limitation would strengthen the manuscript and provide a more balanced interpretation of any findings.

Is the rationale for, and objectives of, the study clearly described?

Yes
Is the study design appropriate for the research question?

No
Are sufficient details of the methods provided to allow replication by others?

Partly
Are the datasets clearly presented in a useable and accessible format?

Not applicable

Competing Interests: No competing interests were disclosed.

Reviewer Expertise: Undergraduate prescribing education

I confirm that I have read this submission and believe that I have an appropriate level of expertise to state that I do not consider it to be of an acceptable scientific standard, for reasons outlined above.

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David Newby, University of Newcastle, Newcastle, Australia

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05 Sep 2025 | for Version 1

David Newby, University of Newcastle, Newcastle, New South Wales, Australia

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Not Approved

This study addresses a meaningful gap in the literature, given the limited evidence on the effectiveness of pharmacy-led prescribing training—or prescribing education more broadly. Considering that prescribing is a routine yet high-stakes task for junior doctors, often performed independently and under pressure (e.g., during night shifts with minimal support), the topic is clearly relevant. That said, I’m unsure whether the study design will allow for a clear demonstration of impact, particularly in the absence of a comparator group. Including such a group could strengthen the study’s ability to attribute outcomes directly to the intervention..

Background:
The study protocol effectively highlights the importance of prescribing training for undergraduate medical students, noting both the current gaps in formal education and the lack of confidence among new graduates in prescribing tasks. The authors also reference their own work to support the value of pharmacist-led prescribing training, which appears to be well-received by students. Additionally, the background insightfully points out that most prescribing education focuses on inpatient scenarios, with limited attention given to outpatient or discharge prescribing—an area that deserves more emphasis.

While the aims of the study are reasonably well-articulated, I have some concerns about whether the proposed methods will adequately address these aims.

Study design:
The protocol outlines a two-phase study: Phase 2A and 2B focus on the immediate impact of a pharmacist-led prescribing intervention on undergraduate medical students, while Phase 3 aims to assess retention of this impact one year post-graduation. However, the role of Phase 2A remains unclear. The authors describe it as contributing to ‘content validity’ and also refer to it as a ‘comparator’ group. Yet, based on the description and Figure 2, Phase 2A participants only complete a pre-test and are not followed up after their 5-week placement (unlike Phase 2B participants). This limits their utility as a true comparator group.

Moreover, the manuscript states that comparisons will be made between post-test data from both Phase 2A and 2B participants. However, Figure 2 shows that Phase 2A participants only complete a single test (equivalent to the pre-test I presume). As described, this appears to be a single-arm pre-post study, which limits the ability to attribute any observed changes in prescribing to the intervention itself. It remains possible that improvements are due to the placement experience rather than the intervention, given the absence of a comparable group that underwent the same placement without the intervention. This represents a significant limitation in the study design. It seems that Phase 2A data are primarily used to establish baseline equivalence with Phase 2B, but without follow-up, their relevance is questionable.

A broader concern is the inconsistent use of tense throughout the manuscript. For example, the methods section refers to the study in the past tense (“This non-randomised pre-post longitudinal study was conducted…” p.4), while later sections use the future tense (“Phase 2B will include the JCU final-year medical student cohort…” p.6). It is clear from the manuscript that this is not a proposed ‘protocol’ – rather it is a half-completed study (i.e. Phase 2A and 2B have been completed). This raises questions about the appropriateness of presenting this as a protocol. Typically, protocols are published prior to study commencement to allow transparency and pre-specification of methods. If Phases 2A and 2B are already complete, the rationale for publishing this as a protocol—beyond outlining Phase 3—is unclear.

The sample size calculation section would benefit from re-structuring. Currently, it begins with the final sample size and then discusses adjustments for attrition. It would be clearer to first explain the expected effect size and the assumptions underlying the power calculation, followed by how this informed the required sample size and any adjustments for dropout.

While the intervention is described in reasonable detail, replication would be difficult based on the current information. Only one example of a prescribing scenario is provided; including a broader sample or an appendix with all scenarios would enhance reproducibility.

The assessment of student prescribing is generally well-described. However, it is unclear whether assessments are conducted by a single assessor or multiple independent assessors. Although the criteria (referred to as the ‘DPSP’) appear to be somewhat objective, inter-rater reliability would be improved by having two or more assessors independently score the responses, with discrepancies resolved by consensus or a third reviewer. Additionally, the acronym ‘DPSP’ is not defined in the manuscript and should be clarified.

Discussion:
The Discussion section appropriately highlights the potential relevance of the study’s findings for informing future medical student training. However, a significant concern that is not addressed in the limitations section is the study’s ability to robustly evaluate the impact of the pharmacist-led prescribing intervention. Based on the protocol as described, the absence of a true comparator arm substantially weakens the study’s capacity to attribute observed changes in prescribing behavior to the intervention itself. This is particularly notable given that Phase 2A, conducted the year prior, could have served as a comparator group. The lack of follow-up for Phase 2A participants limits the ability to distinguish the effects of the intervention from other influences, such as the clinical placement experience. A more explicit discussion of this design limitation would strengthen the manuscript and provide a more balanced interpretation of any findings.

Is the rationale for, and objectives of, the study clearly described?

Yes
Is the study design appropriate for the research question?

No
Are sufficient details of the methods provided to allow replication by others?

Partly
Are the datasets clearly presented in a useable and accessible format?

Not applicable

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

Undergraduate prescribing education

I confirm that I have read this submission and believe that I have an appropriate level of expertise to state that I do not consider it to be of an acceptable scientific standard, for reasons outlined above.

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[1] 1. Australian Medical Council, Medical Board of Australia: Australian Medical Council and Medical Board of Australia’s Preparedness for Internship Survey.2019. Reference Source

[2] 2. Mokrzecki S, Perks S, Pain T, et al.: Australian and New Zealand medical students’ confidence and preparedness to prescribe. BMC Med. Educ. 2025; 25: 536. Publisher Full Text

[3] 3. Newble D, Dawson B, Dauphinee D, et al.: Guidelines for assessing clinical competence. Teach. Learn. Med. 1994; 6(3): 213–220. Publisher Full Text

[4] 4. Health Workforce Australia: Health Professionals Prescribing Pathway (HPPP) Project - Final Report.2013.

[5] 5. NPS MedicineWise: Prescribing Competencies Framework: Embedding quality use of medicines into practice. Sydney: 2nd ed. 2021.

[6] 6. Australian Commission on Safety and Quality in Health Care: Safety and Quality Improvement Guide Standard 4: Medication Safety (October 2012). Sydney: ACSQHC; 2012.

[7] 7. Mokrzecki S, Mallett AJ, Sen Gupta T, et al.: Do educational interventions improve prescribing skills of medical students compared to no additional learning? A systematic review. Med. Educ. Online. 2023; 28(1). PubMed Abstract | Publisher Full Text | Free Full Text

[8] 8. Malca CM, Siccha SC, Cardenas FE, et al.: Improvement in drug prescription skills in medical students through in-person and remote simulated interviews. Preprint. medRxiv. 2023. Publisher Full Text

[9] 9. De Vries TPGM, Henning RH, Hogerzeil HV, et al.: Guide to good prescribing: a practical manual.1994. Reference Source

[10] 10. Haque M: Good prescribing to maximize patient benefit. Int. J. Nutr. Pharmacol. Neurol. Dis. 2018; 8(3): 67–69. Publisher Full Text

[11] 11. Mokrzecki S, Pain T, Mallett AJ, et al.: Pharmacist-Led Education for Final Year Medical Students: A Pilot Study. Front. Med. 2021; 8(732054). PubMed Abstract | Publisher Full Text | Free Full Text

[12] 12. Garbutt JM, DeFer TM, Highstein G, et al.: Safe Prescribing: An Educational Intervention For Medical Students. Teach. Learn. Med. 2006; 18(3): 244–250. Publisher Full Text

[13] 13. Australian Medical Council: Standards for Assessment and Accreditation of Primary Medical Programs 2023.July 2023. Accessed September 2023. Reference Source

[14] 14. Mokrzecki S, Gupta TS, Pain T, et al.: Pharmacist-led prescription writing educational intervention to final-year medical students: A pre-post nonrandomised longitudinal study, 18 February 2025, PREPRINT (Version 1). Research Square. Publisher Full Text

Pharmacist-led prescription writing educational intervention to final-year medical students: A pre-post non-randomised longitudinal study

Abstract

Background

Methods

Discussion

Keywords

Introduction

Figure 1. Infographic describing the characteristics of what makes prescribing medication for the consumer multilayered and multidimensional (reproduced with permission)2.

Protocol

Study design

Figure 2. Design structure of two-phase non-randomised pre-post longitudinal review study.

Study setting

Participants

Intervention

Education modalities

Assessment and data collection methods

Figure 3. Copy of phase 2A written case showing an example of similar Schedule four prescription cases in each phase.

Table 1. DPSP criteria.

Measuring the effectiveness - comparisons

Proposed data analysis

Ethics approval

Dissemination

Study status

Discussion

Declarations

Consent

Clinical trial number

Pre-print

Data availability statement

Acknowledgements

References

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Figure 1. Infographic describing the characteristics of what makes prescribing medication for the consumer multilayered and multidimensional (reproduced with permission)².