Abstract
Introduction
Prescribing for older adults is complex due to frailty, multimorbidity, altered pharmacokinetics, and high risk of adverse drug reactions. Newly graduated doctors write most inpatient prescriptions but often feel underprepared, with error rates up to 10% (Nazar et al., 2015). Simulated prescribing platforms, such as Better Meds, offer a safe, realistic environment to practice. We designed progressive tutorials within geriatrics placement to address prescribing challenges in delirium and polypharmacy.
Method
Two cohorts of medical students participated:
Year 3 (n=20): During the delirium pathway, students managed a case of a 73-year-old with a neck of femur fracture. Using Better Meds, they prescribed perioperative medications including analgesia and VTE prophylaxis, then adjusted for opioid side effects, constipation, dehydration, infection; accounting for delirium risk factors.
Year 4 (n=20): During the frailty week, students worked through a polypharmacy case in the Emergency Department. They prescribed regular medications, explored deprescribing using STOPP/START criteria, reviewed interactions and side effects, and calculated anticholinergic burden.
Students completed pre- and post-session confidence ratings (1–5 Likert scale) across domains including drug identification, dosing, interactions, use of resources, allergy checking, and escalation. Free-text feedback was collected.
Results
Feedback from 40 students showed none had prior experience with the simulated platform. After the sessions, all reported at least a two-point confidence increase. Year 3 students, starting with lower baseline confidence, demonstrated the greatest improvement. Year 4 students described the sessions as more challenging and realistic, reflecting the pressures of prescribing as resident doctors. Free-text feedback valued the realism, safe environment, and dynamic case progression.
Conclusion
Simulated prescribing improved confidence and competence, particularly for Year 3 students. Embedding such tools within geriatrics teaching promotes safer prescribing practices with potential to reduce medication-related harm.
Comments
Great Integration Across Year Groups
What a great idea! It’s really valuable that you’ve included both Year 3 and 4 students, as prescribing skills are often only emphasised before the PSA in final year. I wondered if you had any thoughts on how you might evaluate whether the increased confidence you observed translates into improved prescribing performance in practice?
Thank you very much for your…
Thank you very much for your comment. Yes the aim was to integrate online prescribing as early as possible given we know it is a skill that should be developed over time like other areas of the curriculum. Following up prescribing in practice is something I have only reflected on recently, so I am glad to see your comment! After these cohorts graduate it would definitely be useful to see how it progresses into clinical practice and if not, what actually was useful to them during medical school or their learning during FY1 years on prescribing. Many thanks again for your response.
This is a great piece of…
This is a great piece of work. As a Clinical Teaching Fellow, I really appreciate you targeting the acknowledged prescribing confidence gap in our junior trainees, especially in the complex field of geriatrics. Your results show the immediate value of practical, high-fidelity teaching approaches.
A valuable project
This was great to read and really shows how valuable simulation can be for building prescribing confidence.
Importance of sim practice
It is always daunting learning something new, especially at the start of FY. This will help gain some familiarity with EPMA and help colleagues hit the ground running if implemented widely. Thank you.
Great idea!
This is a great idea for a project and has produced some really valuable results. Becoming more familiar with prescribing prior to your foundation years is such an important topic.