Medical students' errors in pharmacotherapeutics

Objectives This study analysed the errors made by 16 final-year medical stu dents in a classroom prescribing exercise. The aim was to gain greater unde rstanding 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 achie ve better control of seizures. It was based on a real-life case, and was pr esented as a written exercise. Process-tracing and think-aloud techniques w ere 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-ho w. Three different clinical reasoning strategies were observed. Students wh o followed an incremental strategy demonstrated superior scientific knowled ge and this resulted in less hazardous errors. Those who followed gambling or backward-reasoning strategies appeared to possess inferior scientific kn owledge and this resulted in more hazardous errors. Conclusions The results support current trends towards integrating basic me dical science into a foundation of clinical know-how, as in the problem-bas ed curriculum. They also emphasize the importance of a thorough grounding i n medical science as a means of minimizing error.