| Abstract | Abstract Background
Prescribing practice by nurses, pharmacists, and allied health professionals has progressed significantly over the past four decades and is expanding at an accelerated rate. My research questions, educational approaches, and written works stem from an ambition to promote best clinical and educational practice for prescribing decision-making. Published works related to the topics of education, research, and prescribing have been appraised. Aims & Objectives
The overarching aim of this critical appraisal was to examine my unique body of research and peer-reviewed published works spanning 20 years and evaluate the impact on education for enhancing prescribers’ decision-making skills. The underpinning question throughout these works and the appraisal is: What contributes to the evolvement of prescribers’ clinical decision-making? The objectives are:
1. To critically appraise varied methods of research and knowledge transfer to constructively impact the practice of future prescribers.
2. To evaluate how reflexivity, critical thinking, and self-awareness affect practice and examine educational techniques to stimulate these.
3. To analyse key influences on personalised decision-making, identifying strategies to optimise its inclusion in prescribing practice.
4. To examine how published works including mnemonics and models can contribute to prescribing practice, analyse limitations, and recommend ways to address these. Methods
Peer-reviewed published works from 2012 to 2024 are examined to question their influence on prescribing practice and draw conclusions as to how contributions to education and research can be optimised in the future. Review questions centre around knowledge acquisition for prescribing in implementing best practice and effective, person-centred decision-making. The appraised research covers distinct methodologies including primary qualitative, quantitative, as well as secondary integrative review. As such, it spans several approaches, frameworks or paradigms including positivist, critical realism, contextualism, and pragmatism. The primary research generated new knowledge around educative feedback methods while secondary research and resulting publications widely disseminated new information of pertinence to clinical practice, such as a novel clinical decision-making model for prescribing. Ethics approval was previously attained for the primary studies, while for the purpose of this appraisal, ethics was approved for a qualitative survey evaluation of the prescribing consultation model. A diverse set of publications including the decision-making model for prescribing, are appraised in relation to their influence on practice. Consideration is given to my learning journey as a researcher and educator and the themes are gathered to produce a revised model for prescribing practice and other educational resources for future dissemination. Findings
Principal findings of my primary research (Gould and Day, 2012) demonstrate a link between academic feedback methods and students’ self-reported confidence. Secondary research, particularly into research methods for obesity studies (Brown and Gould, 2013) highlight the importance of researcher reflexivity, as a transferrable principle to education and clinical practice. Other research such as a prescribing textbook (Gould and Bain, 2022a) and its subsequent articles (Gould and Bain, 2022b, 2022c, 2022d, and 2023) inform strategies for clinical decision making in prescribing practice. Findings note the use of decision aids to be useful in guiding earlier stages of practice for novice prescribers as they expand their clinical reasoning skills required for safe and effective prescribing. Evaluation of a prescribing consultation model highlights a need to be more direct in advocating for person-centred decision-making and prompted changes to the original model. Impact
Evidence of impact on clinical education comprises the wide dissemination of published works which also prompted speaking engagements within the United Kingdom and internationally. The uptake of the research publications and textbook demonstrates potential for advancing health professionals’ knowledge of clinical decision-making for prescribing by informing and influencing education and practice. Recommendations include partnering for endorsement of the revised prescribing model to further influence the practice of personalised clinical decision-making. |
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