The Feasibility and Quality of the European Prescribing Exam: An International Multicenter Pilot Study Among 3109 Medical Students From 16 Medical Schools

The WHO Global Patient Safety Challenge “Medication Without Harm” emphasizes the need to improve doctors' prescribing competence. Junior doctors are particularly at risk of prescribing errors due to inadequate training. To address this, the European Prescribing Exam was developed to standardize and improve clinical pharmacology and therapeutics (CPT) education across Europe. This study describes the development and quality analysis of the first two pilot examinations. Based on European consensus studies and the Dutch National Pharmacotherapy Assessment, an assessment blueprint was developed. Two pilot examinations, each with 36 knowledge-based and 11 skills-based questions, were administered between 2020 and 2023 at 16 medical schools in 11 countries. We assessed exam quality through reliability (standard error of measurement, Cronbach's alpha, item-rest correlations (R_ir-value), difficulty index (DI)), and content validity (content validity ratio's (CVR)). Questions with a negative R_ir or CVR, or DI < 0.44 were flagged as potential lower quality. In addition, students' scores (% of maximum) and differences between schools and curricula were evaluated. A total of 3109 students participated (Examination 1: 1371; Examination 2: 1745). Most questions were of high quality; 20/94 (21.3%) were flagged. Median scores on the examinations were 66.2% (IQR 55.4–74.3) and 58.9% (IQR 52.1–65.8) for pilot 1 and 2, respectively. Students from schools with problem-based learning or a national prescribing examination scored significantly higher (P < 0.001). In conclusion, this study demonstrates the feasibility of a standardized European Prescribing Exam. However, the wide variation and generally low median scores highlight the need to improve and harmonize CPT education across Europe.