Impact of Real-world Electronic Prescription Audits on Rational Prescribing Skills in Second Year Medical Students: A Quasi-experimental Study

Background Prescribing errors are a major cause of preventable medication-related harm. Although educational interventions such as pharmacotherapy teaching, prescription audits and objective structured practical examination (OSPE)/objective structured clinical examination-based assessments improve prescribing competence, most rely on simulated rather than authentic clinical prescribing experiences. Purpose To evaluate the educational impact of integrating real-world electronic prescription (e-prescription) audits into undergraduate pharmacology teaching using the hospital’s medical records, administration and electronic prescribing software (Medical Information Archiving Software [MIAS]), with a focus on improving rational prescribing competence. Materials and Methods A quasi-experimental pre- and post-test design was implemented among 249 second-year Bachelor of Medicine, Bachelor of Surgery students, grouped into seven batches. Participants received structured training, completed a formative OSPE, performed MIAS-based real-world e-prescription audits, and subsequently undertook a summative OSPE. Performance differences across batches and genders were examined using paired t -tests, analysis of variance and multivariate analysis of variance. Student perceptions were collected to examine their learning experiences. Reporting followed the Transparent Reporting of Evaluations with Nonrandomized Designs guidelines for non-randomised intervention studies. Results Summative OSPE scores were significantly higher than formative scores (mean ± standard deviation: 7.30 ± 0.93 vs 5.72 ± 1.11; p < .001), with a large effect size (Cohen’s d = 1.43). All batches demonstrated consistent improvement, with no significant disparities. MIAS audit scores displayed moderate variation across batches, with one batch performing relatively lower than the other batches. There were no gender differences identified across any method of assessment, confirming the equity and fairness of the intervention. Students’ feedback reflected enhanced skills in prescribing, clinical reasoning, confidence and identification of prescribing errors. Conclusions Integrating real-world e-prescription audits using MIAS in conjunction with structured OSPE-based assessment significantly enhances the competencies of rational prescribing. The intervention elicited consistently significant gains across all batches, without any gender disparities. This highlights the effectiveness of MIAS-based real - world e-prescription audits as an impactful and equitable intervention within a competency-based medical curriculum.