Clinical Context
EPA 3 – Prescribing applies in any clinical context but the critical aspects are to:
- prescribe autonomously when appropriate, taking account of registration, health service policies, and individual confidence and experience with that drug or product.
- prescribe as directed by a senior team member, taking responsibility for completion of the order to ensure it is both accurate and appropriate for the patient.
Training Material
EPA 3 Task Descriptors
The EPA 3 – Prescribing assessment form lists the tasks that may be observed, noting that there is no requirement to observe all components. Prevocational doctors will be asked to tick the relevant tasks, but this may be changed by the assessor.
Click to view task descriptors
- Obtain and interpret medication histories.
- Respond to requests from team members to prescribe medications.
- Consider whether a prescription is appropriate.
- Choose appropriate medications.
- Where appropriate, clarify with the senior medical officers, pharmacists, nursing staff, family members or clinical resources the drug, including name, dose, frequency and duration.
- Actively consider drug—drug interactions and/or allergies and if identified check whether to proceed.
- Provide instruction on medication administration, effects and adverse effects using appropriate resources.
- Elicit any patient concerns about benefits and risks, and, as appropriate, seek advice and support to address those concerns.
- Write or enter accurate and clear prescriptions or medication charts.
- Monitor medications for efficacy, safety, adverse reactions and concordance.
- Review medications and interactions, and cease medications where indicated, in consultation with senior team members, including a pharmacist.
How to Put EPA 3 into Practice
There is considerable variation in the ways EPA 3 – Prescribing may be undertaken. While there is a strong focus on the medical expertise required for prescribing, some tasks incorporate competencies around communication and patient interactions, whilst others incorporate components of professionalism and interprofessional interactions.
Ideally, completing EPA 3 – Prescribing multiple times should consider many of these aspects over time.
Opportunities to complete EPA 3 – Prescribing include:
- When the prevocational doctor identifies a patient with an infection, discuss their approach to antibiotic choice and review the prescription they write.
- On a ward round, when a patient needs fluid prescribed, ask the prevocational doctor for their thoughts and rationale.
- When admitting a new patient, consider how the prevocational doctor obtained the medication history – do they know it is accurate and how?
- When a patient is started on a new medication, observe them providing information to the patient (this may be in the emergency department on on preparing a patient for discharge).
- Your hospital may engage pharmacists to assist in these EPAs.
- You may choose to review a medication chart written by the prevocational doctor (particularly if a paper chart).
Areas to consider for feedback:
- Are you confident that the medication list is up to date (was it a Webster pack, or a written list on a referral letter)? Did the doctor make further attempts to confirm accuracy?
- Did the patient seem to understand what they would be taking and why?
- Is the prevocational doctor able to explain why they made the choice of medication or fluid they did?
- Are there interactions you thought of which have not been addressed?
- If there are social or cultural factors involved – are there considerations for compliance that you have thought of but not heard the prevocational doctor mention (eg. Access to medications)