Development and a validation study of comprehensive prescription writing rubrics for medical students


  • Anupong Kantiwong Department of Pharmacology, Phramongkutklao College of Medicine, Bangkok, Thailand
  • Sethapong Lertsakulbunlue Department of Pharmacology, Phramongkutklao College of Medicine, Bangkok, Thailand



Drug prescription, Generalisability theory, Medical student, Rubric


Background: Prescribing is a complex task for physicians, with many global reports of errors. This study evaluates a comprehensive rubric for medical student prescribing skills regarding validity and reliability.

Methods: Twenty-one third-year medical students participated in three separate prescribing exams. Two pharmacology professors rated the students' prescriptions using a rubric covering ten criteria. Messick validity framework was utilised to enhance the study’s validity. Generalisability theory (G-theory) helped determine the source of variance and the optimal number of raters and test occasions.

Results: Content validity was ensured by three experts and alignment with the Thai Medical Council criterion. The Inter-rater and test-retest reliability were acceptable. The rubric had a Cronbach's alpha 0.70 with item-test correlation, all above 0.40. G-theory indicated that 54.93% of the total variance was due to performance and 27.57% to the interaction between performance and occasions, with a minimal residual variance of 4.28%. To reach an acceptable Phi-coefficient (≥0.70), three occasions with one rater (Phi-coefficient=0.76) or two occasions with two raters (Phi-coefficient=0.72) are needed. Conversely, the Phi-coefficient was low on a single occasion.

Conclusion: The study introduces a comprehensive rubric and description of a prescription writing programme to minimise potential prescribing errors in pre-clinical years. Furthermore, more assessment opportunities enhance knowledge retention and assessment reliability.


Andersen, S. A. W., Nayahangan, L. J., Park, Y. S., & Konge, L. (2021). Use of generalizability theory for exploring reliability of and sources of variance in assessment of technical skills: A systematic review and meta-analysis. Academic Medicine, 96(11), 1609–1619.

Aronson, J. K. (2012). Balanced prescribing – Principles and challenges. British Journal of Clinical Pharmacology, 74(4), 566–572.

Baranski, B., Bolt, J., Albers, L., Siddiqui, R., Bell, A., & Semchuk, W. (2017). Development of a documentation rubric and assessment of pharmacists’ competency for documentation in the patient health record. The Canadian Journal of Hospital Pharmacy, 70(6).

Bloch, R., & Norman, G. (2012). Generalizability theory for the perplexed: A practical introduction and guide: AMEE Guide No. 68. Medical Teacher, 34(11), 960–992.

Brennan, R. L. (2010). Generalizability theory and classical test theory. Applied Measurement in Education, 24(1), 1–21.

Briesch, A. M., Swaminathan, H., Welsh, M., & Chafouleas, S. M. (2014). Generalizability theory: A practical guide to study design, implementation, and interpretation. Journal of School Psychology, 52(1), 13–35.

Brinkman, D. J., Tichelaar, J., Graaf, S., Otten, R. H. J., Richir, M. C., & van Agtmael, M. A. (2018). Do final-year medical students have sufficient prescribing competencies? A systematic literature review. British Journal of Clinical Pharmacology, 84(4), 615–635.

Cassidy, C. E., Boulos, L., McConnell, E., Barber, B., Delahunty-Pike, A., Bishop, A., Fatima, N., Higgins, A., Churchill, M., Lively, A., MacPhee, S. P., Misener, R. M., Sarty, R., Wells, R., & Curran, J. A. (2023). E-prescribing and medication safety in community settings: A rapid scoping review. Exploratory Research in Clinical and Social Pharmacy, 12, 100365.

Donnon, T., McIlwrick, J., & Woloschuk, W. (2013). Investigating the reliability and validity of self and peer assessment to measure medical students’ professional competencies. Creative Education, 04(06), 23–28.

Fanikos, J., Jenkins, K. L., Piazza, G., Connors, J., & Goldhaber, S. Z. (2014). Medication use evaluation: Pharmacist rubric for performance improvement. Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy, 34(S1).

Faul, F., Erdfelder, E., Lang, A.-G., & Buchner, A. (2007). G*Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behavior Research Methods, 39(2), 175–191.

Gautam, P. (2013). Minimizing medication errors: Moving attention from individual to system. Journal of Anaesthesiology Clinical Pharmacology, 29(3), 293.

George, D., & Mallery, P. (2019). IBM SPSS statistics 26 step by step: A Simple Guide and Reference (16th ed.). Routledge.

Gupta, M., Tikoo, D., & Pal, S. (2020). Assessment of Prescription writing skills and impact of an educational intervention on safe prescribing among the first-year postgraduate medical students of tertiary care hospital. AMEI’s Current Trends in Diagnosis & Treatment, 4(1), 51–59.

Hamstra, S. J., & Yamazaki, K. (2021). A validity framework for effective analysis and interpretation of milestones data. Journal of Graduate Medical Education, 13(2s), 75–80.

Heaton, A., Webb, D. J., & Maxwell, S. R. J. (2008). Undergraduate preparation for prescribing: The views of 2413 UK medical students and recent graduates. British Journal of Clinical Pharmacology, 66(1), 128–134.

Hill, J., Ogle, K., Gottlieb, M., Santen, S. A., & Artino, A. R. (2022). Educator’s blueprint: A how‐to guide for collecting validity evidence in survey‐ based research. AEM Education and Training, 6(6).

James, H., Tayem, Y. I. Y., Al Khaja, K. A. J., Veeramuthu, S., & Sequeira, R. P. (2016). Prescription writing in small groups as a clinical pharmacology educational intervention: Perceptions of preclerkship medical students. The Journal of Clinical Pharmacology, 56(8), 1028–1034.

Keijsers, C. J. P. W., Leendertse, A. J., Faber, A., Brouwers, J. R. B. J., de Wildt, D. J., & Jansen, P. A. F. (2015). Pharmacists’ and general practitioners’ pharmacology knowledge and pharmacotherapy skills. The Journal of Clinical Pharmacology, 55(8), 936–943.

Khaja, K. A. J. Al, Handu, S. S., James, H., Mathur, V. S., & Sequeira, R. P. (2005). Assessing prescription writing skills of pre-clerkship medical students in a problem-based learning curriculum. International Journal of Clinical Pharmacology and Therapeutics, 43(09), 429–435.

Khodi, A. (2021). The affectability of writing assessment scores: a G-theory analysis of rater, task, and scoring method contribution. Language Testing in Asia, 11(1), 30.

Koo, T. K., & Li, M. Y. (2016). A guideline of selecting and reporting intraclass correlation coefficients for reliability research. Journal of Chiropractic Medicine, 15(2), 155–163.

Linton, K. D., & Murdoch-Eaton, D. (2020). Twelve tips for facilitating medical students prescribing learning on clinical placement. Medical Teacher, 42(10), 1134–1139.

Loskutova, N. Y., Lutgen, C., Smail, C., Staton, E. W., Nichols, S. D., & Pinckney, R. G. (2022). Stimulant prescribing error assessment rubric development. Journal of Patient Safety, 18(1), e282–e289.

Malau-Aduli, B. S., Hays, R. B., D’Souza, K., Saad, S. L., Rienits, H., Celenza, A., & Murphy, R. (2023). Twelve tips for improving the quality of assessor judgements in senior medical student clinical assessments. Medical Teacher, 45(11), 1228–1232.

Martínez-Domínguez, J., Sierra-Martínez, O., Galindo-Fraga, A., Trejo-Mejía, J. A., Sánchez-Mendiola, M., Ochoa-Hein, E., Vázquez-Rivera, M., Gutiérrez-Cirlos, C., Naveja, J., & Martínez-González, A. (2022). Antibiotic prescription errors: the relationship with clinical competence in junior medical residents. BMC Medical Education, 22(1), 456.

Messick, S. (1995). Validity of psychological assessment: Validation of inferences from persons’ responses and performances as scientific inquiry into score meaning. American Psychologist, 50(9), 741–749.

Mokrzecki, S. M., Mallett, A., Sen Gupta, T., Perks, S., & Pain, T. (2023). Do educational interventions improve prescribing skills of medical students compared to no additional learning? A systematic review. Medical Education Online, 28(1).

Odukoya, O. K., Stone, J. A., & Chui, M. A. (2014). E-prescribing errors in community pharmacies: Exploring consequences and contributing factors. International Journal of Medical Informatics, 83(6), 427–437.

Peeters, M. J., Cor, M. K., Petite, S. E., & Schroeder, M. N. (2021). Validation evidence using generalizability theory for an objective structured clinical examination. INNOVATIONS in Pharmacy, 12(1), 15.

Ross, S., & Loke, Y. K. (2009). Do educational interventions improve prescribing by medical students and junior doctors? A systematic review. British Journal of Clinical Pharmacology, 67(6), 662–670.

Rothwell, C., Burford, B., Morrison, J., Morrow, G., Allen, M., Davies, C., Baldauf, B., Spencer, J., Johnson, N., Peile, E., & Illing, J. (2012). Junior doctors prescribing: Enhancing their learning in practice. British Journal of Clinical Pharmacology, 73(2), 194–202.

Ryan, C., Ross, S., Davey, P., Duncan, E. M., Francis, J. J., Fielding, S., Johnston, M., Ker, J., Lee, A. J., MacLeod, M. J., Maxwell, S., McKay, G. A., McLay, J. S., Webb, D. J., & Bond, C. (2014). Prevalence and causes of prescribing errors: The Prescribing Outcomes for Trainee Doctors Engaged in Clinical Training (PROTECT) Study. PLoS ONE, 9(1), e79802.

Salmasi, S., Khan, T. M., Hong, Y. H., Ming, L. C., & Wong, T. W. (2015). Medication errors in the Southeast Asian countries: A systematic review. PLOS ONE, 10(9), e0136545.

Sam, A. H., Fung, C. Y., Wilson, R. K., Peleva, E., Kluth, D. C., Lupton, M., Owen, D. R., Melville, C. R., & Meeran, K. (2019). Using prescribing very short answer questions to identify sources of medication errors: A prospective study in two UK medical schools. BMJ Open, 9(7), e028863.

Sequeira, R. (2015). Patient safety in medical education: Medication safety perspectives. Indian Journal of Pharmacology, 47(2), 135.

Sottiyotin, T., Uitrakul, S., Sakdiset, P., Sukkarn, B., Sangfai, T., Chuaboon, L., & Palee, P. (2023). Effective formative assessment for pharmacy students in Thailand: Lesson learns from a school of pharmacy in Thailand. BMC Medical Education, 23(1), 300.

Thenrajan, P., & Murugan, Pr. (2016). Impact of patient-based teaching in improving prescription writing skills of II MBBS students. International Journal of Applied and Basic Medical Research, 6(3), 174.

Wiernik, P. H. (2015). A dangerous lack of pharmacology education in medical and nursing schools: A policy statement from the American College of Clinical Pharmacology. The Journal of Clinical Pharmacology, 55(9), 953–954.

Yaman, M. N., Zamzam, R., Mohamad, N., Besar, M. N. A., & Kamarudin, M. A. (2012). Evaluation of case write-up: Assessment of prescription writing skills of fifth year medical students at UKM medical centre. Procedia - Social and Behavioral Sciences, 60, 249–253.




How to Cite

Kantiwong, A., & Lertsakulbunlue, S. (2024). Development and a validation study of comprehensive prescription writing rubrics for medical students. Pharmacy Education, 24(1), p. 403–417.



Research Article