Many times as a junior prescriber you may be asked to sign a prescription, however, not every healthcare professional has the authority to prescribe every medication. For example, junior doctors can not prescribe chemotherapy. During the signing of the prescription, it is important that enough information is provided to create a record of which healthcare professional is authorising the supply or administration of a medication. This enables prescribing practices to be audited and ensure that poor practices are identified. Abdel-Tawab R, James DH, Fichtinger A, Clatworthy J, Horne R, Davies G. Development and validation of the Medication-Related Consultation Framework (MRCF). Patient Education and Counseling. 2011;83:451-457. Objective Structured Video Examinations (OSVE). The variation consists of videotaped recordings of patient-doctor encounters are shown to students simultaneously and questions related to the video clip are asked. Written answers are marked in a standardised manner.

Evaluations of the competence of healthcare professional students, including undergraduate pharmacists, using simulated assessments including Objective Structured Clinical Examinations (OSCEs) and Criterion Referenced Assessments (CRAs) are increasingly commonplace. Patients may be referred to an endocrinologist for hormone replacement if a deficiency in reproductive hormones is found on laboratory testing (e.g. low testosterone). Penile prosthesis McCabe MP, Connaughton C. Sexual dysfunction and relationship stress: how does this association vary for men and women? Curr Opin Psychol [Internet]. 2017;13:81–4. Available from: [LINK]

The assessment of pharmacy students’ readiness to begin the education of an advanced pharmacy practice experience (APPE) in clinical pharmacy settings continues to gain increasing attention. This study aimed to develop an objective structured clinical examination (OSCE) in the core domains acquired through an introductory pharmacy practice experience (IPPE), for evaluating its appropriateness as a tool of assessing clinical pharmacist competency for APPEs in Korean pharmacy students throughout a pilot study. Methods An OSCE usually comprises a circuit of short (the usual is 5–10 minutes although some use up to 15 minute) stations, in which each candidate is examined on a one-to-one basis with one or two impartial examiner(s) and either real or simulated (actors or electronic patient simulators) patients. Each station has a different examiner, as opposed to the traditional method of clinical examinations where a candidate would be assigned to an examiner for the entire examination. Candidates rotate through the stations, completing all the stations on their circuit. In this way, all candidates take the same stations. It is considered to be an improvement over traditional examination methods because the stations can be standardised enabling fairer peer comparison and complex procedures can be assessed without endangering patients health. Mészáros K, Barnett MJ, McDonald K, Wehring H, Evans DJ, Sasaki-Hill D, et al. Progress examination for assessing students’ readiness for advanced pharmacy practice experiences. Am J Pharm Educ. 2009;73(6):109.

Patients with suspected ED will primarily complain of difficulties initiating or sustaining an erection. Further details surrounding these issues should be explored:

At this stage of the consultation, you should revisit any concerns the patient may have about their current medication regime. It’s also important to provide the patient with the opportunity to raise any additional concerns about their medication. Authoring Team: The task of developing OSCE stations can be started after deciding on the examination content and should be undertaken by pharmacy faculty well acquainted with the curriculum and its objectives. Detailed explanations and guidelines that have been reviewed, edited, and agreed upon by the coordinating committee should be given to authors for different stations.

Nocturnal penile tumescence testing (NPT): used to distinguish between organic vs. psychogenic ED. The patient wears the NPT device overnight, measuring number, tumescence and rigidity of erections.

Kurtz S, Silverman J, Benson J, Draper J. Marrying Content and Process in Clinical Method Teaching: Enhancing the Calgary–Cambridge Guides. Academic Medicine. 2003;78:802-809. When making a plan to monitor medication, always consider and identify who will do this and by when. Pharmacists can help in monitoring long-term conditions and therapeutic outcomes, including making recommendations to deprescribe medications which are no longer beneficial for the patient. Table 2: Medications with a narrow therapeutic range To develop OSCE cases related to each OSCE competency domain, we identified case objectives and explored possible case scenarios related to each OSCE topic based on the textbooks of IPPE and pharmacotherapy used in 37 colleges of pharmacy in Korea [ 25, 26] and ideation by the researchers. Subsequently, we finalized the simulated case scenarios and assessment criteria for the clinical performance and communication skills of the students within the given time constraints (i.e., 10 min for each case) through review by external experts qualified for the education of clinical pharmacy and pharmacy practice. They reviewed the OSCE cases and competency criteria to achieve a consensus by the Delphi method [ 27]. The case scenarios consisted of the title, interactive/non-interactive, purpose of the OSCE, time, materials, instructions for students and questions, instructions for standardized patients/physicians, and instructions for assessors (i.e., answer and assessment criteria). The instructions for standardized patients/physicians contained a specific script with an information guide on the reactions of standardized actors to students’ responses. Development of an assessment criteria along with a scoring rubric, helped evaluate clinical performance skills of pharmacy students, such as critical thinking, patient-centered problem solving, overall attitude and behavior, and provision of correct information, as well as their communication skills, according to each OSCE topic [ 6, 7, 8, 25, 28]. Setting and subjects Practicability: OSCE allows the use of simulated patients and clinical materials, thereby decreasing the need for real patients during the examination.

The pitfalls of implementing OSCEs revolve around validity, reliability, feasibility and acceptability. Using an established set of components to assess students in an OSCE may appear accurate, but the efficiency and shrewdness of those able to diagnose with minimum effort is put at disadvantage. As the OSCE necessitates conformation to the structured path of the creators, the focus of the exam is on the exam structure rather than on the learner. 1, 27 Overall validity and reliability of the examination is determined by the quality of individual stations. When stations are too short, the problem could be further compounded and assessment of even simple clinical skills may be more difficult. 26 Historically, doses were written using Latin and over time these were abbreviated. For example, omni die or once a day is abbreviated to OD. Many errors relating to prescriptions are caused by folks not just failing to read Latin, but failing to read abbreviated Latin! For example, quatro die or four times a day is abbreviated to QD, which can be misread as OD, if handwritten, leading to sub-therapeutic doses. To avoid errors then, try to write doses using plain English such as once, twice, three times (avoid thrice) or four times per day. Although several countries such as the US, Canada, Australia, the United Kingdom and Japan have used the OSCE in various ways for evaluating clinical competencies of pharmacy students, most pharmacy schools around the world have not yet introduced or are preparing to introduce the OSCE in their pharmaceutical education systems [ 21, 38]. Therefore, other countries or organizations could refer to the OSCE model developed in this study to develop or improve the OSCE system for competency assessment of students’ readiness for the pharmacy practice experiences in community or hospital pharmacies. The OSCE stations with standardized patients or physicians were appropriate since pharmacy students have been recommended to complete a specific clinical task often in an interactive environment [ 21, 33, 34]. The students’ average performance was the lowest at 32.1% in the case of counseling the patient with the inhaler, and the highest at 79.7% in the OTC counseling. This might indicate towards the insufficient readiness of students, for counseling patients with prescribed inhalers at the community or hospital pharmacies. Contradictorily, the students found the cases related to prescription review and pharmaceutical care service, as well as patient counseling, difficult. In Korean pharmacy schools, the IPPE curriculum is operated as in-class simulation of prescription review, dispensing, medication therapy management, patient counseling, and drug information provision, while the APPE courses are conducted as field training at community or hospital pharmacies [ 2, 3]. Since participating students had not yet started APPE courses, the OSCE cases proved difficult, which resulted in their performance rate dropping below 80%, in certain criteria of all OSCE areas. Malaysian pharmacy students also considered the OSCE areas related to patient counseling, drug dosage review, and drug information service relatively difficult, compared to the areas related to drug-related problems or pharmacokinetics [ 19]. Despite pharmacists being required to counsel patients within the expected duration, and verify patients’ medication knowledge according to the pharmacist-conducted patient counseling guidelines and the textbook used in the Korean college of pharmacy, no student met the relevant assessment criteria [ 25, 34, 35]. This study also showed that students portrayed weaknesses at the beginning and end of the communication in clinical pharmacy practice. Contradictorily, Japanese students showed excellent outcomes in most communication skill areas, which was probably affected by the list of tasks provided a minute before the advanced OSCE [ 36]. The standardized IPPE curriculum applied to all colleges of pharmacy in South Korea is limited. It was reported that the incorporation of simulation based IPPE made pharmacy students more confident on technical and communication skills, and more aware of medication errors and other patient safety issues [ 15]. Therefore, Korean pharmacy colleges’ IPPE education should strengthen their curriculum based on simulation education, for applying the knowledge to actual clinical situations related to the five key competency areas, and involve the preceptors as reviewers to reduce the differences in the outcome assessment. Management can include modification of risk factors, phosphodiesterase-5 inhibitors, psychosexual counselling, hormone therapy and penile prosthesis.The strength must be included for schedule 2 and 3 controlled drug prescriptions. Dose or instructions Decreased bias: Student performance in each station is marked by independent examiners on a predetermined marking template that is customized to each patient scenario, thus reduces the variability of examination. Alprostadil also comes in a topical cream and intraurethral application (MUSE) formulation which can be applied regularly by the patient at home prior to sexual intercourse. Grab a fellow medic/friend/flatmate and practice regularly until your examinations are fluent and confident. Exam nervousness can affect your performance, so it’s better to be a bit overprepared than under. If your medical school allows you to practice with their equipment, then take advantage of those opportunities. If not, things like reflex hammers, blood pressure cuffs and penlights can be bought off the internet for a decent price. Remember to practice with a timer too as the minutes fly by in the real thing. Today the OSCE is used to assess the clinical competency of undergraduate pharmacy students in licensure and certification examinations in many parts of the world. 13, 14 Candidates rotate through several stations on a timed basis in an OSCE. In the United States and Canada, approximately 12 to 16 stations are used for medical and pharmacy licensing exams 5 as compared to Harden’s original OSCE of 16 stations. 2 At each station, the candidate faces a simulated task and has to perform specific functions. Both interactive and non-interactive stations are used. Standardized patients are employed in interactive stations, with a trained examiner evaluating the exam using a marking key that is standardized, while non-interactive stations use written responses (not based on observation). Interpersonal and communication skills, professional judgment, skills of resolution, etc., may be best assessed through a well- structured OSCE in comparison to oral examinations, multiple choice tests and other methods of assessment. High costs and difficulties associated therewith have limited its extensive use. 2, 19 In the 1970s, British Columbia’s College of Pharmacists, the pharmacy practice licensing regulatory body of Canada’s third largest province, started using the OSCE format with patient simulations and standardized problems for the assessment of new and continuing competencies of its member pharmacists. 11 In 1996, the pharmacy regulatory body in Ontario College of Pharmacists introduced the OSCE as part of its mandatory Practice Review and Quality Assurance for all practicing pharmacists. As important entry-to-practice competencies could not be adequately measured via traditional examination formats, momentum increased for a national OSCE for pharmacy. Thus started the development of a national OSCE for pharmacy practice by The Pharmacy Examining Board of Canada and June 1997 witnessed the emergence of a blueprint which outlined the number of stations needed for reliable and valid testing of entry-level competencies inclusive of rest stations and testing time (200 minutes). 11 Identified entry-level competencies included obtaining and interpreting information, recommending appropriate therapeutic options, effective communication, preparation, distribution of drug products and professional judgments and ethics. 4, 20 Ahmed et al. 21 designed and implemented a 13-station OSCE for a clinical pharmacy course. Patient counseling and communication, clinical pharmacokinetics, identification and resolution of drug related problems and literature evaluation/drug information were the broad competencies assessed. A majority of the students felt that the skill required at some stations required a higher degree of learning than they had achieved.