ABSTRACT
Objectives
Dentists commonly encounter patients with complex medical comorbidities that require an advanced level of competence in the art of prescription writing. However, the current structure of dental education often places limited emphasis on this critical skill. This study aimed to develop and validate an innovative teaching module designed to enhance prescription‐writing skills for dental students, with a specific focus on patients with medical comorbid conditions.
Methods
This study was completed in two phases. In phase 1, an interprofessional education (IPE) designed comprehensive teaching module was created. The topics included in this teaching module were medical comorbidities, drug interactions, and best prescription practices. The developed teaching module's face and content were validated, and the item‐ content validity index (I‐CVI) was computed. In phase 2, the teaching module was tested among 48 dental students as part of a randomized controlled trial.
Results
A pool of eight items addressing different aspects related to prescription writing were validated in dental students. All the eight items reached an I‐CVI for relevance and structure of ≥0.8. In phase 2, the intervention group, exposed to the teaching module on skill development of prescription writing, showed a statistically significant increase in their prescription‐writing skill than the control group.
Conclusion
The introduction of a teaching module aimed at developing prescriptions for medical co‐morbidities could substantially improve the prescription writing abilities of dental students.
Keywords: dental education, development, interprofessional education (IPE), medical comorbidities, prescription writing, teaching module, validation
1. Introduction
The correctness and appropriateness of prescription writing must be properly addressed [1]. Prescribing skills is a crucial competency in medical/dental practice considering the increasing number of medications available and the increasingly complex patients with multiple diseases faced in clinical practice. Students need to become proficient in these skills during training. In addition to teaching the fundamentals of safe and cost‐effective prescribing to medical students, evaluating their prescribing skills by faculty members is difficult and time consuming [2]. Prescription writing is a crucial skill for dental students, enabling effective communication of treatment plans for patients with medical comorbid conditions. Various teaching methodologies have been explored in dental education to enhance prescription writing skills. Technology‐enhanced learning (TEL) has been recommended as a learner‐centered approach in dental education [3]. The incorporation of modules on prescription writing within the curriculum has improved the prescription‐writing skills of undergraduate dental students [4]. Additionally, interventions such as problem‐based training have been shown to reduce common prescription errors among medical students [5].
Interprofessional education (IPE) is a critical approach for preparing students to enter health workforce, where teamwork and collaboration are important competencies. IPE has been advocated as a component of healthcare system redesign aimed at fostering interprofessional collaboration, enhancing patient care quality, and improving health outcomes [6]. Educational interventions are pivotal in shaping prescription practices. Studies have emphasized the importance of hands‐on training and reflective practices in enhancing prescription writing skills among medical and dental students [7, 8]. Moreover, the quality of prescriptions can be indicative of the effectiveness of medical education and adherence to regulations [9]. Early exposure to clinical environments and training in prescription writing during undergraduate studies are highlighted as essential for developing competent prescribers [10].
Unfortunately, many dental colleges across India still do not provide structured training in pharmacotherapy. There is also ample evidence that prescription writing by dental students, interns, and fresh graduates can be improved by proper training [9]. Furthermore, the assessment of prescription writing skills among dental professionals has underscored the need for continuous educational programs to reduce errors and enhance safe prescribing practices [11]. Research has indicated that patient‐based teaching methods can be more effective in improving prescription writing skills than traditional approaches [12]. These findings collectively emphasize the importance of structured educational interventions in enhancing prescription writing skills among dental students.
One significant aspect that contributes to escalating healthcare expenditures is drug‐related morbidity. Consequently, the adoption of IPE approaches becomes imperative to address this issue effectively [13]. As prescription writing is a crucial skill for dental students, enhancing competency and confidence in prescription writing is essential. This study is necessary to bridge the gap in dental education by developing and validating a teaching module focused specifically on prescription writing for medical comorbidities. Therefore, this study aimed to develop and validate an innovative teaching module designed to enhance prescription‐writing skills for dental students, with a specific focus on patients with medical comorbid conditions.
2. Methodology
2.1. Study Approval and Registration
Approval for this study was obtained from the Institutional Ethics Committee, on July 17, 2023, with registration number 23037. The study was registered with the Clinical Trial Registry of India (CTRI), with reference number REF/2023/10/074991 AU.
2.2. Study Setting
The study consisted of two phases: phase 1 was the development and validation of the teaching module, while phase 2 was the intervention. A single centered randomized controlled study in phase 2 was conducted at a dental college. The participants in this study consisted of 48 final‐year dental students. Data were gathered between August 1, 2023 and October 31, 2023.
2.3. Sample Size
The sample size for the study was calculated based on an effect size of 0.3, degrees of freedom (df) 2, with a critical chi‐square value of 5.31, a 95% confidence interval and 80% power. The software G*Power 3.1.2 (Heinrich‐Heieneuniversitst Dusseldorf, Germany) was used for calculations. The final total sample size was modified to 48, with 24 participants in the interventional group and 24 in the control group.
2.4. Sampling Procedure
Simple random sampling was used to choose the participants. Using lottery method two groups were randomly assigned, with Group 1 as interventional group and Group 2 as control group.
The enrolment is shown in Figure 1.
FIGURE 1.
Phases of the study and participant allocation.
2.5. Allocation Concealment and Enrolment
A randomization sequence into intervention groups is produced via a pre‐specified method, like numbered containers. The containers were made opaque and sealed in advance to ensure the sequence was truly blinded until the interventions were allocated. This strategy allowed the investigators to maintain the integrity of their randomization without the possibility of any potential bias regarding the assignment of interventions until participants were allocated to their respective groups. The random allocation sequence was generated by a statistician experienced in research methodology, but the person did not take part in either participant enrolment or intervention assignment to ensure randomness and minimize potential bias. The principal investigator notified about the study to the participants who consented and meet the inclusion criteria. These participants were allocated to an intervention group by a research guide who was blinded to the characteristics of the participants to ensure unbiased allocation.
2.6. Eligibility Criteria
This study included participants who were in their final year of undergraduate dental training and were active prescribers of medicines. They had to provide written informed consent for participation and be aged above 18 years. The participants had to be proficient in English to understand the teaching module and assessment to ensure proper participation. The participants also needed to be available at baseline assessment, outcome teaching module intervention, or follow‐up assessments planned at 4‐week duration. Finally, to protect the integrity of the study, none of the participants should have had formal training specifically related to drug dosage calculations and medical contraindications in the last 6 months.
2.7. Phase 1: Development and Validation of the Teaching Module
2.7.1. Development of the Module
A teaching module for prescription writing was developed by an IPE team that comprised professionals/subject experts from variety of disciplines: physician, clinical pharmacist, pharmacologist, oral medicine and radiologist, oral and maxillofacial surgeon, public health dentist/general dentist, and chairman of board of studies. Prescription of drugs was the focus of this module, leaning onto dosage calculation and medical contraindications to the usually prescribed drugs (Table 1).
TABLE 1.
Components of the validated teaching module.
DOMAIN‐KNOWLEDGE AND UNDERSTANDING
|
Overview and importance of prescription writing in health care.
|
Explain how to choose appropriate medication, dosage, route of administration based on patients age, weight, conditions.
|
| Drug interactions, allergies, patient safety, potential conflicts when prescribing multiple medications. |
DOMAIN: SKILLS—PROCEDURAL SKILLS
|
Cover regulations, standards, ethical considerations, patient confidentiality
|
The refinement of the development of the module included several rounds of checking so that the content was relevant, clear, and effective. Refinements involved probe questions so that critical attention to the module components was guaranteed. These questions were directed at guaranteeing that obvious omissions did not exist within the content, that information was clearly represented, and that added value for the module, educationally, was provided. For example, the relevance questions were “Whether the module adequately covered the key areas of prescription writing that dental students need to know?” and “Have any critical topics related to medical co‐morbidities undefined?”
Clarity and understandability were addressed by establishing, “Whether the language used in the module was clear and at the reach of final‐year dental students and whether the instructions and explanations were easy to follow?” whereas practical applicability was considered by determining whether “the module would include practical examples and case scenarios that reflect real clinical situations and how well it prepares students to handle complex prescription writing tasks, especially for patients with multiple medical conditions”.
The interprofessional approach was explored by establishing whether the module effectively incorporated a perspective that emphasized collaboration between dental and medical professions, and whether it provided opportunities for students to understand and address drug interactions and contraindications from a broader health perspective. Assessment and feedback also fell under the lens, with questions such as “to what extent the provided assessment tools were effective to measure the students’ understanding and skills, and whether the module provided sufficient mechanisms for feedback that could assist students in improving their prescription writing skills?”
Based on the responses to probe questions, the module was iteratively refined, adding content and making changes to better address dosage calculations and medical contraindications, while including additional case scenarios in an effort to increase practical application. The revised module was then reviewed again by both the IPE team and subject experts to confirm that all issues identified were satisfactorily addressed.
2.7.2. Validation of the Teaching Module
Content and face validation of the teaching module was performed by a panel of six experts in the subject who were part of the IPE team. Each item listed in the module was rated for relevance, appropriateness of structure, and comprehensibility. Experts rated on a 4‐point Likert scale whereby scores of 3 or 4 meant a particular statement was relevant/appropriate, and scores of 1 or 2 represented an irrelevant/inappropriate rating.
2.8. Calculation of the Item‐Level Content Validity Index (I‐CVI)
Content validity for each item was measured quantitatively by calculating its I‐CVI. It computes the number of experts who have rated the item as either three or four (considered relevant/appropriate) by the total number of experts.
An I‐CVI score of 0.8 or higher is considered an indication of good content validity [14]. Therefore, all items above an I‐CVI score of 0.8 were taken as valid and retained in the teaching module. Items below 0.8 were re‐checked and the modifications were done according to expert comments.
2.9. Revisions and Second Round of Validation
The module was revised, based on feedback from an initial round of validation, to elaborate more fully about dosage calculations and medical contraindications to commonly prescribed drugs. A revised teaching module was subsequently re‐evaluated by the same panel of subject experts in a second round of validation. The I‐CVI was calculated for all eight items in the module; the relevance and structure I‐CVI scores were above 0.8; therefore, all the items had very good content validity. Accordingly, all items were judged to be appropriate for the intervention phase.
2.10. Phase 2: Intervention Phase
All participants, both in the intervention and the control group, were assessed for appropriateness and preparedness in prescribing a drug by means of validated questionnaires before the intervention (Table 2). Then, the teaching module was implemented. Four weeks after the intervention, reassessment of both groups regarding their appropriateness and preparedness in prescribing a drug was conducted. This assessment after intervention allowed evaluating the effectiveness of the teaching module.
TABLE 2.
Questionnaire for phase II (Pre‐post assessment).
|
2.11. Statistical Analysis
The data were analyzed via the Statistical Package for the Social Sciences (SPSS) (v.28, IBM, Armonk, New York). The McNemar test was applied to evaluate changes before and after the intervention. The criterion for statistical significance was a p value < 0.05.
3. Results
An IPE team for development of a teaching module consisted of member from the following department: General Medicine, Oral and Maxillofacial Surgery, Oral Medicine andRadiology, Pharmacology, Clinical Pharmacology, and Public Health Dentistry. The task for development and validation of an IPE module was done by the experts. A module of eight items covering various facets of prescription writing was developed and validated. At the end of round 1 of validation, item 5 (dosage calculation) and item 6 (medical interactions and contraindications) had an I‐CVI score of 0.67. Final modifications were made and incorporated in the module. The eight items in the teaching module underwent another round of validation. All eight items achieved an I‐CV score of ≥0.8 for both relevance and structure (Table 3).
TABLE 3.
Item‐based validation (I‐CVI).
| Items based validation scores as per subject experts (SE) | ||||||||
|---|---|---|---|---|---|---|---|---|
| Items | Field | E1 | E2 | E3 | E4 | E5 | E6 | I‐CVI |
| Items 1 | Relevance | 1 | 1 | 1 | 1 | 0 | 1 | 0.8 |
| Structure | 1 | 1 | 1 | 1 | 0 | 1 | 0.8 | |
| Item 2 | Relevance | 1 | 1 | 1 | 1 | 1 | 1 | 1 |
| Structure | 1 | 1 | 1 | 1 | 1 | 1 | 1 | |
| Item 3 | Relevance | 1 | 1 | 1 | 1 | 1 | 1 | 1 |
| Structure | 1 | 1 | 1 | 1 | 1 | 1 | 1 | |
| Item 4 | Relevance | 1 | 1 | 1 | 1 | 1 | 1 | 1 |
| Structure | 1 | 1 | 1 | 1 | 1 | 1 | 1 | |
| Item 5 | Relevance | 1 | 1 | 1 | 1 | 1 | 1 | 0.8 |
| Structure | 1 | 1 | 1 | 1 | 1 | 1 | 1 | |
| Item 6 | Relevance | 1 | 1 | 1 | 1 | 0 | 1 | 0.8 |
| Structure | 1 | 1 | 1 | 0 | 1 | 1 | 0.8 | |
| Item 7 | Relevance | 1 | 1 | 1 | 1 | 1 | 1 | 1 |
| Structure | 1 | 1 | 1 | 1 | 1 | 1 | 1 | |
| Item 8 | Relevance | 1 | 1 | 1 | 1 | 1 | 1 | 1 |
| Structure | 1 | 1 | 1 | 1 | 1 | 1 | 1 | |
Compared with the control group, the intervention group, which was exposed to the teaching module aimed at enhancing prescription‐writing skills, demonstrated a statistically significant improvement in their prescription‐writing abilities. The assessment, conducted postintervention, revealed a notable increase in the intervention group's mean prescription‐writing scores. The students in the intervention group reported a significant increase in their overall confidence in their ability to write prescriptions. A total of 54.2% of the students in the intervention group and 75% of the participants in the control group “always” asked about the use of over‐the‐counter medications/other medication history. Significant differences were observed between the intervention and control groups for questions 2, 3, 4, and 5 postintervention (Table 4). A greater proportion of the students in the intervention group reported increased confidence levels than did those in the control group. This increase in confidence was statistically significant (p < 0.05). Figure 2A,B represents the change in prescription writing after the intervention.
TABLE 4.
Postintervention comparisons between groups.
| Groups | |||
|---|---|---|---|
| Question | Group 1 (n = 24) | Group 2 (n = 24) | p value |
| Q1 | 54.2% | 75.0% | 0.183 |
| Q2 | 54.2% | 8.3% | 0.002 |
| Q3 | 50.0% | 0.0% | 0.000 |
| Q4 | 54.2% | 0.0% | 0.000 |
| Q5 | 41.7% | 12.5% | 0.001 |
Statistical analysis was carried out via the McNemar test. p < 0.05 was considered statistically significant. The data are presented as the frequency as a percentage.
FIGURE 2.
(A) and (B) Case scenarios used to rate the appropriateness and preparedness of writing prescriptions.
4. Discussion
The purpose of this study was to develop a novel teaching module and its validation for improving the skills of dental students in writing prescriptions, with special attention to patients who are suffering from some comorbid medical disorders. This study has proved the development of a teaching module and medical prescription intervention advantageous. Results showed there was improvement in confidence regarding the selection of medicines and writing of prescriptions in the appropriate format. The results also showed improvement in prescribing skills; after the program was completed, no student inappropriately and/or unsafely prescribed medication.
The current study supports and reaffirms the findings of other studies done in the past, reporting on the positive impact of education in improving prescription writing in interns and students [15, 16]. This would be attributed more to structured educational interventions, which are most likely to encourage cognitive restructuring, boost adequate prescribing practices, and reduce the chance of errors and complications that may follow. The findings from this study are in concert with several earlier studies that have demonstrated the positive impacts of educational interventions on the prescription writing skills of medical and dental students. Several studies have stressed that structured teaching initiatives can improve the abilities of students in writing correct and safe prescriptions [4, 17, 18, 19, 20]. Such educational interventions, like the use of formalized curricula, improve the students’ skills in writing prescriptions accurately and safely [8, 15, 21]. Other studies have emphasized the integral role different teaching methods have in improving prescription writing skills. For instance, education efforts by pharmacists, web‐based modules, and feedback mechanisms all proved to be successful strategies in reducing prescribing errors among junior doctors [11, 21]. Moreover, practical training, clinical teaching methodologies, and workshops centered on prescription writing have been shown to improve the prescribing competencies of both medical and dental students [8, 18, 22].
A systematic review conducted by Mokrzecki, on the educational interventions and prescribing competencies of medical students found that additional learning significantly improved prescribing skills, thus supporting the hypothesis that structured instructional interventions can enhance prescription‐writing skills [18]. In this regard, Ajemigbitse et al. also demonstrated that a focused educational intervention led to improvement in practical prescribing skills among final‐year medical students, thus reinforcing the point that targeted educational interventions can enhance prescription‐writing skills [21].
A study in medication errors and prescription faults by Velo and Minuz, underlined the common problems represented by the dose selection faults and poor handwriting, thus structured educational interventions must be provided to the students to minimize prescribing errors [24]. This study falls in line with the focus on cognitive restructuring and reinforcing proper prescribing patterns in reducing errors in this study among the students. Sandilands et al., analyzed the pattern of prescriptions and prescription errors in a tertiary care hospital and highlighted the importance of following standard treatment guidelines to reduce errors while writing the prescription [23]. Velo and Minuz assessed outpatient prescriptions of the rural area to identify errors and also discussed measures for improvement [24]. They have reflected the need for educational programs for reforms in error‐prone practices while writing the prescription.
The integration of authentic learning opportunities in this study is in line with the key principles of modern education and, therefore enhances the relevance of the teaching module to the real world of medical practice. This strength of the current study is supported by the literature emphasizing the importance of providing experiential learning opportunities to bridge the gap between theoretical knowledge and practical application [27, 28]. It is such authentic learning that can be delivered through the facilitation of internship opportunities, role‐playing sessions considered to enhance the learning and retention of students by applying knowledge within a context [27, 28].
The current study's multifaceted assessment approach, which demonstrated improvements in prescribing skills, increased confidence, and adherence to prescription guidelines, provides a comprehensive evaluation of the impact of the intervention. This comprehensive evaluation strategy is essential for gaining a nuanced understanding of the effectiveness of educational interventions on prescription writing skills [20, 29]. Research has indicated that formative assessments, personalized feedback, and case‐based teaching methods can significantly enhance students’ prescribing skills and confidence in clinical settings [20, 29].
Thus, the literature comparison confirms that educational interventions are effective in improving prescription writing skills among dental students. These educations can be accomplished through structured teaching modules, authentic learning opportunities, and interdisciplinary approaches that enhance the prescription‐writing skills and build confidence among students for improved guideline adherence and ultimately create competent and safe prescribers in healthcare.
However, the follow‐up measurement of outcomes 1 month into the program might be rather short to correctly capture the long‐term sustainability of any improvement observed. Follow‐up assessment over a longer time may produce information about the durability of the intervention effects. The reliance upon self‐reported confidence levels does carry associated risks of response bias.
4.1. Significance of the Study for Dental Education
The ability to write accurate and effective prescriptions is crucial for dentists, particularly when treating patients with multiple systemic conditions. As dental students’ progress through their curriculum, it is essential that they develop skills in prescription writing to ensure safe and effective patient care. In dental practice, where a patient often presents with numerous systemic problems and requires utmost care regarding drug interaction and contraindication, the need for specific education in this area becomes more imperative. This study emphasizes the importance of incorporating structured learning modules when teaching prescription writing to dental students. The findings clearly demonstrate how focused educational interventions can significantly enhance dental students’ competencies in prescription writing, leading to more accuracy, confidence, and conformance with the ethics. The teaching module developed for this study focuses on the specific issues related to medical comorbidities, which represent a critical gap in dental education.
This is further underlined by the development team of the module, which involves an IPE team in developing the teaching module. The IPE team itself should consist of a multidisciplinary health professional team in a position to ensure the module covers a comprehensive perspective in prescription writing, emphasizing the importance of collaboration among dental, medical, and other health professionals. Emphasis on interprofessional collaboration is necessary to develop dental students’ competency in working within the broader healthcare team for improved patient safety and thereby guaranteeing optimal results for high‐quality care.
The integration of these modules within dental curriculum is not only improve the level of services that future dental professionals provide but also contribute toward the broader goal of reducing prescription errors, which indeed will enhance patient safety and further reduce the risk of adverse events. This is because dental professionals are often the first point of contact for many patients, particularly in areas of pain and infection. The emphasis that this research places on practical applicability ensures that dental students are better equipped to handle complex prescribing scenarios encountered in a clinical setting.
5. Conclusion
The study demonstrated that the introduction of an educational teaching module focused on prescription writing for medical comorbid conditions can well enhance prescription‐writing skills among dental students. In comparison with a control group, students who were exposed to an intervention comprising an educational teaching module had higher scores in terms of the accuracy, completeness, and appropriateness of the kind of medication prescribed. The findings emphasize the integration of specific teaching on prescription writing within the dental students’ curriculum, as they are quite likely to come across a variety of medical comorbidities among their patients in professional practice.
The IPE team contribution in developing and refining the teaching module further confirms an interprofessional approach in dental education. A contribution from the IPE team ensured that the module did not concentrate merely on dental practice but was integrated through a wider approach to health with emphasis on collaborative work from both dental, medical, and other health professionals. This interprofessional emphasis will be significant in preparing dental students for practice within a health care team, and this, in turn, will reinforce their management of patients with complex medical conditions.
A module, designed to enhance the art of prescription writing effectively and accurately after due input from the IPE team, will prove an asset in increasing competency among dental students for the prescription of drugs in patients with medically complex conditions. Medical accreditation programs for dentals should view seriously the incorporation of such modules of interprofessional teaching into dental curricula to prepare future dental professionals to handle a wide range of medication problems affecting their patients effectively.
Jodalli P., Bajaj G., Gilbert J. H. V., and Shenoy R., “Development and Validation of a Teaching Module for Prescription Writing for Dental Students: A Randomized Controlled Trial.” Journal of Dental Education 89, no. 9 (2025): 1371–1379. 10.1002/jdd.13860
Contributor Information
Gagan Bajaj, Email: gagan.bajaj@manipal.edu.
Ramya Shenoy, Email: ramya.shenoy@manipal.edu.
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