Understanding Undergraduate Medical Education in Medicines Optimisation and its Broader Importance: a Realist Review and Evaluations

Background: Problematic polypharmacy (PP) burdens and endangers people living with multimorbidity. Medicines optimisation (MO) describes the person-centred approach to ensuring safe and effective medicines use and is a key solution to PP. MO is complex; it can be an exemplar of an activity requiring the practical integration of the biomedical and interpretive illness agendas for clinical decision-making. Despite its importance, MO education is poorly understood, particularly at the undergraduate level. This thesis develops a programme theory (PT) examining the workings of MO education in the undergraduate medical setting and explores the transferable insight arising from this understanding.
Methods: Using a realist evaluation (RE) approach, a realist review developed a PT unpacking the workings of medical undergraduate MO education. This PT was refined using primary data from two RE focussed on the UK context; an individual interview study of expert MO educators and a focus group study of learners. The work was consolidated into an overall synthesis.
Results: The PT explores key aspects of MO educational programmes. Garnering engagement with practice and education focussed on interpretive principles, such as MO, is challenging in the current educational and healthcare context prioritising standardisation of patient care, educational experience and assessment. Therefore, this education must trigger in learners the self-efficacy and security to practice according to interpretive principles and should aim to incorporate these principles into learners’ developing professional identity. These programmes should promote a culture of learning for lifelong professional practice over task-orientated ‘knowing’. The interventions and mechanisms generative of these outcomes are proposed.
Conclusions: This thesis unpacks the workings of undergraduate MO education and uses it as a practical case-study to explore educational approaches supportive of interpretive practice more widely. Effective undergraduate MO education is required to tackle PP and may provide a setting for learners to develop their interpretive practice more broadly.