1
|
Abdel-Latif MM, Elewa HA, El-Kholy AAES. Perceptions and Attitudes of Hospital’ Prescribers towards Drug Information Sources and Prescribing Practices. BRAZ J PHARM SCI 2022. [DOI: 10.1590/s2175-97902022e20498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
|
2
|
Brûlé J, Abboud C, Deschambault É. Smoking cessation counselling practices among Québec optometrists: evaluating beliefs, practices, barriers and needs. Clin Exp Optom 2021; 95:599-605. [DOI: 10.1111/j.1444-0938.2012.00748.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Julie Brûlé
- École d'optométrie, Université de Montréal, Montréal, Québec, Canada. E‐mail:
| | - Carole Abboud
- École d'optométrie, Université de Montréal, Montréal, Québec, Canada. E‐mail:
| | - Émilie Deschambault
- École d'optométrie, Université de Montréal, Montréal, Québec, Canada. E‐mail:
| |
Collapse
|
3
|
Kang MJ, Ngissah RKS. Self-reported confidence and perceived training needs of surgical interns at a regional hospital in Ghana: a questionnaire survey. BMC MEDICAL EDUCATION 2020; 20:386. [PMID: 33109170 PMCID: PMC7590800 DOI: 10.1186/s12909-020-02319-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 10/20/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Due to disparities in their regional distribution of the surgical specialists, those who have finished "housemanship," which is the equivalent of an internship, are serving as main surgical care providers in rural areas in Ghana. However, the quantitative volume of postgraduate surgical training experience and the level of self-reported confidence after formal training have not been investigated in detail in sub-Saharan Africa. METHODS The quality-assessment data of the Department of surgery at a regional hospital in Ghana was obtained from the convenience samples of house officers (HOs) who had their surgical rotation before July 2019. A self-reported questionnaire with 5-point Likert-type scale and open-ended responses regarding the 35 topics listed as learning objectives by the Medical and Dental Council of Ghana were retrospectively reviewed to investigate the volume of surgical experience, self-reported confidence, and perceived training needs. RESULTS Among 52 respondents, the median self-reported number of patients experienced for each condition was less than 11 cases. More than 40% of HOs reported that they had never experienced cases of liver tumor (n = 21, 40.4%), portal hypertension (n = 23, 44.2%), or cancer chemotherapy/cancer therapy (n = 26, 50.0%). The median self-confidence score was 3.69 (interquartile range, 3.04 ~ 4.08). More than 50% of HOs scored ≤2 points on the self-confidence scale of gastric cancer (n = 28, 53.8%), colorectal cancer (n = 31, 59.6%), liver tumors (n = 32, 61.5%), and cancer chemotherapy/cancer therapy (n = 38, 73.1%). The top 3 reasons for not feeling confident were the limited number of patients (n = 42, 80.8%), resources and infrastructure (n = 21, 40.4%), and amount of supervision (n = 18, 34.6%). Eighteen HOs (34.6%) rated their confidence in their surgical skills as ≤2 points. Of all respondents, 76.9% (n = 40) were satisfied with their surgical rotation and 84.6% (n = 44) perceived the surgical rotation as relevant to their future work. Improved basic surgical skills training (n = 27, 51.9%) and improved supervision (n = 18, 34.6%) were suggested as a means to improve surgical rotation. CONCLUSIONS Surgical rotation during housemanship (internship) should be improved in terms of cancer treatment, surgical skills, and supervision to improve the quality of training, which is closely related to the quality of surgical care in rural areas.
Collapse
Affiliation(s)
- Mee Joo Kang
- Center for Liver and Pancreatobiliary Cancer, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, 10408, Republic of Korea
- Department of Surgery, Greater Accra Regional Hospital, P.O. Box 473, Accra, Republic of Ghana
| | | |
Collapse
|
4
|
Woit C, Yuksel N, Charrois TL. Competence and confidence with prescribing in pharmacy and medicine: a scoping review. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2019; 28:312-325. [DOI: 10.1111/ijpp.12595] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 11/01/2019] [Accepted: 11/09/2019] [Indexed: 11/30/2022]
Abstract
Abstract
Objectives
Prescribing is a growing scope of practice for pharmacists. The objective of this scoping review is to explore themes within the literature related to prescribing competence and confidence in the disciplines of pharmacy and medicine.
Methods
Online databases MEDLINE, EMBASE and Global Health were used to identify articles from inception to October 2018. Articles describing either the competence or confidence of physician, pharmacist or student prescribing, including inappropriate prescribing and prescribing errors were included.
Key findings
After applying the inclusion and exclusion criteria, 33 eligible articles remained. Many studies demonstrate that medical students and junior doctors are not competent in prescribing when they enter practice, and their perceived confidence is often higher than their assessed competence. There were fewer studies about pharmacist competence and confidence with prescribing; however, they described pharmacists that felt competent to prescribe but lacked confidence. Themes from the review included self-awareness, lack of education and educational improvements, prescribing errors and resources, prescribing culture and barriers to prescribing, gender differences and benefits to prescribing.
Conclusions
There is little consensus from the outcomes of these studies related to prescribing competence or confidence. While some reflect positively on prescribing competence and confidence, others show major deficits in competence and lack of confidence. Further research needs to be done to evaluate pharmacist competence and confidence with respect to prescribing.
Collapse
Affiliation(s)
- Cassandra Woit
- University of Alberta Faculty of Pharmacy and Pharmaceutical Sciences, Edmonton Clinic Health Academy, Edmonton, Canada
| | - Nese Yuksel
- University of Alberta Faculty of Pharmacy and Pharmaceutical Sciences, Edmonton Clinic Health Academy, Edmonton, Canada
| | - Theresa L Charrois
- University of Alberta Faculty of Pharmacy and Pharmaceutical Sciences, Edmonton Clinic Health Academy, Edmonton, Canada
| |
Collapse
|
5
|
Flores CJ, Quested B, Spigiel T, Thomson A, Saxon B. Junior doctors' perspectives on transfusion education in Australia. Vox Sang 2018; 113:441-448. [PMID: 29740847 DOI: 10.1111/vox.12654] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 03/19/2018] [Accepted: 03/27/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Early postgraduate training is a critical period to develop skills and to influence future clinical practice. Little is known about Australian junior doctors' existing transfusion knowledge and its application in patient care. This study explored their transfusion practice education preferences, developed tools to assist their practice and assessed the usefulness of these tools. METHODS A design-based study was conducted in two phases from April 2016 to March 2017. Phase 1 involved focus group sessions in six hospitals. Transcripts of audio recordings were analysed using thematic analysis. Findings were considered when developing transfusion practice support tools. Phase 2 surveyed junior doctors' response to the tools provided during orientation in five hospitals. Participation was voluntary. RESULTS Fifty-two junior doctors participated in the focus groups. Their priority was to be able to practice safely, appropriately and confidently. Preferred format for transfusion learning included expert-led face-to-face education; printed tools, for example lanyard cards; and for one app that covers essential aspects of transfusion practice. Adverse events management and practical transfusion prescribing were topics of most importance. Thirty-nine survey respondents found the transfusion practice support tools useful and recommended their use to complement practice. CONCLUSION There is a need for improved education to ensure best transfusion practice and patient outcomes. Australian junior doctors want immediate, practical, reliable transfusion information from credible sources to support them in practicing safely and confidently. Their educational needs are driven by real-time patient management. Promotion of the available resources and tools provided by the blood sector is important.
Collapse
Affiliation(s)
- C J Flores
- Clinical Services and Research Division, Australian Red Cross Blood Service, Melbourne, VIC, Australia
| | - B Quested
- Clinical Services and Research Division, Australian Red Cross Blood Service, Adelaide, SA, Australia
| | - T Spigiel
- Clinical Services and Research Division, Australian Red Cross Blood Service, Adelaide, SA, Australia
| | - A Thomson
- Clinical Services and Research Division, Australian Red Cross Blood Service, Sydney, NSW, Australia
| | - B Saxon
- Clinical Services and Research Division, Australian Red Cross Blood Service, Adelaide, SA, Australia
| |
Collapse
|
6
|
Weier N, Thursky K, Zaidi STR. Antimicrobial knowledge and confidence amongst final year medical students in Australia. PLoS One 2017; 12:e0182460. [PMID: 28771549 PMCID: PMC5542537 DOI: 10.1371/journal.pone.0182460] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Accepted: 07/18/2017] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Inappropriate use of antimicrobials is one of the major modifiable contributors to antimicrobial resistance. There is currently no validated survey tool available to assess knowledge and confidence of medical students in infectious diseases (ID) compared to other diseases states, and little is known about this topic. MATERIALS AND METHODS A cross-sectional survey of final year medical students attending universities around Australia was conducted between August and September, 2015. A survey unique from other published studies was developed to survey satisfaction in education, confidence and knowledge in ID, and how this compared to these factors in cardiovascular diseases. RESULTS Reliability and validity was demonstrated in the survey tool used. Students were more likely to rate university education as sufficient for cardiovascular diseases (91.3%) compared to ID (72.5%), and were more confident in their knowledge of cardiovascular diseases compared to ID (74.38% vs. 53.76%). Students tended to answer more cardiovascular disease related clinical questions correctly (mean score 78%), compared to questions on antimicrobial use (mean score 45%). CONCLUSIONS Poor knowledge and confidence amongst final year medical students in Australia were observed in ID. Antimicrobial stewardship agenda should include the provision of additional training in antimicrobial prescribing to the future medical workforce.
Collapse
Affiliation(s)
- Naomi Weier
- Division of Pharmacy, School of Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Karin Thursky
- Doherty Institute, Melbourne, Victoria, Australia
- The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Syed Tabish R. Zaidi
- Division of Pharmacy, School of Medicine, University of Tasmania, Hobart, Tasmania, Australia
- * E-mail:
| |
Collapse
|
7
|
Cullinan S, O’Mahony D, Byrne S. Use of an e-Learning Educational Module to Better Equip Doctors to Prescribe for Older Patients: A Randomised Controlled Trial. Drugs Aging 2017; 34:367-374. [DOI: 10.1007/s40266-017-0451-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
|
8
|
R Hansen C, Bradley CP, Sahm LJ. Factors Influencing Successful Prescribing by Intern Doctors: A Qualitative Systematic Review. PHARMACY 2016; 4:pharmacy4030024. [PMID: 28970397 PMCID: PMC5419364 DOI: 10.3390/pharmacy4030024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 08/15/2016] [Accepted: 08/17/2016] [Indexed: 12/18/2022] Open
Abstract
As the majority of prescribing in hospital is undertaken by intern doctors, the aims of this systematic review were to compile the evidence of the qualitative literature on the views and experiences of intern doctors and to examine the role of the pharmacist in assisting in prescribing by interns. A systematic review of the qualitative literature was done according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement. The findings were synthesized using thematic analysis. Seven publications were included. Factors influencing prescribing behaviour were related to the environment; collaboration in medical teams; hierarchical structures; and patient and individual factors. This review confirmed that interns’ prescribing behaviour is influenced by multiple factors, and further highlighted the need for an educational intervention that supports the intern completing the prescribing task in a complex environment, and not just addresses the presumed knowledge gap(s).
Collapse
Affiliation(s)
- Christina R Hansen
- School of Pharmacy, University College Cork, College Road, Cork T12 YN60, Ireland.
| | - Colin P Bradley
- Department of General Practice, University College Cork, Western Road, Cork T12 YN60, Ireland.
| | - Laura J Sahm
- School of Pharmacy, University College Cork, College Road, Cork T12 YN60, Ireland.
- Pharmacy Department, Mercy University Hospital, Grenville Place, Cork T12 WE28, Ireland.
| |
Collapse
|
9
|
Bridging the gap: improving safe prescribing from university to workplace. Int J Clin Pharm 2016; 38:1023-6. [DOI: 10.1007/s11096-016-0346-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 07/01/2016] [Indexed: 10/21/2022]
|
10
|
Dearden E, Mellanby E, Cameron H, Harden J. Which non-technical skills do junior doctors require to prescribe safely? A systematic review. Br J Clin Pharmacol 2015; 80:1303-14. [PMID: 26289988 DOI: 10.1111/bcp.12735] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Revised: 07/24/2015] [Accepted: 08/03/2015] [Indexed: 11/27/2022] Open
Abstract
AIMS Prescribing errors are a major source of avoidable morbidity and mortality. Junior doctors write most in-hospital prescriptions and are the least experienced members of the healthcare team. This puts them at high risk of error and makes them attractive targets for interventions to improve prescription safety. Error analysis has shown a background of complex environments with multiple contributory conditions. Similar conditions in other high risk industries, such as aviation, have led to an increased understanding of so-called human factors and the use of non-technical skills (NTS) training to try to reduce error. To date no research has examined the NTS required for safe prescribing. The aim of this review was to develop a prototype NTS taxonomy for safe prescribing, by junior doctors, in hospital settings. METHODS A systematic search identified 14 studies analyzing prescribing behaviours and errors by junior doctors. Framework analysis was used to extract data from the studies and identify behaviours related to categories of NTS that might be relevant to safe and effective prescribing performance by junior doctors. Categories were derived from existing literature and inductively from the data. RESULTS A prototype taxonomy of relevant categories (situational awareness, decision making, communication and team working, and task management) and elements was constructed. CONCLUSIONS This prototype will form the basis of future work to create a tool that can be used for training and assessment of medical students and junior doctors to reduce prescribing error in the future.
Collapse
Affiliation(s)
- Effie Dearden
- Centre for Medical Education, University of Edinburgh, Chancellor's Building, 49 Little France Crescent, Edinburgh
| | - Edward Mellanby
- Centre for Medical Education, University of Edinburgh, Chancellor's Building, 49 Little France Crescent, Edinburgh
| | - Helen Cameron
- Centre for Medical Education, University of Edinburgh, Chancellor's Building, 49 Little France Crescent, Edinburgh
| | - Jeni Harden
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK
| |
Collapse
|
11
|
Page MA, Bajorek BV, Brien JAE. Prescribing in Teaching Hospitals: a Qualitative Study of Social and Cultural Dynamics. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2015. [DOI: 10.1002/j.2055-2335.2008.tb00391.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Meredith A Page
- NSW Medicines Information Centre, Darlinghurst, currently Medical Writer, National Prescribing Service Limited, Strawberry Hills
| | - Beata V Bajorek
- Northern Sydney Central Coast Health and The University of Sydney
| | - Jo-anne E Brien
- Therapeutics Centre, St Vincent's Hospital, and Associate Dean (Admissions and Administration); The University of Sydney; Sydney New South Wales
| |
Collapse
|
12
|
Coombes ID, Heel ACY, Stowasser DA, Reid CM, Henderson A, Mitchell CA. Identification of Medication Errors by Nurses During a Simulated Ward, Medication Safety Orientation Program. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2015. [DOI: 10.1002/j.2055-2335.2005.tb00336.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Ian D Coombes
- Queensland Health, Safe Medication Practice Unit
- School of Pharmacy; University of Queensland
| | - Alison CY Heel
- Nursing Practice Development Unit, Princess Alexandra Hospital
| | - Danielle A Stowasser
- Queensland Health, Safe Medication Practice Unit
- School of Pharmacy; University of Queensland
| | - Carol M Reid
- Queensland Health, Safe Medication Practice Unit
| | | | - Charles A Mitchell
- Queensland Health, Safe Medication Practice Unit
- School of Medicine; University of Queensland
| |
Collapse
|
13
|
Lewis PJ, Ashcroft DM, Dornan T, Taylor D, Wass V, Tully MP. Exploring the causes of junior doctors' prescribing mistakes: a qualitative study. Br J Clin Pharmacol 2015; 78:310-9. [PMID: 24517271 DOI: 10.1111/bcp.12332] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Accepted: 01/20/2014] [Indexed: 11/30/2022] Open
Abstract
AIMS Prescribing errors are common and can be detrimental to patient care and costly. Junior doctors are more likely than consultants to make a prescribing error, yet there is only limited research into the causes of errors. The aim of this study was to explore the causes of prescribing mistakes made by doctors in their first year post graduation. METHODS As part of the EQUIP study, interviews using the critical incident technique were carried out with 30 newly qualified doctors. Participants were asked to discuss in detail any prescribing errors they had made. Participants were purposely sampled across a range of medical schools (18) and hospitals (15). A constant comparison approach was taken to analysis and Reason's model of accident causation was used to present the data. RESULTS More than half the errors discussed were prescribing mistakes (errors due to the correct execution of an incorrect plan). Knowledge-based mistakes (KBMs) appeared to arise from poor knowledge of practical aspects of prescribing such as dosing, whereas rule-based mistakes (RBMs) resulted from inappropriate application of knowledge. Multiple error-producing and latent conditions were described by participants for RBMs and KBMs. Poor/absent senior support and a fear of appearing incompetent occurred with KBMs. Following erroneous routines or seniors' orders were major contributory factors in RBMs. CONCLUSIONS Although individual factors such as knowledge and expertise played a role in prescribing mistakes, there were many perceived interrelated factors contributing to error. We conclude that multiple interventions are necessary to address these and further research is essential.
Collapse
Affiliation(s)
- Penny J Lewis
- Manchester Pharmacy School, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
| | | | | | | | | | | |
Collapse
|
14
|
Dallas A, van Driel M, van de Mortel T, Magin P. Antibiotic prescribing for the future: exploring the attitudes of trainees in general practice. Br J Gen Pract 2014; 64:e561-7. [PMID: 25179070 PMCID: PMC4141613 DOI: 10.3399/bjgp14x681373] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Accepted: 04/17/2014] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Antibiotic resistance is a public health concern worldwide. A high proportion of antibiotics are prescribed in primary care, often for conditions where there is no evidence of benefit. Without a change in these prescribing patterns, resistance will persist as a significant problem in the future. Little is known about how trainees in general practice perceive and develop their prescribing. AIM To explore the attitudes of trainees in general practice towards antibiotic use and resistance, and the perceived influences on their prescribing. DESIGN AND SETTING A qualitative study of 17 vocational trainees in general practice (GP registrars) in both rural and urban areas in Australia employing semi-structured interviews and a focus group. METHOD Maximum variation purposive sampling of GP registrars from diverse backgrounds and training stages continued until thematic saturation was achieved. Topics of discussion included awareness of antibiotic resistance, use of evidence-based guidelines, and perceived influences on prescribing. Transcribed interviews were coded independently by two researchers. Data collection and analysis were concurrent and cumulative, using a process of iterative thematic analysis. RESULTS Registrars were aware of the importance of evidence-based antibiotic prescribing and the impact of their decisions on resistance. Many expressed a sense of dissonance between their knowledge and behaviours. Contextual influences on their decisions included patient and system factors, diagnostic uncertainty, transitioning from hospital medicine, and the habits of, and relationship with, their supervisor. CONCLUSION Understanding how trainees in general practice perceive and develop antibiotic prescribing habits will enable targeted educational interventions to be designed and implemented at a crucial stage in training, working towards ensuring appropriate antibiotic prescribing in the future.
Collapse
Affiliation(s)
- Anthea Dallas
- Discipline of General Practice, University of Queensland, Herston, Queensland, Australia
| | - Mieke van Driel
- Discipline of General Practice, University of Queensland, Herston, Queensland, Australia
| | - Thea van de Mortel
- School of Nursing & Midwifery, Griffith University, Meadowbrook, Queensland, Australia
| | - Parker Magin
- University of Newcastle, Discipline of General Practice, Callaghan, New South Wales, Australia
| |
Collapse
|
15
|
Gilmour J, Huntington A, Bogossian F, Leadbitter B, Turner C. Medical education and informal teaching by nurses and midwives. INTERNATIONAL JOURNAL OF MEDICAL EDUCATION 2014; 5:173-177. [PMID: 25341227 PMCID: PMC4217524 DOI: 10.5116/ijme.53f5.ee77] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Accepted: 08/31/2014] [Indexed: 06/04/2023]
Abstract
OBJECTIVE The aim of this study was to examine the contribution of nurses and midwives to the education of medical colleagues in the clinical context. METHODS The research design was a cross-sectional survey using an online questionnaire. A subsample of 2906 respondents, from a total of 4763 nurses and midwives participating in a web-based study, had taught doctors in the 12 months prior to the survey. The questionnaire generated mainly categorical data analysed with descriptive statistics. RESULTS In the group of respondents who taught doctors (n =2906), most provided informal teaching (92.9%, n=2677). Nearly a quarter (23.9%, n=695) self-rated the amount of time spent teaching as at least moderate in duration. The most common named teaching topics were documentation (74.8%, n=2005) and implementing unit procedures (74.3, n=1987), followed by medication charting (61.9%, n=1657) and choosing correct medications (55.8%, n=1493). Respondents felt their contributions were unrecognised by the doctors and students they taught (43.9%, n=1256). CONCLUSIONS Educational contributions while unrecognised could be considered positively by the respondents. However, discussion of teaching responsibilities is necessary to support the development of teaching protocols and supervision responsibilities as respondents reported teaching clinical medical tasks related to medications, consent and other skills within the medical domain. Study limitations include the nature of self-reported responses which cannot be validated and data drawn from a survey concluded in 2009.
Collapse
Affiliation(s)
- Jean Gilmour
- School of Nursing, Massey University, New Zealand
| | | | - Fiona Bogossian
- School of Nursing & Midwifery, The University of Queensland, Queensland, Australia
| | | | - Catherine Turner
- School of Nursing & Midwifery, The University of Queensland, Queensland, Australia
| |
Collapse
|
16
|
Rogers GD, McConnell HW, Jones de Rooy N, Ellem F, Lombard M. A randomised controlled trial of extended immersion in multi-method continuing simulation to prepare senior medical students for practice as junior doctors. BMC MEDICAL EDUCATION 2014; 14:90. [PMID: 24886098 PMCID: PMC4016660 DOI: 10.1186/1472-6920-14-90] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Accepted: 04/25/2014] [Indexed: 05/03/2023]
Abstract
BACKGROUND Many commencing junior doctors worldwide feel ill-prepared to deal with their new responsibilities, particularly prescribing. Simulation has been widely utilised in medical education, but the use of extended multi-method simulation to emulate the junior doctor experience has rarely been reported. METHODS A randomised controlled trial compared students who underwent two, week-long, extended simulations, several months apart (Intervention), with students who attended related workshops and seminars alone (Control), for a range of outcome measures. RESULTS Eighty-four third year students in a graduate-entry medical program were randomised, and 82 completed the study. At the end of the first week, Intervention students scored a mean of 75% on a prescribing test, compared with 70% for Control students (P = 0.02) and Intervention teams initiated cardiac compressions a mean of 29.1 seconds into a resuscitation test scenario, compared with 70.1 seconds for Control teams (P < 0.01). At the beginning of the second week, an average of nine months later, a significant difference was maintained in relation to the prescribing test only (78% vs 70%, P < 0.01).At the end of the second week, significant Intervention vs Control differences were seen on knowledge and reasoning tests, a further prescribing test (71% vs 63% [P < 0.01]) and a paediatric resuscitation scenario test (252 seconds to initiation of fluid resuscitation vs 339 seconds [P = 0.05]). CONCLUSIONS The study demonstrated long-term retention of improved prescribing skills, and an immediate effect on knowledge acquisition, reasoning and resuscitation skills, from contextualising learning activities through extended multi-method simulation.
Collapse
Affiliation(s)
- Gary D Rogers
- School of Medicine, Griffith University, Gold Coast, Queensland 4222, Australia
- Health Institute for the Development of Education and Scholarship, Griffith University, Gold Coast, Queensland 4222, Australia
| | - Harry W McConnell
- School of Medicine, Griffith University, Gold Coast, Queensland 4222, Australia
| | | | - Fiona Ellem
- School of Pharmacy, Griffith University, Gold Coast, Queensland 4222, Australia
| | - Marise Lombard
- School of Medicine, Griffith University, Gold Coast, Queensland 4222, Australia
| |
Collapse
|
17
|
Cashin A, Stasa H, Dunn SV, Pont L, Buckley T. Nurse practitioner prescribing practice in Australia: Confidence in aspects of medication management. Int J Nurs Pract 2014; 20:1-7. [DOI: 10.1111/ijn.12237] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Andrew Cashin
- School of Health and Human Sciences; Southern Cross University; Lismore New South Wales Australia
| | - Helen Stasa
- Sydney Nursing School; University of Sydney; Camperdown New South Wales Australia
| | - Sandra V Dunn
- School of Health; Charles Darwin University; Darwin Northern Territory Australia
| | - Lisa Pont
- Sydney Nursing School; University of Sydney; Camperdown New South Wales Australia
| | - Thomas Buckley
- Sydney Nursing School; University of Sydney; Camperdown New South Wales Australia
| |
Collapse
|
18
|
Patrício KP, Alves NAB, Arenales NG, Queluz TT. Teaching the Rational Use of Medicines to medical students: a qualitative research. BMC MEDICAL EDUCATION 2012; 12:56. [PMID: 22812522 PMCID: PMC3548729 DOI: 10.1186/1472-6920-12-56] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2011] [Accepted: 07/19/2012] [Indexed: 06/01/2023]
Abstract
BACKGROUND Prescribing is a complex and challenging task that must be part of a logical deductive process based on accurate and objective information and not an automated action, without critical thinking or a response to commercial pressure. The objectives of this study were 1) develop and implement a discipline based on the WHO's Guide to Good Prescribing; 2) evaluate the course acceptance by students; 3) assess the impact that the Rational Use of Medicines (RUM) knowledge had on the students habits of prescribing medication in the University Hospital. METHODS In 2003, the RUM principal, based in the WHO's Guide to Good Prescribing, was included in the official curriculum of the Botucatu School of Medicine, Brazil, to be taught over a total of 24 hours to students in the 4th year. We analyzed the students' feedback forms about content and teaching methodology filled out immediately after the end of the discipline from 2003 to 2010. In 2010, the use of RUM by past students in their medical practice was assessed through a qualitative approach by a questionnaire with closed-ended rank scaling questions distributed at random and a single semistructured interview for content analysis. RESULTS The discipline teaches future prescribers to use a logical deductive process, based on accurate and objective information, to adopt strict criteria (efficacy, safety, convenience and cost) on selecting drugs and to write a complete prescription. At the end of it, most students considered the discipline very good due to the opportunity to reflect on different actions involved in the prescribing process and liked the teaching methodology. However, former students report that although they are aware of the RUM concepts they cannot regularly use this knowledge in their daily practice because they are not stimulated or even allowed to do so by neither older residents nor senior medical staff. CONCLUSIONS This discipline is useful to teach RUM to medical students who become aware of the importance of this subject, but the assimilation of the RUM principles in the institution seems to be a long-term process which requires the involvement of a greater number of the academic members.
Collapse
Affiliation(s)
- Karina Pavão Patrício
- Departament of Public Health, Univ. Estadual Paulista - UNESP, Botucatu School of Medicine, Botucatu, SP, Brazil
| | - Nycholas Adriano Borges Alves
- Department of Internal Medicine, Univ. Estadual Paulista - UNESP, Botucatu School of Medicine, Botucatu, SP, 18618-970, Brazil
| | - Nadja Guazzi Arenales
- Department of Internal Medicine, Univ. Estadual Paulista - UNESP, Botucatu School of Medicine, Botucatu, SP, 18618-970, Brazil
| | - Thais Thomaz Queluz
- Department of Internal Medicine, Univ. Estadual Paulista - UNESP, Botucatu School of Medicine, Botucatu, SP, 18618-970, Brazil
| |
Collapse
|
19
|
Monajemi A, Schmidt HG, Rikers RMJP. Assessing patient management plans of doctors and medical students: an illness script perspective. THE JOURNAL OF CONTINUING EDUCATION IN THE HEALTH PROFESSIONS 2012; 32:4-9. [PMID: 22447706 DOI: 10.1002/chp.21118] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
INTRODUCTION Illness script theory offers explanations for expert-novice differences in clinical reasoning. However, it has mainly focused on diagnostic (Dx) performance, while patient management (Mx) has been largely ignored. The aim of the present study was to show the role of Mx knowledge in illness script development and how it relates to diagnostic knowledge in the course of development toward expertise. METHODS The participants were 10 fourth-year and 10 sixth-year medical students, and 10 experienced physicians (ie, internists). Participants were asked to study 4 written clinical cases and provide management plans. Based on propositional analysis the management plans were examined for accuracy and elaborateness as well as the number of Mx and Dx items. RESULTS Providing accurate Mx plans that concurrently pay attention to Dx and Mx was a characteristic of doctors' performance. The Mx plans of sixth-year students were as accurate as fourth-year students, but the format and the size of sixth-year students' plans was more similar to those of doctors. While sixth-year students generated plans with an Mx focus, the plans of fourth-year students were characterized by a Dx focus. DISCUSSION The experienced physicians' accurate management plans are characterized by a high number of the Mx and Dx items. For sixth-year students the management plans are still incomplete, which leads to generic as well as inaccurate Mx orders. For fourth-year students, the Mx focus is lacking, and hence they seem to treat an Mx task as if it were a Dx task.
Collapse
Affiliation(s)
- Alireza Monajemi
- Philosophy of Science Department, Institute for Humanities and Cultural Studies, Erasmus University.
| | | | | |
Collapse
|
20
|
Baysari MT, Westbrook J, Braithwaite J, Day RO. The role of computerized decision support in reducing errors in selecting medicines for prescription: narrative review. Drug Saf 2011; 34:289-98. [PMID: 21417501 DOI: 10.2165/11588200-000000000-00000] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
This narrative review includes a summary of research examining prescribing errors, prescription decision making and the role computerized decision support plays in this decision-making process. A reduction in medication prescribing errors, specifically a reduction in the selection of inappropriate medications, is expected to result from the implementation of an effective computerized decision support system. Previous research has investigated the impact of the implementation of electronic systems on medication errors more broadly. This review examines the specific characteristics of decision support systems that may contribute to fewer knowledge-based mistakes in prescribing, and critically appraises the large volume of information available on the decision-making process of selecting medicines for prescription. The results highlight a need for work investigating what decision strategies are used by doctors with different levels of expertise in the prescribing of medications. The nature of the relationship between decision support and decision performance is not well understood and future research is needed to determine the mechanisms by which computerized decision support influences medication selection.
Collapse
Affiliation(s)
- Melissa T Baysari
- Australian Institute of Health Innovation, Faculty of Medicine, University of New South Wales, Sydney, NSW 2010, Australia.
| | | | | | | |
Collapse
|
21
|
Syhakhang L, Soukaloun D, Tomson G, Petzold M, Rehnberg C, Wahlström R. Provider performance in treating poor patients--factors influencing prescribing practices in lao PDR: a cross-sectional study. BMC Health Serv Res 2011; 11:3. [PMID: 21210989 PMCID: PMC3022646 DOI: 10.1186/1472-6963-11-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2010] [Accepted: 01/06/2011] [Indexed: 11/21/2022] Open
Abstract
Background Out-of-pocket payments make up about 80% of medical care spending at hospitals in Laos, thereby putting poor households at risk of catastrophic health expenditure. Social security schemes in the form of community-based health insurance and health equity funds have been introduced in some parts of the country. Drug and Therapeutics Committees (DTCs) have been established to ensure rational use of drugs and improve quality of care. The objective was to assess the appropriateness and expenditure for treatment for poor patients by health care providers at hospitals in three selected provinces of Laos and to explore associated factors. Methods Cross-sectional study using four tracer conditions. Structured interviews with 828 in-patients at twelve provincial and district hospitals on the subject of insurance protection, income and expenditures for treatment, including informal payment. Evaluation of each patient's medical record for appropriateness of drug use using a checklist of treatment guidelines (maximum score = 10). Results No significant difference in appropriateness of care for patients at different income levels, but higher expenditures for patients with the highest income level. The score for appropriate drug use in insured patients was significantly higher than uninsured patients (5.9 vs. 4.9), and the length of stay in days significantly shorter (2.7 vs. 3.7). Insured patients paid significantly less than uninsured patients, both for medicines (USD 14.8 vs. 43.9) and diagnostic tests (USD 5.9 vs. 9.2). On the contrary the score for appropriateness of drug use in patients making informal payments was significantly lower than patients not making informal payments (3.5 vs. 5.1), and the length of stay significantly longer (6.8 vs. 3.2), while expenditures were significantly higher both for medicines (USD 124.5 vs. 28.8) and diagnostic tests (USD 14.1 vs. 7.7). Conclusions The lower expenditure for insured patients can help reduce the number of households experiencing catastrophic health expenditure. The positive effects of insurance schemes on expenditure and appropriate use of medicines may be associated with the long-term effects of promoting rational use of drugs, including support to active DTC work.
Collapse
|
22
|
|
23
|
Murnion BP, Gnjidic D, Hilmer SN. Prescription and Administration of Opioids to Hospital In-patients, and Barriers to Effective Use. PAIN MEDICINE 2010; 11:58-66. [DOI: 10.1111/j.1526-4637.2009.00747.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
24
|
Gwee MCE. Teaching of medical pharmacology: the need to nurture the early development of desired attitudes for safe and rational drug prescribing. MEDICAL TEACHER 2009; 31:847-54. [PMID: 19811191 DOI: 10.1080/01421590903168119] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Pharmacology, as a basic medical science discipline, provides the scientific basis of therapeutics, i.e. the scientific foundation for safe and rational prescribing of drugs. The public, lay media, and the medical profession have raised serious concerns over the high incidence of errors of drug prescribing which compromise patient safety, including death of some patients, attributed mainly to inadequate teaching of medical pharmacology and, consequently, to medical graduates lacking skills in safe and effective drug prescribing. There is also overwhelming evidence that the pervasive and prevalent doctor-drug industry relationships have a strong influence over the prescribing habits and drug education of doctors. The British Pharmacological Society and American Association of Medical Colleges have crafted some insightful guidelines, including the learning of desired attitudes, for designing a medical pharmacology curriculum aimed at enhancing patient safety. This article will critically review the major issues relating to errors of drug prescribing, including the need to nurture the early development of desired attitudes which foster safe and rational drug prescribing. A simple educational approach, using a task analysis of drug prescribing, is applied to identify desired attitudes which should be incorporated into a basic pharmacology course for medical students in the twenty-first century.
Collapse
Affiliation(s)
- Matthew C E Gwee
- Medical Education Unit and Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
| |
Collapse
|
25
|
Chauhan D, Mason A. Factors affecting the uptake of new medicines in secondary care - a literature review. J Clin Pharm Ther 2008; 33:339-48. [PMID: 18613851 DOI: 10.1111/j.1365-2710.2008.00925.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND OBJECTIVE The rate of uptake of new medicines in the UK is slower than in many other OECD countries. The majority of new medicines are introduced initially in secondary care and prescribed by specialists. However, the reasons for relatively low precribing levels are poorly understood. This review explores the determinants of uptake of new medicines in secondary care. METHODS Nine electronic databases were searched covering the period 1992-2006. Once the searches had been run, records were downloaded and those which evaluated uptake of new medicines in secondary care were identified. UK studies were of primary interest, although research conducted in other countries was also reviewed if relevant. With the exception of 'think pieces', eligibility was not limited by study design. Studies published in languages other than English were excluded from the review. Determinants of uptake in secondary care were classified using Bonair and Persson's typology for determinants of the diffusion of innovation. RESULTS Almost 1400 records were screened for eligibility, and 29 studies were included in the review. Prescribing of new medicines in secondary care was found to be subject to a number of interacting influences. The support structures which exist within secondary care facilitate access to other colleagues and shape prescribing practices. Clinical trial investigators and physicians who sit on decision-making bodies such as Drug and Therapeutic Committees (DTCs) appear to have a special influence due to their proximity to their research and understanding of evidence base. Pharmaceutical representatives may also influence prescribing decisions through funding of meetings and academic detailing, but clinicians are wary of potential bias. Little evidence on the influence of patients upon prescribing decisions was identified. The impact of clinical guidelines has been variable. Some guidelines have significantly increased the uptake of new medicines, but others have had little discernible impact despite extensive dissemination. However given the increasing influence of the National Institute for Health and Clinical Excellence, guidelines may become more important. The impact of financial prescribing incentives on secondary care prescribing is unclear. Although cost and budget may influence hospital prescribing of new drugs, they are of secondary importance to the safety and effectiveness profile of the medicine. If a drug has a novel mechanism of action, or belongs to a class with few alternatives, clinicians are more likely to consider it favourably as a prescribing option. CONCLUSIONS Although price does not appear to be a primary factor behind prescribing decision-making, in secondary care there has long been a historical need for formal purchasing decisions through the DTC, which differentiates it from primary care. This, in addition to increasing pressures for cost-effectiveness within the NHS means that cost will appear more frequently on clinician consciousness. As a result, guidelines are more likely to be implemented using the strong professional networks in existence within secondary care, and although the influence of patients has not been addressed by the literature, they are likely to have an increasing input into the prescribing decision, given the importance of patient involvement in current UK policy.
Collapse
Affiliation(s)
- D Chauhan
- Office of Health Economics, London, UK.
| | | |
Collapse
|
26
|
Coombes ID, Mitchell CA, Stowasser DA. Safe medication practice: attitudes of medical students about to begin their intern year. MEDICAL EDUCATION 2008; 42:427-431. [PMID: 18338996 DOI: 10.1111/j.1365-2923.2008.03029.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
OBJECTIVES Interns are expected to prescribe effectively and safely. This study aimed to assess medical students' perceptions of their readiness to prescribe, associated risks and outcome if involved in an error, as well as their perceptions of available support. METHODS We carried out a survey of 101 students prior to their intern year using a structured questionnaire. An indication of agreement with 21 closed statements was sought. Thematic clusters were identified by factor analysis. RESULTS Most students (84) felt they would be able to prescribe for most simple complaints and complete discharge prescriptions (81). In high-risk situations, fewer students felt comfortable with prescribing: only 54 felt sufficiently confident to prescribe warfarin and 66 felt confident enough to order i.v. fluids. Many felt support such as guidelines was available (87) and that, if in doubt, they could clarify instructions and seek advice. Students were aware of errors occurring within the medication system; however, most (99) believed that the medicines they prescribed would be safely administered. There was a mixed perception of medication errors: 40 felt that their prescribing errors would not be dealt with constructively and 79 indicated that a culture existed at their hospitals where clinicians would be blamed if they made a prescribing error. CONCLUSIONS At the end of medical school education and prior to assuming responsibility for prescribing, students felt unprepared and perceived that negative outcomes would result if they were involved in errors. These findings indicate that much more work is needed to prepare doctors to prescribe safely, improve the safety of prescribing systems and address the issue of blame.
Collapse
Affiliation(s)
- Ian D Coombes
- Safe Medication Practice Unit, Queensland Health, Brisbane, Queensland, Australia.
| | | | | |
Collapse
|
27
|
Monajemi A, Rikers RMJP, Schmidt HG. Clinical case processing: a diagnostic versus a management focus. MEDICAL EDUCATION 2007; 41:1166-1172. [PMID: 18045368 DOI: 10.1111/j.1365-2923.2007.02922.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
CONTEXT Most studies on medical expertise research have focused on diagnostic performance, whereas patient management has been largely ignored. According to knowledge encapsulation theory, applying encapsulated knowledge is a characteristic of expert doctors' diagnostic reasoning, but it is unclear whether or not encapsulated knowledge also plays a prominent role when processing a clinical case with a management focus. METHODS The participants were 40 medical students (20 in Year 4 and 20 in Year 6) and 20 expert doctors (internists). Participants were asked to study the cases with either a diagnostic (Dx) or a management (Mx) focus. Subsequently, participants were asked to write down what they remembered from the case. RESULTS In both conditions, experts recalled fewer propositions and used more high-level inferences than medical students. Furthermore, they processed the cases faster and more accurately than medical students, but no significant difference between Mx and Dx conditions was found. Year 4 students also showed no significant differences in recall and processing speed between conditions. By contrast, Year 6 students recalled more in a Dx than in an Mx condition, but there was no significant difference in processing speed between conditions. CONCLUSIONS In both conditions, findings indicate that the experts' and Year 4 students' performance was not affected by processing focus. The fact that only Year 6 students were affected by processing focus might be explained by the assumption that their diagnostic knowledge and management knowledge are not fully integrated yet, a process that has already taken place in the expert's knowledge structure.
Collapse
Affiliation(s)
- Alireza Monajemi
- Applied Physiology Research Centre, Isfahan University of Medical Sciences, Isfahan, Iran.
| | | | | |
Collapse
|
28
|
Coombes I, Mitchell C, Stowasser D. Safe medication practice tutorials: a practical approach to preparing prescribers. CLINICAL TEACHER 2007. [DOI: 10.1111/j.1743-498x.2007.00164.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
29
|
Abstract
High levels of anxiety and stress during medical education may have negative effects on students' learning and may also influence students' performance, decision-making and caring capabilities. This study aims to compare the anxieties of clerkships of two medical schools that apply two different preclinical curricula; one is problem-based and the other is integrated. Dokuz Eylul University School of Medicine (DEUSM) has the basic clinical and communication skills education by the first year of medical education. However, the students of Marmara University School of Medicine (MUSM) had not any preclinical training about these issues at the time we performed this study. In order to evaluate the perceived anxiety, we used a questionnaire which comprises 39 issues presented as 4-point Likert-type scales. Eighty-six clerkships from MUSM and 115 clerkships from DEUSM participated in the study. According to the students of both of the schools, fear of making mistakes that could harm the patients was at the top of the list of sources of anxiety. The students of MUSM have additional anxieties related to the core clinical skills such as suturing patients, taking blood from patients and giving injections. On the other hand, the students of DEUSM have anxieties mostly related to difficult issues in communication such as breaking bad news. The study has revealed that medical students might have anxiety related to the clinical practice in the beginning of their clerkships. It was also shown that sources of anxiety may vary among students exposed to different preclinical curricula and different educational environment. If basic clinical and communication skills courses are integrated in preclinical curriculum, the students would meet some clinical task in the early year and would be orientated through clinical period.
Collapse
Affiliation(s)
- O Sarikaya
- Department of Medical Education, School of Medicine, University of Marmara, Istanbul, Turkey.
| | | | | |
Collapse
|
30
|
Tan EL, Stark H, Lowinger JS, Ringland C, Ward R, Pearson SA. Information sources used by New South Wales cancer clinicians: a qualitative study. Intern Med J 2006; 36:711-7. [PMID: 17040357 DOI: 10.1111/j.1445-5994.2006.01171.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND This study identified (i) information sources used by cancer clinicians to guide pharmacological treatments, (ii) utilization of, and opinions about, online information sources and (iii) clinicians' ability to access a specific cancer treatment protocol (escalated bleomycin, etiposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, prednisone (BEACOPP) for Hodgkin's Lymphoma). The work was carried out before activation of the Cancer Institute New South Wales Standard Cancer Treatment (CI-SCaT) programme. METHODS We conducted semistructured interviews with a purposeful sample of senior and junior doctors, nurses and pharmacists treating adult cancer patients (n = 32) in eight New South Wales public hospitals. RESULTS Information seeking processes are context specific and vary from clinician to clinician and ward to ward. Clinicians use human, electronic and printed information sources at, or close to, the point of patient care; however, experienced colleagues are preferred where information is needed quickly or in unfamiliar clinical situations. Barriers to using online cancer information are environmental (hardware, connection speeds, time), personal (poor computer literacy and lack of awareness of appropriate sites) and economic (costs of journal subscriptions). Just over half of participants were able to locate a specific cancer protocol and none of these protocols was fully consistent with CI-SCaT recommendations. CONCLUSION There is no standardized approach to the pharmacological treatment of cancer patients in this sample of New South Wales clinicians. CI-SCaT will fill a gap with respect to standardizing oncology treatment. However, to ensure maximal CI-SCaT uptake, implementation plans should harness positive behavioural influences and attempt to modify the negative forces that act on hospital clinicians in their day-to-day work.
Collapse
Affiliation(s)
- E L Tan
- Population Health and Use of Medicines Unit, St Vincent's Hospital, Sydney, NSW, Australia
| | | | | | | | | | | |
Collapse
|
31
|
Ali MH, Kalima P, Maxwell SRJ. Failure to implement hospital antimicrobial prescribing guidelines: a comparison of two UK academic centres. J Antimicrob Chemother 2006; 57:959-62. [PMID: 16531431 DOI: 10.1093/jac/dkl076] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Rational antimicrobial therapy should provide maximum benefit to patients while minimizing the development of resistant microorganisms. OBJECTIVES The aim of this study was to investigate (i) which antimicrobial drugs were chosen by hospital doctors faced with two common infections [community-acquired pneumonia (CAP) and urinary tract infection (UTI)], (ii) whether these choices were compliant with local guidance and (iii) the factors that influenced antimicrobial choice. METHODS A questionnaire based on two hypothetical clinical scenarios was distributed to 316 hospital doctors across four UK NHS hospitals in two cities (Newcastle and Edinburgh). RESULTS Doctors in Newcastle were significantly more aggressive in their management: more patients were admitted (CAP: 78.9% versus 48.4%, P < 0.05) and given antimicrobials intravenously (CAP: 53.4% versus 21.2%, P < 0.05). Adherence to the local hospital guideline for CAP was significantly higher in Newcastle (83.3% versus 38.0%; P < 0.05). Fewer than half of the doctors surveyed used the local hospital guideline when choosing an antimicrobial, and the British National Formulary was the most frequently used resource (>90%). Junior doctors also identified medical school teaching and opinions of senior doctors as important influences. CONCLUSIONS This study highlights inadequacies in the implementation and promotion of local guidelines, and demonstrates the potential for widely varying antimicrobial practices in two comparable UK cities.
Collapse
Affiliation(s)
- M H Ali
- Clinical Pharmacology Unit, University of Edinburgh, Queen's Medical Research Institute, Royal Infirmary of Edinburgh, Little France, Edinburgh EH16 4TJ, UK
| | | | | |
Collapse
|
32
|
Garbutt JM, Highstein G, Jeffe DB, Dunagan WC, Fraser VJ. Safe medication prescribing: training and experience of medical students and housestaff at a large teaching hospital. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2005; 80:594-9. [PMID: 15917365 DOI: 10.1097/00001888-200506000-00015] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
PURPOSE To assess medical students' and housestaff's knowledge, attitudes, and behaviors regarding safe prescribing. METHOD In 2003, 214 housestaff (interns and residents) and 77 medical students in medicine and surgery at Barnes-Jewish Hospital, St. Louis, Missouri, were asked to complete an anonymous, self-administered questionnaire about safe prescribing. Questions asked about training in and attitudes about safe-prescribing and current prescribing behaviors. Fisher exact test was used to compare attitudes and behaviors among subgroups. RESULTS Of the 175 (60%) respondents, 73 (59%) of 123 housestaff and eight (15%) of 52 students agreed that their safe-prescribing training was adequate (p < .001), and 145 (83%) total respondents agreed that prescribing errors were unacceptable. Respondents reported always doing the following: 156 (89%) checked prescribing information before prescribing new drugs, 131 (75%) checked for drug allergies, 103 (59%) double-checked dosage calculations, 98 (56%) checked for renal impairment, and 53 (30%) checked for potential drug-drug interactions. CONCLUSION Routine use of safe medication prescribing behaviors among housestaff and medical students was poor. Contributing factors may have included inadequate training and a culture that does not support safe prescribing. Effective strategies to increase safe medication prescribing need to be identified and implemented.
Collapse
Affiliation(s)
- Jane M Garbutt
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri 63110, USA.
| | | | | | | | | |
Collapse
|
33
|
Higgins MP, Tully MP. Hospital doctors and their schemas about appropriate prescribing. MEDICAL EDUCATION 2005; 39:184-193. [PMID: 15679686 DOI: 10.1111/j.1365-2929.2004.02056.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
OBJECTIVES To investigate cognitive schemas and schema systems used by hospital doctors to influence prescribing, particularly in terms of making appropriate prescribing decisions, and to compare the numbers and content of schemas between doctors with different levels of experience. DESIGN Qualitative interviews with a purposively selected sample. PARTICIPANTS AND SETTING Seven pre-registration (PRHOs) and 5 senior house officers (SHOs) and 5 consultants from a range of medical specialties in a teaching hospital. RESULTS The qualitative analysis of the themes and patterns explored during the interviews indicated that all doctors articulated schemas that influenced their behaviour. The junior doctors seemed to have simplistic schemas, with interdoctor agreement; the consultants appeared to have more sophisticated schemas, with greater individual variation. Those schemas adopted by the PRHOs (prescribing "novices") could be subsumed by, rather than contradicted by, those of the consultants (prescribing "experts"), with a transitional stage demonstrated by the SHOs. The most noticeable distinction was the greater emphasis by consultants on holistic patient care and what might be seen as their separate schemas for appropriate prescribing stemmed from that premise. In contrast, junior doctors appeared to have had a single schema that encompassed both prescribing generally and appropriate prescribing. CONCLUSIONS Although the design of this study was cross-sectional rather than longitudinal, the findings suggest that the acquisition and adjustment of schemas and schema systems are significant factors in the professional development of the hospital doctor from novice through to expert. It could be hypothesised that house officers possess simpler schemas as a way of coping with their job demands, which evolve in complexity as they gain experience. However, the transitional stage found with the SHOs is critical during cognitive development, with implications for the training and support available to doctors throughout their professional careers.
Collapse
Affiliation(s)
- Mark P Higgins
- Department of Pharmacy, Hope Hospital, University of Manchester School of Medicine, Stott Lane, Salford, Manchester M6 8HD, UK
| | | |
Collapse
|
34
|
Chao SD, Maibach HI. Lack of drug interaction conformity in commonly used drug compendia for selected at-risk dermatologic drugs. Am J Clin Dermatol 2005; 6:105-11. [PMID: 15799682 DOI: 10.2165/00128071-200506020-00005] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
BACKGROUND Systemic treatments that have significant efficacy for dermatologic conditions can often cause severe adverse reactions when improperly combined with interacting drugs. We have noted discrepancies in the reporting of such drug-drug interactions among major drug compendia used in hospitals and physicians' offices. OBJECTIVE The aim of this study was to compare the consistency of drug-drug interaction listings among four of the most widely used English language drug compendia in the US. METHODS Drug monographs from Mosby's GenRx, USP DI, AHFS Drug Information, and the Physicians' Desk Reference were compared. The respective drug-drug interactions provided by the various compendia for four systemic agents -- dapsone, erythromycin, methotrexate and prednisone -- commonly prescribed for dermatologic purposes were compiled. RESULTS We found considerable discrepancies among the compendia with respect to the number of drug interactions listed. Agreement among the compendia was especially poor when more than two sources were compared. CONCLUSIONS There is a need for a drug compendium that reconciles drug-drug interaction reporting discrepancies under standardized criteria based on the scientific literature and clinical significance.
Collapse
Affiliation(s)
- Stephanie D Chao
- Department of Dermatology, University of California, San Francisco, CA 94143-0989, USA
| | | |
Collapse
|