Using a self-regulated learning-enhanced video feedback educational intervention to improve junior doctor prescribing

Can a novel constructivist theory-informed feedback intervention reduce prescribing errors ? A pre-post study

CONTEXT

Medical interns (interns) find prescribing challenging and many report lacking readiness when commencing work. Errors in prescribing puts patients' safety at risk. Yet error rates remain high, despite education, supervision and pharmacists' contributions. Feedback on prescribing may improve performance. Yet, work-based prescribing feedback practices focus on rectifying errors. We aimed to explore if prescribing can be improved using a theory-informed feedback intervention.

METHODS

In this pre-post study, we designed and implemented a constructivist-theory informed prescribing feedback intervention, informed by Feedback-Mark 2 Theory. Interns commencing internal medicine terms in two Australian teaching hospitals were invited to engage in the feedback intervention. Their prescribing was evaluated by comparing errors per medication order of at least 30 orders per intern. Pre/baseline (weeks 1-3) were compared with post intervention (weeks 8-9). Interns' baseline prescribing audit findings were analysed and discussed at individualised feedback sessions. These sessions were with a clinical pharmacologist (Site 1) and a pharmacist educator (Site 2).

RESULTS

Eighty eight intern's prescribing over five 10-week terms was analysed from two hospitals. The frequency of prescribing errors significantly reduced at both sites after the intervention, across all five terms (p < 0.001).There were initially 1598 errors in 2750 orders (median [IQR] 0.48 [0.35-0.67] errors per order) and after the intervention 1113 errors in 2694 orders (median [IQR] 0.30 [0.17-0.50] errors per order).

CONCLUSION

Our findings suggest interns' prescribing practices may improve as a result of constructivist -theory learner centred, informed feedback with an agreed plan. This novel intervention, contributed, to a reduction in interns' prescribing errors. This study suggests new strategies for improving prescribing safety should include the design and implementation of theory-informed feedback interventions.

Exploring pharmacists' perspectives on preparing discharge medicine lists: A qualitative study

Background

Hospital pharmacists play an important role in the discharge process, including conducting medicine reconciliation, counselling patients or carers, and generating discharge medicine lists. These contribute to medicine handover at transition of care from hospital discharge. However, pharmacists face numerous barriers to providing comprehensive discharge services.

Aim

To gain a deeper understanding of the hospital pharmacists discharge processes.

Method

Qualitative study design was used to explore pharmacists' experiences and opinions regarding (1) the use of technology and software to prepare patient discharges, (2) involvement of pharmacy assistants in discharge processes, and (3) challenges and facilitators in preparing patient discharges. An independent researcher conducted semi-structured interviews with 15 pharmacists between 29 October and 22 December 2021 (mean interview 21 min). Interview transcriptions were analysed using thematic analysis.

Results

Interviews revealed four overarching themes: patient safety, staff involved in discharge processes, discharge handover procedures and electronic health software. Barriers to completing discharges included staff workloads, poor medical record software integration and lack of advanced discharge notice. Good communication between pharmacists and other clinicians, including the presence of a discharge nurse on the inpatient unit, made discharges more efficient, and most pharmacists favoured utilisation of pharmacy assistants in preparing discharge medicine lists.

Conclusion

Poor integration between medical software systems negatively impacts pharmacists' ability to complete discharge medicine lists. Pharmacists require advance notice of upcoming discharges to effectively prioritise high workloads, while increased utilisation of trained pharmacy assistants may facilitate discharge workflows.

Learning from electronic prescribing errors: a mixed methods study of junior doctors' perceptions of training and individualised feedback data

OBJECTIVES

To explore the views of junior doctors towards (1) electronic prescribing (EP) training and feedback, (2) readiness for receiving individualised feedback data about EP errors and (3) preferences for receiving and learning from EP feedback.

DESIGN

Explanatory sequential mixed methods study comprising quantitative survey (phase 1), followed by interviews and focus group discussions (phase 2).

SETTING

Three acute hospitals of a large English National Health Service organisation.

PARTICIPANTS

25 of 89 foundation year 1 and 2 doctors completed the phase 1 survey; 5 participated in semi-structured interviews and 7 in a focus group in phase 2.

RESULTS

Foundation doctors in this mixed methods study reported that current feedback provision on EP errors was lacking or informal, and that existing EP training and resources were underused. They believed feedback about prescribing errors to be important and were keen to receive real-time, individualised EP feedback data. Feedback needed to be in manageable amounts, motivational and clearly signposting how to learn or improve. Participants wanted feedback and better training on the EP system to prevent repeating errors. In addition to individualised EP error data, they were positive about learning from general prescribing errors and aggregated EP data. However, there was a lack of consensus about how best to learn from statistical data. Potential limitations identified by participants included concern about how the data would be collected and whether it would be truly reflective of their performance.

CONCLUSIONS

Junior doctors would value feedback on their prescribing, and are keen to learn from EP errors, develop their clinical prescribing skills and use the EP interface effectively. We identified preferences for EP technology to enable provision of real-time data in combination with feedback to support learning and potentially reduce prescribing errors.

The challenge of understanding, evaluating and providing feedback on regulation during group learning

Learning in groups is commonly used in academic and clinical health professions education (HPE). There is growing recognition that regulation during learning is essential for both the individual learner and group learning. The authors in this article propose a practical approach for understanding, evaluating and providing feedback on regulation during group learning. The approach is informed by previous studies conducted in other areas of education. Three varieties of regulation during group learning are discussed: individual, co-regulation and shared regulation. Each variety of regulation has a focus on three essential activities during group learning: task, social and motivation. Illustrative scenarios are presented to describe how the approach can be practically used in HPE. The specific and additional focus on regulation can enhance current approaches for providing feedback on group learning and the authors discuss recommendations for practical implementation and future research.

Self-Efficacy, Academic Motivation, and Self-Regulation: How Do They Predict Academic Achievement for Medical Students?

PURPOSE

Self-efficacy, academic motivation, and self-regulation have been identified as important factors contributing to students' learning success in general education. In the field of medical education, however, few studies have examined these variables or their interrelationships as predictors of undergraduate medical students' learning outcomes, especially in the context of flipped learning.

METHODS

Using structural equation modeling (SEM), this study explored the impact of self-efficacy on 146 first- and second-year medical students' academic achievement in a flipped-learning environment, and whether such impact (if any) was mediated by academic motivation and self-regulated learning (SRL) strategies.

RESULTS

On average, students scored highest on self-efficacy (mean = 5 out of a possible 7), followed by intrinsic motivation (mean = 4.59), resource-management strategies (mean = 4.48), metacognitive strategies (mean = 4.46), extrinsic motivation (mean = 4.24), and cognitive strategies (mean = 4.17). Our SEM results suggest that, while there was a direct effect of self-efficacy on learning outcomes, academic motivation and SRL strategies did not mediate it.

CONCLUSIONS

By unpacking the structural relationships among self-efficacy, academic motivation, SRL strategies, and learning outcomes, this study provides evidence-based support for the importance of promoting students' self-efficacy in undergraduate medical flipped-learning environments. Strategies for increasing students' self-efficacy are also discussed.