Readiness to prescribe: Using educational design to untie the Gordian Knot


Autoři: Ciara Lee aff001;  Richard McCrory aff001;  Mary P. Tully aff002;  Angela Carrington aff003;  Rosie Donnelly aff004;  Tim Dornan aff001
Působiště autorů: Centre for Medical Education, Queen’s University Belfast, Belfast, United Kingdom aff001;  Division of Pharmacy and Optometry, University of Manchester, Manchester, United Kingdom aff002;  Belfast Health and Social Care Trust, Belfast, United Kingdom aff003;  South-Eastern Health and Social Care Trust, Belfast, United Kingdom aff004
Vyšlo v časopise: PLoS ONE 15(1)
Kategorie: Research Article
doi: 10.1371/journal.pone.0227865

Souhrn

Introduction

Junior residents routinely prescribe medications for hospitalised patients with only arms-length supervision, which compromises patient safety. A cardinal example is insulin prescribing, which is commonplace, routinely delegated to very junior doctors, difficult, potentially very dangerous, and getting no better. Our aim was to operationalise the concept of ‘readiness to prescribe’ by validating an instrument to quality-improve residents’ workplace prescribing education.

Methods

Guided by theories of behaviour change, implementation, and error, and by empirical evidence, we developed and refined a mixed-methods 24-item evaluation instrument, and analysed numerical responses from Foundation Trainees (junior residents) in Northern Ireland, UK using principal axis factoring, and conducted a framework analysis of participants’ free-text responses.

Results

255 trainees participated, 54% women and 46% men, 80% of whom were in the second foundation year. The analysis converged on a 4-factor solution explaining 57% of the variance. Participants rated their capability to prescribe higher (79%) than their capability to learn to prescribe (69%; p<0.001) and rated the support to their prescribing education lower still (43%; p<0.001). The findings were similar in men and women, first and second year trainees, and in different hospitals. Free text responses described an unreflective type of learning from experience in which participants tended to 'get by' when faced with complex problems.

Discussion

Operationalising readiness to prescribe as a duality, comprising residents’ capability and the fitness of their educational environments, demonstrated room for improvement in both. We offer the instrument to help clinical educators improve the two in tandem.

Klíčová slova:

Human learning – Insulin – Learning – Medical doctors – Medical education – Patients – Pharmacists – Trainees


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2020 Číslo 1