Human factors perspective on the prescribing behavior of recent medical graduates: implications for educators
Morris Gordon,1,2 Ken Catchpole,3 Paul Baker1,4
1Faculty of Health and Social Care, University of Salford, Salford, UK; 2Department of Paediatrics, Fairfield General Hospital, Bury, UK; 3Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA; 4North Western Deanery, Manchester, UK
Background: Junior doctors are at high risk of involvement in medication errors. Educational interventions to enhance human factors and specifically nontechnical skills in health care are increasingly reported, but there is no work in the context of prescribing improvement to guide such education. We set out to determine the elements that influence prescribing from a human factors perspective by recent medical graduates and use this to guide education in this area.
Methods: A total of 206 recent medical graduates of the North Western Foundation School were asked to describe their views on safety practices and behaviors. Free text data regarding prescribing behaviors were collected 1, 2, and 4 months after starting their posts. A 94.1% response rate was achieved. Qualitative analysis of data was completed using the constant comparison method. Five initial categories were developed, and the researchers subsequently developed thematic indices according to their understanding of the emerging content of the data. Further data were collected through group interviews 8–9 months into the placement to ensure thematic saturation.
Results: Six themes were established at the axial coding level, ie, contributors to inappropriate prescribing, contributors to appropriate prescribing, professional responsibility, prescribing error, current practices, and methods for improvement of prescribing. Utilizing appropriate theoretical elements, we describe how recent medical graduates employ situational and error awareness to guide risk assessment.
Conclusion: We have modeled the human factors of prescribing behavior by recent medical graduates. As these factors are related to a number of recognized elements of nontechnical skills training within health care, educators should consider design elements from such existing interventions to support prescribing improvement programs. Future research should seek to assess the effectiveness of prescribing focused nontechnical skills training.
Keywords: medication error, patient safety, nontechnical skills
A Letter to the Editor has been received and published for this article.
This work is published by Dove Medical Press Limited, and licensed under Creative Commons Attribution - Non Commercial (unported, v3.0) License. The full terms of the License are available at http://creativecommons.org/licenses/by-nc/3.0/. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. Permissions beyond the scope of the License are administered by Dove Medical Press Limited. Information on how to request permission may be found at: http://www.dovepress.com/permissions.php
Readers of this article also read:
Ah-kee EY, Khan AA
Published Date: 20 July 2015
The social functional outcome of being naturalistically treated with paliperidone extended-release in patients with schizophrenia
Nakagawa R, Ohnishi T, Kobayashi H, Wakamatsu A, Tanimura A, Morita K, Yamaoka T, Usui H, Ogawa Y, Fujino A, Yoshizawa K
Published Date: 22 June 2015
Niven DJ, Berthiaume LR, Fick GH, Laupland KB
Published Date: 27 April 2012
Is video review of patient encounters an effective tool for medical student learning? A review of the literature
Hammoud MM, Morgan HK, Edwards ME, Lyon JA, White C
Published Date: 22 March 2012
Trikha S, Turnbull AMJ, Agrawal SS, Amerasinghe N, Kirwan JF
Published Date: 17 February 2012
Published Date: 28 June 2010
Choice of ACE inhibitor combinations in hypertensive patients with type 2 diabetes: update after recent clinical trials
Gianpaolo Reboldi, Giorgio Gentile, Fabio Angeli, Paolo Verdecchia
Published Date: 8 May 2009
Misregulation of rhodopsin phosphorylation and dephosphorylation found in P23H rat retinal degeneration
Yoshiyuki Saito, Hiroshi Ohguro, Ikuyo Ohguro, Noriyuki Sato, Futoshi Ishikawa, et al
Published Date: 30 October 2008
Brinzolamide ophthalmic suspension: a review of its pharmacology and use in the treatment of open angle glaucoma and ocular hypertension
Published Date: 5 October 2008
Bernard L Silverman, Christopher J Barnes, Barbara N Campaigne, Douglas B Muchmore
Published Date: 15 January 2007