Nationwide survey entitled ‘Attitudes to prescribing and prescribing education among newly qualified doctors in Ireland’.

Background and Aims: Prescribing errors are an important cause of patient harm. It has been estimated that up to 50% of patients admitted to hospital are exposed to a prescribing error. Junior doctors are responsible for the majority of prescribing in the hospital setting, and therefore make the most prescribing errors, with an error rate of up to 90%. [1, 2] Research has shown that the majority of medical students and newly qualified doctors did not feel confident in prescribing on completion of their medical school education. [3] An Irish medical council report ‘Your Training Counts’ in 2014 demonstrated that 34% of interns did not feel their education and training prepared them well for internship. [4]

Summary of work: The aim of this study was to investigate confidence levels and preparedness among practicing interns (newly qualified doctors). We designed a detailed survey modelled on the UK survey of recent graduates and undergraduates by Heaton et al. [2] An email was distributed to all interns (n=686) who completed their medical training in Ireland requesting their participation with the survey. A reminder email was sent after 2 weeks and the survey concluded after a 4 week study window. The survey requested basic demographic data, and whether they were undergraduate or postgraduate entry programme students. The survey enquired if they felt prepared for prescribing in clinical practice, and if they felt stressed about prescribing medications as an intern. Confidence levels across a range of skills and individual medications were assessed in addition to being asked where they felt prescribing ranked in relation to other important intern skills.

Outcomes: The response rate was 20% (n=142; 56% F: 44% M). 31% were graduate entry programme students, and 69% had completed the undergraduate entry programme. The majority of the interns who responded felt confident in drug history taking (74%), prescription writing (81%) and accessing drug information in the hospital setting (74%), but only 54% felt confident in drug dose calculation, and 31% in preparing and administering drugs. Only 25% of interns felt that their medical education had prepared them for prescribing in clinical practice, and 32% felt stressed about prescribing as an intern. Those interns who felt prepared were significantly less stressed than those who didn’t feel prepared (p<0.05). Regarding specific medications, prescribing intramuscular (38%) and intravenous (23%) sedation was associated with the lowest confidence levels compared with confidence in prescribing IM non-opiate analgesia (60%), IV non-opiate analgesia (61%), IM anti-emetics (78%), and IV anti-emetics (75%). The intern skill deemed most important was communication followed by documentation. 41% of interns ranked prescribing as highly important or moderately important (44%).

Discussion and conclusion: This survey has highlighted that the majority of interns surveyed did not feel prepared for prescribing in clinical practice, with particular concern around the areas of drug dose calculation, and preparing and administering drugs. Prescribing was perceived as a moderately to highly important skill. This overview of attitudes to prescribing among interns allows us to review the prescribing curricula to improve preparedness of undergraduates for prescribing in clinical practice.

References:

1. Dean et al. Causes of prescribing errors in hospital inpatients: a prospective study. Lancet 2002; 359: 1373–8.6 185-197.

2. Ryan etal. Prevalence and causes of prescribing errors: the PRescribing Outcomes for Trainee Doctors Engaged in Clinical Training (PROTECT) study.

3. Heaton et al. Undergraduate preparation for prescribing: the views of 2413 UK medical students and recent graduates. Br J Clin Pharmacol. 2008 Jul; 66(1): 128-34

4. http://www.medicalcouncil.ie/News-and-Publications/Reports/Your-Training-Counts-Survey.pdf