Factors influencing prescribing: an intern's perspective
Article first published online: 20 AUG 2002
Volume 36, Issue 8, pages 781–787, August 2002
How to Cite
Pearson, S.-A., Rolfe, I. and Smith, T. (2002), Factors influencing prescribing: an intern's perspective. Medical Education, 36: 781–787. doi: 10.1046/j.1365-2923.2002.01267.x
- Issue published online: 20 AUG 2002
- Article first published online: 20 AUG 2002
- Received 15 October 2001; editorial comments to authors 30 November 2001; accepted for publication 3 March 2002
- Internship and residency/*standards;
- clinical competence/*standards;
- hospitals, teaching/*standards;
- prescriptions, drug;
- New South Wales
Objectives To examine the self-reported influences on intern prescribing practice.
Design Qualitative interviews with a cross-sectional cohort.
Participants and setting Ten interns practising in two urban teaching hospitals in New South Wales, Australia.
Results The interns identified a number of factors that improve their confidence and perceived competence and allow them to extend their existing skills. These were approachable, available and up-to-date teachers (most often registrars and subspecialty nurses and pharmacists); timely, relevant and practical teaching (such as interactive bedside teaching); concise and widely accepted resources (such as prescribing pocket guides); and a constructive manner on the part of senior staff for dealing with prescribing errors. Interns also identified influences that are detrimental to confidence, conflict with their perceptions of appropriate prescribing and inhibit learning and skills acquisition. These were unapproachable, physically and mentally remote teachers (most often consultants); theoretical, inconsistent and irrelevant teaching (such as grand rounds or didactic education sessions); inconsistent and inaccessible resources; and a confrontational and accusatory way of dealing with prescribing errors. The added pressures of time, hospital hierarchies and the indirect influence of drug company promotion also impeded acquisition of good prescribing habits.
Conclusions At a critical time in skills development, interns encounter many forces that can potentially impact on prescribing practices in both positive and negative ways. Our data contribute to the understanding of the multifaceted learning environment of interns and may be useful in providing a foundation for prescriber education programmes tailored to the specific needs of junior doctors.