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Readiness to prescribe: Using educational design to untie the Gordian Knot
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 dange...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Public Library of Science
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6980548/ https://www.ncbi.nlm.nih.gov/pubmed/31978199 http://dx.doi.org/10.1371/journal.pone.0227865 |
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author | Lee, Ciara McCrory, Richard Tully, Mary P. Carrington, Angela Donnelly, Rosie Dornan, Tim |
author_facet | Lee, Ciara McCrory, Richard Tully, Mary P. Carrington, Angela Donnelly, Rosie Dornan, Tim |
author_sort | Lee, Ciara |
collection | PubMed |
description | 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. |
format | Online Article Text |
id | pubmed-6980548 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | Public Library of Science |
record_format | MEDLINE/PubMed |
spelling | pubmed-69805482020-02-04 Readiness to prescribe: Using educational design to untie the Gordian Knot Lee, Ciara McCrory, Richard Tully, Mary P. Carrington, Angela Donnelly, Rosie Dornan, Tim PLoS One Research Article 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. Public Library of Science 2020-01-24 /pmc/articles/PMC6980548/ /pubmed/31978199 http://dx.doi.org/10.1371/journal.pone.0227865 Text en © 2020 Lee et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. |
spellingShingle | Research Article Lee, Ciara McCrory, Richard Tully, Mary P. Carrington, Angela Donnelly, Rosie Dornan, Tim Readiness to prescribe: Using educational design to untie the Gordian Knot |
title | Readiness to prescribe: Using educational design to untie the Gordian Knot |
title_full | Readiness to prescribe: Using educational design to untie the Gordian Knot |
title_fullStr | Readiness to prescribe: Using educational design to untie the Gordian Knot |
title_full_unstemmed | Readiness to prescribe: Using educational design to untie the Gordian Knot |
title_short | Readiness to prescribe: Using educational design to untie the Gordian Knot |
title_sort | readiness to prescribe: using educational design to untie the gordian knot |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6980548/ https://www.ncbi.nlm.nih.gov/pubmed/31978199 http://dx.doi.org/10.1371/journal.pone.0227865 |
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