Healthy Skepticism Library item: 1847

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Publication type: Journal Article

Pearson S, Smith AJ, Rolfe IE, Moulds RF, Shenfield GM.
Intern Prescribing for Common Clinical Conditions.
Adv Health Sci Educ Theory Pract 2000; 5:(2):141-150
http://www.springerlink.com/app/home/contribution.asp?wasp=e0f7248c20da438d88ea51c792f37dae&referrer=parent&backto=issue,6,7;journal,16,26;linkingpublicationresults,1:102840,1

Abstract:

To examine the ability of interns to prescribe appropriately for common clinical conditions at the commencement and completion of the intern year. Interns’ perceptions of their ability to prescribe and the perceived influences on their practices were also assessed. The study was conducted at a teaching hospital in urban New South Wales, Australia. A self-complete questionnaire was administered to 56 interns at the beginning and end of internship. At the beginning of the year respondents were asked to identify how equipped they felt they were to perform specific functions related to prescribing practice. Interns were also asked to write hospital prescriptions for four common clinical cases scenarios: post-operative pain, urinary tract infection, asthma, and community-acquired pneumonia. At the end of the year interns were asked to prescribe for the same clinical scenarios and also asked to identify the main influences on their practice. At the beginning of the year 54% of interns felt equipped to choose an appropriate drug for common clinical conditions, however, few felt they were able to determine the appropriate dose (23% of respondents) or dose frequency (25%). A previously validated four-point rating scale was used by two assessors to judge appropriateness of prescribing [Kappa = 0.6]. At the beginning of the year at least two-thirds of interns were prescribing ‘inappropriately’ for all clinical conditions. By the end of the year 75% were prescribing ‘appropriately’ for all conditions. The main perceived influences on prescribing practices were registrars, consultants, books and pharmacists.The use of hypothetical clinical cases to explore prescribing ability has shown that doctors are ill-equipped to perform various aspects of prescribing on graduating from medical school. Although our findings may not translate into practice directly they highlight the existence of a potential problem that warrants further study, especially in the areas of actual practice and the influences on it in the early postgraduate years.