Factors influencing prescribing: an intern's perspective.
OBJECTIVE
To examine the self-reported influences on intern prescribing practice.


METHODS
Qualitative interviews with a cross-sectional cohort.


METHODS
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.
Deparment of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, Boston, Massachusetts 02215, USA. sallie-anne_pearson@hphc.org
Sallie-Anne
SA
Pearson
Isobel
I
Rolfe
Tony
T
Smith
D000328:Adult; D002983:Clinical Competence / Q000592:standards*; D015331:Cohort Studies; D011307:Drug Prescriptions; D004502:Education, Medical, Continuing / Q000592:standards; D005260:Female; D006784:Hospitals, Teaching / Q000592:standards; D006801:Humans; D007396:Internship and Residency / Q000592:standards*; D008297:Male; D009517:New South Wales; D010818:Practice Patterns, Physicians'