title: Effect of Attending Practice Style on Generic Medication Prescribing by Residents in the Clinic Setting: An Observational Study.
abstract: BACKGROUND
  Despite increased emphasis on cost-consciousness in graduate medical training, there is little empirical evidence of the role of attending physician supervision on resident practice in this area.
  
  
  OBJECTIVE
  To study whether the prescribing practices of attendings influence residents' prescribing of brand-name statin medications in the ambulatory clinic setting.
  
  
  METHODS
  A retrospective study of statin prescriptions by residents at two internal medicine residency programs, using electronic medical record data from July 2007 through November 2011.
  
  
  METHODS
  We estimated multivariable hierarchical logistic regression models to assess the independent effect of the supervising attending's rate of brand-name prescribing in the preceding quarter on the likelihood of a resident prescribing a brand-name statin.
  
  
  RESULTS
  The sample included 342 residents and 58 attendings, accounting for 10,151 initial statin prescriptions, including 3,942 by residents. Brand-name statins were prescribed in about one-fourth of encounters. After adjusting for patient-, physician-, and practice-level factors, the supervising attendings' brand-name prescribing rate in the quarter preceding the encounter was positively associated with a postgraduate year (PGY)-1 resident's prescribing a brand-name statin, but not for PGY-2 or PGY-3 residents. For PGY-1 residents, the adjusted probability of a resident prescribing a brand-name statin ranged from 22.6 % (95 % CI 17.3-28.0 %, p < 0.001) for residents supervised by an attending who prescribed < 20 % brand-name statins in the previous quarter to 41.6 % (95 % CI 24.6-58.5 %, p < 0.001) for residents supervised by an attending who prescribed at least 80 % brand-name statins in the previous quarter. A higher PGY level was associated with brand-name prescribing (aOR 2.07, 95 % CI 1.28-3.35, p = 0.003 for PGY-2; aOR 2.15, 95 % CI 1.31-3.55, p = 0.003 for PGY-3, vs. PGY-1).
  
  
  CONCLUSIONS
  Supervising attendings' prescribing of brand-name medications may have a significant influence on PGY-1 residents' prescribing of brand-name medications, but not on prescribing by more senior residents.
authors.affiliation: Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, 13-30B4 13th Floor Blockley Hall, 423 Guardian Drive, Philadelphia, PA, 19104, USA, ryskina@mail.med.upenn.edu.
authors.forename: Kira L
authors.initials: KL
authors.lastname: Ryskina
authors.forename: C Jessica
authors.initials: CJ
authors.lastname: Dine
authors.forename: Esther J
authors.initials: EJ
authors.lastname: Kim
authors.forename: Tara F
authors.initials: TF
authors.lastname: Bishop
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Epstein
mesh_terms: D000328:Adult; D000554:Ambulatory Care Facilities; D016568:Drugs, Generic; D004503:Education, Medical, Graduate; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D007388:Internal Medicine / Q000193:education*; D007396:Internship and Residency; D008297:Male; D008505:Medical Staff, Hospital; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D014481:United States
chemical_list: D016568:Drugs, Generic; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors