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Trainee doctors' experiences of common problems in the antibiotic prescribing process: an activity theory analysis of
Anu Kajamaa1, Karen Mattick2, Hazel Parker3
1Faculty of Educational Sciences, University of Helsinki, Finland.
Introduction:
Prescribing antibiotics is an error-prone activity and one of the more challenging responsibilities for doctors in training. The nature and extent of challenges experienced by them at different stages of the antibiotic prescribing process are not well described, meaning that interventions may not target the most problematic areas.
Objectives:
Our aim was to explore doctors in training experiences of common problems in the antibiotic prescribing process using cultural-historical activity theory (CHAT). Our research questions were as follows: What are the intended stages in the antibiotic prescribing process? What are the challenges and where in the prescribing process do these occur?
Methods:
We developed a process model based on how antibiotic prescribing is intended to occur in a 'typical' National Health Service hospital in the UK. The model was first informed by literature and refined through consultation with practising healthcare professionals and medical educators. Then, drawing on CHAT, we analysed 33 doctors in training narratives of their antibiotic prescribing experiences to identify and interpret common problems in the process.
Results:
Our analysis revealed five main disturbances commonly occurring during the antibiotic prescribing process: consultation challenges, lack of continuity, process variation, challenges in patient handover and partial loss of object. Our process model, with 31 stages and multiple practitioners, captures the complexity, inconsistency and unpredictability of the process. The model also highlights 'hot spots' in the process, which are the stages that doctors in training are most likely to have difficulty navigating.
Conclusions:
Our study widens the understanding of doctors in training prescribing experiences and development needs regarding the prescribing process. Our process model, identifying the common disturbances and hot spots in the process, can facilitate the development of antibiotic prescribing activities and the optimal design of interventions to support doctors in training.
Insights
Doctors in training face challenges in antibiotic prescribing. A new model identifies common problems and "hot spots" in the process to improve interventions and support for medical professionals.
Area of Science:
- Medical Education
- Pharmacology
- Health Systems Research
Background:
- Antibiotic prescribing is a complex and error-prone task for doctors in training.
- Existing knowledge gaps hinder the development of targeted interventions to address prescribing challenges.
Purpose of the Study:
- To explore doctors in training's experiences with common problems in antibiotic prescribing.
- To identify challenges and their locations within the antibiotic prescribing process.
- To utilize cultural-historical activity theory (CHAT) to analyze these experiences.
Main Methods:
- Developed a 31-stage process model of intended antibiotic prescribing in a UK National Health Service hospital.
- Informed the model with literature and expert consultation.
- Analyzed 33 narratives from doctors in training using CHAT to identify prescribing problems.
Main Results:
- Identified five key disturbances in antibiotic prescribing: consultation challenges, lack of continuity, process variation, patient handover issues, and partial loss of object.
- The developed process model illustrates the complexity and unpredictability of antibiotic prescribing.
- Highlighted specific 'hot spots' within the process where doctors in training encounter significant difficulties.
Conclusions:
- The study enhances understanding of doctors in training's prescribing experiences and developmental needs.
- The process model and identified disturbances can guide the creation of effective antibiotic prescribing activities.
- Informed interventions can be optimally designed to support doctors in training in antibiotic prescribing.
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