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Overcoming Decisional Gaps in High-Risk Prescribing by Junior Physicians Using Simulation-Based Training: Protocol
Julie C Lauffenburger1, Matthew F DiFrancesco1, Renee A Barlev1
1Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States.
JMIR Research Protocols
|April 27, 2022
Summary
Simulation-based training may reduce the overprescribing of high-risk medications in older adults by junior physicians. This approach, addressing decisional gaps under stress, could be widely applicable to improve prescribing practices.
Area of Science:
- Medical Education
- Behavioral Science
- Geriatric Medicine
Background:
- Decisional gaps between rational thought and actions contribute to suboptimal choices during stress.
- High-risk medications are often prescribed to hospitalized older adults, contrary to guidelines.
- Simulation training can bridge decisional gaps but hasn't been tested for medication overprescribing.
Purpose of the Study:
- To evaluate the impact of simulation-based training on high-risk medication prescribing compared to a control group.
- To assess if simulation training can reduce the prescribing of specific high-risk medications in older adults by medical residents.
Main Methods:
- A pragmatic trial randomizing 36+ first-year medical residents to simulation-based or online educational training.
- Intervention included a 40-minute immersive simulation with debriefing, focusing on benzodiazepines, antipsychotics, and Z-drugs in older adults.
- Primary outcome: medication doses prescribed to older adults not on these medications at admission, measured via EHR data.
Main Results:
- Recruitment occurred between March 2021 and Q4 2021, with follow-up completed by Q1 2022.
- Data on prescribing patterns and outcomes were collected via electronic health records.
Conclusions:
- This trial assesses a simulation-based program using behavioral science to impact junior physicians' prescribing of high-risk medications.
- If effective, this training approach is potentially reproducible for other behaviors and settings.
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