Feeling the Vibes: An Investigation Into Resident Antibiotic Prescribing Practices

Area of Science:

• Medical Education
• Infectious Diseases
• Clinical Pharmacy

Background:

• Improving inpatient antibiotic prescribing requires understanding complex decision-making processes.
• Limited insight exists into the factors influencing antibiotic use by resident physicians.

Purpose of the Study:

• To explore the therapeutic decision-making process for antibiotic use among internal medicine residents.
• To identify factors influencing empiric antibiotic prescribing and challenges faced by trainees.

Main Methods:

• Qualitative study utilizing semistructured focus groups with internal medicine residents.
• Thematic analysis of focus group transcripts by independent researchers.
• Data collected from December 2023 to January 2024 at a teaching hospital system.

Main Results:

• Residents employ a structured approach to empiric antibiotic prescribing, considering illness severity, infection source, and patient factors.
• Prescribing decisions are influenced by institutional culture, stewardship policies, and available resources.
• Key challenges include uncertainty, fear of deterioration, and inconsistent attending physician reasoning; mentorship and experience improve confidence.

Conclusions:

• Understanding resident antibiotic decision-making can inform educational strategies to optimize antibiotic use.
• Interventions targeting decision-making processes may improve adherence to guidelines in teaching hospitals.
• Collaboration with infectious diseases physicians and pharmacists enhances resident confidence and risk tolerance.