Medical Education Unit, Gold Coast Health, Southport, Queensland, Australia.
School of Medicine, Griffith University, Southport, Queensland, Australia.
Med Educ. 2017 Apr;51(4):442-451. doi: 10.1111/medu.13227. Epub 2017 Feb 6.
Learning to prescribe is challenging for junior doctors. Significant efforts have been made to improve prescribing education, especially in view of the high rates of prescribing errors made by junior doctors. However, considerations of educational options often overlook the fact that learning to prescribe and prescribing practices rely on practice-based interactions with informed practitioners, such as pharmacists and consultants. Pharmacists have long made important contributions to developing prescribing capacities.
The present study examines the potential of everyday co-working between junior doctors and pharmacists, in conjunction with consultants, as an accessible means of developing effective prescribing practices.
A qualitative interview study was conducted in an Australian tertiary hospital using thematic analysis to explore junior doctors', pharmacists' and consultants' perspectives on how co-working supports learning to prescribe in an acute tertiary hospital setting. Participants included 34 practitioners, comprising junior doctors (n = 11), consultants (n = 10) and pharmacists (n = 13). The thematic analysis was informed by workplace learning theory.
Learning to prescribe was found to be a highly interdependent process. In particular, junior doctors were dependent on co-working with consultants and pharmacists. Three interrelated themes related to co-working and learning to prescribe in the workplace were identified: (i) prescribing readiness of junior doctors; (ii) need for guidance, and (iii) the challenges of pharmacists co-working as outsiders.
Co-working with pharmacists and consultants contributes positively to junior doctors' prescribing practices. However, co-working is complex and is influenced by differing understandings of prescribing practices. These insights assist in informing how co-working can be enacted routinely in hospital settings to promote safe and effective prescribing practices. Consideration should be given to when and how co-working between junior doctors and pharmacists is initiated, including during medical school. In clinical settings, strategies such as having pharmacists attend ward rounds and adopt a role of learning facilitation rather than error identification may augment everyday opportunities for co-working and learning.
对于初级医生来说，学习开具处方具有挑战性。人们为改善处方教育做出了巨大努力，尤其是鉴于初级医生开具处方错误率较高。然而，在考虑教育方案时，往往忽略了这样一个事实，即学习开具处方和实践处方依赖于与有经验的从业者（如药剂师和顾问）进行基于实践的互动。药剂师长期以来为培养处方能力做出了重要贡献。
本研究考察了初级医生与药剂师日常合作的潜力，同时与顾问合作，作为在急症三级医院环境中发展有效处方实践的一种可行手段。
在澳大利亚一家三级医院进行了一项定性访谈研究，采用主题分析方法探讨了初级医生、药剂师和顾问对日常合作如何支持在急症三级医院环境中学习开具处方的看法。参与者包括 34 名从业者，包括初级医生（n=11）、顾问（n=10）和药剂师（n=13）。主题分析受工作场所学习理论的启发。
研究发现，学习开具处方是一个高度相互依赖的过程。特别是，初级医生依赖于与顾问和药剂师合作。确定了与工作场所合作和学习开具处方相关的三个相互关联的主题：（i）初级医生的处方准备情况；（ii）需要指导；（iii）药剂师作为局外人合作的挑战。
与药剂师和顾问合作对初级医生的处方实践有积极影响。然而，合作是复杂的，受到对处方实践的不同理解的影响。这些见解有助于了解如何在医院环境中常规开展合作，以促进安全有效的处方实践。应考虑何时以及如何启动初级医生与药剂师之间的合作，包括在医学院期间。在临床环境中，例如让药剂师参加病房查房并采用学习促进而不是错误识别的角色，可能会增加日常合作和学习的机会。
