Introduction: Appropriate antimicrobial prescribing is essential for patient care, yet up to
half of antimicrobial prescriptions written in the UK are sub-optimal. Improving
prescriber education has recently been promoted as a mechanism to optimise
antimicrobial use, but identification of key learning objectives to facilitate this is so far
lacking. Using qualitative methods we investigated junior doctor knowledge, attitudes,
and behaviours around antimicrobial prescribing to identify key areas to address in
future educational programmes.
Methods: A cross-sectional survey of qualified doctors in training in West London was
undertaken exploring antimicrobial prescribing practices and educational needs.
Results: Among 140 junior doctors from 5 London hospitals, a third (34%) reported
prescribing primarily unsupervised, and two thirds (67%) reported difficulties obtaining
prescribing support outside of hours. 20% stated not feeling confident in writing an
antimicrobial prescription, but confidence was increased through having confirmatory
diagnostic results (24%) and obtaining advice from a senior doctor (26%); whether this
senior was from their own specialty, or an infection-specialist, varied significantly
(p<0.01) by experience. Only a small percentage (5-13%; depending on number of
years post-qualification) of participants stated their previous antimicrobial education
was effective. 60% of those in their first year post qualification reported wanting further
education in antimicrobial prescribing, rising to 74% among more experienced junior
doctors. Specific areas of educational need identified were (i) principles of antimicrobial
prescribing, (ii) diagnosis of infections, (iii) clinical review of patients with infections, (iv)
prescribing in the context of antimicrobial resistance, and (v) laboratory testing and test
results.
Discussion: A significant proportion of junior doctors report lone prescribing of
antimicrobials in the context of low self-perceived confidence and knowledge in this
field, and frequent difficulty in accessing help when necessary. Innovative training,
targeting five specific areas identified through this needs assessment, is urgently
needed by junior doctors practising in secondary care.