Confidence: when it may not be a doctor's best trait

Eley, Robert (2014). Confidence: when it may not be a doctor's best trait. In: American Psychological Association 122nd Annual Convention (APA 2014), Washington, United States, (). 6-10 August 2014.

Author Eley, Robert
Title of paper Confidence: when it may not be a doctor's best trait
Conference name American Psychological Association 122nd Annual Convention (APA 2014)
Conference location Washington, United States
Conference dates 6-10 August 2014
Publication Year 2014
Sub-type Poster
Open Access Status
Language eng
Formatted Abstract/Summary
Background: Medication errors are well documented in many clinical settings with Emergency Departments (ED) reported to have particularly high rates. This is largely attributed to the need to make rapid clinical decisions without the benefit of time, information or continuity of patient care. However the ability of doctors to make the correct choice of medications is an additional factor, and this study examined both the preparedness and the willingness of doctors to prescribe medications.

Setting: The ED of a large tertiary hospital in Queensland, Australia which receives 55,000 presentations per annum and supports a large training program for doctors through their residency programs.

Participants: Forty residents in emergency medicine, general medicine and surgery eligible to prescribe medications in the ED. The seniority ranged from postgraduate year one to eight.

Methods: A prospective study of the medication knowledge and prescribing practices employing three methods for data collection: i) a face-to-face interview with each doctor to determine their prescribing practices; ii) a questionnaire developed by an expert panel of pharmacologists and consultant emergency physicians to determine each doctor’s knowledge of eight pharmacological aspects of recently and commonly prescribed medications; and iii) the doctor’s self-reported confidence in the prescribing of each medication based on a five-point Likert scale from “completely sure” to “completely unsure”.

Results: Out of 400 medications (40 doctors x 10 medications each) on only 143 (35.7%) occasions were four or more of the eight questions answered correctly. No doctor obtained more than five correct answers for all 10 medications, and only four of the 40 achieved half marks for all 10. The doctors’ knowledge of indications and contraindications, which were two characteristics ranked as “essential” by the consultants, was particularly poor.

Twenty-one doctors admitted not being 100% confident about their knowledge of any of the five medications that they had most recently prescribed. However 19 doctors stated that they were 100% confident on 48 of the 95 occasions (50.5%) they prescribed. This confidence was however misguided as they were found to be correct on only seven occasions (7.4%). Similarly for the most common medications only on 8 percent of the occasions for which they stated complete knowledge did they achieve more than six questions correct. Many doctors acknowledged that they had received little prior education in safe prescribing, and yet their use of reference materials was limited.

Discussion: The study did not aim to determine the safety or accuracy of prescribing undertaken by the participants, but rather to assess their knowledge and willingness to write those prescriptions. When assessed against the knowledge expectations of consultants the majority of the participants in the study had inadequate knowledge on medications. Most significantly half of the junior doctors’ perceptions of their medication knowledge were inflated in relation to their actual knowledge. Their confidence, although usually an admirable trait for doctors to possess, was misplaced. The results point to the need for additional training including strategies for doctors to recognise their own limitations.
Q-Index Code EX
Q-Index Status Provisional Code
Institutional Status Unknown
Additional Notes Poster Session 1, Poster number Q-33.

Document type: Conference Paper
Collection: School of Nursing, Midwifery and Social Work Publications
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Created: Fri, 06 Jun 2014, 15:58:47 EST by Jon Swabey on behalf of School of Nursing, Midwifery and Social Work