Social and professional influences on antimicrobial prescribing for doctors-in-training: A realist review

Journal of Antimicrobial Chemotherapy

Volumn 72, Issue 9, 2017, Pages 2418-2430

  Papoutsi, Chrysanthi ^a   Mattick, Karen ^b   Pearson, Mark ^c   Brennan, Nicola ^d   Briscoe, Simon ^c   Wong, Geoff ^a  

^a UNIVERSITY OF OXFORD   (United Kingdom)

^b UNIVERSITY OF EXETER   (United Kingdom)

^c UNIVERSITY OF EXETER MEDICAL SCHOOL   (United Kingdom)

^d PLYMOUTH UNIVERSITY PENINSULA SCHOOLS OF MEDICINE AND DENTISTRY   (United Kingdom)

Author keywords

[No Author keywords available]

Indexed keywords

ANTIBIOTIC AGENT; ANTIINFECTIVE AGENT;

ANTIBIOTIC THERAPY; ARTICLE; CLINICAL DECISION MAKING; COCHRANE LIBRARY; DATA BASE; DATA EXTRACTION; DATA SYNTHESIS; DYNAMICS; EMBASE; EVIDENCE BASED MEDICINE; HEALTH PRACTITIONER; HEALTH PROGRAM; HUMAN; LEARNING THEORY; MEDICAL SPECIALIST; MEDLINE; PHYSICIAN; PRESCRIPTION; PROFESSIONAL KNOWLEDGE; PSYCINFO; QUALITATIVE ANALYSIS; QUANTITATIVE ANALYSIS; RESPONSIBILITY; SOCIOLOGY; SYSTEMATIC REVIEW; UNCERTAINTY; WEB OF SCIENCE; CLINICAL PRACTICE; HEALTH CARE PERSONNEL; MEDICAL STAFF; MULTIDRUG RESISTANCE; PERCEPTION; PSYCHOLOGY;

ANTI-BACTERIAL AGENTS; DRUG PRESCRIPTIONS; DRUG RESISTANCE, MULTIPLE, BACTERIAL; HEALTH PERSONNEL; HUMANS; MEDICAL STAFF, HOSPITAL; PHYSICIANS; PRACTICE PATTERNS, PHYSICIANS'; SOCIAL PERCEPTION;

EID: 85044959770     PISSN: 03057453     EISSN: 14602091     Source Type: Journal    
DOI: 10.1093/jac/dkx194     Document Type: Article

References (147)

1. United Nations. Draft Political Declaration of the High-Level Meeting of the General Assembly on Antimicrobial Resistance. 2016. http://www.un.org/pga/ 71/wp-content/uploads/sites/40/2016/09/DGACM_GAEAD_ESCAB-AMR-Draft-Political-Declaration-1616108E.pdf
2. Department of Health. Annual Report of the Chief Medical Officer: Infections and the Rise of Antimicrobial Resistance 2011. https://www.gov.uk/ government/uploads/system/uploads/attachment_data/file/138331/CMO_ Annual_Report_Volume_2_2011.pdf
3. Department of Health. UK Five Year Antimicrobial Resistance Strategy 2013 to 2018. 2013. https://www.gov.uk/government/publications/uk-5-year-anti microbial-resistance-strategy-2013-to-2018
4. Department of Health. UK and China Start Global Fund to Tackle Drug Resistant Infections (Press Release). 2015. https://www.gov.uk/ government/news/uk-and-china-start-global-fund-to-tackle-drug-re sistant-infections
5. UK Mission to the United Nations Geneva. Statement by UK Public Health Minister on the First Day of the 68th Session of the World Health Assembly, Geneva (Press Release). 2015. https://www.gov.uk/government/world-loca tion-news/statement-by-uk-public-health-minister-on-the-first-day-of-the-68th-session-of-the-world-health-assembly-geneva-18-may-2015
6. HM Government. Tackling Drug-Resistant Infections Globally: Final Report and Recommendations. 2016. https://amr-review.org/sites/default/files/ 160525_Final%20paper_with%20cover.pdf
7. Howard P, Pulcini C, Levy Hara G et al. An international cross-sectional survey of antimicrobial stewardship programmes in hospitals. J Antimicrob Chemother 2014; 70: 1245-55
8. Ashiru-Oredope D, Budd EL, Bhattacharya A et al. Implementation of antimicrobial stewardship interventions recommended by national toolkits in primary and secondary healthcare sectors in England: TARGET and Start Smart Then Focus.JAntimicrobChemother 2016; 71: 1408-14
9. Ashiru-Oredope D, Sharland M, Charani E et al. Improving the quality of antibiotic prescribing in the NHS by developing a new Antimicrobial Stewardship Programme: Start Smart-Then Focus. J Antimicrob Chemother 2012; 67 Suppl 1: i51-63
10. Royal College of General Practitioners. TARGET Antibiotics Toolkit 2014. http://www.rcgp.org.uk/targetantibiotics/
11. Nathwani D, Christie P. The Scottish approach to enhancing antimicrobial stewardship. J Antimicrob Chemother 2007; 60 Suppl 1: i69-71
12. Department of Health. Hospital Pharmacy Initiative for Promoting Prudent Use of Antibiotics in Hospitals. Department of Health, 2003. http:// www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/docu ments/digitalasset/dh_4013409.pdf
13. Medical Schools Council. Outcomes of the Medical Schools Council Safe Prescribing Working Group 2007. http://www.medschools.ac.uk/publications/ pages/safe-prescribing-working-group-outcomes.aspx
14. Bhattacharya A, Hopkins S, Sallis A et al. A process evaluation of the UKwide Antibiotic Guardian campaign: developing engagement on antimicrobial resistance. J Public Health (Oxf) 2016; doi:10.1093/pubmed/fdw059
15. Friedman SM, Sowerby RJ, Guo R et al. Perceptions of emergency medicine residents and fellows regarding competence, adverse events and reporting tosupervisors: anational survey. CJEM 2010; 12: 491-9
16. HallsworthM, Chadborn T, Sallis A et al. Provision of social norm feedback to high prescribers of antibiotics in general practice: a pragmatic national randomised controlled trial. Lancet 2016; 387: 1743-52
17. PHE. English Surveillance Programme for Antimicrobial Utilisation and Resistance (ESPAUR) Report. 2016. https://www.gov.uk/government/uploads/ system/uploads/attachment_data/file/575626/ESPAUR_Report_2016.pdf
18. Lee GC, Reveles KR, Attridge RT et al. Outpatient antibiotic prescribing in the United States: 2000 to 2010. BMCMed 2014; 12: 96
19. Fleming-Dutra KE, Hersh AL, Shapiro DJ et al. Prevalence of inappropriate antibiotic prescriptions among US ambulatory care visits, 2010-2011. JAMA 2016; 315: 1864-73
20. Dellit TH, Owens RC, McGowan JE et al. Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America guidelines for developing an institutional program to enhance antimicrobial stewardship. Clin Infect Dis 2007; 44: 159-77
21. Barlam TF, Cosgrove SE, Abbo LM et al. Implementing an antibiotic stewardship program: guidelines by the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America. Clin Infect Dis 2016; 62: e51-77
22. Pollack LA, van Santen KL, Weiner LM et al. Antibiotic stewardship programs in U.S. acute care hospitals: findings from the 2014 National Healthcare Safety Network AnnualHospital Survey. Clin Infect Dis 2016; 63: 443-9
23. Goff DA, Kullar R, Goldstein EJC et al. A global call from five countries to collaborate in antibiotic stewardship: united we succeed, divided wemight fail. Lancet Infect Dis 2017; 17: e56-63
24. Arnold SR, Straus SE. Interventions to improve antibiotic prescribing practices in ambulatory care. Cochrane Database Syst Rev 2005; issue 4: CD003539
25. Davey P, Brown E, Charani E et al. Interventions to improve antibiotic prescribing practices for hospital inpatients. Cochrane Database Syst Rev 2013; issue 4: CD003543
26. Charani E, Birgand G. Managing behaviours: social, cultural, and psychological aspects of antibiotic prescribing and use. Chapter 3. In: Laundy M, Gilchrist M, Whitney L. eds. Antimicrobial Stewardship. Oxford: Oxford University Press, 2016
27. Charani E, Castro-Sanchez E, Sevdalis N et al. Understanding the determinants of antimicrobial prescribing within hospitals: the role of "prescribing etiquette". Clin Infect Dis 2013; 57: 188-96
28. Mattick K, Kelly N, Rees C. Awindow into the lives of junior doctors: narrative interviews exploring antimicrobial prescribing experiences. J Antimicrob Chemother 2014; 69: 2274-83
29. Tully MP, Ashcroft DM, Dornan T et al. The causes of and factors associated with prescribing errors in hospital inpatients. Drug Saf 2009; 32: 819-36
30. Brennan N,Mattick K. A systematic review of educational interventions to change behaviour of prescribers in hospital settings, with a particular emphasis on new prescribers. Br J Clin Pharmacol 2013; 75: 359-72
31. Wong G, Brennan N, Mattick K et al. Interventions to improve antimicrobial prescribing of doctors in training: the IMPACT (IMProving Antimicrobial presCribing of doctors in Training) realist review. BMJOpen 2015; 5: e009059
32. Pawson R, Greenhalgh T, Harvey G et al. Realist synthesis: an introduction. ESRC Research Methods Programme. London: ESRC Working Paper Series, 2004
33. Wong G, Greenhalgh T,Westhorp G et al. RAMESES publication standards: realist syntheses. BMCMed 2013; 11: 21
34. Greenhalgh T, Peacock R. Effectiveness and efficiency of searchmethods in systematic reviews of complex evidence: audit of primary sources. BMJ 2005; 331: 1064-5
35. Pawson R, Owen L, Wong G. The Today Programme's contribution to evidence-based policy. Evaluation 2010; 16: 211-3
36. Pawson R. Evidence-Based Policy: A Realist Perspective. London: Sage, 2006
37. Aveling EL, Parker M, Dixon-Woods M. What is the role of individual accountability in patient safety? A multi-site ethnographic study. Sociol Health Illn 2016; 38: 216-32
38. BroomA, Broom J, Kirby E. Cultures of resistance? A Bourdieusian analysis of doctors' antibiotic prescribing. Soc Sci Med 2014; 110: 81-8
39. Goffman E. The Presentation of Self in Everyday Life. Harmondsworth: Penguin, 1978
40. Lave J, Wenger E. Situated Learning: Legitimate Peripheral Participation. Cambridge: Cambridge University Press, 1991
41. Merton R. On sociological theories of the middle-range. In: R. Merton, ed. On Theoretical Sociology: Five Essays, Old and New. New York: Free Press, 1967; 39-72
42. Toulmin SE. The Uses of Argument. New York: Cambridge University Press, 2003
43. Wenger E. Communities of Practice: Learning, Meaning, and Identity. New York: Cambridge University Press, 1998
44. Graham ID, Logan J, Harrison MB et al. Lost in knowledge translation: timefor a map? JContinEducHealthProf 2006; 26: 13-24
45. Pawson R. Middle range theory and programme theory evaluation: from provenance to practice. In: J Vaessen, F Leeuw, eds. Mind the Gap: Perspectives on Policy Evaluation and the Social Sciences. New Brunswick, London: Transaction Publishers, 2010; 171-202
46. Ajemigbitse A, Omole M, Ezike N et al. Assessment of the knowledge and attitudes of intern doctors tomedication prescribing errors in aNigeria tertiary hospital. J Basic Clin Pharma 2014; 5: 7-14
47. Ajemigbitse AA, Omole MK, Osi-Ogbu OF et al. A qualitative study of causes of prescribing errors among junior medical doctors in a Nigeria inpatient setting. Ann Afr Med 2013; 12: 223-31
48. Akici A, Kalaca S, Goren MZ et al. Comparison of rational pharmacotherapy decision-making competence of general practitioners with intern doctors. Eur J Clin Pharmacol 2004; 60: 75-82
49. Ali MH, Kalima P, Maxwell SR. Failure to implement hospital antimicrobial prescribing guidelines: a comparison of two UK academic centres. J Antimicrob Chemother 2006; 57: 959-62
50. BouldMD, Sutherland S, Sydor DT et al. Residents' reluctance to challenge negative hierarchy in the operating room: a qualitative study. Can J Anesth 2015; 62: 576-86
51. Chaves NJ, Cheng AC, Runnegar N et al. Analysis of knowledge and attitude surveys to identify barriers and enablers of appropriate antimicrobial prescribing in three Australian tertiary hospitals. Intern Med J 2014; 44: 568-74
52. Conte H, Scheja M, Hjelmqvist H et al. Exploring teams of learners becoming "WE" in the Intensive Care Unit-a focused ethnographic study. BMC Med Educ 2015; 15: 131
53. Cortoos PJ, DeWitte K, PeetermansWE et al. Opposing expectations and suboptimal use of a local antibiotic hospital guideline: a qualitative study. JAntimicrobChemother 2008; 62: 189-95
54. Dallas A, vanDrielM, van deMortel T et al. Antibiotic prescribing for the future: exploring the attitudes of trainees in general practice. Br J Gen Pract 2014; 64: e561-7
55. De Souza V,MacFarlane A,Murphy AWet al. A qualitative study of factors influencing antimicrobial prescribing by non-consultant hospital doctors. JAntimicrobChemother 2006; 58: 840-3
56. Fakih MG, Berschback J, Juzych NS et al. Compliance of resident and staff physicians with IDSA guidelines for the diagnosis and treatment of streptococcal pharyngitis. Infect Dis Clin Pract 2006; 14: 84-8
57. Gordon LJ, Rees CE, Ker JS et al. Dimensions, discourses and differences: trainees conceptualising health care leadership and followership. Med Educ 2015; 49: 1248-62
58. Lee TC, Frenette C, Jayaraman D et al. Antibiotic self-stewardship: trainee-led structured antibiotic time-outs to improve antimicrobial use. Ann Intern Med 2014; 161: S53-8
59. Liabsuetrakul T, Chongsuvivatwong V, Lumbiganon P et al. Obstetricians' attitudes, subjective norms, perceived controls, and intentions on antibiotic prophylaxis in caesarean section. Soc SciMed 2003; 57: 1665-74
60. Livorsi D, Comer A, Matthias MS et al. Factors influencing antibioticprescribing decisions among inpatient physicians: a qualitative investigation. Infect Control Hosp Epidemiol 2015; 36: 1065-72
61. May L, Gudger G, Armstrong P et al.Multisite exploration of clinical decision making for antibiotic use by emergencymedicine providers using quantitative and qualitative methods. Infect Control Hosp Epidemiol 2014; 35: 1114-25
62. Sculli GL, Fore AM, Sine DMet al. Effective followership: a standardized algorithm to resolve clinical conflicts and improve teamwork. J Healthc Risk Manag 2015; 35: 21-30
63. Tallentire VR, Smith SE, Skinner J et al. Understanding the behaviour of newly qualified doctors in acute care contexts. Med Educ 2011; 45: 995-1005
64. Walton MM. Hierarchies: the BerlinWall of patient safety. Qual Saf Health Care 2006; 15: 229-30
65. Welch SA, Novy M, Preisz P et al. Promoting rational prescribing by emergency department juniormedical officers. Aust J Hosp Pharm 2000; 30: 262-7
66. Ziglam HM, Morales D, Webb K et al. Knowledge about sepsis among training-grade doctors. J Antimicrob Chemother 2006; 57: 963-5
67. Hoff TJ.Howwork context shapes physician approach to safety and error. Qual Manag Health Care 2008; 17: 140-53
68. Hoff TJ, Pohl H, Bartfield J. Teaching but not learning: how medical residency programs handle errors. JOrganiz Behav 2006; 27: 869-96
69. Illing J, Morrow G, Kergon C et al. How Prepared Are Medical Graduates to Begin Practice: A Comparison of Three Diverse UK Medical Schools. Report to the General Medical Council Education Committee, 2008
70. Kilminster S, Zukas M, Quinton N et al. Preparedness is not enough: understanding transitions as critically intensive learning periods. Med Educ 2011; 45: 1006-15
71. McLellan L, Dornan T, Newton P et al. Pharmacist-led feedback workshops increase appropriate prescribing of antimicrobials. J Antimicrob Chemother 2016; 71: 1415-25
72. Navarro-San Francisco C, Del Toro MD, Cobo J et al. Knowledge and perceptions of junior and senior Spanish resident doctors about antibiotic use and resistance: results of a multicenter survey. Enferm Infecc Microbiol Clin 2013; 31: 199-204
73. Stewart J. To call or not to call: a judgement of risk by pre-registration house officers. Med Educ 2008; 42: 938-44
74. Tell D, EngstromS, Molstad S. Adherence to guidelines on antibiotic treatment for respiratory tract infections in various categories of physicians: a retrospective cross-sectional study of data from electronic patient records. BMJ Open 2015; 5: e008096
75. Tobaiqy M, McLay J, Ross S. Foundation year 1 doctors and clinical pharmacology and therapeutics teaching. A retrospective view in light of experience. Br J Clin Pharmacol 2007; 64: 363-72
76. Zaidi ST, Thursky KA. Using formative evaluation to improve uptake of a web-based tool to support antimicrobial stewardship. J Clin Pharm Ther 2013; 38: 490-7
77. BearmanM, LawsonM, Jones A. Participation and progression: new medical graduates entering professional practice. Adv Health Sci Educ Theory Pract 2011; 16: 627-42
78. Friedman Z, Hayter MA, Everett TC et al. Power and conflict: the effect of a superior's interpersonal behaviour on trainees' ability to challenge authority during a simulated airway emergency. Anaesthesia 2015; 70: 1119-29
79. AlmatarMA, Peterson GM, Thompson A et al. Factors influencing ceftriaxone use in community-acquired pneumonia: emergency doctors' perspectives. EmergMed Australas 2014; 26: 591-5
80. Abbo L, Sinkowitz-Cochran R, Smith L et al. Faculty and resident physicians' attitudes, perceptions, and knowledge about antimicrobial use and resistance. Infect Control Hosp Epidemiol 2011; 32: 714-8
81. AlmatarMA, Peterson GM, Thompson A et al. Community-acquired pneumonia: why aren't national antibiotic guidelines followed? Int J Clin Pract 2015; 69: 259-66
82. Ambroggio L, Thomson J, Murtagh Kurowski E et al. Quality improvement methods increase appropriate antibiotic prescribing for childhood pneumonia. Pediatrics 2013; 131: e1623-31
83. Barlow G, Nathwani D, Myers E et al. Identifying barriers to the rapid administration of appropriate antibiotics in community-acquired pneumonia. J Antimicrob Chemother 2008; 61: 442-51
84. Chow A, Lye DCB, Arah OA. Psychosocial determinants of physicians' acceptance of recommendations by antibiotic computerised decision support systems: amixedmethods study. Int J Antimicrob Agents 2015; 45: 295-304
85. Dallas A, Magin P, Morgan S et al. Antibiotic prescribing for respiratory infections: a cross-sectional analysis of the ReCEnT study exploring the habits of early-career doctors in primary care. FamPract 2015; 32: 49-55
86. Doyon S, Perreault M, Marquis C et al. Quantitative evaluation of a clinical intervention aimed at changing prescriber behaviour in response to new guidelines. J Eval ClinPract 2009; 15: 1111-7
87. FakihMG, Hilu RC, Savoy-Moore RT et al. Do resident physicians use antibiotics appropriately in treating upper respiratory infections? A survey of 11 programs. Clin Infect Dis 2003; 37: 853-6
88. Gaur AH, Hare ME, Shorr RI. Provider and practice characteristics associated with antibiotic use in children with presumed viral respiratory tract infections. Pediatrics 2005; 115: 635-41
89. Limbert C, Lamb R. Doctors' use of clinical guidelines: two applications of the theory of planned behaviour. Psychol HealthMed 2002; 7: 301-10
90. Menendez R, Torres A, Zalacain R et al. Guidelines for the treatment of community-acquired pneumonia: predictors of adherence and outcome. Am J Respir Crit CareMed 2005; 172: 757-62
91. Mincey BA, ParkuloMA. Antibiotic prescribing practices in a teaching clinic: comparison of resident and staff physicians. SouthMed J 2001; 94: 365-9
92. Newham R, Thomson AH, Semple Y et al. Barriers to the safe and effective use of intravenous gentamicin and vancomycin in Scottish hospitals, and strategies for quality improvement. Eur J Hosp Pharm Sci Pract 2015; 22: 32-7
93. Vivekananda-Schmidt P, Vernon B. FY1 doctors' ethicolegal challenges in their first year of clinical practice: an interview study. J Med Ethics 2014; 40: 277-81
94. Zallman L, Ma J, Xiao L et al. Quality of US primary care delivered by resident and staff physicians. J Gen Intern Med 2010; 25: 1193-7
95. Asseray N, Mallaret MR, Sousbie M et al. Antibiotherapy in hospital: evaluation of prescription habits within a hospital network. Med Mal Infect 2002; 32: 468-76
96. Undeland DK, Kowalski TJ, BerthWL et al. Appropriately prescribing antibiotics for patients with pharyngitis: a physician-based approach vs a nurseonly triage and treatment algorithm. Mayo Clin Proc 2010; 85: 1011-5
97. Gordon LJ, Rees CE, Ker JS et al. Leadership and followership in the healthcare workplace: exploring medical trainees' experiences through narrative inquiry. BMJ Open 2015; 5: e008898
98. Hong SY, Epstein LH, Lawrence K et al. Evaluation of programmatic changes to an antimicrobial stewardship program with house officer feedback. J Eval ClinPract 2013; 19: 388-92
99. Dobrzanski S, HammondI, Khan G et al. The nature of hospital prescribing errors. Br J Clin Pharmacol 2002; 7: 187-93
100. Tamuz M, Giardina TD, Thomas EJ et al. Rethinking resident supervision to improve safety: from hierarchical to interprofessional models. J HospMed 2011; 6: 445-52
101. Hamui-Sutton A, Vives-Varela T, Gutierrez-Barreto S et al. A typology of uncertainty derived from an analysis of critical incidents inmedical residents: amixed methods study. BMCMed Educ 2015; 15: 198
102. Jaensch SL, Baysari MT, Day RO et al. Junior doctors' prescribing work after-hours and the impact of computerized decision support. Int J Med Inform 2013; 82: 980-6
103. Kroll L, Singleton A, Collier J et al. Learning not to take it seriously: junior doctors' accounts of error. Med Educ 2008; 42: 982-90
104. Lewis PJ, Ashcroft DM,Dornan T et al. Exploring the causes of juniordoctors' prescribingmistakes: a qualitative study. Br J Clin Pharmacol 2014; 78: 310-9
105. Simpson JH, Lynch R, Grant J et al. Reducingmedication errors in the neonatal intensive care unit. Arch Dis Child Fetal Neonatal Ed 2004; 89: F480-2
106. Steinke DT, Bain DJ, MacDonald TM et al. Practice factors that influence antibiotic prescribing in general practice in Tayside. J Antimicrob Chemother 2000; 46: 509-12
107. TeunissenPW, StapelDA, van der Vleuten C, et al. Who wants feedback? An investigation of the variables influencing residents' feedback-seeking behavior in relation to night shifts. Acad Med 2009; 84: 910-7
108. Ummenhofer W, Amsler F, Sutter PM et al. Team performance in the emergency room: assessment of inter-disciplinary attitudes. Resuscitation 2001; 49: 39-46
109. Wiener-Ogilvie S, Bennison J, Smith V. General practice training environment and its impact on preparedness. Educ Prim Care 2014; 25: 8-17
110. Bongiovanni T, Yeo H, Sosa JA et al. Attrition from surgical residency training: perspectives from those who left.AmJ Surg 2015; 210: 648-54
111. Fiordelli M, Schulz PJ, Caiata Zufferey M. Dissonant role perception and paradoxical adjustments: an exploratory study on Medical Residents' collaboration with Senior Doctors and Head Nurses. Adv Health Sci Educ 2014; 19: 311-27
112. Jubraj B, Marvin V, Poots AJ et al. A pilot survey of junior doctors' attitudes and awareness aroundmedication review: time to change our educational approach? Eur J Hosp Pharm Sci Pract 2015; 22: 243-8
113. Maisonneuve JJ, Lambert TW, Goldacre MJ. Doctors' views about training and future careers expressed one year after graduation by UK-trained doctors: questionnaire surveys undertaken in 2009 and 2010. BMC Med Educ 2014; 14: 270
114. Collins J. Foundation for Excellence: an Evaluation of the Foundation Programme. 2010. www.agcas.org.uk/assets/download?file"2053&parent" 793
115. Hilliard R, Harrison C, Madden S. Ethical conflicts and moral distress experienced by paediatric residents during their training. Paediatr Child Health 2007; 12: 29-35
116. Brennan N, Corrigan O, Allard J et al. The transition from medical student to junior doctor: today's experiences of Tomorrow's Doctors. Med Educ 2010; 44: 449-58
117. Farnan JM, Johnson JK, Meltzer DO et al. Resident uncertainty in clinical decision making and impact on patient care: a qualitative study. Qual Saf Health Care 2008; 17: 122-6
118. Garcia C, Llamocca LP, Garcia K et al. Knowledge, attitudes and practice survey about antimicrobial resistance and prescribing among physicians in a hospital setting in Lima, Peru. BMC Clin Pharmacol 2011; 11: 18
119. Kennedy TJT, Regehr G, Baker GR et al. Preserving professional credibility: grounded theory study of medical trainees' requests for clinical support. BMJ 2009; 338: b128
120. Kennedy TJT, Regehr G, Baker GR et al. 'It's a cultural expectation. . .' The pressure on medical trainees to work independently in clinical practice. Med Educ 2009; 43: 645-53
121. Sellman JS, Decarolis D, Schullo-Feulner A et al. Information resources used in antimicrobial prescribing. J AmMed Inform Assoc 2004; 11: 281-4
122. Sutcliffe KM, Lewton E, Rosenthal MM. Communication failures: an insidious contributor tomedicalmishaps. Acad Med 2004; 79: 186-94
123. Belyansky I, Martin TR, Prabhu AS et al. Poor resident-attending intraoperative communication may compromise patient safety. J Surg Res 2011; 171: 386-94
124. Coats RD, Burd RS. Intraoperative communication of residents with faculty: perception versus reality. J SurgRes 2002; 104: 40-5
125. Coffey M, Thomson K, Tallett S et al. Pediatric residents' decisionmaking around disclosing and reporting adverse events: the importance of social context. Acad Med 2010; 85: 1619-25
126. Doyle P, VanDenKerkhof EG, Edge DS et al. Self-reported patient safety competence among Canadianmedical students and postgraduate trainees: a cross-sectional survey. BMJQual Saf 2015; 24: 135-41
127. Kobayashi H, Pian-Smith M, Sato M et al. A cross-cultural survey of residents' perceived barriers in questioning/challenging authority. Qual Saf Health Care 2006; 15: 277-83
128. Pian-Smith MC, Simon R, Minehart RD et al. Teaching residents the twochallenge rule: a simulation-based approach to improve education and patient safety. Simul Healthc 2009; 4: 84-91
129. Sydor DT, Bould MD, Naik VN et al. Challenging authority during a lifethreatening crisis: the effect of operating theatre hierarchy. Br J Anaesth 2013; 110: 463-71
130. van Schaik S, Plant J, O'Brien B. Challenges of interprofessional team training: a qualitative analysis of residents' perceptions. Educ Health (Abingdon) 2015; 28: 52-7
131. Bethune R, Canter R, Abrams P. What do surgical trainees think about patient safety culture, and is this different from their consultants? Clin Risk 2012; 18: 52-7
132. Reader TW, Flin R, Mearns K et al. Interdisciplinary communication in the intensive care unit. Br J Anaesth 2007; 98: 347-52
133. Hall KK, Philbrick J, NadkarniM. Evaluation and treatment of acute bronchitis at an academic teaching clinic.AmJMed Sci 2003; 325: 7-9
134. Pacheco GS, Viscusi C, Hays DP et al. The effects of resident level of training on the rate of pediatric prescription errors in an academic emergency department. J EmergMed2012; 43: e343-8
135. Baker E, Pryce Roberts A, Wilde K et al. Development of a core drug list towards improving prescribing education and reducing errors in the UK. Br J Clin Pharmacol 2011; 71: 190-8
136. Feucht CL, Rice LB. An interventional program to improve antibiotic use. Ann Pharmacother 2003; 37: 646-51
137. Guerra CM, Pereira CA, Neves Neto AR et al. Physicians' perceptions, beliefs, attitudes, and knowledge concerning antimicrobial resistance in a Brazilian teaching hospital. Infect Control Hosp Epidemiol 2007; 28: 1411-4
138. Nambiar S, Schwartz RH, Sheridan MJ. Antibiotic use for upper respiratory tract infections: how well do pediatric residents do? Arch Pediatr Adolesc Med 2002; 156: 621-4
139. Patel R, Green W, MartinezMMet al. A study of Foundation Year doctors' prescribing in patients with kidney disease at a UK renal unit: a comparison with other prescribers regarding the frequency and type of errors. Eur J Hosp Pharm Sci Pract 2015; 22: 291-7
140. Dearden E, Mellanby E, Cameron H et al. Which non-technical skills do junior doctors require to prescribe safely? A systematic review. Br J Clin Pharmacol 2015; 80: 1303-14
141. Rawson TM, Charani E, Moore LSP et al. Mapping the decision pathways of acute infection management in secondary care among UK medical physicians: a qualitative study. BMCMed 2016; 14: 208
142. Dryden M, Johnson AP, Ashiru-Oredope D et al. Using antibiotics responsibly: right drug, right time, right dose, right duration. J Antimicrob Chemother 2011; 66: 2441-3
143. General Medical Council. Leadership and Management for All Doctors. GMC, 2012. http://www.gmc-uk.org/Leadership_and_management_for_all_ doctors___English_1015.pdf_48903400.pdf
144. Wilkie V. Leadership and management for all doctors. Br J Gen Pract 2012; 62: 230-1
145. McCarthy RM, Hilmer SN. Teaching Junior Medical Officers safe and effective prescribing. Intern Med J 2013; 43: 1250-3
146. Thorpe JM, Smith SR, Trygstad TK. Trends in emergency department antibiotic prescribing for acute respiratory tract infections. Ann Pharmacother 2004; 38: 928-35
147. Wong G, Greenhalgh T, Westhrop G et al. Development of methodological guidance, publication standards and training materials for realist and meta-narrative reviews: the RAMESES (Realist And Meta-narrative Evidence Syntheses: Evolving Standards) project. Health Serv Deliv Res 2014; 2