A window into the lives of junior doctors: narrative interviews exploring antimicrobial prescribing experiences

Abstract

Prescribing medications is an important challenge in the transition to junior doctor practice. We explored the antimicrobial prescribing experiences of foundation year (FY) doctors in two UK hospitals. The study answers three research questions: (i) What types of antimicrobial prescribing experiences do FY doctors have?; (ii) How do they make sense of their antimicrobial prescribing experiences?; and (iii) What are their educational needs regarding antimicrobial prescribing? A narrative interview study involving 33 FY1 and FY2 doctors in two UK hospitals (Location 1, England and Location 2, Scotland) was undertaken. Complementary analytical approaches to answer the research questions, including framework analysis and in-depth narrative analysis, were employed. FY doctors made complicated antimicrobial prescribing decisions. The context in which these decisions took place was also challenging, with marked variability in practice between wards within the same hospital, conflicting advice given by senior staff and a dearth of supervision and feedback. In-depth narrative analysis illustrated a complex interplay between what trainees say and how they narrate their prescribing experiences. Three data-derived educational strategies were identified and presented to an Expert Reference Group and research participants for their feedback and ideas for development. The narrative approach provided a window into FY doctors' experiences that was wider than the antimicrobial prescribing experiences themselves. The FY doctors described complex tasks being undertaken in challenging environments, where workplace cultures often failed to promote learning and feedback and where hierarchy sometimes worked against rational antimicrobial prescribing. Some practical solutions to these challenges are offered.