Abstract
Background: Assessing the preparedness of junior doctors to use vancomycin is important in medical education. Preparedness is typically evaluated by self-reported confidence surveys.Materials and Methods: An eight-item vancomycin prescribing confidence questionnaire was developed, piloted, and evaluated. The questionnaire responses were collected from 195 junior doctors and a series of statistical techniques, such as principal component analysis and confirmatory factor analysis, and were implemented to examine the validity and reliability.Results: The principal component analysis supported a one-factor structure, which was fed into a confirmatory factor analysis model resulting in a good fit [comparative fit index (CFI) = 0.99, Tucker–Lewis index (TLI) = 0.99, root mean square error of approximation (RMSEA) = 0.08, standardized root mean square residual (SRMR) = 0.04]. Ordinal-based α was 0.95, and various ωs were all above 0.93, indicating a high reliability level. The questionnaire responses were further proved to be robust to extreme response patterns via item response tree modeling. Jonckheere–Terpstra test results (z = 6.5237, p = 3.429e−11) showed that vancomycin prescribing confidence differed based on the experience in order (i.e., four ordinal independent groups: “≤10 times,” “11–20 times,” “21–30 times,” and “≥31 times”) and therefore provided external validity evidences for the questionnaire.Conclusions: The questionnaire is valid and reliable such that teaching hospitals can consider using it to assess junior doctors' vancomycin prescribing confidence. Further investigation of the questionnaire can point to the relationship between the prescribing confidence and the actual performance.
Highlights
Prescribing is more than a physical writing activity because it consists of documenting a history and examination of the patient, determining the cause, planning the therapeutic intervention and objectives of the treatment, communicating with the patient, recording the prescription, and monitoring the consequences [1]; it requires a solid understanding of pharmacology, physiology, and clinical evaluation as well as risk appraisal knowledge
Being competent in prescribing safely and effectively is essential to a qualified doctor [3, 4]; it has been given substantial concerns about how well junior doctors are prepared for prescribing within the context of continuing medical education [CME; [5]]
The questionnaire was distributed to 195 junior doctors working at Flinders Medical Center in Australia to assess their confidence about prescribing and monitoring vancomycin, where the questions are listed in Figure 1 and the response categories are in a 5-point Likert scale of “Strongly Disagree,” “Disagree,” “Neutral,” “Agree,” and “Strongly Agree” [see [13], for the dataset]
Summary
Prescribing is more than a physical writing activity because it consists of documenting a history and examination of the patient, determining the cause, planning the therapeutic intervention and objectives of the treatment, communicating with the patient, recording the prescription, and monitoring the consequences [1]; it requires a solid understanding of pharmacology, physiology, and clinical evaluation as well as risk appraisal knowledge. Being competent in prescribing safely and effectively is essential to a qualified doctor [3, 4]; it has been given substantial concerns about how well junior doctors are prepared for prescribing within the context of continuing medical education [CME; [5]]. That medical students are not competent in prescribing antibiotics when the basic medical training finishes is a global concern [7,8,9]. Among these medicines, prescribing vancomycin is regarded challenging in practice, because it requires dosing levels and serum drug levels to vary from case to case, in the perspectives of efficacy and toxicity [10, 11].
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