Housestaff Knowledge Research Articles

Improvement in Housestaff Knowledge of Novel Antihyperglycemic Agents Through a Cross-Specialty Beyond Diabetes“Educational Initiative”

Lead Author's Financial Disclosures Nothing to disclose. Study Funding AstraZeneca Pharmaceutical Industry Company. Background/Synopsis Novel antihyperglycemic agents, including sodium-glucose cotransporter-2 inhibitors (SGLT2i) and glucagon-like-peptide-1 receptor agonists (GLP1-RA), demonstrate significant benefits in select patients with and without diabetes (T2DM). These benefits include improvements in cardiovascular, kidney and metabolic outcomes. Despite these benefits, these medications remain underutilized, attributed in part to a lack of provider knowledge across specialties. Our "Beyond-Diabetes" initiative is a health system-wide, multidisciplinary collaboration to raise awareness and prescriber utilization of these medications through a variety of informatics and educational modalities. Objective/Purpose The goal of this component of our initiative was to assess whether lecture based (grand rounds) and case-based conferences delivered via a virtual platform could improve understanding of SGLT2i and GLP1-RA among residents and fellows as part of their core curriculum. Methods We administered a 6-question electronic survey to assess knowledge of SGLT2i and GLP1-RA before and after a 1-hour, virtual case-based education that highlighted clinical uses, contraindications, dosing, adverse effects, and prescribing barriers. The housestaff were previously offered a grand rounds on the topic. The lectures and pre/post surveys were provided to internal medicine residents, as well as cardiology, nephrology, and endocrinology fellows. Efficacy was measured by analyzing the percent correct between pre/post-test questionnaires by a paired, two-sided t-test. Results After evaluating the pre-test and post-test results of the trainees, we found that among all disciplines (n = 119 pre/63 post), the average increase was 15% correct between pre-test and post-test (p-value <0.01) using random pre-test sampling. Limitations of this data include a low response rate with 28% of trainees completing the pre-test (119/418) and 53% completing the post-test (63/119). Cardiology fellows showed the greatest improvement in their overall scores with a 17% change. Endocrinology fellows had the least improvement, with a difference of 6%, likely attributable to having the highest baseline pre-test questionnaire scores. Analysis of each question showed that there was an increase in the percentage answered correctly, with the exception of one question, which had no change after education. Conclusions Our intervention demonstrates that a 1-hour virtual lecture can improve the knowledge of trainees across four disciplines regarding novel antihyperglycemic medications. This data supports the use of virtual lecture and case-based didactics to enhance provider knowledge regarding SGLT2i and GLP1-RA medications. However, further research into the most effective educational initiatives is warranted. This knowledge is essential to increase the utilization of these effective medications, which have been demonstrated to improve clinical outcomes and reduce healthcare expenditures. Nothing to disclose.

ATTENDING PHYSICIANS' PERCEPTIONS AND ATTITUDES OF TEACHING HOUSESTAFF IN THE MEDICAL ICU

TOPIC: Education, Research, and Quality Improvement TYPE: Original Investigations PURPOSE: The education of residents in critical care is largely accomplished through teaching while they rotate through the medical intensive care unit (MICU). A didactic curriculum to enhance critical care education of house staff in our MICU exists, but it's effectiveness is hindered by limited implementation and inconsistent use. In this study, we hope to identify barriers to implementation and ideas to inform the routine and self-sustaining use of the curriculum. METHODS: The study was a prospective survey of the attitudes of MICU attending faculty at a single-center. All faculty who attend in the MICU at least 4 weeks annually were invited to participate. The study was IRB-approved and consent was obtained. The survey was completed through an anonymous, web-based survey. RESULTS: 21 people met inclusion criteria. There were 12 responses to the survey, giving a response rate of 57%. One declined to consent to participate. Out of the 11 who consented to participate, 9 (81%) know there is a formal MICU curriculum. Out of those 9, 6 (67%) reported using it to teach. The top three motivations for teaching are to improve housestaff knowledge, because they enjoy it (each chosen by 10 respondents, 91%), and because they think teaching can improve patient care (chosen by 9 respondents, 82%). 7 (64%) identified improving housestaff knowledge as the most important factor. Many barriers to teaching in the MICU were identified, with the team being too busy (9/11, 82%), not having sufficient time to prepare content (6/11, 55%), and not knowing what housestaff have already been taught (4/11, 36%) being the top three barriers. 5 (45%) identified the team being too busy as the most important barrier. Respondents identified ways to overcome these barriers by establishing protected teaching time in the MICU (7/11, 64%) and if all MICU attendings consistently taught when on service (5/11, 45%). Having off-service faculty come to the MICU to teach and improving the physical space for teaching were each identified by 4 respondents (36%). CONCLUSIONS: The responses confirm that the majority of faculty enjoy teaching and believe it improves housestaff knowledge and patient care. The majority are aware of the curriculum, however the primary barriers to teaching are lack of time and a busy team, which hinders the use of the curriculum, but also teaching of any kind. The majority of respondents proposed dedicating a protected time for teaching and commitment from all faculty to teach in that time, as the most important means to overcome the barriers. CLINICAL IMPLICATIONS: Our initial purpose was to identify barriers to implementation of an existing formal curriculum. Given our survey results identified the most important barriers as lack of protected time for education and the time pressures the team experiences, we hypothesize that scheduling a set daily time for teaching is a necessary first step in order to increase teaching in the MICU. We will address that intervention first; if we are successful, then we plan to subsequently study best practices for implementing the prepared curriculum, including trials of novel interventions for our MICU, such as off-service faculty coming to the MICU to teach. DISCLOSURES: No relevant relationships by Anna Brady, source=Web Response No relevant relationships by Marin McCutcheon, source=Web Response

S1270 Inappropriate PPI Use in an Urban Resident Primary Care Clinic

INTRODUCTION: Proton pump inhibitors (PPIs) are an efficacious treatment for gastroesophageal reflux disease (GERD) and dyspepsia. The American College of Gastroenterology (ACG) guidelines recommend a time-limited 8 weeks of therapy with PPIs for GERD and dyspepsia. PPIs are frequently prescribed in the primary care setting but can be over-prescribed or prescribed for too long. This can result in polypharmacy and other adverse medication-associated side effects. We evaluated the appropriateness of PPI use in patients with GERD and dyspepsia at LAC + USC Medical Center's resident primary care clinic. METHODS: We retrospectively analyzed all the patients seen in one week at LAC + USC's resident primary care clinic. Provider documentation was used to determine reasons for PPI use, indications to continue, and plans to trial off. RESULTS: Patients prescribed a PPI tended to be older (mean age 57.3 [55.8–58.9] vs 53.3 [52.0–54.5], P < 0.01), had more medical issues (7.3 [6.8–7.8] vs 5.6 [5.4–5.8], P < 0.01), specifically rheumatologic conditions (14.2% vs 5.9%, P < 0.01), and were more frequently followed in Gastroenterology specialty clinic (9.7% vs 2.6%, P < 0.01). Among patients on PPIs, 47% were prescribed it for GERD or dyspepsia, while 32% had no reason documented (Figure 1). 49 of 73 (67%) patients on a PPI for GERD or dyspepsia had been on a PPI for greater than two months without an indication to continue PPI therapy, and only 2 of 49 (4%) had a trial off PPI. CONCLUSION: The majority of patients prescribed a PPI for GERD or dyspepsia at the LAC + USC Resident Primary Care Clinic were on the medication for longer than the 8 weeks recommended by the ACG. During the root cause analyses for the inappropriate use of PPIs, gaps in house staff knowledge around guideline directed therapy and PPI side effects, time constraints associated with caring for a patient population with multiple comorbidities, and poor provider documentation in the electronic medical records were identified as significant contributing factors. To address gaps in knowledge, we plan to implement succinct and high yield didactic sessions for residents on appropriate PPI use and monitor for improvements in both documentation and adherence to ACG recommendations.Table 1.: Patient demographics and PPI use in primary care clinic. PPI = proton pump inhibitor, IDDM = insulin-dependent diabetes mellitus, NIDDM = noninsulin dependent diabetes mellitus, CKD = chronic kidney disease, CHF = congestive heart failure, CAD = coronary artery disease, ESRD = end stage renal disease, GERD = gastrointestinal esophageal reflux disease, PUD = peptic ulcer diseaseFigure 1.: Analysis of PPI prescriptions in primary care clinic. PPI = proton pump inhibitor, GERD = gastroesophageal reflux disease.

1333. Developing an Educational Tool to Improve Housestaff Knowledge, Attitudes, and Behavior in Managing Common Infectious Diseases

BackgroundImproving internal medicine (IM) trainees skills in managing common infectious diseases is essential to their development as competent physicians. We currently lack quantitative data of the knowledge and attitudes of IM housestaff regarding their management of common infectious diseases. We applied the knowledge, attitude, and behavior model to a pre-intervention survey aimed to uncover housestaff knowledge gaps and discomfort in managing several of the most commonly encountered infectious diseases at our institution. Using this information, we plan to develop a targeted post-survey intervention to increase self-efficacy and improve antimicrobial prescription practices among trainees.MethodsSurvey questions were based on Infectious Disease Society of America (IDSA) guidelines and developed using an iterative process involving interviews of infectious disease physicians and IM housestaff. We chose to focus on cystitis, pneumonia, and skin and soft-tissue infections. The anonymous survey tool was developed using a secure, online platform, and distributed in January 2018. Participation was voluntary and no remuneration for participation was offered.ResultsOut of 165 survey recipients, 50 trainees (30%) responded. Fifty-eight percent of trainees stated that they possessed only an average level of knowledge regarding the management of cystitis, pneumonia, and cellulitis. While 98% of housestaff confirmed that they utilized additional resources for information, only 24% felt routinely comfortable making decisions without an infectious disease consultation. Ninety-six percent of trainees felt that an institution-specific guide describing the management of common infectious diseases would be highly beneficial.ConclusionTrainees still lack the knowledge and confidence to make decisions regarding the empiric management of cystitis, pneumonia, and skin and soft-tissue infections at our academic medical center. There is a strong desire for an institution-specific educational resource to provide guidance for these decisions. Increasing trainee self-efficacy and improving their antimicrobial prescription practice patterns should be an educational priority. Disclosures All authors: No reported disclosures.

Improving Compliance of Colorectal Cancer Screening Through Housestaff Education in an Urban Community Hospital: A Quality Improvement Study

Introduction: At Brooklyn Hospital Center’s ambulatory Internal Medicine clinic, from 10/1/2016 to 3/31/2017, the rate of colorectal cancer (CRC) screening was reported to be 61%. We believe the low rate of screening is partially due to a knowledge gap regarding appropriate screening guidelines as well as screening alternatives. It is critical for housestaff to understand these guidelines so that we may provide the best and highest quality of care to our patient population. Our hypothesis is that an educational quality improvement intervention will help increase awareness of these guidelines and in turn, indirectly increase the screening rate for CRC. Methods: All Internal Medicine housestaff attending morning conference were included in the study (total of 39). Pre and post-tests were created (Image 1) to examine housestaff knowledge of current guidelines. The pre-test was administered, followed by a brief lecture on current guidelines, after which the post-test was given. The data was collected and analyzed using two-sided tests for significant differences in proportion between the number correct for each question, with a set p-value of < 0.05. Results: The results have been compiled in Table 1 (Image 2). Questions 3, 9, 13 & 15 showed a significant difference in the pre and post-tests. Most housestaff knew that colonoscopy is the preferred prevention test and that FIT is the preferred detection test (as well as FIT being more specific than FOBT). There was a significant increase in their knowledge of the age in which average CRC risk screening should begin. While there was a significant increase in willingness to discuss screening alternatives with patients, overall knowledge of the available alternatives remained low. Conclusion: While this quality improvement study demonstrates significant increase in housestaff knowledge via an educational intervention, there is room for improvement. With the recent introduction of ambulatory FIT, we have a new pathway for alternative screening. Since housestaff did not have a significant increase in knowledge of alternative testing, we theorize that focusing on the newly available FIT as an alternative will increase screening rates. Along with the increased knowledge on average CRC risk screening, this should increase screening via both colonoscopy as well as its alternatives (mainly FIT in our case). Further studies will investigate this, as well as incorporating patient barriers to screening (which are currently being addressed in a pilot study).305_B Figure 2 No Caption available.

A Multicenter Survey of House Staff Knowledge About Sepsis and the "Surviving Sepsis Campaign Guidelines for Management of Severe Sepsis and Septic Shock".

We aimed to assess the knowledge, attitudes, and perceptions of resident physicians regarding sepsis in general and the Surviving Sepsis Campaign Guidelines in particular. After institutional review board approval, we surveyed internal medicine (IM) and emergency medicine (EM) house staff from 3 separate institutions. House staff were notified of the survey via e-mail from their residency director or chief resident. The survey was Internet-based (using http://www.surveymonkey.com ), voluntary, and anonymous. The Surviving Sepsis Campaign Guidelines were used to develop the survey. The survey was open between December 2015 and April 2016. No incentives for participation were given. Reminder e-mails were sent approximately every 3 to 4 weeks to all eligible participants. Comparisons of responses were evaluated using the N-1 2-proportion test. A total of 133 responses were received. These included 84 from IM house staff, 27 from EM house staff, and 22 who selected "other." Eighty (101/126) percent reported managing at least 1 patient with sepsis in the preceding 30 days, 85% (97/114) rated their knowledge of the Surviving Sepsis Guidelines as "very familiar" or at least "somewhat familiar," and 84% (91/108) believed their training in the diagnosis and management of sepsis was "excellent" or at least "good." However, 43% (47/108) reported not receiving any feedback on their treatment of patients with sepsis in the last 30 days, while 24% (26/108) received feedback once. Both IM and EM house staff received comparable rates of feedback (62% vs 48%, respectively; P = .21). For the 3 questions that directly tested knowledge of the guidelines, the scores of the IM and EM house staff were similar. Notably, <20% of both groups correctly identified diagnostic criteria for sepsis. Additional education of IM and EM house staff on the Surviving Sepsis Campaign Guidelines is warranted, along with more consistent feedback regarding their diagnosis and management of sepsis.

Increasing awareness of age-related fertility and elective fertility preservation among medical students and house staff: a pre- and post-intervention analysis

To assess medical students' and house staff's knowledge and personal and professional perceptions of age-related fertility and fertility preservation before and after an educational intervention. Pre-/post intervention survey. University-based medical center. Medical students and house staff. An educational session on age-related fertility decline and elective fertility preservation. Knowledge scores and perceptions assessed immediately before and after the intervention. Sixty-five surveys were administered. Of the 53 respondents, 71.7% were married or in a committed relationship; 89.4% reported that they were delaying childbearing, with career and/or education being the most frequently listed reason (85.7%); 39.5% indicated that they had both personal and professional interest in fertility preservation but identified finances (62.5%) and time (59.4%) as barriers; 86.9% indicated previous exposure, with formal education (80.0%) and social media (40.0%) being the most common sources. Mean scores on a six-question knowledge-based assessment improved significantly following the presentation (54.6 ± 19.0% vs. 78.1 ± 16.0%), as did the number of participants who indicated that they might now recommend elective oocyte cryopreservation to others (71.1% vs. 54.3%). After the intervention, 97.8% thought that it was important for medical professionals to be informed about age-related fertility decline and elective oocyte cryopreservation. Despite professional and personal interest, knowledge of age-related fertility decline and elective fertility preservation is limited among medical students and house staff. This study highlights the need for formal education across all levels of training and specialties, with even brief interventions being of potential benefit.

POLST: House Staff Knowledge and Attitudes (TH340D)

POLST: House Staff Knowledge and Attitudes (TH340D)

Housestaff Knowledge about Sepsis and the Surviving Sepsis Campaign Guidelines: A Multicenter Survey

Housestaff Knowledge about Sepsis and the Surviving Sepsis Campaign Guidelines: A Multicenter Survey

Interactive Online Module Failed to Improve Sustained Knowledge of the Maryland Medical Orders for Life-Sustaining Treatment Form.

Legal documents similar to the Maryland Medical Orders for Life-Sustaining Treatment (MOLST) form requiring physician endorsement are increasingly used by critically ill patients. To evaluate whether an interactive, online training module on completion and interpretation of the MOLST form leads to a sustained increase in knowledge among house staff. Pre/post survey of 329 house staff at Johns Hopkins Hospital who admit and discharge patients between June 2014 and July 2015. House staff were encouraged to complete a voluntary, interactive, online educational module on completing and interpreting MOLST forms. Participants received $25 for accessing the module and $10 for completing each survey. The primary outcome was the change in the number of questions answered correctly on the post- versus presurvey comparing house staff who viewed the module for at least 20 minutes with house staff who never viewed or never completed the module. Overall, 329 (69%) house staff completed the knowledge assessment survey both before and after the module was available, and 201 (61%) of these house staff completed the voluntary module. The median score on the presurvey conducted in July and August of 2014 was 14 out of 21 (interquartile range [IQR] 12, 16). The median (IQR) score on the postsurvey conducted in May and June of 2015 was 15 out of 21 (13, 17). The median (IQR) change in score among those who spent at least 20 minutes completing the module was 1 question (-1, 3), and among those who never viewed or never completed the module it was also 1 (IQR -1, 2). The postsurvey was completed a median (IQR) of 59 (52, 62) days after viewing the module. After adjusting for years of postgraduate clinical training, self-reported baseline experience completing MOLST forms, and self-reported responsibility for discharging patients, viewing the module for at least 20 minutes was associated with a nonsignificant increase in score of 0.41 questions (95% confidence interval, -0.25, 1.06; P = 0.23). An interactive, online educational module had no effect on trainee knowledge of completing and interpreting MOLST forms approximately 2 months after completion. Information conveyed via online modules alone may have minimal sustained impact on house staff knowledge.

Housestaff Knowledge Related to Urinary Catheter Use and Catheter-Associated Urinary Tract Infections.

Despite published catheter-associated urinary tract infection prevention guidelines, inappropriate catheter use is common. We surveyed housestaff about their knowledge of catheter-associated urinary tract infections at a teaching hospital and found most are aware of prevention guidelines; however, their application to clinical scenarios and catheter practices fall short of national goals.

861Evaluation of Infection Control (IC) Knowledge for Central Venous Catheter (CVC) Insertion and Maintenance among the Medicine (MED) Housestaff

Background: Prevention of CVC-associated bloodstream infections is essential to ensure patient safety. Physicians play an important role in preventing infections during the insertion and maintenance of CVC. It is crucial to assure proper knowledge of evidence-based practices among the Housestaff. The objectives are to assess MED Housestaff knowledge of IC practices for CVC insertion and maintenance and to determine if the methods used to educate the Housestaff are sufficient.

Assessing the Housestaff Knowledge, Attitudes, and Perceived Barriers Towards Palliative Care in the ICU

SESSION TITLE: End of Life Care Posters

Improving the Management of Diabetes in Hospitalized Patients: The Results of a Computer-Based House Staff Training Program

Poorly controlled diabetes in hospitalized patients is associated with poor clinical outcomes. We hypothesized that computer-based diabetes training could improve house staff knowledge and comfort for the management of diabetes in a large tertiary-care hospital. We implemented a computer-based training program on inpatient diabetes for internal medicine house staff at the Brigham and Women's Hospital (Boston, MA) in September 2009. House staff were required to complete the program and answer a set of questions, before and after the program, to evaluate their level of comfort and knowledge of inpatient diabetes. Chart reviews of all non-critically ill patients with diabetes managed by house staff in August 2009 (before the program) and December 2009 (after the program) were performed. Chart reviews were also performed for August 2008 and December 2008 to compare house staff management practices when the computer-based educational program was not available. A significant increase in comfort levels and knowledge in the management of inpatient diabetes was seen among house staff at all levels of training (P<0.02), but the increase was smaller for senior house staff compared with junior house staff. Nonsignificant trends suggesting increased use of basal-bolus insulin (P=0.06) and decreased use of sliding-scale insulin (P=0.10) were seen following the educational intervention in 2009, whereas no such change was seen in 2008 (P>0.90). Overall, house staff evaluated the training program as "very relevant" and the technology interface as "good." A computer-based diabetes training program can improve the comfort and knowledge of house staff and potentially improve their insulin administration practices at large academic centers.

Medicine Faculty Survey Regarding Resident Post-Acute Care Training

Introduction/Objective: The US healthcare faces major challenges in transitional care of patients. Residency programs around the nation are tackling this issue by implementing formal transitional care curricula. Most of these curricula focus on discharge summaries, medication reconciliation and post discharge follow up. Resident training regarding post-acute care (PAC) venues and reimbursement of their services is another area of transitional care that requires formal training. The purpose of this survey was to learn how Internal Medicine faculty rate first year house staff's knowledge about PAC services.

Evaluation of Housestaff Knowledge and Perception of Competence in Palliative Symptom Management

The Accreditation Council for Graduate Medical Education requires that internal medicine (IM) core curricula include end-of-life care and pain management concepts and that fellows in hematology/oncology, pulmonary/critical care, and geriatrics should receive formal instruction and clinical experience in palliative and end-of-life care. We aimed to assess the effectiveness of current teaching methods for housestaff in these fields. All of the IM residents, geriatric medicine fellows, hematology/oncology fellows, and pulmonary/critical care fellows from four regional graduate medical education sites were asked to participate in an online survey at the beginning and end of the 2008-2009 academic year. We evaluated seven domains of knowledge of palliative care and pain management with a self-assessment of competence in these areas. We also asked participants to describe their current curriculum and training in palliative medicine. There were 326 e-mailed survey invitations. There were 180 responses for the start-year survey and 102 responses for the end-year survey. All sites were represented in the responses. The only learners to significantly improve their palliative knowledge during a year of training were PGY-1s and PGY-4s. The majority of housestaff surveyed report that their current palliative medicine training is inadequate. The vast majority (84.6%) said a dedicated palliative medicine rotation would be "useful" or "very useful." Housestaff recognize their lack of experience and training in palliative medicine and are interested in many teaching venues to improve their skills. A more focused curriculum in palliative and end-of-life care is required at both resident and subspecialty fellowship levels.

Epidemiology and outcomes of dermatology in-patient consultations in a midwestern U.S. university hospital

A paucity of data exists concerning the utilization of in-patient dermatologic consultations. Previous studies on this subject have indicated a knowledge deficit of primary care providers with regard to common dermatoses, prompting a need for more effective teaching mechanisms in this area. To identify dermatologic conditions in the in-patient setting that are frequently misdiagnosed by non-dermatologists in order to improve future patient care and cost reduction through physician education. Retrospective chart review of 271 consecutive dermatologic consultations from primary ward teams between January 20, 1998, and May 19, 1999. Non-dermatology in-patient services at a Midwestern state-supported university hospital system in the U.S. Patients hospitalized on non-dermatology wards with skin problems prompting a formal dermatologic consultation. None. Prevalence of dermatologic conditions that are most frequently misdiagnosed on non-dermatology in-patient services. Seventy-six percent of the dermatologic consults were requested by Internal Medicine, Surgery, and Psychiatry departments. Common skin conditions accounted for a large majority of dermatologic consultations including: dermatitis (21.0%) and drug eruption (10.0%). The primary ward team submitted a correct dermatologic diagnosis in only 23.9 percent of cases. Dermatology consultation resulted in a change in or addition to treatment in 77 percent of patients. Our results suggest that common skin conditions account for a large majority of dermatologic consultations in a University hospital setting. Modern hospital ward teams continue to struggle with accurately recognizing and appropriately managing common skin problems resulting in inappropriate treatment, wasted resources, and prolonged hospitalization. Increasing medical student and house staff knowledge and experience in the diagnosis and management of common skin disorders could help address this problem.

Evaluation of Housestaff Knowledge and Perception of Competence in Palliative Medicine

Evaluation of Housestaff Knowledge and Perception of Competence in Palliative Medicine

Valved-Holding Chamber Technique in Housestaff Residents: Knowledge-Base versus Skills-Set

RATIONALE: Patients may require specific education to understand that metered-dose inhalers (MDI) used with valved-holding chambers (VHC) can be equally (or more) effective as nebulizers at delivering inhaled medication. We assessed housestaff's knowledge and ability to demonstrate stepwise MDI/VHC technique.

Safe Medication Prescribing: Training and Experience of Medical Students and Housestaff at a Large Teaching Hospital

To assess medical students' and housestaff's knowledge, attitudes, and behaviors regarding safe prescribing. In 2003, 214 housestaff (interns and residents) and 77 medical students in medicine and surgery at Barnes-Jewish Hospital, St. Louis, Missouri, were asked to complete an anonymous, self-administered questionnaire about safe prescribing. Questions asked about training in and attitudes about safe-prescribing and current prescribing behaviors. Fisher exact test was used to compare attitudes and behaviors among subgroups. Of the 175 (60%) respondents, 73 (59%) of 123 housestaff and eight (15%) of 52 students agreed that their safe-prescribing training was adequate (p < .001), and 145 (83%) total respondents agreed that prescribing errors were unacceptable. Respondents reported always doing the following: 156 (89%) checked prescribing information before prescribing new drugs, 131 (75%) checked for drug allergies, 103 (59%) double-checked dosage calculations, 98 (56%) checked for renal impairment, and 53 (30%) checked for potential drug-drug interactions. Routine use of safe medication prescribing behaviors among housestaff and medical students was poor. Contributing factors may have included inadequate training and a culture that does not support safe prescribing. Effective strategies to increase safe medication prescribing need to be identified and implemented.