1. Which skills do junior doctors require to prescribe safely? Dr Effie Dearden StR General Medicine & Geriatric Medicine Fellow in Medical Education

2. What is the problem? Prescribing FY1s Non-technical skills Literature Review results What next? Direct observation l Interviews

3. Prescribing errors very common FY1FY2OtherConsultant EQUIP (2009)8.4%10.3%5.9% PROTECT (2012)7.0%7.5%7.6% FY1/2 doctors wrote 68% of prescriptions in EQUIP Dornan, T. et al., 2009. An in depth investigation into causes of prescribing errors by foundation trainees in relation to their medical education. EQUIP study., London. Ross, S. et al., 2012. Perceived causes of prescribing errors by junior doctors in hospital inpatients: a study from the PROTECT programme. BMJ Quality & Safety, (October), pp.1–6. Rate of prescribing errors

4. Why Non-Technical Skills? Knowledge is easily accessible  BNF  More senior staff  Pharmacy staff Evidence of complex team and communication factors in error analysis

5. ‘Despite the rhetoric about evidence-based medicine…FY1 doctors…learn prescribing by prescribing in specific settings and within specific teams’ Kilminster, S., Zukas, M. & Roberts, T., 2006. Learning practice? Exploring the links between transitions and medical performance. Journal of Health Organization and Management, 24(6), pp.556–570.

6. Systematic Review Junior Doctors AND Prescribing – 1,744 papers screened – 14 included in final analysis No studies examining NTS in prescribing – Interpretative approach taken Papers coded using NVIVO into non-technical skills categories

7. Framework Flin et al. Safety at the Sharp End: A guide to non-technical skills. Aldershot, Hampshire: Ashgate, 2008 Social Skills:  Communication, Teamworking,  Coping with Stress & Fatigue, Leadership Cognitive Skills:  Situational Awareness, Decision-making Task Management

8. Communication & Team-Working Patient as team-member Merged due to overlap 'Send information clearly & concisely' 'Actively receive information’ 'Identify & utilise the skills of other team members' 'Speak up'

9. Situational Awareness Limited experience = few mental models 'Awareness of own skills & limitations' 'Awareness of external & internal influences' 'Gathering, interpreting & checking information' 'Projection to future states'

10. Decision Making Splitting of decisions 'Defining the problem' 'Deciding whether to prescribe' 'Applying norms, guidelines & protocols'

11. Task Management Evidence of positive behaviours 'Being prepared & utilising resources' 'Prioritising tasks & patients' 'Maintaining standards'

12. Conclusion Leadership Coping with stress & fatigue Limitations Acknowledgements Sheila Fisken & Ed Mellanby

13. Research Proposal Direct observation FY1/2 Doctors Medical receiving unit Field notes Follow-up interviews Recorded, transcibed & coded Ethics waived by Scotland A REC

14. Questions? effie.dearden@ed.ac.uk