Improving junior doctor medicine prescribing and patient safety: an intervention using personalised, structured, video-enhanced feedback and deliberate practice

Aim: This research investigated the effectiveness of an intervention for improving the prescribing and patient safety behaviour of Foundation Year doctors. The intervention consisted of simulated clinical encounters with subsequent personalised, structured, video-enhanced feedback and deliberate practice, undertaken at the start of four-month sub-specialty rotations. Method: Three prospective, non-randomised control intervention studies were conducted, within two secondary care NHS Trusts in England. The primary outcome measure, error rate per prescriber, was calculated using daily prescribing data. Prescribers were grouped to enable a comparison between experimental and control conditions using regression analysis. A breakeven analysis evaluated cost effectiveness. Results: There was no significant difference in error rates of novice prescribers who received the intervention when compared with those of experienced prescribers. Novice prescribers not participating in the intervention had significantly higher error rates (p=0.026, 95% CI Wald 0.093 to 1.436; p=0.026, 95% CI 0.031 to 0.397) and patients seen by them experienced significantly higher prescribing error rates (p=0.007, 95% CI 0.025 to 0.157). Conversely, patients seen by the novice prescribers who received the intervention experienced a significantly lower rate of significant errors compared to patients seen by the experienced prescribers (p=0.04, 95% CI-0.068 to -0.001). The break-even analysis demonstrates cost effectiveness for the intervention. Conclusion: Simulated clinical encounters using personalised, structured, video-enhanced feedback and deliberate practice improves the prescribing and patient safety behaviour of junior doctors in their Foundation Training. The intervention is cost-effective with potential to reduce avoidable harm