The Key Literature In Medical Education podcast this week tackles the ongoing theme of educational imprinting. See episode 80 and 82 for previous discussions. We spend a lot of time in #meded talking about ideal instructional methods. But too often we forget that our most powerful teaching is a function of the behaviour that we model. To misappropriate a famous quote, “Teach always. When necessary use words.”
The podcast this weeks examines how an attending physician’s prescribing practice of brand name drugs over generic substitutions can influence the future practice of physicians in training.
This study made me pause when I went to work this week… as I routinely started to write for a brand name drug. Maybe the paper will cause you to reflect on your own practice as a physician, teacher, and role model.
For more details, download the podcast here. But if you want the quick punch lines, the abstract is below.
View/download the abstract here.
Ryskina KL, Dine CJ, Kim EJ, Bishop TF, Epstein AJ. Effect of Attending Practice Style on Generic Medication Prescribing. Journal of General Internal Medicine. 2015 Sept;30 (9):1286-1293
Reviewer: Jason Frank
On KeyLIME, we have covered papers that suggest that medical residents adopt the practice patterns and patient outcomes of their teachers, a phenomenon called educational imprinting. On previous episodes, we discussed how teachers impact their trainees’ costs of care and even their patient’s mortality & morbidity. (See KeyLIME episodes 80 & 82). In this paper from JGIM, we take another look at educational imprinting and prescribing patterns, through the lens of cost-effectiveness.
Ryskina et al set out to examine the correlation between the brand-name vs. generic statin prescribing patterns of US general internists and their residents. Statin choice in the US are considered one of the top 5 interventions to promote cost-effective care.
Type of Paper
Research: Observational database study
Key Points on the Method
The authors retrospectively mined medical record databases of 58 general internist practices, involving the supervision of 342 residents from 2007-2011. The choice of a brand-name vs. a generic statin was captured when the internist was without a trainee and when the trainee wrote the prescription. Refills and drug switches were excluded. Supervisors were stratified into quintiles based on the previous quarter’s % brand-name prescribing pattern (e.g. <20%, 20-39%, etc). Logistic regression was used to model the relationship between attending and resident prescribing of a brand-name statin. The number of brand-name statin prescriptions by residents varied tremendously by year, from 11-529.
The authors conclude that attending physicians seemed to influence resident prescribing patterns.
Listen to the podcast here