Level of clinical competence in junior medical residents and its correlation with antibiotic prescription errors: a cross-sectional study

Background A large portion of prescribing errors can be attributed to medication knowledge deficiency. They are preventable and most often occur in the stage of ordering. Antimicrobials are the drug class most commonly related to prescribing errors. Objectives The study main objective was to describe the relationship between clinical competence and antibiotic prescription errors. Secondary objectives were to measure clinical competence of junior medical residents with an Objective Structured Clinical Examination (OSCE), to describe the frequency and severity of antibiotic prescription errors and to find items and attributes of clinical competence that are correlated with the antibiotic prescription error ratio. Methods A cross-sectional study was designed to assess the clinical competence of junior medical residents, from National Institute of Pediatrics and “Manuel Gea Gonzalez” General Hospital in Mexico City, through an infectious disease OSCE and measure the frequency and severity of antibiotic prescription errors. Statistical analysis included generalizability theory and internal consistency Cronbach’s alpha, a partial correlation controlling sex and time of degree, simple linear regression and item’s exploratory factorial analysis. Results The mean OSCE score was 0.692 ± 0.073. The inter-item Cronbach’s alpha was 0.927 and inter-station Cronbach’s alpha was 0.774. The G coefficient in generalizability theory analysis was 0.84. The antibiotic prescription error ratio was 45.1% ± 7%. The severity of antibiotic prescription errors was: category C (errors that do not cause patient harm) = 56 cases, 15.5%; category D (monitoring required to confirm that errors resulted in no harm to the patient or intervention required to preclude harm) = 51 cases, 14.1%; category E (errors that may contribute to or result in temporary harm to the patient and require intervention) = 235, 65.2%; category F (errors that may contribute to or resulted in temporary harm to the patient and require initial or prolonged hospitalization) = 18 cases, 5%. The correlation between clinical competence and antibiotic prescription errors was established with Pearson correlation (r=-0.33, p<0.05, CI95% -0.57 to -0.07), and partial correlation controlling effect of gender and time since graduation (r=-0.39, p<0.01, CI95% -0.625 to -0.118). Conclusions We found a negative correlation between clinical competence and antibiotic prescription error ratio in graduated physicians who have been accepted in a medical specialty. The therapeutic plan, which is a component of clinical competence score, and the prescription skills had a negative correlation with antibiotic prescription errors. The most frequent mistakes in antibiotic prescriptions errors would need a second intervention.