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Foundation year one and year two doctors’ prescribing errors: a comparison of their causes
  1. Penny J Lewis,
  2. Elizabeth Seston,
  3. Mary P Tully
  1. Division of Pharmacy and Optometry, School of Health Sciences, University of Manchester, Manchester, UK
  1. Correspondence to Dr Penny J Lewis, Division of Pharmacy and Optometry, School of Health Sciences, University of Manchester, Manchester M13 9PT, UK; penny.lewis{at}


Objective Junior doctors have the highest rates of prescribing errors, yet no study has set out to understand the differences between completely novice prescribers (Foundation year one (FY1) doctors) and those who have gained some experience (Foundation year two (FY2) doctors). The objective of this study was to uncover the causes of prescribing errors made by FY2 doctors and compare them with previously collected data of the causes of errors made by FY1 doctors.

Design Qualitative interviews, using the critical incident technique, conducted with 19 FY2 doctors on the causes of their prescribing errors and compared with interviews previously conducted with 30 FY1 doctors. Data were analysed using a constant comparison approach after categorisation of the data using Reason’s model of accident causation and the London protocol.

Results Common contributory factors in both FY1 and FY2 doctors’ prescribing errors included working on call, tiredness and complex patients. Yet, important differences were revealed in terms of application of prescribing knowledge, with FY1 doctors lacking knowledge and FY2 misplacing their knowledge. Due to the rotation of foundation doctors, both groups are faced with novel prescribing contexts, yet the previous experience that FY2 doctors gained led to misplaced confidence when caution would have been expedient.

Conclusions Differences in the contributory factors of prescribing errors should be taken into account when designing interventions to improve the prescribing of foundation doctors. Furthermore, careful consideration should be taken when inferring expertise in FY2 doctors, who are likely to prescribe in contexts in which their experience is little different to an FY1 doctor.

  • education & training (see medical education & training)
  • risk management
  • medical education & training
  • qualitative research
  • quality in health care

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  • Contributors PJL and MPT designed the study. PJL and ES conducted the interviews. Analysis was carried out by PJL, ES and MPT. PJL wrote the first draft. MPT made revisions on subsequent drafts. All authors approved the final version.

  • Funding Funding was provided for the primary data collection of FY2 data by Manchester Foundation Trust Research for Patient Benefit Scheme.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Ethical approval was gained for the primary data collection of FY2 data from the University of Manchester Research Ethics Committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.