BackgroundAppropriate antimicrobial prescribing is essential for patient care, yet up to half of antimicrobial prescriptions written in the UK are sub-optimal. Improving prescriber education has recently been promoted as a mechanism to optimise antimicrobial use, but identification of key learning objectives to facilitate this is so far lacking. Using qualitative methods we investigated junior doctor knowledge, attitudes, and behaviours around antimicrobial prescribing to identify key areas to address in future educational programmes.MethodsA cross-sectional survey of qualified doctors in training in West London was undertaken exploring antimicrobial prescribing practices and educational needs.ResultsAmong 140 junior doctors from 5 London hospitals, a third (34 %) reported prescribing primarily unsupervised, and two thirds (67 %) reported difficulties obtaining prescribing support outside of hours. 20 % stated not feeling confident in writing an antimicrobial prescription, but confidence was increased through having confirmatory diagnostic results (24) and obtaining advice from a senior doctor (26 %); whether this senior was from their own specialty, or an infection-specialist, varied significantly (p < 0.01) by experience. Only a small percentage (5–13 %; depending on number of years post-qualification) of participants stated their previous antimicrobial education was effective. 60 % of those in their first year post qualification reported wanting further education in antimicrobial prescribing, rising to 74 % among more experienced junior doctors. Specific areas of educational need identified were (i) principles of antimicrobial prescribing, (ii) diagnosis of infections, (iii) clinical review of patients with infections, (iv) prescribing in the context of antimicrobial resistance, and (v) laboratory testing and test results.ConclusionsA significant proportion of junior doctors report lone prescribing of antimicrobials in the context of low self-perceived confidence and knowledge in this field, and frequent difficulty in accessing help when necessary. Innovative training, targeting five specific areas identified through this needs assessment, is urgently needed by junior doctors practising in secondary care.

This study explores investigative decision-making processes in the context of major crimes as experienced by the law enforcement agents. Methodology: Episodic interviews were conducted with 6 agents from medium-sized police forces in the UK. Following the framework of Naturalistic inquiry, Qualitative Content Analysis took place with the assistance of Atlas.ti software. To ensure the validity of findings, the within method triangulation was preferred, by additionally analysing the interview transcripts with ALCESTE. Findings: Findings from this study revealed a variety of internal factors at play, shaping the decision making course into an act of balancing various desired goals. Detectives appear to assess a situation based on their experiences confirming that the Naturalistic Decision-making model may assist in understanding investigative decision-making. Limitations/implications: Due to the busy schedule of law enforcement agents the number of participants was limited and availability difficult; therefore, this study can be thought of as a pilot study that will inspire researchers to use the same method for in-depth understanding of investigative decision making. Practical implications: Results captured the ill-defined goals in the police environment and provided ways of decreasing their impact on investigative decision-making thus should help detectives to understand their decision-making limitations and strengths. Investigative Decision Making 2 Social implications: The findings from this project enhance the psychological understanding of investigative decision-making. Originality: This project assists in understanding the psychological aspect of investigative decision-making during police duty and provides the opportunity to law enforcement agents to revaluate situations in order to improve the investigative decision-making process; while adds to existing literature.