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Previous observational studies have indicated that social influences, such as arising from herding-like behaviour, can contribute to medical errors. In this study, we experimentally examined whether general practitioners (GPs) would follow incorrect prescription recommendations from fellow GP or specialists. To investigate this, we conducted an online survey with 475 GPs practicing in England that included two case vignettes. Case vignette 1 focused on sleeping tablets, and case vignette 2 was centred around antibiotics. The vignettes were presented in random order, and within each vignette, study participants were assigned to one of three experimental conditions: control condition (lacking peer recommendation), fellow GP condition (including a recommendation from a fellow GP not aligned with best practice clinical guidelines), or specialist condition (including a recommendation from a specialist not aligned with best practice clinical guidelines). The primary outcome measure was the proportion of GPs who prescribed medication that deviated from best practice clinical guidelines. We found that, in both case vignettes, the percentage of respondents prescribing such medication was highest in those assigned to the specialist condition, followed by those assigned to the control condition. It was lowest in those assigned to the fellow GP condition (case vignette 1: 73.8% vs. 55.6% vs. 36.6% and case vignette 2: 24.0% vs. 12.4% vs. 10.1%). In the case of vignette 1, the difference between the fellow GP condition and the control condition is statistically significant, suggesting that GPs are less likely to prescribe sleeping tablets when recommended by a fellow GP. This implies that GPs are more inclined to prescribe non-guideline-recommended medication when advised by specialists. This study is the first to experimentally demonstrate that physician herding behaviour can result in prescription errors. Future research could extend this inquiry to diverse contexts, including diagnosis. [ABSTRACT FROM AUTHOR]

Background: A holistic approach to emergency care treatment planning is needed to ensure that patients’ preferences are considered should their clinical condition deteriorate. To address this, emergency care and treatment plans (ECTPs) have been introduced. Little is known about their use in general practice. Aim: To find out GPs’ experiences of, and views on, using ECTPs. Design & setting: Online survey of GPs practising in England. Method: A total of 841 GPs were surveyed using the monthly online survey provided by medeConnect, a market research company. Results: Forty-one per cent of responders' practices used Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) plans for ECTP, 8% used other ECTPs, and 51% used Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) forms. GPs were the predominant professional group completing ECTPs in the community. There was broad support for a wider range of community)based health and social care professionals being able to complete ECTPs. There was no system for reviewing ECTPs in 20% of responders’ practices. When compared with using a DNACPR form, GPs using a ReSPECT form for ECTP were more comfortable having conversations about emergency care treatment with patients (odds ratio [OR] = 1.72, 95% confidence interval [CI] = 1.1 to 2.69) and family members (OR =1.85, 95% CI = 1.19 to 2.87). Conclusion: The potential benefits and challenges of widening the pool of health and social care professionals initiating and/or completing the ECTP process needs consideration. ReSPECT plans appear to make GPs more comfortable with ECTP discussions, supporting their implementation. Practice-based systems for reviewing ECTP decisions should be strengthened. [ABSTRACT FROM AUTHOR]

In order to qualify as a lawyer in Australia, each law graduate must complete a recognised practical qualification. In 2002, the Australasian Professional Legal Education Council (APLEC) published a recommended set of competency standards which all entry level lawyers should meet in order to be eligible to be admitted as a legal practitioner. Upon completion of a recognised and accredited course of Practical Legal Training (PLT), potential lawyers must apply to the Supreme Court of the state in which they wish to practise for admission as a legal practitioner. The admission application process is rigorous. Not only does an applicant have to demonstrate completion of all of the academic and practical requirements, but an applicant must also certify to being a "fit and proper person" to be admitted as a legal practitioner. At Flinders University, the PLT course includes 225 hours of work experience in a legal office. The Placement requirement raises issues of equity at various levels. Many students, especially those with children or other dependents, face several challenges in working full time (unpaid) for six weeks. Other students who are already working part-time or full-time in law firms resent having to spend class time in preparation for a placement. Many students are obliged for financial reasons to work full time at their placement and then work at night time to earn an income. Equally important is the question of the level and quality of supervision provided by workplace supervisors. Both employers and students are increasingly viewing the Placement as a recruitment opportunity rather than one of teaching and learning. This article explores these issues from the perspective of the supervising lawyers, the students and the pedagogical motivation of the placement.