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A national study of 31,800 primary care physicians from internal medicine and family medicine residency programs found a connection between residency ratings and antibiotic prescribing during the physicians’ first 5 years of practice. In this study, the competency scores included Accreditation Council for Graduate Medical Education Milestone ratings across 6 core competency areas: patient care, medical knowledge, professionalism, communication skills, systems-based practice, and practice-based learning. Physicians with higher competency ratings near the end of their residency program prescribed somewhat fewer antibiotics for Medicare patients, according to the study, published in JAMA Network Open. Each 1-standard deviation increase in competency rating was associated with a 2% lower annual prescribing rate. As physicians accumulated more years of experience after residency, they tended to prescribe slightly more antibiotics, however. Each additional year since residency was associated with about a 1% increase in prescribing. The authors specify that they only examined prescribing volume rather than appropriateness, and the prescribing rate increase with years since graduation could represent “practice drift”—physicians gradually moving toward greater antibiotic use as they get farther from residency programs.
For clinicians training residents, the findings suggest that competency assessments and prescribing data could help identify opportunities for antibiotic stewardship education, including audit and feedback, communication coaching, and simulation. The Urgent Care Association offers antibiotic stewardship resources designed for urgent care.