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Table 4 Personal paradigm problems related to learning objectives and abilities, based on the MARE design framework [19]

From: Understanding how to improve physicians’ paradigms for prescribing antibiotics by using a conceptual design framework: a qualitative study

Personal paradigm category Respondents Personal paradigm problem (PPP) Learning objective (LO) Type of expected ability
P-diagnosis P 1,3-5,7-9,10–11 1. Neglected to conduct the necessary laboratory tests 1. Implementing microbiological and other investigations to diagnose Knowledge: Skill
P1–2,4-5,9 2. paid no attention to the importance of diagnosis 2. Maintaining patient respect in line with best practice, regulatory standards, and contractual requirements Action: Attitude
P1–11 3. Unversed in the official antibiotics guideline document 3. Stating national public health antibiotics guidelines Knowledge: Cognition
4. Selecting and prescribing antibiotic therapy according to national/local practice guidelines Competence: Cognition
P-treatment P1–2,4-6,8–10 4. Prescribed antibiotics for no obvious evidence of bacterial infection 5. Not initiating antibiotic treatment in the absence of bacterial infection Competence: Attitude
P1,4–5,7,11 5. Failed to communicate with patients about no antibiotic treatments 6. Mastering delayed antibiotic therapy and negotiation with the patient Performance: Skill
7. Educating patients and their caregivers, nurses and other support clinical staff Action: Cognition
P-prescription and P-drug P4–6,8–11 6. Did not know local AMR patterns 8. Using local microbial−/antimicrobial-susceptibility patterns when conducting empirical treatments Competence: Cognition
P2,4–5,9,11 7. Prescribed antibiotics without waiting for laboratory test results 9. Understanding the importance of taking microbiological samples for culture before starting antibiotic therapy Knowledge: Attitude
P3–4,10 8. Preferred to prescribe broad-spectrum antibiotics 10. Avoiding the unnecessary use of broad-spectrum antibiotics Competence: Attitude
P2,4–5,9 9. Preferred to prescribe expensive antibiotics 11. Working within the ethical code of conduct Performance: Attitude
12. Applying legal and ethical frameworks affecting prescribing practice Performance: Attitude
P11 10. Stopped antibiotic treatment when the symptoms disappeared 13. Constructing the prescription for an antimicrobial with its pharmacokinetics and knowing how this affects the choice of dosage regimen Competence: Cognition