Content uploaded by Kwee Choy Koh
Author content
All content in this area was uploaded by Kwee Choy Koh on Jul 15, 2015
Content may be subject to copyright.
13
1Third year medical students, International Medical University, MALAYSIA,
2Clinical Specialist, Department of Internal Medicine, Hospital Tuanku Ja’afar, MALAYSIA
3Associate Professor of Internal Medicine, International Medical University, MALAYSIA
Address for Correspondence:
Assoc Prof Kwee Choy Koh, Department of Medicine, Clinical School, International Medical University, Jalan Rasah, 70400 Seremban,
Negeri Sembilan, MALAYSIA
A comparative study on how medical students learn about the use of abbreviations in
medical practice
Farah Syazana Ahmad Shahabuddin1, Nur Hazirah Ahmat1, Ahmed Ikhwan Mohamad1, Kit Mun Lau1, Siti Aisyah Mohd Yusof1,
Pei Chiek Teh2, Kwee Choy Koh3
Original Article IeJSME 2015 9(2): 13-21
Background: Misinterpretation of abbreviations by
healthcare workers has been reported to compromise
patient safety. Medical students are future doctors.
We explored how early medical students acquired the
practice of using abbreviations, and their ability to
interpret commonly used abbreviations in medical
practice.
Method: Eighty junior and 74 senior medical students
were surveyed using a self-administered questionnaire
designed to capture demographic data; frequency and
reasons for using abbreviations; from where abbreviations
were learned; frequency of encountering abbreviations
in medical practice; prevalence of mishaps due to
misinterpretation; and the ability of students to correctly
interpret commonly used abbreviations. Comparisons
were made between senior and junior medical students.
Results: Abbreviation use was highly prevalent among
junior and senior medical students. They acquired the
habit mainly from the clinical notes of doctors in the
hospital. They used abbreviations mainly to save time,
space and avoid writing in full sentences. The students
experienced difficulties, frustrations and often resorted to
guesswork when interpreting abbreviations; with junior
students experiencing these more than senior students.
The latter were better at interpreting standard and non-
standard abbreviations. Nevertheless, the students felt
the use of abbreviations was necessary and acceptable.
Only a few students reported encountering mishaps in
patient management as a result of misinterpretation of
abbreviations.
Conclusion: Medical students acquired the habit of
using abbreviations early in their training. Senior
students knew more and correctly interpreted more
standard and non-standard abbreviations compared to
junior students. Medical students should be taught to
use standard abbreviations only.
IeJSME 2015 9(2): 13-21
Keywords: Abbreviations, medical students, medical
practice, medical errors, patient safety.
Introduction
Abbreviations and acronyms are closely linked
and often are used interchangeably. However, the
meanings of these two words are distinct from each
other. Abbreviations are shortened or contracted forms
of words or phrases while acronyms are words formed
from the initial letters or group of letters in a set phrase.
Healthcare providers use abbreviations and acronyms
extensively in medical practice because they are short,
space-saving, convenient and easy to use.1 Doctors use
abbreviations for the documentation of patients’ history,
physical findings, ordering of relevant investigations and
the management plan for patients. These abbreviations
are then read and interpreted by other healthcare
professionals like other doctors, pharmacists and nurses.
However, problems may arise in medical practice
due to misinterpretation of abbreviations especially
by non-doctors. Sheppard et. al. (2008)2 reported
variations in the use and meaning of abbreviations
resulting in misunderstandings between healthcare
workers. Misinterpretation of abbreviations in medical
practice may even lead to mismanagement of patients
and medical catastrophes.3 The problem is further
compounded by the ever-growing list of non-standard
abbreviations that are not universally recognised, often
created by doctors or nurses. These abbreviations may
mean different things to different people depending
on the users and settings where they are used. In short,
errors in interpreting abbreviations may potentially
compromise patient safety.
There have been no studies done to explore if the
use of abbreviations began from medical schools. It is
likely that medical students, who will be future doctors,
acquire the habit of using standard and non-standard
abbreviations during their undergraduate medical
14
Original Article – Farah Syazana Ahmad Shahabuddin, Nur Hazirah Ahmat, IeJSME 2015 9(2): 13-21
Ahmed Ikhwan Mohamad, Kit Mun Lau, Siti Aisyah Mohd Yusof,
Pei Chiek Teh, Kwee Choy Koh
training when they are exposed to them in the wards.
Some of these students may even create their own new
abbreviations. It would be of interest to know if the
practice of using abbreviations has its roots in medical
school. Identifying the prevalence of abbreviation
use among medical students may help medical health
educationist plan interventional strategies to regulate
its use.
We report the results of a study designed to explore
the prevalence of abbreviations use among first and final
clinical years’ medical students in a private medical
institution in Malaysia.
Materials and methods
We conducted a cross-sectional survey between
December 2013 and May 2014. A total of 154 medical
students, comprising of 80 first clinical year students and
74 final clinical year students from the International
Medical University (IMU), Malaysia participated in the
survey.
The survey tool was a self-administered questionnaire
containing five sections. The first section contained
questions designed to capture the demographic data
such as identifiers (e.g. names, student number), gender,
age, ethnicity and whether they were first or final
year clinical students. The second section contained
questions designed to assess the frequency of abbreviation
usage, from where did they acquire the habit of using
abbreviations, and the reasons for using abbreviations.
The third section explored the perceptions of students
regarding the use of abbreviations in medical practice.
In this section, a 5-point (ranging from 1: strongly
agree, 2: agree, 3: neutral, 4: disagree and, 5: strongly
disagree) Likert scale was used to assess the students’
responses to several statements. The final section was
designed to explore the perceived impact of the use of
abbreviations on the quality of patient care. The last
section of the questionnaire assessed the ability of the
students in correctly interpreting a list of standard and
non-standard abbreviations. The list of standard and
non-standard abbreviations was compiled from a pilot
study of abbreviations encountered in the admission
notes of patients written by junior doctors in the medical
wards. The list contained six of the most commonly
used abbreviations and forty-seven less commonly
used abbreviations. We used an established guideline
containing a list of approved abbreviations produced
by the Ministry of Health of Malaysia to categorise the
list of abbreviations into standard and non-standard
abbreviations.4 Twenty-three (43.0%) of the total of
fifty-three abbreviations were standard abbreviations.
The questionnaire was then piloted and validated with
randomly selected junior doctors working in the hospital
who had completed their medical rotation. Minor post-
piloting adjustments were made to the questionnaire
mainly to facilitate better comprehension before
distribution.
The study site was the Clinical School of the
International Medical University in the city of
Seremban, Malaysia. First clinical year and final clinical
year medical students at the study site were briefed
about the objectives of the survey and participation
was voluntary. Written consent was obtained from the
students before distribution of the survey tool. The
students were allowed 20 minutes to complete the
questionnaire without assistance.
The sample size required for statistical significance was
calculated to be 116 assuming 95% confidence interval
(CI) with 5% margin of error. Data was presented in
mean or percentage where appropriate. Descriptive
analysis was used to delineate the demographic data
of the respondents. The independent Student’s t-test
was used to compare the means between first year and
final year students. Statistical significance was explored
using the chi-square test. A p value of < 0.05 with
95% confidence interval was considered significant.
All statistical analyses were performed using the
Statistical Package for the Social Sciences (SPSS)
version 20 for Windows 7.
15
Original Article – Farah Syazana Ahmad Shahabuddin, Nur Hazirah Ahmat, IeJSME 2015 9(2): 13-21
Ahmed Ikhwan Mohamad, Kit Mun Lau, Siti Aisyah Mohd Yusof,
Pei Chiek Teh, Kwee Choy Koh
This study was approved by the International Medical
University Research Joint and Ethics Committee and
was registered with the National Medical Research
Registry of Malaysia.
Results
Demography
Eighty out of eighty-six first year clinical students and
seventy-four out of eighty final year clinical students
responded to the survey, giving response rates of 93%
and 92%, respectively. The male to female ratio was
1:1. The majority of the students were Chinese (70.8%)
followed by Indians (13%), Malays (8.4%) and others
(7.8%) (Table 1).
Table 1: Demographic characteristic of first and final
clinical years’ students (N=154)
1ST YEAR (%) FINAL YEAR (%) TOTAL (%)
Number 80 (100) 74 (100) 154 (100)
Gender
Male 41 (51.3) 37 (50.0) 78 (50.6)
Female 39 (48.7) 37 (50.0) 76 (49.4)
Ethnicity
Malay 8 (10.0) 5 (6.8) 13 (8.4)
Chinese 55 (68.8) 54 (72.9) 109 (70.8)
Indian 10 (12.5) 10 (13.5) 20 (13.0)
Others 7 (8.7) 5 (6.8) 12 (7.8)
Prevalence of abbreviation use
Details regarding the usage of abbreviations by the
medical students are shown in Table 2. Majority of both
first year and final year students (37.0%) reported using
abbreviations most of the time, while 31.2% reported
using them sometimes and 18.8% reported using them
all the time. The most common source from where these
students acquired the use of abbreviations were from the
documentations made by house officers (92.5% first year
students vs. 91.9% final year students, p = 0.888) and
medical officers (51.3% first year students vs. 67.6% final
year students, p = 0.040), respectively.
Both groups of students (first year vs final year)
reported using abbreviations in order to save time
(86.3% vs 93.2%, p = 0.155); for convenience (67.5%
vs 63.5%, p = 0.603); avoid the tedium of writing in
full sentences (63.8% vs 55.4%, p = 0.291) and to save
space (57.5% vs 54.1%, p = 0.667). Interestingly, a small
number of students reported using abbreviations because
they assumed “everyone understands it” (13.8% firstt
year vs 27.0% final year, p = 0.040).
The number of students who reported encountering
medical mishaps in the wards that could be attributed
to the incorrect interpretation of abbreviations used
was relatively small. Generally, the final year students
reported encountering more incidences of delay in
therapy administration (p = 0.667), delay in procedure
(p = 0.949), delay in diagnosis (p = 0.378), error in
therapy administration (p = 0.145), error in procedure
done (p = 0.458) and diagnostic errors (p = 0.041);
compared to first year students.
16
Original Article – Farah Syazana Ahmad Shahabuddin, Nur Hazirah Ahmat, IeJSME 2015 9(2): 13-21
Ahmed Ikhwan Mohamad, Kit Mun Lau, Siti Aisyah Mohd Yusof,
Pei Chiek Teh, Kwee Choy Koh
Table 2: Abbreviation use by first and final clinical years’ medical students.
ITEM 1ST YEAR (N = 80) FINAL YEAR (N = 74) TOTAL (N = 154) P VALUE*
N (%) N (%) N (%)
Frequency of using abbreviations
All the time 13 (16.3) 16 (21.6) 29 (18.8)
Most of the time 30 (37.5) 27 (36.5) 57 (37.0)
Sometimes 26 (32.5) 22 (29.7) 48 (31.2)
Rarely 11 (13.7) 7 (9.5) 18 (11.7)
Never 0 (0.0) 2 (2.7) 2 (1.3)
Source of learning the use of abbreviations
Copied House Ofcer’s entry 74 (92.5) 68 (91.9) 142 0.888
Copied Medical Ofcer’s entry 41 (51.3) 50 (67.6) 91 0.040
Copied from Nurses’ entry 16 (20.0) 24 (32.4) 40 0.079
Reasons for using abbreviations
Saves time 69 (86.3) 69 (93.2) 138 0.155
Saves space 46 (57.5) 40 (54.1) 86 0.667
Tedious to write full sentences 51 (63.8) 41 (55.4) 92 0.291
It is convenient 54 (67.5) 47 (63.5) 101 0.603
Everyone understands the abbreviations 11 (13.8) 20 (27.0) 31 0.040
Problems encountered from the use of abbreviations
Delay in administrating therapy 7 (8.6) 8 (10.8) 15 0.667
Delay in procedure 10 (12.5) 9 (12.2) 19 0.949
Delay in diagnosis 10 (12.5) 13 (17.6) 23 0.378
Wrong therapy given 6 (7.5) 11 (14.9) 17 0.145
Wrong procedure done 5 (6.3) 7 (9.5) 12 0.458
Wrong diagnosis made 7 (8.6) 15 (20.3) 22 0.041
*P value derived from chi-square test between 1st year and nal year clinical students with 95% condence interval
17
Original Article – Farah Syazana Ahmad Shahabuddin, Nur Hazirah Ahmat, IeJSME 2015 9(2): 13-21
Ahmed Ikhwan Mohamad, Kit Mun Lau, Siti Aisyah Mohd Yusof,
Pei Chiek Teh, Kwee Choy Koh
Students’ perceptions on the use of abbreviations in
medical practice
Majority of students from both groups reported
frequent encounters with the use of abbreviations in
medical practice. Similarly, majority of students reported
difficulties when interpreting these abbreviations;
feeling frustrated when interpreting the abbreviations;
and often had to resort to guessing the meaning of the
abbreviations. Interestingly, junior students reported
having more difficulties and feeling more frustrations
when interpreting the abbreviations compared to
their seniors; p = 0.010 and p = 0.004, respectively.
Nevertheless, most of the students from both groups
agreed that the use of abbreviations is necessary and
acceptable in medical practice (Table 3).
Correct interpretation of standard and non-standard
abbreviations.
Details regarding the proportion of first and final
year medical students who correctly interpreted a
list of standard and non-standard abbreviations in
the questionnaire are shown in Table 4. The final
year clinical students generally outperformed the first
year clinical students in correctly interpreting the
23 standard abbreviations. However, many in both
groups of students were unable to correctly interpret
several abbreviations such as MCL, OT, RTF/RT, STI
and Tx.
Similarly, with regards to the non-standard
abbreviations in the questionnaire, the final year
clinical students again generally outperformed the first
year clinical students in correctly interpreting these
abbreviations. Both groups of students had difficulties
in correctly interpreting certain non-standard
abbreviations like DIL, ICD, N/A and W/out.
TABLE 3: First and final clinical years’ medical students’ perceptions on the use of abbreviations in clinical setting
ITEMS 1ST YEAR* FINAL YEAR* P VALUE#
1 2 3 4 5 MEAN 1 2 3 4 5 MEAN
1. I often encounter abbreviations in case le 59 20 1 0 0 1.28 56 15 2 0 1 1.31 0.594
2. I have difculty interpreting abbreviations 17 39 22 2 0 2.11 4 38 22 9 1 2.53 0.010
3. I often have to guess the meaning of abbreviations 22 39 12 6 1 2.06 10 42 14 8 0 2.27 0.213
4. I feel frustrated when interpreting abbreviations 25 20 27 7 1 2.24 6 29 24 13 2 2.68 0.004
5. I think abbreviations are necessary 17 30 27 5 1 2.29 10 24 32 8 0 2.51 0.358
6. I think abbreviations are acceptable 17 43 15 4 1 2.11 7 42 23 2 0 2.27 0.121
*Number of respondents under each category of the Likert scale: 1: strongly agree; 2: agree; 3: neutral; 4: disagree; 5: strongly disagree.
#P value derived from comparison of means between 1st year and nal clinical year students using the Student t-test between 1st year and nal year
clinical students with; 95% condence interval.
18
Original Article – Farah Syazana Ahmad Shahabuddin, Nur Hazirah Ahmat, IeJSME 2015 9(2): 13-21
Ahmed Ikhwan Mohamad, Kit Mun Lau, Siti Aisyah Mohd Yusof,
Pei Chiek Teh, Kwee Choy Koh
TABLE 4: Proportion of first and final clinical years’ medical students who correctly interpreted standard and
non-standard abbreviations.
NO ABBREVIATION MEANING 1ST YEAR (%) FINAL YEAR (%) P VALUE#
STANDARD
1 A/B Antibiotic 52 (65.0) 58 (78.4) 0.183
2 ADL Activity of Daily Living 17 (21.3) 67 (90.5) <0.001
3 ANA Anti-Nuclear Antibody 38 (47.5) 60 (81.1) <0.001
4 BKA Below Knee Amputation 15 (18.8) 66 (89.2) <0.001
5 BP Blood Pressure 80 (100.0) 73 (98.6) 0.297
6 BPH Benign Prostate Hypertrophy/Hyperplasia 77 (96.3) 74 (100.0) 0.243
7 Cm Coming/ Come Morning 7 (8.8) 41 (55.4) <0.001
8 FFP Fresh Frozen Plasma 31 (38.8) 65 (87.8) <0.001
9 GXM Group Cross Match 1 (1.3) 50 (67.6) <0.001
10 HD Haemodialysis 20 (25.0) 60 (81.1) <0.001
11 MCL Mid Clavicular Line 12 (15.0) 16 (21.6) <0.001
12 NBM Nil By Mouth 68 (85.0) 71 (95.9) 0.004
13 O/E On Examination 56 (70.0) 70 (94.6) <0.001
14 OT Occupational Therapy 0 (0.0) 24 (32.4) <0.001
15 PR Pulse Rate 74 (92.5) 69 (93.2) 0.624
16 RA Rheumatoid Arthritis 69 (86.3) 72 (97.3) 0.046
17 RTF/RT Ryle’s Tube Feeding/Ryle’s Tube 3 (3.8) 19 (25.7) <0.001
18 SOB Shortness of Breath 79 (98.8) 74 (100.0) 0.335
19 STI Soft Tissue Injury/Infection 3 (3.8) 15 (20.3) 0.001
20 STO Suture To Open/ Off 34 (42.5) 48 (64.9) <0.001
21 TRO To Rule Out 70 (87.5) 74 (100.0) 0.002
22 Tx Transfusion 4 (5.0) 14 (18.9) 0.001
23 U/S Ultrasound/Ultrasonography 65 (81.3) 73 (98.6) 0.001
NON-STANDARD
1 A/E Air Entry 30 (37.5) 60 (81.1) <0.001
2 Bil Bilirubin 39 (48.8) 49 (66.2) 0.054
3 BPPV Benign Paroxysmal Positional/Postural Vertigo 59 (73.8) 47 (63.5) 0.335
4 CECT Contrast Enhanced Computerized Tomography 26 (32.5) 42 (56.8) <0.001
5 Cigg Cigarette 56 (70.0) 64 (86.5) 0.022
6CRT Capillary Rell Time 25 (31.3) 62 (83.8) <0.001
7 DFU Diabetic Foot Ulcer 36 (45.0) 73 (98.6) <0.001
8 DIL Death In Line 2 (2.5) 6 (6.1) 0.249
19
Original Article – Farah Syazana Ahmad Shahabuddin, Nur Hazirah Ahmat, IeJSME 2015 9(2): 13-21
Ahmed Ikhwan Mohamad, Kit Mun Lau, Siti Aisyah Mohd Yusof,
Pei Chiek Teh, Kwee Choy Koh
NO ABBREVIATION MEANING 1ST YEAR (%) FINAL YEAR (%) P VALUE#
9 DRNM Dual Rhythm No Murmur 55 (68.8) 70 (94.6) <0.001
10 HAP Hospital Acquired Pneumonia 42 (52.5) 61 (82.4) <0.001
11 ICD Implanted Cardioversion Debrillator 2 (2.5) 3 (4.1) 0.861
12 ICS Intercostal Space 14 (17.5) 38 (51.4) <0.001
13 IVI Intravenous Infusion 26 (32.5) 46 (62.2) <0.001
14 K/C/O Known Case Of 10 (12.5) 64 (86.5) <0.001
15 KUB Kidney Ureter Bladder 51 (63.8) 67 (90.5) <0.001
16 LTOT Long Term Oxygen Therapy/Treatment 22 (27.5) 42 (56.8) 0.001
17 MTF Metformin 15 (18.8) 23 (31.1) 0.015
18 MZ Mid/ Middle Zone 22 (27.5) 60 (81.1) <0.001
19 N&V Nausea and Vomiting 7 (8.8) 41 (55.4) <0.001
20 N/A No Abnormalities 9 (11.3) 18 (24.3) 0.072
21 NKDA No Known Drug Allergies 46 (57.5) 54 (73.0) 0.129
22 NKFA No Known Food Allergies 25 (31.3) 31 (41.9) 0.255
23 NPO2 Nasal Prong Oxygen 30 (37.5) 53 (71.6) <0.001
24 OHA Oral Hypoglycemic Agent 29 (36.3) 65 (87.8) <0.001
25 P/w Present With 68 (85.0) 74 (100.0) 0.002
26 RN Runny Nose 11 (13.8) 46 (62.2) <0.001
27 RRT Renal Replacement Therapy/ Treatment 10 (12.5) 39 (52.7) <0.001
28 SNT Soft Non Tender 9 (11.3) 32 (43.2) <0.001
29 U/L Underlying 67 (83.8) 73 (98.6) 0.006
30 W/out Watch Out 6 (7.5) 18 (24.3) 0.002
#P value derived from chi-square test between 1st year and nal year clinical students with 95% condence interval
20
Original Article – Farah Syazana Ahmad Shahabuddin, Nur Hazirah Ahmat, IeJSME 2015 9(2): 13-21
Ahmed Ikhwan Mohamad, Kit Mun Lau, Siti Aisyah Mohd Yusof,
Pei Chiek Teh, Kwee Choy Koh
Discussion
Our study showed that the habit of using abbreviations
was acquired as early as the first clinical year of medical
school. As these students progress to become seniors,
they encounter and use abbreviations more. Similarly,
their ability to correctly interpret abbreviations,
standard or otherwise, improved as the students gain
more knowledge with more clinical exposure.
Nevertheless, both groups of students had difficulties
in correctly interpreting a number of standard
abbreviations. This may be attributed to the relatively
infrequent use of these abbreviations (e.g. DIL: death-
in-line, or ICD: intra-cardiac defibrillator) in the wards
resulting in fewer exposures for the students. The
students also had difficulties in correctly interpreting
abbreviations that may have ambiguous meanings such
as ‘STI’ (‘soft tissue injury’ or ‘sexually transmitted
disease’), ‘Tx’ (‘transfusion’ or ‘treatment’), ‘MCL’
(‘mid-clavicular line’ or ‘medial collateral ligament’),
‘N/A’ (‘not applicable’ or ‘no abnormalities’), and ‘W/
out’ (‘watch out’ or ‘without’).
On the other hand most of the students were
able to correctly interpret standard and widely used
abbreviations such as ‘BP’ (blood pressure), ‘BPH’
(benign prostate hyperplasia), ‘NBM’ (nil by mouth),
‘PR’ (pulse rate), ‘SOB’ (shortness of breath), ‘TRO’ (to
rule out), ‘U/S’ (ultrasound), and ‘O/E’ (on examination).
In short, unfamiliarity to abbreviations and ambiguity
of abbreviations were important contributing factors
leading to misinterpretation of abbreviations by the
students. These factors have been identified as significant
factors leading to medical errors that have become an
international patient safety issue.1,5,6
The primary source from where these students
acquired the habit of abbreviation use seemed to be
from the clinical notes of patients in the wards. Notably,
these notes were mostly written by house officers who
themselves, may be relatively inexperienced in the use
of abbreviations in medical practice. It is quite likely
that these house officers acquired the habit of using
abbreviations, often non-standard and often relevant
only to the department or hospital, from each other;
the ward nurses or from medical officers. Although a
Ministry of Health guideline for the use of approved
standard abbreviation exists4, the information in the
guideline is often not transmitted to junior doctors or
nurses. To the best of our knowledge, house officers in
the hospital, where these students received their clinical
training, were not provided with formal training on the
proper use of standard abbreviations in medical practice
when they join the department.
It is hard to quantify whether misinterpretation of
abbreviations in medical practice directly compromised
patient safety in this study as only a small number of
students reported encountering mismanagement of
patients as a direct result of incorrect use of abbreviations.
This is not unusual as the medical students were often
not directly involved in the management of patients
thus limiting their ability to accurately gauge the
impact of misinterpretation of abbreviations on patient
safety. Nonetheless, medical mishaps attributed to
misinterpretation of abbreviations have been reported.
For instance, the Institute for Safe Medication
Practices reported that over 7,000 deaths per year
might be attributed to medical errors in which the use
of abbreviation and medical notation were significant
contributors to the statistic.1,7
Interestingly, despite the difficulties and frustrations
felt in interpreting abbreviations in medical practice,
both groups of students felt that the use of abbreviations
is both a necessity and acceptable. This indicates, at
least in the hospital where the students received their
clinical training, the widespread use of abbreviations in
the day-to-day management of patients and hence its
acceptance.
Indeed, an ideal situation would be to totally
eliminate the use of abbreviations in medical practice
in order to avoid potential medical errors but in reality,
many institutions produce their own list of approved
abbreviations.1 The alternative to a total ban on the
21
Original Article – Farah Syazana Ahmad Shahabuddin, Nur Hazirah Ahmat, IeJSME 2015 9(2): 13-21
Ahmed Ikhwan Mohamad, Kit Mun Lau, Siti Aisyah Mohd Yusof,
Pei Chiek Teh, Kwee Choy Koh
use of abbreviations would be to for organisations, and
this should include medical schools, to design creative
solutions and best practices that would support patient
safety in relation to the use of abbreviations. These ‘best
practices’ typically fall under three strategies, namely
education, enforcement and leadership.1
Medical schools have a responsibility to ensure early
exposure for their undergraduate students to the reality of
the widespread use of abbreviations in medical practice,
the potential pitfalls from its use that may jeopardise
patient safety outcome; and educating the students on
the importance of using only approved standardised
abbreviations.
Study limitations
The results of this study cannot be generalised to
other medical institutions and hospitals elsewhere in
Malaysia as the clinical exposures of the students and
the list of approved abbreviations may differ. Indeed,
as this study was conducted within the confines of the
medical department of the hospital, the results may not
be applicable in surgical-based departments. In addition,
we had intentionally left out exploring the significant
issue regarding the use of abbreviations in prescriptions
leading to dispensing errors in our study, as we believed it
was beyond the scope of a medical students’ perspective
although we recognise this issue to be one of the most
common and preventable sources of medication errors.7
Conclusions
The habit of using abbreviations in medical practice
among medical students was acquired as early as the
first clinical year of medical school. Senior students
knew more, used more and correctly interpreted more
standard and non-standard abbreviations compared to
junior students, suggesting that greater clinical exposure
in the former had a significant role in the development
of this habit.
The use of abbreviations in medical practice is a
universal problem and is unlikely to be eliminated despite
efforts to promote the use of sanctioned abbreviations.3,8,9
The source of knowledge of abbreviations among the
medical students in this study appeared to be from
the documentations made by the junior doctors in the
wards. This link is a potential target for remedial actions.
If this link can be regulated, medical students can be
guided to develop the habit of using only approved or
sanctioned abbreviations appropriately instead of using
non-standard and potentially harmful abbreviations in
their future practice as doctors. Further studies should
be done to explore how medical students can be guided
to use proper abbreviations for correct documentations
in medical practice.
Acknowledgements
The authors would like to acknowledge the
contribution of Dr K Sree Raman, consultant physician,
Department of Medicine, Hospital Tuanku Ja’afar
Seremban for providing vital in-hospital and Ministry of
Health literature for this study.
REFERENCES
1. Kuhn IF. Abbreviations and acronyms in healthcare: when shorter
isn’t sweeter. Pediatc Nurs. 2007; 33(5): 392-8.
2. Sheppard JE, Weidner LCE, Zakai S, et al. Ambiguous abbreviations:
an audit of abbreviations in paediatric note keeping. Arch Dis Child.
2008; 93: 204-6.
3. Dimond B. Abbreviations: the need for legibility and accuracy in
documentation. Brit J Nurs. 2005; 14(12): 665-6.
4. Senarai Kata Singkatan untuk Rekod Perubatan. Ministry of Health,
Malaysia; 2006.
5. Das-Purkayastha P, McLeod K, Canter R. Specialist medical
abbreviations as a foreign language. Journal of the Royal Society of
Medicine. 2004; 97: 456-7.
6. Manzar S, Nair A, Pai GM, Al-Khusaiby S. Use of abbreviations
in daily progress notes. Archives of Disease in Childhood Fetal and
Neonatal Edition. 2004; 89(4): F374-6.
7. FDA and ISMP launch campaign to reduce medication mistakes
caused by unclear medical abbreviations. 2006 [cited 8 April
2015]. Available from: http://www.fda.gov/newsevents/newsroom/
pressannouncements/2006/ucm108671.htm#main
8. Joint Commission on Accreditation of Healthcare Organization.
Medication errors related to potentially dangerous abbreviations.
Sentinel Event Alert. 2001; (23): 1-4.
9. Sinha S, McDermott F, Srinivas G, et al. Use of abbreviations by
healthcare professionals: what is the way forward. Postgrad Med J.
2011; 87: 450-2.
