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Medical Students To Learn How To Prescribe Safely And Effectively

June 23, 2003

Tomorrow's doctors will be better prepared for the complexities of prescribing modern medicines following new training recommendations produced by the British Pharmacological Society. 'Teaching safe and effective prescribing in UK medical schools' is published in the June issue of the British Journal of Clinical Pharmacology.

The society has initiated new guidelines on the core curriculum for undergraduate courses because, as author Dr Simon Maxwell from the University of Edinburgh says, "Prescribing medicines is almost the definition of what doctors do. For the vast majority, drugs represent the major treatment they can offer to their patients." Newly qualified doctors are expected to prescribe powerful medicines from day one of their clinical work. Although these have the potential to bring great benefits to patients, if used incorrectly, they can also cause great harm.

The rapid pace of new drug developments, increasing specialisation and the vulnerability of elderly patients to side effects are among the many pressures doctors have to cope with. Yet, says the society, training in the basic principles of prescribing and therapeutics, drug action and basic knowledge about commonly used drugs is failing.

Professor Rod Flower, president of the BPS said, "We could see a scene unfold in which the patients would not receive optimal treatment simply because doctors do not know how to prescribe properly. The astonishing advances in medicines would be undermined by inadequate knowledge."

The problem was highlighted in a report by the Audit Commission, 'A Spoonful of Sugar' (December 2001), which demonstrated that the rising number of errors in medication and adverse effects of medicine are a major cause of preventable death in UK hospitals. The medical school curriculum, recently updated by the General Medical Council, recognised the importance of training in the principles of therapy but did not offer guidance how this might be achieved. Over the last few years, several medical schools have lost their pharmacology departments where medical students learn about how drugs work in the body and how to prescribe medicine safely and effectively.

The disappearance of specific courses in scientific disciplines such as pharmacology from some medical school curricula means that students are now expected to absorb the knowledge in other parts of the course. "In reality, this is difficult because of competition with other learning priorities," said Dr Maxwell. "Even if they hear about the drugs that would be used for certain conditions, they do not get the practical information they require to prescribe them safely and effectively when they qualify."

The BPS will distribute the document to medical schools as a tool to integrate essential training into the core curriculum, ideally overseen by an individual teacher in each school. It defines the knowledge and skills required by students, covering aspects such as writing prescriptions, monitoring the impact of drug therapy, avoiding adverse effects and interaction between drugs, legal and ethical issues of prescribing and, importantly, advising patients and obtaining informed consent. Among the core attitudes a young doctor is expected to acquire are risk-benefit analysis and recognising personal limits in his or her knowledge.

Robust assessment of the learning objectives will help to overcome the dangers of poor prescribing. 'It should not be possible to compensate for a poor performance in this area by a good performance in other areas,' it states.

Dr Ross Taylor from the department of general practice and primary care at the University of Aberdeen and a member of the Committee on Safety of Medicines (CSM), said, "For the GP, prescribing is the most important part of the patient care. Nurses and pharmacists, however, are now authorised to prescribe medicines, while responsibility for the more complex forms of treatment remain with the medical practitioner." Welcoming the BPS's initiative, he added that the new recommendations will enable doctors to cope more efficiently with the pressures they face when making decisions about treatment.

"There is a crystal clear need for students to have a good grasp on how to prescribe," said Dr Maxwell. "Our recommendations offer a blue-print on how this can be achieved."

Snell Communications Ltd