The Bristol Clinical Pharmacology Curriculum 2008 to 2009
Tomorrow’s Doctors (2002) states the basic competencies required of a qualifying doctor
The Bristol curriculum aims to fulfil these requirements and to provide a sound educational base to students about drugs
“Anyone can read the British National Formulary but not everyone can understand it.”
Our aim is to consider the pharmacological and scientific basis which underpins the valuable prescribing information which is to be found in the BNF thus educating our graduates to be careful to always assess the risks and benefits when using drug treatments.
Prescribing errors account for about a quarter of all drug related adverse incidents as monitored at UBHT. In 2006 total medication related incidents amounted to 813. Noone wants to be one of those prescribers who caused an incident.
Medication error by process 2006
1% 5% 1% Not recorded Administration 29% 39% Dispensing Other Prescribing Supply 11% Unknow n 14%
Clinical Pharmacology at Bristol
• Year 1
– Mechanisms of drug action and autonomic pharmacology – use and action of drugs and the CVS
• Year 2
– use and action of drugs in respiratory, GI, renal and neurology
• Year 3
– plenary sessions delivered at end and beginning of units – academy based CPT tutorials – learning in the clinical areas
• Year 4
– devoted sessions in the clinical units
• Year 5
– Plenary sessions in “Preparing for Practice 1” – Devoted sessions within the units
Learning objectives of the 9 plenary sessions in clinical pharmacology in the 3rd year
• To understand the concept of the risk to benefit ratio in prescribing drugs • To understand the sources of risk • To learn a framework for maintaining knowledge on drug prescribing • To improve awareness, observation and appreciation of prescribing matters in the wards and clinics • To consider the pharmacological basis which underpins prescribing • To begin to formulate management plans for common medical conditions
Programme for 2008-2009
This aide memoire published as part of a national curriculum is a major learning tool to be used by students
Clinical Pharmacology and Therapeutics during the 4th year
• COMP1
– Workshop on prescribing in children lead by paediatrician and pharmacist – Prescribing testing station in end of unit OSCE
• COMP2
– 10 sessions covering CVS prophylaxis, prescribing in elderly, situations in general practice, the breathless patient etc
• RHCN
– Therapeutics integrated into clinical teaching – One session on evidence based prescribing related to the neonate
Clinical Pharmacology and Therapeutics in Year 5
• Plenary sessions in Preparing for Practice 1 • Detailed instruction on analgesics and drugs used in terminal care in Palliative Care Unit • Pharmacist-lead tutorials in academies during senior medical and/or surgical units • Opportunity to practise prescribing in Preparing for Practice 2.
Learning Objectives of Clinical Pharmacology sessions in “Preparing for Practice 1”
• To orient thinking towards learning common management regimens during forthcoming “shadowing”. • To consolidate some theoretical and some factual knowledge • To remind about the pitfalls in prescribing
Programme for 2008-2009
Extract from 5th year handbook
You should have a working knowledge of therapeutics. You should know the uses, dose, side effects, contraindications and alternatives for widely used medication. For example (in rough order of exposure frequency): a) Aspirin b) Loop and other diuretics (thiazides, amiloride etc.) c) Minor analgesics d) Antibiotics e) Treatments for bronchial asthma f) Laxatives g) Proton pump inhibitors and H2 antagonists h) ACE inhibitors i) Enteral steroids j) GTN and slow release nitrates k) Beta blockers l) Antidepressants 1. Iron, thiamin and other vitamins 2. Warfarin 3. Benzodiazepines 4. Digoxin 5. NSAIDs 6. Statins 7. Treatments for type I and type II diabetes 8. Calcium antagonists 9. Thyroxine 10.Major tranquillizers 11.Anticonvulsants 12.Amiodarone 13.The contraceptive pill
N.B. This is not a complete list of those drugs with which you need to be familiar
Assessment
• Pharmacological and therapeutics questions embedded in written assessments • DOSCE station aimed at testing recognition of poor prescribing • DOSCE station aimed at assessing ability to prescribe for common conditions
Website: the following website contains links to current programmes, teaching material and delivered lectures and important nationally produced documents
• http://www.zyworld.com/clive_roberts/cpt.htm
Our goal is for students to have achieved a little wisdom when using management protocols and prescribing information.