… at the …
Number 72
Monthly news
Teaching Doctors to Prescribe
Pharmacy Input into Medical Student Training
Pam Adams and Nick Butler
Clinical Pharmacy Managers GHNHSFT
 Peri-and
post-operative
medicines
 Basic drugs in cardiology
 Antibiotics
 Drug interactions
1st October 2009
management
of
Why?
How?
A topic of sometimes lively debate amongst pharmacists
is who teaches doctors to prescribe? Over the years
there has been an expectation that the therapeutic use
of drugs ought to be covered at medical school. This
topic may be termed pharmacology, clinical
pharmacology or therapeutics and its delivery is variable
to say the least. As pharmacists we are faced with a
practical problem which comes round on an annual basis
– new junior doctors have had little or no experience of
writing a safe, complete and effective prescription for an
inpatient. They may know the theory behind acute
coronary syndrome but, when push comes to shove,
prescribing appropriately for it is a whole different ball
game. Things to be considered include:
A series of eight 90 minute tutorials are held on a
Monday afternoon during each 5th year placement.
The tutorials are included in the timetable for both
the medical and surgical placements, and are well
attended. The format of most tutorials is similar:
some input from the tutor, followed by practical
exercises. These include a quiz on drug interactions;
writing an in-patient chart for a patient admitted with
ACS; peri-operative management of medicines; and
deciding which items to include (and which items not
to) on a discharge prescription. Building on these
sessions, we also run a series of mini workshops
during the Shadowing and Induction weeks for F1s.
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What drugs are known to have benefits in ACS
What are the contra-indications to them
What doses should be used and what patient
factors may vary these
What route, frequency and times are appropriate
and sensible
What drugs are recommended in local guidelines
or formulary
What drugs are most cost-effective
How to ensure that nurses understand and can
deliver the drugs requested by the doctor
In 2005 we came up with a plan to try and improve the
prescribing experience for all concerned. We wanted to
introduce therapeutics teaching which moved away from
pharmacology textbooks towards how medicines are
used in clinical practice. If we could promote good habits
as undergraduates, transition into practice during the
foundation year would be easier for doctors and their
healthcare colleagues.
The 5th year Therapeutics programme was born! We
would use clinical pharmacy specialists to deliver a
series of tutorials on topics including:
 Basics of prescribing (writing a prescription chart
which was legal, safe and complete)
 Drug treatment review admission and discharge
(drug histories, how to write a TTO)
 Anticoagulation
The pilot programme ran at Cheltenham General
during 2005 and was very positively received. This
led to funding through the Academy and it has been
available on both sites from September 2006.
Student’s evaluation
A pre-course questionnaire was introduced during
2008 to help us understand the student’s perceived
gaps in knowledge, along with what they were
hoping to learn from the sessions.
The responses have shown some consistent themes.
Students feel most confident about “simple drugs”
and “common things” as well as using the BNF. They
are less confident over drug doses, drug interactions,
writing drug charts and especially writing up insulin,
anticoagulants, infusions and controlled drugs. We
were encouraged that this matched many of the
areas we were already covering.
The students were also asked what they wanted to
learn. Common responses included side effects,
contra-indications and drug interactions, the correct
method of prescribing, and how to treat medical
emergencies. Three students wanted to know
enough to pass their finals, and two of them then
wanted enough knowledge to do an F1 job. We felt
this may be a little beyond eight 90 minute tutorials!
The post-course evaluation shows that drug interactions
and cardiology are the favourite sessions. The use of
antibiotics was appreciated too, although it re-iterated
ground covered before for some. The session on
communication on admission and discharge was felt to
be least useful although during the shadowing week,
exercises involving TTOs and patient education certainly
show that this information is needed for the job.
We use this feedback to review the session contents
annually.
A Reflection
The sessions have certainly been appreciated by the
students, and helped us as pharmacists to build good
working relationships with F1 and F2 doctors within the
Trust. As you might expect, our input to the 3 cohorts
during the year varies a little. Cohorts 2 and 3 who have
had a little more hospital experience are not quite so
daunted by the sight of a prescription chart, or the
practical exercises. Common to all though is a realisation
that drugs are important and that there is a lot more to
prescribing than looking in the BNF
The experience has given both of us opportunity to
develop our teaching skills, and build on our learning
through the TLHP course. It has also given some junior
colleagues valuable teaching experience. When our
students return as F1s, we often recognise them and,
gratifyingly, they seem to remember us and some of the
principles we went through.
Where Next?
We are currently reviewing the sessions as part of our
preparation for 2009/10. We are also talking with the
Academy about how the students may shadow
pharmacists at ward level to add something extra to the
5th year placement experience in Gloucestershire.
We would also like to explore how the sessions impact
on practice. This may include:

Asking students to estimate their current
knowledge of a variety of topics before and after
the course.

Comparing the performance of those F1 doctors
who had attended the course with those who
have not when completing the Trust e-learning
package on Medicines Management
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Co-ordinating a network of pharmacy colleagues
to offer a similar therapeutics programme in the
other academies
Finally, we must thank Peter Fletcher for his consistent
support and encouragement as we have developed the
programme, and Emily Shingleton-Smith for her valuable
help in organising the sessions for each cohort.
University of Bristol
Centre for Medical Education
David.Mumford@bristol.ac.uk (Director of Medical Education)
Tim.Lovell@bristol.ac.uk (Director of Student Affairs)
General Practice
debbie.sharp@bristol.ac.uk
Andrew.Blythe@bristol.ac.uk
Consultant Senior Lecturer General Practice (Glos)
Martin.Nicholas@gp-L84040.nhs.uk
Teaching and Learning for Health Professionals Certificate course
http://www.medici.bris.ac.uk/tlhp
Stephen.Greenwood@bristol.ac.uk
Medical Dean University of Bristol at Gloucestershire
(GRH Ex 6230) [also enquiries re electives and preparing for
professional practice (PfPP)
Peter.Fletcher@glos.nhs.uk
Undergraduate Skills Lead (GRH 5667)
Hannah.Chant@glos.nhs.uk
Undergraduate Medical Education Coordinator (GRH Ext 6231)
Angie.Coulson@glos.nhs.uk
Undergraduate Administrator (GRH Ext 6233)
Emily.Shingleton-Smith@glos.nhs.uk
Leads for Curriculum Units within Gloucestershire
NHS
Year 3 Medicine and Surgery A (‘TUBES’)
Caroline.Rodd@glos.nhs.uk
Year 3 Psychiatry (2gether NHSFT)
Attila.Sipos@bristol.ac.uk
Year 3 Medicine and Surgery B (‘AER’N’)
Paul.Morrish@glos.nhs.uk
Year 3 ‘MDEMO’
Philip.Davies@glos.nhs.uk
Year 3 Ethics
Royse.Murphy@nhs.net
Year 3 Ophthalmology
Richard.Caesar@glos.nhs.uk
James.Nairne@glos.nhs.uk
Year 4 O&G and neonates (‘RHCN’)
Philip.Kaloo@glos.nhs.uk
Isaac.Babarinsa2@glos.nhs.uk
Russell.Peek@glos.nhs.uk
Year 4 paediatrics (‘COMP1’)
Simon.Ackroyd@glos.nhs.uk
Alison.Rushforth@glos.nhs.uk
Year 4 CoE, GP& dermatology (‘COMP2’)
Pauline.Morrow@glos.nhs.uk
Andrew.Monro@glos.nhs.uk
Martin.Nicholas@gp-L84040.nhs.uk
Tom.Millard@glos.nhs.uk
Year 4 Pathology
Rebecca.Frewin@glos.nhs.uk
Year 4 Anaesthesia (C & G)
Mahesh.Parmar@glos.nhs.uk
Daniel.Evans@glos.nhs.uk
Year 5 Oncology and Palliative Care
Kim.Benstead@glos.nhs.uk
Year 5 Medicine (C & G)
Ian.Crossley@glos.nhs.uk
Tripti.Mahajan@glos.nhs.uk
Year 5 Surgery (C & G)
James.Wheeler@glos.nhs.uk
Mark.Vipond@glos.nhs.uk