Introduction to e-Prescribing Curriculum Resources

This product of a previous eCampusOntario grant provides a curated list of key e-curriculum resources that have been evaluated by clinical, research, usability and e-learning experts. Most resources are international (for example, the Australian National Prescribing Curriculum (NPC) is excellent), therefore Canadian preambles are provided for areas of translation.

General Preamble

Our own work with Canadian medical students shows that many lack basic clinical pharmacology and therapeutics knowledge, and prescribing skills as schools struggle to meet all of their required curricula objectives.1, 2 Expertise in this broad-based specialty is scarce, and most medical schools no longer have dedicated clinical pharmacology courses. However, for the first time, the Medical Council of Canada has recently launched specific Prescribing Practices objectives that schools must cover.3

Safe prescribing is a complex activity requiring detailed knowledge of dozens of drug families, accurate patient diagnosis and individual risk assessment, excellent communication and interprofessional collaboration skills, and professionalism. More than 700 million prescriptions are written annually in Canada for drugs from approximately 1100 therapeutic groups.4 Medication errors are common, usually go unrecognized and can pose a serious patient safety hazard.2, 5-8 Medical students and residents are especially vulnerable, with prescribing errors on 7-10% of their prescriptions.5

Competent prescribing and medication management is even more essential as years go on, given the dozens of new medications introduced each year, primarily high-risk medications and very expensive medications, increasing numbers of patients with extreme polypharmacy, lethal problems with drug overdose and poisoning, and poor adherence with effective medications.

  1. Royal College of Physicians and Surgeons of Canada: The Prescribing Safely Canada Physician Prescribing Competencies – Executive Summary
  2. The Prescribing Safely Canada Physician Prescribing Competencies- https://oracle.royalcollege.ca/mssites/prescribingsafely/EN/PSCCOMP2018.pdf
  3. College of Physicians and Surgeons of Ontario’s Advice to the Profession on Prescribing Drugs CPSO – Prescribing Drugs CPSO – Advice to the Profession: Prescribing DrugsAdditional, valuable documents for learners on the prescribing competence topic include:
  4. The World Health Organization’s Guide to Good Prescribing: A Practical Manual – useful not specifically for the patient examples or specific drug examples, but for the recommended process of prescribing.
  5. The Essential Drugs List for McMaster Medical Students: http://hdl.handle.net/ 11375/27291 – useful for specific drug and drug family examples that should become familiar to every medical trainee
  6. The Institute for Safe Medication Practices Canada (ISMP Canada)’s resources including i) DO NOT USE List of Dangerous Abbreviations Symbols and Dose Designations – abbreviations, symbols, and dose designations reported as being frequently misinterpreted and contributing to harmful medication errors, and ii) List of High-Alert Drugs – medications with an increased risk of causing significant patient harm when they are used inappropriately, including lack of indication, wrong dose, contraindications, etc. 9, 10
  7. Health Canada’s Drug Product Database provides access to the full product monographs from all manufacturers of medications approved for use in Canada. Product monographs are the ‘bottom line’ on your medico-legal responsibilities. In other words, if a medication does not have an official indication for the disease or condition that you are treating or does not have clear, supportive randomized trial evidence, and you cannot justify that you have tried all other reasonable avenues and the patient was aware of and agreed with your rationale to prescribe the drug, then if a major adverse event related to the drug occurs, you will be at risk of successful legal and disciplinary challenge.
  8. Drug formulary and coverage is an essential consideration when prescribing any medication. Formularies in Canada are based on the highest quality cost-effectiveness information and evaluation.11 Each province and territory has their own that can be accessed individually. For Ontario, this can be accessed via: https://www.formulary.health.gov.on.ca/formulary/.
  9. Conflicts of Interest – Physicians must avoid conflicts of interest to ensure that their professional priorities remain patients and advancing healthcare, particularly when dealing with the pharmaceutical and device industry.12

References:

  1. Holbrook A, Liu JT, Rieder M, Gibson M, Levine M, Foster G, et al. Prescribing competency assessment for Canadian medical students: a pilot evaluation. Can Med Educ J. 2019;10(1):e103-e10. ↑
  2. Liu J, Wong S, Foster G, Holbrook A. Prescribing Competency of Medical Students: National Survey of Medical Education Leaders. J Popul Ther Clin Pharmacol. 2018;25(1):e18-e24. ↑
  3. MCC. Prescribing Practices Ottawa, Canada: MCC; 2022 [Available from: https://mcc.ca/objectives/expert/key/125/]. ↑
  4. Canada Health Infoway. Current prescribing and dispensing landscape in Canada: CHI; 2017 [Available from: https://infocentral.infoway-inforoute.ca/en/resources/docs/medmgmt/1778-report-2017-current-prescribing-and-dispensing-landscape-in-canada. Accessed on 23 Apr 2019]. ↑
  5. Dornan T, Ashcroft D, Heathfield H, Lewis P, Miles J, Taylor D, et al. An in-depth investigation into causes of prescribing errors by foundation trainees in relation to their medical education: EQUIP study. London: General Medical Council. 2009:1-215. ↑
  6. Lazarou J, Pomeranz BH, Corey PN. Incidence of adverse drug reactions in hospitalized patients: a meta-analysis of prospective studies. JAMA. 1998;279(15):1200-5. ↑
  7. Ryan C DP, Francis J, Johnston M, Ker J, Lee AJ, et al. The Prevalence of Prescribing Errors amongst Junior Doctors in Scotland. Basic and Clinical Pharmacology and Toxicology. Basic and Clinical Pharmacology and Toxicology. 2011;109(35). ↑
  8. Young H. Lack of pharmacological training causes overuse and misuse of drugs. CMAJ. 2008;178(3):276. ↑
  9. ISMP. Do Not Use: Dangerous Abbreviations, Symbols and Dose Designations. Toronto, ON: ISMP 2018 [Available from: https://www.ismp-canada.org/download/ISMPCanadaListOfDangerousAbbreviations.pdf]. ↑
  10. ISMP. ISMP List of High-Alert Medications in Acute Care Settings. Toronto, ON: ISMP; 2018 [Available from: https://www.ismp.org/sites/default/files/attachments/2018-08/highAlert2018-Acute-Final.pdf]. ↑
  11. CADTH. Guidelines for the Economic Evaluation of Health Technologies: Canada. Ottawa, ON: CADTH; 2017. ↑
  12. CPSO. Physicians’ Relationships with Industry: Practice, Education and Research. Toronto, ON: CPSO; 2014 [Available from: https://www.cpso.on.ca/Physicians/Policies-Guidance/Policies/Physicians-Relationships-with-Industry-Practice]. ↑

Holbrook A, Patel D, Yoo L. Introductory Preambles to Clinical Pharmacology and Toxicology eCurriculum Resources for Canadian Medical Students [MacSphere]. McMaster University, Department of Medicine: Hamilton, Ontario; 2022. Available from http://hdl.handle.net/11375/27381

 

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Clinical Pharmacology and Prescribing Skills: Copyright © by Dr Anne Holbrook,MD,PharmD,MSc,FRCPC is licensed under a Ontario Commons License, except where otherwise noted.

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