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Medical Education issues

August 2016 New National Prescribing Safety Assessment for medical students

Adverse Drug Reactions (ADRs) are dose related

In a review of a conference held at the Royal College of Physicians, Clinical Pharmacologist, Duncan Richards stated "Some of the barriers to the implementation of this are the organisational complexity of the design of curricula, and the reduction in numbers of academics in specialties such as clinical pharmacology". Duncan Richards works for Glaxo Smith Klyne and lectures at Oxford University.

Please read his review of the conference  Problems and Perils of Prescription Medicines.

At the time of this meeting in 2003, Professor Steven Evans, Professor of Pharmacoepidemiology, London School of Hygiene and Tropical Medicine, stated:

"There are only 2000 active substances used in medicines and some ADRs may be expected. Age and gender had not been evaluated in their use."

This problem of drugs licensed for use by women, yet not tested on women during clinical trials, is supported by anaesthetist /researcher, Dr Anita Holdcroft as she commented in her presentation at our conference

Professor Evans felt there could be better detection of ADRs with better use of databases. This was later reflected in a study by Clinical Pharmacologist Andrew Herxheimer, who found the MHRA data analsyis of Yellow Card ADR reports was "chaotic and misconceived".

Professor Evans also felt we could incorportate pharmacological knowledge into expectations of ADRs. He also suggested the MHRA could offer a prize for the doctor who finds first indication of a problem with a medicine.

Professor Evans quoted in 1982, a doctor reported coughing was an adverse effect of Captopril, sold under the trade name Capoten, is an angiotensin-converting enzyme (ACE) inhibitor used for the treatment of hypertension. Yet it was not until 1985, this became more common knowledge due to a letter in The Lancet.

He mentioned ruptured achiles tendons caused by flouroquinolone antibiotics, myalgia with statins

This idea of prizes for good efforts encourage harm prevention is currently one used by the
Therapeutics Journal Prescrire. An excellent means of reviewing drug safety as assessed by pharmacists.

If any medical student would like to see the slides from the Royal College of Physicians conference, Problems and Perils of Prescription Medicines, please contact APRIL.

The history of medical education includes the fact when the General Medical Council (GMC) made a decision to remove Clinical Pharmacololgy and Therapeutics from 'Tomorrow's Doctors' their guidelines for medical schools to follow, they could not have forseen the consequences.

"Are medical students adequately prepared to prescribe when they qualify?" asked Professor Simon Maxwell, Clinical Pharmacologist of Edinburgh University - He with colleagues has worked hard to improve medical education but we still have a long way to go.

The GMC guidelines encouraged 'Integrated Mediicine' excluding Clinical Pharmacology and Therapeutics as a specific subject to be studied. This led to students graduating with little or now knowledge of how to recognise early signs of intollerance, or how to treat ADRs or withdrawal issues.

An interesting talk byby two eminent Clinical Pharmacologists, Dr John Halliday of Kings' College and Professor Simon Maxwell of Edinburgh Univerisity took place at our conference Educating a new Generation for Safe Prescribing

Prof Maxwell is a major influence on the new Prescribing Safety Assessment for medical students and other initiatives towards improving patient safety.

The World Health Organisation and Health Action International have prepared a course for medical students that would help future generations of prescribers to be alert to the pressure from industry to prescribe, when it may be better for the patient not to prescribe. Understanding and Responding to Pharmaceutical Promotion- a practical guide for educators and students. If any student would suggest a lecturer who may be interested, a representative of HAI will be available to do a workshop at your college.





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