Many medical students are unprepared for skilled prescribing, warn doctors in this week's BMJ.Evidence of poor prescribing in the UK is abundant, write Jeffrey Aronson and colleagues. Effective treatments are often underprescribed and prescription errors are common, especially when new doctors start work in hospitals.
The reasons for these errors are manifold, say the authors. Some relate to system failures, while another fundamental problem is that medical students are not adequately trained.
For example, in 1994, UK medical students received an average 61 hours of teaching related to pharmacology, clinical pharmacology, and therapeutics. Since then the numbers of pharmacologists and clinical pharmacologists in the UK (and thus the amount of teaching) have fallen.
In contrast, nurses seeking to obtain the Postgraduate Certificate in Prescribing must complete a training course of 162 hours of theory and 90 hours of practice.
Prescribing is becoming increasingly difficult, and the inherent risks of adverse reactions and interactions have increased, they add. Tomorrow's doctors need a firm grounding in the principles of pharmacology and clinical pharmacology, linked to practical therapeutics, so that they can weigh up the potential benefits and harms of treatment; understand the sources of variability in drug response; base prescribing decisions on sound evidence; and monitor drug effects appropriately.
Their prescription to improve prescribing includes regular education and assessment (linked to a licence to prescribe), a national prescription form for hospitals, guidelines and computerised prescribing systems.
There are too few pharmacologists and clinical pharmacologists to provide all the necessary teaching and assessments, so partnerships with other prescribers should be encouraged, they write. Medical students too can play their part by encouraging their medical schools to provide more tuition in practical drug therapy and prescribing.
"We challenge medical students, and all those involved in teaching students and training doctors to implement these proposals. After all, we shall all benefit from better prescribing," they conclude.