VOLUME 2 - ISSUE 4 - CLINICAL SECTION REPORT
Winter has arrived again and the next meeting of the Clinical Pharmacology Section is fast approaching. Mike Rawlins and colleagues at Newcastle will be hosting us during for the annual meeting of the Section on the 14-15 December.
The first day will be devoted to two symposia. The morning session is entitled ‘Genetic factors affecting outcome of drug treatment’ and will bring together a number of eminent speakers in the field. In the afternoon the we are hosting a joint symposium with the Association for Human Pharmacology in the Pharmaceutical Industry (AHPPI) entitled ‘Innovative approaches to clinical trials’ that will include topics relating to predictive value of preclinical models, uses and definition of biomarkers and informatics in early clinical trials.
The symposium will be followed by the Clinical Section AGM and Committee meetings.
The second day will be devoted to the usual mix of posters and oral communications, and Professor David Webb ( Edinburgh) will deliver the Lilly Prize lecture, entitled ‘Endothelin: of mice and men’. I am pleased that the meeting will also include a session for SpR trainees, who should find plenty of interest and relevance in the rest of the programme. This will also be the first time that we welcome medical students from around the country who have been awarded BPS Prizes for Clinical Pharmacology. Some will be presenting their work and I hope that everyone will take the opportunity to make them feel at home. For more information about the Newcastle meeting visit the BPS web site.
This report is the last during my period as Vice-President (Clinical) and presents an opportunity to reflect on some of the more important events during the last 3 years.
We continue to be concerned about the standard of education of medical students in relation to the use of drugs. The pressures on junior prescribers have never been greater with increasing numbers of drugs, more vulnerable patients, increasingly complicated treatment protocols, an expanding evidence base and greater demand from patients for information about their treatments. It is a paradox that the profile of clinical pharmacology in UK medical curricula seems to have progressively diminished in recent years. A major factor has been the changing emphasis in undergraduate education, stimulated by the GMC’s proposals contained in Tomorrow’s Doctors, which strengthened the position of organ-based -ologies to the disadvantage of the non-organ-based ones. Although the 2002 revision placed more emphasis on developing safe and effective prescribers there was little detail available as to how this might be achieved.
The Clinical Section’s proposals for a core curriculum for medical students were published in 2003 (BJCP 2003;55:496-503). The intention was to state in simple terms how the important knowledge and skills outcomes relating to prescribing and therapeutics might be incorporated into a modern medical course. Copies were sent to all Deans and lead teachers in UK medical schools. Although we received some encouraging responses there is still a widespread belief that the appropriate skills will develop in the absence of specific courses and assessments.
I continue to believe that our work on the curriculum has been a valuable exercise that provides a useful benchmark for those trying to improve undergraduate teaching. I think there can be optimism that the tide is slowly turning in this area. Students themselves are highlighting prescribing as an area of weakness in their education and NHS organisations also appear to be dissatisfied with levels of performance. I believe that we might, in the future, develop some learning materials which could be made freely available to support the curriculum objectives. There may also be an opportunity for the BPS to influence education in other areas. The new Foundation Programmes for junior doctors will place increasing emphasis on training in core skills including prescribing. There are also other professional groups (eg. nurses and pharmacists) that are increasingly taking on prescribing rights. The BPS is a source of expertise in prescribing and safe use of drugs, and should aim to engage with these developments.
Although the previous system of awards for intercalating medical students had some enthusiastic support it suffered from the disadvantage that the awards tended to reach a relatively small number of students based in a limited number of centres with strong clinical pharmacology units. Following consultation with the Section it was agreed that we would look for an alternative system that might encourage interest and excellence in clinical pharmacology potentially within all UK medical schools. The Society wrote to each medical school in 2003 to offer a generous £1,000 BPS Prize to be awarded to their most outstanding student in clinical pharmacology. Recognizing the varied nature of medical curricula, we proposed that the schools could make the award in one of three ways:
• Examination – the best performance in a specific summative assessment of knowledge and skills in the area of clinical pharmacology, prescribing, or therapeutics.
• Special Study Module (SSM) – the best report on a project involving novel research into any aspect of the use of drugs in the clinical setting.
• Pharmacology Research Project – the best report on a project undertaken during a period of research in the area of pharmacology or clinical pharmacology (eg an intercalated BSc project).
I am delighted to report that, after a slow start, the majority of schools have now indicated their wish to participate in the scheme. Wherever possible we have encouraged a local committee with strong BPS representation to take charge of advertising the prize and assessing the quality of project submissions. The final nominations are ratified by the Prize’s subcommittee before the awards are made. We expect a further group of medical schools to join the scheme in 2004-2005.
The individual awards of £1,000 are generous and we hope that they will realise their aim of stimulating interest in Clinical Pharmacology amongst UK medical students. A selection of the students who won on the basis of inter-calated projects or SSMs will be making presentations at the Newcastle meeting.
It has become increasingly important that senior doctors, including clinical pharmacologists, can demonstrate that they are taking steps to keep up to date with developments in their specialty. Although the breadth of our specialty is great, 42 core competencies characteristic of a clinical pharmacologist were identified in a Delphi exercise. A small editorial group, energetically led by John Mucklow, commissioned and edited CPD material covering each competency including basic knowledge, references to further reading and self-assessment questions. I hope that most clinical pharmacologists and their trainees will have taken the chance to access the resource and try it for themselves. The site is hosted by Blackwell Science but can be accessed via the BPS website.
The CPD website has attracted interest from not only UK clinical pharmacologists but also from abroad. The future challenges will be to keep the material updated, to decide on what terms we might allow wider access to the site, and to gain recognition for this resource as a means of external CPD from the Federation of Royal Colleges. Although there has formerly been resistance to validation of web-based CPD materials, I am hopeful that formal accreditation will be given shortly.
Other matters and the future
There are certainly plenty of challenges ahead. The EU directive on clinical trials continues to present a threat to academic clinical pharmacology and the BPS has repeatedly tried to make this point. I hope that there will be continued progress in preventing academic studies that focus on mechanisms of action becoming bound up in excessive regulation. The future of the specialty itself demands some attention. Clinical pharmacology was the only medical specialty to contract during the 1990s. Where then does the future lie? Can we see an expansion in either academic or NHS posts? Will there be enough posts for our current trainees? Does the specialty require ‘rebranding’? It is also unclear as to how specialist training in clinical pharmacology will be achieved within the new Modernising Medical Careers framework.
Internally, we still have a challenge to maintain attendance and participation in the Winter meeting, now our only annual gathering. We need to work to draw SpR trainees into the Society’s activities. Although there have been a number of dedicated SpR meetings, most have been poorly attended. There are obvious opportunities to provide education around key areas of the SpR curriculum but also a need for SpRs to attend and present at BPS meetings.
On a positive note, UK members continue to make a major contribution to the running of the EACPT with Michael Orme (Liverpool) recently elected as President and John Cockcroft (Cardiff) taking over from him as Honorary Secretary. In addition, the UK has been awarded the honour of hosting the 2009 EACPT congress in Edinburgh. The challenges and tasks outlined above will now fall to a new team. I am pleased to welcome Dr Albert Ferro (GKT) who will succeed me as Vice-President (Clinical). Dr Robin Ferner (Birmingham) will take over as Chairman of the Clinical Section and Professor David Webb (Edinburgh) takes over as chair of the Committee of Heads and Professors of Clinical Pharmacology. I would like to wish them all well in their new posts and hope they enjoy their time working with the BPS as much as I have.
Lastly, and most importantly, I would extend my thanks to everyone who has contributed to the work of the Clinical Section over the last 3 years. Maintaining a healthy Clinical Section, as well as developing the activities outlined above, demands a combination of enthusiasm and hard work from the many colleagues who have served on committees, attended meetings, responded to consultations, written reports, and reviewed the work of others. I would like to pick out two names for special mention. I am not the first, and will not be the last, to find that the support of Sarah-Jane Stagg at the BPS Office has been a key factor in managing the various issues that have crossed my desk. It has also been a pleasure to work in close collaboration with Tom Walley (Chairman of the Clinical Section). In addition to his own contribution, Tom has always been a source of sound advice when it has been required.