Are you prescribing safely? Assess your skills

Susan Brien
November 13, 2019 | Author: Susan Brien

I was reflecting on how practice has changed. As an example, when a nurse calls me at night and seeks a prescription because a patient has high blood pressure, I should not be prescribing one of the two drugs I learned about and used during residency. So how would I know what is now considered the best anti-hypertensive to prescribe?

With the exception of perhaps training in Clinical Pharmacology and Toxicology, we don’t talk about the competencies of prescribing. Medical schools and some training programs have some basic content in the early years, but there’s not a lot of focus on assessing peoples’ prescribing skills in practice. This leaves many of us in practice with only a few options for updating our knowledge (besides asking for help from our Internal Medicine consultant teams!):

  • Attend a webinar or conference on anti-hypertensives (which, in my case, might be unusual for a surgeon!)
  • Attend an event sponsored by the pharmaceutical industry (but could it be biased if it’s not accredited?)
  • Call a pharmacist (though, prescribing ordinary medications is something that most physicians feel they should be able to do).

Now we have another option: Prescribing Safely Canada.

These online assessments are designed to help physicians identify where they might have a gap, by exploring some of the challenges and competencies related to prescribing medication.

Prescribing is more than writing a prescription

Many believe “well, I have a pharmacist on my team” or “I can always call the pharmacy” — and pharmacists play an important role in delivering care — but ultimately, as a physician, you are responsible for writing that prescription and ensuring that it is the right medicine for the right context. For example, many of us might prescribe a medication for one of our elderly patients and note what other drugs they are on, but we also need to have some basic knowledge about what those drugs are, what could be the interactions, what sort of symptoms could in fact be reactions or side effects to those drugs…. As more and more drugs are being used and as patients generally get older and their health more complex, these are things we have to pay attention to.

Prescribing Safely Canada is a multi-year partnership between the Royal College and the British Pharmacological Society. It focuses on the prescribing competencies that physicians need (in a Canadian context) [PDF] and aims to make more high quality learning accessible to Fellows.

In taking one of these assessments and using the feedback from the questions, you may also uncover areas of prescribing you haven’t really thought about. This can become inspiration of where to direct more learning.

And, of course, Fellows can earn Section 3 MOC credits.

Learn and earn Section 3 credits

Right now, we have assessments available in

  • Internal Medicine,
  • Pediatrics and
  • Family Medicine.

In 2020, we will release new accredited assessments focused on families of medications: anti-coagulants, analgesic and adjuvant, and antidepressants and anxiolytic.

For more details or to access the modules, visit

Susan Brien, MD, FRCSC, is director of Performance and Systems Innovation at the Royal College of Physicians and Surgeons of Canada. She also practises Neurosurgery in Gatineau, Que.

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