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An expert Canadian faculty group, formed by the Royal College of Physicians and Surgeons of Canada, using the literature and a consensus project, has established Physician Prescribing Competencies that can be used by all levels of trainees. They include: <\/p>\n\n

Perform a comprehensive assessment of the patient to identify a therapeutic target<\/li>\n\t
Consider optimal pharmacological and non-pharmacological options<\/li>\n\t
Prescribe medications appropriate to the patient\u2019s diagnoses, considering cost and risk of benefit and harm.<\/li>\n\t
Provide medication-related information ensuring patient\/family understanding and ability to access<\/li>\n\t
Reach a shared decision on medication use and monitoring with the patient and\/or family<\/li>\n\t
Monitor and review the patient\u2019s medications and adherence at each encounter, aiming to optimize the regimen<\/li>\n\t
Prescribe carefully with attention to medication safety<\/li>\n\t
Prescribe responsibly and ethically within legal and regulatory frameworks<\/li>\n\t
Critically assess and improve prescribing<\/li>\n\t
Demonstrate leadership by fostering high quality medication management across the continuum of care<\/li>\n<\/ol>\n\n
\n
Brien S, Chan M-K, Grill A, Holbrook A, Landriault A, Matlow A. The Prescribing Safely Canada - Physician Prescribing Competencies Executive Summary [internet]. Ottawa Canada: Royal College of Physicians and Surgeons of Canada; May 2018. Available from psc-prescribing-competencies-executive-summary-e (3).pdf<\/a><\/p>\n"},"library":"H5P.AdvancedText 1.1","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"},"subContentId":"cb1c0137-e04d-494e-8930-8a8954d832a1"},"useSeparator":"auto"}]},"library":"H5P.Column 1.15","subContentId":"bfb74303-d8bc-453c-93dc-2a57be3cae6b","metadata":{"contentType":"Column","license":"U","title":"Physician Prescribing Competencies"}},{"params":{"content":[{"content":{"params":{"text":"
Medical student objectives in CPT as directed by the Medical Council of Canada, are:<\/p>\n\n
1. Undertake a thorough clinical assessment, including:<\/strong>\n\n\t
  - Apply principles of clinical pharmacology in prescribing medication to:<\/strong>\n\t\n\t\t
    address the effect of comorbidities, current medications, liver and renal function, genetics, age, and pregnancy on the risks and benefits of prescribing the medication;<\/li>\n\t\t
    apply an evidence-based approach to clinical and cost effectiveness, including prescribing generic medications when appropriate;<\/li>\n\t\t
    anticipate the potential for adverse effects and take steps to mitigate them (e.g., prescribing appropriate routes, strengths, and quantities of medication);<\/li>\n\t\t
    recognize potential medical interactions when prescribing new medications;recognize barriers to patients access to the medication (e.g., affordability, accessibility, supply) and advocate to resolve these where possible; and<\/li>\n\t<\/ul>\n\t<\/li>\n\t
    Document the prescription appropriately, including:<\/strong>\n\t\n\t\t
    generating a clear and legible prescription that meets legal requirements; recognizing common cases of medication errors and how they can be prevented;<\/li>\n\t\t
    creating contemporaneous clinical notes of prescribing decisions; documenting appropriate follow-up plans for review of the effectiveness of the prescribed medication and any adverse effects encountered; and<\/li>\n\t<\/ul>\n\t<\/li>\n\t
    Communicate with the patient or, if appropriate, their family or caregivers to:<\/strong>\n\t\n\t\t
    build a therapeutic relationship that encourages adherence but respects the patient's values, beliefs, and expectations about medications and their right to refuse treatment;<\/li>\n\t\t
    ensure they understand the rationale for the prescription;<\/li>\n\t\t
    provide them with information about any adverse effects, how to report them, and what they should do if adverse effects occur;<\/li>\n\t\t
    ensure that those involved in sharing care or transfer of prescribing responsibilities are adequately informed about the prescription.<\/li>\n\t<\/ul>\n\t<\/li>\n<\/ol>\n\n
    \n
    Available at: https:\/\/www.mcc.ca\/objectives\/expert\/key\/125\/<\/a>. Accessed June 14, 2021 (see Appendix 1)<\/p>\n"},"library":"H5P.AdvancedText 1.1","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"},"subContentId":"94c9fe86-1d1a-4888-9d58-a277553dcf84"},"useSeparator":"auto"}]},"library":"H5P.Column 1.15","subContentId":"71b9171c-7ba4-4859-9e70-2f902c64e59d","metadata":{"contentType":"Column","license":"U","title":"Medical student objectives in CPT"}},{"params":{"content":[{"content":{"params":{"text":"
    Clinical Pharmacology & Toxicology orientation and objectives for residents, include: <\/p>\n"},"library":"H5P.AdvancedText 1.1","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"},"subContentId":"1d9c31c5-1bca-42ad-9089-384e040b7203"},"useSeparator":"auto"},{"content":{"params":{"panels":[{"content":{"params":{"text":"
    Anne Holbrook. MD, PharmD, MSc, FRCPC<\/strong>
    \nDirector, Division of Clinical Pharmacology and Toxicology<\/p>\n\n
    From McMaster Internal Medicine Residency Program accreditation documents:<\/p>\n\n
    Clinical Pharmacology & Toxicology:
    \nThere is a strong Clinical Pharmacology & Toxicology (CPT) rotation supervised by Dr Anne Holbrook. Dr Holbrook supervises residents from Internal Medicine, Emergency Medicine and other programs on elective at St Joseph\u2019s Hospital and Juravinski Hospital. She and three other Clinical Pharmacologists \u2013 Dr Mitch Levine, Dr Dan Perri, and Dr Joanne Ho serve as attending physicians on Internal Medicine CTUs.<\/em><\/p>\n\n
    Dr Holbrook is the division director, and has markedly increased the profile of this specialty with medical residents. The hospital-based rotation specializes in prescribing competence, evidence-based therapeutics, medication safety and an introduction to drug policy. She is a regular presenter in the research curriculum, supervises resident research, tutors in the Evidence-based Medicine retreat, and along with other members of CPT faculty participates in Academic Half-day at least annually.<\/em><\/p>\n"},"library":"H5P.AdvancedText 1.1","subContentId":"49ba1df5-05c4-405d-8780-76bb83d297ec","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"title":"Coordinator:"},{"content":{"params":{"text":"
    \n\t
    Knowledge, skills and attitudes consistent with rational, evidence-based drug therapy<\/li>\n\t
    Appropriate, legal prescribing as a physician responsibility<\/li>\n\t
    Selecting and prioritizing amongst drugs in a therapeutic class \u2013 evidence and economics<\/li>\n\t
    Adverse drug reactions including drug allergy, drug interactions<\/li>\n\t
    Poisonings and drugs of abuse<\/li>\n\t
    Formularies, cost-effectiveness and drug regulation<\/li>\n\t
    Developing a Personal Formulary based on a Canadian Essential Drugs list<\/li>\n\t
    Advancing communication skills with patients<\/li>\n\t
    Medication adherence<\/li>\n<\/ul>\n"},"library":"H5P.AdvancedText 1.1","subContentId":"b9a90863-07fb-460f-b162-0690f8c31ce1","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"title":"Objectives Highlights for rotation in Clinical Pharmacology and Toxicology:"},{"content":{"params":{"text":"
    \n\t
    Clinical consults<\/strong> \u2013 first call for the Clinical Pharmacology Inpatient Consult Service (CPICS) at St Joes, which specializes in Major Polypharmacy, diagnosis and treatment of Adverse Drug Events including drug interactions, Expensive Non-formulary drugs and a wide variety of eConsults. Within 2 weeks, residents will complete a curriculum that emphasizes high quality medication reconciliation, prescribing and de-prescribing high risk medications, incorporating best evidence quickly into all decisions, navigating medication regulations, understand drug safety reporting requirements, improve teaching skills using \u2018key pearls\u2019 approach, <\/li>\n\t
    Education<\/strong> \u2013 rounds (medicine grand rounds, CPT rounds, Toxicology rounds (Friday mornings online), Geriatrics Clin Pharm rounds, teaching sessions, in-services, curriculum development for medical students, case scenarios,<\/li>\n\t
    Research<\/strong> \u2013 participate in quality assurance projects on medication optimization, participation in a wide range of ongoing CPT projects and research programs as desired, peer review of grants or papers,<\/li>\n\t
    Policy<\/strong> - assisting with Ontario Exceptional Access requests, and expert advisory committee activities on drug approval, reimbursement and use at federal, provincial and regional levels.<\/li>\n<\/ul>\n"},"library":"H5P.AdvancedText 1.1","subContentId":"c31d34bd-d550-4a6a-9840-939eacdc436b","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"title":"Trainee Activities:"},{"content":{"params":{"text":"
    Clinical pharmacology is a medical specialty concerned with the research, teaching and clinical application of what the human body does to drugs and what drugs do to humans. The knowledge and correct application of drug therapies is a core responsibility of every physician and crosses every disease and organ group. At a population level, Canada along with every other developed country, has noted that drugs form the fastest growing component of health care budgets. This means that there is tremendous pressure to ensure that medicines are provided in the most judicious (effective, safe and cost-effective) manner to optimize health. More recently, medication safety problems have been recognized as the most prominent single source of internal medicine patient adverse events and as a common source of disciplinary action against physicians. At an international, national and local level, it has been noted that trainees receive inadequate training in clinical pharmacology and therapeutics. In addition, overdose and drug use disorders are common and require toxicology knowledge and expertise.<\/p>\n\n
    Clinical pharmacologists with combined clinical expertise, critical appraisal abilities, knowledge of drug action and familiarity with regulatory and reimbursement policies, influence healthcare at all levels (policy, provider and patient) and are in exceedingly short supply. <\/p>\n\n
    It is imperative that each practicing medicine specialist has a basic competence in safe prescribing and evidence-based therapeutics. <\/p>\n"},"library":"H5P.AdvancedText 1.1","subContentId":"7a65bd04-1041-4c29-973c-5f609e9e9c7a","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"title":"Clinical Pharmacology and Toxicology (CPT) detailed description:"},{"content":{"params":{"text":"
    Our objective in this elective is to assist trainees in developing knowledge, skills and attitudes consistent with rational, evidence-based drug therapy.<\/p>\n\n
    Communicator<\/strong><\/p>\n\n
    \n\t
    develop effective patient rapport to allow full history and physical exam to be completed, using both verbal and non-verbal cues, develop approach to difficult or hostile patient, <\/li>\n\t
    develop effective medication history skills, including current and past medications; allergies and drug intolerances; adherence and issues interfering with adherence; expectations and preferences with regard to medications,<\/li>\n\t
    effectively communicate with patient\u2019s next-of-kin or family as appropriate,<\/li>\n\t
    effectively obtain consent to contact and interview the patient\u2019s primary provider(s), pharmacist(s), and online medication history as appropriate, <\/li>\n\t
    clearly and accurately present a clinical pharmacology consult with full therapeutic plan, directly supported by critically appraised evidence from the literature,<\/li>\n\t
    demonstrate that referring providers, patient and caregivers have an understanding of the therapeutic plan, and have participated in the discussion and decision-making as much as they wish,<\/li>\n\t
    demonstrate sensitivity to and account for the influences of socioeconomic status, culture, religion, etc., on the patient\u2019s medication management practices,<\/li>\n\t
    provide a clear, accurate written record of the clinical pharmacology consultation,<\/li>\n\t
    effectively teach fellow trainees,<\/li>\n\t
    utilize communication skills as outlined above for requests for advice from governments, formulary plans and other drug policy groups. <\/li>\n<\/ol>\n\n
    Collaborator<\/strong><\/p>\n\n
    \n\t
    participate effectively in an inter-professional healthcare team, understanding own and others\u2019 role, expertise, limitations - in a common goal to optimize patient care, <\/li>\n\t
    participate as above, when approaching a research problem, educational task or drug policy question,<\/li>\n\t
    understand principles of team dynamics, including confidentiality, resource allocation and professionalism, assume leadership role where appropriate and be able to prevent and resolve conflict.<\/li>\n<\/ol>\n\n
    Manager\/Leader<\/strong><\/p>\n\n
    \n\t
    understand and participate in key management roles for clinical pharmacologists aside from direct patient care, such as medication safety management, drug utilization review, formulary review with economic analysis, national pharmaceutical strategy,<\/li>\n\t
    understand the Canadian drug regulatory process from drug development stages to post-marketing surveillance,<\/li>\n\t
    develop appropriate organizational and time management skills, to allow for future practice management,<\/li>\n\t
    develop personal continuous practice quality improvement goals and skills,<\/li>\n\t
    within the patient consultation environment, utilize above-stated manager knowledge and skills to optimize cost-effectiveness of patient care. <\/li>\n<\/ol>\n\n
    Professional<\/strong><\/p>\n\n
    \n\t
    Display appropriate professional behaviours including integrity, initiative, commitment, compassion, altruism and respect,<\/li>\n\t
    Display a strong commitment to improving the quality of one\u2019s care and maintenance of competence including provision and receipt of constructive criticism, <\/li>\n\t
    Recognize and deal appropriately with common ethical issues including consent, confidentiality, conflict of interest, cultural and socioeconomic issues if barriers to optimal drug therapy, population formulary rules versus individual patient needs\/requests, dealing with industry sales representatives, etc.,<\/li>\n\t
    Demonstrate an understanding of medical ethical codes, requirements for practice, the peer review process and expected response to unprofessional behaviours by colleagues, Tri-Council Policy Statement for research ethics, <\/li>\n\t
    Articulate self-awareness principles to optimize personal health and sustainable, high quality practice.<\/li>\n<\/ol>\n\n
    Scholar<\/strong><\/p>\n\n
    \n\t
    Understand and use the literature in all activities, advance critical appraisal skills, learn principles of cost-effectiveness, efficient systematic literature searches, levels of evidence, generalizability, and critically appraised topics (CATs)\/Bottom Line summaries,<\/li>\n\t
    Attend all clinical pharmacology and associated rounds and educational sessions and communicate a learning summary at end of each, <\/li>\n\t
    Deliver several informal teaching sessions for fellow trainees and participate in at least one ongoing research project,<\/li>\n\t
    Participate in ongoing clinical pharmacology curriculum and syllabus development, <\/li>\n\t
    Participate in at least one practice audit\/drug utilization review with an appropriate learning question and post-audit recommendations for changing own practice, <\/li>\n\t
    Facilitate the learning of others as appropriate \u2013 patient, family, other trainees, other healthcare professionals, the public<\/li>\n<\/ol>\n\n
    Health Advocate<\/strong><\/p>\n\n
    \n\t
    Identify and advocate for the preventive care needs of patients, and opportunities for health promotion and disease prevention where medications may assist,<\/li>\n\t
    Identify and mitigate the role of cost and inadequate medication access in medication adherence and patient outcomes, <\/li>\n\t
    Appreciate determinants of health, including health literacy, and the role of clinical pharmacology in promoting evidence-based drug therapy and in discouraging inappropriate drug therapy, to improve the health of patients and populations,<\/li>\n\t
    Prioritize within the complexities of multiple comorbidities and polypharmacy to advocate for health,<\/li>\n\t
    Understand the principles of and the evidence behind various types of advocacy in clinical pharmacology,<\/li>\n\t
    Recognize and deal with the occasional conflict in role as health advocate for the patient or community with role as manager or gatekeeper.<\/li>\n<\/ol>\n"},"library":"H5P.AdvancedText 1.1","subContentId":"04c70772-9c48-456d-85bf-d5c01a2cb2ed","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"title":"Detailed CanMEDS Objectives for CPT:"},{"content":{"params":{"text":"
    \n\t
    Knowledge, skills and attitudes consistent with rational, evidence-based drug therapy<\/li>\n\t
    Appropriate, legal prescribing as a physician responsibility<\/li>\n\t
    Selecting and prioritizing amongst drugs in a therapeutic class \u2013 evidence and economics<\/li>\n\t
    Adverse drug reactions including drug allergy, drug interactions<\/li>\n\t
    Poisonings and drugs of abuse<\/li>\n\t
    Formularies, cost-effectiveness and drug regulation<\/li>\n\t
    Developing a Personal Formulary based on a Canadian Essential Drugs list<\/li>\n\t
    Advancing communication skills with patients<\/li>\n\t
    Medication adherence<\/li>\n\t
    Appropriate medication utilization as a team\/system responsibility<\/li>\n\t
    Rules, regulations and policies for prescribing<\/li>\n\t
    Clinical pharmacokinetics and therapeutic drug monitoring<\/li>\n\t
    Pharmacogenetics\/pharmacogenomics<\/li>\n\t
    Prescribing specific to vulnerable groups, including elderly, pregnant, breast-feeding patients or those with renal or liver disease. <\/li>\n\t
    Substance abuse and treatment of poisoned patient<\/li>\n\t
    Lifecycle of drug development through post-marketing surveillance<\/li>\n\t
    e-prescribing and other medication decision support systems<\/li>\n<\/ul>\n\n
    By the end of a 4-week rotation, trainees should have a basic competence in pharmacotherapy in Internal Medicine and related specialties, and be able to effectively complete a clinical pharmacology consultation for clinical, research, education, and drug policy colleagues.
    \n <\/p>\n"},"library":"H5P.AdvancedText 1.1","subContentId":"8b5ae651-3af9-4a0a-9803-0c7dbef8eb00","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"title":"Objectives for clinical skills in clinical pharmacology and toxicology include:"},{"content":{"params":{"text":"
    \n\t
    Develop personal learning goals and objectives for this rotation and negotiate action plan with supervisor within first 3 days of rotation,<\/li>\n\t
    Work with the ED consult team, or on call team, or CTU pharmacist on at least one occasion to practice offering CPT consultation support in \u2018real time\u2019.<\/li>\n\t
    Lead at least one CPT education session with other housestaff \u2013 morning report or noon rounds, including at least one \u201cCAT \u2013 critically appraised topic\u201d for team,<\/li>\n\t
    Complete and edit at least 8 full, formal academic CPT consultation notes suitable for sending (with referencing),<\/li>\n\t
    Complete at least 2 witnessed EPAs or mini-CEX exercises targeted at CPT history, physical examination, counseling skills, patient safety assessment, or complex prescription writing,<\/li>\n\t
    Complete at least 2 formal medication reconciliation exercises at admission or discharge with \u2018gold standard\u2019 provided by pharmacist,<\/li>\n\t
    Complete at least one written formulary review summary using the style of Common Drug Review, Committee to Evaluate Drugs, or hospital formulary assessment, <\/li>\n\t
    Contribute to at least 1 small quality assurance project on medication-related topic (list available) with emphasis on evaluation of methods of improving prescribing behaviours or advancing toxicology practice,<\/li>\n\t
    Complete one small CPT education evaluation exercise \u2013 either curriculum development, curriculum evaluation, education evaluation development, CPT quiz expansion, etc.<\/li>\n\t
    Try some of the Holbrook CPT quiz.<\/li>\n<\/ul>\n"},"library":"H5P.AdvancedText 1.1","subContentId":"6de3af6e-656a-4382-85ea-a98460d1a4f0","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"title":"Trainees are encouraged to:"},{"content":{"params":{"text":"
    Number of Residents:<\/strong> 1 - 2 per rotation<\/p>\n\n
    Recommended duration: <\/strong> 4 weeks <\/p>\n\n
    Contact: <\/strong> <\/p>\n\n
    Dr Anne Holbrook
    \nDirector, Division of Clinical Pharmacology & Toxicology
    \nDepartment of Medicine, McMaster University
    \nc\/o G624 SJHH, 50 Charlton Ave E
    \n905-522-1155 Ext 35269
    \nholbrook@mcmaster.ca<\/a>
    \n <\/p>\n"},"library":"H5P.AdvancedText 1.1","subContentId":"090c86fb-45c5-41df-953c-fa624a640c98","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"}},"title":"Other details:"}],"hTag":"h2"},"library":"H5P.Accordion 1.0","metadata":{"contentType":"Accordion","license":"U","title":"Untitled Accordion"},"subContentId":"65a795b1-5981-4a01-b120-87bfc5ed8b14"},"useSeparator":"auto"}]},"library":"H5P.Column 1.15","subContentId":"248db4ba-e9d5-4c86-abd8-611141112ba7","metadata":{"contentType":"Column","license":"U","title":"Clinical Pharmacology and Toxicology orientation and objectives"}},{"params":{"content":[{"content":{"params":{"text":"
    Objectives for Fellowship<\/strong><\/p>\n\n
    Overall objective is to assist trainees in developing knowledge, skills and attitudes that will lead to leadership in rational, evidence-based drug therapy, medication safety and drug policy for clinical practice, education and research. <\/p>\n\n
    a) develop clincal expertise to serve as a clinical pharmacology consultant on the inpatient consult service and a future adverse drug reaction clinic.<\/p>\n\n
    b) develop knowledge and skills to lead education of medical students and residents, pharmacy students and residents, fellow clinicians, with a solid background in the evidence and evidence-based interventions behind improving prescribing practices. Leads at least one formal teaching session for fellow trainees per block. <\/p>\n\n
    c) develop basic health research methology knowledge and skills, rapid literature retrieval and critical appraisal skills, to be conversant in evidence-based therapautics and evidence-based drug policy. Leads at least one ongoing research or quality assurance project. <\/p>\n"},"library":"H5P.AdvancedText 1.1","metadata":{"contentType":"Text","license":"U","title":"Untitled Text"},"subContentId":"1353e1b6-d433-486a-856e-89f12f2241a8"},"useSeparator":"auto"}]},"library":"H5P.Column 1.15","subContentId":"1b51f374-b7b1-49fe-84e9-842a32d97fe4","metadata":{"contentType":"Column","license":"U","title":"McMaster Clinical Pharmacology Fellowship Objectives"}}],"behaviour":{"tabPlacement":"top","tabSpread":100,"colorBackground":"rgba(255, 255, 255, 0)"},"l10n":{"tab":"tab","noContent":"There is no content to be displayed."},"a11y":{"tabLsist":"Choose a tab."}}

Learning Objectives for CPT for Medical Students and Residents

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