If you don’t value your time, then don’t bother reading on. If you value your time and want to get the most out of your course, then continue readingFaheem Ahmed award-winning pharmacist prescriber
If only I knew
Plan. Plan and plan. That is the recipe for success. The same advice will apply here, and I will explain to you what you need to consider; aren’t you lucky?
Anatomy & physiology
The biggest mistake I made was not realizing the prescribing course would not teach me the clinical skills I needed to diagnose and treat disease. So instead, I learned the long way; by the way, if you’re wondering how long the answer is 4 years.
So, you need to start developing your basic understanding of clinical anatomy and physiology. I say clinical because you do not need to know the human body inside out (although it would be helpful). A book that I found useful and recommended to my students when teaching is Anatomy and physiology made incredibly easy.
The term clinical skills can mean a range of different things to different people. To clarify, what I mean by clinical skills is being able to take a thorough patient history, examine the body systems and apply the information to diagnose a patient.
Before undertaking my prescribing qualification, I took patient histories and diagnosed patients as best as possible, but it was more geared towards ‘symptoms in a pharmacy’ or over-the-counter prescribing. For example, I would use the acronym ‘WWHAM’ to gather information about the history of the patient complaints, which I have come to realize has some severe limitations. I also never really had a set structure with taking patient records and what was worse was that I could not examine the body systems. In all fairness, even if I did know how to examine the body systems I wouldn’t have known what to do with the information.
The above leads me to the most critical point, and that is being able to apply your knowledge. Before beginning the prescribing course, you need to take patient histories, which should allow you to figure out likely causes of the patient symptoms, i.e., differential diagnosis. Your physical examination should then provide information to decipher your list of potential causes to nail a diagnosis.
So, you might be wondering how I can learn this all. Well, I suggest developing your history taking and physical examination skills read either Macleods Physical Examination or Bates physical examination; both are useful but require you to understand anatomy and some physiology. Lastly, any book on internal medicine such as Harrison’s internal medicine will help you with the application of your histories.
The course itself
Right. So far, you should understand that you need to develop basic human body science (i.e., anatomy and physiology) and clinical skills. Assuming you appreciate this pre-requisite, you are now ready to learn how to get the most out of the actual course itself. So let us get right into it.
Okay. So the course is 6 months and trust me this will fly by. You will have a series of lectures, assignments, portfolio, exams, and supervision sessions with your designated prescribing practitioner to complete during the course. If you were like me and struggle with timekeeping then the 6 months will be horrible. So I would suggest you dedicate 30 minutes a day over 6 months to all paperwork-related requirements of the course and you will not go wrong. If you do not do this, I can promise you, you will struggle or panic at some point like I did and end up gaining a lot of weight due to stress.
So stay consistent and manage your time. It’s only 30 minutes a day, and you are good to go.
The academic stuff
For some reason (I don’t know why), but many students struggle with the academic side of things during the course. Now I certainly did. This may be because this course may be the only academic study we have done after university, and we’re slightly out of touch for some of us. If you are unsure about any of the academic requirements, speak with the tutors and ask for their help. Do not do what I did and assume things. Just simply ask the tutors for help, and they will help.
Regarding the portfolio itself, essentially, this component requires you to demonstrate that you have met the RPS Competency Framework For Prescribers. So what you have to do is read the standards and evidence how you meet the criteria. I will be talking about this in more depth in a future article, but the example below will shed some light.
The RPS standard
1.1 Takes an appropriate medical, social, and medication history, including allergies and intolerances.
Student evidence to demonstrate they meet the standard
Please refer to the Cambridge and Calgary template I have developed for undertaking hypertension reviews. The template is comprehensive and covers all aspects of history taking.
Time with Designated prescribing practitioner (DPP)
The time you spend with your DPP can make a difference. The key here is to have a structure in place.
If you’re reading this and you think the DPP is there to ‘teach’ and provide you with a structure, then think again. The DPP is merely there to facilitate your learning and provide a safe environment to enhance and further practice your EXISTING skills.
Please don’t underestimate the role of the DPP. However, ultimately, in my opinion, it’s unreasonable to expect in 90 hours to be taught anything, let alone master medicine.
As such, I would suggest from the outset you identify your learning needs as part of a learning contract examples of which include;
- I would like to be able to assess and consult with patients effectively,
- understand and apply relevant legislation to the practice of a pharmacist prescribing,
- understand and apply existing and new knowledge of pharmacology in my prescribing practice area of expertise, etc.
Once you identified your learning needs, then think about how you intend to meet these needs. Think of activities that you could do to help you. Let’s take an example of the following learning need;
To be able to assess and consult with patients effectively.
Right. To be able to meet the above need, you may consider the following;
- developing a template or checklist to ensure you always approach a patient history in a structured way,
- undertake patient examinations under the supervision of the DPP,
- regular case-based discussions with the DPP and DPP feedback to identify areas you are doing well and where you need to improve, etc
As you may have gathered from the above, there are plenty of opportunities to learn and practice if you have the existing skills. Otherwise, if you planning to learn ‘on the job’, it may take 4 years after you gain your qualification.
Books and summary
Personally, I never read many books during the course itself. However, if you did want some help regarding legal aspects of prescribing (sometimes they like to ask questions on this in exams), then a reference book on non-medical prescribing may be helpful, such as the Textbook of Non-Medical Prescribing by Dilyse Nuttall, Jane Rutt.
Wow. So if I was to wrap this up and keep it short and sweet, my advice would be for you to develop your clinical skills first, have a clear understanding of your learning needs and structure your learning. If you follow these, you can not go wrong.