Skip to main content

Main menu

  • Home
  • Content
    • Current issue
    • Past issues
    • Early releases
    • Collections
    • Sections
    • Blog
    • Infographics & illustrations
    • Podcasts
    • COVID-19 articles
    • Obituary notices
  • Authors & Reviewers
    • Overview for authors
    • Submission guidelines
    • Submit a manuscript
    • Forms
    • Editorial process
    • Editorial policies
    • Peer review process
    • Publication fees
    • Reprint requests
    • Open access
    • Patient engagement
  • Physicians & Subscribers
    • Benefits for Canadian physicians
    • CPD Credits for CMA Members
    • Subscribe to CMAJ Print
    • Subscription prices
    • Obituary notices
  • Alerts
    • Email alerts
    • RSS
  • JAMC
    • À propos
    • Numéro en cours
    • Archives
    • Sections
    • Abonnement
    • Alertes
    • Trousse média 2023
    • Avis de décès
  • CMAJ JOURNALS
    • CMAJ Open
    • CJS
    • JAMC
    • JPN

User menu

Search

  • Advanced search
CMAJ
  • CMAJ JOURNALS
    • CMAJ Open
    • CJS
    • JAMC
    • JPN
CMAJ

Advanced Search

  • Home
  • Content
    • Current issue
    • Past issues
    • Early releases
    • Collections
    • Sections
    • Blog
    • Infographics & illustrations
    • Podcasts
    • COVID-19 articles
    • Obituary notices
  • Authors & Reviewers
    • Overview for authors
    • Submission guidelines
    • Submit a manuscript
    • Forms
    • Editorial process
    • Editorial policies
    • Peer review process
    • Publication fees
    • Reprint requests
    • Open access
    • Patient engagement
  • Physicians & Subscribers
    • Benefits for Canadian physicians
    • CPD Credits for CMA Members
    • Subscribe to CMAJ Print
    • Subscription prices
    • Obituary notices
  • Alerts
    • Email alerts
    • RSS
  • JAMC
    • À propos
    • Numéro en cours
    • Archives
    • Sections
    • Abonnement
    • Alertes
    • Trousse média 2023
    • Avis de décès
  • Visit CMAJ on Facebook
  • Follow CMAJ on Twitter
  • Follow CMAJ on Instagram
  • Listen to CMAJ podcasts
News

Lack of pharmacological training causes overuse and misuse of drugs

Huguette Young
CMAJ January 29, 2008 178 (3) 276; DOI: https://doi.org/10.1503/cmaj.071819
Huguette Young
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Responses
  • Metrics
  • PDF
Loading
  • © 2008 Canadian Medical Association

Keeping up with the latest drugs on the market is no small feat for any doctor at the best of times.

With more than 20 000 drug products on the market in Canada, it can be overwhelming, even for physicians who are determined to remain current with the medical literature on prescription drugs.

And with more than 400 million prescriptions written every year in Canada (at a cost of $24 billion), there is ample room for error. According to Dr. Jean Gray, professor emeritus of medical education, medicine and pharmacology at Dalhousie University, problems occur “across the board” in part because physicians aren't getting adequate pharmacological training.

Family physicians and specialists alike get “into trouble” when prescribing drugs, Gray says.

Figure

Just 4 of Canada's 17 medical schools have a required course in clinical pharmacology. Image by: Photos.com

The extent of overuse, underuse or misuse of prescription drugs is, however, difficult to assess. “It exists. But whether it's getting worse or better is difficult to say,” she adds. “There's no mechanism to collect that information in Canada.”

Equally problematic, Gray says, is the fact that clinical pharmacology, a discipline that promotes safe and effective use of medicines, is not getting the attention it deserves in medical schools. It's a concern often-expressed, most recently in a highly-touted November report, Safe and Sound: Optimizing Prescribing Behaviour, in which the Health Council of Canada raised flags about prescribing practices in Canada. The report questioned whether doctors had the required training and sufficient exposure to clinical pharmacology to safely prescribe drugs.

“The concern is that people are going out in practice without a comprehensive understanding either of how drugs work or how to use them more rationally in a therapeutic situation,” says Gray.

The result can be dangerous or even deadly.

As a bare minimum, traineess should understand how drugs work, how to prescribe them, and how to monitor patients and adjust medication when “patients don't fit the mould,” Gray says.

According to the Royal College of Physicians and Surgeons of Canada, clinical pharmacology is a required course in only 4 of Canada's 17 medical schools.

However, all students and residents do receive some pharmacology training, says Dr. Deborah Danoff, the director of the college's Office of Education.

“In residency training, all trainees receive education about therapeutics, including prescription medication,” she says. “Residents are trained in reading the literature so when they go into practice, they can read about new drugs and understand the benefits and disadvantages of new drugs. … It's a required component.”

Once in practice, doctors also have to keep up to date to maintain their certification, Danoff adds.

Still, there is room for improvement. The college is in the midst of changing the rules so that residents in 5 primary disciplines — internal medicine, emergency medicine, anesthesiology, pediatrics and psychiatry — will have to take the 2-year clinical pharmacology program as a prerequisite for certification.

They'll also have to write an exam. Presently, students merely receive an attestation stating they've completed the program.

The exam will be gradually phased-in. In the fall of 2008, residents will have the choice of taking the written exam, or receiving an attestation stating they've completed the program.

But this program doesn't address concerns about physicians already in practice.

There's no way of knowing if a doctor has kept up with the literature on new drugs once he or she has been in practice for say, a decade, says Dr. Ed Schollenberg, Registrar of the College of Physicians and Surgeons of New Brunswick. Newly trained doctors “rarely come to our attention,” he says. “At our office, experience has shown there is no problem in the first 5 years.”

Problems only surface if there is a patient complaint or a random review at a doctor's office by the college. “It's passive. We wait for the phone to ring.”

The Health Council argued that academic detailing programs (CMAJ 2007; 176[4]: 429-431) are an excellent means of enhancing a physicians training. Under such programs, physicians get balanced information from an independent source during a one-on-one encounter at the doctor's office, says Dr. Michael Allen, director of the Dalhousie Academic Detailing Service. “From educational research, the indications are there is an immediate effect of 6% improvement in prescribing behavior or patient outcomes per topic.”

PreviousNext
Back to top

In this issue

Canadian Medical Association Journal: 178 (3)
CMAJ
Vol. 178, Issue 3
29 Jan 2008
  • Table of Contents
  • Index by author

Article tools

Respond to this article
Print
Download PDF
Article Alerts
To sign up for email alerts or to access your current email alerts, enter your email address below:
Email Article

Thank you for your interest in spreading the word on CMAJ.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Lack of pharmacological training causes overuse and misuse of drugs
(Your Name) has sent you a message from CMAJ
(Your Name) thought you would like to see the CMAJ web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
Lack of pharmacological training causes overuse and misuse of drugs
Huguette Young
CMAJ Jan 2008, 178 (3) 276; DOI: 10.1503/cmaj.071819

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
‍ Request Permissions
Share
Lack of pharmacological training causes overuse and misuse of drugs
Huguette Young
CMAJ Jan 2008, 178 (3) 276; DOI: 10.1503/cmaj.071819
Digg logo Reddit logo Twitter logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like

Jump to section

  • Article
  • Responses
  • Metrics
  • PDF

Related Articles

  • No related articles found.
  • PubMed
  • Google Scholar

Cited By...

  • Development and evaluation of an online medication safety module for medical students at a rural teaching hospital: the Winchester District Memorial Hospital
  • Google Scholar

More in this TOC Section

  • Saying goodbye to CMAJ News
  • How Canadian hospitals are decreasing carbon emissions
  • National survey highlights worsening primary care access
Show more News

Similar Articles

Collections

  • Topics
    • Medical education, residency, internship
    • Pharmacology & toxicology

 

View Latest Classified Ads

Content

  • Current issue
  • Past issues
  • Collections
  • Sections
  • Blog
  • Podcasts
  • Alerts
  • RSS
  • Early releases

Information for

  • Advertisers
  • Authors
  • Reviewers
  • CMA Members
  • CPD credits
  • Media
  • Reprint requests
  • Subscribers

About

  • General Information
  • Journal staff
  • Editorial Board
  • Advisory Panels
  • Governance Council
  • Journal Oversight
  • Careers
  • Contact
  • Copyright and Permissions
CMAJ Group

Copyright 2023, CMA Impact Inc. or its licensors. All rights reserved. ISSN 1488-2329 (e) 0820-3946 (p)

All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association or its subsidiaries.

To receive any of these resources in an accessible format, please contact us at CMAJ Group, 500-1410 Blair Towers Place, Ottawa ON, K1J 9B9; p: 1-888-855-2555; e: [email protected]

CMA Civility, Accessibility, Privacy

 

Powered by HighWire