Clinical Pharmacology in European health care-outcome of a questionnaire study in 31 countries.

INTRODUCTION: In order to discover how well the discipline of clinical pharmacology (CP) has developed in Europe, a questionnaire survey was undertaken in 31 countries. METHODS: The senior delegate of each of the 31 countries on the Council of the European Association for Clinical Pharmacology and Therapeutics (EACPT) was approached personally. This study was not an official EACPT survey. RESULTS: Based on the results of the completed survey forms, CP is recognized as an academic discipline in teaching and research fields in 28 of the 31 participating countries, but as a medical specialty in only 22 of these 31 countries. Surprisingly, France and Italy were two of the nine countries where CP was not recognized as a medical specialty. In 50 % of the countries where CP was recognized as a medical specialty, this recognition had occurred more than 30 years ago. The training of clinical pharmacologists in terms of years after internship varied between the countries. In eight countries the training was predominantly in internal medicine with shorter periods in pharmacology. In 11 countries the training was predominantly in CP, and in six countries there was dual training in pharmacology and clinical medicine. The training played a decisive role in terms of the clinical functions undertaken in health care. There was considerable variation in the numbers of clinical pharmacologists in each country, with the total figure varying between ≤ 10 to 600. In terms of the number of clinical pharmacologists per million inhabitants, nine countries have ≤ 1 (Belgium, Bulgaria, France, Greece, Italy, Lithuania, Poland, Turkey and UK) while four have ≥ 10 (Hungary, Norway, Slovakia and Sweden). Stumbling blocks which inhibit the development of CP as a discipline in health care are the lack of defined functions and consultant posts for clinical pharmacologists in health care in many countries and the underrepresentation of CP in pre- and postgraduate curricula. CONCLUSION: The majority of the responding countries suggested that EACPT should prioritize that CP becomes recognized and accredited as a European medical specialty.

Efforts and success world-wide in the field of clinical pharmacology. A personal review on the occasion of Folke Sjöqvist's 80th birthday.

In this personal review I describe my early expectations and experiences when I first came to work with Prof. Folke Sjöqvist as a training fellow in the early 1970s. At that time Prof. Sjöqvist and his unit had already earned an international reputation, and in the following decades this success has been magnified many times. Although a description of the research performed by Prof. Sjöqvist during his long career is not the main objective of this article, it is clear that the research carried out in his unit has been instrumental in the development of his international reputation. Over an 18-year period from 1994 onwards, some 272 papers bearing the name of Folke Sjöqvist have been cited over 13,000 times, with an average of over 50 citations per paper. In terms of training clinical pharmacologists from around the world, at the last count 112 individuals from 37 different countries have received a substantial part of their training in his unit. As another measure of his world-wide success, 33 individuals from 18 different countries who received a substantial part of their training in his unit between 1968 and 1996 have gone on to become professors of clinical pharmacology. Prof. Sjöqvist has been requested to consult on various aspects of clinical pharmacology in 15 different countries, from Russia to Spain and from Egypt to Latvia. Here I describe the long-term involvement that Prof. Sjöqvist has had with IUPHAR (now the International Union of Basic and Clinical Pharmacology) and with institutions such as the World Health Organisation (WHO). In particular, I recount his role in the long-term saga involved in updating the original WHO manifesto on clinical pharmacology published in 1970 up to the eventual success of the new manifesto published by WHO in 2012. Finally, I briefly describe the international honours that have been bestowed on Prof. Sjöqvist, including various prizes, designated lectureships and honorary Doctorates (5). Taken together, these honours provide a magnificent measure of Prof. Sjöqvist's world wide-success-a success that has been emulated by very few clinical pharmacologists.

Educating European (junior) doctors for safe prescribing.

Evidence of poor prescribing is widespread including overuse of medicines, underuse of effective medicines, avoidable adverse drug reactions and medication errors. Junior doctors who have recently graduated are responsible for much of the prescribing that takes place in hospitals and are implicated in many of the adverse medication events. Analysis of such events suggests that lack of knowledge and training underlies many of them and it has been shown that dedicated training can increase prescribing performance. In the context of these problems, it is a matter of increasing concern that recent changes to undergraduate medical education may have reduced exposure to clinical pharmacology, a discipline dedicated to optimal practice in relation to medicines. For this reason, the European Association of Clinical Pharmacology and Therapeutics (EACPT) and British Pharmacological Society (BPS) jointly organized a meeting to explore (i) the state of undergraduate education in clinical pharmacology in Europe, (ii) the knowledge and competencies in relation to medicines that should be expected of a new graduate, (iii) assessments that might demonstrate that this minimum standard had been reached, (iv) a curriculum that might help medical students to achieve this standard and (v) how competence can be developed in the postgraduate phase. It was agreed that the lack of exposure to clinical pharmacology is a cause for concern at a time when the challenges facing junior prescribers have never been greater. The potential for undertaking further research was discussed.

Clinical pharmacology education in Europe: undergraduate through postgraduate to continuing professional development.

Education and training in clinical pharmacology and therapeutics (CPT) has undergone many changes over the last decade. Most of these changes have been driven by changes to the general medical curriculum that primarily affects undergraduates but impacts into the postgraduate and the continuing medical educations areas. Some of the changes that have taken place are described in this article and suggestions are made to make sure that the quality of education in CPT is sustained, and if possible improved.

Towards a core curriculum in clinical pharmacology for undergraduate medical students in Europe.

Undergraduate medical education has been under the spotlight for many years in Europe. In the United Kingdom the General Medical Council, which validates the final medical examination in all UK Medical Schools, has been trying to influence the curriculum for at least the last 50 years. Following their publication of the document "Tomorrow's Doctors" in 1993 many medical schools in the UK have completely changed their curriculum design away from didactic learning and towards an integrated problem-orientated or problem-based approach. There has been concern that, as the process continues, some of the more traditional learning of pharmacology and clinical pharmacology may be lost with nothing to replace it. This manuscript describe two ways of developing a core curriculum for clinical pharmacology. The first uses a drug orientated approach (almost an essential drug list) where drugs are listed according to whether they are essential for students to know about with just over 120 chemical entities; and a shorter list of drugs that students would be expected to know about but not know in any detail. The second approach is a disease-orientated one with three types of disease process: a list of 67 disease states that students must know how to manage (category M), a list of 158 diseases that students must be able to diagnose (category D) and a list of 36 diseases that students should be aware of. The disease orientated approach, though designed in one EU country (the UK) has been field tested in a second (Germany) with little difficulty in transfer.