Authors
Bakkum, M.J1,2. (0000-0003-0928-812X); Richir,
M.C1,2; van Agtmael, M.A.1,2((0000-0002-7966-6934) and Tichelaar J1,2.
(0000-0002-7485-9219) on behalf of the EurOP2E
consortium
Author’s affiliations1. Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Internal
Medicine, Section Pharmacotherapy, De Boelelaan 1117, 1081 HV,
Amsterdam, Netherlands
2. Research and Expertise Centre in Pharmacotherapy Education (RECIPE),
De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
Main text (word count 741/800)
We read the invited review on sustainable medicines use in clinical
practice by Adeyeye et al[1] and would like to congratulate the
authors with the captivating way in which they used scientific facts
combined with very practical solutions to convey their call to action.
This call is primarily addressed to the NHS, which the authors suspect
will resonate with other health systems. While we fully agree with
necessity of this top-down approach, we additionally believe that there
is much to be gained by making future prescribers more knowledgeable and
aware about the impact they have on planetary health. The article
remains very brief about next generation of healthcare professionals by
quoting the General Medical Council’s statement that “newly qualified
doctors must be able to apply the principles, methods and knowledge of
population health and the improvement of health and sustainable
healthcare to medical practice“[2]. However, the underlying
question - how we effectively train future healthcare professionals in
these attitudes underpinned by knowledge – is not addressed.
The Association for Medical Education in Europe’s (AMEE) recent
consensus statement provides a clear global, collaborative,
representative and inclusive vision on how to educate an
interprofessional workforce that can provide sustainable healthcare and
promote planetary health[3]. One of the cornerstones in enacting
this vision is via faculty engagement and development, and it is here
that we foresee difficulties for sustainable clinical pharmacology and
therapeutics (CPT) education. CPT teachers often have to balance their
teaching tasks with clinical duties and in many countries there is a
shortage of clinical pharmacologists. To incorporate sustainable
prescribing in their teaching is something that most teachers simply do
not have time for and even if they have the time, they may feel that
there are more urgent improvements to be made. Many have stated intend
to progress to more problem-based curricula, but recent surveys show
that this transition is slow at best[4, 5]. Moreover, the (mostly
generation X or older) teachers may not be as invested in the issues of
planetary health as the current (generation Y and Z) young doctors and
students and they may not feel confident that they have the expertise to
teach about it[6].
If we want large numbers of students to learn about sustainable
prescribing, it is of utmost importance to make the job of the teacher
as easy as virtually possible. That means not expecting everyone to
single-handedly invent the wheel, but to collaboratively create
standpoints, teaching materials and faculty development (or “teach the
teacher”) materials and to share them openly. That is free (without
cost or copyright restrictions) and easy to re-use, revise (e.g. to
local standards if necessary) and redistribute (e.g. local versions,
improvements or translations). This is the goal of the European Open
Platform for Prescribing Education (EurOP2E). Aimed at
improving and harmonizing international CPT education,
EurOP2E is an online environment for CPT teachers to
collaborate and to share and create open educational resources. The
framework for the platform was recently published[7], and it is set
to go live in early 2022. Alike the call to action towards the NHS, we
hereby make an appeal for teachers in CPT to join the
EurOP2E network, and for those who are invested in
sustainable prescribing to collaboratively create open educational
resources about this
(www.prescribingeducation.eu).
Planetary health should be a cross-cutting theme throughout the whole of
medical education
(ref).
Within medical education, prescribing is likely to have the most impact,
as human pharmaceuticals not only account for an estimated 25% of all
medical greenhouse gas emissions, but also exert direct ecotoxicological
effects via sewage systems[8]. Moreover, prescribers may directly
influence their environmental impact through individual treatment
decisions. Therefore, while any ready-to-use teaching materials will
provide a welcome start, planetary health must be incorporated in the
basics of pharmacotherapy education. The six-step model of the WHO guide
to good prescribing and the accompanying teacher’s guide to good
prescribing are currently under revision[9]. Aside from
pharmaceutical advances, globalization of information and digitization
of both the prescribing process and medical education, the revision will
include sustainable medicines use. We expect that specifically step 3(b)
of the six-step process – to verify the suitability of a (standard)
treatment and adapt it to the individual needs of a patient – will be
updated so that prescribers learn to take the environmental impact of
their treatment decisions into account. The exact nature of the update
will be decided in a consensus meeting with its users, interested
readers are welcome to apply via
http://www.guidetogoodprescribing.org.