One of the key aims of the undergraduate curriculum is to make you all safe prescribers. Medicine management is therefore an important thread throughout all the years, and the clinical placements across the 5 years will allow you to learn about the drugs that you are most likely to use as pre-registration (F1) house officers, building on what you have learnt in pharmacology and therapeutic teaching sessions at the university.

We know that it can be a daunting task and we have devised the following guidance to help you develop your own personal student formulary. There are many hundreds of drugs are available, and it is clearly not possible for the F1 to have in-depth knowledge of all of them. There are however about 100 drugs used commonly in both primary and secondary care which have been used to develop the student formulary. We have categorized drugs into three categories (E, B, and S) in order to guide students about how much they need to learn about particular drugs.

Red flag drugs marked by ▼ are those where strong emphasis should be given to teaching and learning (pharmacology, administration, routes, interactions, monitoring) as they are the medicines most associated with severe harm across the NHS. These include blood products, intravenous fluids, antibiotics, analgesics (including opiates), insulins and anticoagulants/anti-thrombotics. Students will be expected to pay particular attention to red flag drugs in relation to wider contexts around prescribing procedures, patient evaluation and safety.

Prescribing Safety Assessment (PSA)

From 1 August 2016 all new F1 doctors will be required to pass the national Prescribing Safety Assessment exam (PSA). You will be given further information closer to the time during year 5. It is designed to enable students to demonstrate competencies in relation to the safe and effective use of medicines. You are extensively assessed in all aspects of prescribing throughout the course so if you have engaged well with this and your personal drug profiles, the PSA should provide no additional burden.

Drug Categories

To start off your knowledge of medicines we ask you to look at over the counter medications in year 1. You will then learn about emergency drugs (E) in year 2 along with knowledge of the analgesic ladder and some common antibiotics. In year 3 you will widen your knowledge by looking at some of the drugs that we have named ‘basic drugs’ (B). In your last 2 years you will build up to looking at some of the more specialist drugs (S) during your specialist placements so that you should feel well prepared to prescribe as an F1.

• Category E (emergency drugs)

The F1 should know the indications, doses, and routes of administration of Category E drugs when they are used in an emergency. This refers to life-threatening conditions in which the drug has to be given immediately and when the F1 may not have time to check with colleagues or textbooks.

You will start to learn about some of these drugs on placement in year 2 when you cover about how to manage emergencies. This will then be built on in the subsequent years until by the end of year 4 you should have an in depth knowledge of all of these medications. Some of these drugs will also be included in Category B, but for indications outside of emergencies.

• Category B (basic drugs)

The F1 should have sufficient knowledge of a Category B drug to be able to prescribe it safely, usually when requested to do so by a colleague, but also occasionally (and only in an emergency) on their own. The F1 should be aware of important contraindications, adverse effects, and interactions, and should be able to institute the appropriate monitoring for benefit and harm and adjust the dose accordingly. In the event of uncertainty, the F1 would be expected to check with senior colleagues or drug information sources.

By the end of year 4 the clinical student would be expected to know about these drugs in detail, their main indications, their important contraindications, their adverse effects, important drug interactions, the effects of renal and liver failure on their use, and how to monitor therapy.

• Category S (specialist drugs)

The F1 would not be expected to initiate a prescription for a Category S drug, but should recognise its name and class and be aware of the main indications for its use. You may have to prescribe these drugs for patients already taking them in hospital or primary care. Before continuing a prescription for this drug, the F1 would be expected to consult a senior or specialist colleague, as well as other drug information reference sources (especially the BNF). This class will also contain drugs that a F1 will not have heard of; in that case the same principles apply. For the purposes of the 4th and 5th year examinations the clinical student would usually not be examined in depth about these drugs but would be expected to have a passing knowledge of these. Some specialty ICU leads may require a more in depth knowledge of certain specialist drugs in year 4 but will clearly signpost this during your ICU placement.

Drug Profiles

To help develop your own student formulary we would like you to complete the following drug profile sheets. Some of the information that you need for these will be obtained during central teaching sessions, some on clinical placement and some during self-directed learning time.

You may want to consider getting together with other students, learning about different medicines and sharing your knowledge, or arranging for some of the drugs to be discussed as part of tutorials during your clinical attachments. If you look at the drug chart or the prescription for a patient you will find that the same drugs appear frequently, you will see that these are the drugs that we have tried to concentrate on for our student formulary.