Postgraduate (clinical) pharmacology curriculum: A balancing act.

Sir,

The proposed draft pharmacology curriculum for medical postgraduates in India is indeed a welcome move which was long overdue.[1] The changes seem to be largely driven by the need to improve medical education, accommodate the ethical concerns regarding animal experimentation, and the practical need to equip the new pharmacologists with knowledge relevant to their future careers. In particular, the emphasis on inclusion of more of clinical aspects (clinical postings, case-based learning, interdepartmental symposia, patient-centric teaching, etc.) is a significant step forward. While some of these are already being practiced in some institutions, the draft proposal serves to provide a roadmap ensuring uniformity and importantly, incorporate these as a part of student assessment. The difficulty in designing a well-structured curriculum in clinical pharmacology is partly explained by the following statement by JW Black – ”Gradually the traditional departments, which have organized biomedical research and teaching for most of this century, are disappearing into larger, anonymous biological condominiums. Pharmacology departments have been a prominent casualty. Pharmacology, and particularly clinical pharmacology, seems to me to be in the throes of an identity crisis.”[2] Indeed this dilution of borders is the source of a basic question asked by many nonpharmacologists, and young pharmacologists-What do pharmacologists do? In reply to the question “What is pharmacology?” Sir John Gaddum famously replied, “Pharmacology is what pharmacologists do.”[3] Interestingly, JK Aronson, President Emeritus of the British Pharmacological Society, conducted a survey in 2012 on “What do clinical pharmacologists do?” in the United Kingdom.[4] To be clear, those with a MD Pharmacology degree are clinical pharmacologists and hence, a pharmacology curriculum (particularly the currently practiced pharmacology practicals) largely divorced from the “clinical” aspect would hardly justify the degree. Aronson's survey revealed five broad responsibilities for a clinical pharmacologist– teaching, research, clinical work, policy and administration, editorial work and writing with 70% of the time being spent on research and clinical work.[45] Assuming that the same would be broadly applicable to clinical pharmacologists in India, a balanced approach is necessary to train the pharmacologist in each of these responsibilities. Relating this to the current draft postgraduate curriculum, one does find each of the five aspects being addressed. The challenge now is to design and develop the individual components for each learning domain in a way that ensures reasonable uniformity and is subjected to proper assessment methods.

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