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Curriculum standards

Entrustable Professional Activities

LG10: Prescribing

Prescribing 10

Prescribing

Prescribe and deprescribe therapies tailored to patients’ needs and conditions

This activity requires the ability to:

  • accurately obtain and interpret medication histories, including non-prescription medications (considering the use of native traditional treatments, such as Rongoā Māori) and herbal / natural preparations
  • take complete histories of allergies and prior medication adverse effects
  • choose appropriate medications based on an understanding of pharmacological principles, taking into consideration patients’ age, comorbidities, out-of-pocket cost, possible adverse effects, potential drug interactions, and projected benefit
  • communicate effectively with patients, families and/or carers about the benefits and relevant risks of prescribing proposed therapies, as well as the rationale for deprescribing, considering their beliefs, past experiences and thoughts on their medications
  • provide clear instructions on medication administration, desired / predicted effects, and potential adverse effects
  • monitor for medication efficacy and safety
  • review medications regularly, and assess for potential interactions
  • collaborate effectively with pharmacists
  • promote medication adherence, and work with patients to develop strategies to improve medication adherence

Professional practice framework domain

Medical expertise

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

  • identify patients’ conditions that require therapy
  • consider evidence-based non-pharmacologic therapies where appropriate
  • where robust evidence is lacking, use expert peer advice to help guide practice
  • consider age, allergies, chronic disease status, lifestyle factors, patients’ preference, and potential drug interactions prior to prescribing new medications
  • consider oral and once daily medications to improve ease of administration and adherence
  • consider importance of timing on medication prescription
  • review necessity of all medications and the evidence base for their continued use in individual patients
  • recognise the difference between medication effect and class effect, and the nuances of pharmacological properties of medications within a single class
  • recognise the prescribing cascade, and work to avoid occurrence of same in individual patients
  • use a recognised framework, including consideration of the culturally appropriate models of health and wellbeing, for deprescribing medications in line with patient-negotiated goals of care, expected illness trajectory, and medication safety concerns
  • recognise and manage toxidromes and the effects of medication overdose
  • use national and local guidelines on appropriate and safe prescribing
  • actively evaluate medication efficacy during follow-up
  • use therapeutic drug levels appropriately where indicated, and demonstrate the ability to interpret these results
  • identify clinically significant medication interactions or contraindications, and take active steps to address these, including deprescribing when appropriate

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

  • be aware of potential side effects and practical prescription points, such as medication compatibility and monitoring in response to therapies
  • select medicines for common conditions appropriately, safely, and accurately
  • demonstrate understanding of the benefits, contraindications, dosage, drug interactions, rationale, risks, and side effects
  • identify and manage adverse events

Communication

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

  • discuss and evaluate the risks, benefits, and rationale of treatment options, making decisions in partnership with patients
  • discuss medication adherence in a non-judgemental way to identify barriers and develop strategies to overcome them in collaboration with patients
  • ask patients about possible medication side effects at each consultation
  • explore patients’ understanding of and preferences for non-pharmacological and pharmacological management
  • write clear and legible prescriptions, including the anticipated duration of therapy and indication, using generic medication names unless there are known brand-specific medication properties to consider
  • educate patients about the intended use, expected outcomes, and potential side effects for each prescribed medication to improve patients’ adherence to pharmacotherapy
  • describe how the medication should and should not be administered, including any important relationships to food, time of day, and other medicines being taken
  • ensure patients understand prescribing details, including when to return for monitoring and whether therapy continues after a single prescription
  • supply specific medication instructions in legible written form using plain language
  • identify patients’ concerns and expectations, and explain how medicines might affect their everyday lives
  • assess patients’ readiness for deprescribing and negotiate agreed deprescribing plans, including monitoring for return of symptoms and weaning where appropriate
  • communicate with other health professionals to ensure safe use of pharmacological therapy, particularly around transitions of care
  • encourage and support patient self-determination and management
  • offer patients effective choices based on their expectations of treatment, past experiences of pharmacological treatment, health beliefs, and cost
  • check quality and accuracy of reports or documentation generated by others and technologies, including artificial intelligence-informed large language models
  • tailor information provided to patients dependent on their health literacy
  • ensure appropriate information is available at all steps of the medicine management pathway

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

  • discuss and explain the rationale for treatment options with patients, families, or carers
  • explain the benefits and burdens of therapies, considering patients’ individual circumstances
  • write clearly legible scripts or charts using generic names of the required medication in full, including mg / kg / dose information and all legally required information
  • seek further advice from experienced clinicians and/or clinical pharmacists when appropriate

Quality and safety

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

  • clearly document all patient allergies and the clinical manifestation using designated systems
  • clearly document any suspected or confirmed medication side effects, and categorise severity using designated systems
  • clarify and update patients’ medication lists, including accurate dosages, at each review, to minimise prescribing errors
  • actively assess for medication efficacy and side effects
  • actively assess patients’ adherence to prescribed therapies
  • use electronic prescribing tools where available, and access electronic drug references to minimise errors caused by drug interactions and poor handwriting
  • use generic medication names except in specific circumstances
  • substitute new medicines only when they have been demonstrated to be safer or more effective at achieving patient-oriented outcomes than existing medicines
  • participate in clinical audits to improve prescribing behaviour and/or equity, including an approach to polypharmacy, prescribing cascade and access to medication in varied communities
  • report suspected adverse events to the Advisory Committee on Medicines, and record it in patients’ medical records

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

  • check the dose before prescribing
  • monitor side effects of medicines prescribed
  • identify medication errors and institute appropriate measures
  • use electronic prescribing systems safely
  • rationalise medicines to avoid polypharmacy
  • use a state-based registry or equivalent local systems to monitor for prescription of Section 8 medications

Teaching and learning

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

  • ensure patients understand management plans and health benefits of adhering to therapeutic recommendations
  • use appropriate guidelines and evidence-based medicine resources to maintain a working knowledge of current medicines, keeping up to date on new medicines
  • use continuously updated software for computers and electronic prescribing programs

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

  • undertake continuing professional development to maintain currency with prescribing guidelines
  • reflect on prescribing, and seek feedback from a supervisor

Research

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

  • critically appraise research material to inform optimal medication prescribing, ensuring the use of the most efficacious, best tolerated therapy that achieves patient-oriented outcomes, including equitable resource use / distribution
  • use sources of independent information about medicines that provide accurate summaries of the available evidence on new medicines

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

  • make therapeutic decisions according to the best evidence
  • recognise where evidence is limited, compromised, or subject to bias or conflict of interest

Cultural safety

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

  • explain how cultural knowledge such as Mātauranga Māori and non-Western therapies may be used in parallel, such as Rongoā Māori and bush medicine
  • explain differences in health beliefs, acceptability of pharmacologic therapy, and treatment expectations
  • identify factors influencing adherence to treatment, such as competing family / community demands, concern about the safety of medication in the house, periods spent away from home without access, past experiences of pharmacological treatment, health beliefs, and perceived side effects
  • identify systemic factors that potentially affect adherence to treatments and trust, such as racism and the impact of colonisation

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

  • consider patients’ cultural and religious backgrounds, attitudes, and beliefs, and how these might influence the acceptability of pharmacological and non-pharmacological management approaches

Ethics and professional behaviour

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

  • provide information to patients about:
    • how to take the medicine
    • potential side effects
    • what the medicine does
    • what the medicine is for
    • when it should be stopped
  • make prescribing decisions based on robust clinical data, demonstrating the high likelihood of benefit and acceptably low risk as these relate to individual patient-oriented outcomes
  • recognise the ethical implications of pharmaceutical industry-funded research and marketing
  • communicate directly with medical colleagues when proposing changes to pharmacologic therapies that fall specifically within their area of specialty practice

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

  • consider the efficacy of medicines in treating illnesses, including the relative merits of different non-pharmacological and pharmacological approaches
  • follow regulatory and legal requirements and limitations regarding prescribing
  • follow organisational policies regarding pharmaceutical representative visits and drug marketing

Judgement and decision making

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

  • use a systematic, evidence-based approach to select treatment options
  • implement non-pharmacological therapies when these have been proven to be safe and effective, and where this is practical / feasible
  • introduce medication therapy when non-pharmacological measures have failed or are not feasible
  • use medicines safely and effectively to get the best possible results with the lowest possible risk and cost to patients
  • prescribe medicines appropriately to patients’ clinical needs, in doses that meet their individual requirements, for a sufficient length of time, with the lowest cost to them
  • evaluate new medicines in relation to their demonstrated efficacy and safety profile, and how this might apply to individual patients’ care

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

  • recognise personal limitations and seek help in an appropriate way when required
  • consider the following factors for all medicines:
    • contraindications
    • cost to patients, families, and the community
    • funding and regulatory considerations
    • generic versus brand medicines
    • interactions
    • risk-benefit analysis

Leadership, management, and teamwork

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

  • work collaboratively with medical, pharmacy, nursing staff, and other health providers to ensure safe and effective medicine use
  • collaborate with treating specialists to best manage patient care with the most rational use of pharmacotherapy

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

  • work collaboratively with pharmacists
  • participate in medication safety and morbidity and mortality meetings

Health policy, systems, and advocacy

confident
Ready to perform without supervision

Expected behaviours of a trainee who can routinely perform this activity without needing supervision

The trainee will:

  • choose medicines based on comparative efficacy, safety, and cost-effectiveness against medicines already on the market
  • consider equitable use of limited resources within the healthcare system to inform judicious prescribing habits, including communities who have not had previous access to specific medications
  • be familiar with institutional support frameworks and options when advocating for patients or disadvantaged populations
  • identify and address equity determinants as they pertain to prescribing
  • apply understanding of the prescription of medications within the Pharmaceutical Benefits Scheme or PHARMAC / special authority, both within the hospital system and the non-hospital setting, including when specific criteria / prescribing permissions apply

direction
Requires some supervision

Possible behaviours of a trainee who needs some supervision to perform this activity

The trainee may:

  • prescribe in accordance with the organisational policy