Clinical Pharmacology and Therapeutic (CPT) with General Internal Medicine (GIM) CESR Portfolio Guide

• Aware of, and adheres to, the GMC professional requirements
• Aware of public health issues including population health, social determinants of health and global health perspectives
• Demonstrates effective clinical leadership
• Demonstrates promotion of an open and transparent culture
• Keeps up to date through learning and teaching
• Demonstrates engagement in career planning
• Demonstrates capabilities in dealing with complexity and uncertainty
• Aware of the role and processes for commissioning
• Aware of the need to use resources wisely

• Aware of national legislation and legal responsibilities, including safeguarding vulnerable groups
• Behaves in accordance with ethical and legal requirements
• Demonstrates ability to offer apology or explanation when appropriate
• Demonstrate ability to lead the clinical team in ensuring that ethical and legal factors are considered openly and consistently

• Communicates clearly with patients and carers in a variety of settings
• Communicates effectively with clinical and other professional colleagues
• Identifies and manages barriers to communication (e.g. cognitive impairment, speech and hearing problems, capacity issues)
• Demonstrates effective consultation skills including effective verbal and non-verbal interpersonal skills
• Shares decision making by informing the patient, prioritising the patient’s goals and wishes, and respecting the patient’s beliefs, concerns and expectations
• Shares decision making with children and young people
• Applies management and team working skills appropriately, including influencing, negotiating, re-assessing priorities and effectively managing complex, dynamic situations

• Makes patient safety a priority in clinical practice
• Raises and escalates concerns where there is an issue with patient safety or quality of care
• Demonstrates commitment to learning from patient safety investigations and complaints
• Shares good practice appropriately
• Contributes to and delivers quality improvement
• Understands basic Human Factors principles and practice at individual, team, organisational and system levels
• Understands the importance of non-technical skills and crisis resource management
• Recognises and works within limit of personal competence
• Avoids organising unnecessary investigations or prescribing poorly evidenced treatments

• Manages clinical information / data appropriately
• Understands principles of research and academic writing
• Demonstrates ability to carry out critical appraisal of the literature
• Understands the role of evidence in clinical practice and demonstrates shared decision making with patients
• Understands public health epidemiology and global health patterns
• Demonstrates appropriate knowledge of research methods, including qualitative and quantitative approaches in scientific enquiry
• Demonstrates appropriate knowledge of research principles and concepts and the translation of research into practice
• Follows guidelines on ethical conduct in research and consent for research
• Recognises potential of applied informatics, genomics, stratified risk and personalised medicine and seeks advice for patient benefit when appropriate

• Delivers effective teaching and training to medical students, junior doctors and other healthcare professionals
• Delivers effective feedback with action plan
• Able to supervise less experienced trainees in their clinical assessment and management of patients
• Able to supervise less experienced trainees in carrying out appropriate practical procedures
• Able to act as a clinical supervisor to doctors in earlier stages of training

• Demonstrates professional behaviour with regard to patients, carers, colleagues and others
• Delivers patient centred care including shared decision making
• Takes a relevant patient history including patient symptoms, concerns, priorities and preferences
• Performs accurate clinical examinations
• Shows appropriate clinical reasoning by analysing physical and psychological findings
• Formulates an appropriate differential diagnosis
• Formulates an appropriate diagnostic and management plan, taking into account patient preferences, and the urgency required
• Explains clinical reasoning behind diagnostic and clinical management decisions to patients/carers/guardians and other colleagues
• Appropriately selects, manages and interprets investigations
• Recognises need to liaise with specialty services and refers where appropriate

• Able to manage patients who have been referred acutely to a specialised medical service as opposed to the acute unselected take
• Demonstrates professional behaviour with regard to patients, carers, colleagues and others
• Delivers patient centred care including shared decision making
• Takes a relevant patient history including patient symptoms, concerns, priorities and preferences
• Performs accurate clinical examinations
• Shows appropriate clinical reasoning by analysing physical and psychological findings
• Formulates an appropriate differential diagnosis
• Formulates an appropriate diagnostic and management plan, taking into account patient preferences, and the urgency required
• Explains clinical reasoning behind diagnostic and clinical management decisions to patients/carers/guardians and other colleagues
• Appropriately selects, manages and interprets investigations
• Demonstrates appropriate continuing management of acute medical illness in a medical specialty setting
• Refers patients appropriately to other specialties as required

• Demonstrates professional behaviour with regard to patients, carers, colleagues and others
• Delivers patient centred care including shared decision making
• Demonstrates effective consultation skills
• Formulates an appropriate diagnostic and management plan, taking into account patient preferences, and the urgency required
• Explains clinical reasoning behind diagnostic and clinical management decisions to patients/carers/guardians and other colleagues
• Demonstrates appropriate continuing management of acute medical illness inpatients admitted to hospital on an acute unselected take or selected take
• Recognises need to liaise with specialty services and refers where appropriate
• Appropriately manages comorbidities in medial inpatients
• Demonstrates awareness of the quality of patient experience

• Demonstrates professional behaviour with regard to patients, carers, colleagues and others
• Delivers patient centred care including shared decision making
• Demonstrates effective consultation skills
• Formulates an appropriate diagnostic and management plan, taking into account patient preferences
• Explains clinical reasoning behind diagnostic and clinical management decisions to patients/carers/guardians and other colleagues
• Appropriately manages comorbidities in outpatient clinic, ambulatory or community setting
• Demonstrates awareness of the quality of patient experience

• Demonstrates effective consultation skills (including when in challenging circumstances)
• Demonstrates management of medical problems in inpatients under the care of other specialties
• Demonstrates appropriate and timely liaison with other medical specialty services when required

• Applies management and team working skills appropriately, including influencing, negotiating, continuously re-assessing priorities and effectively managing complex, dynamic situations
• Identifies appropriate discharge plan
• Ensures continuity and coordination of patient care through the appropriate transfer of information demonstrating safe and effective handover
• Effectively estimates length of stay
• Delivers patient centred care including shared decision making
• Recognises the importance of prompt and accurate information sharing with primary care team following hospital discharge

• Demonstrates prompt assessment of the acutely deteriorating patient, including those who are shocked or unconscious
• Demonstrates the professional requirements and knowledge of legal processes associated with consent for resuscitation
• Participates effectively in decision making with regard to resuscitation decisions, including decisions not to attempt CPR, and involves patients and their families
• Demonstrates competence in carrying out resuscitation

• Identifies patients with limited reversibility of their medical condition and determines palliative and end of life care needs
• Identifies the dying patient and develops an individualised care plan, including anticipatory prescribing at end of life
• Demonstrates effective consultation skills in challenging circumstances
• Demonstrates safe and effective use of syringe pumps in the palliative care population
• Able to manage non complex symptom control including pain
• Facilitates referrals to specialist palliative care across all settings
• Demonstrates compassionate professional behaviour and clinical judgement

• Able to define the factors that determine the benefit to harm balance in therapeutic interventions
• Able to define, identify, classify, investigate and manage adverse drug reactions appropriately
• Able to explain the role of pharmacovigilance including post Market Authorisation surveillance and reporting systems such as the Yellow Card system of the Medicines and Healthcare products Regulatory Agency (MHRA).
• Able to describe how adverse event signals are evaluated and the actions that medicines regulators may take.
• Reports adverse drug reactions appropriately through the yellow card system
• Works effectively with pharmacy to promote policy and good practice to avoid drug errors, including involvement in safety and governance processes that reach across primary and secondary care
• Able to define, identify, classifies, investigate and manage common drug overdoses and poisoning appropriately
• Able to describe the role of the National Poisons Information Service and accesses information by telephone or via TOXBASE to support the management of drug overdose
• Demonstrates initial assessment and management of suicide risk, mental capacity and mental health status in poisoned patients, including effective interaction and multidisciplinary working with liaison psychiatry services.
• Shows preparedness for chemical incidents, including terrorism, by describing examples of hazardous substances and explaining how local Trust major incident plans and Public Health England guidance prepare healthcare systems to deal with such incidents

• Can formulate a comprehensive assessment of patients with complex prescribing needs, including characterisation of patient, carer and clinician priorities, assessment of adherence, medication intolerances and treatment burden
• Effectively communicates complex prescribing issues and proposed management choices to patients, their carers and healthcare providers, including in primary care. Signposts patients to reliable resources to support decision making
• Works in partnership with patients to construct a medicines optimisation plan to address complex prescribing needs.
• Summarises options and strategies available to deal with polypharmacy, poor adherence or medication intolerance, using evidence-based approach.
• Able to describe General Medical Council and national guidance on prescription of off-label or unlicensed medicines.

• Able to state the underlying determinants of drug kinetics and applies these principles to therapeutic decisions
• Uses knowledge of mechanisms of action and pharmacokinetics of therapeutic drugs to select the correct drug, dose, route of administration and duration of treatment
• predict likely effects, both beneficial or adverse, of introducing novel drugs
• predict the effects of combinations of drugs and uses this to guide therapeutic decisions
• Able to explain basic pharmacokinetic concepts such as the area under a plasma drug concentration-time curve (AUC), clearance, volume of distribution and half-life
• Advises on indication for, optimum timing of, and type of drug concentration, analyses and interprets the relationship between blood concentration and drug effects
• Able to make therapeutic decisions that consider individual variation including genetic, age- and gender- related, co-existing renal, hepatic and other disease, and drug interaction
• Orders pharmacogenomic tests and interprets the results appropriately.
• Uses national guidelines to personalise medication regimens for patients

• Use the best available evidence to clinically assess and manage patients with the relevant presentations and conditions
• Systematically collect, synthesise and apply information from the scientific literature to develop therapeutic protocols, guidelines and care pathways
• Deliver audit and quality improvement projects related to the therapeutics used or proposed
• Contribute to the evidence base for that area through design, delivery, analysis and dissemination of clinical research and trials
• Share expertise with the multiprofessional team in the relevant specialist area through contribution to MDT meetings, delivering teaching and training sessions
• Works with patients in the selected therapeutic area to promote shared decision making, the patient voice and inclusivity in relation to research and quality improvement projects.

• Able to define pharmacoepidemiology and describes the main types of pharmacoepidemiology studies
• Systematically collects, synthesises, appraises and applies information from a wide range of, sometimes conflicting, sources in relation to the efficacy, clinical effectiveness, safety and cost of medicines and therapeutics
• Participates in decision making processes of multiprofessional committees making decisions about medicines
• Makes an objective assessment of cost effectiveness, safety and rational use of medicines in clinical use
• Considers the factors that affect drug utilisation including social class, ethnicity, nationality, economic status, co- morbidity, age and gender
• Considers the factors that affect professional and public perception of drugs and their use in treating and preventing disease
• Applies understanding of the structure and function of medicines regulation in the UK and internationally
• Contributes to the development of prescribing policies, formularies and guidelines and clinical decision support systems related to medicines
• Able to describe how NICE and SIGN select and make evidence based clinical guidance and technology appraisals about new medicines.

• Develops and delivers effective education and training in clinical pharmacology, therapeutics and prescribing for undergraduate students and postgraduate practitioners
• Develops and delivers training and competency assessment in prescribing for medical and non-medical prescribers
• Develops and delivers effective training to multiple staff groups who are not prescribers focusing on the safe and effective use of medicines
• Supports national initiatives around safe and effective use of medicines
• Contributes to public education about drugs and their utilisation.
• Develops assessment materials relevant to clinical pharmacology, therapeutics and prescribing education in undergraduate or postgraduate arenas

• Able to describe the phase of clinical trials, including for each phase appropriate clinical trial design, selection of participants, dosing strategy and outcome measures
• Able to describe the design and interprets the results of early phase studies to determine the pharmacokinetic and pharmacogenetic parameters
• Explains what is meant by parallel, crossover, platform, basket, umbrella, adaptive trial designs, when they are used, their advantages and limitations.
• Able to describe the national structure for clinical trial delivery in the NHS
• Explains the purpose of guidelines produced by the International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use (ICH) and acquires and maintains certification in Good Clinical Practice (GCP)
• States the regulatory, legal and ethics requirements for clinical trial approval, trial registration and reporting in the UK
• Able to describe the process by which pre-clinical drug discovery and development data are generated and is able to synthesise and analyse pre-clinical data
• Contributes to clinical study design and delivery including critical review of protocols, study set up, meeting regulatory requirements and maintaining documentation
• Demonstrates research leadership e.g., by one or more of; acting as a trial co-principal investigator or sub-investigator, medical monitor or study sponsor physician, membership of research management or governance committees, membership of research ethics committee.

Currency Window

Evidence of your recent practice will be given more weight to reflect current capabilities and we suggest that approximately 50% of your evidence for a curriculum outcome is drawn from within the last five years of clinical practice (WTE).

Evidence Volume

around 100 electronically uploaded documents