Pharmacology educators as leaders of programmatic assessment for safe prescribing in competency-based medical education

Abstract

Unsafe prescribing remains a persistent source of preventable patient harm despite extensive pharmacology instruction in medical curricula. This gap likely reflects not a lack of content in the curricula, but a failure of structured curriculum integration, accountability, and longitudinal assessment. We argue that competency-based medical education (CBME), particularly through Entrustable Professional Activity 4 (EPA 4), requires a fundamental redefinition of the pharmacology educator’s role - from content expert to leader of programmatic assessment for prescribing competence. We propose a model of pharmacology thread leadership grounded in cognitive integration (spiraling, spacing, and interleaving), governance authority, and fidelity metrics to ensure consistency between what is taught, assessed, and practiced. This model aligns pharmacological reasoning with clinical decision-making through multi-method programmatic assessment, which may include written assessments, prescribing Objective Structured Clinical Examinations, workplace-based observations, and simulation. We further outline the structural enablers necessary for implementation, including faculty development, equity-focused design, and institutional support. While centered on pharmacology, this framework provides a transferable template for other foundational sciences seeking to achieve measurable impact on clinical competence. This paper reinforces the key role pharmacology educators have in integrated medical curricula by claiming explicit leadership in the EPA-aligned system of assessment, advancing multi-institutional research on prescribing outcomes, explicitly highlighting pharmacology as a discipline essential to well-supported decisions about readiness for practice, in other words, entrustment decisions, and patient safety.