Urinary Incontinence

A woman who has come to you with stress urinary incontinence as you what she can do. She wants to know if there are any medications to help with the urine leaking. The best response to her would be:
a. Suggest pelvic floor training or Kegel exercises
b. Suggest the use of estrogen therapy.
c. Suggest the use of an anticholinergic medication
d. Suggest the use of a tricyclic antidepressant.

How to Study and Prepare for the PEBC


One of the most frequent questions I get is “How do I prepare for the PEBC examinations?”.

This is not an easy question to answer since everyone has different needs and knowledge.

No matter when you graduated or where you graduated from, do not underestimate the difficulty of these exams.  These exams are tough and require a lot of hard work and preparation.  If you think you can just write the exams with only a few days of study, you are mistaken.

Here are a few tips to help you prepare:

1. Read the PEBC website thoroughly and make sure you understand everything.  Do not skip anything since this will be one of the most important things you read.  Do the practice questions.  The site: www.pebc.ca

2. Set aside 1-2 hours of study every day.  No exceptions.  You must be disciplined and keep these times for study.  Make sure you take breaks.  Make sure you have a quiet place to study.  As you get closer to the exam dates, you will want to study probably 4-6 hours per day. 

3. One of the key things that the PEBCs will test is your ability to PROBLEM SOLVE.  The PEBC is not just about regurgitation of facts.  You must be able to solve everyday problems.  Some of the problems will be therapeutic, but also a lot will be about ethics, privacy, jurisprudence, team work, education, communication and so forth.  You might be given a case study and presented with a problem.  You must come up with the best answer.  

4. In many cases, you will be asked to use your PROFESSIONAL JUDGEMENT.  This is often difficult to do since they don’t teach you this at pharmacy school.  If you want to know about professional judgement, check out the www.ocpinfo.ca for more information.  There is a really good section worth reading on professional judgement.

5. Do as many sample questions as possible.  That is why we created iMCQ.  It is a database of hundreds of sample questions that cover all the NAPRA competencies.  There is a lot of free continuing education available on the Internet with sample quizzes.  Do those as well.  See www.agrohealth.com/imcq.

6. Please see our blog about what references to use and study from. 

7. Where to start?  Try reading Therapeutic Choices and Patient Self Care.  Of course it is necessary to know all the ‘big’ diseases like diabetes, asthma, hypertension, heart failure and infectious diseases, but you may also get questions asked about conditions like diaper rash or eye infections or sun burn.  If you want to get more details, say the pathophysiology of a disease, go into a useful textbook listed in www.pebc.ca.  You will also have to know non-drug therapies: diet, smoking cessation, exercise, and when to recommend these.

8. Identify gaps in your knowledge early on.  It is not uncommon to spend too much time reviewing material we are most familiar with.  While it is important to review all relevant material, be sure to identify your knowledge gaps early, so that you can devote enough study time to these areas.

9. Consider starting with a practice test, to identify and focus on the areas where you need the most improvement.  Some on-line multiple choice test banks, like iMCQ, provide a “test mode” to help you quickly assess your strengths and weaknesses in a timed, test-like setting, as well as a “practice mode” to help you review specific topics at your own pace for more in-depth studying

10. A common myth suggests you should cram your studying right before the exam so that the material will be fresh in your memory.  However, research shows that spacing out your study time over a few weeks produces the best results.  Cramming late at night just before the exam will leave you mentally and physically tired.  You will retain much less information and may make more careless mistakes on the exam

11. Simulate the exam experience.  

  • If the exam will be a closed-book exam, it is important to practice answering questions without access to your notes or text books. 
  • Practice answering questions that someone else has selected.  You are not the one setting the exam questions, so asking yourself questions that you have developed on your own is usually a poor way to re-create the exam experience. Workbooks, accredited continuing education (CE) lesson test questions, and on-line test banks, like iMCQ, are essential tools to aid your preparations for the PEBC Qualifying exam or the OCP Quality Assurance Practice Review – they provide you with challenging practice questions, developed by content experts.
  • Be sure to practice using questions based on Canadian content that is designed to assess the NAPRA professional competencies for Canadian pharmacists.

Top Reasons for Failing the OSCE exam

Top Reasons Why People Fail the OSCE exam

1. You haven’t solved the main drug related problem. This a major reason for failing OSCE. There is usually one major problem, but you have to gather information to solve the problem. Sometimes the problems are subtle and not easy to find.

2. You have put a patient at harm or risk. If you make a recommendation to a patient or doctor and the recommendation puts the patient at risk, you will most likely fail. For example, if a patient complains of stomach pains and you recommend ibuprofen, you’d probably fail since the patient might have a bleeding ulcer.

3. You have given wrong information. If you have given an incorrect dose or an incorrect recommendation you might fail. If you catch yourself making a wrong recommendation, correct yourself and save yourself.

4. You have not completed all the steps of pharmaceutical care. Make sure you know all the steps of pharmaceutical care. If you miss a step, you will lose marks. Do not forget to document your interaction (just tell the patient that you are keeping a record of the interaction). Do not forget the follow up with the patient.

5. You could not be understood by the evaluator. It could be because your English was not understood or you were too quiet. Make sure your patient can understand you. Do not use technical language. Make sure your spoken and written English is well understood.

6. You wasted too much time looking into the references. This is a very common mistake. Students will search the CPS for 5 minutes and run out of time without finding what they were looking for. Make certain you can find the information quickly in the references. The CPS is a difficult book to find information. Know how to use it!

7. Your interview was incomplete and missing some valuable information. You might have missed family history or the fact the patient was not using their medication. The patient might have cognitive impairment and you did not acknowledge it.

8. You did not use your time wisely. You only have 7 minutes and time passes very quickly especially when you are nervous. Make sure you listed for the 2 minute warning bell. When you hear the 2 minute warning, it is time to wrap up and summarize everything.

9. You haven’t used the ‘clues’ in the station to help you solve the problem. I always tell students that there are several clues in a station. The best clue is the patient. Ask questions to help you solve the problem. If there is a medication record on the table, use it. The medication record can tell you a lot of useful information. If there is a pamphlet on the table, it is there for a reason. Use it if needed.

10. You did not know your OTC ingredients well enough. Make sure you know your OTC ingredients and when to recommend them. You will most certainly get an OTC station where you have to make a recommendation. Make sure you know the ingredients and when to recommend and when not to recommend.

11. You did not use your PROFESSIONAL JUDGEMENT. This is often the most difficult for some people to use. You must make tricky decisions. Not all situations are black and white. Make sure you use your judgement. That is why you are a professional!

12. You could not control your nervousness. This is also a major problem. Learn to control your stress levels. Practice deep breathing continuously during OSCE day. Everyone will be nervous. If you mess up an OSCE station, forget it and move on. Do not think about it during the day.

Question of the Week

5. Which of the following statements are TRUE about cholinesterase inhibitors?:
I. They have a role with behavioural and psychotically symptoms.
II. They are most effective in mild to moderate dementia.
III. They differ in their efficacy
IV. The benefits are large especially when started in the early stages of dementia.

a. I and II
b. II and III
c. III and IV
d. IV

References to Use to Study for the PEBC

Hi Everyone:

Everyone always asks me what I should study for PEBC MCQ (Part 1). One of the observations I have made over the last 15 years of teaching pharmacy students, is that IPGs have excellent drug knowledge.
What you have to do is put that drug knowledge into a clinical perspective or PATIENT CARE perspective.

In other words, it is not enough to know the half life of a particular drug or what side effects to encounter. What you should be able to do is make recommendations like: What is the drug of choice in a patient with otitis media but is allergic to penicillin?

Or what drug would you use to treat hypertension in a patient that also has angina?

Or what would you do if you have a diabetic patient whose blood sugars are not controlled?

You have to learn how to solve problems not just regurgitate drug facts.

Here are some good references and some comments:

1. Therapeutic Choices 6th ed. is a good start HOWEVER the information is very limited and top level only. Do not use this as your only book.

2. Rx Files is an excellent comparative summary of drugs and their uses. It is very useful with easy to find information.

3. Patient Self Care is NOT a great book, but you’ll have to know OTC products in Canada. I suggest studying from it.

4. Make sure you know the Pharmaceutical Care Model. This is essential. A good reference is Pharmaceutical Care Practice by Cipolle, Strand and Morley.

5. One of my favourites for the OSCE: Communication Skills in Pharmacy Practice 5th ed.

6. The CPS is a TERRIBLE book but you MUST know how to use it. The font is tiny, the paper thin and it is difficult to find information. BUT you must know how to find information since this may be the only reference you have in an OSCE station. Borrow one from a library. Don’t buy one. Test yourself on finding information.

7. There are some Clinical Practice Guidelines published in www.cma.ca Many ‘purists’ do not like to use Clinical Practice Guidelines, but they are an excellent way to find out how diseases are treated in Canada.

If you use an American reference, remember the units of measurement may be different. For example, blood sugar and cholesterol units are different.

There are some other references listed in www.pebc.ca but use your judgement.

I hope that helps you.


PEBC myths

PEBC targets against non-Canadian candidates.  NOT true.  Although a higher percentage of IPGs fail the PEBC, it is because their university curriculum is different than the Canadian curriculum.  It would be unethical and illegal to target non-Canadian pharmacists.

PEBC targets against non-English speaking pharmacists.  This may be true since OSCE (Part II) involves speaking clearly, consistently, confidently so that the patient actors and the evaluator understand you.  If they do not understand you, you will fail the station.  Practice your English speaking skills every day.

If you write the exam in May (when most Canadian students are writing), the exam will be harder to pass. NOT true.  The PEBC clearly states on their website that the passing criteria is not based on those who wrote but according to the number of correctly answered questions deemed necessary by experts to obtain their license qualification.  Focus on your own preparation.  By the way, the University of Waterloo students write in November!

You have to pass every competency to pass the PEBC.  Not true.  See above.  It would not make sense to fail someone just because they failed a competency worth 2-3%.  This is FALSE.

If you found this blog useful and informative, please let me know.





Releasing Personal Health Information

All regulated Health Professionals in Canada are legally and ethically obligated to protect the confidentiality of a patient’s personal health information.  Under the Personal Health Information Protection Act (PHIPA), personal health information may only be disclosed by health information custodians if the individual consents or if PHIPA specifically permits the disclosure without consent.

So when do you disclose information to a parent?  Say for example, a 13 year old wants to purchase Plan B or a smoking cessation aid.  Any person may consent to receive treatment, regardless of age, if he or she is able to understand the information about the treatment including possible risks and benefits.  Permission from a parent is nor required for a minor child if the pharmacist believes the patient understands the information provided and is able to give an informed consent. If there is a conflict between a parent and the capable child who is under 16, the decision of the child overrides that of the parent.

For more information, consult http://www.ipc.on.ca/images/resources/up-phipa02_e.pdf


PEBC MCQ sample question posted on Facebook

You receive a prescription for Tylenol No. 3.

a. Refills are NOT permitted on narcotic preparation prescriptions (part-fills are permitted) – (a is FALSE)
b. Verbal prescriptions ARE permitted with narcotic preparations (b is FALSE)
c. A record of sales in the Narcotic register is required (c is FALSE)
d. Refills are NOT permitted.  (d is TRUE)