what do medical students need to know about drugs? and how should we assess them? michael orme...
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What do Medical Students need to know about Drugs?
And how should we assess them?
Michael OrmeUniversity of Liverpool , U.K. andEuropean Association for Clinical Pharmacology and Therapeutics
European Association for Clinical Pharmacology and Therapeutics
(EACPT)
• EACPT was founded in 1993 and runs biennial congresses.
• 32 European Countries are in membership
• EACPT Education Sub-Committee started work in 1997
European Medical Schools
• Some 400 medical schools in “Europe”
• Great variety of administrations and courses.
• For example Russia
Russian Medical Schools
• Stretch from St. Petersberg to Vladivostok• On average each school teaches 200
hours of ‘pharmacology’ ( 50 lectures, 65 demonstrations, 85 hrs of self study)
• Assessment is by factual recall• Elsewhere in Europe ‘hours’ are difficult to
calculate and many different curricula exist such as problem-solving or problem based.
Importance of Clinical Pharmacology teaching for Clinical
Care
• Case already made by previous speakers
speakers!
* Thus how should we teach?
What Should Medical StudentsKnow About Drugs
• The idea of a Core Curriculum
• The importance of Basic Science
• At Least three approaches
• Core Knowledge and Understanding
• An essential drug list ( not WHO )
• A Disease Based approach
Core Knowledge and Understanding
• Eg Basic Pharmacology,• Clinical Pharmacokinetics• Adverse Drug Reactions/ Pharmacovigilance
• Medication Errors, Drug Interactions, • Prescribing for the Elderly /Children• Prescribing in Patients with Liver or Kidney
disease• New Drug Development
Core Knowledge and Understanding
Core Skills
• Taking a drug history
• Drug Allergy
• Drug Administration
• Analysis of New data
• Prescription Writing
Core Knowledge and UnderstandingCore Attitudes
• A Rational Approach to Drug Prescribing• Life Long Learning• Risk Benefit Analysis• Cost Benefit Analysis• Responsibilities of a Prescriber• Recognition of the role of other health care
workers in the field –eg Pharmacists
Core Curriculum Essential Drug List
• Not necessarily based on WHO system
• Preparation of a list of perhaps 120 drugs
to be known in some detail by students
• In some case students prepare their own formulary ( eg P drugs )
• There will be perhaps 80 or so other drugs the student should be aware of
Core Curriculum –Drugs (1)What should the student know about the Core
Drugs?
• Drug Name – generic or approved
• Drug Class - ?alternatives• Indication – Route and Dose ?Look Up
• Adverse Effects
• Elimination –and effects of disease
• Drug Interactions
• Patient Information
Core Curriculum – Drugs (2)
• Core Drugs in Hypertension * Calcium Channel Blockers ( eg Amlodipine ) * ACE Inhibitors ( eg lisinopril ) * Diuretcis ( eg Bendrofluazide ) * Selective Beta Blockers ( eg Atenolol) * + AT1 receptor antagonists ( eg Losartan ) * + Centrally Acting Drugs ( eg Clonidine ) * + Alpha Blockers ( eg Prazosin ) + Indicates the need for student awareness
Core Curriculum – Drugs ( 3 )
• Respiratory Drugs *Inhaled Glucocorticoids ( eg Beclomethasone)
* Beta 2 Agonists ( eg salbutamol, Salmeterol) * Ipratropium * Theophylline * [Codeine ] * + Cromoglycate * + Leukotriene Antagonists ( eg Montelukast) * + Acetylcysteine [ ] indicates the drug is found elsewhere in formulary
Core Curriculum – Diseases
• Code M - Diseases that students must know how to manage ( n= 67 )
• Code D - Diseases that students must know how to diagnose ( n = 158 )
• Code A - Diseases that students should be aware of ( for specialist care ) (n=36 )
Core Curriculum –Diseases (2)
• Typical Code M Diseases * Acute Myocardial Infarction
* Deep Vein Thrombosis
* Diabetes Mellitus
* Constipation
* Urinary Tract Infection
* Angina
* Gout
Core Curriculum – Diseases (3)
• Typical Code D Diseases * Bacterial Endocarditis
* Jaundice
* Nephrotic Syndrome
* Parkinson’s Disease
* Bronchial Carcinoma
* Limb Fractures
* Ectopic Pregnancy
Core Curriculum – Diseases (4)
• Typical Code A Diseases * Addison’s Disease
* Cirrhosis of the Liver
* Bladder cancer
* Schistosomiasis
* HIV/AIDS
* Cystic Fibrosis
* Motor Neurone Disease
Core Curriculum - Diseases
• The Disease system has worked well in those European Countries where it has been piloted.
• However world wide the criteria for codes M,D and A may well need to change
How Should they be assessed?
• Should examinations be Nationally, Regionally or Medical School based?
In Europe most are school based• Should there be a specific examination in
clinical pharmacology or rational prescribing?
With the advent of integrated curricula specific CPT exams have largely gone. Good thing or Bad Thing?
Core Curriculum in CPT Assessments
• Assessments drive the curriculum
• Students will usually learn only those areas that they think will be exam tested
• A variety of assessment methods may be needed depending on circumstances
Assessements (1)
• Knowledge based Multiple ( True/False) choice exams ( MCQs) are often unreliable and
measure only factual knowledge. • Problem solving MCQs give a better assessment * OSCE’s ( Objective Structured Clinical Exams)
can be useful but station size is usually limited
Assessments (2)
• Essay writing is usually a waste of time for students and examiners
• May be better if model answers are agreed
• Short essays ( eg 10 lines) are possibly the best written test if model answer is used and scripts are double marked
Assessments (3)
• Ideally there should be an assessment of the ability to prescribe safely and rationally
• This can be achieved in an OSCE (OSPE)
but it is difficult to have more than a few stations.
* Should some stations carry an automatic failure? ie if you fail the station you fail the exam.