Transcript What do Medical Students need to know about

What do Medical Students need
to know about Drugs?
And how should we assess them?
Michael Orme
University of Liverpool , U.K. and
European 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
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Case already made by previous speakers
speakers!
* Thus how should we teach?
What Should Medical Students
Know 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
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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
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Taking a drug history
Drug Allergy
Drug Administration
Analysis of New data
Prescription Writing
Core Knowledge and
Understanding
Core Attitudes
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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?
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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
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Deep Vein Thrombosis
Diabetes Mellitus
Constipation
Urinary Tract Infection
Angina
Gout
Core Curriculum – Diseases (3)
• Typical Code D Diseases
* Bacterial Endocarditis
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Jaundice
Nephrotic Syndrome
Parkinson’s Disease
Bronchial Carcinoma
Limb Fractures
Ectopic Pregnancy
Core Curriculum – Diseases (4)
• Typical Code A Diseases
* Addison’s Disease
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Cirrhosis of the Liver
Bladder cancer
Schistosomiasis
HIV/AIDS
Cystic Fibrosis
Motor Neurone Disease
Core Curriculum - Diseases
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The Disease system has worked well in those
European Countries where it has been piloted.
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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.
Conclusions
• Much work remains to be done to assess
the European situation and to try to
produce effective education so that
doctors are able to prescribe rationally and
safely