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.

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.

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