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Transcript
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 • 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 • • • • • • 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 Understanding Core 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