Complementary and Alternative Medicine Familiarization: What's happening in Medical Schools in Wales?

Despite recommendations that complementary and alternative medicine (CAM) familiarization should be offered to UK medical students, in Wales little such teaching was offered. We decided to assess medical students' knowledge of CAMs, perceived training needs in CAMs, their view of its role in the National Health Service (NHS) and current teaching given. Analysis of data from a questionnaire given to medical students and direct questioning of senior academic medical school staff in Cardiff and Swansea Medical Schools was carried out. The participants comprised 78 first year medical students in the undergraduate entry program in Cardiff and 58 first year medical students from the graduate entry program in Swansea. Senior academic medical school staff at Cardiff and Swansea Medical Schools were asked about current CAM teaching. Results revealed that 32% of undergraduate entry students (UGES) had previous knowledge of CAMs compared with 51% of graduate entry students (GES). Of the UGES, 62% believed they should be taught about CAM's compared with 94% of GES. Of UGES 31% felt that CAMs have a role in the NHS compared with 50% of GES. None of the students had received teaching about CAMs and little formal CAM teaching is currently included in the curricula at each site. The majority of medical students in Wales would like to receive CAM teaching and significant numbers support a role for CAMs in the NHS. Little formal teaching is currently provided.     

Adverse drug reaction and medication error reporting by pharmacy students

BACKGROUND: The reporting of adverse drug reactions (ADRs) and medication errors is the responsibility of all who are involved, particularly pharmacists. Since pharmacists are often privy to information surrounding ADRs and medication errors, it is of utmost importance that they are educated regarding the procedures of reporting. OBJECTIVE: To determine pharmacy students' knowledge of and ability to report ADRs and medication errors. METHODS: A total of 1322 students from 9 colleges of pharmacy were surveyed. RESULTS: The largest group of respondents was fifth-year pharmacy students (38%) followed by third-, fourth-, and sixth-year students (28%, 26%, and 8%, respectively). The majority of students reported learning about ADR and medication error reporting programs via didactic experiences. In comparison, fewer students cited alternative mechanisms of learning, including experiential rotations and work experience. Overall, respondents demonstrated the most experience with MedWatch and the least experience with the Vaccine Adverse Event Reporting System (VAERS). As students progressed through pharmacy curricula, there was a positive trend in the ability to locate and complete MedWatch forms. For VAERS and Medication Error Reporting (MER) program forms, however, this positive trend was broken at year 4. For all programs, significantly fewer students demonstrated appropriate use of the forms compared with those indicating familiarity with the programs. CONCLUSIONS: This study demonstrated that students are becoming familiar with ADR and MER programs via the college curriculum; however, there is opportunity for greater exposure and understanding. Colleges of pharmacy should continually seek methods to strengthen the education provided to pharmacy students regarding these programs.     

Setup of a national system of adverse drug reaction reporting in Lebanon: results of the first year of activity

OBJECTIVE: The aim of this publication is to present the results of the first year of activity of the national adverse drug reactions (ADR) reporting system in Lebanon. METHODS: We started our survey with 3 teaching hospitals (more than 160 beds/hospital). Pharmacy students were responsible for collecting and investigating ADRs reported by physicians. RESULTS: After 7 months, 40 cases of suspected ADRs were reported, of which the majority (32 cases) had a causality score of "probable" according to the French method of causality assessment. Skin and allergic reactions occurred in the largest proportion of the ADRs reported (46%). The most common drugs involved in the ADRs were antimicrobial agents (43%) followed by anticonvulsant and anticoagulant drugs (12% each). CONCLUSION: Our objectives are to extend the reporting system in other hospitals throughout Lebanon.     

An international survey of undergraduate medical education in palliative medicine

A 9-item mail survey dealing with availability and characteristics of undergraduate medical education programs in palliative medicine was sent to all medical schools in Canada (16) and the United Kingdom (UK) (30), and 129 randomly selected medical schools in the United States (US) and Western Europe. The overall response rate was 117/175 (67%). The highest percentage of mandatory (required by the university) rotations in palliative medicine was in the UK medical schools (14/22, 64%). Considerably lower numbers were obtained from the other countries: US; 4/37, 11%, Canada; 2/14, 14%, and Western Europe; 8/43, 19% (P = 0.001). Elective rotations in palliative medicine were more readily available in the UK; 18/22, 82% and Canada; 10/14, 71%, compared with the US; 23/37, 62%, and Western Europe; 13/43, 30% (P=0.001). Seventy-two percent (13/18) of UK, 70% (7/10) of Canadian, 59% (16/27) of US, and 9/30 (30%) of Western European medical schools provide educational reading material in palliative medicine (P = 0.014). Case-based learning in small groups and small group discussion were favored by the UK, 14/22 (63%) and 17/22 (77%), respectively, and Canadian medical schools, 8/14 (57%) and 8/14 (57%), respectively (P = 0.176). The number of universities with academic faculty positions for palliative medicine and the median number of positions for the countries were as follows-Canada 8/13 (62%) and 2; UK 12/22 (55%) and 1; US 5/36 (14%) and 1; and Western Europe 9/24 (21%) and 1, respectively (P = 0.001). Besides the UK, mandatory (required) rotations in undergraduate palliative medicine education are lacking in Canadian, US, and Western European medical schools. The median number of 1 academic faculty member per responding medical school is discouraging. In order for undergraduate and postgraduate medical education in palliative medicine to improve, the number of both educational programs and faculty members will need to be increased.     

Survey to assess public awareness of patient reporting of adverse drug reactions in Great Britain

What is known and Objective: Patient reporting to the Yellow Card Scheme (YCS) for reporting adverse drug reactions (ADR) has been available in the UK since 2005. By the end of 2009, 18% of the ADRs reported were submitted by patients. Thus, some patients are aware of the scheme, but we do not know how much awareness exists in the general population and hence the true impact of patient reporting. Methods: We added eight questions to a telephone omnibus survey of the adult population of the UK, administered over two weekends in January 2009. Results and Discussion: Results are based on 2028 completed interviews. Of respondents, 8·5% (n = 172) had heard of the YCS, but only three individuals had self‐reported to the scheme. People of a higher social grade and those with further education were significantly more likely to be aware of the YCS. Those who reported a preference for online reporting were more likely to be men, younger, of middle social grade with further education and in full‐time employment. Those suggesting a preference for telephone reporting tended to be women, of working class and with a lower level of education, as did those who expressed a preference for postal reporting, but in addition they were more likely to be older and retired. Each of the three current methods of reporting was preferred by some respondents and could be continued. This is supported by reports that each of the three methods is currently used. What is new and Conclusion: This first survey of awareness of the YCS in the general population of the UK indicates awareness is low and could be improved.     

Cardiopulmonary resuscitation. Paper 1: A survey of undergraduate training in UK medical schools.

This paper presents the results of a UK national survey of Basic Life Support (BLS) and Advanced Cardiac Life Support (ACLS) training for undergraduate medical students. In all responding medical schools, undergraduates are taught BLS at least once during their course but the assessment and refresher aspects of BLS training are not uniformly covered. There are inconsistencies in ACLS teaching, with some schools providing formal courses, some teaching specific techniques and others providing no ACLS teaching. Most interestingly, of those completing the questionnaire, only 52% considered present undergraduate training adequate to enable junior house officers to provide an effective resuscitation service. We recommend that all aspects of BLS and ACLS training for medical undergraduates be improved and standardized throughout the UK.     

Survey of current status of intensive care teaching in English-speaking medical schools

OBJECTIVE: To identify a consensus of opinion regarding the content of an intensive care core syllabus for undergraduate medical students and factors that may limit its teaching. DESIGN: Cross-sectional postal survey containing 35 items ranging from department structure to curriculum content and factors that limit the teaching of intensive care. SETTING: English-speaking medical schools (n = 210) listed in the 1986 World Health Organization Directory. MEASUREMENTS AND MAIN RESULTS: Of 122 (58%) returned questionnaires, a 45% return was achieved from the United States and 86% from non-U.S. countries. Most respondents (84%) considered teaching undergraduate intensive care to be essential; however, teaching intensive care was compulsory in only 31% of schools. Many schools (43%) reported recent changes to their intensive care curriculum. Most respondents (60%) thought that intensive care specialists should teach and that each student required a median (interquartile range) of 20 (10-80) hrs of teacher contact time. Resuscitation skills were taught in 98% of schools. In comparison, 63% of schools had no intensive care syllabus. More than 90% of respondents thought that the intensive care syllabus should include the following: cardiopulmonary resuscitation, assessment and management of the acutely ill patient; management of respiratory, circulatory, and multiple organ system failure (including systemic inflammatory response syndrome and sepsis); management of the unconscious patient; early postoperative care; and communication skills and ethics as they relate to end-of-life issues. Factors that limited intensive care teaching were lack of staff, funding, and time dedicated to teaching and excessive clinical workload. Student performance in intensive care was assessed by 66% of schools, but only 28% used a written or oral examination. CONCLUSIONS: By surveying a wide range of medical schools internationally, we have been able to define an undergraduate intensive care syllabus that could be delivered in 20 hrs or 1 wk of dedicated teaching time. Factors that impede the provision of undergraduate intensive care teaching are a lack of staff, funding, and dedicated teaching time.     

Complementary medicine education in Japanese medical schools: a survey

OBJECTIVES: To evaluate the present state of complementary medicine (CM) education in Japanese medical schools. DESIGN: This investigation consisted of two studies: (1) a telephone survey to curricular office workers in September 1998; and (2) a self-completed questionnaire to representatives of sponsoring departments in July 1999. SETTINGS: All 80 medical schools for Western medicine. MAIN OUTCOME MEASURES: Presence of a CM course and sponsoring department. Titles of courses and teaching methods. RESULTS: The response rate to the telephone survey and self-completed questionnaire was 100 and 95%, respectively. Of 80 medical schools, CM was officially taught in 16 schools (20%). Of these 16 schools, there were 19 CM courses and the anesthesia department sponsored the most courses (six courses). All courses had oriental medicine titles such as acupuncture and Kampo except for one course. CONCLUSION: Twenty per cent of Japanese Medical Schools taught CM with predominantly oriental medicine themes.     

Factors associated with preventability, predictability, and severity of adverse drug reactions

OBJECTIVE: To determine the rate of adverse drug reactions (ADRs) in hospitalized patients in an Iranian hospital and to assess factors associated with preventability, predictability, and severity of ADRs. DESIGN AND PARTICIPANTS: A prospective, randomized study was conducted on 370 patients in a hospital at the Tehran Medical Sciences University, from March to December 1996. Patients who experienced at least one ADR (n = 62) were entered into the database. Preventability, predictability, and severity of reactions were determined, based on the available algorithms developed by other investigators. SETTING: A 1200-bed tertiary care university teaching hospital in Tehran, Iran. RESULTS: Approximately 16.8% (n = 62) of the 370 patients who were included in this study had at least one ADR. One hundred two ADRs were reported during this study. Approximately 58.8% of the ADRs (60 reactions) were identified as preventable reactions and 96.1% as predictable reactions. The severity of 9.8% of the ADRs was identified as mild, 86.3% as moderate, 1% as severe, and 2.9% as lethal. The length of hospitalization increased with the severity of the ADRs. Preventable ADRs were more severe than those that were nonpreventable. In addition, the incidence of preventable ADRs increased with the patients' age and caused longer hospitalization than did nonpreventable ones. The most predictable ADRs were hematologic. CONCLUSIONS: This study noted that the rate of ADRs in Iran is probably as high as the rate in other parts of the world. These results indicate a need for a strong national ADR program that detects and reports adverse drug events in Iran.