The teaching of pharmacology in Italian medical schools: the point of view of Italian doctors

Objective: A survey was carried out to gather the opinions of doctors about the current method of teaching pharmacology in Italy. Methods: A questionnaire was mailed to 3860 doctors, who were asked a series of questions regarding the teaching of pharmacology to medical students in Italian universities. Results and conclusions: The great majority of those who replied considered the teaching they received to be mainly theoretical. The doctors thought that much more time and attention should be dedicated to those pharmacology subjects that are more closely connected to physiopathology and clinical practice (clinical pharmacology).     

Problem-based learning and teaching of medical pharmacology

In the Faculty of Health Sciences at McMaster University, the traditional discipline-based boundaries dividing the teaching and learning of basic medical sciences, such as physiology and pharmacology, do not exist. For more than 3 decades, student-centered, self-directed problem-based learning (PBL) has been the main form of instruction for students learning pharmacology within the medical curriculum and the pharmacological issues are always embedded within a health-care problem, with consideration of many other relevant non-pharmacological issues. In PBL, pedagogic emphasis is placed on the process of learning via constructive inquiry rather than cumulative acquisition of factual knowledge. For the science students, typically in the Biology/Pharmacology cooperative courses, both student-centered learning and teacher-centered teaching approaches are being used. In this case, the PBL approach is adopted to complement the conventional lectures at the course level. For medical students, PBL continues to be the major form of instruction in a small-group tutorial setting at the curricular level. The PBL curriculum is integrated across organ systems (cardiovascular, renal, respiratory, gastrointestinal, neural, etc) and across the life cycle, spanning population- and behavior-related perspectives, rather than being recreated from discrete disciplinary areas (such as physiology, anatomy, biochemistry, pharmacology, and community medicine). Those students who lack a pharmacology background or wish to enhance their pharmacological knowledge can take a block elective or horizontal elective in pharmacology. Unlike science students, medical students need to sort out pharmacological principles from the overload of information, to integrate them into the clinically relevant situations, and to ultimately apply them to the management of patients' illness. This is most effectively achieved in a student-centered environment conducive to life-long learning.     

药理学教学中学生自我发展意识的培养

目的笔者阐述了学生自我发展的内涵与价值,并主要从培养学生良好的心理品质等四个方面论述了怎样在药理学教学中培养学生的自我发展意识.     

Problem- vs. lecture-based pharmacology teaching in a German medical school

We have compared the effectiveness of problem-based learning (PBL) and classical lecture-based learning (LBL) in conveying medical facts in a general pharmacology class of third year medical students ( n=107). Three groups with a total of 31 students were randomly assigned to PBL. The PBL groups (9-12 students each) received ten 2-h sessions in which a clinical case was discussed and ten 2-h sessions in which areas of pharmacology not covered by the case discussions were presented in an LBL format (one group with all 31 students). The other students were assigned to groups of 14-15 students and received 20 2-h sessions in an LBL format. At the end of the semester all students received a questionnaire and participated in the same 30-question multiple-choice exam. The mean number of false answers was 7.6+/-4.0 and 9.7+/-4.7 in the PBL and LBL groups, respectively ( P<0.05 in a two-tailed t-test), and the percentage of failing students (>10 false answers) was 27% and 38%, respectively. Both groups were asked to rate their pharmacology class on a scale of 1 (lowest) to 10 (highest). In this questionnaire, PBL students by average rated generated interest in pharmacology, conveyed knowledge in pharmacology and understanding of medical questions approximately 1 point higher than LBL students. In an additional questionnaire given to the PBL students only, they reported to have prepared themselves 0.9+/-1.1 h for their lecture sessions but 3.0+/-1.4 h for their case discussions. The above findings were largely confirmed in the next semester when students were allowed to decide whether to participate in PBL or LBL classes. Moreover, PBL students did not score worse than LBL students in nation-wide pharmacology exams (523+/-76 vs. 500+/-91 points, P=0.09). We conclude that a switch from LBL to PBL teaching of pharmacology does not occur at the expense of factual knowledge transmission.     

Teaching rational prescribing: a new clinical pharmacology curriculum for medical schools

In most U.S. and Canadian medical schools, pharmacology is taught during the preclinical year 2 of the 4-year-long curriculum. This is despite the fact that medical school graduates and residency directors have identified teaching rational therapeutics as a priority. Hence, we have developed a core curriculum in clinical pharmacology for 4th-year medical students that builds on the core principles of rational therapeutics described by Nierenberg 10 years ago (Nierenberg, DW. Clin Pharmacol Ther 1990; 48:606-610). Here we report on our 3-year experience teaching this course, which addresses the following teaching objectives: to teach medical students on how to (1) critically evaluate medications; (2) obtain a complete medication history including herbal and over-the-counter medications; (3) apply pharmacokinetic principles to clinical practice; (4) recognize and report adverse drug events and interactions; (5) optimize pain management; (6) recognize and treat substance abuse and poisoning; and (7) prescribe rationally regardless of prescribing environment. Student assessment was in the form of multiple-choice and formative oral examinations, which were validated against the clinical part of the U.S. medical licensing examination. The course significantly increased the student rating of clinical pharmacology teaching measured by a national survey of U.S. medical school graduates. We conclude that this course may be useful for teaching rational prescribing to medical students. With the guidance and educational material provided by this article, a successful implementation of such a course should be possible in most medical schools.     

Teaching of clinical pharmacology and therapeutics in UK medical schools: current status in 2009

AIM

To describe the current structure, delivery and assessment of Clinical Pharmacology and Therapeutics (CPT) teaching in UK medical schools.

METHODS

An online questionnaire was distributed to the person with overall responsibility for CPT teaching at all UK medical schools in June 2009.

RESULTS

Thirty of the 32 UK medical schools responded. 60% of schools have a CPT course although in 72% this was an integrated vertical theme. At 70% of schools pharmacologists have overall responsibility for CPT teaching (clinical 67%, non-clinical 33%); at 20% teaching is run by a non-specialist clinician and at 7% by a pharmacist. Teaching is commonly delivered by NHS clinicians (87%) and clinical pharmacists (80%) using lectures (90%) but additionally 50% of schools use e-Learning and 63% have a student formulary. CPT is assessed throughout the curriculum at many schools through written, practical examinations and course work. 90% of schools have specific CPT content in their written examinations. 90% of respondents believed that their students were ‘fairly’ to ‘well’ prepared for the foundation year but only 37% of schools gather data on the competence of their graduates.

CONCLUSIONS

CPT teaching in UK medical schools is very diverse. Most schools do not assess the performance of their graduates as prescribers and there is a lack of evidence that many of the teaching approaches employed are suitable for the development of prescribing skills. It is vital that developments in CPT teaching are driven by validated, real-world assessments of the prescribing skills of medical students and newly qualified doctors.     

Teaching of pharmacology in Universiti Malaya and the other medical schools in Malaysia -- a historical perspective

Traditional pharmacology teaching has focused more on drug instead of therapeutics, such that although pharmacological knowledge is acquired, practical skills in prescribing remain weak. In Malaysia many new medical schools (both public and private) have been set up in the last 12 years due to a change in government policy, resulting in a wide spectrum of medical curricula. Universiti Malaya (UM) being the oldest medical school in Malaysia was deep set in its traditional way of teaching-learning, since its inception in 1962, until a visit from the General Medical Council of the United Kingdom in 1984 triggered off a change of tide. Since then the medical curriculum in UM has undergone two major revisions. The first revised curriculum (1988) aimed to inject more clinical relevance into basic science teaching, through introducing clinical lectures and skills in the paraclinical year. Professional behaviour was also addressed. The second revised curriculum (1998) sought to improve further the integration of knowledge as well as to produce a holistic doctor, viewing the patient as a person instead of a clinical entity. The teaching-learning of pharmacology has gradually moved from factual regurgitation to more clinical reasoning, from lab-based to more patient-oriented approach. As more new medical schools are being set up in Malaysia, exchange of experience in this area of learning will hopefully help us find a happy medium between “the old is best” and “the new is better” type approach so that a pedagogically sound and yet logistically practical curriculum can be found in our local setting, to help produce doctors with good prescribing practice.     

互动式教学法在临床药理学教学中的探索

目的:探索临床药理学教学新的方法和形式.方法:在循环系统、消化系统、呼吸系统用药为主理论课教学中对部分学生采用互动式教学法,同时以同年级的其它学生为对照.结果:互动式教学法有助于培养学生和提高在自学、团队合作、分析问题和解决问题的多方面能力,所涉及的内容书面测试掌握较好,平均成绩较高.结论:在临床药理学教学中采用互动式教学法可行.     

Incorporation of clinical pharmacology into the fourth year of the medical curriculum: teaching clinical pharmacology without a clinical pharmacologist

In congruence with the educational goals of the institution, the pharmacology department has developed courses for senior students. By using the students' recently acquired clinical knowledge, these courses amplify material from the core course in pharmacology. Engaging students in this type of course requires significant commitment from the faculty involved and also from the dean and department chairman. This course has outlasted many curricular changes and has remained in the mainstream of medical education. Goals of this course remain consistent with current proposals to develop new directions in medical education.     

Information overload in the teaching of pharmacology

Medical students are usually drawn from the best of students, but it is not unusual to see these brilliant students fail their exams or even dismissed from medical school because of poor academic performance. Information overload has been recognized as one of the major contributing factors to this problem. The situation is expected to get worse, with the ever-present technology-induced exponential growth in information. In discussing this issue, the authors echo the concerns of several experts regarding the content overload of medical school curricula, particularly in pharmacology. It is the increasing awareness of this problem that led the Association of American Medical Colleges and the General Medical Council of Britain to promote the concept of a core curriculum for each of the principal disciplines in medicine. Several medical schools have adopted the concept and also the problem-based learning approach, which focuses on ameliorating the complex problems associated with information growth in medical education. Based on the authors' experience as medical students, medical practitioners, and pharmacology teachers, they discuss the factors that contribute to information overload, from psychological and nonpsychological perspectives. Issues such as the design and structure of the curriculum, the quality of training and effectiveness of the teachers (clinically qualified vs. nonclinically qualified teachers), and the psychological preparedness of the students are discussed. The authors make suggestions for improvement.