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.     

Learning of medical pharmacology via innovation： a personal experience at McMaster and in Asia

Pharmacology in the traditional medical curriculum has been treated as a discrete “preclinical” discipline identifying itself distinctly different from the other preclinical sciences or clinical subjects in knowledge base as well as learning/teaching instructions. It is usually run in series with other pre-clinical courses (eg, anatomy, biochemistry, physiology etc), but in parallel with other paraclinical courses such as pathology, microbiology and community medicine. Clinical pharmacology was only introduced relatively recently designed to overcome the perceived deficiency in “preclinical” pharmacology regarding its therapeutic relevance and application to medicine. In many universities, both preclinical and clinical pharmacology courses co-exist, usually independently offered by two separate, sometimes non-interacting Departments of Pharmacology and Clinical Pharmacology. In this model, pharmacology is generally taught in a teacher-centered, discipline-oriented, and knowledge-based curriculum. Furthermore, pharmacology courses are commonly taught by “expert” teachers, who usually engage in excessive-teaching, often adopt a knowledge-based approach in both instruction and assessment, and frequently evade or ignore clinical relevance. The clinical relevance of the pharmacological sciences is sometimes also taught in a didactic and problem-solving manner, although it is usually case-oriented. In recent years, problem-based medical curricula have emerged, in varying forms, as a platform in which pharmacology is viewed as an integrated component in a holistic approach to medical education. In this problem-based learning (PBL) model, pharmacology is learned in a student-centered environment, based on self-directed, clinically relevant and case-oriented approach, usually in a small-group tutorial format. In PBL, pharmacology is learned in concert with other subject issues relevant to the case-problem in question, such as anatomy, physiology, pathology, microbiology, population health, behavior science, etc. Students learn via problem-evoked curiosity and motivation, in an environment which encourages free inquiries and intensive discussions in a cooperative rather than competitive atmosphere. Teachers facilitate students‘ learning objectives rather than deliver pre-packed knowledge and dictate what they think students should learn. Based on the above two models, a change towards PBL curriculum appears to be beneficial in better preparing the medical students as life-long learners capable of coping with changes in knowledge and skills associated with the progressive and dynamic social/economic transformation in the Asia-Pacific regions. Evidence is presented that this is indeed happening.     

Problem-based learning in pharmacology： a survey of department heads in Taiwan, China

Problem-based learning (PEL) requires active student participation and the use of clinical cases as a trigger to learn within a given area. It has gained much attention as a pedagogic alternative in the course of reform in medical education due to information overload. From discipline-based consideration, it is interesting to understand the views of department heads of pharmacology about implementing PBL for their medical students. According to a     

Clinical pharmacology and therapeutics education for senior medical students

In many medical schools instruction of students in clinical pharmacology remains informal and may be inadequate. To determine the short-term efficacy of a mandatory senior medical year course in clinical pharmacology, we compared examination scores of senior students in the College of Medicine, University of Iowa, either prior to or following the Clinical Pharmacology and Therapeutics Lecture Series. A significantly higher (P less than .001) mean score was demonstrated by students taking the examination following the course (75 +/- 4% correct) versus those taking the examination prior to the course (55 +/- 4% correct). To determine student acceptance, postcourse questionnaires were completed. Students surveyed immediately postcourse and alumni surveyed up to four years after graduation highly recommended the course and favored retaining it as a mandatory part of the fourth-year curriculum. This study confirms the efficacy and acceptance of senior medical courses in therapeutics and suggests an effective role for clinical pharmacologists in their design and execution.     

Clinical pharmacology and therapeutics in undergraduate medical education in the UK: current status.

1. Medical undergraduate education is currently undergoing major changes in the UK in response to calls for the development of a core curriculum. Teaching in clinical pharmacology and therapeutics will also change to meet these demands. A postal survey was conducted to assess the current status of teaching in these subjects. 2. A questionnaire based on previous similar surveys conducted elsewhere was sent to departments or individuals in 27 medical schools in the UK; 22 (81%) replied. 3. Departmental priorities were defined as (in order): clinical research, undergraduate teaching, basic scientific research and clinical service provision. No change in these priorities in the future was foreseen by respondents. 4. Teaching methods were for the most part traditional, with the lecture as the most widely used and important technique. Specific clinical teaching was conducted by some and was considered very important by them. Teaching by problem solving was much less common. 5. Respondents were asked for free text comments; many of the remarks suggested dissatisfaction with the resources and time currently available for teaching in clinical pharmacology and therapeutics. Some expressed significant concerns that their teaching commitment would be reduced further by the development of the core curriculum.     

A clinical nutrition course to improve pharmacy students' skills and confidence in counseling patients

Objective

To create, implement, and evaluate a PharmD course on primary care nutrition.

Design

A 2-credit hour elective course was offered to second- and third-year pharmacy students. It was informed by the Socratic method using a minimum number of formal lecture presentations and featured problem-based learning exercises, case-based scenarios, and scientific literature to fuel informed debate. A single group posttest design with a retrospective pretest was used to assess students'' self-efficacy.

Assessment

There was a significant overall improvement in students'' self-efficacy in their ability to practice primary care nutrition.

Conclusion

Completion of a nutrition course improved students'' confidence in providing primary care nutrition and empowered them to speak more comfortably about the role of nutrition in the prevention of chronic diseases.     

基础医学教育中的双语教学实践

本文阐述了对双语教学的理念、模式、可行性的认识,总结了佳木斯大学基础医学教育中开展双语教学工作的失败教训和成功经验,提出了将留学生教育与双语教学工作相结合的新见解.     

以问题为基础互动式教学法用于临床药理学教学的探讨

目的 探讨以问题为基础学习(PBL)互动式教学法在临床药理学课堂教学中的实施及效果.方法 对2008级及2009级共87名学生的互动班,采用PBL互动式教学法进行课堂授课;而2006级及2007级共91名学生的传统班,采用传统式教学法,从学生课堂表现、考试成绩及学生对教学评价3个方面,评价两种教学法的教学效果.结果 互动班较传统班学生课堂表现和考试成绩明显改善,学生对教学评价明显提高.结论 PBL互动式教学法的实施,可改善教学效果,激发学习兴趣,提高学生思考、创新能力.     

Setting CME standards in Europe: guiding principles for medical education

Abstract

Objective:

The requirement for formal Continuing Medical Education (CME) is growing in Europe with a concomitant focus on quality and independence of medical educational programmes, together with a need for measurable effects on patient outcomes. However, during this rapid evolution, it has become clear that there are misunderstandings and confusion amongst CME providers in relation to standard and regulations. To address this challenging situation, the Good CME Practice Group undertook an initiative to establish a set of standard core principles with a view to adoption by European CME providers and other key organisations involved in provision of CME programmes.     

Clinical pharmacology and the provision of drug information

Summary Clinical pharmacologists have a service role in the provision of drug information to individuals both in hospitals and primary health care. We present here a systematic approach in answering questions in a drug information centre (DIC), and describe the working method and the documentation of the work in a question answer (Q/A) data base.Drugline is a full-text data base offering problem-oriented drug evaluation comparable to a clinical consultation. The drug information is produced in a non-commercial drug information centre sponsored by the national health care sector and the National Corporation of Swedish Pharmacies, and run jointly by clinical pharmacologists and pharmacists.A minor part of Drugline is available in English for online searching, in parallel with Medline at the database host, the Medical Information Centre at the Karolinska Institute Library and Information Centre, and the users represent mainly medical libraries, hospital pharmacies, university clinics, and the pharmaceutical industry. A network of DICs has been organized in Swedish university hospitals with access to Drugline for searching and the storage of questions and answers.This network has the potential for expansion throughout Europe. It offers the unique possibility of complementing drug product information with problem-oriented drug information emerging from cases in the real world of prescribing.     

Clinical pharmacology education in a division of cardiology

A working model of how clinical pharmacology education can be interwoven into the matrix of an academic cardiology program that includes didactic teaching, clinical research, and patient care has been presented. Essential to the success of such a program is the commitment and dedication of both its full-time and voluntary faculty. Moreover, a comprehensive plan of organization and allocation of efforts is vital to the success of such a complex undertaking. As we look to the future, the discipline of clinical pharmacology will be increasingly relevant to the practicing cardiologist.     

临床医学教育的目标与实践

通过加强临床教师综合素质的培养,对临床医学学生加强人文教育理念、伦理学教育及医德医风的教育。不断的改革和完善教学内容与教学方法,同时加强与其他学科的横向联系,真正培养出专业知识精湛,较强的医学实践能力,创新精神,集医疗、预防、保健、康复为一体的应用新型医学人才,为适应和促进我国经济的高速发展和社会进步做出巨大贡献。     

Clinical pharmacology: special safety considerations in drug development and pharmacovigilance.

The dose of a drug is a major determinant of its safety, and establishing a safe dose of a novel drug is a prime objective during clinical development. The design of pre-marketing clinical trials precludes the representation of important subpopulations such as children, the elderly and people with co-morbidities. Therefore, postmarketing surveillance (PMS) activities are required to monitor the safety profile of drugs in real clinical practice. Furthermore, individual variations in pharmacogenetic profiles, the immune system, drug metabolic pathways and drug-drug interactions are also important factors in the occurrence of adverse drug reactions. Thus, the safety of a drug is a major clinical consideration before and after it is marketed. A multidisciplinary approach is required to enhance the safety profile of drugs at all stages of development, including PMS activities. Clinical pharmacology encompasses a range of disciplines and forms the backbone of drug safety consideration during clinical drug development. In this review we give an overview of the clinical drug development process and consider its limitations. We present a discussion of several aspects of clinical pharmacology and their application to enhancing drug safety. Pharmacokinetic-pharmacodynamic modelling provides a method of predicting a clinically safe dose; consideration of drug pharmacokinetics in special populations may enhance safe therapeutics in a wider spectrum of patients, while pharmacogenetics provides the possibility of genotype-specific therapeutics. Pharmacovigilance activities are also discussed. Given the complex nature and unpredictability of type B reactions, PMS activities are crucial in managing the risks drugs pose to the general population. The various aspects of clinical pharmacology discussed make a strong case for this field as the backbone of optimising and promoting safe development and use of drugs.