A Context-Learning Pharmacotherapy Program for Preclinical Medical Students Leads to More Rational Drug Prescribing During Their Clinical Clerkship in Internal Medicine
ABSTRACT The irrational prescribing of drugs seems to be a general problem in medical practice, occasionally leading to serious consequences. In order to improve the drug prescribing performance of medical students, a compulsory context-learning pharmacotherapy module was implemented in 1998 in the medical curriculum of 2nd-4th-year medical students at theVU University Medical Center (VUmc), Amsterdam, The Netherlands. As part of this program, preclinical medical students are taught how to select, prescribe, and evaluate a drug regimen rationally. The aim of this study was to investigate the effect of this preclinical pharmacotherapy program on the quality of rational prescribing during the ensuing clinical clerkship of these students in internal medicine. The results of this study indicate that preclinical context-learning in pharmacotherapy leads to the use of more rational prescribing modalities by medical students during their ensuing clinical clerkship in internal medicine. This effect was obtained not only with respect to the clinical topics in which training had been given as part of the pharmacotherapy curriculum, but also for other disease situations that the students dealt with. This implies that students not only remember the specific information they have learned during the training, but are also able to apply the acquired skills in new situations (transfer effect).
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ABSTRACT: To assess ability of interns immediately before starting clinical practice in New South Wales (NSW) teaching hospitals to prescribe medications safely and appropriately and to describe their impressions of the adequacy of their clinical pharmacology training in medical school. A cross-sectional study was performed on all interns (n= 191) who attended intern orientation programmes at four NSW hospitals in January 2008. A clinical case scenario that tested prescribing ability and a survey investigating impressions of clinical pharmacology training in medical school were administered to the interns in exam format. Outcome measures were: (i) ability to prescribe medications safely and appropriately for the clinical case scenario and (ii) interns' impressions of their training in clinical pharmacology at medical school. No intern completed all prescribing tasks correctly. No intern charted the patient's usual medications on admission completely correctly, only six wrote an accurate discharge medication list, and none wrote both an accurate discharge medication list and a legal Schedule 8 discharge script. None of the respondents strongly agreed that they felt adequately trained to prescribe medications in their intern year and 84% would have liked to have more training in pharmacology as medical students. Interns about to commence clinical practice in NSW teaching hospitals demonstrated significant deficits in prescribing of regular medications, initiation of new therapies, prescribing of discharge medications, and particularly prescribing of Schedule 8 medications. Most interns recognized these deficits and would have liked more clinical pharmacology training at medical school.Internal Medicine Journal 04/2009; 39(7):428-34. DOI:10.1111/j.1445-5994.2009.01942.x · 1.70 Impact Factor
- Internal Medicine Journal 08/2009; 39(7):425-7. DOI:10.1111/j.1445-5994.2009.01975.x · 1.70 Impact Factor
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ABSTRACT: Avoidable drug-related problems (DRPs) cause substantial morbidity, mortality and costs. As most prescription errors are committed by recently graduated doctors, undergraduate training should specifically address DRPs. This study set out to investigate whether a DRP teaching module can reduce prescription errors made by advanced medical students in varying clinical contexts. A total of 74 Year 5 medical students (mean age 25 +/- 3 years; 24 men, 50 women) participated in a randomised controlled crossover study. Students filled in patients' prescription charts before and after a special DRP training module and a control intervention. The 1-week training module comprised a seminar on common prescription errors, a prescribing exercise with a standardised paper case patient, drafting of inoperative prescription charts for real patients and discussions with a lecturer. During the observation points, prescription charts for standardised patient cases in different clinical contexts had to be completed. These prescription charts were subsequently analysed by two independent raters using a checklist for common prescription errors. Prior to training, students committed a mean of 69 +/- 12% of the potential prescription errors. This decreased to 29 +/- 15% after DRP training (P < 0.001). Prescription errors can be significantly reduced in a relatively brief training time by implementing a specific DRP teaching module.Medical Education 10/2009; 43(10):1010-8. DOI:10.1111/j.1365-2923.2009.03452.x · 3.62 Impact Factor