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Donker EM, Osmani H, Brinkman DJ, van Rosse F, Janssen B, Knol W, Dumont G, Jorens PG, Dupont A, Christiaens T, van Smeden J, de Waard-Siebinga I, Peeters LEJ, Goorden R, Hessel M, Lissenberg-Witte BI, Richir MC, van Agtmael MA, Kramers C, Tichelaar J. The impact of a summative national prescribing assessment and curriculum type on the development of the prescribing competence of junior doctors. Eur J Clin Pharmacol 2023; 79:1613-1621. [PMID: 37737911 PMCID: PMC10663181 DOI: 10.1007/s00228-023-03567-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 09/13/2023] [Indexed: 09/23/2023]
Abstract
PURPOSE The primary aim of this study was to investigate the effect of including the Dutch National Pharmacotherapy Assessment (DNPA) in the medical curriculum on the level and development of prescribing knowledge and skills of junior doctors. The secondary aim was to evaluate the relationship between the curriculum type and the prescribing competence of junior doctors. METHODS We re-analysed the data of a longitudinal study conducted in 2016 involving recently graduated junior doctors from 11 medical schools across the Netherlands and Belgium. Participants completed three assessments during the first year after graduation (around graduation (+ / - 4 weeks), and 6 months, and 1 year after graduation), each of which contained 35 multiple choice questions (MCQs) assessing knowledge and three clinical case scenarios assessing skills. Only one medical school used the DNPA in its medical curriculum; the other medical schools used conventional means to assess prescribing knowledge and skills. Five medical schools were classified as providing solely theoretical clinical pharmacology and therapeutics (CPT) education; the others provided both theoretical and practical CPT education (mixed curriculum). RESULTS Of the 1584 invited junior doctors, 556 (35.1%) participated, 326 (58.6%) completed the MCQs and 325 (58.5%) the clinical case scenarios in all three assessments. Junior doctors whose medical curriculum included the DNPA had higher knowledge scores than other junior doctors (76.7% [SD 12.5] vs. 67.8% [SD 12.6], 81.8% [SD 11.1] vs. 76.1% [SD 11.1], 77.0% [12.1] vs. 70.6% [SD 14.0], p < 0.05 for all three assessments, respectively). There was no difference in skills scores at the moment of graduation (p = 0.110), but after 6 and 12 months junior doctors whose medical curriculum included the DNPA had higher skills scores (both p < 0.001). Junior doctors educated with a mixed curriculum had significantly higher scores for both knowledge and skills than did junior doctors educated with a theoretical curriculum (p < 0.05 in all assessments). CONCLUSION Our findings suggest that the inclusion of the knowledge focused DNPA in the medical curriculum improves the prescribing knowledge, but not the skills, of junior doctors at the moment of graduation. However, after 6 and 12 months, both the knowledge and skills were higher in the junior doctors whose medical curriculum included the DNPA. A curriculum that provides both theoretical and practical education seems to improve both prescribing knowledge and skills relative to a solely theoretical curriculum.
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Affiliation(s)
- Erik M Donker
- Unit Pharmacotherapy, Department of Internal Medicine, Amsterdam UMC, Location VUmc, De Boelelaan 1117, 1081HV, Amsterdam, The Netherlands.
- Research and Expertise Centre in Pharmacotherapy Education (RECIPE), Amsterdam, The Netherlands.
| | - Hayaudin Osmani
- Unit Pharmacotherapy, Department of Internal Medicine, Amsterdam UMC, Location VUmc, De Boelelaan 1117, 1081HV, Amsterdam, The Netherlands
| | - David J Brinkman
- Unit Pharmacotherapy, Department of Internal Medicine, Amsterdam UMC, Location VUmc, De Boelelaan 1117, 1081HV, Amsterdam, The Netherlands
- Research and Expertise Centre in Pharmacotherapy Education (RECIPE), Amsterdam, The Netherlands
| | - Floor van Rosse
- Department of Hospital Pharmacy, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Ben Janssen
- Department of Pharmacology and Toxicology, Maastricht University, Maastricht, The Netherlands
| | - Wilma Knol
- Department of Geriatric Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Glenn Dumont
- Department of Hospital Pharmacy and Clinical Pharmacology, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
| | - Philippe G Jorens
- Department Pharmacotherapy, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
| | - Alain Dupont
- Department of Clinical Pharmacology, Free University of Brussels (VUB), Brussels, Belgium
| | - Thierry Christiaens
- Clinical Pharmacology, Department of Basic and Applied Medical Sciences, Ghent University, Ghent, Belgium
| | - Jeroen van Smeden
- Department of Education, Centre for Human Drug Research, Leiden, The Netherlands
- Department of Clinical Pharmacy and Toxicology, Leiden University Medical Center, Leiden, The Netherlands
| | - Itte de Waard-Siebinga
- Department Clinical Pharmacy and Pharmacology, University Medical Center Groningen, Groningen, The Netherlands
| | - Laura E J Peeters
- Department of Hospital Pharmacy, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Ronald Goorden
- Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marleen Hessel
- Department of Clinical Pharmacy and Toxicology, Leiden University Medical Center, Leiden, The Netherlands
| | - Birgit I Lissenberg-Witte
- Department of Epidemiology and Data Science, Amsterdam UMC, Location VUmc, Amsterdam, The Netherlands
| | - Milan C Richir
- Unit Pharmacotherapy, Department of Internal Medicine, Amsterdam UMC, Location VUmc, De Boelelaan 1117, 1081HV, Amsterdam, The Netherlands
- Research and Expertise Centre in Pharmacotherapy Education (RECIPE), Amsterdam, The Netherlands
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Michiel A van Agtmael
- Unit Pharmacotherapy, Department of Internal Medicine, Amsterdam UMC, Location VUmc, De Boelelaan 1117, 1081HV, Amsterdam, The Netherlands
- Research and Expertise Centre in Pharmacotherapy Education (RECIPE), Amsterdam, The Netherlands
| | - Cornelis Kramers
- Pharmacology-Toxicology and Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jelle Tichelaar
- Unit Pharmacotherapy, Department of Internal Medicine, Amsterdam UMC, Location VUmc, De Boelelaan 1117, 1081HV, Amsterdam, The Netherlands
- Research and Expertise Centre in Pharmacotherapy Education (RECIPE), Amsterdam, The Netherlands
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2
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Bakkum MJ, Richir MC, Sultan R, de la Court JR, Lambooij AC, van Agtmael MA, Tichelaar J. Can Students Create Their Own Educational Escape Room? Lessons Learned from the Opioid Crisis Escape Room. MEDICAL SCIENCE EDUCATOR 2021; 31:1739-1745. [PMID: 34950526 PMCID: PMC8651969 DOI: 10.1007/s40670-021-01425-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 09/27/2021] [Indexed: 06/14/2023]
Abstract
Educational escape rooms (EERs) are live-action, team-based games used to teach content-related and generic knowledge and skills. Instead of students just playing the EER, we believed that giving them the opportunity to create their own EERs would augment the learning effects of this teaching method. We report on the feasibility, evaluation, and lessons learned of our assignment on an opioid epidemic-based EER. This original teaching method appealed to most students, but the workload was evaluated to be too high. Our lessons learned include the need for sufficient (extrinsic) motivation, careful explanation of the assignment, and small group sizes.
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Affiliation(s)
- Michiel J. Bakkum
- Department of Internal Medicine, Section Pharmacotherapy, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, Netherlands
- Research and Expertise Centre in Pharmacotherapy Education (RECIPE), De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Milan C. Richir
- Department of Internal Medicine, Section Pharmacotherapy, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, Netherlands
- Research and Expertise Centre in Pharmacotherapy Education (RECIPE), De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Rowan Sultan
- Department of Internal Medicine, Section Pharmacotherapy, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, Netherlands
- Research and Expertise Centre in Pharmacotherapy Education (RECIPE), De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Jara R. de la Court
- Department of Internal Medicine, Section Pharmacotherapy, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, Netherlands
- Research and Expertise Centre in Pharmacotherapy Education (RECIPE), De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Anke C. Lambooij
- Dutch Institute For Rational Use of Medicines (IVM), Churchilllaan 11, 3527 GV Utrecht, The Netherlands
| | - Michiel A. van Agtmael
- Department of Internal Medicine, Section Pharmacotherapy, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, Netherlands
- Research and Expertise Centre in Pharmacotherapy Education (RECIPE), De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
- https://www.eacpt.eu/
| | - Jelle Tichelaar
- Department of Internal Medicine, Section Pharmacotherapy, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, Netherlands
- Research and Expertise Centre in Pharmacotherapy Education (RECIPE), De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
- https://www.eacpt.eu/
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3
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Soon JA, Whelan AM, Yuksel N, Rafie S. Enhancing access to contraception through pharmacist prescribing across Canada. Can Pharm J (Ott) 2021; 154:356-362. [PMID: 34777642 PMCID: PMC8581806 DOI: 10.1177/17151635211034534] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 02/02/2021] [Indexed: 11/16/2022]
Affiliation(s)
- Judith A. Soon
- Faculty of Pharmaceutical Sciences, University of British Columbia
- Department of Family Practice, University of British Columbia
| | | | - Nesé Yuksel
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, Alberta
| | - Sally Rafie
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California–San Diego, California
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Brinkman DJ, Monteiro T, Monteiro EC, Richir MC, van Agtmael MA, Tichelaar J. Switching from a traditional undergraduate programme in (clinical) pharmacology and therapeutics to a problem-based learning programme. Eur J Clin Pharmacol 2021; 77:421-429. [PMID: 33098019 PMCID: PMC7867513 DOI: 10.1007/s00228-020-03027-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 10/15/2020] [Indexed: 10/26/2022]
Abstract
PURPOSE The pharmacology and clinical pharmacology and therapeutics (CPT) education during the undergraduate medical curriculum of NOVA Medical School, Lisbon, Portugal, was changed from a traditional programme (i.e. discipline-based, lectures) to a problem-based learning (PBL) programme (i.e. integrated, case-based discussions) without an increase in teaching hours. The aim of this study was to investigate whether this change improved the prescribing competencies of final-year medical students. METHODS Final-year students from both programmes (2015 and 2019) were invited to complete a validated prescribing assessment and questionnaire. The assessment comprised 24 multiple-choice questions in three subdomains (working mechanism, side-effects and interactions/contraindications), and five clinical case scenarios of common diseases. The questionnaire focused on self-reported prescribing confidence, preparedness for future prescribing task and education received. RESULTS In total, 36 (22%) final-year medical students from the traditional programme and 54 (23%) from the PBL programme participated. Overall, students in the PBL programme had significantly higher knowledge scores than students in the traditional programme (76% (SD 9) vs 67% (SD 15); p = 0.002). Additionally, students in the PBL programme made significantly fewer inappropriate therapy choices (p = 0.023) and fewer erroneous prescriptions than did students in the traditional programme (p = 0.27). Students in the PBL programme felt more confident in prescribing, felt better prepared for prescribing as junior doctor and completed more drug prescriptions during their medical training. CONCLUSION Changing from a traditional programme to an integrated PBL programme in pharmacology and CPT during the undergraduate medical curriculum may improve the prescribing competencies of final-year students.
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Affiliation(s)
- David J Brinkman
- Section Pharmacotherapy, Department of Internal Medicine, Amsterdam University Medical Centers, De Boelelaan 1117, 1081, HV, Amsterdam, The Netherlands.
- Research and Expertise Center in Pharmacotherapy Education (RECIPE), Amsterdam, The Netherlands.
| | - Teresa Monteiro
- Faculdade de Ciências Médicas, NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Emilia C Monteiro
- Faculdade de Ciências Médicas, NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Milan C Richir
- Section Pharmacotherapy, Department of Internal Medicine, Amsterdam University Medical Centers, De Boelelaan 1117, 1081, HV, Amsterdam, The Netherlands
- Research and Expertise Center in Pharmacotherapy Education (RECIPE), Amsterdam, The Netherlands
| | - Michiel A van Agtmael
- Section Pharmacotherapy, Department of Internal Medicine, Amsterdam University Medical Centers, De Boelelaan 1117, 1081, HV, Amsterdam, The Netherlands
- Research and Expertise Center in Pharmacotherapy Education (RECIPE), Amsterdam, The Netherlands
| | - Jelle Tichelaar
- Section Pharmacotherapy, Department of Internal Medicine, Amsterdam University Medical Centers, De Boelelaan 1117, 1081, HV, Amsterdam, The Netherlands
- Research and Expertise Center in Pharmacotherapy Education (RECIPE), Amsterdam, The Netherlands
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5
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Chhabra A, Nidhi C, Jain A. Knowledge, attitudes and practice preference regarding drug prescriptions of resident dental doctors: A quantitative study. INTERNATIONAL JOURNAL OF RISK & SAFETY IN MEDICINE 2020; 30:91-100. [PMID: 31256074 DOI: 10.3233/jrs-180021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND There has been an increasing need to examine undergraduate dental education in prescribing to confirm whether it is establishing the goal of producing safe and rational prescribers. Prescribing by dental doctors after graduation is influenced by a variety of factors: the different teaching approaches of the professors at the clinics and in the pharmacology course, fellow colleagues and even the information provided by the pharmaceutical industry. OBJECTIVE The aim of this study was to assess the prescription knowledge, attitude, preference and common errors made by junior resident dental doctors in the dental department of two medical colleges and hospitals in India. METHODS Dental graduates (n = 70) who served as junior resident doctors at dental departments and graduated from various dental colleges in India, participated in the study. A survey was conducted among 70 junior resident dental doctors in the dental department, applying a previously validated questionnaire consisting of open-ended questions. The knowledge, attitude and practice preference of resident doctors regarding drug prescription and common errors made by them were analyzed and reviewed. RESULTS The most frequent response to each question was considered the most significant. The most common reason for prescribing medication was infection (n = 33, 47.14%) and the most widely prescribed antibiotic was amoxicillin (n = 29, 41.42%). The most frequent error reported by resident doctors was lack of knowledge about drug posology (n = 31, 44.28%). Maximum number of junior doctors acquired the information for prescribing drugs from their faculty (n = 33, 47.14%). Around 45.71% dental doctors had no knowledge about the WHO Guide to Good Prescribing. About 50- 60% doctors had knowledge about the dose, frequency, duration and route of administration of the drug prescribed. While prescribing drugs to the patient, 25.71% doctors explain the disease and treatment properly to the patient; 24.28% doctors do not criticize other doctors, and 10% doctors address the patient by name. CONCLUSION The results of this study indicate that resident dental doctors' knowledge, attitudes and behavior about the drug prescription need to be improved. More studies are needed to determine whether this issue affects the quality of patient care and the effectiveness and safety of treatments.
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Affiliation(s)
- Anuj Chhabra
- Department of Dental Surgery, North Delhi Municipal Corporation Medical College and Hindu Rao Hospital, New Delhi, India
| | - C Nidhi
- Department of Dental Surgery, North Delhi Municipal Corporation Medical College and Hindu Rao Hospital, New Delhi, India
| | - Anurag Jain
- Department of Dental Surgery, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
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Brinkman DJ, Nijland N, van Diermen DE, Bruers JJM, Ligthart WSM, Rietveld PJ, Tams J, Vissink A, Wilhelm AJ, Rozema FR, Tichelaar J, van Agtmael MA. Are Dutch dental students and dental-care providers competent prescribers of drugs? Eur J Oral Sci 2019; 127:531-538. [PMID: 31821657 PMCID: PMC6973271 DOI: 10.1111/eos.12658] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2019] [Indexed: 11/26/2022]
Abstract
Dental students and dental‐care providers should be able to prescribe drugs safely and effectively. As it is unknown whether this is the case, we assessed and compared the prescribing competence of dental students and dental‐care providers in the Netherlands. In 2017, all Dutch final‐year dental students and a random sample of all qualified general dental practitioners and dental specialists (oral and maxillofacial surgeons and orthodontists) were invited to complete validated prescribing knowledge‐assessment and skills‐assessment instruments. The knowledge assessment comprised 40 multiple‐choice questions covering important drug topics. The skills assessment comprised three common clinical case scenarios. For the knowledge assessment, the response rates were 26 (20%) dental students, 28 (8%) general dental practitioners, and 19 (19%) dental specialists, and for the skills assessment the response rates were 14 (11%) dental students, eight (2%) general dental practitioners, and eight (8%) dental specialists. Dental specialists had higher knowledge scores (78% correct answers) than either dental practitioners (69% correct answers) or dental students (69% correct answers). A substantial proportion of all three groups made inappropriate treatment choices (35%–49%) and prescribing errors (47%–70%). Although there were some differences, dental students and dental‐care providers in the Netherlands lack prescribing competence, which is probably because of poor prescribing education during under‐ and postgraduate dental training. Educational interventions are urgently needed.
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Affiliation(s)
- David J Brinkman
- Department of Internal Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands.,Research and Expertise Center in Pharmacotherapy Education (RECIPE), Amsterdam, The Netherlands
| | - Nina Nijland
- Faculty of Dentistry, Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, The Netherlands
| | - Denise E van Diermen
- Department of Oral Medicine, Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, The Netherlands
| | - Josef J M Bruers
- Department of Social Dentistry and Behavioural Sciences, Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, The Netherlands.,Department of Research and Information, Royal Dutch Dental Association (KNMT), Nieuwegein, The Netherlands
| | | | - Patrick J Rietveld
- Faculty of Dentistry, Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, The Netherlands
| | - Jan Tams
- Faculty of Dentistry, University Medical Center Groningen, Groningen, The Netherlands
| | - Arjan Vissink
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Abraham J Wilhelm
- Department of Clinical Pharmacology and Pharmacy, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Frederik R Rozema
- Department of Oral Medicine, Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, The Netherlands
| | - Jelle Tichelaar
- Department of Internal Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands.,Research and Expertise Center in Pharmacotherapy Education (RECIPE), Amsterdam, The Netherlands
| | - Michiel A van Agtmael
- Department of Internal Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands.,Research and Expertise Center in Pharmacotherapy Education (RECIPE), Amsterdam, The Netherlands
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Schutte T, Tichelaar J, Donker E, Richir MC, Westerman M, van Agtmael MA. Clarifying learning experiences in student-run clinics: a qualitative study. BMC MEDICAL EDUCATION 2018; 18:244. [PMID: 30367661 PMCID: PMC6204044 DOI: 10.1186/s12909-018-1352-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Accepted: 10/16/2018] [Indexed: 05/24/2023]
Abstract
BACKGROUND Student-run clinics (SRCs) are outpatient clinics run and organized by undergraduate medical students. While these clinics offer participating students multiple learning opportunities, little is known about how participation in an SRC contributes to learning and how this learning is influenced. METHODS In this qualitative clarification study, we conducted semi-structured interviews with a purposive sample of 20 students and student-coordinators participating in our learner-centred SRC (LC-SRC), to gain in-depth insight into their experiences and learning. These interviews were analysed using Glaser's approach to grounded theory. RESULTS Analysis revealed that responsibility, authenticity, and collaboration described how SRC participation contribute to learning. Responsibility encompassed the responsibility students had for their patients and the responsibility that the student coordinators had for the students. Authenticity reflected the context and tasks in the LC-SRC. Collaboration covered collaboration with other students, with student coordinators, and with clinical supervisors. These three themes are interrelated, and together enhanced motivation and promoted patient-centred learning in both the LC-SRC and the regular curriculum. CONCLUSIONS Learning in an LC-SRC is highly dependent on students' feelings of responsibility for real authentic tasks and is stimulated by extensive collaboration with fellow students and supervising doctors.
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Affiliation(s)
- Tim Schutte
- Department of Internal Medicine, pharmacotherapy section, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
- RECIPE (Research & Expertise Center In Pharmacotherapy Education), Amsterdam, The Netherlands.
- Department of Internal Medicine, Zaans Medisch Centrum, Zaandam, The Netherlands.
| | - Jelle Tichelaar
- Department of Internal Medicine, pharmacotherapy section, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- RECIPE (Research & Expertise Center In Pharmacotherapy Education), Amsterdam, The Netherlands
| | - Erik Donker
- Department of Internal Medicine, pharmacotherapy section, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- RECIPE (Research & Expertise Center In Pharmacotherapy Education), Amsterdam, The Netherlands
| | - Milan C Richir
- Department of Internal Medicine, pharmacotherapy section, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- RECIPE (Research & Expertise Center In Pharmacotherapy Education), Amsterdam, The Netherlands
| | - Michiel Westerman
- Department of Internal Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Research in Education, VUmc School of Medical Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Michiel A van Agtmael
- Department of Internal Medicine, pharmacotherapy section, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- RECIPE (Research & Expertise Center In Pharmacotherapy Education), Amsterdam, The Netherlands
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8
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Brinkman DJ, Tichelaar J, Mokkink LB, Christiaens T, Likic R, Maciulaitis R, Costa J, Sanz EJ, Maxwell SR, Richir MC, van Agtmael MA. Key Learning Outcomes for Clinical Pharmacology and Therapeutics Education in Europe: A Modified Delphi Study. Clin Pharmacol Ther 2018; 104:317-325. [PMID: 29205299 PMCID: PMC6099198 DOI: 10.1002/cpt.962] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 11/21/2017] [Accepted: 11/25/2017] [Indexed: 11/19/2022]
Abstract
Harmonizing clinical pharmacology and therapeutics (CPT) education in Europe is necessary to ensure that the prescribing competency of future doctors is of a uniform high standard. As there are currently no uniform requirements, our aim was to achieve consensus on key learning outcomes for undergraduate CPT education in Europe. We used a modified Delphi method consisting of three questionnaire rounds and a panel meeting. A total of 129 experts from 27 European countries were asked to rate 307 learning outcomes. In all, 92 experts (71%) completed all three questionnaire rounds, and 33 experts (26%) attended the meeting. 232 learning outcomes from the original list, 15 newly suggested and 5 rephrased outcomes were included. These 252 learning outcomes should be included in undergraduate CPT curricula to ensure that European graduates are able to prescribe safely and effectively. We provide a blueprint of a European core curriculum describing when and how the learning outcomes might be acquired.
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Affiliation(s)
- David J Brinkman
- Department of Internal Medicine, VU University Medical Center, Amsterdam, The Netherlands.,Research and Expertise Center in Pharmacotherapy Education (RECIPE), Amsterdam, The Netherlands
| | - Jelle Tichelaar
- Department of Internal Medicine, VU University Medical Center, Amsterdam, The Netherlands.,Research and Expertise Center in Pharmacotherapy Education (RECIPE), Amsterdam, The Netherlands
| | - Lidwine B Mokkink
- Department of Epidemiology and Biostatistics and Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | | | - Robert Likic
- Unit of Clinical Pharmacology, University of Zagreb School of Medicine and Clinical Hospital Centre Zagreb, Zagreb, Croatia
| | - Romaldas Maciulaitis
- Institute of Physiology and Pharmacology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Joao Costa
- Department of Pharmacology and Clinical Pharmacology, University of Lisbon, Lisbon, Portugal
| | - Emilio J Sanz
- Faculty of Medicine, University of La Laguna, Tenerife, Spain
| | - Simon R Maxwell
- Clinical Pharmacology Unit, University of Edinburgh, Edinburgh, UK
| | - Milan C Richir
- Department of Internal Medicine, VU University Medical Center, Amsterdam, The Netherlands.,Research and Expertise Center in Pharmacotherapy Education (RECIPE), Amsterdam, The Netherlands
| | - Michiel A van Agtmael
- Department of Internal Medicine, VU University Medical Center, Amsterdam, The Netherlands.,Research and Expertise Center in Pharmacotherapy Education (RECIPE), Amsterdam, The Netherlands
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9
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Brinkman DJ, Tichelaar J, Graaf S, Otten RHJ, Richir MC, van Agtmael MA. Do final-year medical students have sufficient prescribing competencies? A systematic literature review. Br J Clin Pharmacol 2018; 84:615-635. [PMID: 29315721 PMCID: PMC5867102 DOI: 10.1111/bcp.13491] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 11/19/2017] [Accepted: 11/26/2017] [Indexed: 01/12/2023] Open
Abstract
Aims Prescribing errors are an important cause of patient safety incidents and are frequently caused by junior doctors. This might be because the prescribing competence of final‐year medical students is poor as a result of inadequate clinical pharmacology and therapeutic (CPT) education. We reviewed the literature to investigate which prescribing competencies medical students should have acquired in order to prescribe safely and effectively, and whether these have been attained by the time they graduate. Methods PubMed, EMBASE and ERIC databases were searched from the earliest dates up to and including January 2017, using the terms ‘prescribing’, ‘competence’ and ‘medical students’ in combination. Articles describing or evaluating essential prescribing competencies of final‐year medical students were included. Results Twenty‐five articles describing, and 47 articles evaluating, the prescribing competencies of final‐year students were included. Although there seems to be some agreement, we found no clear consensus among CPT teachers on which prescribing competencies medical students should have when they graduate. Studies showed that students had a general lack of preparedness, self‐confidence, knowledge and skills, specifically regarding general and antimicrobial prescribing and pharmacovigilance. However, the results should be interpreted with caution, given the heterogeneity and methodological weaknesses of the included studies. Conclusions There is considerable evidence that final‐year students have insufficient competencies to prescribe safely and effectively, although there is a need for a greater consensus among CPT teachers on the required competencies. Changes in undergraduate CPT education are urgently required in order to improve the prescribing of future doctors.
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Affiliation(s)
- David J Brinkman
- Department of Internal Medicine, section Pharmacotherapy, VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.,Research and Expertise Center in Pharmacotherapy Education (RECIPE), De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Jelle Tichelaar
- Department of Internal Medicine, section Pharmacotherapy, VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.,Research and Expertise Center in Pharmacotherapy Education (RECIPE), De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Sanne Graaf
- Department of Internal Medicine, section Pharmacotherapy, VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - René H J Otten
- Medical Library, Vrije Universiteit, Amsterdam, De Boelelaan 1105, 1081 HV, Amsterdam, The Netherlands
| | - Milan C Richir
- Department of Internal Medicine, section Pharmacotherapy, VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.,Research and Expertise Center in Pharmacotherapy Education (RECIPE), De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Michiel A van Agtmael
- Department of Internal Medicine, section Pharmacotherapy, VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.,Research and Expertise Center in Pharmacotherapy Education (RECIPE), De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
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Brinkman DJ, Tichelaar J, Okorie M, Bissell L, Christiaens T, Likic R, Mačìulaitis R, Costa J, Sanz EJ, Tamba BI, Maxwell SR, Richir MC, van Agtmael MA. Pharmacology and Therapeutics Education in the European Union Needs Harmonization and Modernization: A Cross-sectional Survey Among 185 Medical Schools in 27 Countries. Clin Pharmacol Ther 2017; 102:815-822. [PMID: 28295236 PMCID: PMC5655694 DOI: 10.1002/cpt.682] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 03/01/2017] [Accepted: 03/06/2017] [Indexed: 11/10/2022]
Abstract
Effective teaching in pharmacology and clinical pharmacology and therapeutics (CPT) is necessary to make medical students competent prescribers. However, the current structure, delivery, and assessment of CPT education in the European Union (EU) is unknown. We sent an online questionnaire to teachers with overall responsibility for CPT education in EU medical schools. Questions focused on undergraduate teaching and assessment of CPT, and students' preparedness for prescribing. In all, 185 medical schools (64%) from 27 EU countries responded. Traditional learning methods were mainly used. The majority of respondents did not provide students with the opportunity to practice real-life prescribing and believed that their students were not well prepared for prescribing. There is a marked difference in the quality and quantity of CPT education within and between EU countries, suggesting that there is considerable scope for improvement. A collaborative approach should be adopted to harmonize and modernize the undergraduate CPT education across the EU.
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Affiliation(s)
- D J Brinkman
- Department of Internal Medicine, VU University Medical Center, Amsterdam, The Netherlands.,Research and Expertise Center in Pharmacotherapy Education (RECIPE), Amsterdam, The Netherlands
| | - J Tichelaar
- Department of Internal Medicine, VU University Medical Center, Amsterdam, The Netherlands.,Research and Expertise Center in Pharmacotherapy Education (RECIPE), Amsterdam, The Netherlands
| | - M Okorie
- Medical Education Unit, Brighton and Sussex Medical School, Brighton, UK
| | - L Bissell
- Medical Education Unit, Brighton and Sussex Medical School, Brighton, UK
| | - T Christiaens
- Department of Clinical Pharmacology, Ghent University, Ghent, Belgium
| | - R Likic
- Unit of Clinical Pharmacology, University of Zagreb School of Medicine, Zagreb, Croatia
| | - R Mačìulaitis
- Faculty of Medicine, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - J Costa
- Department of Pharmacology and Clinical Pharmacology, University of Lisbon, Lisbon, Portugal
| | - E J Sanz
- Faculty of Medicine, University of La Laguna, Tenerife, Spain
| | - B I Tamba
- Department of Pharmacology and Algesiology, Gr. T. Popa University of Medicine and Pharmacy, Iasi, Romania
| | - S R Maxwell
- Unit of Clinical Pharmacology, University of Edinburgh, Edinburgh, UK
| | - M C Richir
- Department of Internal Medicine, VU University Medical Center, Amsterdam, The Netherlands.,Research and Expertise Center in Pharmacotherapy Education (RECIPE), Amsterdam, The Netherlands
| | - M A van Agtmael
- Department of Internal Medicine, VU University Medical Center, Amsterdam, The Netherlands.,Research and Expertise Center in Pharmacotherapy Education (RECIPE), Amsterdam, The Netherlands
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11
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Schutte T, Tichelaar J, Dekker RS, Thijs A, de Vries TPGM, Kusurkar RA, Richir MC, van Agtmael MA. Motivation and competence of participants in a learner-centered student-run clinic: an exploratory pilot study. BMC MEDICAL EDUCATION 2017; 17:23. [PMID: 28122557 PMCID: PMC5264437 DOI: 10.1186/s12909-017-0856-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 01/09/2017] [Indexed: 06/06/2023]
Abstract
BACKGROUND The Learner-Centered Student-run Clinic (LC-SRC) was designed to teach and train prescribing skills grounded in a real-life context, to provide students with early clinical experience and responsibility. The current studies' theoretical framework was based on the Self-determination Theory. According to the Self-determination Theory, early involvement in clinical practice combined with a high level of responsibility makes the LC-SRC an environment that can stimulate intrinsic motivation. We investigated the different types of motivation and the proficiency in CanMEDS competencies of the participating students. METHOD Type of motivation was measured using the Academic Motivation Scale and Intrinsic Motivation Inventory. CanMEDS competencies were evaluated by faculty using a mini-clinical examination and by the students themselves using a post-participation questionnaire. RESULTS The 29 participating students were highly intrinsic motivated for this project on all subscales of the Intrinsic Motivation Inventory. Motivation for medical school on the Academic Motivation Scale was high before and was not significantly changed after participation. Students considered that their CanMEDS competencies "Collaborator", "Communicator", "Academic", and "Medical expert" had improved. Their actual clinical team competence was judged by faculty to be at a junior doctor level. CONCLUSION Students showed a high level of intrinsic motivation to participate in the LC-SRC and perceived an improvement in competence. Furthermore their actual clinical competence was at junior doctor level in all CanMEDS competencies. The stimulating characteristics of the LC-SRC, the high levels of intrinsic motivation and the qualitative comments of the students in this study makes the LC-SRC an attractive place for learning.
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Affiliation(s)
- Tim Schutte
- Department of Internal Medicine, Pharmacotherapy Section, VU University Medical Center, De Boelelaan 1117 - room ZH 4A50, 1081 HZ, Amsterdam, The Netherlands.
- RECIPE (Research & Expertise Center In Pharmacotherapy Education), Amsterdam, The Netherlands.
| | - Jelle Tichelaar
- Department of Internal Medicine, Pharmacotherapy Section, VU University Medical Center, De Boelelaan 1117 - room ZH 4A50, 1081 HZ, Amsterdam, The Netherlands
- RECIPE (Research & Expertise Center In Pharmacotherapy Education), Amsterdam, The Netherlands
| | - Ramon S Dekker
- Department of Internal Medicine, Pharmacotherapy Section, VU University Medical Center, De Boelelaan 1117 - room ZH 4A50, 1081 HZ, Amsterdam, The Netherlands
| | - Abel Thijs
- Department of Internal Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - Theo P G M de Vries
- Department of Internal Medicine, Pharmacotherapy Section, VU University Medical Center, De Boelelaan 1117 - room ZH 4A50, 1081 HZ, Amsterdam, The Netherlands
- RECIPE (Research & Expertise Center In Pharmacotherapy Education), Amsterdam, The Netherlands
| | - Rashmi A Kusurkar
- School of Medical Sciences, VU University Medical Center, Amsterdam, The Netherlands
| | - Milan C Richir
- Department of Internal Medicine, Pharmacotherapy Section, VU University Medical Center, De Boelelaan 1117 - room ZH 4A50, 1081 HZ, Amsterdam, The Netherlands
- RECIPE (Research & Expertise Center In Pharmacotherapy Education), Amsterdam, The Netherlands
| | - Michiel A van Agtmael
- Department of Internal Medicine, Pharmacotherapy Section, VU University Medical Center, De Boelelaan 1117 - room ZH 4A50, 1081 HZ, Amsterdam, The Netherlands
- RECIPE (Research & Expertise Center In Pharmacotherapy Education), Amsterdam, The Netherlands
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12
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Guraya SY, Guraya SS, Mahabbat NA, Fallatah KY, Al-Ahmadi BA, Alalawi HH. The Desired Concept Maps and Goal Setting for Assessing Professionalism in Medicine. J Clin Diagn Res 2016; 10:JE01-5. [PMID: 27437247 DOI: 10.7860/jcdr/2016/19917.7832] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Accepted: 03/28/2016] [Indexed: 11/24/2022]
Abstract
Due to the multi-dimensional characteristics of professionalism, no single assessment modality has shown to reliably assess professionalism. This review aims to describe some of the popular assessment tools that are being used to assess professionalism with a view to formulate a framework of assessment of professionalism in medicine. In December 2015, the online research databases of MEDLINE, the Educational Resources Information Center (ERIC), Elton Bryson Stephens Company (EBSCO), SCOPUS, OVID and PsychINFO were searched for full-text English language articles published during 2000 to 2015. MeSH terms "professionalism" AND "duty" AND "assessment" OR "professionalism behavioural" AND "professionalism-cognitive" were used. The research articles that assessed professionalism across medical fields along with other areas of competencies were included. A final list of 35 articles were selected for this review. Several assessment tools are available for assessing professionalism that includes, but not limited to, mini clinical evaluation exercise, standardised direct observation of procedural skills, professionalism mini-evaluation exercise, multi-source feedback and 360 degree evaluation, and case based discussions. Because professionalism is a complex construct, it is less likely that a single assessment strategy will adequately measure it. Since every single assessment tool has its own weaknesses, triangulation involving multiple tools can compensate the shortcomings associated with any single approach. Assessment of professionalism necessitates a combination of modalities at individual, interpersonal, societal, and institutional levels and should be accompanied by feedback and motivational reflection that will, in turn, lead to behaviour and identity formation. The assessment of professionalism in medicine should meet the criteria of validity, reliability, feasibility and acceptability. Educators are urged to enhance the depth and quality of assessment instruments in the existing medical curricula for ensuring validity and reliability of assessment tools for professionalism.
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Affiliation(s)
- Salman Y Guraya
- Professor, Department of Surgery and Consultant Colorectal Surgeon, College of Medicine Taibah University Almadinah Almunawwarah, Saudi Arabia
| | - Shaista S Guraya
- Assistant Professor, Department of Radiology, College of Medicine Taibah University Almadinah Almunawwarah, Saudi Arabia
| | - Nehal Anam Mahabbat
- Resident, Department of Plastic Surgery, National Guards Hospital , Riyadh, Saudi Arabia
| | - Khulood Yahya Fallatah
- Resident, Department of Dermatology, Maternity and Children Hospital , Riyadh, Saudi Arabia
| | - Bashaer Ahmad Al-Ahmadi
- Resident, Department of Pediatrics, Prince Sultan Military Medical City , Riyadh, Saudi Arabia
| | - Hadeel Hadi Alalawi
- Resident, Department of Surgery Orthopeadic, Prince Sultan Armed Forces Hospital , Almadinah Almunawwarah, Saudi Arabia
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13
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Tichelaar J, Uil den SH, Antonini NF, van Agtmael MA, de Vries TPGM, Richir MC. A 'SMART' way to determine treatment goals in pharmacotherapy education. Br J Clin Pharmacol 2016; 82:280-4. [PMID: 26914983 DOI: 10.1111/bcp.12919] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 01/31/2016] [Accepted: 02/17/2016] [Indexed: 11/29/2022] Open
Abstract
AIM Determining treatment goals is an important part of the treatment decision-making process, but medical students are not trained in a structural way on how to define these goals. 'SMART' criteria are widely used in non-medical professions for determining goals and may improve treatment goal setting. The aim of this study was to assess the effect of implementation of SMART criteria on medical students' ability to set treatment goals and to analyze the effects on treatment choice and monitoring. METHODS We performed a prospective, randomized controlled minimal intervention study with one control and two intervention groups (WHO group and SMART group). Second year medical students had to complete a WHO six step treatment plan for four written case reports of patients with asthma. The treatment plans were assessed using a standard scoring sheet developed by a Delphi procedure among respiratory physicians from all eight university medical centres in the Netherlands. RESULTS A total of 251 second year medical students participated. The SMART group had significantly higher scores for setting treatment goals than the WHO and control groups (68.5 % vs. 29.6 % and 30.8 %, respectively, both P < 0.001). The SMART group also had significantly better scores for treatment monitoring than the WHO and control groups (34.2 % vs. 19.3 % and 24.6 %, respectively, both P < 0.001). There were no between group differences in treatment choice. Regardless of the study group, better setting of treatment goals was associated with better treatment monitoring, an association not reported earlier. CONCLUSION SMART criteria improve the setting of treatment goals and treatment monitoring.
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Affiliation(s)
- Jelle Tichelaar
- RECIPE (Research and Expertise Center In Pharmacotherapy Education), Amsterdam, the Netherlands.,Department of Internal Medicine, section Pharmacotherapy, VU University Medical Center, Amsterdam, the Netherlands
| | - Sjoerd H Uil den
- Department of Internal Medicine, section Pharmacotherapy, VU University Medical Center, Amsterdam, the Netherlands
| | - Ninja F Antonini
- Department of Internal Medicine, section Pharmacotherapy, VU University Medical Center, Amsterdam, the Netherlands
| | - Michiel A van Agtmael
- RECIPE (Research and Expertise Center In Pharmacotherapy Education), Amsterdam, the Netherlands.,Department of Internal Medicine, section Pharmacotherapy, VU University Medical Center, Amsterdam, the Netherlands
| | - Theo P G M de Vries
- RECIPE (Research and Expertise Center In Pharmacotherapy Education), Amsterdam, the Netherlands.,Department of Internal Medicine, section Pharmacotherapy, VU University Medical Center, Amsterdam, the Netherlands
| | - Milan C Richir
- Department of Internal Medicine, section Pharmacotherapy, VU University Medical Center, Amsterdam, the Netherlands
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14
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Brinkman D, Disselhorst G, Jansen B, Tichelaar J, van Agtmael M, de Vries T, Richir M. What Should Junior Doctors Know about the Drugs they Frequently Prescribe? A Delphi Study among Physicians in the Netherlands. Basic Clin Pharmacol Toxicol 2015; 118:456-61. [PMID: 26506082 DOI: 10.1111/bcpt.12508] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Accepted: 10/20/2015] [Indexed: 11/28/2022]
Abstract
The aim of this study was to identify the information about commonly prescribed drugs that junior doctors should know in order to prescribe rationally in daily practice, defined as essential drug knowledge (EDK). A two-round Internet Delphi study was carried out involving general practitioners from one practice cluster, and registrars and consultants from two Dutch academic and eight teaching hospitals. A preliminary list of 377 potential EDK items for three commonly prescribed drugs was assessed on a dichotomous scale; an item was considered EDK if at least 80% consensus was reached. The consensus list of EDK items was discussed by the research team to identify similarities between the three drugs, with a view to forming a list of general EDK items applicable to other commonly prescribed drugs. Sixty experts considered 93 of the 377 items (25%) as EDK. These items were then used to form a list of 10 general EDK items. The list of EDK items identified by primary and secondary care doctors could be used in medical curricula and training programmes and for assessing the prescribing competence of future junior doctors. Further research is needed to evaluate the generalizability of this list for other commonly prescribed drugs.
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Affiliation(s)
- David Brinkman
- Research and Expertise Center In Pharmacotherapy Education (RECIPE), Amsterdam, the Netherlands.,Department of Internal Medicine, Section Pharmacotherapy, VU University Medical Center, Amsterdam, the Netherlands
| | - Guus Disselhorst
- Research and Expertise Center In Pharmacotherapy Education (RECIPE), Amsterdam, the Netherlands.,Department of Internal Medicine, Section Pharmacotherapy, VU University Medical Center, Amsterdam, the Netherlands
| | - Bernard Jansen
- Research and Expertise Center In Pharmacotherapy Education (RECIPE), Amsterdam, the Netherlands.,Department of Internal Medicine, Section Pharmacotherapy, VU University Medical Center, Amsterdam, the Netherlands
| | - Jelle Tichelaar
- Research and Expertise Center In Pharmacotherapy Education (RECIPE), Amsterdam, the Netherlands.,Department of Internal Medicine, Section Pharmacotherapy, VU University Medical Center, Amsterdam, the Netherlands
| | - Michiel van Agtmael
- Research and Expertise Center In Pharmacotherapy Education (RECIPE), Amsterdam, the Netherlands.,Department of Internal Medicine, Section Pharmacotherapy, VU University Medical Center, Amsterdam, the Netherlands
| | - Theo de Vries
- Research and Expertise Center In Pharmacotherapy Education (RECIPE), Amsterdam, the Netherlands.,Department of Internal Medicine, Section Pharmacotherapy, VU University Medical Center, Amsterdam, the Netherlands
| | - Milan Richir
- Research and Expertise Center In Pharmacotherapy Education (RECIPE), Amsterdam, the Netherlands.,Department of Internal Medicine, Section Pharmacotherapy, VU University Medical Center, Amsterdam, the Netherlands
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15
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Dekker RS, Schutte T, Tichelaar J, Thijs A, van Agtmael MA, de Vries TPGM, Richir MC. A novel approach to teaching pharmacotherapeutics--feasibility of the learner-centered student-run clinic. Eur J Clin Pharmacol 2015; 71:1381-7. [PMID: 26268444 PMCID: PMC4613888 DOI: 10.1007/s00228-015-1916-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Accepted: 07/23/2015] [Indexed: 12/02/2022]
Abstract
ᅟ Medical students should be better prepared for their future role as prescribers. A new educational concept to achieve this is learning by doing. This encompasses legitimate, context-based training and gives students responsibility as early as possible in their medical education. Student-run clinics (SRCs) are an example of this concept. Aim Describe the development of a new SRC for insured patients, primarily focused on medical (pharmacotherapy) education, the learner-centered student-run clinic (LC-SRC), and its feasibility. Methods Teams each comprising of three students (first, third, and fifth year) performed consultations including proposing management plans, all under the supervision of an internist. Patients were voluntary selected from the internal medicine outpatient clinic for follow-up in the LC-SRC. Feasibility was evaluated using a set of questionnaires for patients, supervisors, and students. Results In total, 31 consultations were conducted; 31 students and 4 clinical specialists participated. A pharmacotherapeutic treatment plan was drawn up in 33 % of the consultations. Patients were content with the care provided and rated the consultation with a 7.9 (SD 1.21) (1(min)-10(max)). Supervisors regarded LC-SRC safe for patients with guaranteed quality of care. They found the LC-SRC a valuable tool in medical education although it was time-consuming. Students appreciated their (new) responsibility for patient care and considered the LC-SRC a very valuable extracurricular activity. Discussion The LC-SRC is feasible, and all participants considered it to be a valuable educational activity. It offers students the opportunity to learn in a real interprofessional and longitudinal setting for their future role as prescriber in clinical practice. The benefits and learner effects need to be investigated in a larger study with a longer follow-up. Electronic supplementary material The online version of this article (doi:10.1007/s00228-015-1916-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ramon S Dekker
- Department of Internal Medicine, Pharmacotherapy Section, VU University Medical Center, room PK 1X74, De Boelelaan 1118, 1081 HZ, Amsterdam, The Netherlands
| | - Tim Schutte
- Department of Internal Medicine, Pharmacotherapy Section, VU University Medical Center, room PK 1X74, De Boelelaan 1118, 1081 HZ, Amsterdam, The Netherlands.
- RECIPE (Research and Expertise Center In Pharmacotherapy Education), Amsterdam, The Netherlands.
| | - Jelle Tichelaar
- Department of Internal Medicine, Pharmacotherapy Section, VU University Medical Center, room PK 1X74, De Boelelaan 1118, 1081 HZ, Amsterdam, The Netherlands
- RECIPE (Research and Expertise Center In Pharmacotherapy Education), Amsterdam, The Netherlands
| | - Abel Thijs
- Department of Internal Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - Michiel A van Agtmael
- Department of Internal Medicine, Pharmacotherapy Section, VU University Medical Center, room PK 1X74, De Boelelaan 1118, 1081 HZ, Amsterdam, The Netherlands
- RECIPE (Research and Expertise Center In Pharmacotherapy Education), Amsterdam, The Netherlands
| | - Theo P G M de Vries
- Department of Internal Medicine, Pharmacotherapy Section, VU University Medical Center, room PK 1X74, De Boelelaan 1118, 1081 HZ, Amsterdam, The Netherlands
- RECIPE (Research and Expertise Center In Pharmacotherapy Education), Amsterdam, The Netherlands
| | - Milan C Richir
- Department of Internal Medicine, Pharmacotherapy Section, VU University Medical Center, room PK 1X74, De Boelelaan 1118, 1081 HZ, Amsterdam, The Netherlands
- RECIPE (Research and Expertise Center In Pharmacotherapy Education), Amsterdam, The Netherlands
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16
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Schutte T, Tichelaar J, Dekker RS, van Agtmael MA, de Vries TPGM, Richir MC. Learning in student-run clinics: a systematic review. MEDICAL EDUCATION 2015; 49:249-263. [PMID: 25693985 DOI: 10.1111/medu.12625] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Revised: 07/22/2014] [Accepted: 09/12/2014] [Indexed: 06/04/2023]
Abstract
CONTEXT Student-run clinics (SRCs) have existed for many years and may provide the most realistic setting for context-based learning and legitimate early clinical experiences with responsibility for patient care. We reviewed the literature on student outcomes of participation in SRCs. METHODS A systematic literature review was performed using the PubMed, EMBASE, PsycINFO and ERIC databases. Included articles were reviewed for conclusions and outcomes; study quality was assessed using the Medical Education Research Study Quality Instrument (MERSQI). RESULTS A total of 42 articles met the inclusion criteria and were included in the quantitative synthesis. The effects of participation on students' attitudes were mainly positive: students valued the SRC experience. Data on the effects of SRC participation on students' skills and knowledge were based mainly on expert opinions and student surveys. Students reported improved skills and indicated that they had acquired knowledge they were unlikely to have gained elsewhere in the curriculum. The quality of specific aspects of care delivered by students was comparable with that of regular care. CONCLUSIONS The suggestion that students should be trained as medical professionals with responsibility for patient care early in the curriculum is attractive. In an SRC this responsibility is central. Students valued the early training opportunity in SRCs and liked participating. However, little is known about the effect of SRC participation on students' skills and knowledge. The quality of care provided by students seemed adequate. Further research is needed to assess the effect of SRC participation on students' skills, knowledge and behaviour.
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Affiliation(s)
- Tim Schutte
- Research and Expertise Centre in Pharmacotherapy Education (RECIPE), Amsterdam, The Netherlands; Pharmacotherapy Section, Department of Internal Medicine, VU University Medical Centre, Amsterdam, The Netherlands
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17
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Brinkman DJ, Tichelaar J, van Agtmael MA, de Vries TPGM, Richir MC. Self-reported confidence in prescribing skills correlates poorly with assessed competence in fourth-year medical students. J Clin Pharmacol 2015; 55:825-30. [PMID: 25650568 DOI: 10.1002/jcph.474] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2014] [Accepted: 01/29/2015] [Indexed: 11/08/2022]
Abstract
The objective of this study was to investigate the relationship between students' self-reported confidence and their objectively assessed competence in prescribing. We assessed the competence in several prescribing skills of 403 fourth-year medical students at the VU University Medical Center, the Netherlands, in a formative simulated examination on a 10-point scale (1 = very low; 10 = very high). Afterwards, the students were asked to rate their confidence in performing each of the prescribing skills on a 5-point Likert scale (1 = very unsure; 5 = very confident). Their assessments were then compared with their self-confidence ratings. Students' overall prescribing performance was adequate (7.0 ± 0.8), but they lacked confidence in 2 essential prescribing skills. Overall, there was a weak positive correlation (r = 0.2, P < .01, 95%CI 0.1-0.3) between reported confidence and actual competence. Therefore, this study suggests that self-reported confidence is not an accurate measure of prescribing competence, and that students lack insight into their own strengths and weaknesses in prescribing. Future studies should focus on developing validated and reliable instruments so that students can assess their prescribing skills.
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Affiliation(s)
- David J Brinkman
- Research and Expertise Center in Pharmacotherapy Education (RECIPE), Amsterdam, The Netherlands.,Department of Internal Medicine, Section Pharmacotherapy, VU University Medical Center, Amsterdam, The Netherlands
| | - Jelle Tichelaar
- Research and Expertise Center in Pharmacotherapy Education (RECIPE), Amsterdam, The Netherlands
| | - Michiel A van Agtmael
- Research and Expertise Center in Pharmacotherapy Education (RECIPE), Amsterdam, The Netherlands.,Department of Internal Medicine, Section Pharmacotherapy, VU University Medical Center, Amsterdam, The Netherlands
| | - Theo P G M de Vries
- Research and Expertise Center in Pharmacotherapy Education (RECIPE), Amsterdam, The Netherlands.,Department of Internal Medicine, Section Pharmacotherapy, VU University Medical Center, Amsterdam, The Netherlands
| | - Milan C Richir
- Research and Expertise Center in Pharmacotherapy Education (RECIPE), Amsterdam, The Netherlands.,Department of Internal Medicine, Section Pharmacotherapy, VU University Medical Center, Amsterdam, The Netherlands
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