1
|
Shi W, Qin H, Vaughan B, Ng L. Educational Interventions for Medical Students to Improve Pharmacological Knowledge and Prescribing Skills: A Scoping Review. PERSPECTIVES ON MEDICAL EDUCATION 2023; 12:348-360. [PMID: 37662713 PMCID: PMC10473179 DOI: 10.5334/pme.1006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Accepted: 06/24/2023] [Indexed: 09/05/2023]
Abstract
Introduction Medication-related errors place a heavy financial burden on healthcare systems worldwide, and mistakes are most likely to occur at the stage of prescribing. Junior doctors are more likely to make prescribing errors, and medical graduates also lack confidence and preparedness towards prescribing. Thus, this review aimed to evaluate the existing educational approaches to improve pharmacological knowledge and prescribing skills among medical students. Methods CENTRAL, CINAHL, ERIC, Ovid Embase, Ovid MEDLINE, Ovid PsycINFO, and Scopus were searched with keywords related to "pharmacological knowledge", "prescribing skills", "educational interventions" for articles published since 2016. Results 3595 records were identified, and 115 full-text articles were assessed for eligibility. Eighty full-text articles were eligible and included in this review. Thirty-seven studies focused on improving prescribing skills, whilst 43 targeted pharmacological knowledge. A broad range of interventions was implemented, including e-learning, case-based, interprofessional, and experiential learning. Pharmacological knowledge and prescribing skills were measured in various ways, and all studies reported one or more positive findings at Kirkpatrick level 1 or 2. No study reported outcomes at Kirkpatrick levels 3 and 4. Discussion The World Health Organisation's Good Guide to Prescribing was the foundation of the development of prescribing educational interventions. Emerging interventions such as experiential and interprofessional learning should be incorporated into the prescribing curriculum. Innovative approaches such as game-based learning can be considered for clinical pharmacology teaching. However, there was a lack of outcomes at Kirkpatrick levels 3 and 4. Robust methodology and reliable outcome measures are also needed in future studies.
Collapse
Affiliation(s)
- Weiwei Shi
- Melbourne Medical school, The University of Melbourne, Melbourne, Victoria, Australia
| | - Helen Qin
- Department of Medical Education, The University of Melbourne, Melbourne, Victoria, Australia
| | - Brett Vaughan
- Department of Medical Education, The University of Melbourne, Melbourne, Victoria, Australia
| | - Louisa Ng
- The University of Melbourne, Melbourne Medical school, and Department of Medical Education, Australia
- Department of Rehabilitation Medicine, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| |
Collapse
|
2
|
Budakoğlu Iİ, Coşkun Ö, Kıyak YS, Uluoğlu C. Teaching rational prescribing in undergraduate medical education: a systematic search and review. Eur J Clin Pharmacol 2023; 79:341-348. [PMID: 36622428 DOI: 10.1007/s00228-022-03448-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 12/20/2022] [Indexed: 01/10/2023]
Abstract
AIM This study aimed to reveal the current status of the literature on rational prescribing training in undergraduate medical education. METHODS This study followed the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. An online search using 50 keywords in four databases was performed to access the studies published between 2008 and 2020. Specific features of the training such as aims or objectives of teaching, methods or model, and evaluation of effectiveness were extracted. Kirkpatrick levels were used to evaluate the effectiveness of teaching. RESULTS Of 74 studies included in the full review, 16 (21.6%) of them reported the use of WHO 6-Step Model for Rational Prescribing in their educational interventions. In terms of effectiveness, only two of the studies investigated changes in learner behavior in the context for which they are being trained, and only one study showed the effect of training on patient outcomes. CONCLUSION The evidence on the effectiveness of rational prescribing training has been presented mostly by using student satisfaction surveys and test of knowledge and skills. A higher level of evidence such as patient outcomes of the training needs to be reported.
Collapse
Affiliation(s)
- Işıl İrem Budakoğlu
- Department of Medical Education and Informatics, Faculty of Medicine, Gazi University, Gazi Üniversitesi Hastanesi E Blok 9. Kat, 06500, Beşevler, Ankara, Turkey.
| | - Özlem Coşkun
- Department of Medical Education and Informatics, Faculty of Medicine, Gazi University, Gazi Üniversitesi Hastanesi E Blok 9. Kat, 06500, Beşevler, Ankara, Turkey
| | - Yavuz Selim Kıyak
- Department of Medical Education and Informatics, Faculty of Medicine, Gazi University, Gazi Üniversitesi Hastanesi E Blok 9. Kat, 06500, Beşevler, Ankara, Turkey
| | - Canan Uluoğlu
- Department of Medical Pharmacology, Gazi University Faculty of Medicine, Gazi Üniversitesi Hastanesi E Blok 9. Kat, 06500, Beşevler, Ankara, Turkey
| |
Collapse
|
3
|
Krishnan DG, Keloth AV, Ahmad S, Pg M. Role Play versus Small Group Discussion in Teaching Prescription Communication Skills: A Comparative Study on students of Phase Two of the Bachelor of Medicine and Bachelor of Surgery (MBBS) Course. JOURNAL OF ADVANCES IN MEDICAL EDUCATION & PROFESSIONALISM 2023; 11:34-41. [PMID: 36685140 PMCID: PMC9846093 DOI: 10.30476/jamp.2022.96136.1679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 09/10/2022] [Indexed: 06/17/2023]
Abstract
INTRODUCTION Inadequate prescription communication skills of the medical graduates lead to poor therapeutic outcome and increased burden on the healthcare system. This gap has to be addressed through effective methods for teaching prescription communication skills to medical students. This study compared the effectiveness of Role play and Small Group Discussion (SGD) in teaching prescription communication skills to students of Phase Two of the Bachelor of Medicine and Bachelor of Surgery (MBBS) course. METHODS This was a prospective interventional study done in the Department of Pharmacology affiliated to the Department of Surgery at a Tertiary Care Centre in North Kerala for a period of 3 months from March 2021 to May 2021. After obtaining ethical clearance and informed consent, students of Phase Two of the MBBS course students (n=60) were selected by convenience sampling and divided into 2 groups by simple randomisation. The groups were taught prescription communication skills by Role play and SGD, respectively. Each group received six independent interventions on different topics. An Objective Structured Clinical Examination (OSCE) was conducted 1 week after each session for both groups. At the end of six sessions, feedback on the sessions was collected through a perception questionnaire. Quantitative data were compared using independent t-test. Ordinal data were expressed as percentages. Statistical analysis was done using online statistical calculators. P<0.05 was considered statistically significant. RESULTS Mean OSCE scores for each session was significantly higher in the Role play group than the SGD group. Mean total OSCE score of the Role play group was significantly higher than the SGD group (60.39±6.33, 47.79±4.27, P <0.001). CONCLUSION Role play is more effective than SGD in teaching prescription communication skills to MBBS students. Students have shown more favourable perception towards Role play than SGD for teaching prescription communication skills.
Collapse
Affiliation(s)
- Divya G Krishnan
- Department of Pharmacology, KMCT Medical College, Kerala University of Health Sciences, India
| | - Anukesh Vasu Keloth
- Department of Surgery, KMCT Medical College, Post Manassery, Kerala University of Health Sciences, Kozhikode, Kerala 673602, India
| | - Shafi Ahmad
- Department of Surgery, KMCT Medical College, Post Manassery, Kerala University of Health Sciences, Kozhikode, Kerala 673602, India
| | - Mohandas Pg
- Department of Surgery, KMCT Medical College, Post Manassery, Kerala University of Health Sciences, Kozhikode, Kerala 673602, India
| |
Collapse
|
4
|
Omer U, Danopoulos E, Veysey M, Crampton P, Finn G. A Rapid Review of Prescribing Education Interventions. MEDICAL SCIENCE EDUCATOR 2021; 31:273-289. [PMID: 34457882 PMCID: PMC8368780 DOI: 10.1007/s40670-020-01131-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 10/15/2020] [Indexed: 06/13/2023]
Abstract
INTRODUCTION Many studies conducted on the causes and nature of prescribing errors have highlighted the inadequacy of teaching and training of prescribers. Subsequently, a rapid review was undertaken to update on the nature and effectiveness of educational interventions aimed at improving the prescribing skills and competencies. METHODS Twenty-two studies taking place between 2009 and 2019 were identified across nine databases. RESULTS AND DISCUSSION This review reinforced the importance of the WHO Guide to Good Prescribing to prescribing curriculum design as well as the effectiveness of small group teaching. However, it also highlighted the lack of innovation in prescribing education and lack of longitudinal follow-up regarding the effectiveness of prescribing education interventions.
Collapse
Affiliation(s)
- Usmaan Omer
- Health Professions Education Unit, Hull York Medical School, University of York, York, YO10 5DD UK
| | - Evangelos Danopoulos
- Health Professions Education Unit, Hull York Medical School, University of York, York, YO10 5DD UK
| | - Martin Veysey
- Health Professions Education Unit, Hull York Medical School, University of York, York, YO10 5DD UK
| | - Paul Crampton
- Health Professions Education Unit, Hull York Medical School, University of York, York, YO10 5DD UK
| | - Gabrielle Finn
- Health Professions Education Unit, Hull York Medical School, University of York, York, YO10 5DD UK
| |
Collapse
|
5
|
Nayak V, Adiga S, Shenoy S, Holla S. Implementation and assessment of a module to enhance prescribing competency in undergraduate medical students. Med J Armed Forces India 2021; 77:S122-S128. [PMID: 33612942 PMCID: PMC7873684 DOI: 10.1016/j.mjafi.2020.12.025] [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] [Received: 08/12/2020] [Accepted: 12/28/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Enhancing the prescribing competency of medical students will help them evaluate each case based on their knowledge. It will help them prescribe independently and they will also be able to empathize and counsel patients effectively. In view of this, it was planned to implement a module on prescribing competency and assess the same for undergraduate medical students. METHODS Faculty training to implement the module was conducted by eminent faculty in this area. After a pre-test, a workshop was conducted for students, wherein they were trained on rational prescribing based on WHO guide to good prescribing followed by small group discussions to identify P (personal) drugs for bronchial asthma and later with comorbidities. Students had to write a prescription and practice communicating the same to a standardized patient. The module was evaluated using a check list (from the WHO guide) and compared with a pre-test. A feedback was provided to the students at the end of the assessment. RESULTS The scores (median and interquartile values) for prescribing significantly improved from 5 (2, 7) to 25 (24, 27), maximum score being 30. The scores for the communication also increased from 17.5 (14, 24.25) to 53 (52, 55), maximum score being 60, in the post-test. The differences were statistically significant p < 0.01(Wilcoxon Signed Ranks Test). The students expressed that their critical thinking and problem solving capabilities had increased and more importantly 'they felt like a doctor'. CONCLUSION More such modules need to be prepared and prescribing competency needs reinforcement during the clinical years of the medical curriculum for its effective implementation communicating the same to a standardized patient. The module was evaluated using a check list (from the WHO guide) and compared with a pre-test. A feedback was provided to the students at the end of the assessment.
Collapse
Affiliation(s)
- Veena Nayak
- Associate Professor (Pharmacology), Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Shalini Adiga
- Professor (Pharmacology), Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Smita Shenoy
- Professor (Pharmacology), Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Sadhana Holla
- Assistant Professor (Pharmacology), Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| |
Collapse
|
6
|
Peer Role-Play for Training Communication Skills in Medical Students: A Systematic Review. Simul Healthc 2020; 15:106-111. [PMID: 32168292 DOI: 10.1097/sih.0000000000000412] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
STATEMENT Peer role-play (PRP) is a simulation-based training method (SBTM) in which medical students alternately play the patient's and clinician's role. This review aimed to assess the effectiveness of PRP for improving the communication skills of medical students. A systematic search was conducted in the MedLine, PsycInfo, and ERIC databases. Studies were qualitatively analyzed according to the Kirkpatrick evaluation level (Kirkpatrick level) and the Medical Education Research Study Quality Instrument.Twenty-two studies were included. Studies assessing the "reaction" of students (Kirkpatrick level 1, n = 15) found that PRP was appreciated, whereas those assessing the effect of PRP on "learning" (Kirkpatrick level 2, n = 12) found that PRP improves communication skills but no more than other SBTMs. No study assessed real-life "attitudes" or "clinical outcomes" (Kirkpatrick levels 3 and 4), whereas 2 studies found that using PRP had a better cost-efficacy ratio than the use of simulated patients. Compared with other SBTMs, PRP improved communication skills similarly in medical students and seemed less expensive.
Collapse
|
7
|
Changiz T, Yamani N, Shaterjalali M. The challenge of planning learning opportunities for clinical medicine: a triangulation study in Iran. BMC MEDICAL EDUCATION 2019; 19:292. [PMID: 31366343 PMCID: PMC6670133 DOI: 10.1186/s12909-019-1719-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Accepted: 07/19/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND An essential characteristics of clinical education is the need to learn a large number of practical and communication skills along with theoretical knowledge. It is challenging to design learning opportunities (LOs) for clinical setting. We aimed to determine optimal learning opportunities from the viewpoint of Medical curriculum planners, to determine the gap between the current condition and the optimal condition in medical schools, and to present feasible tactic for clinical learning opportunities. METHODS This study comprised of three sub-studies and was conducted using triangulation. The first sub-study was performed using the Modified Delphi method with a view to identifying optimal learning opportunities. Data was collected by online focus group discussion and a questionnaire. The second sub-study was conducted with the aim of comparing the current condition and the optimal condition. Data was collected from nine medical schools across Iran using a checklist, available documents, observation, and interview. The third sub-study was conducted using an expert panel comprising of seven curriculum planners of the M.D. PROGRAM The goal of this phase was to provide feasible tactic to improve clinical education in medical schools. RESULTS In the first sub-study, the participants determined all items, including student-centered learning, non-threatening learning environment, and record and management system of clinical learning opportunities as implementable learning opportunities with over 70% consensus. However, in the second sub-study, student-centered teaching methods were practiced in 33% of medical schools and the non-threatening learning environment in 67% of the schools, while the record and management system of learning opportunities was not launched in any of the schools. From the viewpoint of the expert panel members, learning opportunities adapted to clinical contents, specification of content-based learning opportunities, and continuous supervision on learners to achieve the expected learning outcomes were among clinical learning opportunities with over 70% consensus. CONCLUSIONS Student-centered clinical learning practices, together with virtual learning methods, can lead to clinical enhancement. Opportunities such as interactive and participatory practices should gain further consideration. Also assigning responsibility to learners and monitoring them are strategies for enhancement.
Collapse
Affiliation(s)
- Tahereh Changiz
- Department of medical education, Medical educational research center, Isfahan University of Medical Science, Isfahan, Iran
| | - Nikoo Yamani
- Department of medical education, Medical educational research center, Isfahan University of Medical Science, Isfahan, Iran
| | - Maria Shaterjalali
- School of Medical Science, Islamic Azad university of Tonekabon branch, Tonekabon, Iran
| |
Collapse
|
8
|
Lavanya SH, Kalpana L, Veena RM, Bharath Kumar VD. Role-play as an educational tool in medication communication skills: Students' perspectives. Indian J Pharmacol 2016; 48:S33-S36. [PMID: 28031605 PMCID: PMC5178052 DOI: 10.4103/0253-7613.193311] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objectives: Medication communication skills are vital aspects of patient care that may influence treatment outcomes. However, traditional pharmacology curriculum deals with imparting factual information, with little emphasis on patient communication. The current study aims to explore students’ perceptions of role-play as an educational tool in acquiring communication skills and to ascertain the need of role-play for their future clinical practice. Materials and Methods: This questionnaire-based study was done in 2nd professional MBBS students. A consolidated concept of six training cases, focusing on major communication issues related to medication prescription in pharmacology, were developed for peer-role-play sessions for 2nd professional MBBS (n = 122) students. Structured scripts with specific emphasis on prescription medication communication and checklists for feedback were developed. Prevalidated questionnaires measured the quantitative aspects of role-plays in relation to their relevance as teaching–learning tool, perceived benefits of sessions, and their importance for future use. Statistical Analysis: Data analysis was performed using descriptive statistics. Results: The role-play concept was well appreciated and considered an effective means for acquiring medication communication skills. The structured feedback by peers and faculty was well received by many. Over 90% of the students reported immense confidence in communicating therapy details, namely, drug name, purpose, mechanism, dosing details, and precautions. Majority reported a better retention of pharmacology concepts and preferred more such sessions. Conclusions: Most students consider peer-role-play as an indispensable tool to acquire effective communication skills regarding drug therapy. By virtue of providing experiential learning opportunities and its feasibility of implementation, role-play sessions justify inclusion in undergraduate medical curricula.
Collapse
Affiliation(s)
- S H Lavanya
- Department of Pharmacology, BGSGIMS, Bengaluru, Karnataka, India
| | - L Kalpana
- Department of Pharmacology, BGSGIMS, Bengaluru, Karnataka, India
| | - R M Veena
- Department of Pharmacology, BGSGIMS, Bengaluru, Karnataka, India
| | | |
Collapse
|