Competence of medical students in communicating drug therapy: Value of role-play demonstrations

Educational Interventions for Medical Students to Improve Pharmacological Knowledge and Prescribing Skills: A Scoping Review

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.

Teaching rational prescribing in undergraduate medical education: a systematic search and review

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.

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

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.

A Rapid Review of Prescribing Education Interventions

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.

Implementation and assessment of a module to enhance prescribing competency in undergraduate medical students

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.

Peer Role-Play for Training Communication Skills in Medical Students: A Systematic Review

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.

The challenge of planning learning opportunities for clinical medicine: a triangulation study in Iran

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.

Role-play as an educational tool in medication communication skills: Students' perspectives

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 2^nd 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 2^nd 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.