Indian Journal of Pharmacology Medknow Publications on behalf of Indian Pharmacological Society ISSN: 0253-7613 EISSN: 1998-3751 Vol. 36, Num. 6, 2004, pp. 385-386

Indian Journal of Pharmacology, Vol. 36, No. 6, November-December, 2004, pp. 385-386

Correspondence

Experiences regarding modification of the teaching and evaluation pattern in practical pharmacology

Bhavsar VH

Department of Pharmacology, Government Medical College, Surat
Correspondence Address:Department of Pharmacology, Government Medical College, Surat skbhavsar@gauanand.com

Code Number: ph04137

Sir,

In a previous editorial in the IJP[1] the urgent need for massive and sweeping revision of the medical curriculum related to pharmacology was pointed out. I believe that teachers at various institutions may already be making the efforts, but various factors may prevent them from putting it into actual practice. At many places the revisions made may be very minor but quite meaningful. Modifications made at various places if brought to the notice of other colleagues through a platform like IJP, may be useful to many. I am communicating our experiences at the Government Medical College, Surat as I feel that the changes, though small, can be easily adopted by teachers of pharmacology. At our center, we have made gradual changes over the past years in the curriculum. In this letter I will focus only on the changes that we have made in relation to teaching and evaluation of practical sessions.

The following aspects led us to modify the training during practical sessions and the evaluation pattern in practical examination.

1. We realized that formulation-based teaching and the evaluation of dispensing pharmacy is out of context in present-day medical practice. This was hence deleted.
2. Handling of ′prescription-writing′exercises in pharmacology-practical-examination looked meaningless for a number of reasons. Students are given one or two problems and asked to write the prescription. Many times the problems were not well defined, creating confusion among the examinees. It was expected that the students remember data-based drug-information like the doses, dosage forms, strength, etc. It is obvious that the students may not remember the doses of all possible drugs likely to be used in a given condition and so may select the drug, of which he/she remembers the dose rather than following the rational steps in selecting a drug. Whether the student has written the prescription taking into consideration all these aspects rationally cannot be judged when an examiner evaluates only the written answer and so we strongly felt the need for viva-based evaluation.
3. We also realized that the students have limited background information when they are exposed to practical training sessions. We felt the need to supplement the same in the training program.
4. The need for emphasis on rational therapeutics, paying attention to adverse drug reactions, drug interactions and analytical thinking about available dosage forms, was acknowledged.

Certain changes in our teaching program have already been reported[2] and subsequently, a few modifications have been done which are outlined below.

Training program

Basically, practical-teaching is covered under the following heads:

(I) Clinical pharmacy and pharmacology

1. Clinical pharmacy, pharmacology and prescription writing

Initial introduction includes basics of clinical pharmacology, clinical pharmacy, dispensing pharmacology, dosage forms, principles of prescription writing, rational therapeutics, ethics and responsibility of a doctor towards patient-care etc. Clinical problems in various areas like respiratory system, gastrointestinal tract, anemia, diabetes mellitus, pain management, infections and dermatology are covered in subsequent sessions. The students are provided some essential information about dosage forms and doses of the drugs needed to cover the problems in these areas. While writing prescriptions the students are supposed to use this handy informative script.

2. Handling of dosage forms

Students are taught basics related to injecting drugs. Proper use of syringe, needles, and i.v. infusion-set, observing aseptic precautions and understanding the principles of disposal of biomedical wastes are included as part of the training. At the end of the sessions the students are able to calculate appropriately to set up intravenous infusions of various drugs at the required rates. The ability of students to fill up syringes with drugs like adrenaline, insulin (including combinations of two insulin preparations) and to handle other dosage forms like dry syrup, various varieties of tablets and home made ORS solutions can be tested.

3. Emergency therapeutics

This is a new aspect introduced recently where the students are taught about 25 emergency conditions and are expected to know and remember the pharmacotherapy of those conditions.

4. Criticism

In this section students are expected to offer an opinion on various aspects like planning of the treatment, selection of drug/s, route of administration, dose, frequency of administration, rationality of formulations, possibility of adverse effects and drug interactions. Alternative suggestions for treatment are also expected.

(II) Experimental pharmacology

In the experimental pharmacology section demonstrations, discussions, simulation models are used to cover various aspects like new drug development (pre-clinical and clinical), qualitative and quantitative methods (quantal and graded dose responses, assay methods, comparison of agonist and antagonist) in experiments involving isolated tissues, conscious animals and anesthetized animals. Graphic presentations of various experiments are included in training sessions. Simulation model for pharmacokinetic principles, a novel exercise developed in this department is also included. In the experimental pharmacology teaching, the emphasis is on understanding the basic actions of the drugs, mechanism of action and clinical applications.

(III) A clinical case presentation by each student

Each student under the guidance of the teacher presents a case which he/she has recorded from a ward. Basically, the approach of pharmacotherapy, a brief description of the drugs used and comparison of treatment in a given case with the textbook descriptions are presented by the students in front of a small group of students. A discussion is conducted with the help of the teacher and important practical points are emphasized. This exercise is meant to create general awareness regarding the actual practice of medicine.

Examination

Practical examination consists of 25 marks. The following five exercises (5 marks each) are included in the examination:

1. Prescription writing for a given situation
2. Handling of injectables (setting i.v. infusion, filling the syringe of the required drug in a given situation
3. Exercises based on emergency therapeutics
4. Exercise based on criticism
5. Exercise based on experimental pharmacology

Please note that for the first two exercises the handy informative script is allowed (it can be considered as ′open book examination′). For the remaining three exercises no aid is allowed.

All the five exercises are evaluated by viva. There is a good amount of interaction between the examinee and the examiners. This system of practical examination involves a lot of work for the examiners. Besides usual table-viva (at two places), there is additional viva on exercises at five places. To save time, the viva of the first two exercises (prescription writing for a given situation and handling of injectables) are clubbed together and the viva of the remaining three exercises (exercises based on emergency therapeutics, criticism and experimental pharmacology) are clubbed together.

Feasibility

We have been working with this system for the last five years and I can say that it works satisfactorily for teaching as well as examination.

The Surat Municipal Corporation College in the city of Surat (under the South Gujarat University) also follows the same program. Some other centers in our state like the M. P. Shah Medical College, Jamnagar, Din Dayal Upadhay Medical College, Rajkot and Medical College, Surendranagar (under the Saurashtra University) have adopted this system with their own modifications both at the teaching as well as examination levels.

We believe that the program puts forward a few ideas such as:

1. Writing prescriptions accurately with the help of informative script,
2. Exercises based on (a) handling of injectable drugs and (b) emergency therapeutics
3. Conducting the examination related to the exercises of prescription-writing and handling of dosage in an ′open book′ fashion.
4. Changing the emphasis on experimental pharmacology towards analytical thinking and paractical applications

ACKNOWLEDGEMENTS

The author is thankful to Dr. S. K. Vajpeyee, Dean and eEx-Professor of Pharmacology, Government Medical College, Surat for his contribution to and active involvement in the implementation of the program. Suggestions and active support from Dr. V. V. Kelkar, Ex- Professor of Pharmacology, Government Medical College, Surat; involvement and contribution of all the teaching staff of the Department of Pharmacology, Government Medical College, Surat are also acknowledged.

REFERENCES

Copyright 2004 - Indian Journal of Pharmacology