INNOVATIVE LEARNING METHODS FOR

RATIONAL DRUGS PRESCRIBING.

ITTHIPANICPONG C.,CHOMPOOTAWEEP S., CHONGTRAKUL P.,

NANTAWAN P., THAMAREE S., WITTAYALERTPANYA S.,

LIMPANASITHIKUL W., LILITKARNTAKUL P. and WANGSATURAKA D.

Department of Pharmacology, Faculty of Medicine, Chulalongkorn University.

Bangkok 10330, THAILAND

ABSTRACTThis study was designed to use innovative learning methods in rational

drug prescribing in the third year medical students in the 2002 academic year who attended the three weeks block of Degeneration and Diseases of Aging. A modified problem-based learning (PBL) was the main educational strategy in this module. Three key problems were ‘polyuria’, ‘knee pain’, and ‘dyspnea’. For each problem, students met in tutorial groups to identify their learning objectives. After the tutorial sessions, students attended a lecture and adviced on a self-directed learning (SDL) period. They would then meet in groups to summarise what they had learned and discussed what drugs were most appropriate for the patient with the problem according to the principles of rational drug use. Students were also asked to submit a prescription for the patient in each of the cases. To promote students’ use of information technology in their SDL, we created a web site (www.sdl.academic.chula.ac.th. ), named ‘PBL RDU EBM Web Based Instruction’. We designed it as a gateway to other relevant electronic sources in pharmacology and medicine. Multiple choice questions (MCQ) were used for the assessment of the students’ conceptual knowledge. An individual structured report was designed for prescription writing skills and attitude assessment.

Most students (79.60%) received good marks for their MCQ examination and structured reports (87.56%). They also demonstrated positive attitudes towards the course’s learning outcome.

Irrational drug prescribing causes a high

healthcare expenditure each year. It also

affects individual in term of getting

unnecessary drugs which sometime harmful

to them. There is a need for medical schools to

create new physicians who possess conceptual

knowledge, skill and attitude in rational drug

prescribing.

Problem statement :

Educational strategies

MODIFIED PROBLEM-BASED LEARNING

10 groups of 3rd year medical students with 20 students in each group

case scenarios(polyuria, knee pain and dyspnea)

2 facilitators in each group

formulate learning objective

A set of learning objective was developed by students in the group.The students were asked to write prescription in each scenario.

Self-directed learning

I students search through provided learning resources• Textbooks, literatures, articles• Online textbook, journals and medical databases• Web-Based Instruction in Pharmacology (WWW.SDL.ACADEMIC.CHULA.AC.TH) (PBL RDU EBM Web Based Instruction)

II Meet resource persons

Concept formulation

• Presentation of the acquired information• Discussion on rational prescribing for management of the patient. (RDU) using evidence-based medicine.• Conclusion

PBL = Problem-based learning, RDU = Rational drug use, EBM = Evidence-based medicine

Rational drug prescribing

Evidence-Based Medicine

Written communication

Holistic approach

Roles of doctor

Basic and clinical science

Medical ethics

Leadership and teamwork

Professional and personal development

Learning outcomes of the course

Student assessment

Educational outcomes

Assessment

methods

Rational

drug

prescribing

Evidence-

based

medicine

Written

communication

Holistic

approachRoles of

doctor

Professional

and personal

development

Basic and

clinical

science

Medical

ethics

Leadership

and

teamwork

Written examination

(MCQ 5 choices and - - - - -

short essay)

Rating scale - - - - -

(5 points)

Structured report

on rational -

drug prescribing

/ / / /

/ / / /

/ / / / / / //

1) Diagnosis2) Indication3) Prescription writing (rational prescribing)

3.1) Efficacy 3.2) Risk 3.3) Cost4) Underpinning prescription writing5) Duration of treatment and follow up period6) Patient education7) Conclusion8) References

Components of a structured report

Structured report grade distribution

A+B++B = 87.56%

18%

30%

32%

A+B++B = 79.60%

MCQ grade distribution

Students’ attitude towards the achievement of course learning outcomes :

Learning Outcomes Total score 5

• problem solving ability 4.10• apply concept of evidence-based medicine 4.03• utilize information technology for 4.09 information searching• rational drug prescribing 4.20• holistic mind 4.03• basic and clinical science knowledge 3.85• ethics 3.65• self-directed learning 4.07• attitude towards working in healthcare team 3.84

Conclusion

Innovation of the learning method for rational drug prescribing was a modified problem-based learning using the created web-based instruction inPharmacology (WWW.SDL.ACADEMIC.CHULA.AC.TH)( PBL, RDU, EBM Web Based Instruction) as one of the learning resources and utilize structured report for authentic assessment in addition to conventional assessment methods.The result demonstrated good conceptual knowledge and practice in rational drug prescribing.To maintain the studentcompetency in rational drug prescribing, the process hasto be repeated and continued through the whole curriculum.

1) Outcome-Based Education. AMEE Education Guide

no.14 1999

2) Wangsaturaka D. Wiwanitkit V. An evaluation of

prescription writing and rational prescribing in

Third-Year Medical Students, Faculty of Medicine,

Chulalongkorn University. Thai J Pharmacol 2000

May-Aug; 22(2): 115-20.

References