INNOVATIVE LEARNING METHODS FOR RATIONAL DRUGS PRESCRIBING.

1. 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

2. ABSTRACT This 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.

3. Problem statement : 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.

4. 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 A set of learning objective was developed by students in the group. The students were asked to write prescription in each scenario. formulate learning objective • 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 Self-directed learning • Presentation of the acquired information • Discussion on rational prescribing for management of • the patient. (RDU) using evidence-based medicine. • Conclusion Concept formulation PBL = Problem-based learning, RDU = Rational drug use, EBM = Evidence-based medicine

8. Learning outcomes of the course Rational drug prescribingEvidence-Based Medicine Written communicationHolistic approachRoles of doctorBasic and clinical scienceMedical ethicsLeadership and teamworkProfessional and personal development

9. Student assessment Educational outcomes Rational drug prescribing Leadership and teamwork Professional and personal development Holistic approach Basic and clinical science Medical ethics Evidence- based medicine Written communication Roles of doctor Assessment methods Written examination (MCQ 5 choices and - - - - - short essay) / / / / / / / / Rating scale - - - - - (5 points) Structured report on rational - drug prescribing / / / / / / / /

10. Components of a structured report 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

11. MCQ grade distribution Structured report grade distribution A+B++B = 87.56% A+B++B = 79.60%

12. 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

13. Conclusion Innovation of the learning method for rational drug prescribing was a modified problem-based learning using the created web-based instruction in Pharmacology (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 student competency in rational drug prescribing, the process has to be repeated and continued through the whole curriculum.

14. References 1) Outcome-Based Education. AMEE Education Guide no.14 19992) 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.