Teaching clinical pharmacology using team-based learning: a comparison between third- and fourth-year medical students.

The purpose of this study was to formulate evidence-based recommendations on whether to deliver the team-based learning (TBL)-designed clinical pharmacology course at the American University of Beirut Faculty of Medicine (AUBFM) during the third year instead of the fourth and final year of the medical curriculum. Between June 2010 and May 2011, AUBFM offered the course to both classes simultaneously to compare their performance. The findings of this endeavor supported the introduction of the course during the third year, first because fourth-year students did not outperform third-year students despite having the advantage of an additional year of clinical experience, and second, third-year teams seemed more likely to develop into better functioning teams. The findings also suggested that simultaneous delivery of TBL sessions to both third- and fourth-year teams was less favorably recommended because of the varying learning pace of both student groups.

Pharmacogenetics and personalized medicine: the future for drug prescribing.

Pharmacogenetics, the study of interindividual variations in DNA sequence related to drug response, aims at the optimization of treatment regimens based on each patient's unique genetic makeup. Currently, there is a trend towards moving away from the concept of "one drug fits all" to a rather more individualized and personalized medicine. The goal is to define the appropriate drug dose that maximizes efficacy and minimizes toxicity in each individual patient. An example of genotyping for CYP2C9 genetic polymorphisms in patients receiving oral anticoagulants is provided. In spite of its inherent challenges, we hope that pharmacogenetic research and clinical applications expand to improve healthcare outcomes in Lebanon and worldwide.

Using team-based learning to teach pharmacology to second year medical students improves student performance.

BACKGROUND: Team-based learning (TBL) is an innovative instructional method that fosters active learning. It has been shown to improve student performance in some health care education courses. AIM: To examine the effect of teaching pharmacology using a TBL approach on second year medical students' satisfaction and performance. METHODS: A modified TBL method was used in two case-based discussion sessions of the second year pharmacology course: a relatively easy drug metabolism/pharmacogenetics session and a more challenging pharmacokinetics/pharmacodynamics (PK/PD) session. Individual and group answers to all questions were recorded, and an evaluation form was collected for each session. Class performance on a summative quiz was compared to previous years. RESULTS: Students provided positive feedback. Group performance was better than individual performance during the TBL exercises. TBL was less successful when the questions were very difficult, with a difficulty range of 30-70% being the most appropriate. Performance of the class on the pharmacology summative quiz showed significant improvement over that in previous years in the PK/PD part, but was unchanged in other topics taught traditionally. CONCLUSION: The results suggest that TBL provides a better outcome for students, and provide insight into appropriate design of TBL exercises.

Herbal medicine, what physicians need to know.

Herbal medicine, the most major component of traditional medicine, is as old as recorded history. Beginning in the early 1800s, with the development in the science of chemistry, a new era in pharmacotherapeutics was initiated whereby active chemical ingredients in plants, historically known to produce a favorable therapeutic effect, were extracted, purified and their structure disclosed. This ushered the modern era of therapy with drugs based on exploration of pure chemical products as to chemical identity, physicochemical properties, pharmacodynamic actions, pharmacokinetic behavior in the biological system, toxicological profile and effective and safe application in therapy. This relegated herbal medicine to a secondary role. More recently, a revival in the use of herbal medicine has been witnessed, even in culturally advanced societies, probably enhanced by the false belief that natural products are safe and also by vigorous promotion. Parallel to the increase in the use of herbal preparations as remedies for major diseases, there is currently a growing concern about their efficacy, safety and control. This prompted the World Health Organization to come out with recommendations for control in the document "Research Guidelines for Evaluating the Safety and Efficacy of Herbal Medicines" in 1993. The guidelines are equal in strictness to those applicable for drugs in general. A large number of member states have adopted these guidelines. The dangers in using herbal preparations for treatment include: * unproven therapeutic benefit * undisclosed toxicities * interaction of the chemicals in herbal preparations with each other and with concomitantly taken drugs, at the level of functionally important biological entities such as the plasma proteins, receptors, ion channels, transporters and others * incompatibilities with patient-related factors such as age, sex, genetic background and the function of the organs responsible for eliminating the effects of chemicals in herbal preparations such as the liver or kidney * the difficulty in standardizing treatments and * the inclusion of regular drugs with the herbal preparations without disclosure. In Lebanon, a committee is charged with the control of herbal preparations but a stricter control is required to handle preparations with a therapeutic claim as well as the issue of promotion.