Toward Interprofessional Education of Pharmacogenomics: An Interdisciplinary Assessment.

INTRODUCTION: Pharmacogenomics, which emerged from disciplines such as pharmacology and genetics, is an increasingly important interdisciplinary field of health research, as indicated by the rapid growth of related literature. The aim of this study was to evaluate knowledge among genetics and pharmacology health-care students and to evaluate their exposure to and perceptions of pharmacogenomics. METHODS: An anonymous, 28-item online survey was distributed to medical and pharmacy students enrolled at Yarmouk University, Jordan. RESULTS: The respondents (n = 300) had an overall moderate level of knowledge regarding genetics and pharmacology. Most respondents recognized the benefits of pharmacogenomics for therapy optimization, but they had insufficient exposure to the topic. Most respondents supported providing pharmacogenetic testing in Jordan. The most preferred educational format in pharmacogenomics was integration in pharmacology courses. DISCUSSION/CONCLUSION: Medical and pharmacy students are becoming increasingly aware of the importance of pharmacogenomics in therapy optimization. Challenges such as the complexity of the topic and low retention of previous knowledge should be addressed to promote pharmacogenomics education. More work is needed to increase students' exposure to pharmacogenomics information. A deeper integration of pharmacogenomics applications into pharmacology courses is proposed to emphasize applications of pharmacogenomics.

Lower scores in pharmacokinetics than in pharmacodynamics assessment among students in a health and life sciences curriculum.

In pharmacology teaching, pharmacokinetics (PK) and pharmacodynamics (PD) may be defined as part of the 'general pharmacology' domain, whereas effects of drugs on the autonomic nervous system and clinical trial design might be defined as part of the 'medical' and 'clinical' pharmacology domain, respectively. We recently designed a pharmacology course covering these domains for second year Health and Life Sciences students at the Vrije Universiteit Amsterdam (VU). We used a combination of lectures, problem-based learning and practicals to transfer knowledge to students in order for them to acquire sufficient knowledge and insight to solve real-world pharmacological problems. To evaluate whether we 1) successfully aligned our course objectives with both our teaching strategy and assessment, and 2) to identify topics in our course that would benefit from improvement in teaching strategy and/or effort, we determined success rate of the exam questions in above-defined pharmacology domains. We analyzed 3 consecutive second year cohorts (n = 377) of students enrolled in our course, and found a statistically significant reduction in success rate in exam questions of the general pharmacology domain (especially in PK), compared to domains covering 'medical' and 'clinical' pharmacology. In addition, we found lower success rates for 'knows how' questions compared to 'knows' questions in the combined PK/PD domain. Our data show that we overall succeeded in aligning our course objectives with both our teaching strategy and assessment, but that outcomes on the PK domain might benefit from additional attention.

Development of a safe drug administration assessment instrument for nursing students.

OBJECTIVE: to determine the content and face validity of a safe drug administration assessment instrument for nursing students. METHOD: quantitative, descriptive study. The literature on medication errors made by students was analyzed, and an instrument was developed using the Architecture of Integrated Information Systems and the Work Breakdown Structure. Face validity was analyzed using the nominal technique, with experts in education, management, research and/or clinical practice. RESULTS: nine experts participated in the validation process, which resulted in an instrument containing 8 sub-processes and 58 items, adjusted to the simulation environment and to clinical practice. CONCLUSION: the instrument may be used for the evaluation of safe drug administration by nursing students, especially in a simulation environment.

Development of a safe drug administration assessment instrument for nursing students / Elaboração de um roteiro de avaliação de administração segura de medicamentos em estudantes de enfermagem / Elaboración de una pauta de evaluación de administración segura de medicamentos en estudiantes de enfermería

Objective: to determine the content and face validity of a safe drug administration assessment instrument for nursing students. Method: quantitative, descriptive study. The literature on medication errors made by students was analyzed, and an instrument was developed using the Architecture of Integrated Information Systems and the Work Breakdown Structure. Face validity was analyzed using the nominal technique, with experts in education, management, research and/or clinical practice. Results: nine experts participated in the validation process, which resulted in an instrument containing 8 sub-processes and 58 items, adjusted to the simulation environment and to clinical practice. Conclusion: the instrument may be used for the evaluation of safe drug administration by nursing students, especially in a simulation environment.

Objetivo: determinar a validade de face e conteúdo de um roteiro de avaliação de administração segura de medicamentos em estudantes de enfermagem. Método: estudo quantitativo, descritivo. Analisou-se a literatura relativa a erros de medicação em estudantes e elaborou-se um roteiro utilizando a metodologia Arquitetura Integrada de Sistema de Informação e a Estrutura de Decomposição do Trabalho. Analisou-se a validade de face utilizando a técnica nominal com especialistas em educação, gestão, pesquisa e/ou prática clínica. Resultados: nove especialistas participaram de todo o processo de validação, do qual se obteve um roteiro com 8 subprocessos e 58 itens, ajustados ao ambiente de simulação e prática clínica. Conclusão: o roteiro se encontra em condições de ser testado na avaliação da administração segura de medicamentos em estudantes de enfermagem, principalmente em ambiente de simulação.

Objetivo: determinar la validez de aspecto y contenido de una pauta de evaluación de administración segura de medicamentos en estudiantes de enfermería. Método: estudio cuantitativo, descriptivo. Se analizó la literatura respecto a errores de medicación en estudiantes y se creó una pauta utilizando la metodología Arquitectura Integrada de Sistema de Información y la Estructura de Descomposición del Trabajo. Se analizó la validez de aspecto utilizando la técnica nominal con personas expertas en educación, gestión, investigación y/o práctica clínica. Resultados: Nueve personas expertas participaron durante todo el proceso de validación, se obtuvo una pauta con 8 subprocesos y 58 ítems, ajustados al ambiente de simulación y práctica clínica. Conclusión: La pauta se encuentra en condiciones de ser probada en la evaluación de la administración segura de medicamentos en estudiantes de enfermería, especialmente en el ambiente de simulación.

Correlation of online assessment parameters with summative exam performance in undergraduate medical education of pharmacology: a prospective cohort study.

BACKGROUND: Learning analytics aims to improve learning outcomes through the systematic measurement and analysis of learning-related data. However, which parameters have the highest predictive power for academic performance remains to be elucidated. The aim of this study was to investigate the correlation of different online assessment parameters with summative exam performance in undergraduate medical education of pharmacology. METHODS: A prospective study was conducted with a cohort of undergraduate medical students enrolled in a pharmacology course at Technical University of Munich, Germany. After a four-week teaching and learning period, students were given access to an online assessment platform consisting of 440 multiple choice (MC) questions. After 12 days, a final written summative exam was performed. Bivariate correlation and multiple regression analyses were performed for different online assessment parameters as predictors and summative exam performance as dependent variable. Self-perceived pharmacology competence was measured by questionnaires pre- and postintervention. RESULTS: A total of 224 out of 393 (57%) students participated in the study and were included in the analysis. There was no significant correlation for the parameters "number of logins" (r = 0.01, p = 0.893), "number of MC-questions answered" (r = 0.02, p = 0.813) and "time spent on the assessment platform" (r = - 0.05, p = 0.459) with exam performance. The variable "time per question" was statistically significant (p = 0.006), but correlated negatively (r = - 0.18) with academic performance of study participants. Only "total score" (r = 0.71, p < 0.001) and the "score of first attempt" (r = 0.72, p < 0.001) were significantly correlated with final grades. In a multiple regression analysis, "score first attempt" accounted for 52% of the variation of "score final exam", and "time per question" and "total score" for additional 5 and 1.4%, respectively. No gender-specific differences were observed. Finally, online assessments resulted in improved self-perceived pharmacology competence of students. CONCLUSION: In this prospective cohort study, we systematically assessed the correlation of different online assessments parameters with exam performance and their gender-neutrality. Our findings may help to improve predictive models of academic performance in undergraduate medical education of pharmacology.

[Preparing for the licence to prescribe in medical school - a questionnaire study on medical students professional confidence in the art of prescribing]. / Läkemedelsarbete behöver vara integrerat i klinisk utbildning - Att göra många läkemedelsgenomgångar ökar trygghet och reflektion över patientens behandling, visar enkätstudie.

A prerequisite for rational use of medicines is adequate prescribing skills; drug treatment is a complex task requiring diagnostic competence combined with pharmacologic knowledge and patient communication skills. Acquiring professional confidence in the art of prescribing is essential during medical training. The results of this questionnaire study, conducted in four medical schools in Sweden after the course in internal medicine (252 respondents; response rate: 74%; median age: 24 years, 61% female), show that 45% and 62% were confident in performing medication reviews and writing medication summary reports, respectively, i.e. the basics of prescribing. The confidence increased by the number of reviews and reports performed, i.e. the extent of practice (correlation coefficients: 0.41 and 0.38, respectively, both p<0.0001), as did the extent of the students' reflection on important aspects of drug treatment such as adherence, adverse reactions, renal function, dosing, and drug interactions. In multivariate regression analyses, major predictors for confidence in performing medication reviews were extent of practice and extent of clinical supervision. The results suggest that these factors are keys to acquiring professional confidence in the art of prescribing.

Rational drug use and prescribing behavior of family physicians in Erzurum, Turkey.

BACKGROUND: Widespread irrational medical prescription adversely affects the outcomes of patient health and medical services. AIM: This study aims to investigate the determinants of medical prescription behavior of family physicians in Erzurum Province. MATERIALS AND METHODS: This cross-sectional descriptive study was conducted during August-December 2016 on a voluntary sample of 191 out of 234 physicians (81.6%) working at family health centers in the districts of Erzurum. Physicians were visited at their workplaces, and data were collected using a self-administered and structured, 45-item questionnaire. RESULTS: The mean age of the physicians was 34.7 ± 7.9 years, and 70.7% (n = 135) of the participants were males. About 83.8% (n = 160) of physicians responded "yes" or "sometimes" to the question "Do you prescribe medicine on demand of the patients?" The two most important factors that affected the prescribing behavior of the participants were the pharmacology lectures attended during medical education (50.8%) and the prescribing experience acquired during clinical internship (46.0%). Presentations given by the representatives of drug companies, in-service training programs after graduation, and Internet/mobile phone applications had the lowest rate of contribution as behavioral determinants. The participants perceived having sufficient information in the areas of indication for use (77.5%) and daily dose (72.8%). Only 4.2% of participants deemed their knowledge of medication costs sufficient. Pharmacology lessons were found to be more effective in the prescribing behaviors of the physicians who had less than 10 years of professional experience (Chi-square = 12.131; P = 0.002). CONCLUSION: Rational medical prescription continues to be a trouble among family physicians. The study findings suggest a substantial knowledge gap in participating physicians occurring after graduation and clinical internship training, in the areas of costs of medicine and rational medical prescribing.

Progress and assessment of a contextualized teaching session of pharmacology.

BACKGROUND: Learning transfer, in medical teaching, remains an essential question and optimizing it is the main preoccupation of every trainer in medical sciences. Some learning methods showed their efficacy as the contextualized learning in the framework of a professional activity or in a situation recalling it in a realistic manner. AIM: To describe steps of planning and progress of a session of clarification, illustration, application et participation (CIAP) of pharmacology teaching students from second cycle of medical studies (DCEM) and to assess the session. METHODS: We performed a descriptive transversal study in April 2017 in the Faculty of Medicine of Tunis. Our work was composed of two parts. The first part consisted in a description of the preparation and the progress of the CIAP session entitled antiepileptic drugs, which is comprised in the pharmacology teaching of the certificate of Neurology to the students of DCEM. The second part consisted in an assessment of knowledge acquisition and the progress of the session by the students. RESULTS: We proceeded to a planning of the session which resulted in a contextualized teaching and induced an active participation and an interactivity of the students. Comparison of the results of the pretest and the posttest showed a statistically significant difference in terms of good responses. The assessment of the session progress was good. CONCLUSION: Our study demonstrated the feasibility of a session of contextualized teaching session or CIAP of pharmacology and its input in terms of knowledge to the students.

Online Self-testing Resources Prepared by Peer Tutors as a Formative Assessment Tool in Pharmacology Courses.

Objective. To assess the effectiveness of optional online quizzes written by peer tutors in a pharmacology course for doctor of pharmacy students. Methods. Online quizzes were written by peer tutors for second-year pharmacy students. Quizzes reflected the material taught during lecture and were in a format similar to that of the examinations. Data related to performance on each quiz and each examination were collected throughout the semester. At the end of the semester, students and peer tutors were surveyed to gather information on the utility and success of the quizzes. Results. Students taking online quizzes performed significantly better on examinations than those who did not take quizzes. In addition, students received higher scores on examinations than when practicing with the quizzes. Surveys suggest that students liked the quizzes and felt they increased their confidence and performance on examinations. Conclusion. The quizzes were beneficial to student performance on examinations as well as student perception of performance and confidence going into the examinations. Quizzes were also beneficial learning experiences for peer tutors.

Application of a utility analysis to evaluate a novel assessment tool for clinically oriented physiology and pharmacology.

Multiple-choice questions are a gold-standard tool in medical school for assessment of knowledge and are the mainstay of licensing examinations. However, multiple-choice questions items can be criticized for lacking the ability to test higher-order learning or integrative thinking across multiple disciplines. Our objective was to develop a novel assessment that would address understanding of pathophysiology and pharmacology, evaluate learning at the levels of application, evaluation and synthesis, and allow students to demonstrate clinical reasoning. The rubric assesses student writeups of clinical case problems. The method is based on the physician's traditional postencounter Subjective, Objective, Assessment and Plan note. Students were required to correctly identify subjective and objective findings in authentic clinical case problems, to ascribe pathophysiological as well as pharmacological mechanisms to these findings, and to justify a list of differential diagnoses. A utility analysis was undertaken to evaluate the new assessment tool by appraising its reliability, validity, feasibility, cost effectiveness, acceptability, and educational impact using a mixed-method approach. The Subjective, Objective, Assessment and Plan assessment tool scored highly in terms of validity and educational impact and had acceptable levels of statistical reliability but was limited in terms of acceptance, feasibility, and cost effectiveness due to high time demands on expert graders and workload concerns from students. We conclude by making suggestions for improving the tool and recommend deployment of the instrument for low-stakes summative assessment or formative assessment.

Education on prescribing for older patients in the Netherlands: a curriculum mapping.

PURPOSE: Pharmacology and pharmacotherapy education is being increasingly integrated in medical curricula, which might lead to a specific loss of knowledge in these subjects. This, in turn, could lead to harmful prescribing errors, especially in vulnerable older patients. METHODS: Teachers who coordinated education in Dutch medical schools completed a structured interview on (geriatric) pharmacology and pharmacotherapy education. A list of core learning goals was developed. Pharmacology and pharmacotherapy education in general was compared to geriatric pharmacology and pharmacotherapy education. RESULTS: All Dutch medical schools participated. Contact hours for education in pharmacology and pharmacotherapy ranged from 39 to 107 h; ECTSs (representing 28 study hours) ranged from 0 to 3. The various curricula covered, on average, 79% of all learning goals for these subjects: knowledge 85%, skills 76%, and attitudes 66%; the curricula also covered specific geriatric goals: knowledge 87% and skills 65%. All geriatric learning goals were met if a geriatrician was among the coordinators. Half (4 of 8) of the medical schools lacked appropriate assessment procedures. Evaluation was mostly based on students' opinions. Teachers rated students as being moderately well prepared for daily practice. CONCLUSIONS: There are large differences in the quantity and quality of (geriatric) pharmacology and pharmacotherapy education in Dutch medical schools. In general, more time should be devoted to skills and attitude, and the assessment procedures should be optimized with high priority. Other curricula with a problem-based approach might benefit from the points of improvement described in this article.

Academic pharmacy strikes Hawai'i. Part 2.

In partnership with the Hawai'i Journal of Medicine & Public Health, the Daniel K. Inouye College of Pharmacy (DKICP) is pleased to provide Scripts on a regular basis. In the inaugural "Script," a brief history of the profession in Hawai'i was presented up to the founding of the DKICP, Hawai'i's only academic pharmacy program. In this second part of the inaugural article, we describe some key accomplishments to date. The mission of the College is to educate pharmacy practitioners and leaders to serve as a catalyst for innovations and discoveries in pharmaceutical sciences and practice for promoting health and well-being, and to provide community service, including quality patient care. Examples are given to support the stated goals of the mission. With 341 graduates to date, and a 96% pass rate on the national licensing board exams, the college has played a significant role in improving healthcare in Hawai'i and throughout the Pacific Region. Additionally, a PhD program with substantial research programs in both pharmacy practice and the pharmaceutical science has been launched. Considerable extramural funding has been garnered from organizations such as the National Institutes of Health and Centers for Medicare and Medicaid Services. The economic impact of the College is estimated to be over $50 million each year. With over 200 signed clinical affiliation agreements within the state as well as nationally and internationally, the DKICP has helped to ameliorate the shortage of pharmacists in the state, and has enhanced the profile and practice standard of the pharmacist's role on interprofessional health care teams.

Doctors' perspectives on the barriers to appropriate prescribing in older hospitalized patients: a qualitative study.

AIMS: Older patients commonly suffer from multimorbidites and take multiple medications. As a result, these patients are more vulnerable to potentially inappropriate prescribing (PIP). PIP in older patients may result in adverse drug events (ADEs) and hospitalizations. However, little has been done to identify why PIP occurs. The objectives of this study were (i) to identify hospital doctors' perceptions as to why PIP occurs, (ii) to identify the barriers to addressing the issues identified and (iii) to determine which intervention types would be best suited to improving prescribing. METHODS: Semi-structured interviews based on the Theoretical Domains Framework (TDF), a tool used to apply behaviour change theories, were conducted with 22 hospital doctors. Content analysis was conducted to identify domains of the TDF that could be targeted to improve prescribing for older people. These domains were then mapped to the behaviour change wheel to identify possible intervention types. RESULTS: Content analysis identified five of the 12 domains in the TDF as relevant: (i) environmental context and resources, (ii) knowledge, (iii) skills, (iv) social influences and (v) memory/attention and decision processes. Using the behaviour change wheel, the types of interventions deemed suitable were those based on training and environmental restructuring. CONCLUSION: This study shows that doctors feel there is insufficient emphasis on geriatric pharmacotherapy in their undergraduate/postgraduate training. An intervention providing supplementary training, with particular emphasis on decision processes and dealing with social influences would be justified. This study has, however, uncovered many areas for potential intervention in the future.

Survey of patients' experiences and perceptions of care provided by nurse and pharmacist independent prescribers in primary care.

BACKGROUND: In the United Kingdom, nurses and pharmacists who have undertaken additional post-registration training can prescribe medicines for any medical condition within their competence (non-medical prescribers, NMPs), but little is known about patients' experiences and perceptions of this service. OBJECTIVE: to obtain feedback from primary care patients on the impact of prescribing by nurse independent prescribers (NIPs) and pharmacist independent prescribers (PIPs) on experiences of the consultation, the patient-professional relationship, access to medicines, quality of care, choice, knowledge, patient-reported adherence and control of their condition. DESIGN: Two cross-sectional postal surveys. SETTING AND PARTICIPANTS: Patients prescribed for by either NIPs or PIPs in six general practices from different regions in England. RESULTS: 30% of patients responded (294/975; 149/525 NIPs; 145/450 PIPs). Most said they were very satisfied with their last visit (94%; 87%), they were told as much as they wanted to know about their medicines (88%; 80%), and felt the independent prescriber really understood their point of view (87%; 75%). They had a good relationship with (89%; 79%) and confidence in (84%; 77%) their NMP. When comparing NMP and doctor prescribing services, most patients reported no difference in their experience of care provided, including access to it, control of condition, support for adherence, quality and safety of care. DISCUSSION AND CONCLUSIONS: Patients had positive perceptions and experience from their NMP visit. NMPs were well received, and patients' responses indicated the establishment of rapport. They did not express a strong preference for care provided by either their non-medical or medical prescriber.

Should pharmacometrics be training the next R&D president?

We continue to train pharmacometric scientists primarily in methodology. The lack of training in business and drug development concepts, however, is preventing pharmacometricians from becoming high-level decision makers. The more recent growth of opportunities in pharmacometrics is propelled by applications within both companies and regulatory agencies. However, these applications themselves may not lead to sustained growth of opportunities. How can we prepare pharmacometricians to fundamentally re-engineer the drug development paradigm?