A PRESCRIBING CURRICULUM FOR AUSTRALIAN MEDICAL STUDENTS Smith AJ, Hill SR,Tasioulas T,Cockayne NL....

A PRESCRIBING CURRICULUM FOR AUSTRALIAN MEDICAL

STUDENTS

Smith AJ, Hill SR,Tasioulas T,Cockayne NL.National Prescribing Service, Sydney &

Clinical Pharmacology Unit, University of Newcastle, Australia

Background

• The Australian National Prescribing Service (NPS) not-for-profit, independent organisation

• Activities aim to improve the overall quality of use of medicines in Australia

• Development of curriculum as a response to: – Documented sub-optimal prescribing by doctors– A perceived deficit in prescribing education for

senior students in medical schools - despite good programs in pharmacology/clinical pharmacology

Objectives

• To design, field-test, implement and evaluate the impact of a modular, problem-based web-interactive prescribing curriculum based on the WHO “Guide to Good Prescribing”

Methods (1)

Design• Jointly sponsored by NPS and the Australasian

Society for Clinical and Experimental Pharmacologists and Toxicologists (ASCEPT)

• Collaboration with teachers from each of the Australian medical schools

• Clinical conditions were selected from those that interns claimed were common and raised prescribing issues

• The 12 written cases were converted to web-based interactive form by Knowledge South and the University of South Australia

Methods (2)

Field-testing and implementation• The 12 modules were field-tested for ease of

navigation and for content by medical students and staff

• The curriculum could not be mandated and uptake was dependent on NPS advocacy and the influence of the teachers who had helped construct the program

• The completed modules were made available to each of the 11 Australian medical schools in January, 2002

Methods (3)

Evaluation• Measurement of ‘hits’ on the website by each

medical school• Structured interviews with 15 teachers from 9

medical schools and online survey of 121 medical students from 5 medical schools

• An assessment of students’ ability to select drugs for four common conditions: – before using the curriculum– after one year’s voluntary use– after a further one year’s compulsory use

Results (1)

Annual 'Hits' to web site by each Medical School*

0

20000

40000

60000

80000

100000

120000

1 2 3 4 5 6 7 8 9

2002 2003

*Medical Schools have been de-identified

Results (2)Qualitative feedback: In-depth interviews with

teaching staff• All used it as a tool for individual self-directed

learning tool – five with added case-discussions

• Five schools made the curriculum assessable in final examinations

• Issues/problems: – Technical aspects e.g. navigation and browser capability– “Need to engage more teaching staff within faculty”

• Generally, “an excellent, practical resource”

Results (3)

Qualitative feedback: student online survey • 97/107 (91%) therapeutic content appropriate to

needs

• 92/107 (86%) felt better able to prescribe after using the curriculum

• 57 (54%) had developed their own personal formulary – a major goal of the program

Results (4)

Improvements in selecting appropriate drugs in each condition were significant (2=37, p=0.01)

Student Assessment of Ability to Select Appropriate Drugs in

Four Conditions (Pre and Post Testing)

0

20

40

60

80

100

Condition 1 Condition 2 Condition 3 Condition 4

% C

orr

ect Res

ponse

Start Year 4 (Curriculum voluntary, n= 54) Start Year 5 (Curriculum compulsory, n=58) End Year 5 (Curriculum compulsory, n=24)

Conclusions

• The program has proved very popular with students and staff

• Uptake in the first two years has been better than predicted but the program needs more ‘marketing’

• The modules have now been revised and plans are in place for more thorough evaluation in 2004

• Website URL: http://nps.unisa.edu.au