Followino an opening statement exnlaininc the imnortance of small groups as an educational innovation, the author examines seven different types of groups, their oraanization and function. 1) The task group involves students in many types of meaningful work, with each member able to make a useful contribution towards the completion of the task. 2) The didactic group has the teacher or leader presenting material with the purpose of informino, reviewing or clarifying. 3) The tutorial group puts the emphasis on individual instruction, usually of a remelial nature. 4) The discursive group provides for free and uninhibited discussion by students of a topic of prime importance to them, with the teacher in the role of interested observer. 9 The brainstorming group is problem or solution centered, without criticism, and the teacher's role is to motivate, to get the ball rolling, and then to stay out. A) The heuristic grogu Places the emphasis on inquiry and discovery, and is intended to make students skillful askers of questions. /1 The maieutic group uses the Socratic method to determine the answer to a question through the onc-n and honest exchanae of informed opinion.

/pdf/learning-in-the-small-groups-2eibyc0lv2.pdf

Learning in the Small Groups.

To sensitize the fourth year undergraduate medical students about rational prescribing, 600 prescriptions of private practitioners were collected by them and analyzed using WHO/INRUD indicators. There were average 3.81 drugs per prescriptions. Drugs were prescribed in generic name only in 5 prescriptions. About 50% drugs were prescribed from the Essential Drug List; only 17.5% of prescriptions were complete in respect to patient medical information. Antibiotics were prescribed in 72.5% of the prescriptions; injections were prescribed in about 12.1% of the prescriptions. Although the exercise revealed few elementary aspects of the prescribing, the medical students participated in the exercise enthusiastically and perhaps understood the issues related to rational prescribing effectively.

/pdf/evaluation-of-prescribing-pattern-of-the-private-5gn53u0zr4.pdf

Evaluation of prescribing pattern of the private practitioners by the undergraduate medical students

Irrational prescribing originates in undergraduate therapeutics education, where prescribing skills have been overlooked. P-drug, a rational prescribing approach, has been developed in response to poor prescribing. In 2004, the first cohort of PBL final year students at Nelson R. Mandela School of Medicine reported feeling unprepared to prescribe medicines and requested help. We aimed to assist students in improving their prescribing competence and confidence. Students were tested and asked to rate their confidence for some of their responses. A stratified sample of 10 of these students, were interviewed, where they prescribed treatment for 4 paper cases. A week-long intervention was designed, covering key areas of weakness and prescribing skills and employing several learning strategies. Students evaluated the course, rating how they felt key competences changed. Test results averaged 47 per cent. True/false questions were better answered (69 per cent) than short answer questions (21 per cent), the worst of these testing drug level interpretation (48 per cent) and dosage calculation (5 per cent) respectively. Students interviewed gave appropriate treatment for 4 of 40 cases and important patient information in only 1 case. Eight students gave an appropriate text for further information. The student evaluation showed an improvement for all prescribing abilities. South African Journal of Higher Education Vol. 20 (3) 2006: 426-441

Building successful therapeutics into a problem-based medical curriculum in Africa

BACKGROUND Preventable adverse drug events (ADE) occur in up to three percent of patients admitted to Australian hospitals. Many result from prescribing errors involving either drug selection or prescription writing. Two strategies have been reported to reduce prescribing errors: 1) introduction of a standardised (and ideally electronic) prescribing system; and 2) education; (such as the National Prescribing System [NPS] web based prescribing program). Education aims to increase doctors’ pharmacological knowledge, prescribing ability and awareness of medication risks. However, these interventions do not address all underlying factors, and in fact the introduction of some systems has been shown to increases errors when the factors are not fully understood. AIMS This thesis aimed to identify the attitudes and perceptions of students and interns to safe prescribing, and understand the factors causing prescribing errors. Based on these findings, system and educational interventions were developed and evaluated. The hypothesis tested was that a standardised medication chart, combined with a program to increase knowledge and skills in safe prescribing of students, and would improve the attitudes and prescribing behaviours of junior doctors. METHOD A questionnaire was developed to identify students’ attitudes to prescribing and medication safety. Interns involved with prescribing errors were interviewed to identify underlying factors. Focus groups of interns and registrars were undertaken to explore these findings and identify changes needed to the systems and training. The interventions consisted of a standard medication chart and a Safe Medication Practice Tutorial (SMPT) Program. The chart was developed by a multidisciplinary collaborative, applying human factor principles and using findings from error analysis. The impact of the chart was evaluated by observations of prescribing before and after its implementation. The problem-based SMPTs were delivered by a multidisciplinary team to two cohorts of students at one intervention hospital and compared to those at a control hospital. Evaluation of the SMPT included qualitative feedback, individual changes to attitudes, and comparison of intervention and control students’ knowledge and prescribing skills in their final exam. Prescribing behaviour was compared at the end of the intern year. RESULTS Students reported feeling unprepared to prescribe safely, but assumed the medicines they prescribed would be safely administered. A perception of a blame culture existed. Prescribers associated with 21 errors identified multiple causes, with a median of four (range 2-5) different performance influencing factors per error. Lack of drug knowledge was not the single factor in any incident. The factors involved with new prescribing errors included: team, individual, patient and task factors. Factors associated with re-prescribing errors were environmental, task and duration on rotation. Defenses, such as other clinicians and guidelines, were porous. Supervision was inadequate and not tailored to the risks related to patient, task, interns’ experience and environment. These errors occurred in the context of a latent culture in which prescribing was seen as a repetitive, low risk chore. The introduction of the standard medication chart was associated with a reduction in prescribing errors. The total error rate significantly decreased from 2300 in 9772 orders (23.5%) to 1935 in 10352 orders (18.7%) after implementation (p<0.001). A designated warfarin section prompting for indication and target international normalised ratio (INR) ranges, resulted in a significant reduction of INRs greater than five from 271 (1.88%) before the chart was introduced to 249 (1.45%) of INRs after (p=0.004). The chart was introduced in all Queensland Health hospitals and formed the basis for the National Inpatient Medication Chart. The interns’ confidence in their ability to prescribe in common situations increased significantly after attending the SMPTs. Prescribing errors in the fourth year exam in 2004 were significantly fewer in the intervention group 285 in 907 orders (31.4%) compared with the control group 600 in 1225 orders (48.9%; p<0.0001). There were also significantly fewer prescribing errors in 2005; 248 in 668 orders (37.1%) compared with 411 in 864 orders (47.6%; p <0.0001). In 2005, there were significantly fewer drug selection errors, with more appropriate consideration of patients’ individual risks in the intervention group; 161 in 668 orders (24.1%) compared with 260 in 864 orders (30.1%) in the control group (p=0.009). In an observational audit of intern prescribing, the error rate per order was 27.4% for control interns. This was not significantly different to the 24.5% error rate for intervention interns. However, the entire intern cohort made significantly fewer errors at 25.4% of orders compared to the 33.9% for non-intern prescribers, (p<0.05). CONCLUSION In summary, unprepared interns made prescribing errors in an error prone system. They lacked appropriate supervision. A culture existed in which doctors perceived prescribing was primarily about drug selection, and re-prescribing and prescription generation were low risk tasks. Introduction of a standard chart with decision support reduced prescribing errors. The SMPT program increased knowledge, awareness of errors and safe prescribing behaviour. Introducing summative assessment drove learning about prescription writing in the following year’s cohort. Based on these findings, safe prescribing must become a fundamental component of undergraduate and intern education. The additional value of the combination of the SMPT with the NPS prescribing curriculum remains to be evaluated. Interns require appropriately tailored supervision by registrars and close liaison with pharmacists to further develop as safe prescribers. Further improvements in safety could also be gained in the future with the introduction of electronic prescribing with decision support based on our findings and within a safe prescribing culture.

Improving the safety of junior doctors' prescribing - systems, skills, attitudes and behaviours

Background: Graduating medical students have reported concern regarding inadequate training in pharmacotherapy. Teaching by clinical pharmacists may improve medical students’ pharmacotherapy knowledge. Purpose: To assess the impact of pharmacist led workshops on 4th year medical students’ knowledge of pharmacotherapy and satisfaction. Methods: Senior medical students enrolled in intensive care unit rotations at a US medical school were randomized to an intervention of pharmacist led case-based workshops or a control group without an explicit pharmacotherapy curriculum. Intervention group students attended four weekly 1-hour workshops that covered topics in pharmacokinetics, pharmacodynamics, drug interactions and toxicity. A multiple-choice test of clinical vignettes assessed students’ knowledge of pharmacotherapy. An end of clerkship survey assessed student satisfaction with teaching. Results: Of 176 medical students eligible, 148 agreed to participate and were randomized to the intervention (n = 63) or ...

Pharmacist-Led Workshops to Enhance Pharmacotherapy Knowledge for Medical Students

Three cohorts of third-year medical students on clinical placements were compared (n = 48). One cohort (study group, n = 18) attended a series of therapeutic tutorials led by the pharmacist. The other two cohorts (control group A and control group B) did not. The tutorials focused on using problem-based cases to review the therapeutic management of common medical conditions. The performance of the three cohorts was assessed using a written therapeutics test consisting of multiple-choice questions and problem-based cases. The study group also completed a questionnaire, which sought to obtain their opinions on the tutorials. The study group performed significantly better than control group A and control group B in both the multiple-choice questions and problem-based cases (p < 0.05, Student's t-test). The responses to the questionnaires indicated that all students welcomed the opportunity for structured teaching of therapeutics during their clinical placements. The students identified the need for more teac...

Evaluation of the impact of pharmacist-led therapeutic tutorials on third-year medical students' knowledge and understanding of drugs used in clinical practice.

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Evaluation of the impact of pharmacist-led therapeutic tutorials on third-year medical students' knowledge and understanding of drugs used in clinical practice.