Letters

Abstract

To the Editor. To optimize drug therapy, knowledge is needed at the time of therapy decisions. The use of information technology, such as personal digital assistants (PDAs), is often utilized to provide point-of-care information resources. A survey of information resources used in antimicrobial prescribing, an area often implicated in medical errors, found that 55% of physicians refer to an external resource regarding an antimicrobial prescription.1,2 The PDA can also serve as a real-time educational tool in the classroom. Students can utilize PDA-based infectious diseases references to access information related to antimicrobials and participate in patient-related case discussions. A case-based approach to learning infectious diseases pharmacotherapy, instead of relying primarily on lectures to deliver content (which promotes student memorization), should assist in reinforcing content, making course material more clinically relevant, and sharpen clinical problem-solving skills. By utilizing the resource in class, students are prepared to use the PDA application to obtain relevant information during patient encounters and multidisciplinary rounds during experiential rotations and in professional practice. In order to familiarize students with a personal digital assistant (PDA) application that is available to support infectious diseases clinical decision-making, third-year doctor of pharmacy students enrolled in an Infectious Diseases Pharmacotherapy course in 2007 were provided with a PDA application installer CD of the Sanford Guide to Antimicrobial Therapy 2006 for use on their Dell Axim X30 PDAs (provided by Virginia Commonwealth University School of Pharmacy). To ensure familiarity with the resource, an in-class demonstration session was held. Limitations of the resource were emphasized including that generating antimicrobial regimens is not “cookbook medicine” and that often there is not just one antibiotic option; that the Sanford Guide is not all encompassing; and that students will need to access primary literature and fully referenced guidelines at times, as well as local antimicrobial susceptibility data. In the first half of the course, didactic lectures were given on antibiotics and clinical microbiology. To ensure that students learned the fundamentals of infectious diseases pharmacotherapy, a direct recall multiple-choice examination was given. The students were administered a second examination in which the majority of the questions were based on the students' ability to effectively use the Sanford Guide to ensure that they became adept at using the software. Students were then given infectious diseases cases generated from real-life patient scenarios. Students reviewed relevant background reading material before class and quizzes were administered via the Web-based Blackboard system. During class, students used their PDAs as a tool in generating appropriate antimicobial regimens, including modifications for renal impairment. Students worked in small groups as they worked through a case, allowing them to discuss different approaches in choosing antimicrobial regimens and monitoring parameters. For example, students were given a case involving a patient with infectious endocarditis who had Gram-positive cocci obtained from blood cultures. Students answered questions such as: (1) what empiric antibiotic regimen would you select for the patient and how would you monitor and dose the regimen? (2) how would change your empiric regimen after final culture and susceptibilities return? (3) is rifampin indicated? The utility of the PDA application was assessed by students using a questionnaire with Likert-scale responses. The survey response rate was 98% (61/62). The majority of students perceived the use of the Sanford Guide as a positive learning experience. Ninety percent of students agreed that information on antimicrobials was easy to retrieve with the PDA application, while a slightly lower percent (86%) agreed that information on infectious diseases was easy to retrieve. The majority (92%) agreed that a case-based approach to learning infectious diseases pharmacotherapy enhanced learning and 85% agreed that it prepared them for professional practice. The question with the highest agreement (95%) was the one inquiring whether being tested on utilizing the PDA was helpful in becoming familiar with the resource. Others have emphasized the importance of user training for the implementation and adoption of technology, such as PDAs, into the curriculum.3 Education on the use of the tool and subsequent testing on the proficiency ensures understanding of the tool's capability and an ability of the user to obtain information in a quick and adept manner. Amy Pakyz, PharmD, MS School of Pharmacy Virginia Commonwealth University