Teaching and Assessing Principles of Pharmacokinetics and Pharmacodynamics in an Integrated Medical School Curriculum

Abstract

IntroductionPharmacology is a crucial component of undergraduate medical education. The foundational principles of Pharmacology, including Pharmacodynamics (PD) and Pharmacokinetics (PK) are among the most challenging subjects for students. At the Zucker School of Medicine, Pharmacology is organized longitudinally as an integral sub‐component of all courses taught in the preclinical years. The foundational concepts of PK/PD are introduced in the first course. In order to identify areas of difficulty for our students, we reviewed course feedback and performed an anlysis of the final course exam from the previous two classes. This analysis revealed that while our learners were adept at restating certain PK/PD concepts, a significant number of students were unable to correctly apply these concepts to solve complex problems. This helped us develop modules targeting the challenging areas of PK/PD and to revisit PK/PD in later courses with increasing complexity.MethodBased on the information from the previous two years, the present study was conducted with the present 102 first year medical students at Zucker School of Medicine. Prior to each pharmacology classroom session, students were assigned pre‐reading and pre‐class practice problems that were graded by the faculty. These pre‐class assignments tested concepts that included drug affinity, potency, efficacy, volume of distribution (Vd), clearance (Cl), half‐life (t1/2), loading dose and maintenance dose. These practice problems allowed the faculty to identify areas of difficulty and to tailor the follow up classroom sessions to the students’ needs. Moreover, given that essay exams were used in Zucker School of Medicine, the faculty was able to assess the reasoning behind the students responses. Analysis of their answers allowed the faculty to identify gaps/areas in PK/PD needing further clarification in subsequent courses.ResultsNinety‐eight percent of the students completed the pre‐reading and submitted their pre‐class assignments. Based on the results from the assignments, most of the students demonstrated definitional understanding (basic) of the concepts but had difficulty with application (complex). The material on the final exam was more complex than the pre‐class practice. In general, the students improved by the end of course after faculty addressed the issues in PK/PD application. However, some students still encountered difficulty in a more complex setting and this will be the focus of future classroom sessions (see table ).ConclusionTo enhance our students’ understanding of PK/PD, we used pre‐class test and post course exam analysis to guide the delivery of PK/PD content. Results from the current study show that pre‐class exercises were very useful in assisting faculty to better target areas of difficulty during classroom sessions. Additionally, post course exam analysis provided faculty with areas of PK/PD that needed further reinforcement. To this end, faculty has developed modules to be implemented in later courses so as to ensure that the students achieve mastery of these pharmacology principles during the pre‐clinical years. Students’ performance on pre‐class practice test and end of course exam (correct rate) Concept tested Pre‐class practice test End of course exam Potency 56% (moderately complex) 67% (highly complex) Efficacy 88% (basic) 97% (highly complex) Loading dose 79% (basic) 72% (highly complex) Maintenance dose 66% (basic) 75% (highly complex) Cl 18% (moderate complex) ‐ (indirectly tested) Vd 85% (basic) ‐ (indirectly tested) T1/2 59% (moderately complex) ‐ (indirectly tested) The test questions are designated as basic, moderately complex or highly complex, based on their degree of difficulty and integration.