Clinical Pharmacology Training Research Articles

Serious gaming as potential training tool for recognition of adverse drug reactions: side-effect exposure—medical education (SeeMe)

PurposeThe recognition of adverse drug reactions (ADRs) is an important part of daily clinical work. However, medical education in this field is mostly drug-based and does not address adequately the complexity of this field regarding individual risk factors and polypharmacy. This study investigates the potential of the web-based serious game SeeMe (side-effect exposure—medical education) in pharmacological education of medical students to improve the recognition of relevant ADRs.MethodsOne hundred fifty-seven medical students were recruited to evaluate the serious game SeeMe. SeeMe was developed to improve knowledge and recognition of ADRs in clinical practice. Players take on the role of a physician trying to understand fictional patients with ADRs. Before and after an 8-week playing period, an evaluation was carried out through a pre- and post-questionnaire and a pre- and post- knowledge test.ResultsThe students achieved significantly better results in the knowledge test, as almost twice as many exam-relevant questions were answered correctly (p < 0.001). The serious game had a positive effect on the students’ perception of the importance of ADRs.ConclusionThis study demonstrates the potential of web- and case-based fictional serious games in medical education. The improved recognition of side effects represents a crucial step for education and training in clinical pharmacology. Future versions of the serious game may take this further and focus on training in the treatment of ADRs and their relevance in various healthcare professions.

Evaluation of a short-structured learner-centric training program on rational drug prescribing for medical interns: A quasi-experimental study.

Rational drug prescribing skills of interns remain bleak despite clinical pharmacology training during their second year, warranting the need for further training. This study was designed to evaluate the effectiveness of a short-structured learner-centric training program using the World Health Organization (WHO) guide to good prescribing in improving interns' knowledge of rational drug use and their rational drug prescribing skills. This quasi-experimental study was implemented at a tertiary care teaching hospital in South India. We conducted a short-structured learner-centric training program on rational drug prescribing for interns in September 2022, using the WHO guide to good prescribing. The medical interns who consented to participate were included in the study. A pre-test was administered at the start of the training, followed by a post-test and feedback questions at the end of the program. Statistical tests used for quantitative data were the Wilcoxon signed-ranks test and McNemar's Chi-square test. Qualitative data were analyzed using manual content analysis. Of the 77 interns who attended the training program, 73 provided consent and completed both the pre-test and the post-test. Their mean age was 22 years, with a slight preponderance of female participants (53.4%). Overall, there was a statistically significant increase in the median (interquartile range) total scores from 52 (44.6 - 60) to 84 (70 - 88) after the training (P = 0.001), out of a maximum score of 93. Also, a significantly greater number of them wrote legible prescriptions (grade 4/excellent - 44 in pre-test vs 52 in post-test; P = 0.001) after the training. The short-structured learner-centric training program based on the WHO guide to good prescribing significantly improved the knowledge of rational drug use and rational drug prescribing skills among medical interns.

Knowledge, attitude and practices related to drug prescription among postgraduate medical students: A cross sectional study

Pharmacology, being both the basic and applied science of drugs, forms the backbone of rational therapeutics. With an emphasis on learning the facts of medications, traditional pharmacology teaching is mostly teacher-centred. The erroneous prescribing that can result from inadequate understanding can cost a great deal of money and lives. The aim of the present study was to assess doctors' prescription knowledge, attitudes, and practices.The information was gathered from postgraduate students (residents) using questionnaires about their undergraduate training in clinical pharmacology and therapeutics, prescribing practices, frequently used drug information sources, and any perceived shortcomings in their undergraduate clinical pharmacology teaching. There was a calculation of descriptive statistics and a chi-square test.Among the 149 responses, 86 (57.71%) of them were male and 63 (42.28%) were female. Only 33 (22.1%) participants knew the components of a prescription, and 135 (90.6%) participants were aware that prescription writing was taught in their undergraduate course. Around 41 (27.5%) participants were aware of the concept of P drugs. Among them, 89 (59.73%) residents had good knowledge of prescriptions. Only 35 (23.5%) strongly agreed, and 113 (75.8%) agreed that undergraduate pharmacology training taught them to prescribe safely. About 83 (55.7%) participants disagreed, 33 (22.1%) strongly disagreed, and only 10 (6.7%) agreed that undergraduate pharmacology teaching should be improved. According to the patient's needs, 146 (98%) participants were prescribed additional vitamins and irons. Around 52 (34.9%) participants reported having difficulty prescribing during their internship rotation. Among them, 77 (51.67%) residents had good practice of prescription.A majority of postgraduate students believed that additional training should be provided on writing rational prescriptions to make them more confident in their prescribing practices.

The European List of Key Medicines for Medical Education: A Modified Delphi Study.

Rational prescribing is essential for the quality of health care. However, many final-year medical students and junior doctors lack prescribing competence to perform this task. The availability of a list of medicines that a junior doctor working in Europe should be able to independently prescribe safely and effectively without supervision could support and harmonize teaching and training in clinical pharmacology and therapeutics (CPT) in Europe. Therefore, our aim was to achieve consensus on such a list of medicines that are widely accessible in Europe. For this, we used a modified Delphi study method consisting of three parts. In part one, we created an initial list based on a literature search. In part two, a group of 64 coordinators in CPT education, selected via the Network of Teachers in Pharmacotherapy of the European Association for Clinical Pharmacology and Therapeutics, evaluated the accessibility of each medicine in his or her country, and provided a diverse group of experts willing to participate in the Delphi part. In part three, 463 experts from 24 European countries were invited to participate in a 2-round Delphi study. In total, 187 experts (40%) from 24 countries completed both rounds and evaluated 416 medicines, 98 of which were included in the final list. The top three Anatomical Therapeutic Chemical code groups were (1) cardiovascular system (n = 23), (2) anti-infective (n = 21), and (3) musculoskeletal system (n = 11). This European List of Key Medicines for Medical Education could be a starting point for country-specific lists and could be used for the training and assessment of CPT.

Dental Faculty Experiences of Drug Prescription Patterns: A Qualitative Study

Background: Dental prescribing is considered a basis for short-term treatment of clinical problems. Therefore, dentists should be familiar with the patterns of rational drug prescription. Neglecting this important issue can lead to misprescription and side effects. Accordingly, the present study aimed to investigate the experiences of a group of dental specialists about prescribing drugs. Methods: This qualitative study was conducted using a conventional content analysis approach. A total of 19 specialists from 5 different fields (oral diseases, pediatric dentistry, oral and maxillofacial surgery, endodontics, and periodontics) participated in this study. Purposive and theoretical sampling was used to collect data and semi-structured in-depth interviews were conducted in the form of focus group discussions from each department at Kerman dental school. Data collection and content analysis were performed simultaneously. Results: The analysis of the data revealed five categories including more frequently prescribed drugs, common concerns about prescribing drugs, recommendations for reducing potential side effects, experience of clinical pharmacology training, and criteria for prescribing new drugs. Conclusion: Since the knowledge of dental students affects the quality and effectiveness of treatment and patient safety, this study emphasized the need to improve clinical pharmacology training provided to dentistry students, residents, and dentists.

Knowledge, attitude and practices related to drug prescription among medical officers and postgraduate residents in B. P. Koirala Institute of Health Sciences

Background: Pharmacology, being both basic and applied science, forms the backbone of rational therapeutics. Traditional teaching of pharmacology is teacher centered with emphasis on learning the facts on drugs. Inadequate knowledge may cause irrational prescribing which leads to huge loss of lives and money. Objective was to evaluate the knowledge, attitude and practices among doctors regarding prescription. Methods: A semi-structured questionnaire was used among medical officers and postgraduate residents to collect the data regarding their undergraduate training in clinical pharmacology and therapeutics, prescribing habits, commonly consulted drug information sources and any perceived deficiencies in their undergraduate clinical pharmacology teaching. Descriptive statistics were calculated. Results: Out of 116 respondents, 69 were males and mean age was 28.8±2.3 years. Ninety-eight (84.5%) participants were aware about teaching of prescription writing in their undergraduate course and 101 (87.1%) participants knew the parts of prescription. One hundred (86.2%) participants considered safety as the most important aspects of prescribing a drug. One hundred and four (89.7%) participants thought that undergraduate pharmacology training taught them to prescribe safely. One hundred and eleven (95.7%) thought that the undergraduate pharmacology teaching should be improved. Out of 116 participants, 84 (72.4%) had encountered problems while prescribing during their internship. Sixty-eight (58.6%) participants used internet as a source of information about safety, efficacy and cost of drugs for prescription. Ninety-five (81.9%) participants prescribed supplemental vitamins and irons according to patient need. Conclusions: Majority of participants felt that they do have good knowledge in prescribing medicines and the training on prescription writing should be reinforced.

A European cross-sectional survey to investigate how involved doctors training in clinical pharmacology are in drug concentration monitoring

PurposeTherapeutic drug monitoring (TDM) is widely recognised as a key attribute of clinical pharmacologists; yet, the extent to which physicians undertaking postgraduate training in clinical pharmacology (hereafter trainees) are involved in TDM is poorly characterised. Our own experience suggests wide variation in trainee exposure to TDM.MethodWe performed a Europe-wide cross-sectional internet-based survey of trainees to determine the nature and extent of trainee involvement in TDM.ResultsThere were 43 responses from eight countries analysed. Of the 21 respondents from the UK, all were also training in general internal medicine (GIM), while all of the respondents who were solely training in clinical pharmacology were from outside the UK. Overall, 86.0% of respondents reported access to drug monitoring for clinical care at their affiliated institution, of which 81.0% were personally involved in TDM in some capacity. On average, trainees reported that drug monitoring was available for 16 of the 33 (48%) of the drug/drug classes surveyed. UK-based respondents were involved in requesting drug-level investigations and interpreting the results for patients under their care in 76.2% and 85.7% of cases, respectively, while non-UK respondents supported other healthcare professionals to interpret results in 45.4% of cases. Trainees felt TDM training was generally either insufficient or very inadequate.ConclusionWhile access to TDM is relatively available at institutions where trainees are based, the role of trainees is variable and affected by a variety of factors including country and training programme. Universally, trainees feel they need more education in TDM.

Pharmacogenomics: Relevance and opportunities for clinical pharmacology

Pharmacogenomics: Relevance and opportunities for clinical pharmacology

A new curriculum to strengthen pharmacology and clinical pharmacology training in fundamental nursing education

Among medical care incidents in Japan, an increase in medicine-related errors by nurses have been reported. These errors may be caused by a lack of knowledge of clinical pharmacology and drug interactions. It is important for nurses to acquire risk-management skills based on clinical pharmacology. In order to improve fundamental knowledge in pharmacology and clinical pharmacology for nurses, various training programs exist. We reviewed a number of educational programs in medicine and report our results. Based on our results, it is necessary for medical education programs to include the following 5 essential elements: 1) An analysis of frequently-occurring medication errors in the field of clinical pharmacology, 2) drugs administer for patient characteristic and patient observation practices, 3) an emphasis on the interactions between drugs and food or other drugs, 4) assessment of patient symptoms, risk-management, and the efficacy of drugs, 5) the necessity of using the package inserts. In a new curriculum, it is necessary to have systematic, step by step training in pharmacology and clinical pharmacology. It is also necessary to develop these teaching methods in cooperation with specialists and experts in the field.

Ontogeny of Pediatric Pharmacogenetics: Celebrating the Past and Vision for the Future.

Ontogeny of Pediatric Pharmacogenetics: Celebrating the Past and Vision for the Future.

Implementing a specialist paediatric clinical pharmacology service in a UK children's hospital.

AimsRoyal College of Paediatrics and Child Health subspecialist training in Paediatric Clinical Pharmacology and Therapeutics has been delivered in the UK for 20 years, but no specialist clinical services have been set up previously.MethodsProspective audit and service evaluation of paediatric clinical pharmacology service pilot phase and dedicated service at a UK children's hospital.ResultsPilot scheme (May–October 2019), then weekly service (established June 2020). Service covers the High Dependency Unit, and inpatients with polypharmacy. The pilot demonstrated high levels of acceptance, with 89% of suggested medication changes agreed by lead clinical team, and success, with 97.5% of suggested changes continued until discharge/pilot completion. Economic analysis estimated direct annualised cost savings on medications of up to £10 000. After 20 ward rounds of the established service, 270 potential medication changes were identified, 213 were carried out (78.9%). The most common were deprescribing (n = 143), prescribing (n = 47) and dose adjustment (n = 8). Seventy‐five different medications were deprescribed, most commonly chloral hydrate (n = 12), Lactulose, ibuprofen, Bio‐Kult and sodium alginate (all n = 4). The percentage of inpatients prescribed ≥10 medications decreased from 38.5 to 32.1%, while the subset prescribed ≥20 medications decreased from 11.0 to 5.67%. The mean number of medicines prescribed decreased from 9.0 to 8.0, while the median was unchanged at 7. Annual Yellow Card reports of suspected adverse drug reactions more than doubled (n = 66).ConclusionA UK model for subspecialist paediatric clinical pharmacology service delivery has demonstrated a positive clinical impact and could be replicated at other UK secondary/tertiary children's hospitals.

Clinical Pharmacology Worldwide: A Global Health Perspective.

Low- and middle-income countries (LMICs) have the highest rates of mortality and morbidity globally, but lag behind high-income countries in the number of clinical trials and trained researchers, as well as research data pertaining to their populations. Lack of local clinical pharmacology and pharmacometrics expertise, limited training opportunities, and lack of local genomic data may contribute to health inequalities and limit the application of precision medicine. Continuing to develop health care infrastructure, including well-designed clinical pharmacology training and data collection in LMICs, can help address these challenges. International collaboration aimed at improving training and infrastructure and encouraging locally driven research and clinical trials will be of benefit. This review describes several examples where clinical pharmacology expertise could be leveraged, including opportunities for pharmacogenomic expertise that could drive improved recommendations for clinical guidelines. Also described are clinical pharmacology and pharmacometrics training programs in Africa, and the personal experience of a Tanzanian researcher currently on a training sabbatical in the United States, as illustrative examples of how training in clinical pharmacology can be effectively implemented in LMICs. These training efforts will benefit from advocacy for employment opportunities and career development pathways for clinical pharmacologists that are gradually being recognized and developed in LMICs. Clinical pharmacologists have a key role to play in global health, and development of training and research infrastructure to advance this expertise in LMICs will be of tremendous benefit.

How to attract doctors to careers in the fields of pharmaceutical medicine and medical devices?

It has become a major challenge not only to retain but also to attract medical professionals to a career in the healthcare products field whether in the public or private sector. There is no denying that France has a shortage of doctors qualified to work in these fields and that public or private organisations alike are experiencing great difficulty in filling vacancies. Unlike elsewhere in Europe, and with the exception of complex pathways imposed on university hospital professors, French training courses do not really provide doctors with specialised training in healthcare products. Many and varied careers nevertheless do exist. However, these careers are not sufficiently visible to future doctors or to the general public. A more dedicated specialist curriculum is called for to meet the many needs of public institutions and private companies. Any such curriculum should be underpinned by solid initial clinical training as an indispensable foundation regardless of future career path. To improve visibility, specialty training in Clinical Pharmacology and Therapeutics must be set up with the support and assistance of the various national bodies. Against a backdrop of activities with a largely globalised reach, the availability in France of healthcare product specialists is key to maintaining national control of activities that exert a significant impact on the economy and on public health.

Unique approach to continuing medical education in clinical pharmacology across Australia and New Zealand.

Advanced physician training in clinical pharmacology lacks a continuing education programme. There is a need for continuing medical education but how to introduce and develop education remains unclear. The primary aim was to develop and implement a peer-led, web-based multiple choice question approach to continuing education in clinical pharmacology training across Australia and New Zealand. Secondary aims included determining, quality, difficulty, utility, relevance, user-friendliness, sustainability and potential to form part of formal clinical pharmacology physician training. In February 2018, a survey of clinical pharmacology trainees identified topics for question development. Questions covering requested topics were developed and piloted in PeerWise between March and October 2018. Participants could rate quality and difficulty of questions using categorical rating scales and make free text comments. After questions were piloted, a survey using a 0-10-point Likert scale and yes/no responses assessed utility, relevance, user-friendliness, sustainability and formalisation potential. Twenty-four trainees were invited to participate. Nine (38%) of trainees completed the initial survey, 10 (42%) attempted questions and 7 (29%) completed the end survey. Median scores of 8.00 (IQR 6.50 - 9.00), 7.00 (IQR 6.50 - 7.50) and 8.00 (IQR 6.50 - 8.00) using a 0-10-point Likert scale indicated trainees found this approach useful, relevant and user-friendly. Five (71%) out of seven responding trainees felt this approach was sustainable and could be incorporated as part of formal clinical training. This study suggests that peer-led multiple choice questions could form an enduring education modality which could be incorporated into clinical pharmacology training.

Concept of clinical pharmacology and therapeutics sensitization and training for interns

Background: Rational prescribing of the medicines is an essential skill required by all the doctors. Interns are not prepared or confident in rational prescription either because of inadequate training or knowledge is not retained by the time they come to internship or due to fast change in the concepts or protocols in pharmacology. The objectives of the study were to introduce and assess a short sensitization and training for interns regarding clinical pharmacology and therapeutics (CPT).Methods: It was a quasi-experimental type of interventional study done on 30 pediatrics interns. A short sensitization and training was given regarding CPT using flipped classroom model. Pre-test and post-test was conducted to know the effectiveness of the sensitization/training. Students’ opinion was also taken regarding the training and incorporation of similar training in other departments.Results: The mean percentage scores of the objective type questions in the pretest was 40.6±3.25 which increased significantly (p&lt;0.05) to 74±2.95 in post-test. The mean percentage scores of the problem solving type questions in the pretest was 30.78±5.25 which increased significantly (p&lt;0.05) to 65.21±4.65 in post-test.Conclusions: The sensitization and training was effective and there was overall satisfaction of conduct of such training among pediatrics interns. Further detailed research has to be conducted in different departments and faculties’ opinion regarding incorporation of CPT training and feasibility has to be considered before we recommend such training during internship.

From Molecule to Patient and Ways to Get the Dose Precisely Right

From Molecule to Patient and Ways to Get the Dose Precisely Right

Present and future IUPHAR plans for network support in training and capacity building in pharmacology and clinical pharmacology in resource strained countries

Present and future IUPHAR plans for network support in training and capacity building in pharmacology and clinical pharmacology in resource strained countries

Developing Capabilities in Practice for Clinical Pharmacology Training in the UK

Developing Capabilities in Practice for Clinical Pharmacology Training in the UK

New Challenges in Postgraduate Education and Training in Clinical Pharmacology in Slovakia

New Challenges in Postgraduate Education and Training in Clinical Pharmacology in Slovakia

An International Asset Map of Clinicians, Educators, and Researchers Pursuing Better Medicine Use in Children: Initial Findings.

The world's 1.89 billion children (age 0-14) too frequently receive treatments that have not been validated through clinical pharmacology research, especially in low- and middle-income countries. Initial findings from an international asset map of professionals and clinician scientists available to address the needs for education, research, and treatment support suggest a critical shortage of clinical pharmacologists, clinical pharmacists, and other professionals with advanced training in the evaluation of therapies for childhood conditions and illnesses. A total of 497 individuals responded to a survey conducted between May 2015 and February 2016. An alarming signal is apparent showing that, while the overall resource pool is unquestionably limited, 87% of relevant qualified personnel are located in high-income countries. The data suggest an urgent need for targeted training in pediatric clinical pharmacology, with particular focus on the needs in Africa, Latin America, and most of Asia.