Health Administrator Vol : XIX Number 1: 93-103

CHAPTER 23 GRADUATE TRAINING PROGRAMES IN PHARMACOLOGY IN INDIA

Dr Daniel Joseph* Curriculum is defined as a planned programme of teaching-learning experience offered to learners usually under the guidance of a formal educational institution. It implies deliberate and systemic plan to bring about desirable change in learners behavior and performance . Undergraduate (UG) curriculum has been framed on the basis of the appropriateness to the need, interests of learners and consistency with social realities. The basic knowledge about a drug in the absence of patient is primarily acquired during Para clinical years and the applied aspect reinforced during the years the students undergo clinical training. An under-graduate student is confined to the facts oriented to drugs but as a prescriber he/ she is confronted with problems oriented to patients. A good knowledge of clinical pharmacology and rational therapeutics can be expected to induce better prescribing habits and less harmful drug therapy. Furthermore, it is generally felt that pharmacology curricula in medical schools is outdated. There has been a failure to keep pace with rapid changes and requirements of clinical practice. Given below is a recommended UG training to be carried out in all medical schools. THEORY:? A pharmacology teaching programme can be conveniently divided into general principels of therapeutics, systemic pharmacology and prescribing patterns. Desirable to adopt a largely clinical approach to the teaching of pharmacology to medical students. Subjects such as details of chemistry & SAR should be given less coverage. Coverage of pharmacological actions and mechanisms should be restricted to those with a bearing on important clinical uses. Courses on systemic pharmacology should be divided into sections dealing with drugs likely to be used by all doctors, drugs usually employed by specialists and drugs that are used only rarely. A careful attention should be given to the WHO list of essential drugs and local list of essential drugs when decisions are taken. Selection of drugs by family physicians and specialists. Tutorials should be taken once weekly on the topics decided by the university.

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PRACTICALS :Practical courses in pharmacology leave much to be desired. Experimental Pharmacology is being phased out because of its irrelevance, the scarcity of animals, animals activists objecting to repetitive experiments, learning from already known facts and computer simulated experiments being available.

* Professor and Head, MGM Medical College, Mumbai

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The continuation of dispensing pharmacy in medical curricula attracts widespread ridicule since ready made preparations are available. But in view of the compulsory rural posting, it needs a fresh look. Some practical exercises are suggested below:? ? Demonstration of dosage forms. Demonstration and preparation of some commonly used and easily made medicaments (e.g.ORS, Powder Aspirin, Antibiotic solution). Demonstration and practice of parenteral routes of drug administration especially in view of WHOs observations on Unsafe Injection Practices in India. Critical review of various commercial products, including combinations. Assessment of pharmaceutical promotional material. Decision making in actual or simulated clinical situations. Practical demonstration of certain clinical or emergency procedure and asking the students to practice. Review of actual or simulated ready made prescriptions. Writing of prescriptions of common clinical situations . Identification and use of various sources of drug informations. Preparations of ideal formularies. Preparation and review of information sheets and package inserts. Interpretations of clinical trial reports.

trained to perform a particular skill and that they are not required to absorb excessive theoretical detail. ? Class lectures are rated as much less useful than tutorials, group discussions and question and answer sessions particularly if these are conducted in presence of a clinician. Audiovisual aids can be stimulating. Power Point presentations specially with added graphics can be used to make lectures interesting. Visits to wards, Primary health centres & pharmaceutical laboratories & carrying out of hospitals-or-community based drug projects, all have a place in integrated teaching. Computer assisted teaching may also be employed. Proper weightage should be given to simple, safe and inexpensive methods of treatment. The importance of cost should be discussed with students. More practice in curriculum and problem solving education should be taught. Need for far more education on rational use of drugs. More hours for clinical pharmacology in the curriculum .

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EVALUATION :? An effort should be made to assess students abilities to decide on drug treatments in given clinical situation. Total reliance on a final examination is inadvisable, equal importance should be attached to continuous assessment on the basis of objectively structured techniques.

TEACHING TECHNIQUES :? Teaching method could easily be improved if we realized that students supposed to be

Selection of the course content should be based on the following:? ? How much basics the student should learn ? What facts are important ?

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What standard of performance are required ? This is well summarized by Abbatt (1992) as shown:-

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Treatment of CHF, antiarrythmatics, antihyperlipidaemias. Oxytocics , Uterine relaxants. Sex hormones, ovulation inducers & gonadotropins. Chemotherapy of malignancy.

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Nice to know 10% Desirable to know 20% Must know, Must do, Must value80%

COURSE CONTENT IN SYSTEMIC PHARMACOLOGY THE MOST COMMONLY USED DRUGS RECEIVING DETALIED COVERAGE :? Analgesics, antipyretics, NSAID,s antiflammatory drugs, skeletal muscle relaxants. Sedatives, antiepileptics Ethyl alcohol & methyl alcohol for methyl alcohol poisoning. Clinical uses of Adrenaline & Atropine & their substitutes. Beta-blockers. Treatment of insecticide poisoning. Treatment of cold, cough, bronchial asthma , anti-histaminics, Treatment of iron deficiency anemia. Treatment of vomiting, gastroenteritis, peptic ulcer, constipation. Antimicrobials :- Treatment of common infections. Corticosteroids, oral contraceptives. Vitamins, nutrients, vaccines. General & local anesthetics. Thyroid & antithyroid drugs, antidiabetics.

LEAST COMMONLY USED DRUGS, RECEIVING BRIEF COVERAGE :? ? ? ? ? ? CNS stimulants, anorexiants. Alpha-adrenergic blockers. Ganglion blockers & stimulants. Anterior pituitary hormones. Heavy metal antagonists. Treatment of pernicious anemia.

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In UG medical curriculum, the BASIC AIM of teaching pharmacology is to give adequate pharmacokinetic, pharmacodyanamic & therapeutic information on a large number of drugs in current use. Integrated teaching may be practiced for better student learning by:? ? Interdepartmental integration. Horizontal integration :- Two or more departments teaching concurrently merge their educational identities and organize their teaching programme. Vertical integration :- Integration between disciplines traditionally taught in different phases of curriculum Systematic approach :- A whole system is taught in its entirety covering all the disciplines.

LESS COMMONLY USED DRUGS RECEIVING MODERATE COVERAGE :? ? Psycho pharmaceuticals. Drug therapy of Parkinsonism & Myasthenia Gravis.

At present teaching is compartmentalized and concentrated in particular specialty. Integrated lectures as recommended by WHO should follow the earlier coverage by individual departments. Problem Based Learning (PBL) as compared to Traditional learning should be preferred because

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it is an approach to learning revolving around a problem. This has been amplified by the results of Christian Medical College, Ludhiana participating in 13 centres evaluation of Problem Based Learning spread over a number of countries. POSTGRADUATION THEORY :There should be :? ? ? ? Problem based learning. Interactive computer based learning. Virtual learning environment. Collaboration between the institutions.

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Ethical issues. Good Clinical Practice (GCP). Training to PGs on instruments such as High Pressure Liquid Chromatography (HPLC), Spectrophotometer Colorimeter so that principles of drug testing are mastered. Should have the latest information and should be updated through personal efforts and journals. Review of articles in journal club. Computer retrieval system for preparation of Drug Information Library.

RESEARCH:? ? Student research can contribute to the published output of an institution. Research experiences can help improve students skill in searching & critically appraising the medical literature, independent learning & writing research papers. The medical curriculum must begin to incorporate & emphasize evidence based medicine. To stimulate students interest they should undertake a mandatory course in research skills, along with a compulsory project.

The Postgraduate (PG) student should learn :? ? ? ? ? ? History of pharmacology . Systemic Pharmacology. Molecular basis of drug action. Emerging fields in pharmacology. Bioassays. Pharmacotherapeutics.

PRACTICAL :The following can be considered mandatory, ? ? Execution of one research project during training period. Orientation on the proper conduct of clinical trials. The postgraduate should be an active participant in undergraduate teaching. REFERENCES :1. Indian Journal of Pharmacology, June 2006, Vol38 Issue 3 Tutorials : students Viewpoint. Indian Journal of Pharmacology, June 2006, Vo.38 Issue 3 Clinical orientation of undergraduate pharmacology practicals : An intervention study. P.S.Bhuiyan, N.N.Rege, A.N.Supe. The Art Of Teachiong Medical Students 2002, 2 nd Edition.

CLINICAL TRIALS :Training involves the following :? ? ? Clinical trial methodology. Documentation methods. Statistical analysis .
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Abstract from the Panel Discussion on Training And Evaluation Of Pharmacology Postgraduates, SRC-IPS, 27th -28th May 2006, JNMC, Belgaum, Safe Drug Therapy. K.Ray, R.K. Dikshit, National Consultation Meeting on Rational Use of Drugs, Foundation for Health Action Calcutta School of Tropical

Medicine & West Bengal Voluntary Health Association, November 02-04, 1995. 6. Essential Drugs Monitor No.33 (2003) Career dedicated to essential medicine concept, Dr.V.Lepakhin, Asst. Director General, Health Technology & Pharmaceutical Cluster, WHO Headquaters, Geneva.

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