INNOVATIVE LEARNING METHODS FOR RATIONAL DRUGS PRESCRIBING. ITTHIPANICPONG C.,CHOMPOOTAWEEP S., CHONGTRAKUL P., NANTAWAN P., THAMAREE S., WITTAYALERTPANYA S., LIMPANASITHIKUL W., LILITKARNTAKUL P. and WANGSATURAKA D. Department of Pharmacology, Faculty of Medicine, Chulalongkorn University. Bangkok 10330, THAILAND

ABSTRACT This study was designed to use innovative learning methods in rational drug prescribing in the third year medical students in the 2002 academic year who attended the three weeks block of Degeneration and Diseases of Aging. A modified problem-based learning (PBL) was the main educational strategy in this module. Three key problems were ‘polyuria’, ‘knee pain’, and ‘dyspnea’. For each problem, students met in tutorial groups to identify their learning objectives. After the tutorial sessions, students attended a lecture and adviced on a self-directed learning (SDL) period. They would then meet in groups to summarise what they had learned and discussed what drugs were most appropriate for the patient with the problem according to the principles of rational drug use. Students were also asked to submit a prescription for the patient in each of the cases. To promote students’ use of information technology in their SDL, we created a web site ( ), named ‘PBL RDU EBM Web Based Instruction’. We designed it as a gateway to other relevant electronic sources in pharmacology and medicine. Multiple choice questions (MCQ) were used for the assessment of the students’ conceptual knowledge. An individual structured report was designed for prescription writing skills and attitude assessment. Most students (79.60%) received good marks for their MCQ examination and structured reports (87.56%). They also demonstrated positive attitudes towards the course’s learning outcome.

Irrational drug prescribing causes a high healthcare expenditure each year. It also affects individual in term of getting unnecessary drugs which sometime harmful to them. There is a need for medical schools to create new physicians who possess conceptual knowledge, skill and attitude in rational drug prescribing. Problem statement :

Educational strategies MODIFIED PROBLEM-BASED LEARNING 10 groups of 3 rd year medical students with 20 students in each group case scenarios (polyuria, knee pain and dyspnea) 2 facilitators in each group formulate learning objective A set of learning objective was developed by students in the group. The students were asked to write prescription in each scenario. Self-directed learning I students search through provided learning resources Textbooks, literatures, articles Online textbook, journals and medical databases Web-Based Instruction in Pharmacology ( (PBL RDU EBM Web Based Instruction) II Meet resource persons Concept formulation Presentation of the acquired information Discussion on rational prescribing for management of the patient. (RDU) using evidence-based medicine. Conclusion PBL = Problem-based learning, RDU = Rational drug use, EBM = Evidence-based medicine

Rational drug prescribing Evidence-Based Medicine Written communication Holistic approach Roles of doctor Basic and clinical science Medical ethics Leadership and teamwork Professional and personal development Learning outcomes of the course

Student assessment Educational outcomes Assessment methods Rational drug prescribing Evidence- based medicine Written communication Holistic approach Roles of doctor Professional and personal development Basic and clinical science Medical ethics Leadership and teamwork Written examination (MCQ 5 choices and short essay) Rating scale (5 points) Structured report on rational - drug prescribing / / / / / /// /// // ///

1) Diagnosis 2) Indication 3) Prescription writing (rational prescribing) 3.1) Efficacy 3.2) Risk 3.3) Cost 4) Underpinning prescription writing 5) Duration of treatment and follow up period 6) Patient education 7) Conclusion 8) References Components of a structured report

Structured report grade distribution A+B + +B = 87.56%A+B + +B = 79.60% MCQ grade distribution

Students’ attitude towards the achievement of course learning outcomes : Learning Outcomes Total score 5 problem solving ability4.10 apply concept of evidence-based medicine4.03 utilize information technology for4.09 information searching rational drug prescribing4.20 holistic mind4.03 basic and clinical science knowledge3.85 ethics3.65 self-directed learning4.07 attitude towards working in healthcare team3.84

Conclusion Innovation of the learning method for rational drug prescribing was a modified problem-based learning using the created web-based instruction in Pharmacology ( ( PBL, RDU, EBM Web Based Instruction) as one of the learning resources and utilize structured report for authentic assessment in addition to conventional assessment methods. The result demonstrated good conceptual knowledge and practice in rational drug prescribing.To maintain the student competency in rational drug prescribing, the process has to be repeated and continued through the whole curriculum.

1) Outcome-Based Education. AMEE Education Guide no ) Wangsaturaka D. Wiwanitkit V. An evaluation of prescription writing and rational prescribing in Third-Year Medical Students, Faculty of Medicine, Chulalongkorn University. Thai J Pharmacol 2000 May-Aug; 22(2): References