Methods for evaluation of a prescribing curriculum for Australian senior medical students AJ Smith, SR Hill, T Tasioulas, NL Cockayne.

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Presentation transcript:

Methods for evaluation of a prescribing curriculum for Australian senior medical students AJ Smith, SR Hill, T Tasioulas, NL Cockayne.

Objectives  To design, field-test, implement and evaluate the impact of a modular, problem-based web-interactive prescribing curriculum based on the WHO “Guide to Good Prescribing”.

Summary of methods  Curriculum developed by a consortium from all medical schools.  Made web-based, interactive by “Knowledge South” and the University of South Australia.  Field-tested for content and ease of navigation by medical students and staff.  Made available to medical schools - could not be mandated.

Evaluative methods – the ideal  A pre-planned randomised allocation of medical schools to receive/not receive the curriculum with pre- and post-testing of each group on ability to select medicines discussed in the modules.  OR  Randomisation within each school with delayed introduction of the curriculum to one of the two student groups – but potential problem with “contamination”

Obstacles to the ideal.  No advance knowledge of which, if any, school would use the curriculum  No knowledge of whether all or only part of the curriculum would be used  No ability to do delayed introduction as students needed to be moving through at the same rate if the curriculum replaced conventional teaching, which was what teachers wanted.

What was feasible ?  “Hits” on the website organised by school  In-depth interviews with staff, on-line feedback from 107 med. students representing the schools that used the curriculum  Before-and-after testing of a cohort of students from one school.

What were the problems in interpretation of the results ?  “Hits” only mean that the page has been opened – not an assessment of learning.  Staff respondents were uniformly supportive  Student responses may have only come from the enthusiasts and not be fully representative.  Before-after results show that compulsion works but are they a fair test of the program’s ability to change prescribing ability ? Were there any other influences working at the same time? No control group.

How would we do it differently ?  Difficult unless we can construct control groups and, perhaps, conduct the testing over a shorter period.  If schools do not take up the curriculum, seek to use their students as controls for further before-after tests.

A PRESCRIBING CURRICULUM FOR AUSTRALIAN MEDICAL STUDENTS Smith AJ, Hill SR,Tasioulas T,Cockayne NL. National Prescribing Service, Sydney & Clinical Pharmacology Unit, University of Newcastle, Australia

Background  The Australian National Prescribing Service (NPS) not-for-profit, independent organisation  Activities aim to improve the overall quality of use of medicines in Australia  Development of curriculum as a response to:  Documented sub-optimal prescribing by doctors  A perceived deficit in prescribing education for senior students in medical schools - despite good programs in pharmacology/clinical pharmacology

Objectives  To design, field-test, implement and evaluate the impact of a modular, problem- based web-interactive prescribing curriculum based on the WHO “Guide to Good Prescribing”

Methods (1) Design  Jointly sponsored by NPS and the Australasian Society for Clinical and Experimental Pharmacologists and Toxicologists (ASCEPT)  Collaboration with teachers from each of the Australian medical schools  Clinical conditions were selected from those that interns claimed were common and raised prescribing issues  The 12 written cases were converted to web-based interactive form by Knowledge South and the University of South Australia

Methods (2) Field-testing and implementation  The 12 modules were field-tested for ease of navigation and for content by medical students and staff  The curriculum could not be mandated and uptake was dependent on NPS advocacy and the influence of the teachers who had helped construct the program  The completed modules were made available to each of the 11 Australian medical schools in January, 2002

Methods (3) Evaluation  Measurement of ‘hits’ on the website by each medical school  Structured interviews with 15 teachers from 9 medical schools and online survey of 121 medical students from 5 medical schools  An assessment of students’ ability to select drugs for four common conditions:  before using the curriculum  after one year’s voluntary use  after a further one year’s compulsory use

Results (1) *Medical Schools have been de-identified

Results (2) Qualitative feedback: In-depth interviews with teaching staff  All used it as a tool for individual self-directed learning tool  five with added case-discussions  Five schools made the curriculum assessable in final examinations  Issues/problems:  Technical aspects e.g. navigation and browser capability  “Need to engage more teaching staff within faculty”  Generally, “an excellent, practical resource”

Results (3) Qualitative feedback: student online survey  97/107 (91%) therapeutic content appropriate to needs  92/107 (86%) felt better able to prescribe after using the curriculum  57 (54%) had developed their own personal formulary – a major goal of the program

Results (4) Improvements in selecting appropriate drugs in each condition were significant (  2 =37, p=0.01)

Conclusions  The program has proved very popular with students and staff  Uptake in the first two years has been better than predicted but the program needs more ‘marketing’  The modules have now been revised and plans are in place for more thorough evaluation in 2004  Website URL: