Integrative Pharmacotherapeutics

Pharmacology for the 21st Century: The Successful Implementation of an Innovative Integrative Longitudinal Pharmacotherapeutics Curriculum for Medical Students

Proposal

Until 2012, the second year pharmacology curriculum taught at Eastern Virginia Medical School (EVMS) consisted of a traditional didactic–based course. The course was not synchronized with other courses, included only five small group sessions to discuss clinical cases, and assessed a student’s competency with four exams, using non-USMLE style questions, plus an additional final subject exam. Over the last several years the course received the lowest evaluation scores of any of the basic sciences and attendance figures were very low (10-20%). Students in the 3rd and 4th year gave the curriculum low marks for preparing them for their clinical rotations. In January, 2012, a new course director was assigned to revise the pharmacology curriculum. The course director is a clinical pharmacist and Board Certified Pharmacotherapy Specialist.

Methods: The previous pharmacology curriculum for second year medical students was 100% revised in less than one year. The course name was changed to Integrative Pharmacotherapeutics (IPT) to reflect new objectives, entirely new clinical course content, and synchronization with other basic science courses. IPT also used new instructors, USMLE style exam questions, and introduced active learning methods to supplement and reinforce traditional didactic presentations. The principle objective of IPT was to prepare students to manage a patient’s medications by their 3rd year. The new course structure consists of nine modules spread over a period of seven months, each module containing five to seven presentations, one Team Based Learning (TBL) session, and one exam. Presentations are preceded by a quiz based on assigned readings. The final exam is the national pharmacology subject (shelf) exam.
Course content is in a standardized format and provides a balance of basic pharmacology with current therapeutic use guidelines and strategies. How to choose and manage medications based on pharmacokinetic, pharmacodynamic, and individual patient characteristics is discussed using case vignettes. Marketing strategies, drug costs, and evidence-based trial data are also reviewed. A personal response system (PRS) is used to capture quiz performance and answers to USMLE style questions during class as well as provide an individual attendance record. Modified TBL sessions consisted of learning communities of 6 to 7 students each. Without prior preparation, teams were expected to review detailed clinical cases and, using course material and other web resources, present a therapeutic plan including drug regimen adjustments and monitoring parameters. Teams were chosen at random to answer a series of questions for each case.

Results: The new IPT course was successfully implemented in August, 2012 for 145 students. All objectives were met, many beyond expectations. Although not mandatory, attendance consistently averaged 80 to 95%. Mid-term and end of year student evaluations were the highest of any of the basic science courses. Mean scores on both the Pharmacology Subject Exam and the USMLE Step One exam were higher than previous years. Feedback from 3rd year students and clerkship directors has also been very positive.

Conclusion: A new pharmacotherapeutics curriculum for second year medical students that emphasizes the clinical use of drugs resulted in high attendance, excellent student evaluations, and positively affected the pharmacology subject exam and the USMLE Step 1 exam scores.

Abstract

An entirely new clinically-focused pharmacotherapeutics curriculum was developed to replace a traditional didactic-based pharmacology curriculum for second-year medical students. Developed by a clinical pharmacist and utilizing interactive learning strategies including TBL, the course exceeded all expectations and resulted in high attendance rates, excellent evaluations, and Pharmacology Subject exam and USMLE Step 1 exam scores higher than previous years.

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