Irrational use of medicines is a major problem all over the world

Jun 15 2007

The World Health Organization (WHO) and many other bodies are concentrating on improving the use of medicines. Problem-based teaching of Pharmacology and Therapeutics to undergraduate medical students has been recognized as a key intervention to improve the use of medicines.

Personal or P-drugs are important for medical students, doctors in training and prescribers. P-drugs are drugs with which a person has become familiar and has chosen to prescribe regularly. The P-drug concept is not just the name of a pharmacological substance but also includes the dosage form, dosage schedule and duration of treatment.

Personal drugs are drugs with which a doctor has chosen to become familiar and which he/she intends to use regularly in treatment. The department of Pharmacology at the Manipal College of Medical Sciences (MCOMS), Pokhara, Nepal concentrates on teaching rational use of medicines to medical students.

The department has been teaching the P-drug concept to the third and fourth semester medical students for over two years in our institution. Students select a drug for a disease on the basis of efficacy, safety, cost and convenience. The method described in the WHO books, The Guide to Good Prescribing and the teachers Guide to Good Prescribing is basically followed. We use the numerical method developed by Joshi and Jayawickramarajah at the Institute of Medicine, Kathmandu, Nepal.

The students are being assessed in P-drug selection, verifying the suitability of the selected P-drug to a particular patient and writing the prescription in the practical assessment examination. The students are allowed to bring in text books and other reference material to the examination.

Student opinion regarding the sessions was obtained using focus group discussions. The three main nationalities of students at the institution, Nepalese, Indians and Sri Lankans were selected. The study was conducted by Dr. Shankar and coworkers at MCOMS. Twelve respondents were selected. The overall student opinion regarding the session was positive. Students were occasionally confused about whether a P-drug was for a patient or for a disease. Group consensus during the small group learning sessions was commonly used to select values for the different criteria. The large number of brands created occasional problems. The sessions should be continued and strengthened and sessions can be considered during the clinical years and internship training.