Pharmacotherapy teaching/learning

Theo PGM de Vries, MD PhDClinical Pharmacology and PharmacyVU University Medical Center AmsterdamGent/EACPT 2007 Amsterdam

Introduction

- Competence

- Learning

- Assessment

Conclusion

Still incompetence in choosing and prescribing drugs….

…despite increasing CP knowledge.

• Model status

diagnosistreatment

Pharmacotherapy competence

Goalcompetence

Methodlearning

Monitorassessment

1. Patiënt’s problem

2. Therapeutic objective

3. Treatment choice

a. standard (best evidence)

b. verify suitability for patient

4. Start treatment

5. Give patiënt information

6. Monitor treatment

Pharmacotherapy competenceWHO 6-step: the student/doctor is able to:

WHO 1994; Nierenberg 1990; Walley 1997; Maxwell 2003

WHO 6-step: Cogn. Comm. Mot.

1. Patient’s problem + + +

2. Therapeutic objective + + + + + +

3. Treatment choice

a. standard (best evidence) + + +

b. verify suitability for patient + + + + +

4. Start treatment + + + + + + +

5. Give patient inform./instr. + + + + + +

6. Monitor treatment + + + + + +

Pharmacotherapy competence

- physiology, pathophysiol. etc

- internal medicine etc.

- research methodology

!

!

answers

responsibilityspecific experiences + abstract theor. concepts

meaningful sets of connections (memory networks)

easy accessible “illness scripts”

condensation

Regehr 1996; Schmidt 1990

Symptoms & signs

diagnosis

Analyticslow, conscious, systematic, evidence based, novice

Non-analyticfast, unconscious, heuristic, experience based, expert

Illness script

Regehr 1996; Schmidt 1990; Eva 2005

- physiology, pathophysiology

- pharmacology

- internal medicine etc.

- research methodology

!

!

answers

responsibilityspecific experiences + abstract theor. concepts

meaningful sets of connections (memory networks)

easy accessible “treatment scripts”??

condensation

Regehr 1996; Schmidt 1990

Diagnosis Treatment

Analyticslow, conscious, systematic, evidence based, novice

Non-analyticfast, unconscious, heuristic, experience based, expert

Treatment script

Geyteman (review; subm. 2007)

Choosing (1)

An oven cloth

Conscious/analytical?

Unconscious/non-analytical?

Choosing (2)

A room

Conscious/analytical?

Unconscious/non-analytical?

Choosing (3): study

Students: presented several related items (oven cloths/rooms)

Dijksterhuis 2005

Group 2: instructed: carefull choice (conscious/analytical)

Group 3: distracted (unconscious/non-analytical)

Group 1: immediate choice

Which group made the best choice (reference)?

Complicated problems/many factors (rooms):

- unconscious/non-analytical thinking

- very large ‘brain’ capacity (‘hard disk’)

- role experience??

Less complicated problems/few factors (oven cloths):

- conscious/analytical thinking

- limited ‘brain’ capacity (‘working memory’)

Dijksterhuis 2005

Choosing (4): theory

Diagnosis Treatment

Analyticslow, conscious, systematic, evidence based, novice

Non-analyticfast, unconscious, heuristic, experience based, expert

Treatment script

Geyteman (review; subm. 2007)

Pharmacotherapy learning & assessment

Goalcompetence

Methodlearning

Monitorassessment

- physiology, pathophysiology

- pharmacology

- internal medicine etc.

- research methodology

!

!

answers

responsibilityspecific experiences + abstract theor. concepts

meaningful sets of connections (memory networks)

easy accessible “treatment scripts”??

condensation

Regehr 1996; Schmidt 1990

Context learning & assessment

Criteria:

1. Setting of future occupation

2. Responsibility and involvement

3. Feedback and reflection

4. Repeated cycle

Coles 1998, Ashley 2000, Lewkonia 2001, Branch 2002

Degree of reality of the setting

real practice

simulated practice

demonstration in practice

description of practice

Vollebregt 2006

Setting (‘OSCE’: 3 stations; 9 students)

D1 D2 D3

P1

A1

P2

A2

P3

A3D = doctor

P = patient

A = assessor

Vollebregt 2006

Geneesmiddelonderzoek

* p<0.001 ANOVA

*

Richir, Schneider

Miller 1990, Rethans 1991

(knows procedures)

(performance)

(competence)

Assessment:

- valid

- reliable

- predictive

Conclusion (1) Pharmacotherapy curriculum

because: Students remember:

20% of what they hear

30% of what they see

50% of what they hear and see

70% of what they teache

90% of what they experience

Tell me and I will forget,

show me, and I may not remember,

INVOLVE ME, and I will understand.

Ashley, 2000