The WHO Guide to Good Prescribing
The path leading to this platform started in the 1980's with the development of the WHO Guide to Good Prescribing (1994). Prof. Dr. Theo de Vries noted that medical students at the start of their clinical training did not really know how to prescribe medicines. While they had had pharmacological training in their preclinical curriculum, this was usually very drug-centered and not aimed at learning to prescribe the right drug for the right patient. The Guide's six-step method for rational prescribing provided a framework for teaching students how to prescribe medicines. The steps are:
- Define the patient's problem
- Specify the therapeutic objective
- Verify whether your P(ersonal)-treatment is suitable for the patient
- Start the treatment
- Give information, instructions and warnings
- Monitor (stop) treatment
The guide and accompanying Teacher's Guide to Good Prescribing are widely adopted as teaching methods, and the guides have been translated in more than 25 languages.
Problem based learning and context based learning
The
WHO Guide to Good Prescribing and Teacher's guide advocate problem based learning (PBL). In short,
PBL reverses the traditional approach to teaching and learning. It starts with
individual examples or problem scenarios which stimulate student learning. In
so doing, students arrive at general principles and concepts which they then
generalize to other situations. PBL is appealing to students, encourages deep
learning and facilitates the acquisition of generic skills (e.g.
problem-solving, teamwork etc.). In addition to PBL, the WHO Guide to Good
Prescribing and aforementioned recommendations of the EACPT Education Working
Group also lend heavily on context based learning pedagogy (CBL). CBL strives
for context to learning situations as authentic as possible to situations that
students will encounter in their later professions, for example by letting
students take real responsibility for actual patient care, letting them work in
interprofessional teams (like they will in their later professions) and examining
them in a simulated or clinical context. Moving from a traditional teaching
style to a PBL (and CBL) based curriculum, means that the role of teachers will
have to change from “Sage on the Stage” to “Guide on the Side”.
2018 - Rational Prescribing in Europe. Are Future doctors well prepared?
In
his 2018 PhD thesis, David Brinkman reported that undergraduate medical
education in Europe is leaving medical students both subjectively and
objectively underprepared to safely prescribe medicines. In a standardized
examination, 895 final year medical students from 17 medical schools in 15 EU countries
(then including the UK) were asked to provide a (pharmaco)therapy for five case
scenarios. Nearly half of their therapies (46.2%) was inappropriate and at
times harmful (15.2%) or potentially lethal (3.7%) to the patient. Moreover,
this skill examination correlated poorly with the results of a knowledge test
and it was shown that students from universities with a problem-based
curriculum (defined in the next section) outperformed students from
universities with a traditional curriculum. In a subsequent study, Brinkman
showed that pharmacotherapy curricula throughout Europe are highly heterogeneous
in the number of allocated contact hours (median 68 hours, interquartile range
35–100) and that the majority of pharmacotherapy courses still follow a
primarily traditional teaching style. Brinkman concluded that improvement and
harmonization of European pharmacotherapy education is urgently required.
Together with the European Association for Clinical Pharmacology and
Therapeutics’ Education Working Group, he provided 11 recommended several improvements.
"Schools should implement a valid and reliable final prescribing assessment at or near the end of the medical curriculum to assess whether graduates are able to prescribe safely and effectively."
One of these recommendations was to provide a reliable final prescribing assessment. This recommendation grew to be the the European Prescribing Exam, which can also be found on this online platform.
"Schools should utilize more online learning resources and preferably share these at national or international level."
Another recommendation was to utilize more online learning resources and to collaborate internationally. This recommendation formed the start of our investigation into online and open educational resources, as well as the possibility to launch a platform for international collaboration. In this project, we
- Found that digital learning resources are effective for teaching clinical pharmacology and therapeutics.
- Found that digital learning resources are commonly used for CPT education Europe, but that they are rarely made openly available.
- Found that this is not due to unwillingness to share, but rather a lack of right infrastructure and that the European Open Platform for Prescribing Education could facilitate this.
- Investigated what type of resources European CPT teachers would like to find on the platform.
- Proposed and created several open educational resources, such as:
- An Educational Escape Room about the Opioid Crisis
- A CPT teacher's guide on race-based medicine, inclusion and diversity
- Ideas for teaching sustainable prescribing practices
- Learning from international differences in prescribing.
The framework for the European Open Platform for Prescribing Education. Read more in the European Journal of Clinical Pharmacology.
The content suggestions for the European Open Platform for Prescribing Education. Read more in NPJ Science of Learning.
