Letters to the Editor
American undergraduate pharmacology curriculum: A fresh perspective Access this article online Website: www.ijp-online.com
Quick Response Code:
DOI: 10.4103/0253-7613.135968
Sir, I have worked for a couple of years as a faculty in a medical college recognized by the Medical Council of India. Following this, I worked for four years as a faculty in an International medical school in India, which comes under the purview of the American University of Antigua (AUA). I would like to highlight the pharmacology curriculum of the American system that is being practiced in this institution. It offers a fresh perspective to curriculum in Pharmacology, the merits and demerits of which we could reflect on. In the said curriculum, the animal experiments, including demonstrations are excluded. However, a brief introduction of their fundamental principles is taught in the lecture class. A few clinically relevant topics such as hypolipidemics, antiplatelet agents, antimanics, tetracyclines, fluoroquinolones, etc., are dealt with in “Case Based Group Discussion (CBGD)” or simply put Case Based Learning-CBL, a form of Self Directed Learning (SDL)/active learning, wherein students are provided the learning objectives relevant to the topic and small clinical vignettes for every one or two learning objectives, two weeks in advance. Students do a self study based on the learning objectives and present the cases in groups of 6-8 each. No lectures are delivered on these topics. Thus the volume of didactic lectures can be curtailed. The aim of this exercise is to promote critical thinking, minimize rote learning, reduce dependency on faculty’s notes, and above all to develop self confidence in students. This exercise is not graded (known as gradeless assessments). When students, irrespective of their background, are inspired by the faculty and given an opportunity to perform by providing interesting clinical vignettes and learning objectives in a non-threatening learning-conducive environment, they learn better. Learning is not a spectator sport. Students do not learn much simply by sitting in class, listening to teachers, memorizing pre-packaged assignments, and writing answers learnt by rote. They must talk about what they are learning, write about it, relate it to past experiences, and apply it to their daily lives.[1] Active learning is generally defined as any instructional method that engages students in the learning process. In short, active learning requires students to perform meaningful learning activities and 458 Indian Journal of Pharmacology | August 2014 | Vol 46 | Issue 4
think about what they are doing.[2] The role of a teacher here is to act as a facilitator instead of information provider. In every session, one ‘Problem Based Learning (PBL)’ exercise is conducted wherein a clinical scenario with emphasis on the drugs is distributed. The case is discussed in groups and the students define the tentative learning objectives. This comprises the ‘brainstorming’ session. The students then read the topics and create a formal presentation in the next class after two weeks. Each student presents a specific objective (decided on the spot by lots and not preselected). These topics are also not taught in the regular lectures and students do a self study based on the learning objectives. However, the difference here from case based group discussion (CBGD) is that PBL is a graded exercise and the scores are added to the internals. Ethics and communication skills are observed by the facilitator and can affect the final score of a student. We observed over a period of time that students enjoyed CBGD and PBL and definitely preferred these over the conventional didactic lectures.[3,4] PBL is seen as a way of enabling students to develop key reasoning and critical thinking skills more efficiently than traditional methods of medical education. The development of clinical reasoning skills characteristic of the expert clinician was cited as one of the main educational objectives of PBL.[5] In this institute, students go for hospital postings in the second year (only in the afternoon hours thrice a week) to learn the basics of clinical medicine, i.e. how to take history, how to communicate with a patient, and how to perform a general physical examination and identify and discuss the basics of medicine such as anemia, cyanosis, heart sounds, breath sounds, etc. The primary focus in the second year is to learn the basics of pathology, pharmacology, and microbiology, so as to have a strong foundation of these paraclinical subjects. Pharmacology is an interesting and clinically relevant subject. It can be taught by a combination of lectures, PBL, CBGD, etc., which will definitely tap the clinical reasoning skills of the students, improve their communication and problem solving skills and build their confidence during final phase of the medical program. Yeshwanth Rao K. Department of Pharmacology, Melaka Manipal Medical College, Manipal, Karnataka, India Correspondence to: Dr. Yeshwanth Rao K., E-mail: [email protected]
Letters to the Editor
References 1. 2. 3.
Chickering AW, Gamson ZF. Seven Principles for Good Practice in Undergraduate Education. 1987. p. 3. Prince M. Does Active Learning Work? A Review of the Research. J Eng Educ 2004;93:223-31. Vernon DT, Blake RL. Does problem-based learning work? A meta-analysis of
4. 5.
evaluative research. Acad Med 1993;68:550-63. McParland M, Noble LM, Livingston G. The effectiveness of problem-based learning compared to traditional teaching in undergraduate psychiatry. Med Educ 2004;38:859-67. Goss B, Reid K, Dodds A, McColl G. Comparison of medical students’ diagnostic reasoning skills in a traditional and a problem based learning curriculum. Int J Med Educ 2011;2:87-93.
Pharmaceutical waste from hospitals and homes: Need for better strategies Access this article online Website: www.ijp-online.com
Quick Response Code:
DOI: 10.4103/0253-7613.135969
Sir, It has become clear now that the ever-increasing use of pharmaceuticals in clinical and veterinary practice can have adverse influence on the environment, which is probably best exemplified by the association between the use of diclofenac for treatment in livestock and decline in number of vultures in the Indian subcontinent.[1] Consequently, the concept of ecopharmacovigilance (defined as science and activities concerning detection, assessment, understanding, and prevention of adverse effects or other problems related to the presence of pharmaceuticals in the environment, which affect human and other animal species) is gaining momentum.[2] Leftover, unwanted medication from hospitals and homes are one of the major source of pharmaceutical waste, and its safe disposal has become more important than ever. Pharmaceutical waste in hospital wards could be generated through partially used or unused dosage forms, patient’s personal medications, outdated drugs, etc. Besides, expired drugs may accumulate, though albeit slowly, in dispensaries and drug stores of hospitals due to inappropriate donations or inadequacies in stock management and distribution. In healthcare facilities purchasing drugs through rate contract system, it is not uncommon to come across substandard or misbranded drugs. All these factors contribute to increase in pharmaceutical waste in hospitals. Substantial waste, similarly, can be generated from leftover medicines from households and other places in society ranging from workplaces to zoos and cruise ships. Because these products are frequently purchased in excess or are not fully consumed as directed (due to patient non-compliance, physician-altered treatment, intolerable effects, etc.), widespread accumulation of unwanted leftover drugs can occur eventually leading to need for disposal.[3] The question is how is this pharmaceutical waste disposed? A study assessing pharmaceutical waste management at selected hospitals and homes in Ghana showed that four out of five hospitals do not have any separate collection and disposal
program for pharmaceutical waste. Half of the population surveyed confirmed having unused, leftover, or expired medicines at home, and over 75% population disposed them through the normal waste bins, which end up in the landfills or dump sites.[4] A questionnaire survey in dental students from North India showed that 70% of students possessed up to five expired medications at home, and the predominant method adopted for disposal was via household trash.[5] In India, rules and regulations regarding handling and management of various types of wastes are applicable to six main categories of waste: Municipal solid waste, hazardous waste, bio-medical waste (BMW), plastic waste, e-waste, and batteries.[6] All healthcare establishments, irrespective of the quantum of waste generated, come under BMW rules.[7] These rules classify discarded, contaminated, or outdated medicines and cytotoxic drugs into category five and recommend their disposal by incineration. Deep burial can be an option only in rural areas with no access to centralized treatment facility, with prior approval from prescribed authority. However, hardly anything is known about actual practices followed by healthcare facilities. The authorities concerned with disposal of these pharmaceuticals also need to be extra cautious to ensure security from scavenging and pilferage. Anti-neoplastics or cytotoxic drugs must be handled with extreme care as they have the ability to kill or stop growth of living cells and can have extremely serious effects, such as interfering with reproductive processes in various life forms.[8] It is noteworthy that the current BMW guidelines are not applicable to radioactive waste or hazardous chemicals. Some of the pharmaceutical waste (e.g. unused discarded nicotine patches[9]) meets the definition of hazardous waste by the Resource Conservation and Recovery Act (RCRA), U.S. Proper management of hazardous waste is highly complex and needs methods different from those used for disposal of biomedical waste. Presently, those who handle drugs (pharmacists and nurses) in hospitals do not receive appropriate training in hazardous waste management during their academic studies, and those who do receive such training (environment personnel) may not be familiar with active ingredients in various pharmaceutical formulations. All this confusion stresses the need to formulate specific guidelines that would include all aspects of pharmaceutical waste management for hospitals and homes and to implement appropriate programs for collection and disposal of unwanted medications from these sources. As pharmaceutical waste not only poses threat to the environment Indian Journal of Pharmacology | August 2014 | Vol 46 | Issue 4 459
Copyright of Indian Journal of Pharmacology is the property of Medknow Publications & Media Pvt. Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
American undergraduate pharmacology curriculum: A fresh perspective Access this article online Website: www.ijp-online.com
Quick Response Code:
DOI: 10.4103/0253-7613.135968
Sir, I have worked for a couple of years as a faculty in a medical college recognized by the Medical Council of India. Following this, I worked for four years as a faculty in an International medical school in India, which comes under the purview of the American University of Antigua (AUA). I would like to highlight the pharmacology curriculum of the American system that is being practiced in this institution. It offers a fresh perspective to curriculum in Pharmacology, the merits and demerits of which we could reflect on. In the said curriculum, the animal experiments, including demonstrations are excluded. However, a brief introduction of their fundamental principles is taught in the lecture class. A few clinically relevant topics such as hypolipidemics, antiplatelet agents, antimanics, tetracyclines, fluoroquinolones, etc., are dealt with in “Case Based Group Discussion (CBGD)” or simply put Case Based Learning-CBL, a form of Self Directed Learning (SDL)/active learning, wherein students are provided the learning objectives relevant to the topic and small clinical vignettes for every one or two learning objectives, two weeks in advance. Students do a self study based on the learning objectives and present the cases in groups of 6-8 each. No lectures are delivered on these topics. Thus the volume of didactic lectures can be curtailed. The aim of this exercise is to promote critical thinking, minimize rote learning, reduce dependency on faculty’s notes, and above all to develop self confidence in students. This exercise is not graded (known as gradeless assessments). When students, irrespective of their background, are inspired by the faculty and given an opportunity to perform by providing interesting clinical vignettes and learning objectives in a non-threatening learning-conducive environment, they learn better. Learning is not a spectator sport. Students do not learn much simply by sitting in class, listening to teachers, memorizing pre-packaged assignments, and writing answers learnt by rote. They must talk about what they are learning, write about it, relate it to past experiences, and apply it to their daily lives.[1] Active learning is generally defined as any instructional method that engages students in the learning process. In short, active learning requires students to perform meaningful learning activities and 458 Indian Journal of Pharmacology | August 2014 | Vol 46 | Issue 4
think about what they are doing.[2] The role of a teacher here is to act as a facilitator instead of information provider. In every session, one ‘Problem Based Learning (PBL)’ exercise is conducted wherein a clinical scenario with emphasis on the drugs is distributed. The case is discussed in groups and the students define the tentative learning objectives. This comprises the ‘brainstorming’ session. The students then read the topics and create a formal presentation in the next class after two weeks. Each student presents a specific objective (decided on the spot by lots and not preselected). These topics are also not taught in the regular lectures and students do a self study based on the learning objectives. However, the difference here from case based group discussion (CBGD) is that PBL is a graded exercise and the scores are added to the internals. Ethics and communication skills are observed by the facilitator and can affect the final score of a student. We observed over a period of time that students enjoyed CBGD and PBL and definitely preferred these over the conventional didactic lectures.[3,4] PBL is seen as a way of enabling students to develop key reasoning and critical thinking skills more efficiently than traditional methods of medical education. The development of clinical reasoning skills characteristic of the expert clinician was cited as one of the main educational objectives of PBL.[5] In this institute, students go for hospital postings in the second year (only in the afternoon hours thrice a week) to learn the basics of clinical medicine, i.e. how to take history, how to communicate with a patient, and how to perform a general physical examination and identify and discuss the basics of medicine such as anemia, cyanosis, heart sounds, breath sounds, etc. The primary focus in the second year is to learn the basics of pathology, pharmacology, and microbiology, so as to have a strong foundation of these paraclinical subjects. Pharmacology is an interesting and clinically relevant subject. It can be taught by a combination of lectures, PBL, CBGD, etc., which will definitely tap the clinical reasoning skills of the students, improve their communication and problem solving skills and build their confidence during final phase of the medical program. Yeshwanth Rao K. Department of Pharmacology, Melaka Manipal Medical College, Manipal, Karnataka, India Correspondence to: Dr. Yeshwanth Rao K., E-mail: [email protected]
Letters to the Editor
References 1. 2. 3.
Chickering AW, Gamson ZF. Seven Principles for Good Practice in Undergraduate Education. 1987. p. 3. Prince M. Does Active Learning Work? A Review of the Research. J Eng Educ 2004;93:223-31. Vernon DT, Blake RL. Does problem-based learning work? A meta-analysis of
4. 5.
evaluative research. Acad Med 1993;68:550-63. McParland M, Noble LM, Livingston G. The effectiveness of problem-based learning compared to traditional teaching in undergraduate psychiatry. Med Educ 2004;38:859-67. Goss B, Reid K, Dodds A, McColl G. Comparison of medical students’ diagnostic reasoning skills in a traditional and a problem based learning curriculum. Int J Med Educ 2011;2:87-93.
Pharmaceutical waste from hospitals and homes: Need for better strategies Access this article online Website: www.ijp-online.com
Quick Response Code:
DOI: 10.4103/0253-7613.135969
Sir, It has become clear now that the ever-increasing use of pharmaceuticals in clinical and veterinary practice can have adverse influence on the environment, which is probably best exemplified by the association between the use of diclofenac for treatment in livestock and decline in number of vultures in the Indian subcontinent.[1] Consequently, the concept of ecopharmacovigilance (defined as science and activities concerning detection, assessment, understanding, and prevention of adverse effects or other problems related to the presence of pharmaceuticals in the environment, which affect human and other animal species) is gaining momentum.[2] Leftover, unwanted medication from hospitals and homes are one of the major source of pharmaceutical waste, and its safe disposal has become more important than ever. Pharmaceutical waste in hospital wards could be generated through partially used or unused dosage forms, patient’s personal medications, outdated drugs, etc. Besides, expired drugs may accumulate, though albeit slowly, in dispensaries and drug stores of hospitals due to inappropriate donations or inadequacies in stock management and distribution. In healthcare facilities purchasing drugs through rate contract system, it is not uncommon to come across substandard or misbranded drugs. All these factors contribute to increase in pharmaceutical waste in hospitals. Substantial waste, similarly, can be generated from leftover medicines from households and other places in society ranging from workplaces to zoos and cruise ships. Because these products are frequently purchased in excess or are not fully consumed as directed (due to patient non-compliance, physician-altered treatment, intolerable effects, etc.), widespread accumulation of unwanted leftover drugs can occur eventually leading to need for disposal.[3] The question is how is this pharmaceutical waste disposed? A study assessing pharmaceutical waste management at selected hospitals and homes in Ghana showed that four out of five hospitals do not have any separate collection and disposal
program for pharmaceutical waste. Half of the population surveyed confirmed having unused, leftover, or expired medicines at home, and over 75% population disposed them through the normal waste bins, which end up in the landfills or dump sites.[4] A questionnaire survey in dental students from North India showed that 70% of students possessed up to five expired medications at home, and the predominant method adopted for disposal was via household trash.[5] In India, rules and regulations regarding handling and management of various types of wastes are applicable to six main categories of waste: Municipal solid waste, hazardous waste, bio-medical waste (BMW), plastic waste, e-waste, and batteries.[6] All healthcare establishments, irrespective of the quantum of waste generated, come under BMW rules.[7] These rules classify discarded, contaminated, or outdated medicines and cytotoxic drugs into category five and recommend their disposal by incineration. Deep burial can be an option only in rural areas with no access to centralized treatment facility, with prior approval from prescribed authority. However, hardly anything is known about actual practices followed by healthcare facilities. The authorities concerned with disposal of these pharmaceuticals also need to be extra cautious to ensure security from scavenging and pilferage. Anti-neoplastics or cytotoxic drugs must be handled with extreme care as they have the ability to kill or stop growth of living cells and can have extremely serious effects, such as interfering with reproductive processes in various life forms.[8] It is noteworthy that the current BMW guidelines are not applicable to radioactive waste or hazardous chemicals. Some of the pharmaceutical waste (e.g. unused discarded nicotine patches[9]) meets the definition of hazardous waste by the Resource Conservation and Recovery Act (RCRA), U.S. Proper management of hazardous waste is highly complex and needs methods different from those used for disposal of biomedical waste. Presently, those who handle drugs (pharmacists and nurses) in hospitals do not receive appropriate training in hazardous waste management during their academic studies, and those who do receive such training (environment personnel) may not be familiar with active ingredients in various pharmaceutical formulations. All this confusion stresses the need to formulate specific guidelines that would include all aspects of pharmaceutical waste management for hospitals and homes and to implement appropriate programs for collection and disposal of unwanted medications from these sources. As pharmaceutical waste not only poses threat to the environment Indian Journal of Pharmacology | August 2014 | Vol 46 | Issue 4 459
Copyright of Indian Journal of Pharmacology is the property of Medknow Publications & Media Pvt. Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
