American undergraduate pharmacology curriculum: A fresh perspective

K Yeshwanth Rao 
 Department of Pharmacology, Melaka Manipal Medical College, Manipal, Karnataka, India

Correspondence Address:
K Yeshwanth Rao
Department of Pharmacology, Melaka Manipal Medical College, Manipal, Karnataka
India

Full Text

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 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.

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