“Which ones do I actually have to know?” An e-learning tool to guide medical students through a pre-clinical pharmacology curriculum

Background and Aims: Pharmacology remains a challenging area for most pre-clinical medical students at UCL Medical School. A short questionnaire distributed to 46 second-year pre-clinical students who currently undergo a mostly lecture-based pharmacology course highlighted difficulties in deciding which drugs were clinically relevant and “need to know”. Additionally, our own experiences as clinical medical students indicate that links between pre-clinical scientific concepts and clinical medicine are not always clear. Moreover, it is known that a proportion of recently qualified junior doctors have difficulties with prescribing, with some studies reporting junior doctor error prescribing rates of up to 8.4% (1); this could be related to a failure to link theory and practice (2). We thus sought to develop a means of developing an appreciation of the clinical context of pre-clinical pharmacology as well as aiding revision of the pharmacology course for students.

Summary of Work: We piloted an e-learning tool for pre-clinical medical students, combining the scientific knowledge required for the pre-clinical course with clinical cases. Using the university online learning portal, we uploaded four clinically orientated cases on the topics of cardiovascular, antibacterial, antipsychotic, and antidepressant drugs. Each case was checked for factual accuracy by senior teaching staff, and consisted of 15-20 single-best answer (SBA) questions: the format used in current medical school exams. To evaluate improvements in learning, we compared student scores in pre- and post- tutorial quizzes, comprising of 5 SBAs before and after each case. We also collected qualitative feedback in the form of a questionnaire after completing the four cases.

Outcomes: An average of 139 students worked through each case with an average of 56 students completing the accompanying pre- and post-test quizzes. Using a Wilcoxon signed rank test, a statistically significant improvement in post-test score was observed for three of the four cases (p<0.01), though there was no significant improvement (p=0.76) in the final anti-bacterial case. Additionally, the qualitative feedback received was overwhelmingly positive (n=46). All respondents agreed that the tool provided them with a better understanding of pharmacology in a clinical context. More than 95% of those surveyed agreed that the cases were user friendly, helped to consolidate knowledge, and aided preparation for end of year examinations.

Discussion and conclusion: Based on these results, this tool appears to be useful adjunct to pharmacology teaching for pre-clinical students. The lack of significant improvement in the anti-bacterials case may have been due to the large subject matter being covered with an insufficient number of questions. To remedy this, we plan to add more questions and possibly divide the case into different sections. This mirrors our future aim to extend this tool to more questions and cases to map the whole pre-clinical pharmacology curriculum. We feel that this tool can be generalized to other subjects in the pre-clinical medical curriculum, to allow a better appreciation of clinical context early on in the course.

1. An in depth investigation into causes of prescribing errors by foundation trainees in relation to their medical education – EQUIP study, http://www.gmc-uk.org/about/research/25056.asp

2. Baker E, et al. (2011). Br J ClinPharmacol. 71(2): 190–198.