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 Table of Contents    
RESEARCH ARTICLE
Year : 2016  |  Volume : 48  |  Issue : 7  |  Page : 19-24
 

Opinion of stakeholders on existing curriculum for postgraduate (MD) course in Pharmacology: A survey


1 Department of Pharmacology, Christian Medical College and Hospital, Ludhiana, Punjab, India
2 Department of Pharmacology, Dr. SM CSI Medical College and Hospital, Thiruvananthapuram, Kerala, India

Date of Submission30-Aug-2016
Date of Acceptance05-Oct-2016
Date of Web Publication2-Nov-2016

Correspondence Address:
Dinesh K Badyal
Department of Pharmacology, Christian Medical College and Hospital, Ludhiana, Punjab
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0253-7613.193316

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 » Abstract 


Objectives: To survey the opinion about various curricular components of Doctor of Medicine (MD) pharmacology curriculum in India by stakeholders, including faculty and students.
Materials and Methods: An online survey was done to evaluate the various curricular components of MD pharmacology curriculum being used in India. A total of 393 respondents including faculty, MD students, and other stakeholders completed the survey. The survey was developed using SurveyMonkey platform and link to survey was E-mailed to stakeholders. The results were expressed as percentages.
Results: There was a balanced representation of respondents from various designations, teaching experience, regions, and age groups. Most of the respondents (83%) were aware of the MD pharmacology curriculum. However, they reported that it is more inclined to knowledge domain. About half of respondents (53%) said that animal experiments are being used. The most common teaching methods mentioned are seminars (98.5%), journal clubs (95%), and practical exercises by postgraduates (73%), but there is less use of newer methods (25%) in theory and less of clinical pharmacology exercise (39%) in practical classes. The log books are maintained but not assessed regularly. Internal assessment is sparingly used.
Conclusion: The MD pharmacology curriculum needs to be made uniform at the national level and updated to include the newer methods in teaching-learning and assessment. There should be sharing of newer methods at a common platform implemented at the national level.
Key message:
Emerging trends in pharmacology and therapeutics and the changing career avenues for pharmacologists brings forth a need for uniformity in curricular components of M.D. (Pharmacology) course in India. The uniformity in the curriculum is currently lacking and needs to be revamped to suit the contemporary needs.


Keywords: Curriculum, Doctor of Medicine, pharmacology, stakeholders, survey


How to cite this article:
Badyal DK, Daniel SR. Opinion of stakeholders on existing curriculum for postgraduate (MD) course in Pharmacology: A survey. Indian J Pharmacol 2016;48, Suppl S1:19-24

How to cite this URL:
Badyal DK, Daniel SR. Opinion of stakeholders on existing curriculum for postgraduate (MD) course in Pharmacology: A survey. Indian J Pharmacol [serial online] 2016 [cited 2020 Jul 7];48, Suppl S1:19-24. Available from: http://www.ijp-online.com/text.asp?2016/48/7/19/193316




The Medical Council of India (MCI) provides very broad guidelines for postgraduate (PG) curriculum in general.[1] There is no syllabus or other details given subject wise. These guidelines are good in a sense that it provides flexibility to the institutes/universities to design Doctor of Medicine (MD) pharmacology course as per regional needs and as per infrastructure available in their regions. However, in spite of this flexibility, only a few universities have framed their curriculum/syllabus for MD in Pharmacology course.[2] Most of these curricula emphasize a lot on the traditional set of knowledge-based learning and not on relevant competency/skill-based learning. None of these discuss affective domain in detail. Some curriculum just gives objectives and few teaching–learning methods while others describe a long list under each category.[3],[4],[5],[6],[7] Most of these curricula have extensive list of items in practical exercises. There is a huge variability in these curricula. The variability in these curricula adds an element of nonuniformity in MD course. Hence, as of present, there is no standard defined curriculum for the MD pharmacology course at the national level.

The various stakeholders in MD pharmacology curriculum have raised their concerns related to its relevance in the present day scenario as well as its uniformity. The stakeholders include students, teachers, universities, employers, and even regulatory bodies. The emerging trends in the field of pharmacology have opened up exciting career opportunities for young medical pharmacologists in various fields such as academics, pharmaceutical industries, scientific writing, clinical research organizations, and regulatory bodies.[8],[9],[10],[11],[12] Hence, the million-dollar question which crops up is that “Are our MD training programs adequate for the students, satisfying their future career/job needs?”

There have been few studies in India on MD curriculum in pharmacology; however, these studies used only a part of curricula with a limited number of stakeholders. These studies do report that existing MD curriculum in pharmacology in India has not kept pace with the recent needs and developments. The training needs of MD pharmacology course need to be standardized and made uniform at all the places.[8],[9],[10] It prompts us to share the fallacies of what these students are being taught versus what they are expected to know in their future job profiles. Just think about where major time of students and teachers is invested in teaching–learning activities in MD pharmacology course. Most time is spent in practical exercises related to experimental pharmacology, calculation in kinetics, statistical calculations, and knowledge-based items such as seminars/journal clubs. One survey pointed out that 96.6% of the participants have never used their knowledge of bioassay during their 10 years of post-MD career whether in pharmaceutical industry or in academics.[11] Now think about the future job profiles of these students. Majority of the students join industry where they need to be proficient in clinical trials. A number of them join academics too. Are we inculcating skills for teaching and conduct of clinical trial in these students? In fact, the question should be reframed as, “Are we investing major time in training these students in relevant skills such as teaching skills and skill in conduct of clinical trials?” If the answer is yes, then we are right on the track, otherwise we need to rethink our strategies and curriculum.

The increasing restrictions on the use of animals, wide variation in curriculum between instituions and neglect of topics such as clinical trial methodology, teaching skills in MD pharmacology curriculum led us to design this study to collect and evaluate the information through a questionnaire on MD pharmacology curriculum including objectives, teaching–learning methods, and assessment strategies being used in various medical colleges in India.


 » Materials and Methods Top


Following approval from the Instituional Ethics Commitee, this questionnaire-based study was conducted in medical colleges conducting the PG MD pharmacology course in India. There are 742 MD pharmacology seats per year in 247 medical colleges recognized/permitted by the MCI for MD pharmacology course and 3638 faculties in pharmacology departments as of now.[12]

Faculty of pharmacology, who are PG teachers in MCI recognized medical colleges conducting MD pharmacology course, MD pharmacology students in 2nd or 3rd year in MCI recognized medical colleges, and other MD/DM pharmacology stakeholders in pharmaceutical industry, research institutes, etc., were included in the study. Faculty and MD students in the department of pharmacology working in medical colleges not recognized by MCI for conducting MD pharmacology course and MD pharmacology students in 1st year were excluded from the study.

The questionnaire was prepared based on MCI broader guidelines and the essential components of curriculum.[1],[2] A brainstorming session with the faculty and the PGs of the department of pharmacology was conducted to revise it. The questionnaire included questions related to all components of the curriculum, i.e., objectives, teaching–learning materials/methods, and assessment. The teaching–learning methods include questions from all three domains of learning such as cognitive, psychomotor, and affective domains. Similarly, assessment was also asked in relation to these domains.

The questionnaire was pilot tested in five institutions involving ten faculty and ten PGs. The final questionnaire was made available through SurveyMonkey online platform. The SurveyMonkey online platform is a very useful tool for creating survey and getting responses online. We have being using it for medical education workshops and training program surveys. The use of SurveyMonkey in subject-related survey at national level made the process easier in designing survey, validating survey, sharing link, and getting responses. The online link was E-mailed to the faculty and PGs of Pharmacology Departments of Medical Colleges as well as to other stakeholders. The E-mail addresses were obtained from the respective departments from their websites as well as from the MCI website. We also posted a letter about the questionnaire to all medical colleges by post, and five reminders were given to all nonresponders. The study was approved by the Institutional Ethics Committee, and we also obtained a waiver of consent for this study as per the Indian Council of Medical Research guidelines.[13]


 » Results Top


The survey was successfully completed by 396 participants from various MCI recognized medical colleges conducting MD pharmacology course. Three forms were rejected as they were filled by 1st year MD student, faculty of other specialty, and faculty from dental college. The results of 393 participants are expressed in percentages. [Figure 1] shows the types of respondents. The maximum number of respondents were from government medical colleges (57.9%), followed by private medical colleges (38.1%) and rest were from other places such as multispecialty hospitals, contract research organizations, and research institutes. Out of all responders, 21.9% assistant professors, 18.9% associate professors, 20.2% professors, 29.1% MD students, 5.6% senior residents, and 2.1% medical advisor/director from pharmaceutical industry [Figure 2] responded. Region-wise distribution shows that 31.6% of the responses were obtained from Northern states of India while 25.2% from the Southern states [Figure 3]. The response rates from the central, western, and north eastern states were 22.5%, 10.3%, and 10.6%, respectively. More respondents (65.4%) were in the age group of less than 40 years. Information about the teaching experience was obtained from the faculty members and it was observed that around 38.8% of the faculty have teaching experience between ≥3 and <6 years, 24.1% between ≥6 and <12 years, 18% between ≥12 and <18 years, and 19.1% has >18 years. The qualification of 95.7% of the respondents was MD pharmacology, 4.3% PhD pharmacology, 2.10% DM clinical pharmacology, and 1.3% DNB. DM and DNB qualified participants have done MD earlier.
Figure 1: Stakeholders who responded to a questionnaire about Doctor of Medicine pharmacology curriculum in India (n=393)

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Figure 2: Designation wise distribution of respondents of the questionnaire on Doctor of Medicine pharmacology in India (n=393)

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Figure 3: Region-wise distribution of respondents of the questionnaire on Doctor of Medicine pharmacology in India

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Responding to a question about their awareness of the MCI broader guidelines for MD course, 83.1% of the respondents have responded that they were aware of the MCI guidelines for MD pharmacology curriculum. Nearly 54.3% of the respondents said that the curriculum is being followed in their institution, 38.4 said that it is being followed partly, and 7.3% respondents said that it is not being followed. A total 69.7% of the respondents said that their university has a separate curriculum for MD pharmacology. However, they added that curriculum mainly focuses on cognitive domain (45.55%) and less on psychomotor (29.5) and affective (24.95%) domain. When asked about the future career prospects, participants are well aware of pharmacologist’s roles in academics (70.8%), pharmaceutical industries (73%), clinical research organizations (68%), and regulatory bodies (50%). Few added that the pharmacologist can have a role as clinical pharmacologist in hospitals, as a physician, in patient care by providing pharmacology consult, helping in interpretation of laboratory data about drug levels, etc.

Experimental Pharmacology

Almost half (53.2%) of the respondents have said that experiments using live animals/tissues are being conducted in their institutes, 21.5% said that it is partly done, and 25.3% reported that animal experiments are not conducted in their institution. Approximately, 64.8% of participants mentioned that computer-based alternatives are being used to replace animal experiments. Almost 29.5% said that noncomputer-based alternatives (graphs and charts) are being used to replace animal experiments. The common computer-based alternatives used include various software available in India such as CAL, ExPharm, and Xcology; video demonstration of experiments and using paper-based exercises such as graphs/charts. Two respondents mentioned the use of cell lines in tissue culture and bioassay using chick intestine obtained from slaughterhouse.

Teaching/training Methods

[Figure 4] shows various teaching–learning methods being used. The most common methods used are seminars (98.5%) and journal clubs presented by PG students (95%). Other methods include the practical exercises conducted by PG students and supervised by faculty members (72.6%), practical exercises conducted by PG students which are not supervised by the faculty (44%), and lectures for PG students by faculty (49%). The respondents did mention few other methods such as group discussions, case discussions, tutorials, taking MBBS class, hospital or laboratory postings, and pharmacovigilance postings. When asked about interdepartmental postings, 48.5% of respondents said that they do not have interdepartmental postings and 18.8% occasionally get it. Approximately, one-fourth (26.5%) of the respondents said that PGs attend ward rounds to learn trends in the usage of drugs. The duration on dedicated interdepartmental posting varies from 1 week to 2 months in departments such as medicine, emergency services, dermatology, cardiology, and psychiatry. This is apart from usual clinical hours spent during thesis work and pharmacovigilance work. Similarly, 25.4% respondents said that newer teaching methods such as case-based learning (CBL) and bedside teaching are being used in their department. However, most of them described the use of a clinical case followed by one discussion. There is also mention of microteaching in existing teaching methods as well as in newer methods. On being questioned about clinical pharmacology exercises, 38.9% responded that they conduct clinical pharmacology experiments for PG students. The various clinical pharmacology exercises being conducted are mentioned in [Table 1]. The various other trainings in the MD pharmacology curriculum practiced by different colleges included separate curriculum on ethics and professionalism (28.5%), basic biomedical statistics and research methodology (83.4%), and pharmacokinetic exercises (67.7%). Most of the respondents (82.4% - yes, 15.5% - partly) said that added that PG students are involved in undergraduate (UG) teaching (82.4%) and they are provided feedback too (69.9%). The feedback methods mentioned are by taking viva before class, by microteaching, and by checking their notes/slides. Majority of the respondents (91.4%) said that the teaching load is appropriate or very less. PG students usually take practicals and very few topics of theory related to minor topics. Most of the respondents (79.9%) added that PG students are never posted regularly in pharmaceutical industry. Only in a very few (8.6%) said that PGs are posted regularly in industry. The postings are variable and sometimes only a single day visit. Mostly, it is of 1–2 weeks duration, and at 4 places it is from 2 to 3 months.
Table 1: Various clinical pharmacology exercises using human volunteers (n=139)

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Figure 4: Various teaching–learning methods used for postgraduate teaching in pharmacology (n=393)

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Assessment

Majority of the responders (95.9%) have conveyed that it is mandatory for PG students to maintain a log book during their PG course. Less than half of responders (41.5%) stated that the log books and PG activities are reviewed monthly at the departmental level, 8.3% added that it is reviewed only at the end of 3 years, and 3.6% have said that it is never reviewed. At the institutional level, 64% have said that log books and PG activities are never reviewed or reviewed only at the end of 3 years, and only 5.7% have said that they have monthly review. The methods of assessment used for PG students in the course of 3 years were regular theory test papers (61.2%), practical tests (37.7%), marks/grades awarded to seminars (48.4%), subjective assessments based on day–to-day activities (34.2%), term end/yearly examinations (55.4%), and objectively structured practical examination (28.4%). The objectively structured practical examination (OSPE) is being used for the last 1–4 years. This assessment includes knowledge (87%), psychomotor (70%), and affective domains (56%). The respondents have also answered that their PG university examinations regularly include teaching assessment (86%), management skills (32%), viva voce (95%), and human experiments (23.3%). [Table 2] shows the various assessment methods used in university examination as marked by respondents. Responders (73.1%) added that their departments make an internal assessment for PG students based on their performance throughout the 3 years. However, there is a marked variation in the way internal assessment is marked. One extreme mentioned was “to please head of the department only”, and the other was that “it is done periodically based on day-to-day performance and all the tests conducted in the department”. At some places, it is held marked at interval of 6–12 months. The contribution of three areas of learning domains, for example, cognitive, psychomotor, and affective domain in existing objectives, teaching–learning methods, and assessment is compared in [Table 3]. There is no proper alignment of these domains in the objectives, teaching–learning methods, and assessment.
Table 2: Various components of university practical examination

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Table 3: The blueprint of weightage to learning domains in curricular components

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 » Discussion Top


In this study, we surveyed all components of curriculum and involved relevant stakeholders. Responses were received from all types of stakeholders. The respondents were well distributed in various age groups, qualifications, teaching experience, and designations; hence, the views of all important stakeholders contributed to the results. However, the representation from nonacademic originations such as industries and research organizations was less. This aspect also shows the expansion of the avenues in pharmacology. A pharmacologist has an important role in patient care and in research institutes too, which is often under-rated. Patient care in hospitals and research institutes. The neglected area seems to be regulatory bodies. However, the respondent did mention to see pharmacologists in future in this area also. The response from government medical colleges was high as compared to other institutes. The region-wise response shows a good participation from all regions. The western and northern east region needed to have more responses. Our results show that most of the participants were well aware of the MCI guidelines on MD pharmacology curriculum and most of the respondents have said that their university has a separate curriculum for MD pharmacology. It is evident from the results that the curriculum is followed in some institutions, whereas it is partly followed and not followed in many other institutions. This shows that there are nonuniformity and extreme variations in the MD pharmacology curriculum that is being followed in different universities.[7],[8]

A nonuniformity and a state of confusion still in the area of experimental pharmacology. Our survey results are similar to other studies published earlier.[7],[8],[9],[11],[14] Many institutions have replaced animal experiments with computer-based alternatives, charts, and graphs, but some institutes are performing experiments with live animals/tissues. This is probably because of the absence of clear guidelines on whether and to what extent can and should the animal experiments be continued.[7],[14] Various institutions have developed alternative methods of teaching and evaluation.[15] The use of some new methods such as bioassay using chick intestine seems interesting. In fact, recently, the authors have come across some institutes successfully using chick intestine obtained from slaughter houses, and it works quite well. The noncomputer-based alternatives include paper-based cases or exercises on graphs or clinical pharmacology exercises.

It is evident that the teaching/training methods that are used are mostly same in all institutions. The present curriculum insists on conventional teaching/learning methods such as lectures, practical classes, seminars, and journal clubs.[7],[8],[11] Our results show that these training methods are being used and well followed, but the use of innovative methods such as CBL, problem-based learning, interactive teaching, clinical pharmacology exercises, and project work is lacking. Only in very few places, these innovative teaching/learning methods are followed. Only a few institutions conduct clinical pharmacology experiments, pharmacokinetic exercises, and teaching during ward rounds. A number of clinical pharmacology exercises are doable as they need minimum infrastructure. Basic statistics are covered by most of the colleges. The interdepartmental postings and postings in pharmaceutical industry are good options but being followed by few institutes only. The PG students are quite frequently used in practical pharmacology exercises for UG classes and the load of UG teaching on PG students seem to be appropriate. There is mention of two terms but in variable meanings by respondents, i.e., CBL and microteaching. This is not an exactly CBL, but the use of cases in learning. CBL usually has multiple session on the same case, involvement of dedicated facilitators, self-directed learning time, and follow-up discussion.[16] Microteaching is another term being used in various connotations. The term has evolved over time and truly speaking it is always volunteered and happens in a nonthreatening environment. Hence, it cannot be an assessment method. Microteaching means a teacher voluntary asks few colleagues of his/her choice to provide feedback. The micropart is group size (5–6), time (5–10 min), one skill at a time (e.g., only body language in one session), and the feedback which is provided in a set pattern of asking teacher to say what went well followed by colleague’s providing what went well. This is followed by teacher adding how it can be improved and colleagues adding to how it can be improved further.[17] The appropriate term to be used in MD practical examination should be “assessment of teaching” and not “microteaching.”

It was emphasized earlier too that departmental seminars and journal clubs should have assessments and periodic reviews of the PG students. There is a mandatory need for PG students to maintain a log book during their 3 years of postgraduation program. In our survey, some respondents have said that the log books are reviewed at departmental level only, whereas in some other colleges, log books are never reviewed. The review at institutional level is lacking. The regular assessment and review of log books at departmental and institutional level are needed. It was also stated that the examination pattern is mostly theory oriented with less of practical-based approach.[9] Our results also show that in majority of the institutes, theory test papers are usually conducted for assessment. Practical tests, marks/grades awarded to seminars, and subjective assessments based on day-to-day activities are less considered for the assessment of PGs. The final university examinations include theory papers, practical exercises (long and short experiments), viva voce, teaching assessment and clinical pharmacology (human experiments), statistical and pharmacokinetic exercises, and management skills. The internal assessment is not frequently used for PGs, and its methodology is not uniform. The various methods of teaching learning and assessment mentioned in this study are not being used by all institutes as per results of this study. Hence, these methods can be shared by the institute at a national platform leading to optimal utilization of resources.

The alignment between objectives, teaching–learning methods, and assessment is not adequate. This blueprint represents that the curriculum suffers due to this misalignment. The various stakeholders might have different interpretations of these areas. Hence, the proportion of various learning domain needs to be balanced in the context of objectives of the course. The curriculum can also be designed keeping in view competencies expected from a PG student. These broader competencies can be framed at the national level, and enough flexibility be provided to universities to frame curriculum around these competencies.


 » Conclusion Top


Considering the emerging trends in pharmacology and therapeutics and the new openings for medical pharmacologists in various fields, there is a crucial need to frame and bring uniformity in all curricular components of MD pharmacology course in India.

Acknowledgments

The authors thank the responders who have spent their valuable time to respond to the survey.

Financial Support and Sponsorship

Nil.

Conflicts of Interest

There are no conflicts of interest.

 
 » References Top

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    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]
 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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