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In This Article
 »  Abstract
 » Introduction
 »  Historical Miles...
 »  The Evolution in...
 » Animal Experiments
 »  Pharmacy-Shift t...
 »  New Courses and ...
 » Pharmacovigilance
 » Assessment
 » Prescription Writing
 »  Innovative Evolu...
 » Conclusion
 »  References
 »  Article Figures
 »  Article Tables

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 Table of Contents    
EDUCATIONAL FORUM
Year : 2018  |  Volume : 50  |  Issue : 4  |  Page : 159-168
 

Evolution of pharmacology education in India: Past and future


Department of Pharmacology, Christian Medical College and Hospital, Ludhiana, Punjab, India

Date of Submission09-Jul-2018
Date of Acceptance08-Aug-2018
Date of Web Publication1-Nov-2018

Correspondence Address:
Dr. Dinesh K Badyal
Department of Pharmacology, Christian Medical College and Hospital, Ludhiana - 141 008, Punjab
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijp.IJP_239_18

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 » Abstract 


Pharmacology education has passed through various stages in the evolution sequence due to ever-changing type and repository of drugs as well as technological advancements in the educational processes. This article reviews the journey of evolution of pharmacology education. Pharmacology is relevant component of various curricula in medical, dental, and paramedical courses. A huge number of students learn pharmacology as a subject. Important milestones in evolutionary sequence included revisions and updates in learning objectives, teaching-learning material/methods and assessment in undergraduate (UG) and postgraduate (PG) levels. During this period, a number of pharmacology organizations and associations were formed for the progress of the subject. The inception of Indian Pharmacological Society and International Union of Pharmacology is worth mentioning. There are standardization and unification efforts being done in pharmacology education at national and international levels. The era of animal experimentation is struggling to survive in the new era of animations and simulations. There is increasingly more emphasis on the relevant clinical pharmacy and clinical pharmacology components in the education. The past evolutionary sequences provide leads for future evolutions. New courses and innovations are being designed and implemented to make pharmacology education more meaningful and useful to the new technology-savvy students. A number of innovations in the form of case-based learning, objective-structured practical examination, small group learning, interactive, and integrated methods are being implemented. There is a lot of work being done to introduce a competency-based intergraded curriculum in medical UG and PG courses. All these evolutionary sequences require changing and evolving role of teachers as facilitators.


Keywords: Education, evolution, India, pharmacology


How to cite this article:
Badyal DK. Evolution of pharmacology education in India: Past and future. Indian J Pharmacol 2018;50:159-68

How to cite this URL:
Badyal DK. Evolution of pharmacology education in India: Past and future. Indian J Pharmacol [serial online] 2018 [cited 2018 Nov 13];50:159-68. Available from: http://www.ijp-online.com/text.asp?2018/50/4/159/244718





 » Introduction Top


The education of pharmacology has evolved over time, and this has given us a rich past era of pharmacology. The evolutionary changes started from teaching few extracts in isolation to the creation of a separate discipline of pharmacology and then to publications and development of pharmacology organizations. The present era of detailed drug regulations, systematic drug development, huge number of courses/students, and technology advancements makes it interesting and challenging for further evolutions in pharmacology education. There are important milestones during the evolutionary process in pharmacology education that deserve special mention. This article depicts the evolutionary changes in various aspects of pharmacology education.

The number game

The demand for trained pharmacologists in India is continuously increasing. The demand has been in academics as well in other areas such as pharmaceutical industry, regulatory bodies, and national institutes. The new courses in pharmacology have evolved over the time. All major medical, dental, nursing, paramedical, and even veterinary courses have significant teaching-learning activities in pharmacology.

Most medical schools in the world started teaching few components of both basic and clinical pharmacology as early as 1960, as the pace of drug development improved in those years.

The number of graduates and postgraduates (PGs) in pharmacology is quite huge in India looking at a number of medical colleges (441), dental colleges (312), pharmacy colleges (>450), nursing colleges (>2670), and training institutes providing clinical research training. Approximately 52,000 medical graduates, 48,000 pharmacy graduates, 30,000 dental graduates and >260,00 nursing graduates are produced every year in India.[1],[2],[3],[4] After undergraduate (UG) medical course of 5½ years i.e., “Bachelor of Medicine, Bachelor of Surgery (MBBS), or in Latin: Medicinae Baccalaureus, Baccalaureus Chirurgiae,” student can go for additional studies such as diploma in clinical research, pharmacovigilance, clinical trials, or specialization in pharmacology of 3 years, i.e., Doctor of Medicine (MD) in Pharmacology or PhD in Pharmacology.[5] After MD in Pharmacology, there is option to opt for super-specialization in the form of 3 years Doctor of Medicine (DM) in Clinical Pharmacology or Diplomate of National Board (DNB) in Clinical Pharmacology. Alternative systems of medicine in India train approximately 27,000 graduates and 2300 PGs every year.[6] Some specialized training programs are being supported by the Indian Council of Medical Research (ICMR) and other National organizations.[7]

The armamentarium of drugs available in the market gets a complete new stock after every 12–15 years. Thus, continuous updating about new and better drugs is the need of the hour as there are many technological advancements in drugs development. The drugs are being marketed simultaneously in India as in other countries. Hence, the lag period is not there, and our budding doctors need to know about updates on drugs and pharmacotherapeutics right from their education in UG and PG courses. There are also enormous changes in curricula including teaching-learning methodologies due to improvised high-end equipment and methods. The evolutionary changes are happening in pharmacology education at all levels.


 » Historical Milestones in Pharmacology Education in India Top


Scientists and associations in India

The genesis of pharmacology as a subject in India can be traced back 1921 when Col. Ram Nath Chopra was made the first Professor of Pharmacology at the School of Tropical Medicine, Calcutta. Col. Chopra (1882–1973) is hence known as the 'Father of Pharmacology' in India. He initiated several studies to evaluate the potential uses and adverse effects of indigenous drugs used in the country since ancient times. The national organization of pharmacologists gave momentum to the pharmacology education in India. The genesis of the Indian Pharmacological Society dates back to 1966 when at 12th Annual Conference of Association of Physiologists and Pharmacologists of India in Patna, the pharmacologists attending the conference commenced an organization exclusively for pharmacologists. Prof. Desmond Lawrence of Clinical Pharmacology Division in the University of London was a great help in the development of the new organization. Other stalwarts like Professors G. Achari, K. P. Bhargava, R. P. Kohli, and P. N. Saxena carried forward the organization.[8]

Clinical pharmacology as discipline

There is a desired shift happening in the pharmacology practical teaching from animal-based and pharmacy-based redundant experiments to more clinically relevant clinical pharmacology exercises [Figure 1]. Clinical pharmacology includes rational prescribing, clinical trials of drugs, adverse drug reaction (ADR) monitoring, pharmacokinetics, pharmacodynamics, toxicity, drug interactions, prescribing, and pharmacotherapeutics.[9]
Figure 1: Shift of education from experimental and pharmacy to clinical pharmacology

Click here to view


The use of clinical pharmacology as a scientific discipline dates back to the middle of the 20th century. The classical writing on foxglove use in heart failure by William Withering is one of the earliest initiatives for the discipline of clinical pharmacology. Clinical pharmacology developed as a discipline in the 1960s in USA, Europe, and the UK. In India, clinical pharmacology began due to efforts of eminent pharmacologists like Dr. U. K. Sheth, Dr. Ranjit Roy Chaudhary, Dr. P. L. Sharma, and many others. In fact, Seth GS Medical College Mumbai has been conducting workshops on clinical pharmacology for >40 years supported by Indian Council of Medical Research. There is also a mystery surrounding the first use of term clinical pharmacology. It is quoted that Harry Gold used this term first time in the early 1940s. Others consider Paul Martini, professor of medicine in Bonn, as the first clinical pharmacologist.

Initial books and journals

Paul Martini authored a monograph in German literature titled “methodology of therapeutic Investigation.”[10],[11] However, a number of these writings could not get the attention of the English-speaking world. John Bruce wrote a book entitled “Materia Medica and Therapeutics” in English. These Materia Medica became traditions in Pharmacology, particularly in Scotland. An important book in 1884 entitled “An Introduction to the rational treatment of disease” was later renamed Dilling's 'Clinical Pharmacology' in its 20th edition. This book got published in 1960 at the same time when the landmark book “Clinical Pharmacology' by Desmond was published. The development of the discipline of clinical pharmacology was most robust in the United Sates of America. This fact is supported by publication of the most respected book “Goodman and Gilman's-The Pharmacological Basis of Therapeutics” and first subject journal entitled “Clinical Pharmacology and Therapeutics” in 1960 by Walter Modell and AT Cornell. This country emerged as the World center for training in clinical pharmacology in early 1960s. Louis Lasagna, an apprentice of Harry Beecher at John Hopkins Hospital Lasagna published, “Present status and future development of clinical pharmacology”, a very lucid publication in the context at that time.[10],[11],[12]

Scientists and associations in the World

Similarly, developments in the discipline happened in Europe, more in the UK due to better infrastructure facilities in pharmacology and clinical medicine that helped the discipline to grow. In the end of 1960s, chairs in clinical pharmacology were formed in Germany, the UK, and Sweden. The Chair in clinical pharmacology has been created in India by ICMR. European Journal of clinical Pharmacology brought out a series of papers about the role of clinical pharmacology in three major components of health profession, i.e., teaching, research, and healthcare. The World Health Organization (WHO) brought out a report on the scope, organization, and training of clinical pharmacology in 1970. The International Union of Pharmacology (IUPHAR) took early initiatives starting from 1980. The IUPHAR in collaboration with WHO and the council for international organizations of medical sciences (CIOMS) CIOMS has brought a document on “Clinical Pharmacology in Health Care, Teaching and Research”. The document has been developed to help the emerging countries to evolve in line with developments in all aspects of clinical pharmacology.[13] Clinical pharmacologist's contribution is quite evident in the work of several Nobel Prize laureates like Sir John Vane, Sir James Black, George Hitchings, Gertrude Elion, and Arvid Carlsson. Oswald Schmiedeberg (1838–1921) is regarded as the “Father of modern pharmacology.” John Jacob Abel (1857–1938) is accepted as Father of American Pharmacology.[9],[10],[11],[12],[13]


 » The Evolution in Pharmacology Curricula Top


Undergraduate medical curriculum

The curriculum tells us about the layout of all components of a course. The present UG medical course syllabus was implemented in the year 1997. It has been >20 years now. The present curriculum is traditional and based on subject wise teaching with no integration. The various components of a typical pharmacology curriculum include objectives, teaching-learning methods, and assessment.[14]

Objectives

The learning objectives are given on Medical Council of India (MCI) website. It emphasizes on what the learner should be able to do in various learning domains, i.e., domain of knowledge (cognitive), domain & of skills (psychomotor), and domain of sympathy, professionalism (affective).[15] These objectives address a number of specific, important drugs and therapeutic problems and this might be used to provide rational clinical applications of the drugs. Since the upcoming curriculum is likely to be competency-based, there will be defined competences for various roles, for example, whether a student is competent to prescribe rationally, inject intramuscularly, etc.[3],[6],[13],[16]

Teaching-learning methods

The teaching-learning methods commonly used include lectures, tutorials, practicals, and group discussions. However, it need not limit to these methods only. A few of institutes are also using innovative methods such as case-based learning, problem-based learning, clinical case presentations, seminars, quizzes, bed-side teaching, and a number of other innovative methods. The innovative methods call for more work by the faculty and also needs infrastructure and sometimes finances.[15],[17] The MCI is a recommending body, and hence, teachers get a lot of freedom to choose teaching methods.

The student feedback and faculty feedback clearly suggest that lectures should be decreased and there should be more hands-on experience, discussions, seminar, or other innovative methods. The very concept of pharmacology being considered a very volatile subject by students is the result of putting too much emphasis on theory part and neglecting the hands-on experience. It is awful to find that even today our UGs cannot properly write prescriptions or inject drugs, or even fill ADR form. The biggest impact of pharmacology teaching-learning has to be on correct prescriptions, rational use of drugs, calculations of doses, and providing pharmacology consult to patients.[18],[19] This has been discussed so many times, but unfortunately, this area remains neglected. However, students often complain about the large number of drugs they are being taught. This can be taken care by limiting the teaching of few (50–60) core drugs that can be regarded as the “student formulary” that can help to provide learning objectives that are appropriate and feasible.[20]

Teaching hours in the UG medical education in the subject of pharmacology are 300 h as per MCI regulations of 1997. Out of these, 200 h (three-fourth) are mandatory for nondidactic classes including practicals, clinical classes, seminars, tutorials, discussions, etc. Out of these, 100 h are for typical didactic lectures. Most of the institutes are taking >100 lectures and less of discussions, tutorials, seminars, etc. The worst part is the mushrooming of “PPT teachers” i.e., teachers dependent too much on powerpoint slides. The blackboard teaching is becoming extinct. This problem has been further aggravated by the increase in number of students. Hence, when a teacher has a class of 200 students, using PPT slides is seen as a comfortable and feasible method.[16],[21]

The upcoming curriculum, i.e., vision 2015 by MCI is planning to decrease pharmacology hours to 240 from 300 h, and it needs to be covered in shorter duration, i.e., 12 months. The new module will have a case-based scenario in small group sessions and integrated teaching sessions. One of the module attitude, ethics, and communication is going to be implemented in all medical colleges. It includes case scenarios on pharmacological aspects like pharmacoeconomics.[21],[22] However, as the new curriculum is competency-based involving integrated teaching, pharmacology will be taught in all years starting from year one.[6],[23] However, it needs to be seen how cutting the basic sciences teaching will affect clinical sciences teaching.[24]

Assessment

This component has an important bearing on the students as students learn as per assessment or in other words assessment drives learning. The present assessment system has not been updated for a long time. The emphasis is mainly on the knowledge component even in practical examinations. An authentic assessment needs to be valid, reliable, feasible, acceptable and should have a positive educational impact.[25] The new competency-based curriculum will have an updated assessment at university levels too.

In 1997, revision of UG medical curriculum second professional subjects such as microbiology and pathology got a clinical component in the form of proper laboratory in the clinical area of hospital. It is quite interesting to note that there was similar plan for pharmacology to add clinical pharmacology component in the formal way with a dedicated clinical area. We missed a big opportunity at that time.

Postgraduate medical curriculum

Unfortunately, till 2017, the specialization courses in Pharmacology such as MD and DM did not have standardized common curriculum. In the absence of clearly defined objectives till now, nonuniformity existed in curricula across institutions in India. Few universities have framed their curriculum for MD Pharmacology. However, most of these curricula emphasize on the traditional approach of knowledge-based learning and not on the acquisition of skills and the requisite levels of competency.[26] Only recently in 2018, MD Pharmacology curriculum has been posted on MCI website. This competency-based curriculum comprises of knowledge, practical/clinical skills, thesis writing skills, attitudes/professionalism, communication skills, and training in research methodology. This curriculum says that “job prospects for a medical pharmacologist are in academics, pharmaceutical industry/clinical research organization, government research institutions, in regulatory bodies and as scientific writer or science manager. Accordingly, an MD student in Pharmacology should be competent to meet the job requirements at all these places.” The animal experiment component has been curtailed with clear guidelines. Teaching skills and clinical pharmacology skills have been given proper place.[27]

Pharmacy curriculum

The practice of pharmacy profession in India is more industry and product based whereas in developed countries, it is clinical pharmacy based. For clinical pharmacy, exposure of students to patients and greater interaction with clinicians and other healthcare providers is necessary for better understanding of efficacy, interactions, and adverse reactions to drugs. The curricula in M. Pharm and D. Pharm have not been revised for a long time now. It is recommended that the M. Pharm curriculum should focus more on preclinical areas, molecular biology, gene expression, proteomics, pharmacogenomics, and cell/tissue culture.[5],[10] More exposure to clinical services is needed. Pharm. D syllabus should use more of computer-assisted/simulation-based modules/mannequins to replace the unnecessary use of animals.

Other curricula

The dental curriculum has defined well the limited syllabus of pharmacology for the dental graduates.[28] However, the examiners are invariably taken from medical stream teaching only medical students; hence, these students are unnecessary assessed in those areas that are not part of their syllabus. The physiotherapy syllabus is very variable throughout the country, quite extensive and irrelevant.[29] The syllabus should be trimmed down and made more relevant to their needs. Nursing curriculum also needs extensive trimming and uniformity.[30]

The teaching-learning of pharmacology has been heavily based on theoretical knowledge. After looking at numbers, historical evolution and evolution of curricula, let us elaborate on the evolutions in common pharmacology areas which have caused major alterations in education.


 » Animal Experiments Top


The restrictions on the use of animals in medical education have been quite confusing in India, and this has led to very unfortunate conflicting scenarios in the country. The regulatory bodies like MCI, University Grants Commission (UGC) and Committee for purpose of control and supervision on experiments on animals all have their own recommendations, and there is no consensus on the common final guidelines. The compliance asked in 2015 by the UGC from all colleges about not using animals in UG and PG teaching is another deterrent.[3],[6],[31]

Undergraduate curriculum

The worse effect of these debatable guidelines was on the practical component of the pharmacology education. Most of the institutes discontinued the animal experimentations in UG studies. The sacrifice of animals to show the effect of drugs such as adrenaline, beta blockers, etc., is something that can easily be shown on the computers. The students also did not prefer sacrificing animals for pharmacology practicals. During this transit period, a number of institutes started using alternatives to animal experiments. The word “alternatives” was somehow used as synonym with computer simulation models (CSM). However, exact simulation of animal experiments on computer-assisted modules is very complex due to variations in biological responses. The word of caution is that we should not become too excited about CSM. The use of animal simulations forces me to think why we need to use animal simulations for UG students who are going to handle humans. Why not human simulations, for example, a simulation showing the effect of enalapril or felodipine on blood pressure in humans rather than effect of adrenaline or acetylcholine on rabbit or frog heart. We can use the animations of drug actions in teaching. A number of animations are available free. In fact, two major CSMs were developed in India only and have been used by medical and pharmacy institutes.[32]

Postgraduate curriculum

The use of animals in PG Pharmacology curriculum to demonstrate the action of various drugs, to evaluate nature of unknown drug and for understanding bioassay is still continuing at number of institutions. The confusion continues based on different guidelines. However, National Board of Examination has stopped using animals for DNB course in Pharmacology. The million-dollar question about using animal experiments such as bioassay and screening experiments in MD pharmacology is “Do we need to train our MD students in this aspect in the present scenario”? Almost all MD students join either academics or industry. Hence, their major need for training during MD should be training them in teaching skills or teaching them to be an investigator in clinical trials. However, it is rarely seen that MD students are trained in teaching skills or involved in clinical trials. Are we catering to their future job needs? Some of the institutes have evolved a number of alternative exercises in clinical pharmacology on which MD students are trained.[26],[33],[34] Hence, it is need of the hour to introduce a common platform to share clinical pharmacology and teaching skills training for MD students.[26]


 » Pharmacy-Shift to Clinical Pharmacy Top


The pharmacy component of teaching has undergone a sea change. Conventionally, pharmacy is related to preparation, compounding, labeling, and dispensing of drugs. However, presently, clinicians get drugs manufactured and packed by pharmaceutical industry. The doctor's job is to ensure rational use and prescription of these drugs. Hence, the traditional conventional practical experiments of pharmacy where students make various formulations have been discontinued at most places. However, since a number of institutes are not using new/innovative methods in practicals, they are continuing with few pharmacy preparations. The real need of the hour is to make our graduates familiar with the clinical pharmacy part and make sure that they can correctly interpret the information on the label of drugs calculate doses, make dilutions as per individual patients, inject drugs using various routes of administration, and trained in using new delivery methods for drugs.[5],[10],[16]

The pharmacy graduates, on the other hand, should be able to get hands-on experience in making formulations. Hence, pharmacy component is relevant to them. At present, hospital pharmacies do not prepare drugs/formulations. Only few formulations needed in skin conditions are prepared. The major function of pharmacies is to advise rational use of drugs and emphasize on important precautions to patients. Pharmacies can also provide information to clinicians, nursing, and paramedical staff. Hence, the clinical pharmacy part is of great importance in pharmacology education in pharmacy courses and must be strengthen further.[10]


 » New Courses and Nomenclature Top


The pharmacology education has also diversified into super-specialty, so after doing MD Pharmacology, students can opt for DM Clinical Pharmacology. The DM course never became very popular, and hence, there are only 24 seats in 8 institutes in India. On the other hand, MD Pharmacology seats are 827 in 262 colleges.[1] The opportunities for doing PhD in Pharmacology are not so good in the country. There is also a 1–2 years diploma in clinical research that incorporates most of the clinical pharmacology curriculum.

The inappropriate use of term clinical pharmacology and its differentiation from pharmacology has led to a lot of confusion in various courses. The main concern is related to the nomenclature of PG degrees in pharmacology. The MD degree is in Pharmacology and DM degree is in Clinical Pharmacology. However, DM course in India is limited to few institutes only and number of seats in very less.[1] The basic education practically being imparted in MD and DM is not too different. At places where DM course is not there, MD Pharmacology training has similar components as in DM course. There was an effort to rename MD degree as CPT (Clinical pharmacology and therapeutics), but it did not materialize. This whole nomenclature has not done any good to the subjects; in fact, it has created few rifts here and there.


 » Pharmacovigilance Top


The topic was always important; however, the due consideration was dependant on National programs of pharmacovigilance in India. However, the programs could not achieve the expectations and were frequently changes. The present program emphasizes to train all UG and PG in medical, dental, nursing, and pharmacy stream to be aware of and familiar with ADR reporting. This has received considerable attention as the regulatory agencies throughout the world have become very stringent in concern with ADRs. In fact, pharmacovigilance program of India (PvPI) has collaborated with MCI and pharmacy council to make pharmacovigilance part of the regular curriculum in UG and PG courses. The requirement is huge at the moment, and it seems it is like another hot and happening area that needs more training.[35]

The economic aspect of this problem has been understood by all the countries, and hence, there is renewed interest in pharmacovigilance. However, in India, we have reached an important bottleneck that prevents regulatory bodies to ban drugs in India. This happened with nimesulide and now with fixed-dose combinations in 2016. The ban was revoked due to lack of data of ADRs in Indian population.[36] This unique practical scenario has become a reality which we thought to be a theoretical possibility only. Hence, we need to regularly educate all health workers such as doctors, dentists, pharmacist, nurses, and consumers to report ADRs promptly. In April 2015, VigiAccess was launched by PvPI in India. Anyone can search for summary statistics from VigiBase and more information about ADRs.[37]


 » Assessment Top


This component of curriculum is the most neglected in all courses, hence, needs special mention here. There should be authentic system of assessment to ensure the achievement of curricular outcomes/learning objectives by learners in pharmacology. Unfortunately, the present system of assessment is mainly knowledge based and minimally designed to test acquisition of practical skills in pharmacology. The viva is considered to be the major deciding factor in pass-fail decision on the day of examination. Unfortunately, the viva mainly concentrates on knowledge component much more than the practical/clinical/applied aspect of the subject. This is a problematic issue in UG as well as in PG assessment. Even in knowledge component its mainly recall the type of question which are asked. Higher levels in knowledge domain are usually not asked. Hence, the assessment as well as teaching-learning methods should be designed for higher level of knowledge too. Bloom's levels of knowledge can be very helpful in ascending to higher knowledge levels that are usually neglected [Figure 2].[25]
Figure 2: Levels of knowledge domain as per Bloom's Taxonomy with pharmacology example. ADR = Adverse drug reaction

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The various tools to be used in assessment should be a mix of multiple methods like written examinations, therapeutic case scenarios, directly observed practical skills, seminars, day-to-day assessment including professionalism and ethics. This is true for assessing competencies. The Miller's pyramid can be very helpful in designing assessment for competencies [Figure 3]. The use of multiple tools for assessment and also the use of multiple test items improves validity and reliability of the assessment. The objective structured practical examination (OSPE) is an appropriate format for this type of assessment.[17],[25],[34] This can also be equally effective in PG assessment. Students should be provided with continuous formative assessments throughout the course and self-assessment opportunities at regular intervals during the course.[38]
Figure 3: Assessment of competency as per Miller's pyramid. OSPE = Objective-structured practical examination, MCQ = Multiple-choice question, SAQ = Short-answer question

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 » Prescription Writing Top


The pharmacology education should make the budding doctors ready to prescribe rationally and safely. There has been a lot of emphasis to writing a correct and rational prescription for decades. In fact WHO guide to good prescribing dates back to 2001. A number of societies have organized so many programs to train doctors to write a good, legible, and correct prescription. However, the quality of prescriptions is still not up to the mark. This issue of incorrect prescriptions has led to so many fatal incidents.[39],[40]

Based on the problems due to inappropriate prescriptions, the MCI has recommended using a new prescription format from 2015.[41] Medical councils of all states of India have urged physicians to use this new format. The education and training of budding doctors in this area need further attention. The latest edition of the National List of Essential Medicines (NLEM), 2015 with 376 drugs will further help this cause. The new NLEM in India is keenly watched by the pharmaceutical industry as this is the basis for the National Pharmaceutical Pricing Authority (NPPA), to revise the list of medicines that should come under government price control. These topics should be part of teaching in all courses and even beyond during their practice years.[14],[16],[42] There is also an effort going on to introduce a prescription module for teaching and assessment in internship for UG medical courses.


 » Innovative Evolutionary Changes: Ongoing and Futuristic Top


Microteaching or teaching assessment!!

The assessment methods being used also needs rethinking, for example, microteaching is a common component in PG assessment. However, if you look at the evolved meaning of microteaching, it is quite a different method being used in nonthreatening environment. Microteaching means that a teacher wants to have feedback on the teaching skills. The teacher voluntarily invites some colleagues and present a small topic or part of topics in a short time. The microcomponent is group size (5–7), topic (5–7 min), skill (one skill at one session), and feedback (what was good, how it can be improved further).[14],[43] Hence, the session in examination should be renamed as “Assessment of teaching skills” and not “Microteaching”. The questions should be related to teaching skills primarily and not the contents.

Training in assessment

The common problem in assessment is that examiners divert to asking more questions on the content than the teaching skills. This also indirectly points to the fact that we hardly train PG students in teaching skills and hence it is conveniently neglected in assessment (examination) too. Similarly, most of the experiments, cases, stations, etc., in PG examination get converted to mini-vivas defeating the purpose of practical examination. Practical examination will be more focused on observations of practical skills. Training of faculty in assessment component to improve questions setting, direct observation and OSPE is needed.[25] There is more need to train PGs in teaching skills.[26]

Bedside teaching

We need an urgent reconsideration of using human volunteers or patients in teaching of pharmacology. The bed-side teaching has been seen as a panacea to teach clinical pharmacology. However, this has been a nonstarter everywhere for UG and PG education. We can introduce a number of less resource intensive methods to teach clinical pharmacology.

Clinical pharmacology exercises

Some examples of clinical pharmacology experiments are given in [Table 1]. These experiments can be easily scheduled for UG as well as PG medical students. The UG can be given experiments such as the use of newer delivery devices such as use of inhalers, use of skin parches, etc. Student should be avoided as subjects in any project as they are vulnerable groups.[17] IUPHAR is making a lot of efforts to improve clinical pharmacology teaching and training through its subcommittee “Development of clinical pharmacology in emerging countries”. As co-chair and member of this committee, I was able to put forward the issues related to clinical pharmacology education in UG and PG teaching in India. The subcommittee has been instrumental in developing a clinical pharmacology document.[13],[17],[24]
Table 1: Clinical pharmacology exercises

Click here to view


Small group learning

The upcoming UG curriculum in India focuses more on small group learning using modules having cases, triggers, real patients, etc. There are a number of advantages, for example, active participation and this improves their interest and learning; one-to-one interaction between student and facilitators; optimal use of verbal and nonverbal communication; and development of problem-solving/critical thinking capabilities and team building motivation. Most of the studies report that SGL is a preferred mode of learning by students. The various small groups teaching techniques include fish-bowl system, snow ball groups, jigsaw groups, buzz groups, crossover groups and horseshoe groups.[17],[24],[25]

Case-based learning

The case-based learning is being used worldwide in all countries to cover a part of curriculum or the entire curriculum. The method is commonly used in the business management world for the learning. The method is reported to be student-centered and encourages active learning. They become better self-directed learners in beginning of their carrier; communication skills improve and decision-making capabilities are developed. The upcoming integrated and competency-based curriculum will focus a lot on case-based teaching-learning.[17],[25]

Objectively structured clinical examination

OSPE is adapted from objectively structured clinical examination. OSPE is a method of assessment that can evaluate skills uniformly and objectively. An OSPE set up typically comprises of a number of predetermined stations through which each student is required to rotate. At observed stations, a marker/observer is present to mark the student's performance using a predetermined checklist. At unobserved stations scoring is done after the conduct of OSPE. A number of institutes have started doing OSPE now in pharmacology in UG and PG courses.[45] Over a period, you can develop OSPE bank and keep on updating your stations regularly. However, OSPE is resource-intensive initially. It is better to include higher levels of cognitive domains and psychomotor and attitudinal domain for testing in OSPE. For one, OSPE station focus on one task or objective.[17],[24],[44]

Seminars in undergraduate courses

The method involves giving a chance to students to sharpen their skills of designing a topic, interacting with teachers, presentation in front of class, and defending their topics. A short topic can be allotted to students. Since number of students is usually more than 100, 2 students can be assigned one topic and one day two topics can be covered. It means four students will get a chance on one day in 1 h session. The one seminar can be for 20 min, followed by 10 min of discussion. The students are informed at least 15 days before the seminars about the topic and the teacher moderator. The interactions during moderation can be documented, and students are also graded as per their interactions with teachers. At the end of each presentation, other student should ask questions, and the presenters need to answer those queries. These interactions should also be documented.[17]

Poster making in undergraduate courses

The students can be involved in designing academic posters on various topics of pharmacology. The topic should be selected based on the relevance of topics to the common problems and community. A group of 3–4 students can be assigned to one teacher. The time allocated is usually 2 weeks. The students discuss with their allocated teacher and start building a concept for the poster. The students work together in a group, and teachers facilitate their work. A competition can be held for first 3–10 posters and students can be awarded for posters.[17]

Interactive lectures

The typical didactic lectures which are usually one-way communication can be made interactive using various techniques. These techniques can be asking questions in-between, optimal use of attention span of students, think-pair-share, brainstorming in small groups, debates, quizzes, multiple-choice questions, etc. Try to make lecture, a two-way communication using principles of adult learning. The adult learning principles include safe, nonthreatening environment, learner becomes an active contributor, builds on existing knowledge of students, use relevant content, problem-centered approach, self-directed learning, and constructive feedback.[45]

Integrated teaching

The teaching can be done in integrated fashion involving other subjects. In second year, pharmacology can be integrated with other subjects such as microbiology and pathology. The level of integration needs to be higher and not simply taking lectures on same topic by different subjects. The new upcoming curriculum by MCI has integrated modules to be used by all subjects.[15],[17]

Use of media

There is a huge scope for the improved use of audio-visual aids in pharmacology education. Visualizers that can project the drugs sample in three-dimensional (3D) shape are easily available and can be attached to projector. This can be used to demonstrate all drugs in 3D even in a large class. The teacher can manipulate the sample and show various aspects of the formulation. Social media, such as WhatsApp groups and E-mail groups, can also be used for particular topics.[17]


 » Conclusion Top


The present-day pharmacology education is quite different from yesterday's traditional way of teaching-learning pharmacology. Continuous updates are the need of the hour in pharmacology education for rational, safe, affordable drugs, and better patient care. The adoption of newer and innovative methodologies in teaching methods and assessment methods along with training of faculty can help to refresh pharmacology education as per the needs of the present social media savvy students. The challenges to pharmacology education include shifting gears for teachers from information providers to facilitators so that the students become life-long learners. The students prefer to use online media a lot, which needs to be channeled in the right direction to optimize its use in education.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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    Figures

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

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