Mission statement: Impart knowledge to use essential medicines rationally.

Chronology: Undergraduate MBBS course started in 1994 and MSc. Programme started in 2003 and MD programme in 2008


Facilities

Lecture halls with audiovisual aids (shared), student laboratories and departmental library.

Activities

Facilitating undergraduate medical students to learn how to use essential medicines rationally, facilitating postgraduate (MD/ MSc Pharmacology) students to learn to be good preceptors in medical schools. Drug information center and Pharmacovigilance center in the Manipal Teaching Hospital.

Services provided by the department

• Drug information services: The department runs a Drug Information Centre in the hospital which provides drug related information to the health care professionals and students of MTH and Western region of Nepal
• Pharmacovigilance activities: The department runs a Pharmacovigilance Centre in the hospital which collects the drug safety related information in MTH and Western region of Nepal
• Patient counseling activities: The department has a Medication counseling centre in the MTH that provides information on medicines, disease and lifestyle modifications to the patients visiting MTH
• Health clinic for the students (Sanjeevani clinic): The department runs a health clinic in the basic sciences campus (Deep campus) of MCOMS wherein the students are provided treatment for minor ailments

Learning methodologies:

• Didactic lectures
• Problem-stimulated learning
• During practical sessions
• Small groups of 7 or 8 students
• Multinational
• Activity-based
• Teachers act as facilitators

Special exercises for the students: Among the various exercises carried out are solving common clinical problems, critical analysis of drug advertisements and drug promotional materials, assessing the rationality of prescriptions, evaluating drug use according to WHO/INRUD prescribing indicators and role plays detailing the interaction between medical representatives and prescriber. Delivering drug and non-drug information to a simulated patient, selecting P-drugs (Personal-drugs) for common disease conditions, delineating drug use problems and possible steps for their solution are other exercises.

Evidence based medicine: The students visit the Drug Information Center (DIC) and become acquainted with different sources of drug information. The concept of Evidence-Based Medicine (EBM) is introduced and the students are taught how to solve specific problems related to medicines using the resources available in the DIC.

Patient counseling: The students also visit the Medication Counseling Center (MCC) and witness the patients being counseled regarding the use of various devices like metered dose inhaler, spacer, insulin pen, insulin syringe, rotahaler, suppositories, pessaries etc. Role plays are enacted by the students regarding counseling for common disease conditions. The student exercises are carried out in small groups and faculty members act as facilitators.

Topics like compliance and ways to improve it, adverse drug reactions (ADRs), ADR monitoring, and the various phases of testing before a drug can be introduced in the market. The randomised double-blind placebo-controlled clinical trial and the interpretation of the results of such trials are discussed. The learning process is problem stimulated and activity-based.

Pharmacovigilance: During visits to the Pharmacovigilance cell, the students learn about the system of spontaneous reporting for adverse events carried out in our hospital. The importance of ADR reporting is emphasised and we are happy that a few students have reported adverse events to the cell during the clinical phase of their training.

Community based pharmacology learning: Visits to primary healthcare institutions in the periphery are organised in collaboration with the department of Community Medicine of our institution and the Essential Medicines for different levels of primary healthcare delivery in Nepal are discussed. (The Nepalese primary healthcare system operates at three levels. The level of first contact is usually the sub-health post followed by the health post and the primary health centre. The lists of Essential Medicines for the three levels are different.) The working of the Community Drug Programme is demonstrated.

Critical analysis of drug advertisements: Analysis of drug advertisements is carried out as a group activity and the groups are given advertisements from medical journals or other promotional material to analyse according to the WHO Criteria for Drug Promotion. The strengths and weaknesses of the advertisement, the points covered and the percentage (approx.) to which it meets the WHO criteria are elicited.

The students plan out role plays of the interaction between Medical representatives (MRs) and prescriber. The role-plays are of around 4 to 5minutes duration. We stress on optimising time spent with MRs and the students are taught to take control of the discussion right from the start and to ask for monographs of the drug and compare the facts recited by the MR with those in the monograph.

Reference materials for various claims made should be provided. Emphasis is laid on not accepting free gifts and invitation to dinners and other events hosted by the industry. The different groups present their role plays and this is followed by comments from the house and the facilitators.

Communication skills: Communication skills training is carried out for common diseases or problems like tuberculosis, leprosy, scabies, hypertension, bronchial asthma, diabetes mellitus, oral and injectable contraceptives, diarrhoea, amebic dysentery, acid peptic disease, insomnia, malaria and epilepsy. One student acts as the doctor and another as the patient. We emphasise the use of simple, non-technical language. The doctor is expected to define the patients’ problem in simple language, suggest relevant lifestyle modifications and non pharmacological measures. He/ she is expected to make a proper choice of medicine/ s, take a drug history and tell the patients how to use the medicines. Common and important adverse effects should be covered. We teach the importance of feedback (where the patient repeats the doctor’s instructions) as a means of checking patient understanding. For devices like a metered dose inhaler or insulin pen the doctor is expected to demonstrate the correct use of the device to the patient.

Good prescribing: The WHO Guide to Good Prescribing, the Essential Drugs Monitor, How to Investigate Drug Use in Health Facilities and the National List of Essential Drugs are used as course material. Copies of the publications are accessible to the students.

The department publishes a quarterly Drug Information Bulletin which discusses various topics related to Rational Use of Medicines (RUM) and EBM and is often used as a reference material. For guidelines regarding the framing of clinical problems the Teachers Guide to Good Prescribing is used as a reference.

The students are assessed in RUM during the practical examinations in Pharmacology. Assessment of communication skills is carried out using standardised checklist and simulated patients. The students are asked to critically analyse a given drug advertisement, calculate prescribing indicators from the set of given prescriptions.

Assessing rationality of prescription: Exercises on assessing the rationality of prescriptions are also included. Writing prescriptions and solving common clinical problems are other exercises. RUM has been taught during the practical sessions in Pharmacology for over two years at our institution. Feedback obtained from the students through discussions and questionnaire-based surveys suggest that the students find the sessions on RUM interesting, informative and useful although there are no formal sessions on RUM during the clinical years of study.

It is recommended that training sessions on RUM for the interns and medical officers are taken up as a matter of priority. The sessions should be strengthened and continued during the clinical years of study.

Research activities in the department:

Core research area of the department members

• Pharmacoepidemiology
• Pharmacovigilance & drug safety
• Tuberculosis
• Rational use of medicines
• Complementary medicines
• Pharmaceutical promotion
• Patient counseling
• Pharmacoeconomics
• Medical Education
• Student research
• Drug information services

Post graduate research projects 

• A study of adverse drug reactions caused by first line anti- tubercular drugs used in Directly Observed Treatment, Short Course (DOTS) therapy in western Nepal, Pokhara by Ms. Anupa KC during the year 2005 
• Utilisation of intravenous fluids and intravenous medicines among inpatients by Mr. Sudesh Gyawali during the year 2006 
• Impact of educational intervention on pattern of drug - drug interactions in internal medicine wards of a Teaching hospital in Nepal by Ms. Durga Bista during the year 2006

 

Ongoing PhD research projects in the department

• Mr. P. Subish: Evaluation of the impact of Pharmacovigilacne program in Western Nepal Registered in : University Sains Malaysia, Malaysia 
• Mr. Dinesh K. Upadhyay: Evaluation of the Pharmaceutical care program for diabetes patients in a teaching hospital in Western Nepal. Registered in : University Sains Malaysia, Malaysia 
• Mr. Kadir Alam: Impact of educational intervention on more Rational use of Medicines. Registered in: Chulolongkorn University, Bangkok, Thailand.

Research projects carried out by the Faculty members of the department 

• Analysis of drug information services in a teaching hospital in Western Nepal 
• Drug utilisation in the intensive care unit of a teaching hospital in Western Nepal 
• Drug utilisation among pediatric inpatients in a teaching hospital in Western Nepal 
• Teaching ethical drug promotion using role plays
• Designing a spontaneous ADR reporting form: an exercise for medical students 
• Reading habits of medical students: a questionnaire based survey
• Student attitudes towards basic sciences 
• Teaching rational use of medicines: Student feedback 
• Medical student stress and coping strategies 
• Using postgraduate students as simulated patients during communication skills learning and assessment 
• Learning style of medical students 
• Activity based learning of pharmacology 
• Drug utilisation among outpatients in a teaching hospital 
• Teaching critical analysis of journal articles 
• Analysing rationality of prescriptions as a means to inculcating good prescribing habits 
• Drug utilisation among geriatric inpatients 
• Drug utilisation among surgical outpatients 
• Medical student attitudes towards the doctor-patient relationship 
• Fluoroquinolone utilisation among inpatients in a teaching hospital 
• Pattern and economic impact of cutaneous adverse drug reactions – an experience from the regional pharmacovigilance center, Western Nepal 
• Correct use of metered dose inhaler: a prospective interventional study among healthcare professionals in a Nepalese teaching hospital (In collaboration with Department of Medicine) 
• Price variation among oral hypoglycemic agents in a teaching hospital in Nepal 
• Postgraduate students as facilitators in problem-stimulated learning microteaching sessions 
• Diagnosing Abdominal Tuberculosis: A Retrospective Study From Nepal. (In collaboration with Department of Medicine)
• Knowledge, attitude and practice about diabetes among diabetes patients in Western Nepal 
• Impact Of Educational Intervention On Inhaler Techniques: A Pilot Study 
• Pattern of potential drug-drug interactions in diabetic out-patients in a tertiary care teaching hospital in Nepal
• Preliminary evaluation of use pattern of pneumococcal vaccine in a developing country- a study of 24 cases in a tertiary care hospital in Nepal
• Pattern of adverse drug reactions experienced by tuberculosis patients in a tertiary care Teaching hospital in western Nepal 
• Learning session on Disease mongering- Student feedback
• Drug utilisation pattern in dental outpatients in a tertiary care teaching hospital in Western Nepal
• Utilisation of cancer chemotherapeutic agents in a tertiary care teaching hospital in Western Nepal 
• Drug utilisation with special reference to antimicrobials in a sub health post in western Nepal
• Fluoroquinolone utilisation among inpatients in a teaching hospital in Western Nepal 
• Evaluation of the impact of pharmacist provided medication counseling in terms of patient perception, expectation and satisfaction with the pharmacists

 
Publications from the department: During the past five years the department has published nearly 250 articles in National and International Journals. The department also publishes a Quarterly Drug Information Bulletin for the health care professionals. The bulletin is circulated to the Faculty Members of MCOMS, healthcare institutions in Nepal and few agencies outside Nepal.

Achievement

The faculties of the department have presented several papers in national and international conferences. The department is also organising a Research methodology Workshop on ‘Social issues in the use of Medicines’ during 21st to 24th December, 2008.

Future plans, proposed expansion etc.

We plan to strengthen the post graduate courses (MD/MSc) by increasing the number of intakes and also by improving the research capacity and infrastructure of the department.