Views of postgraduate students and postgraduates with reference to the competency-based postgraduate training programme for MD in pharmacology

INTRODUCTION

MD pharmacology as a specialisation course was established in 1950 in India. Due to the absence of a uniform curriculum, curricula designed by universities were focused on traditional learning and not competency-based skill development.^[1] In 2018, a common curriculum was devised by the Medical Council of India (MCI). This curriculum was competency-based which included knowledge, skills (practical, clinical, writing and communication), research and professionalism.^[2]

This curriculum focused on making pharmacologists competent not only in academics, but also pharmaceutical industry, clinical research, governmental institutions and scientific writing. The animal experiment component has been curtailed with clear guidelines. Teaching skills and clinical pharmacology skills have been given proper place.^[2] The desirable shift from animal-based studies to more relevant clinical exercises was taken into consideration.^[3]

This curriculum was revised as the revised guidelines for the competency-based postgraduate (PG) training programme for MD in pharmacology published by the PG Medical Education Board, National Medical Commission in 2022.^[4] There has been a major revision in the curriculum, which will be implemented in the near future.

The objective of the present study was to study the opinions of PG students and medical teachers with reference to the revised programme for MD in pharmacology.

MATERIALS AND METHODS

It was a descriptive cross-sectional questionnaire-based study conducted at S.B.K.S. Medical Institute and Research Centre, Sumandeep Vidyapeeth, Piparia, Vadodara. The study was initiated after obtaining ethical approval from the Institutional Ethics Committee.

All PG Students in MD pharmacology, PGs in MD pharmacology, and other medical pharmacology teachers of Medical Colleges in India, irrespective of their job profile, were included in the study. PG students and PGs in medical fields other than pharmacology were excluded from the study.

The differences in the guidelines for the curriculum of 2018 and 2022 were studied and summarised. Based on these differences, a questionnaire was designed. In the introductory part of the questionnaire, the individuals were informed regarding the confidentiality of the study and individuals who responded were included considering their implied consent to participate in the study. The summary of differences in the older and newer guidelines was shared for ready reference, along with links to the guidelines [Annexure 1].

The questionnaire consisted of 13 questions containing the designation, experience in years and place of employment [Annexure 2]. The other questions (closed-ended) were divided on the basis of domains of Research, Clinical Pharmacology, Assessment, Postings and overall impression. Two open-ended questions asked for pros and cons/suggestions for the better implementation of the guidelines. The questionnaire was validated internally as well as externally by pharmacologists.

The questionnaire was shared in the form of a Google link, which was sent by WhatsApp, Facebook, Gmail and SMS. The link for the Google form was kept open for 1 month, and the candidates were requested to share the message along with a link to the questionnaire with their colleagues. The snowball sampling technique was applied for the collection of data.

The sample size included all the responses (116) received within a month. The responses received were screened for the above selection criteria, and relevant responses were included in the study. The data were collected in the form of a Google sheet and analysed using descriptive statistics.

RESULTS

Table 1 displays responses of participants with regards to the changes in Research, Clinical Pharmacology domain and assessment. The inclusion of requirement of additional research project, training in Good publication practices and additional CMEs were considered essential by the responders. Similarly, inclusion of topics like functioning of the Drugs and Therapeutics Committee, Hospital formulary development, Drug information services, Medication error detection and mitigation advice, Antimicrobial resistance and antibiotic stewardship, Drug counselling as well as Emergency drugs used in crash cart/resuscitation were opined to be necessary. Also changes suggested in summative assessment were welcomed by majority of responders. The responses were similar irrespective of qualification of responders.

Responses of participants to other questions are displayed in Table 2. Addition of Case presentation, case work up, case handling/management in the Formative assessment were considered beneficial by the responders. The revised student appraisal form, although appraised by majority, scored lesser (78, 67.2%) as compared to responses to other questions. Similarly, mandatory rotational postings were considered not beneficial by half of Undergraduate responders (20), while 52 (68.4%) Postgraduates were in favour of the postings. Training in MEU and DOME were considered impactful in students overall growth by most of the responders. Inclusion of in vivo/in vitro animal experiments as desirable instead of mandatory was considered to be in alignment with present scenario by most of the responders. Most of the responders were not in the favour of DRP. It was opined by the majority that the revised programme was necessary and at the same time challenging to implement.

DISCUSSION

Due to non-uniformity, the older pharmacology curriculum devised by Universities in India was more oriented toward academics. However, there have been many advances in the subject and changes in guidelines for animal and human experimentation for both academics as well as research, which necessitated changes in the teaching curriculum of pharmacology. The focus of practical teaching in pharmacology has been shifted from animal and pharmacy-based studies to clinically pertinent pharmacology exercises.^[5] Various job profiles are expected from a pharmacologist in hospitals, the pharmaceutical industry and drug regulatory bodies.^[6] A pharmacologist has a varied role to play in academics, industry and research.^[7] The older curriculum did not include these requirements of the budding pharmacologist.

The present study was conducted to take the opinion of PG students and PGs in pharmacology with regard to the changes in the curriculum in MD pharmacology. Figure 1 shows distribution of participants with respect to their place of work and Figure 2 shows distribution of participants with respect to their qualification.

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Figure 1:

Distribution of participants with respect to place of work.

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Figure 2:

Distribution of participants with respect to their qualification.

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The inclusion of various requirements with respect to research, clinical pharmacology and assessment was considered essential by most of the participants [Table 1]. With regard to research, the inclusion of mandatory publication was likened to more exposure to research by some participants, while it was regarded by others as a non-productive task and could have benefitted more from Continued Medical Education. It was suggested that the overall focus on therapeutics, exposure to proceedings of ethics committees and research analysis was missing. Some participants felt that it would incur a financial burden on the students (not included in the table). Thus, although the changes in the curriculum for research were welcome, the opinions on mandatory publication and other requirements in research varied.

With respect to clinical pharmacology, the inclusion of topics of upcoming importance, such as drugs and therapeutic committee, hospital formulary development, drug information services, medication error detection and mitigation advice, antimicrobial resistance and antibiotic stewardship and drug counselling and emergency drugs, have been given importance [Table 1]. Some participants perceived that the curriculum is oriented to pharmaceutical jobs. However, others felt that it did not include Industry internship and lags job-oriented approach. Participants suggested a focused approach to Pharmacovigilance, Clinical Trial Exposure and Medical Marketing. The curriculum should focus on developing soft skills, including presentations, communication skills, decision-making, conflict resolution, project management, etc. Thus, although there have been changes in curriculum to include pharmaceutical requirements, these were perceived as insufficient by the PGs who worked in pharmaceutical industries.

Most of the participants supported the inclusion of training in the Medical Education Unit (MEU) in the curriculum. The training of medical teachers of India in MEU is mandatory for overall development as an academician. The PG students are future teachers and their training in MEU during postgraduation is a welcome sign. The uniformity in the summative and formative assessment was favoured by most of the participants [Table 2]. It was also suggested to include a common examination pattern for practical evaluation.

Most of the participants replied that animal experiments should be desirable and not mandatory [Table 2]. The use of simulation software and human studies instead of in vitro and in vivo studies in animals was supported by the participants. These opinions are in line with the changes in regulations of the use of animals for educational and training purposes by the Committee for the Purpose of Control and Supervision of Experiments on Animals and University Grants Commission^[8,9] while a few suggested not to exclude experimental pharmacology, while it is believed that one cannot learn pharmacology completely without animal experiments,^[10] The PG students may get acquainted with the essence of experimental pharmacology through simulation studies and save animals from unnecessary harm.

The majority of PG students were against Mandatory Rotational Postings as against the PGs. However, most of them opined that the 3 months District Residency Programme (DRP) was not necessary [Table 2].

These postings were perceived as a break in the teaching, and students with an inclination toward pharmaceutical jobs should instead be provided rotation duties to Pharmaceutical Companies. A few participants supporting these postings opined that it would give clinical exposure, promote active participation and help in practical application to the students. The participants opined that the structure of current health care needs to be modified to include the pharmacologist’s view in therapy. Thus, the inclusion of flexible postings as per the interest of the PG students instead of the stress of mandatory rotational postings and DRP may be more welcome.

To summarise, the participants felt the necessity of the new programme, but also opined that implementation of the new programme will be a challenging task. The pros of the new curriculum, as perceived by the participants, were that it is centred around personal performance growth, focused on teaching and clinical skills. The implementation of the new curriculum was perceived as challenging, and the need for guidelines for proper execution and summative assessment was felt. It also gives less importance to preclinical studies.

CONCLUSION

DRP, Mandatory rotational postings (by PG students) and Animal experiments were perceived to be unimportant in the new programme. The new programme requires more focus on job requirements in Pharmaceutical Industries. Otherwise, in the views of Pharmacologists, the new Curriculum is a welcome change.