Pharmacology Department, Lagos State University College of Medicine, Ikeja, Lagos, Nigeria.
BMC Med Educ. 2009 Jul 28;9:50. doi: 10.1186/1472-6920-9-50.
A sound knowledge of pathophysiology of a disease and clinical pharmacology and therapeutics (CPT) of a drug is required for safe and rational prescribing. The aim of this study was therefore to assess how adequately the undergraduate CPT teaching had prepared interns in Nigeria for safe and rational prescribing and retrospectively, to know how they wanted the undergraduate curriculum to be modified so as to improve appropriate prescribing. The effect of internship training on the prescribing ability of the interns was also sought.
A total of 100 interns were randomly selected from the Lagos State University Teaching Hospital (LASUTH), Ikeja; Lagos University Teaching Hospital (LUTH), Idiaraba; General Hospital Lagos (GHL); the EKO Hospital, Ikeja; and Havana Specialist Hospital, Surulere. A structured questionnaire was the instrument of study. The questionnaire sought information about the demographics of the interns, their undergraduate CPT teaching, experience of adverse drug reactions (ADRs) and drug interactions since starting work, confidence in drug usage and, in retrospect; any perceived deficiencies in their undergraduate CPT teaching.
The response rate was 81%. All the respondents graduated from universities in Nigeria. The ability of the interns to prescribe rationally (66, 81.4%) and safely (47, 58%) was provided by undergraduate CPT teaching. Forty two (51.8%) respondents had problems with prescription writing. The interns would likely prescribe antibiotics (71, 87.6%), nonsteroidal analgesics (66, 81.4%), diuretics (55, 67.9%), sedatives (52, 62.9%), and insulin and oral hypoglycaemics (43, 53%) with confidence and unsupervised. The higher the numbers of clinical rotations done, the more confident were the respondents to prescribe unsupervised (chi2 = 19.98, P < 0.001). Similarly, respondents who had rotated through the four major clinical rotations and at least a special posting (chi2 = 11.57, P < 0.001) or four major clinical rotations only (chi2 = 11.25, P < 0.001) were significantly more confident to prescribe drugs unsupervised.
Undergraduate CPT teaching in Nigeria appears to be deficient. Principles of rational prescribing, drug dose calculation in children and pharmacovigilance should be the focus of undergraduate CPT teaching and should be taught both theoretically and practically. Medical students and interns should be periodically assessed on prescribing knowledge and skills during their training as a means of minimizing prescribing errors.
为了安全合理地开具处方，需要对疾病的病理生理学和药物的临床药理学和治疗学（CPT）有深入的了解。因此，本研究的目的是评估尼日利亚本科生的 CPT 教学在多大程度上为他们的安全和合理处方做好了准备，并回顾性地了解他们希望本科生课程如何修改以提高适当的处方。还研究了实习培训对实习生开处方能力的影响。
从拉各斯州立大学教学医院（LASUTH）、伊凯贾；拉各斯大学教学医院（LUTH）、伊迪亚拉巴；拉各斯综合医院（GHL）；伊凯贾的 EKO 医院和苏鲁雷的哈瓦纳专科医院随机抽取 100 名实习生。问卷调查是研究的工具。问卷旨在了解实习生的人口统计学特征、他们的本科 CPT 教学、开始工作以来不良反应（ADR）和药物相互作用的经验、对药物使用的信心，以及回顾性地了解他们在本科 CPT 教学中可能存在的任何缺陷。
回应率为 81%。所有受访者均毕业于尼日利亚的大学。本科生 CPT 教学为实习生合理（66%，81.4%）和安全（47%，58%）处方提供了依据。42（51.8%）名受访者在处方书写方面存在问题。实习生可能会有信心地开具抗生素（71 人，87.6%）、非甾体类镇痛药（66 人，81.4%）、利尿剂（55 人，67.9%）、镇静剂（52 人，62.9%）和胰岛素和口服降糖药（43 人，53%），无需监督。临床轮转次数越多，受访者就越有信心进行非监督处方（chi2 = 19.98，P < 0.001）。同样，在四个主要临床科室轮转并至少有一个特殊岗位（chi2 = 11.57，P < 0.001）或仅在四个主要临床科室轮转（chi2 = 11.25，P < 0.001）的受访者在开具非监督处方时更有信心。
尼日利亚的本科生 CPT 教学似乎存在不足。合理处方原则、儿童药物剂量计算和药物警戒应成为本科生 CPT 教学的重点，并应从理论和实践两个方面进行教学。在培训期间，应定期评估医学生和实习生的处方知识和技能，以尽量减少处方错误。
