Department of Clinical Pharmacology and Pharmacy, VU University Medical Center, Amsterdam, The Netherlands.
Eur J Clin Pharmacol. 2010 Apr;66(4):407-12. doi: 10.1007/s00228-009-0743-3. Epub 2009 Nov 24.
Although the importance of rational prescribing is generally accepted, the teaching of pharmacotherapy to undergraduate medical students is still unsatisfactory. Because clinical teachers are an important role model for medical students, it is of interest to know whether this extends to therapeutic decision-making. The aim of this study was to find out which factors contribute to the drug choices made by medical students and their teachers (general practitioners and clinical specialists).
Final-year medical students (n = 32), and general practitioners (n = 29), lung specialists (n = 26), orthopaedic surgeons (n = 24), and internists (n = 24) serving as medical teachers from all eight medical schools in the Netherlands participated in the study. They were asked to prescribe treatment (drug or otherwise) for uncomplicated (A) and complicated (B) written patient cases and to indicate which factors influenced their choice of treatment, using a list of factors reported in the literature to influence drug prescribing.
Final-year medical students primarily based their drug choice on the factors 'effectiveness of the drugs' and 'examples from medical teachers'. In contrast, clinical teachers primarily based their drug choice on the factors 'clinical experience', 'effectiveness of the drugs', 'side effects of the drugs', 'standard treatment guidelines', and 'scientific literature'.
Medical teachers would appear to base their drug choice mainly on clinical experience and drug-related factors, whereas final-year medical students base their drug choice mainly on examples provided by their medical teachers. It is essential that medical teachers clearly explain to their students how they arrive at a specific choice of medication since medical students tend to copy the therapeutic drug choices from their teachers, mainly because of a lack of experience. Presenting students with clinical therapeutic problems early during undergraduate training will not only give them a chance to gain experience in solving medical problems but will also give meaning to what they are studying as opposed to merely reproducing what they learn or copying what they are told.
尽管合理用药的重要性已得到普遍认可，但医学生的药物治疗教学仍不尽如人意。由于临床教师是医学生的重要榜样，因此了解这是否会延伸到治疗决策是很有趣的。本研究的目的是找出哪些因素会影响医学生及其教师（全科医生和临床专家）的药物选择。
来自荷兰所有八所医学院的 32 名医学专业的最后一年学生、29 名全科医生、26 名肺病专家、24 名骨科医生和 24 名内科医生作为医学教师参与了这项研究。他们被要求为简单（A）和复杂（B）的书面患者病例开出治疗方案（药物或其他方案），并使用文献中报告的影响药物处方的因素列表来指示影响治疗选择的因素。
医学生主要根据“药物的有效性”和“医学教师的例子”来选择药物。相比之下，临床教师主要根据“临床经验”、“药物的有效性”、“药物的副作用”、“标准治疗指南”和“科学文献”来选择药物。
医学教师似乎主要根据临床经验和与药物相关的因素来选择药物，而医学生主要根据他们的医学教师提供的例子来选择药物。医学教师必须向学生清楚地解释他们如何做出特定的药物选择，因为医学生主要因为缺乏经验而复制他们教师的治疗药物选择。在本科培训早期向学生提出临床治疗问题，不仅可以让他们有机会获得解决医疗问题的经验，还可以让他们理解他们正在学习的内容，而不是仅仅重复他们所学的内容或复制他们被告知的内容。
