Evaluating student understanding of pharmacodynamics core concepts.

Pharmacodynamics is an essential subdiscipline of pharmacology that underpins safe and effective prescribing and therapeutic decision-making, as well as drug discovery and development. The exponential increase in the number of therapeutic drugs has prompted members of the pharmacology educator community to question existing pharmacology curricula focused on individual drugs and move toward a curriculum focused on conceptual understanding. A first step towards conceptual understanding is to establish what students currently know about pharmacodynamic core concepts. A total of 218 students from 10 universities were invited to complete a questionnaire that assessed their understanding of drug efficacy, drug-target interaction, drug tolerance, and structure-activity relationship. Pairs of pharmacology experts independently assessed each student's response and flagged any misconceptions that arose. The experts then compared their evaluations, achieved a consensus decision, and grouped the misconceptions into themes. Less than 25% of students provided core concept meanings that fully aligned with those of the expert group. By contrast, more than 75% of students could apply the core concept to a novel scenario at least in part. Overall, 480 misconceptions were identified and grouped into 55 misconception themes. The concept of drug efficacy was the core concept with which students struggled most. It is unclear why students were better able to apply their knowledge than to define the core concepts, although this might reflect a focus on active learning in pharmacology courses globally. The deficits in defining and understanding pharmacodynamic core concepts, and the misconceptions revealed in student responses, can be used by educators to guide their efforts.