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E-DRUG: Re: Lack of Impact from Undergraduate Prescibing Training

Dear colleagues,

I do agree with Richard Laing in the opinion that undergraduate training has
(possibly) low impact in precribing behaviour later on, under the "real"
working conditions. In fact, most practitioners do learn therapeutics from
the 2nd year residents.... or other young peers. But the whole question
is about what do really mean by "rational prescribing", "Rational use of
drugs" or even "Good Prescribing Practices". The inter-country differences
in drug prescribing, as observed through multiple Drug Utilization Studies,
show such a big differences in the therapeutic traditions from one country
to another, or even in regions withina country, that the "international
consensus" something are just a kind of "gold standard" at, approximately,
the same distance as ... heaven!. There are more cultural, social -anthropo-
logical- factors influencing drug prescribing that changes in morbidity or
mortality. May be the training of pre-graduate (and post-graduate) students
should be directed to teach the skills for a critical evaluation of the new
medication, and to "implement" on them the idea of a continuous revision of 
their therapeutic habits.

In this sense the work by the WHOPER and Theo de Vries is more directed 
toward teaching the idea of self-selection, and self re-evaluation. We
ask our students on the last year of Medicine to prepare their own
"personal Formulary" with no more than 50 pharmaceutical specialities
(out of the 10.000 in the Spanish market). As this is evaluated for the
final score, the main topic for the students are not the actual therapeutic
regimens, or the appropriate treatment of certain conditions, but rather,
the criteria used for the selection of that particular presentation.

They will probably not follow that "Personal Formulary" more than few months,
but we hope to be able to teach them how to revise it every now and then.
It is hard to show any objective improvement, but the main question I would
put into the discussion is about the variables to be meassured to elicit
such improvement....

It is a hot and difficult topic, but very relevant for those dealing with
academical work.

Emilio J. Sanz, MD, PhD
Senior Lecturer in Clinical Pharmacology
Universidad de La Laguna
38071 La Laguna. Tenerife 
Spain
Tfno:+34 (9)22 603477, -71
Fax :+34 (9)22 655995 

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