Enseñanza de la farmacología

Enseñanza de la farmacología médica y prescripción de medicamentos

Juan Carlos Morales Ruiz M.D.

Grupo de Pensamiento “Calidad de la Educación Médica”

Asociación Colombiana de Facultades de Medicina


Perfil del médico en Colombia

Un profesional poseedor de una sólida formación humanística filosófica, científica y social, fundamentada en aspectos pertinentes de las ciencias básicas generales, las ciencias básicas médicas, las ciencias clínicas, las ciencias sociales y de las áreas del conocimiento y la práctica clínica.



"Apto para el reconocimiento de situaciones de salud y para actuar en función de la promoción, prevención, diagnóstico, tratamiento y rehabilitación ... "



"Consciente de su responsabilidad de actualizar y mantener su idoneidad profesional de acuerdo con los avances del conocimiento y los progresos de la ciencia y la tecnología..."


Competencias en medicina

“…la tendencia de la educación médica gira en torno al fenómeno de la globalización y a la necesidad de incorporar en el proceso de formación de los futuros profesionales, competencias requeridas para el ejercicio de dicha actividad en los ámbitos local, regional, nacional y global..."


Competencias en medicina

Valores, actitudes, ética

Bases Científicas de la Medicina

Habilidades Clínicas

Salud Poblacional y Sistemas Sanitarios

Habilidades Comunicativas

Gestión de la información

Pensamiento crítico e

investigación


Competencias específicas

Valores, actitudes, ética

Bases Científicas de la Medicina

Habilidades Clínicas

Salud Poblacional y Sistemas Sanitarios

Habilidades Comunicativas

Gestión de la información

Pensamiento crítico e

investigación

√

√

√

√ √


Atención Primaria en Salud

“Asistencia sanitaria esencial basada en métodos y tecnologías prácticos, científicamente fundados y socialmente aceptables… y a un costo que la comunidad y el país puedan soportar, en todas y cada una de las etapas de su desarrollo con un espíritu de autorresponsabilidad y autodeterminación…”

OMS Declaración de Alma Ata. 1978


“La farmacología constituye la base esencial para la terapéutica, por tal razón su enseñanza dentro de la formación de médicos y profesionales de la salud posee una importancia relevante y se sitúa dentro de las disciplinas que tienen una incidencia determinante en la calidad del profesional de las ciencias médicas”

Congreso Educación Médica para el Siglo XXI.” Hacia la equidad en salud”. Simposio Educación en Farmacología. La Habana (Cuba) 2014


En el año 1970, se publica el informe técnico 446 de la OMS, “Farmacología Clínica: actividades, servicios y enseñanza”, en el que se recomienda el desarrollo de la especialidad como una disciplina integrada en los sistemas de salud…”

Sociedad Española de Farmacología Clínica. 2015. Disponible en internet en:http://www.se-fc.org/gestor/la-sociedad/que-es-la-farmacologia-clinica.html

http://www.se-fc.org/gestor/la-sociedad/que-es-la-farmacologia-clinica.html


En 2012, se publica la actualización de este documento, bajo el nombre “Clinical pharmacology in health care, teaching and research”, en la que se resalta la importancia de focalizarla en el cuidado de la salud.

M. Orme, F. Sjoqvist, D. Birkett, et al. Clinical Pharmacology in Health Care, Teaching and Research. D. Abernethy, K. Brosen, I. Cascorbi (Eds.), et al.WHO, CIOMS and IUPHAR (2012). Clin Ther. 2015; 35 (8): e123.


Una investigación llevada a cabo en 31 países de la Unión Europea en 2013, identificó una debilidad muy importante de la farmacología clínica en el cuidado de la salud, particularmente en la promoción del uso racional de medicamentos.

M. Orme, F. Sjoqvist, D. Birkett, et al. Clinical Pharmacology in Health Care, Teaching and Research. D. Abernethy, K. Brosen, I. Cascorbi (Eds.), et al.WHO, CIOMS and IUPHAR (2012). Clin Ther. 2015; 35 (8): e123.


“For most physicians, drug therapy is the main tool at their disposal to influence the health of their patients. New graduates are typically expected to start prescribing drugs regularly as soon as they begin their first medical post…”

Clinical Pharmacology in Health Care, Teaching and Research. D. Abernethy, K. Brosen, I. Cascorbi (Eds.), et al.WHO, CIOMS and IUPHAR (2012).


“Prescribing drugs is a skilled task that always carries a risk of significant harms as well as benefits”



“It is clear that all medical graduates should have a firm grounding in the principles of practical prescribing, as underpinned by the science of clinical pharmacology, at the point of graduation, as the basis for rational prescribing”



“The primary determinant of the effectiveness of a prescriber in most areas of practice will be the education and ability of a prescriber to respond to changes in pharmacotherapy”



“Several studies have shown that lack of training and familiarity with drugs among prescribers is an important factor in serious medication incidents”



“The core content can be conveniently divided into knowledge and understanding, skills and attitudes with emphasis on critical drug evaluation”



“Most of the outcomes [in pharmacology] are generic requirements for the safe and effective use of drugs in all areas of clinical practice.”



“These core learning objectives can be linked to a number of specific drugs and therapeutic problems which might be used to provide relevant clinical examples of the principles of CPT in practice.”



“One [organization]model is to focus teaching on a selected list of the most commonly prescribed 50–100 drugs that will be influenced by the pattern of disease in the country concerned these.”



“CPT and prescribing (or equivalent) should be identified as an important component of the curriculum, visible to students in all years, either as an identified course itself or a theme that integrates with other modules.”



“Core learning objectives [in CPT] should be clearly identified including knowledge and understanding about drugs, skills related to the prescribing of drugs and attitudes towards pharmacotherapy.”



“The factual burden posed by the large number of drugs should be eased by prioritising learning around a core list of commonly used drugs (a ‘student formulary’), similar to the process used by the WHO in developing their ‘Essential Drugs’ policy.”



“There should be an identifiable and robust assessment that indicates whether the main learning objectives have been met, this might form part of an integrated assessment but it should not be possible to compensate for a poor performance in this area by a good performance in other items.”



“Traditionally, the teaching of pharmacology in medical schools follows a discipline-based and lecture-based approach with a heavy emphasis on acquiring factual knowledge concerning drugs and does not train the medical students adequately in their therapeutic application” [1, 2]

1. R.P. Shankar, A.K. Dubey, S. Palaian, M. Pranaya, A. Saha, V.Y. Deshpande. Favorable student attitudes towards pharmacology in a medical college in western Nepal. JIAMS, 15 (1) (2005), pp. 31–38.

2. S. Maxwell, T. Walley . Teaching safe and effective prescribing in UK medical schools: a core curriculum for tomorrow's doctors. Br J Clin Pharmacol, 55 (6) (2003), pp. 496–503


“… the need for improved education in clinical pharmacology is clear, the fact that assessment methodologies in pharmacology for medical students have shown little change during the past several decades suggests that little is known regarding how to accomplish such improvements”

Maxwell S, Walley T. Teaching safe and effective prescribing in UK medical schools: a core curriculum for tomorrow's doctors. Br J Clin Pharmacol, 55 (6) (2003), pp. 496–503


“Changes in pharmacology teaching are being driven by various pressures such as from changes in the discipline itself from the government, from the professional load, from student, from changes in teaching styles…”

Anuradha J, Mayank T. Innovations in pharmacology teaching. Int J Pharm Biomed Res 2010, 1(2): 62 - 64


Algunas tensiones


Diseño Curricular

• Cursos aislados / Asignaturas• Cursos Integrados• Núcleos problemáticos transversales• Otros modelos de organización


Plan de estudios

• Farmacología Básica• Farmacología Clínica• Terapéutica• Cursos integrados / Cursos asociados

Capellá D, de Abajo F, de Cos L et al. Teaching of Pharmacology, clinical Pharmacology and Therapeutics in Spanish Medical Schools. preliminary results. Clinical Therapeutics. 2015; 37 (8): e 17.

http://www.sciencedirect.com.ez.urosario.edu.co/science/journal/01492918



Contenidos temáticos

• Bases farmacológicas / Terapéutica• Farmacovigilancia• Farmacoeconomía• Aspectos éticos




• Seguridad del paciente• Investigación y Desarrollo• Terapéutica basada en la evidencia




• Medicamentos genéricos vs medicamentos “de marca”• “Terapias complementarias”• Nuevos medicamentos



Estrategias didácticas

• Clases magistrales• Talleres de aprendizaje significativo• Aprendizaje basado en problemas• Resolución de casos• Simulación


Estrategias de Evaluación

• Conceptualización• Aplicación de conceptos• Asociación / Discriminación• Resolución de casos


Innovaciones

“Several innovations in pharmacology teaching are already in vogue, for instance, problem based learning modules, computer assisted learning modules to create a virtual learning environment, seminar presentation by students as a part of integrated learning and poster making on descriptive topic”



Innovaciones

“The free pharmacology Teaching Resource Centre (TRC, http://www.coo.lumc.nl/trc) was created to illustrate drug action in the (patho)physiological context in a consistent way…”

Rissmann R, Messayeh J, Pinkaers JH et al. Pharmacology E-learning with the Mobile teaching resource center. Clin Ter. 2015; 37(8): e6.

http://www.coo.lumc.nl/trc


Innovaciones

“[…] films are of interest to illustrate how dugs (medicines) could be misused or abused. We think that the films can demonstrate the toxicological interest, usage patterns, consequences of their use and the ethical connotations that produce such practices in the domain of medicine and clinical pharmacology.…”

Mateus J. Pérez Mañá C, Papaseit E et al. Commercial Movies To Teach Non-Medical And Undesirable Use of Drugs. Clin Ter. 2015; 37(8): e 40 – 141.


Innovaciones

“Autobiography of a drug refers to student’s intellect on the knowledge of pharmacokinetic features of the drug. Example: I am one of the suppressors of gastric acid secretion. Many of my congeners are available in the market. I am to be given 30 minutes before meals and I am able to suppress acid secretion for 24 to 48 h..…” ¿Who am I?

Anuradha J, Mayank T. Innovations in pharmacology teaching. Int J Pharm Biomed Res 2010, 1(2): 62 – 64.


Innovaciones

“On the premise that all physicians prescribe drug therapy for the diagnosis, prevention and treatment of disease, and that pharmacology should be taught in the context that it will be used, it is rational to teach pharmacology and pathophysiology in tandem.”

Quest D. A Clinically oriented Approach To Teaching ‐ Medical Pharmacology. Department of Medical Education, Paul L. Foster School of Medicine. El Paso Texas University.


Innovaciones

“[…] a PKPD model, and PKPD modeling has become an essential activity in preclinical and clinical drug development and clinical drug usage, and it could be used as a good scenario on pharmacology teaching and learning”

Aarons L. The role of modelling and simulation in clinical pharmacology. Clin Ther. 2013; 35 (8): e 111.


Innovaciones

“One of the most important underpinnings of simulation education is the ability of instructors and centers to create a milieu where learners can ‘suspend disbelief’, permitting them to act in a manner that most accurately reflects the way they would act with a real patient.”

Donoghue A, Nishisaki A. High-fidelity in simulation education: Only a part of the answer. Resuscitation. 2015; 93: A3 – A4



Conclusiones

Formación médica vs ejercicio profesional: Una dicotomía por resolver

Nuevos desarrollo en el área vs actualización profesional: El papel de la academia.

Prescripción de fármacos vs autonomía médica: Las competencias de los médicos


Conclusiones

El rol del gobierno, los administradores, el paciente y la industria farmacéutica: Relaciones peligrosas

Aspectos éticos de la prescripción médica: conocimiento, autonomía, responsabilidad.

Enseñanza de la farmacología

Education

Transcript of Enseñanza de la farmacología