The importance of active learning and practice on the students' mastery of pharmacokinetic calculations for the intermittent intravenous infusion dosing of antibiotics

Implementing a strategy for promoting long-term meaningful learning in a pharmacokinetics course

INTRODUCTION

The purpose of this paper is to describe the evolution and effectiveness of instructional strategies that were implemented over a seven-year period to enhance the authenticity of instruction and assessment in a pharmacokinetics (PK) course.

METHODS

Baseline data from 2011 and 2012 were analyzed to identify opportunities for improvement. In 2013 and 2014, lectures, PK workshops, and exam questions were modified to represent more authentic learning and assessment. Counter to expectations, 2013 and 2014 exam scores were significantly lower when compared to 2011 and 2012 scores. The course was modified further in 2015 to incorporate post-workshop quizzes that provided corrective feedback and required the use of retrieval as a learning strategy. Exam scores were compared across the three phases of course improvement (2011/2012 vs. 2013/2014 vs. 2015/2016/2017) using statistical analyses.

RESULTS

The average final examination score in 2011-2012 was 84.6%. After increasing the number of authentic assessment exam items, the average on the final examination in 2013-2014 decreased to 80.3% (p < 0.0001). Following the implementation of the post-workshop quizzes, the average final examination scores increased from 2015-2017 to 85.9% (p < 0.0001, compared to 2013-2014; p = 0.08, compared to 2011-2012).

DISCUSSION

Implementation of these evidence-based learning and instructional strategies (authentic learning, retrieval of new learning, and corrective feedback) was associated with higher student performance on the final examination over time.

CONCLUSION

These strategies may be valuable in improving student learning outcomes in other challenging professional program courses.

Perspective of Spanish medical students regarding undergraduate education in infectious diseases, bacterial resistance and antibiotic use

INTRODUCTION

One of the main tools to optimize antibiotics use is education of prescribers. The aim of this article is to study undergraduate education in the field of infectious diseases, antimicrobial resistance and antibiotic stewardship from the perspective of Spanish medical students.

MATERIAL AND METHODS

An anonymous online questionnaire was distributed among sixth grade students using different channels in Europe, within the ESGAP Student-Prepare survey. The questionnaire included 45 questions about knowledge, attitudes and perceptions about diagnosis, bacterial resistance, use of antibiotics and undergraduate training in infectious diseases. We present here the Spanish results.

RESULTS

A total of 441 surveys were received from 21 medical schools. A total of 374 responses (84.8%) were obtained from the 8 most represented faculties, with a response rate of 28.9%. Most students felt adequately prepared to identify clinical signs of infection (418; 94.8%) and to accurately interpret laboratory tests (382; 86.6%). A total of 178 (40.4%) acknowledged being able to choose an antibiotic with confidence without consulting books or guidelines. Only 107 (24.3%) students considered that they had received sufficient training in judicious use of antibiotics. Regarding learning methods, the discussion of clinical cases, infectious diseases units rotatories and small group workshops were considered the most useful, being evaluated favorably in 76.9%, 76% and 68.8% of the cases.

CONCLUSION

Medical students feel more confident in the diagnosis of infectious diseases than in antibiotic treatment. They also feel the need to receive more training in antibiotics and judicious antibiotic use.

ADAM, a hands-on patient simulator for teaching principles of drug disposition and compartmental pharmacokinetics

AIMS

To design, construct and validate a pharmacokinetics simulator that offers students hands-on opportunities to participate in the design, administration and analysis of oral and intravenous dosing regimens.

METHODS

The Alberta Drug Administration Modeller (ADAM) is a mechanical patient in which peristaltic circulation of water through a network of silicone tubing and glass bottles creates a representation of the outcomes of drug absorption, distribution, metabolism and elimination. Changing peristaltic pump rates and volumes in bottles allows values for pharmacokinetic constants to be varied, thereby simulating differences in drug properties and in patient physiologies and pathologies. Following administration of methylene blue dye by oral or intravenous routes, plasma and/or urine samples are collected and drug concentrations are determined spectrophotometrically. The effectiveness of the simulator in enhancing student competence and confidence was assessed in two undergraduate laboratory classes.

RESULTS

The simulator effectively models one- and two-compartment drug behaviour in a mathematically-robust and realistic manner. Data allow calculation of numerous pharmacokinetic constants, by traditional graphing methods or with curve-fitting software. Students' competence in solving pharmacokinetic problems involving calculations and graphing improved significantly, while an increase in confidence and understanding was reported.

CONCLUSIONS

The ADAM is relatively inexpensive and straightforward to construct, and offers a realistic, hands-on pharmacokinetics learning opportunity for students that effectively complements didactic lectures.

Individualized Hydrocodone Therapy Based on Phenotype, Pharmacogenetics, and Pharmacokinetic Dosing

OBJECTIVES

(1) To quantify hydrocodone (HC) and hydromorphone (HM) metabolite pharmacokinetics with pharmacogenetics in CYP2D6 ultra-rapid metabolizer (UM), extensive metabolizer (EM), and poor metabolizer (PM) metabolizer phenotypes. (2) To develop an HC phenotype-specific dosing strategy for HC that accounts for HM production using clinical pharmacokinetics integrated with pharmacogenetics for patient safety.

SETTING

In silico clinical trial simulation.

PARTICIPANTS

Healthy white men and women without comorbidities or history of opioid, or any other drug or nutraceutical use, age 26.3±5.7 years (mean±SD; range, 19 to 36 y) and weight 71.9±16.8 kg (range, 50 to 108 kg).

MAIN OUTCOME MEASURES

CYP2D6 phenotype-specific HC clinical pharmacokinetic parameter estimates and phenotype-specific percentages of HM formed from HC.

RESULTS

PMs had lower indices of HC disposition compared with UMs and EMs. Clearance was reduced by nearly 60% and the t1/2 was increased by about 68% compared with EMs. The canonical order for HC clearance was UM>EM>PM. HC elimination mainly by the liver, represented by ke, was reduced about 70% in PM. However, HC's apparent Vd was not significantly different among UMs, EMs, and PM. The canonical order of predicted plasma HM concentrations was UM>EM>PM. For each of the CYP2D6 phenotypes, the mean predicted HM levels were within HM's therapeutic range, which indicates HC has significant phenotype-dependent pro-drug effects.

CONCLUSIONS

Our results demonstrate that pharmacogenetics afford clinicians an opportunity to individualize HC dosing, while adding enhanced opportunity to account for its conversion to HM in the body.