The Georgetown researchers surveyed 105 directors of third-year internal medicine clerkships (programs for medical students), and the directors of 420 internal medicine residency programs (post-MD degree training), choosing internal medicine programs because “internal medicine programs train future physicians to care for patients with complex medical problems usually necessitating use of multiple medications,” they reported. “This type of patient would be prone to experiencing an adverse drug reaction.”
Each program director completed a two-page survey that asked questions about the percentage of their institution’s curriculum dedicated to adverse drug reactions or interactions. They were also asked whether they felt that these topics should be added to the curriculum if not already included; and about their familiarity with a widely publicized Institute of Medicine report on medical errors.
The Georgetown study found that 53% of the medical schools did not offer training in clinical pharmacology or adverse drug reactions to third- and fourth-year medical students, and of those schools at which such training was available, only 8% of these rotations were mandatory. While more than 60% of residency programs offered lectures in adverse drug reactions, 25% of residency program directors surveyed had never reported an adverse drug reaction, the study found. Additionally, 23% believed adverse drug reactions were difficult to report, and 18% did not review adverse drug reactions during their regular mortality and morbidity conferences.
The study also found that while many medical educators were willing to incorporate courses in clinical pharmacology, including the study of adverse drug reactions, into their curricula, they themselves lacked training in the field.
Educators have little incentive to incorporate clinical pharmacology into their curricula, the study concluded, because this discipline is not included as an independent topic in the medical licensing examinations that all American physicians must pass, nor is it included in the specialty certification examinations for internists. And “despite results of studies revealing that involving clinical pharmacists as part of the health care team results in improvements in health care outcome, fewer than 50% of internal medicine residents are exposed to this expertise and culture,” the study reported.
The majority of respondents to the study survey indicated a willingness to incorporate drug reaction education into their curricula if educational modules were available. Georgetown researchers, in collaboration with the U.S. Food and Drug Administration, have recently developed such a module for use in medical schools and residency programs. This was done as part of Georgetown’s mission as one of seven Centers for Education and Research on Therapeutics (CERTs) nationwide. CERTs were created by the Agency for Healthcare Research and Quality, an agency of the U.S. Department of Health and Human Services, to improve the outcomes and quality of health care, reduce its costs, address patient safety and medical errors, and broaden access to effective services.
Support for the study published in Clinical Pharmacology & Therapeutics was provided by the National Institutes of Health (NIH) and the Agency for Healthcare Research and Quality (AHRQ). The study authors were Curtis J. Rosebraugh, MD, MPH, medical officer in the FDA Division of Pulmonary and Allergy Drug Products who led this research during a clinical pharmacology fellowship at Georgetown; Peter K. Honig, MD, MPH, director of the FDA’s Office of Postmarketing Drug Risk Assessment and clinical assistant professor of medicine at Georgetown; Sally Usdin Yasuda, MS, PharmD, assistant professor of pharmacology at Georgetown; John C. Pezzullo, PhD, associate professor of pharmacology and biostatistics at Georgetown; and Raymond L. Woosley, MD, PhD, former associate dean for clinical research at Georgetown, currently vice president for health sciences at the University of Arizona Health Sciences Center, and director of the Arizona CERTs (which was formerly at Georgetown).
Georgetown University Medical Center includes the nationally ranked School of Medicine, School of Nursing and Health Studies, the Lombardi Cancer Center and a biomedical research enterprise. For more information, visit www.georgetown.edu/gumc.
Journal
Clinical Pharmacology & Therapeutics