Students learn how to develop a set of first-choice drugs, drawing on a wide range of
authoritative drug information. They are then shown how to apply these drugs to specific
patient problems. The approach is patient- rather than drug-oriented, with a strong focus
on effective and sensitive communication. Students not only learn how to how to select
drugs rationally but how to consult, understand and use existing treatment guidelines
intelligently, and where necessary, to adapt them to the individual patient. Further on in
their careers they will be subject to many other influences on their prescribing,
including scientific publications, commercial information and patient pressure. The manual
creates awareness of these influences and helps students to evaluate and make optimal use
of the information available. Audiovisual material is recognised to be a powerful
communication tool. India's Jawaharlal Institute of Postgraduate Medical Education - well
known for its commitment to rational drug use - is now using video to teach young doctors
to evaluate promotional practices and other sources of drug information. The audiovisual
training package, recently developed by the Institute, depicts an interaction between a
physician and two industry representatives. It provides a good basis for a lively,
structured discussion of ethical issues, based on WHO's ethical criteria for drug
promotion. The video and accompanying materials highlight the strengths and weaknesses of
different types of drug information, and their contribution to good clinical practice.
Access by physicians to continuing education is equally important, but is often difficult
for geographical and other reasons.
In Australia, Monash University's new distance learning package on rational prescribing
enables established doctors to increase their knowledge and skills at a pace and place
which they can choose. Originally developed as part of a Masters programme in family
medicine, the package can also be used as a stand-alone course. Audiovisual materials,
practice surveys, self audit and discussion of community perspectives are some of the
tools used to develop critical, analytical and clinical skills. Although developed in a
national context, the course has created considerable interest in neighbouring countries
and could easily be adapted.
On the other side of the globe, in the Netherlands, a national network of pharmacotherapy
counselling groups has taken root in the health care system. Backed by their professional
organizations and the Dutch Foundation for Efficient Drug Use, general practitioners and
community pharmacists, meet regularly throughout the country to discuss drug therapy and
develop local prescribing guidelines. The strengths of the groups lie in their capacity to
draw on the complementary skills of both the medical and pharmacy professions, and to have
a regular and established forum for communication and consensus building. In research,
close collaboration between those who identify the problems for study, those who conduct
the research, and those who are the potential users of the findings, is necessary if
research is to be relevant and usable. One district health team in a rural area of
Indonesia is using such a participatory approach to solve problems of drug misuse at the
local level. Its report shows how quantitative and qualitative tools, developed for a
research project, are now being used by health workers themselves for self-monitoring.
This approach is now being introduced into other districts.
A common thread running through all these initiatives is a focus on communication and
problem-solving skills within an interdisciplinary framework, rather than just rote
knowledge. This issue describes only a few of the educational activities that are part of
a welcome trend to move onwards from an outdated and narrow biomedical approach to
clinical practice, towards the development of broader based skills built on an
understanding of the many - not always scientific - influences on prescribing practice.
The acquisition of such skills is essential to achieve appropriate and evidence-based
therapeutic practice set firmly within a multidisciplinary and a community context.