Revising Preservice Curriculum to Incorporate Rational Medicine Use Topics: A Guide
(2013; 90 pages)

Systems for Improved Access to Pharmaceuticals and Services (SIAPS). 2013. Revising Preservice Curriculum to Incorporate Rational Medicine Use Topics: A Guide. Submitted to the US Agency for International Development by the SIAPS Program. Arlington, VA: Management Sciences for Health.


Rational medicines use requires that patients receive medications appropriate to their clinical needs, in doses that meet their individual requirements, for an adequate period of time, and at the lowest cost to them and their community (World Health Organization 1985). However, irrational medicine use is a widespread and persistent problem. The World Health Organization (WHO) estimates that as much as 50 percent of global medicine use is inappropriate (WHO 2010). Poor medicine use can harm individual patients through treatment failure, for example, or can harm society, through the promotion of antimicrobial resistance (AMR).

AMR is a steadily growing global health crisis that leaves established first-line treatments ineffective at managing several significant infectious diseases, such as malaria, tuberculosis, and gonorrhea. Irrational medicine use is a major contributor to this problem. AMR, and therefore, poor medicine use, requires an urgent and concerted response from health workers at every level and across many disciplines. Future health professionals must receive training on AMR to gain the knowledge and skills to contain its development and spread. Recognizing this need, WHO recommends undergraduate training of health care professionals on AMR-related issues as a first-priority intervention in the Global Strategy for the Containment of Antimicrobial Resistance (WHO 2001).

In this guidance document, the concept of rational medicine use (RMU) also encompasses medicine safety or pharmacovigilance. The three areas of pharmacovigilance include product quality, adverse drug reactions, and medication errors. It is easy to see how RMU, pharmacovigilance, and AMR fit together, and topics associated with all three should be a part of any comprehensive preservice training program. When you see “rational medicine use” or “RMU,” in this document, we intend to include all three concepts.

These guidelines provide guidance for those who recognize the need to increase RMU training and seek to be change agents at their institutions—either individuals or groups, such as an official curriculum review board. Schools in resource-limited settings need a tool to assess RMU content in existing curriculum and to guide changes where necessary. These guidelines attempt to outline a simple but systematic approach to assessment and implementation of AMR curriculum that can be used in the context of an institution’s unique curriculum review process.

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