Teaching Pharmacology in an Innovative Medical Curriculum: Challenges of Integration, Technology, and Future Training

The Flexner report of 19101,2 set the stage for significant improvements in the growth and development of the individual subject disciplines that made up medicine. Aided by the chip technology in the latter half of the century, research grew without bounds and with it the individual disciplines and the body of knowledge required from each to produce the composite, fit-to-practice medical doctor. This posed serious challenges with regards to accommodating the ever-increasing knowledge base within the fixed timeframe for training the medical doctor.3,4 This scenario has been described by many medical educationalists in very impressionable terms. Guilbert5 describes “curriculopathy” as a syndrome that arises from the failure of the curriculum to catch up with factors that influence training, such as the increasing body of knowledge, lack of relevance, predominance of basic and biological sciences, faculty attitude to teaching, cost, and the organization of the delivery of medical education. These challenges largely constitute the forces that gave birth to innovative medical curricula,3 classical among which is the problem-based learning (PBL) paradigm that was developed in McMaster, Canada, in the mid-1960s. With increasing awareness in medical education, other curricular notions have since emerged, including the hybrid PBL curriculum, outcome-based curriculum, concept-based learning, case-based learning, and task-based learning. A critical analysis of these educational philosophies reveals a significant overlap of concepts with most (if not all) deriving largely from or are basically variants of the PBL philosophy, or what we choose to describe as the “metoo curriculum.” The undisputable common goal of innovative curricula is the training of a tomorrow's doctor who enters medical practice with a holistic mind-set achieved through a curriculum regimen that emphasizes the horizontal and vertical integration of the basic and clinical sciences, respectively, while promoting lifelong learning skills through self-directed learning.6 Innovative curricula also emphasize the application of information and communication technology (ICT) in the teaching-learning process, with ICT being, perhaps, the main engine that drives information growth and access. It is our experience, however, that the implementation of these essential elements (integration and use of ICT) of innovation paradoxically portends challenges to the teaching/learning of pharmacology and its growth/development. These are challenges that all teachers of pharmacology and curriculum managers should be aware of. In this editorial exploring these challenges in the innovative (PBL) curriculum, we focus on the challenges of integration in the teaching of pharmacology, the challenges of ICT in the teaching of pharmacology, and the challenges of training tomorrow's pharmacologist. The concept of the integrated curriculum arose from the perceived weakness of the traditional curriculum to adequately promote the application of the basic sciences in the clinical context because of its dichotomous (preclinical-clinical divide) curricular arrangement in which the medical student is taught the individual basic science disciplines in the early phase and is expected to apply the knowledge in the latter (clinical) phase of the curriculum. The reality of the holistic nature of man in health and disease is what integration essentially aims to capture, and perhaps the only meaningful way to deliver this in a curriculum is to learn the basic sciences in clinical context as exemplified by the PBL philosophy and its tutorial process. Pharmacology delivers special skills, knowledge, and attitudes as part of a multidisciplinary-input medical curriculum.1 Its proper delivery cannot be taken for granted even in a traditional discipline-based medical curriculum and perhaps much less so in innovative curricula without the traditional departmental structures that protect and advance the interests of the discipline. The possibility of inadequate delivery of pharmacology creates serious worries, especially so with reports of morbidity and mortality in clinical practice traceable to inappropriate uses of medication, a consequence of poor prescribing skills, which, given that the goal of the medical pharmacology curriculum is the rational use of drugs, is attributable to a defective pharmacology curriculum.7,8 We assert that there is an increasing need for the pharmacology component of any medical curriculum to be clearly defined in terms of the input and expected outcomes that must be reliably and validly assessed as a prerequisite for medical school graduation—a view affirmed by various professional bodies.9,10 The objectives of the PBL paradigm are well captured by the SPICES curriculum model—an acronym that stands for self-directed learning, problem based, integrated, community oriented, electives, and systematic.11 In addition, the PBL paradigm emphasizes professionalism, including team spirit and communication skills. It promotes early clinical exposure (to enhance integration), small group teaching (for the tutorial process), lifelong learning, and ICT competency. The educational qualities of these goals, especially in the context of lifelong learning, are clear indicators that the PBL paradigm and other similar curricular philosophies are here to stay. Compared to the traditional teacher-centered, discipline-based curriculum, it is our experience that the goals of integration (the central theme of all innovative curricula) are indeed better achieved through the PBL paradigm. Our students and others12 aver, and we concur, that team spirit and communication skills are much better acquired through the PBL than the traditional lecture-based curriculum. The following are sample (students') quotes from our study in response to a question on perceived advantages of PBL over lecture-based curriculum:13 Makes me speak more. Brings out the best in a student (leadership qualities). Learning new knowledge from friend at “student level.” From the perspective of the discipline (pharmacology), however, the following questions always agitate the mind of the teacher: Where is pharmacology in the (PBL) curriculum? Who teaches it and by what delivery tool? How is it assessed? How are we growing the discipline? The rest of this editorial attempts to address these concerns. At the end of the day, the essence of any curriculum is that the learner learns (to acquire knowledge, skills, and attitudes required for prescribed outcomes/competencies). It follows, therefore, that resolving the challenge of where pharmacology is in the curriculum comes down to evaluating the factors/issues that may specifically affect the learning of pharmacology. These would include the following: How much of pharmacology objectives/outcomes have been prescribed for the students (the learning contract/syllabus)? How much of the syllabus has been delivered and how? How much of the delivered (and prescribed) have been learned with appropriate outcomes? This is perhaps the most important question, given (as stated above) that the essence of the curriculum is learning. How much of the delivered (and prescribed) have been validly and reliably assessed? The answers to these fundamental curricular questions begin with the provision of a detailed curriculum map that only few curricula can boast of. A curriculum map provides details of learning objectives, the teaching-learning activities, the sequence of their delivery, and the learning outcomes. It is an information base for all stakeholders, including students, teachers, and assessors/evaluators of the curriculum. 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