I am coauthor with principle author in some of article related to same subject. Principle author and myself has established Medicine and Therapeutic Committee (MTC) in KIST Medical College, one of the objectives of MTC is to promote rational use of medication in the teaching hospital. I was also facilitator on conducting sessions on pharmaceutical promtion module for second year MBBS students in year 2011. 

Teaching versus unethical marketing in rational antibiotic use implementation: review and comment

The article by Shankar et al. (2011) stressed on their experience in teaching Pharmacology using a problem based approach in the area of rational antibiotic use. Various aspects that were addressed i.e. “learning to use essential medicines rationally, the Personal or P-drug selection process, Understanding social issues in use of medicines, Understanding and responding to pharmaceutical promotion, Using independent sources of medicine information, Using antibiotics rationally, Analyzing prescribing using World Health Organization (WHO)/International Network for the Rational Use of Drugs (INRUD) indicators, Communicating with a simulated patient, Reporting adverse drug reactions (ADRs) and carrying out simple calculations in pharmacology”, were really of great importance. Moreover, examples of scenarios are also provided [1].

Moreover, the aspect of “understanding and responding to pharmaceutical promotion” [1] is very important, though unethical marketing may interfere with the implementation of rational antibiotic use, when the students have graduated and work as a doctor. It is a public secret that unethical marketing may affect prescribing, more than doctors realize [2], as well as affecting professional behavior, and even malpractice, [2-5] and therefore should be addressed in education, as well as policy [3].

Further, the aspect of “using independent sources of medicine information” [1] should be emphasized as Pharmaceutical company acquired research funding may influence the outcome of research [2].

However, the article did not describe the results of practical assessment s and did not analyze the result of this teaching method to know whether the method was successful in the theoretical implementation of rational antibiotic use by students. It was stated that “The practical assessment in pharmacology at the institution has been described in a recent article,” but the cited article only described the methods use in practical assessment without describing the results [6]. Even though, student feedback about the module that was published in another article has been positive, the validity and reliability of the questions in the questionnaire to measure the rational antibiotic use was not analyzed [7]. Moreover, the positive feedback may be due to the inclination of students during the basic science years to prefer studying clinical related sciences that make them feel as playing a doctor.

Finally, testing the results in the prescriptions of the graduates will provide a very valuable data on irrational antibiotic prescription and malpractice, to show whether appropriate teaching and learning method can compete with certain pharmaceutical company unethical marketing.

In conclusion, it will be better if information concerning the results of practical assessment is provided, and future study to obtain data on prescriptions and malpractice of the graduates will be conducted.

References

I am involved in developing of modules for problem based learning, resource person, lecturer and facilitator in PBL in the Fac. of Medicine Univ. of Indonesia, and also doing research in Medical education.

3. There are similar studies conducted in other medical schools

6. I think there is adequate information which is applicable at any Medical school

Such studies do help students to learn antibiotic prescribing,but then how much is used in their daily practise remains a query,because once the student becomes a intern(internship) they usually prescribe the drugs suggested by the consultant.

The aim of such studies are really good,but implementing this in really life situations does not happen most of the time.

Professor of pharmacology,Co-ordinator of pharmacovigilance and Convenor of Medical Education Unit

In our pharmacology practicals we teaching students to choose the antibiotics based on the culture sensitivity report and cost and discuss in detail the P drug selection

A good review article summarising the rationale of antibiotic usage. It would be reasonable to expand the same to include all drug prescriptions. The article may perhaps be classified under review article / expert review rather than as case report.

This is essentially a day-to-day practical issue when I do rounds, see patients in the clinic and write orders after surgery.

Good paper! Specially for developing countries.

I am professor of dermatology and always find problems similarly of these described.

This is a despcriptive rather than research based article but is a good description of an important area of medical education that deserves wide circulation. It give a comprehensive account of how rational antibiotic prescribing is taught in a new medical school in Nepal using appropriate guidelines and interactive teaching techniques.

In my opinion only minor corrections to the English grammar are needed to improve it.

As a General Practitioner I have to be continuously aware of local antibiotic prescribing guidelines in order to avoid contributing to resistance development. As a medical educator I have to consider how to best teach young doctors how to use antibiotics rationally.