Should medical students learn to develop a personal formulary? An international, multicentre, randomised controlled study

Abstract

Objective: This study was performed to determine whether students who are trained in developing a personal formulary become more competent in rational prescribing than students who have only learned to use existing formularies.

Methods: This was a multicentre, randomised, controlled study conducted in eight universities in India, Indonesia, the Netherlands, the Russian Federation, Slovakia, South Africa, Spain and Yemen. Five hundred and eighty-three medical students were randomised into three groups: the personal formulary group (PF; 94), the existing formulary group (EF; 98) and the control group (C; 191). The PF group was taught how to develop and use a personal formulary, whereas e the EF group was taught how to review and use an existing formulary. The C group received no additional training and participated only in the tests. Student's prescribing skills were measured by scoring their treatment plans for written patient cases.

Results: The mean PF group score increased by 23% compared with 19% for the EF group (p < 0.05) and 6% for controls (p < 0.05). The positive effect of PF training was only significant in universities that had a mainly classic curriculum.

Conclusion: Training in development and use of a personal formulary was particularly effective in universities with a classic curriculum and with traditional pharmacology teaching. In universities with a general problem-based curriculum, pharmacotherapy teaching can be based on either existing or personal formularies.

Fig. 1

Study design: PF personal formulary group, EF existing formulary group and C control group. Clinical subjects: A essential hypertension, B osteoarthritis, C acute bronchitis and D gastroenteritis. Complexity levels: 1 straightforward case of a middle-aged adult patient, 2 patient with a contraindication to a generally accepted drug of first choice, 3 severe case and 4 case without effect of previous treatment and side effects

Fig. 2

Pre- and posttest scores for different prescribing skills of students from countries with a traditional curriculum (Yemen, the Russian Federation and Indonesia). PF personal formulary group (–), EF existing formulary group (.....), C control group (- -). Posttest scores are annotated, # = PF > EF