Descriptive title: Importance of transferable skills in pharmacology

Short title: Transferable skills and pharmacology

DR.P.Ravi Shankar M.D.

Lecturer

Department of Pharmacology

Manipal College of Medical Sciences

Pokhara, Nepal.

Mr.Pranaya Mishra M.Pharm.

Assistant Professor

Department of Pharmacology

Manipal College of Medical Sciences

Pokhara, Nepal.

DR.Praveen Partha D.N.B.

Lecturer

Department of Medicine

Manipal Teaching Hospital

Pokhara, Nepal.

Source of financial support: None

Manipal College of Medical Sciences,Pokhara,Nepal

DR.P. Ravi Shankar

Department of Pharmacology

Manipal College of Medical Sciences

P.O. Box 155

Deep Heights

Pokhara, Nepal.

Fax: 00977-61-22160

E-mail: mcoms@mos.com.np

pathiyilravi@rediffmail.com

Background: The increasing importance of self-learning in pharmacology places a greater responsibility on individual undergraduates to develop good ‘transferable’ skills. Objectives: To assess the attitudes of first year undergraduates towards transferable skills in pharmacology, and investigate gender, nationality and medium of instruction differences in these attitudes. To assess the contribution of integrated teaching to skills development. Methods: Second year students were given a questionnaire asking them to rate: a) the importance of the particular transferable skill in pharmacology; b) their own ability in these skills and c) the influence of integrated teaching. Results: All students regarded transferable skills as very important in pharmacology. Female students rated the importance of selection of drugs and communication skills more highly than men. Indian students rated the importance of communication skills higher than the other nationalities. Overall, students have a high level of confidence in their own skills. The Indian students rated their problem solving skills higher. The male students rated their skill at problem solving higher than women. The vernacular medium students rated their communication skills higher than the English medium students. Students felt that integrated teaching had enhanced their skills in pharmacology. Conclusions: Our results suggest that students are well equipped to succeed in the revised curriculum of Kathmandu university, Nepal which will place a greater responsibility on students for self-learning.

Key words: Attitude; educational measurement; learning; medical education; nationality factors; undergraduate; sex factors

Introduction:

The revised curriculum of the Kathmandu university, Nepal suggests changes in the teaching of pharmacology to undergraduate medical students. In keeping with global trends,(1,2) there is a proposed reduction in the factual content of medical courses and lecture based teaching and an increased emphasis on self-directed and problem based learning.

In pharmacology there is an increased emphasis on rational drug therapy, problem solving skills and an increased integration with the clinical disciplines. Communication skills have been given their rightful importance in the curriculum. Previous studies(3,4) have shown that students considered the pharmacology teaching they received to be mainly theoretical. Practising doctors thought that much more time and attention should be devoted to clinical pharmacology. Students in the problem based learning (PBL) class had a more positive attitude towards their learning environment and also they found PBL an excellent way to learn.(5)

The change in teaching and learning methods will place a greater responsibility on individual students to manage their own learning of pharmacology, and highlights the need for students to develop a good standard of transferable skills in pharmacology.

It has been reported that gender differences exist in the perception of their transferable skills in recent medical(6) and science graduates.(7) Similar gender differences have also been reported in medical undergraduates.(8) These differences may affect the performance of male and female students on courses which rely more heavily on self-directed learning. At the Manipal college of medical sciences, Pokhara, Nepal there are students from Nepal, India, Sri Lanka and also non-resident Indians. These students come from diverse cultural, socioeconomic and educational backgrounds. Any nationality or educational background differences in students’ perceptions of transferable skills, may affect the performance in pharmacology once the revised curricula is introduced.

The aims of this study are:

1. to assess the attitudes of second year undergraduates towards the importance of transferable skills in pharmacology, their level of competence in these skills and the impact of integrated teaching on students’ skill development
2. to investigate any gender differences in these attitudes
3. to investigate any nationality differences in these attitudes and
4. to investigate any influence of the medium of instruction at school on these attitudes.

A survey was undertaken on 96 undergraduates during the second half of the second year of their MBBS course. Students were asked to complete a questionnaire which asked them to consider 12 transferable (key) skills, grouped into three categories: problem solving; selection of drugs and prescription writing and communication skills (Table 1). The skills included in the questionnaire were those which will have a significant contribution towards successful completion of the undergraduate programme in pharmacology.

Students were given a brief explanation of the aims of the study but were not told that results would be analysed for gender, nationality and medium of instruction differences. For each listed transferable skill listed, students were asked to score using the following scoring system: 0 (no or least importance) and values from 1 to 4 in order of increasing importance. The students were allowed to use only whole numbers like 0,1,2,3 etc. The scores were in relation to three separate categories:

1. how important they considered the particular skill
2. how good they thought they were at this skill
3. how much the integrated teaching had helped to develop this skill.

Results were analysed using the SPSS statistical package and Mann-Whitney tests were performed as the test of significance.

70 students participated in the study. 31 female (44.3%) and 39 male students (55.7%) completed the questionnaire. The nationality-wise distribution of the students was: British 1 (1.47%), Indian 25 (35.7%), Nepalese 32 (45.7%) and Sri Lankan 12 (17.1%). 55 students were educated in English medium schools and 15 students in vernacular medium schools.

How important they considered this skill to be in pharmacology: All students were clearly aware of the importance of transferable skills in pharmacology. All three categories of skills had nearly similar ratings. Considering the individual skills within each category 'application of textbook knowledge' had a low rating within the category of 'problem solving' skills (mean=3.31 compared to group mean of 3.56). 'Rational prescribing' was rated to be the most important (mean=3.72) and 'format of prescription' the least important (mean=3.07) within the category 'selection of drugs' (category mean=3.49). The Indian students rated the importance of communication skills lower than the British, Nepalese and Sri Lankan students (p=0.038). The female students rated the importance of selection of drugs (p=0.024) and communication skills (p=0.026) more highly than the male students. The students from the vernacular medium schools rated the importance of communication skills higher than the English medium students (p=0.004).

How good they thought they were at this skill: In general, students have a high level of confidence in their transferable skills, scoring >2.5 in the main categories. The students considered their communication skills to have the highest rating and their skill at selection of drugs and prescription writing to have the lowest rating. However, the differences were slight. The students rated their own skills less highly than the importance of that skill in pharmacology. The Indian students rated their skill at problem solving more highly than the other nationalities (p=0.029). There is also borderline evidence of the Indian students rating their skill in drug selection and prescription writing higher than the other nationalities (p=0.058).

The male students rated their skill at problem solving more highly than the female students (p=0.005). The vernacular medium students rated their communication skills more highly than the English medium students (p=0.004).

How much the integrated teaching had helped to develop this skill: Students rated that the course had helped to develop their skills in problem solving and drug selection the most and in communication skills the least. Scores ranged from 2.77 to 2.96. Within the individual categories, 'relevance to practice' within the 'problem solving' section was considered by students to be the least affected by integrated teaching. Within the 'communication skills' section, the integrated teaching was least effective in developing 'empathy' (mean=2.38) and most effective in teaching about the delivery of drug related information to the patient (mean=2.98). There were no sex and nationality differences in the students' assessment of the influence of integrated teaching on skills development.

Importance of transferable skills: Students in this study demonstrate a high level of awareness of transferable skills in pharmacology. This could be due to the emphasis on the problem based approach to learning pharmacology. The other benefits of problem based learning (PBL) reported in an earlier study are use of additional learning resources, interdisciplinarity and making learning fun.(9,10) There should be a strong motivation to acquire, develop and practise these skills during the period of training in pharmacology. The students thus appear well equipped for the rigours of the revised curriculum of Kathmandu University with its increased emphasis on self-directed learning.

Students' perception of their own skills: The students generally had a high opinion of their own skills in pharmacology. However, this finding may also suggest that the undergraduates lack the experience to evaluate their own skills effectively.(11) Self- evaluation, an essential part of learning, is often neglected during undergraduate medical education. Self-evaluation improves students' insight into their own strengths and weaknesses.(12)

Influence of integrated teaching on skills development: Students felt that the integrated teaching had contributed to the development of their transferable skills in most areas of pharmacology, although the influence of the high student opinion of their own skills levels may have influenced the outcome. The low influence of integrated teaching on communication skill development might because of the use of simulated patients, conducting the exercise in English and lack of integration with the clinical sciences. The exercise should be allotted more time than what is being allotted at present (3 minutes).

Nationality differences: The higher importance attached to communication skills by the Sri Lankan students could be due to the higher proportion of women among the Sri Lankans as women have graded the importance of this skill higher than men. It could also be related to the higher level of literacy and social development in Sri Lanka as literate patients have higher expectations from their doctors.

Sex differences: The observation that females rate the importance of transferable skills in medical education more highly compared to the male students is similar to that observed in a previous study.(8) However in this study there were no sex differences as regards the students’ assessment of their own skill level.

Medium of instruction differences: A larger proportion of the Sri Lankan students were educated in their mother tongue as compared to the Nepalese and the Indian students. However, the unexpected finding that the vernacular students rated their communication ability higher than the English medium students is difficult to explain given the fact that communication skills are conducted in English on simulated patients.

Although a small study, the findings show that medical undergraduates have the awareness and self-confidence to succeed in a course that requires a high level of transferable skills in pharmacology. The students seem well equipped to tackle the challenges of the revised curriculum of Kathmandu university.

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Table 3: Nationality analysis of the influence of integrated teaching on skill development in pharmacology