Undergraduate medical students as future prescribers: Enhancing their participation in adverse drug reaction reporting in India by revising the curriculum

Sir, Medicine has a paramount role in the health system. However, adverse drug reactions (ADRs) are a major limitation of its use. A study conducted in a tertiary healthcare setting in India observed that ADRs accounted for 0.7% of total hospital admissions and 1.8% of total deaths, although it could vary according to hospital setting.[1] The majority of ADR are preventable if identified timely and corrected promptly.[2] Healthcare professionals (HCPs) are important stakeholders in ADR reporting, and their knowledge, skills, and attitudes toward it have an important bearing on its success. Hence, there is a need for a curriculum review to extend active support for active learning of ADR reporting by future health professionals. A medical graduate in India can practice medicine after completing his internship. To ensure the safe use of medicines, he should have the required competency in identifying and treating any untoward occurrences associated with the use of prescribed medicines. “Catch them while young” is a popular phrase. It emphasizes the importance of a child’s formative years and how they have a bearing on a child’s later behavior. Hence, it is expected that if medical students are taught and trained in pharmacovigilance during their undergraduate period, it may positively influence their mindset toward reporting ADRs and the safe use of medicines. “Today’s boy is tomorrow’s man.” Today’s undergraduate medical student may lead a team of medical personnel comprising HCPs tomorrow. If the team leader possesses sound knowledge and positive intention towards patient safety and ADR reporting, he will motivate team members to get involved in pharmacovigilance, which will eventually promote the safe use of medicines. Studies conducted in India among undergraduate medical students highlighted their positive attitude toward ADR reporting.[3] However, it was observed that students lacked the required knowledge about pharmacovigilance.[3] If students lack basic knowledge about Pharmacovigilance (PV), they may not show any interest in ADR reporting. The competency of the students can be increased by incorporating the necessary PV training into the undergraduate study curriculum. A study curriculum describing desired competencies and learning outcomes and providing practical materials regarding prevention, recognition, management, and reporting of ADR is essential for undergraduate students. A study by van Eekeren et al. had outlined the objectives of the WHO PV core curriculum for undergraduate students. Those are: (1) Recognizing PV’s significance in the context of medication, (2) Avoiding ADRs if feasible, (3) Identifying ADRs as soon as they happen, (4) Handling ADRs, and (5) ADR reporting.[4] In India, most medical colleges follow a uniform study curriculum developed by the National Medical Commission (NMC). As compared to content-driven traditional teaching models, emphasis is now being placed on competency-based teaching models.[5] In both curricula, identification and reporting of ADR have been included. In both NMC and AIIMS, Bhubaneswar curricula, as well as the identification and reporting of ADR, have been included. The AIIMS, Bhubaneswar curriculum has also included causality assessment of ADR. Including a demonstration of VigiFlow software or first-hand experience in the study curriculum will go a long way in training ADR reporting. If the concerned medical college is not an AMC (ADR Monitoring Centre), then a visit to a nearby AMC can be arranged. Pharmacovigilance has received due importance in both curricula and covers more or less the different aspects as outlined by the WHO curriculum. However, there is a need for PV to go beyond the pharmacology classroom. Apart from receiving training in pharmacology classes about filling the ADR reporting form, students should also get an exposure to the clinical aspect of PV during their clinical posting in a real-life hospital setting. They should be exposed to reporting an actual ADR, assessing causality of ADR reports, etc., which will help them understand the complexities of PV and empower them to report. Indian Council of Medical Research has a unique measure in the form of a short-term student project to foster research among undergraduate medical students. Every year, it awards research grants to undergraduate medical students to conduct research. If something akin to this can be commenced for pharmacovigilance under the aegis of the Indian Pharmacopeia Commission involving undergraduate medical students, then it would certainly positively influence their behaviour toward ADR reporting. Currently, all the attention is focused on HCPs, and hardly any workshops or continuous medical activities are conducted to enhance the knowledge and skills of undergraduate medical students. AMC can regularly organise quizzes, debates, and other academic activities among undergraduate medical students at the institutional level in a week, termed “pharmacovigilance week,” to generate buzz among them. By developing PV competencies, we may take the first step in this journey of change. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.