Background

Pharmacovigilance is the “science and activities relating to the detection, assessment, understanding and prevention of adverse effects or any other drug related problems”. Nepal joined the international pharmacovigilance programme as a full member in 2007. KIST Medical College, Lalitpur, Nepal joined the national programme as a regional centre from mid-July 2008. Currently, the pattern and scope of adverse drug reactions (ADRs) in Nepal remains unexplored.

Aims

To observe and analyse the pattern of ADRs at KIST Medical College, Lalitpur, Nepal.

Method

A retrospective analysis of all ADRs reported to the centre from mid July 2008 to July 2011 was performed. Data was analysed for ADR severity, causality, and preventability.

Results

A total of 113 ADR reports were obtained from various clinical departments. The maximum number of reactions was due to antimicrobials, followed by anti-hypertensives and NSAIDs.

Conclusion

Antimicrobials were the commonest group of drugs causing ADRs and the most commonly seen ADR was maculopapular rash followed by diarrhea and vomiting.

Background

In Nepal, a developing country in South Asia, the number of female medical students has increased significantly.

Aims

The present study was carried out to explore perceived perceptions for this increase, study the perceived impact on teaching-learning activities, medical school infrastructure and possible perceived changes in the doctor-patient relationship.

Method

First, second and third year students were invited to participate in focus group discussions (FGDs). Fifty-four students were willing to participate. Twenty-five were from the first year, 20 from the second and 9 from the third year. The FGDs conducted over a 90 minute period were voice and video recorded. The groups consisted of both males and females from a particular intake. The findings were transcribed verbatim.

Results

Participants felt more female students were taking up medicine in the country because of more colleges opening in the cities and towns making it easier for female students to enrol in the course. Also parents consider medicine as a safe, noble and dignified profession for their daughters. Participants suggested women are more empathetic doctors and the doctor-patient relationship might become more patient-focused. Women doctors can serve as a source of inspiration and the overall impact on Nepal would be positive.

Conclusion

Participating students perceived the increasing number of female medical students may be due to changes in Nepalese society. This study was carried out only among three batches of students in a single medical school. Further studies among different batches of students and among interns in other medical schools are required. Studies among postgraduate students and doctors are also needed.

Medical schools have a major challenge in teaching students to choose and prescribe medicines safely and effectively. Problem-based learning based on national essential medicine lists and standard treatment guidelines has been strongly recommended to improve prescribing. In Nepal, pharmacology is taught during the first two years of the undergraduate medical course. At KIST Medical College, Lalitpur the Department of Clinical Pharmacology teaches students to use essential medicines rationally. Small group, activity-based learning is used during practical sessions. In this article the author lists the 10 basic competencies which students should have developed by the end of the pharmacology practical module and also describes a selection of activities with regard to a particular competency used during the practical module and an exercise used to assess these competencies during the practical examination.

Medical journals published in South Asia and other developing regions encounter many challenges. Often authors do not perceive that they have received a fair deal from the journals. In this article the author puts forward a few suggestions to strengthen medical journals in South Asia and also other developing regions.

KIST Medical College follows the curriculum of the Institute of Medicine, Tribhuvan University. The programme aims to produce socially responsible and competent physicians who are willing and able to meet the existing and emerging challenges of the national and international healthcare system. The first cohort of undergraduate medical students (MBBS) students was admitted in November 2008 and three cohorts including the one admitted in 2008 have been admitted at the time of writing. The basic science subjects are taught in an integrated, organ-system-based manner with community medicine during the first two years. I was appointed as the MBBS Phase I programme coordinator in September 2008 and in this article I share my experiences of running the basic sciences programme and also offer suggestions for running an efficient academic programme. The manuscript will be of special interest to readers running undergraduate medical programmes. The reader can understand our experiences in running the programme in adverse circumstances, learning to achieve greater integration among basic science, community medicine and clinical departments, obtain information about a community diagnosis programme and know about running special modules on the medical humanities and pharmaceutical promotion.

Background

Small group learning sessions are used in pharmacology at the KIST Medical College, Lalitpur, Nepal. Feedback about student behaviours that enhance and hinder small group effectiveness was obtained. This will help us improve the small group sessions and will also be useful to educators using small groups in other medical schools.

Method

The small groups were self-managing with a group leader, time-keeper, recorder and presenter. Small group effectiveness was measured using the Tutorial Group Effectiveness Instrument (TGEI) developed by Singaram and co-authors. The instrument was administered in June 2010 and key findings obtained were shared with students and facilitators. The instrument was administered again in August. The mean cognitive, motivational, demotivational and overall scores were compared among different categories of respondents in June and August. Scores were also compared between June and August 2010.

Results

A total of 89 students participated in the study in June and 88 in August 2010. In June, females rated overall group productivity higher compared to males. The cognitive and motivational scores were higher in August 2010 while the demotivational score was lower.

Conclusion

The small group effectiveness was higher in August after the educational intervention which utilised feedback about problems observed, theoretical considerations of effective small groups and how this information can be applied in practice.

Personal or P-drug selection teaches students to use impartial, objective information to make prescribing decisions. It is an important exercise recommended to reduce irrational prescribing and improve the prescribing behaviour of healthcare professionals. The exercise of P-drug selection has not been widely implemented in health professions schools in South Asia. This article describes the author’s personal experiences of P-drug selection teaching, learning and assessment in two Nepalese medical schools, Manipal College of Medical Sciences, Pokhara and KIST Medical College, Lalitpur.

This report outlines the content of a one-day workshop on Generic Medicines that was held at KIST Medical College, Lalitpur, Nepal on 13th December 2010, which was attended by 32 delegates from different institutions in Nepal, including pharmacists, pharmacologists and medical doctors. Right medicine, right patient, right dose, right frequency and duration, right information and right monitoring are conditions to be fulfilled for the rational use of medicine (RUM). The World Health Organization (WHO) defines generic medicine as ‘a pharmaceutical product, usually intended to be interchangeable with the innovator product, marketed after the expiry of patent or other exclusivity rights’. Economic factors, supportive legislation and regulation, public and professional acceptance and quality assurance are key enabling factors promoting use of generics. Increased patent protection for medicines and removing process patents is a key feature of new trade agreements and newer medicines for diseases like HIV/AIDS, tuberculosis and infectious diseases are likely to be more expensive. The Medicine and Therapeutics Committee (MTC) can play a key role in promoting generic medicine use in institutions.

Nepal being among the Least Developed Countries (LDCs) need not provide patent protection for medicines until 31st December 2015. Only a few ‘true’ generics are available in Nepal and there is huge cost variation in the price of different branded generics. Clinicians have concerns about the quality of medicines in general, substitution of poor quality brands by pharmacists and about therapeutic substitution. Generics have to meet the same regulatory requirements and be bioequivalent to reference preparations assuring their quality.