Editor-in-Chief Hatice Kübra Elçioğlu Vice Editors Levent Kabasakal Esra Tatar Online ISSN 2630-6344 Publisher Marmara University Frequency Bimonthly (Six issues / year) Abbreviation J.Res.Pharm. Former Name Marmara Pharmaceutical Journal
Journal of Research in Pharmacy 2013 , Vol 17 , Num 3
The evaluation of prescription dispensing scores of the pharmacy students before and after the problem-based “rational drug use” course: Results of the two years' experience
Hale Zerrin Toklu1,2, Rümeysa Demirdamar2
1Marmara University, School of Pharmacy, Istanbul, Türkiye
2Near East University, Faculty of Pharmacy, Nicosia, KKTC
DOI : 10.12991/2013171312


Eczacıların ilaçların akılcı kullanımının sağlanmasındaki önemi büyüktür. Bu nedenle eczacılık fakülterindeki eğitimin farmakoterapi sürecinde problem çözme ve karar verme yetilerini kazandıracak nitelikte olması gerekir. Probleme dayalı yöntemlerle yapılan eğitim öğrencinin edindiği teorik bilgiyi uygulamada kullanma becerisini kazanmasına yardımcı olabilir. Bu çalışmada Yakın Doğu Üniversitesi Eczacılık Fakültesi'nde 3. Sınıf öğrencileri için 2011 ve 2012 yıllarinda açılan “Akılcı İlaç Kullanımı” dersinin reçete karşılama skoruna etkisi Türk Farmakoloji Derneği tarafından geliştirilen OSPE değerlendirme ölçeği ile araştırılmıştır. Öğrencilerin derse başlamadan önceki reçete karşılama skoru A grubundaki 34 öğrenci için 34.26 ± 13.6 ve B grubundaki 17 öğrenci için 34.94 ± 11.6 iken bu değerler kurs bitiminde yapılan değerlendirmede anlamlı olarak (p<0.001) artmış; sırasıyla 62.18 ± 13.0 ve 67.06 ± 15.6'a çıkmıştır. Simüle hasta kullanılarak probleme dayalı yöntemle yapılan farmakoterapi dersleri reçete karşılama davranışının iyileştirilmesi açısından yararlı gözükmektedir.


Pharmacists are healthcare professionals who dispense medications and are responsible of the patients's safe and effective medication use.

Traditionally the role of the pharmacist mainly consisted of compounding, but compounding functions were significantly reduced in the last decade, and replaced by the dispensing functions[1,2]. The mission of the pharmacy practice is to provide medication as well as other health care products and services, and to help people and society make the best use of their medication[3,4]. The role of today's pharmacists needs to be expanded to include pharmaceutical care concepts[5] which involves identifying, preventing, and resolving drug-related problems, as well as encouraging the proper use of medications, general health promotion and education, thus improving clinical outcome[6]. The changing role of the pharmacist as patient counselor/educator in the ambulatory setting must be taken into consideration for achieving a better outcome and thus provide the rational use of drugs[7,8]. Therefore new pharmacotherapy teaching models have been developed for teaching pharmacotherapy to pharmacists[4,9].

As in many developing countries, in the Turkish Republic of Northern Cyprus (TRNC) pharmacists have a distinct role in pharmaceutical care and patient education since many patients attend pharmacies as a primary care in the health system[10]. The need for qualified pharmacy services enforce for the improvement of teaching methods in pharmacy education. Pharmacy schools need to prepare programs that are competitive with the changing role of the pharmacist. Thus the education should provide ability for critical thinking, improve problem- solving skills and decision making during pharmacotherapy. Therefore students should be trained to create, transmit, and apply new knowledge based on latest research in the pharmaceutical, social, and clinical sciences; collaborate with other health professionals and enhance the quality of their patients' life thus resulting in improved health for people in our society as well as the global community[8,11].

In many countries, including Turkey and Northern Cyprus, pharmacotherapy courses are generally given as lectures by the pharmacologists in the medical and pharmacy schools. Some medical schools have developed new teaching methods (e.g. Groningen model) for promoting rational use of medicine among the prescribers[12]. These methods are also used in medical schools in Turkey[13,14].

However pharmacy students often face the similar problems as medical students in implementing theoretical pharmacotherapy knowledge into practice. Therefore, a novel pharmacotherapy teaching method based on simulated patients and evaluation of dispensing scores was developed by ‘Turkish Pharmacological Society'[9,15] and recommended to be used in schools of pharmacy in Turkey[9,16]. This novel pharmacotherapy teaching model has also been implemented at the Near East University, Faculty of Pharmacy TRNC since 2011[11].

At Near East University pharmacy education consists of 10 semesters. Pharmacology courses are completed by the end of 5th semester. The rational pharmacotherapy course was offered in the 6th semester and it was pre-acquisitive to the completion of the pharmacology courses. And the students have summer training at the end of the 4th semester. Therefore, the students were familiar with the drugs and patient counseling. However, the course aimed to improve behavior and possess attitude change in addition to knowledge. Thus, it was evaluated with pre and post-tests. The present study reviews the results of this two year experience.


The rational pharmacotherapy course is an elective for 3rd Year students (6th semester) of Near East University, Faculty of Pharmacy in TRNC. Of the eligible 2011 class 35 students (Group A) chose the course, but only 34 completed it. Of the eligible 2012 class 17 students (Group B) took the course and completed. The dispensing score of each student was calculated twice: in the pre-test (before taking the course) and posttest (at the end of the course).

The checklist used in the medical schools is called “OSCE (objective structured clinical examination). To develop teaching methods for pharmacy students, a model OSPE (objective structured practical examination) sheet (Appendix 1) for assessing the dispensing score of pharmacy students and pharmacists was prepared by the pharmacology lecturers of the ‘Turkish Pharmacological Society'[9]. “Rational Drug Use” courses employing this method (based on simulated patients and dispensing score) enables problem based learning and are also used by some of the schools of pharmacy in Turkey. The course was approved by the institutional educational board and has been included in the curriculum.

The checklist consists of three main parts:

1. The first part evaluates “checking the properties of the patient and the prescription”.

2. The second part is mainly for evaluating “the information supplied to the patient about his/her medical condition and the medication”.

3. The third part consists of the evaluation of “the communication skills of the pharmacist”.

The total score is 100 points.

OSPE sheet was validated and used in Rational Drug Use course in Marmara University School of Pharmacy. The previous experience showed that there were no significant difference between the scores of the independent evaluators.9 However, in the present study all ratings were done by a single trainer.

The trainer observed the dispensing and communication process between the patient (role player) and student. The grading system consisted of the following categories:

The communication skills grading was evaluated according to the interaction, use of professional vocabulary, language quality, fluency, pronunciation and presentation.

0 Lacks the features of an acceptable presentation.

1 Poor: Difficulty in keeping up with the discussion and contributes only occasionally. Frequent hesitations and pauses. Keywords are mispronounced, communication characterized by frequent inaccuracies and misunderstanding. Student is unfamiliar with the topic.

2 Moderate: Some structural weaknesses and only limited transitional elements. Basic level of acquaintance with the topic. Generally acceptable but often hesidant. Successful though limited in terms of accuracy. Some unresolved misunderstanding.

3 Good: Maintains contact with the audience. Level is appropriate, but the listener is not totally convinced that the presenter knows his/her topic well.

4 Excellent: Correct and adequate information is given confidently with a fluent, understandable vocabulary. Presentation is well structured, uses transitional elements, and follows the conventions of the field. Level is appropriate for intended audience.

Simulated patients were the role playing students of the Faculty of Performing Arts Department of Theatre.

During the course simulated cases are role played and discussed. The trainer acts as a facilitator. The students have to identify and solve the problem itself while the others are watching. The student has 5 minutes for each case and approximately an average of 15 minutes discussion is done afterwards. The students are allowed to use the computer based drug database (RxMediaPharma, Interactive Drug Information Source, editor Prof. Levent Ustunes, developed by Gemas Engineering) or pharmacotherapy books and drug lists. Educational intervention consists of combination of role playing, inquiring, decision making, counseling, brain storming and discussions.

SPSS for windows v 13.0 was used for statistical analysis. Student's t-test was done for comparing the pre-and post-test scores. Difference as P<0.05 was accepted as significant.


Before starting the pharmacotherapy course all students were subjected to a simulated case scenario and their dispensing behaviors were scored in accordance to the OSPE form (pre-test).

The results have shown that the average dispensing score of group A was 34.26 ± 13.6 in the pre-test, whereas it was 34.94 ± 11.6 for group B. After the completion of the course all students were again subjected to a simulated case scenario and dispensing scores were calculated (post-test). The average dispensing score were increased almost twice to 62.18 ± 13.0 and 67.06 ± 15.6 respectively in Group A and B at the end of the course (post-test). The improvement in the dispensing score was statistically significant (p<0.001) (Table 1).

TABLE 1: The dispensing scores of the students in Group A (n=34) and Group B (n=17) evaluated by Objective Structured Practical Examination

At the end of the course after the post-tests were done, a short questionnaire was given to the students. The students' opinions about the course are presented in Table 2.

TABLE 2: Evaluation of the rational use of drugs (RUD) teaching course in regard to the questionnaire (group A (year 2011): n=34; group B (year 2012): n=17)


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