Papers by L. Friedlaender
JAMA: The Journal of the American Medical Association, 2001
Adverse drug reactions are responsible for a considerable amount of morbidity and account for a s... more Adverse drug reactions are responsible for a considerable amount of morbidity and account for a significant number of patient deaths. 1,2 However, the extent of formal education in recognition, identification, and prevention of such events in US undergraduate internal medicine clerkships has not been recently studied. We studied existing curricula about adverse drug reactions and interactions in US internal medicine clerkship programs. Methods. We conducted a survey of all US undergraduate internal medicine clerkship programs in the spring of 2000. A 2-page, 1-stage survey instrument was sent to all internal medicine clerkship directors (N=105) identified by using the Clerkship Directory in Internal Medicine (CDIM) membership directory. Repeat surveys were sent to nonresponders. We chose internal medicine clerkship programs because, based on national averages, medical students spend an average of 12 weeks in this rotation, the most of any required clinical experience. 3 Also, the discipline of internal medicine trains future physicians to care for patients with complex medical problems that frequently require multiple medications, which may place patients at an increased risk of experiencing an adverse drug reaction. 4 The survey questions addressed adverse event curricula and learning experiences. We specifically asked about total lecture hours, rotations with formal adverse drug event instruction, clerkship directors' content knowledge of the Institute of Medicine report 1 on medical errors, and clerkship directors' willingness to add adverse drug reaction/interaction educational modules. Descriptive statistics were computed for each survey question. Questions were asked with 1 to 5 Likert scale responses in which response 3 was used as the midline "undecided" anchor. Results. Of the program directors surveyed, 79 (75%) responded. The mean average of total formal lectures on all topics was 32 (range, 0-160) hours. Sixteen percent of internal medicine clerkships had formal lectures on adverse drug reactions/ interactions. Sixty-five percent of the programs surveyed responded that they would incorporate 1 or 2 (mean average, range 1-10) hours of educational material on adverse drug reactions/interactions, if educational modules were available. Interestingly, 35% of clerkship directors had little or no familiarity with the Institute of Medicine report on medical errors, even though this survey was performed during a period of intense media attention in both the popular and scientific press. After reading a survey question that contained a brief summary of the report, 83% of the clerkship directors responded that heightened surveillance and training should occur as a method to decrease adverse drug reactions. Sixty-one percent of all respondents felt that a high-quality educational training module would be of value and they would incorporate it into their program. Seventy-eight percent of clerkship directors completely or closely follow CDIM/Society of General Internal Medicine core curriculum recommendations, which indicates that there is general consensus among clerkship directors regarding pertinent curriculum topics. Comment. The concept of "drug-induced illness" as introduced by Jick 5 in 1977 has received renewed attention. The results of this survey indicate that US medical students have little exposure to adverse drug reaction clinical curriculum during their internal medicine clerkship rotation. Many clerkship directors recognize this as a weakness in their program and indicate interest in incorporating educational modules into their programs.
JAMA: The Journal of the American Medical Association, 2001
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Papers by L. Friedlaender