LIBRARY
MichiganState

University

{\ ’Il

*

 

 

This is to certify that the

thesis entitled
A COMPARATIVE STUDY OF CONTENT AND INSTRUCTION
OF BASIC PHARMACOLOGY AT MEDICAL SCHOOLS
IN THE REPUBLIC OF SOUTH AFRICA AND
THE STATE OF MICHIGAN

presented by

Hunadi Euphemia Mateme

has been accepted towards fulfillment
of the requirements for

 

 

M.S. degree in Pharmacology & Toxicology

 

 

Major professor

Dr. D. A. Reinke

Date 15 May 1985

0-7639 MS U is an Affirmative Action/Equal Opportunity Institution

 

 

MSU

LIBRARIES
m

~—

 

 

BEIQRILNGL WET LS :

Place in bypk H700 to
remove this rhocxout from
your record. EQNES will
be Charged if hook is
returned after tne date
Stamped below.

 

 

 

“a

A COMPARATIVE STUDY OF CONTENT AND INSTRUCTION
OF BASIC PHARMACOLOGY AT MEDICAL SCHOOLS
IN THE REPUBLIC OF SOUTH AFRICA AND

THE STATE OF MICHIGAN

By

Hunadi Euphemia Mateme

A THESIS
Submitted to
Michigan State University

in partial fulfillment of the requirements
for the degree of

MASTER OF SCIENCE

Department of Pharmacology and Toxicology

1985

IL“)

-_\. _.l
D I e

*7

ABSTRACT
A COMPARATIVE STUDY OF CONTENT AND INSTRUCTION
OF BASIC PHARMACOLOGY AT MEDICAL SCHOOLS
IN THE REPUBLIC OF SOUTH AFRICA AND
THE STATE OF MICHIGAN
By

Hunadi Euphemia Mateme

This study was designed to compare the content and
instruction of basic pharmacology of medical schools in the
Republic of South Africa (RSA) and the State of Michigan
regarding basic principles, depth, instructional strategies,
organization, specific drugs, prescribed texts, faculty and
facilities.

Data was obtained through correspondence, traveling
and interviewing, telephone calls, and reference to uni—
versity brochures and bulletins.

Major finding is that the teaching of pharmacology in
some of the medical schools in the RSA appears insufficient.
In addition, there is a serious shortage of well-qualified
pharmacology teachers. In some courses the organization does
not facilitate learning. In most RSA pharmacology courses,
principles are not reinforced throughout the course.

Funding of the pharmacology departments is inconsistent.

Some recommendations, central to which is the training

of basic pharmacologists, are made.

DEDICATION

To my deceased grandmother and namesake, Hunadi, my
deceased mother, and my father, for the outlook they gave
me which made this study possible.

To my children, Tghegwane, Masetopa and Mapulanyane,
who oftentimes did without their well-deserved mother's care
when this study was in progress.

To my teacher-husband, Mabu, who provided the insight
into the principles of pedagogy which this study required,
despite the fact that he has no knowledge whatsoever about

pharmacology.

ii

ACKNOWLEDGEMENTS

I wish to express my sincere gratitude to the Guidance
Committee members, Doctors T. M. Brody, D. A. Reinke and
J. E. Thornburg, who made this study possible. Special
appreciation is given to my mentor and Thesis Committee
Chairman, Dr. D. A. Reinke, for his invaluable advice,
encouragement, guidance and understanding throughout this
study.

I am also specially indebted to Dr. P. I. Folb
(University of Cape Town), for his encouragement, support,
and especially his supply of important information of which
I was not aware.

Gratitude is also expressed to the Michigan State
University's Urban Affairs Programs without whose graduate
assistantship this study would not have been done.

I wish to thank the Office of Medical Education,
Research and Development (OMERAD) and the Michigan State
University Office of Educational Programs for the valuable
ideas and suggestions contributed towards this study.

My unqualified appreciation is given for the full
cooperation I got from the Pharmacology Departments of
Michigan State University, University of Michigan, Wayne
State University, University of Cape Town, Medunsa, and
University of Natal. I also appreciate the partial

iii

cooperation of University of Pretoria, University of
Stellenbosch and the University of the Witwatersrand.‘

I am indebted to the full support given by the Lebowa
Department of Health and Social Welfare. I am further
indebted to the medical doctors who participated in the
interviews, for their professional input.

My gratitude is extended to the South African Pharma-
cological Society and the South African Medical and Dental
Council for their responses.

I wish to thank those students who provided the
"persevere spirit" for a foreign student throughout my

graduate study.

iv

TABLE OF CONTENTS

LIST OF TABLES
CHAPTER
1 OVERVIEW OF THE STUDY . .
1.1 Introduction . . . . . . . . . . .

1.2 Background Information

1.2.1 The Medical Schools of Interest

1.2.2 Bodies Governing the Standards
of Medical training

1.2.3 Admission Requirements .
1.2.4 Duration of Training

1.2.5 Stage (in years) at which Pharma-
cology is Taught . .

1.2.6 Degrees at the End of Training
Statement of the Problem

Purpose of the Study

Rationale for the Study

Limitations and Delimitations of the
Study 0 O O O O O O 0

Organization of the Study . . . . . . .

REVIEW OF SELECTED LITERATURE . . . .
Introduction . . . . . . . . . . .

Historical Background

10
12
19

20

25

27

28
28

28

2.6

On Teaching of Pharmacology . . .

On What Pharmacology is, Why

it should be taught,

Whom o o o o

and by

The Importance of Pharmacology In-
struction . . . . .

Curriculum Content

2.4.1

Curriculum Models

2.4.1.1

American Association

of Dental Schools'

model

2.4.1.2

2.4.1.2.].

2.4.1.2.2

2.4.1.2.3

The Faculty . . . .

Teaching Methods . .

2.6.1
2.6.2
2.6.3
2.6.4
2.6.5
2.6.6

2.6.7

Introduction

Lectures . .

Demonstrations

Laboratory Exercises

Discussions .

Seminars . .

Unsupervised Reading

vi

Association for Medi—
cal School
model

Pharmacology

Areas of
Pharmacology

Experimental
Laboratories
as Learning

Tools . . . .

Clinical
Pharmacology

4O

42
45

48

48

49

51

59

6O
62
7O
70
71
72
72
74
74

74

2.6.8

2.6.9

2.6.10 Audio-based Self-Instruction

METHODOLOGY OF DATA COLLECTION AND DATA

Project

Self-Instruction

ANALYSIS PROCEDURES

3.1 Introduction .

3.2 Research Questions .

3.3 Selection of Medical Schools

3.4 Type of Data and Collection Methods

3.4.1
3.4.2
3.4.3

3.4.4

3.5 Data Analysis Procedures

Correspondence
Travelling and Interviewing
Interview Questions

Telephone Calls,
and References

ANALYSIS OF DATA .

4.1 Introduction .

4.2 Summaries of the Syllabi

4.2.1

Michigan
4.2.1.1
4.2.1.2
4.2.1.3
RSA . .
4.2.2.1

4.2.2.2

O

MSU
UOM
WSU
UCT

MED

vii

Consultations

75

76
76
76
77
79
79
80

81

82

83

84
84
84
84
84
85
85
87
87

88

4.3
4.3.
4.3.
4.3.
4.3.
4.3.
4.3.
4.3.

4.4

SUMMARY,

5.1

5.2

5.3

Answers to

Summary of the Interview Answers

Introduction
Brief Review of the Study
Summary of the Major Findings - RSA

5.

3.

1

CONCLUSIONS AND RECOMMENDATIONS

1

A

First Research Question (basic

.2.

.2.

NAT

OFS

PRE

STE

WIT

Research Questions

principles)

Second Research Question (depth).

Third Research Question (in-
structional strategies)

Fourth Research Question (course
organization)

Fifth Research Question
(specific drug)

Sixth

Seventh Research Question
(pharmacology departments)

Findings Based on the Interviews
Conducted in the RSA

Research Question
(prescribed texts)

viii

Page
88

88
89
89
89

9O

9O

90

100

108

117

119

123

126

128
128
128

130

133

5.4 Summary
Michigan

5.5 Some Int
servatio

5.6 Conclusi

5.7 Recommen

APPENDICES, B
REFERENCES .

Appendix A -

Appendix B -
Appendix C -

Appendix D -

Appendix E -

Bibliography

General Refer

of Incidental Findings -

eresting Miscellaneous Ob-

ns I O O O O O O O O O O O O 0

Gus O O O O O O O O O O O O O

dations O O O O O O O O O O O

IBLIOGRAPHY, AND GENERAL

Data Collection Correspondence
(A1 “ A9) 0 o o o o o o o o o

The Syllabi (Bl - B15) . . . .
More on Depth (Cl — C3) . . .

Some Miscellaneous Exerpts
(D1 - D5) 0 o o o o o o o O 0

Diagrams in Aid of Abstractness
(El - E2) 0 o o o o o o o o o

ences O O O O O O O O O O O 0

ix

134

137

138

147

147
159

197

206

216

218

223

Table

LIST OF TABLES

3333
SOME DISSIMILARITIES IN TRAINING . . . . . . 3
ADMISSION REQUIREMENTS INTO MEDICAL SCHOOL . 4
THE M.D. (DOCTOR OF MEDICINE) DEGREE IN

SOUTH AFRICA . . . . . . . . . . . . . . . . 11
FACULTY WITH DOCTORAL DEGREES IN PHARMACOLOGY
DEPARTMENTS AT THE MEDICAL SCHOOLS . . . . . 14
SUMMARY OF THE MICHIGAN SYLLABI . . . . . . . 86
SUMMARY OF THE RSA SYLLABI . . . . . . . . . 91

BASIC PRINCIPLES IN PHARMACOLOGY (MICHIGAN) . 93
BASIC PRINCIPLES IN PAHRMACOLOGY (RSA) . . . 95
A SPECIFIC DRUG: CHLORAMPHENICOL (MICHIGAN). 101
A SPECIFIC DRUG: CHLORAMPHENICOL (RSA) . . . 104

CLASSIFICATION OF ANTIMICROBIAL DRUGS
(MICHIGAN) . . . . . . . . . . . . . . . . . 110

CLASSIFICATION OF ANTIMICROBIAL DRUGS (RSA) . 111

STE: CROSSING OF ANTIBIOTICS OVER THE

BLOOD BRAIN BARRIER . . . . . . . . . . . . . 116
PRESCRIBED TEXTS, MANNER OF USE, OTHER

SOURCES OF INFORMATION . . . . . . . . . . . 120
THE PHARMACOLOGY DEPARTMENTS . . . . . . . . 124

CHAPTER 1

OVERVIEW OF THE STUDY

1.1 Introduction

Few patients suffer from the inability of the

physician to remember all the bones in the foot,

but patients can suffer if the physician fails

to appreciate the dangers and inadequacies of

therapeutic agents that might prolong the

patient's life (Csaky, 1976, p. 935).

Sice (1975) points out that critics of current pre-
scribing practices have been concerned with means of improv-
ing pharmacological education. Similarly, this study has
been inspired by inadequate prescriptions the writer has
handled for some years as a hospital pharmacist in the Republic
of South Africa (RSA). This study focuses on the teaching
of basic pharmacology in medical school because the re-
searcher agrees with Sicé that the nature of the prescrip-
tion is to an extent indicative of the teaching of basic
pharmacology in medical school.

The teaching of pharmacology, like teaching in general,
resolves itself into the why, the what, and the how of in—

struction. Along with these, are the problems of whom to

teach and who should teach (Malherbe, 1964).

This study focuses less on the "ghgt" part of the
teaching of pharmacology because all the universities of
interest treat most of the topics known to be relevant to
the medical pharmacology of the time (see Appendices Bl -
B10). They differ only in detail and organization. For

" part, it is established that to prepare the medical

the "331
‘student for rational use of drugs, basic pharmacology should
be part of the curriculum; basic pharmacology is the basis
of therapeutics (Bucheim, 1876; Sapeika, 1964, 1965; Eales,
1964; Catzel, 1978; Charlton, 1978; Straughan, 1978; Offer-
meier, 1978; Schnieden, 1976; Botha, 1978). Concerning

the "how" part, this study focuses on the nature of the

instruction (curriculum)under:

1. the stage at which basic pharmacology is taught;

2. the organization of the topics so as to provide a co-
herent course that can be assimilated by students;

3. the detail, whether enough, too much or too few for
the medical student; and to a lesser extent on

4. the teachers.

The "ghgm" to teach is alluded to in the dissimilarities
between the training of the medical doctor in the RSA and
in Michigan (Table 1.1); and the admission requirements
into medical school (Table 1.2). The "by whom" is discussed
in the review of selected literature, and the discussion
of findings in this study. The literature is almost unani-
mous that the teaching of basic pharmacology is the domain

of the basic pharmacologist.

 

.owo~uomo~ :wumafiam
xufimcm>wcb Oumum maze:

Aucauueoz Lo tenuoav .o.z

mama» wwuzu mo Essflcfiz

ummz vacuum

mama» hzom
svaum sawmuo>wcs
uo memo; usow sanmu0wvum

mowmfiaoo amuwvoz emu
luums< mo COwumwuomm< och

ed coaszz
.HH osaao> .cduo_#:m
:awflcofiz mo sumfiuo>wcz OLE

AOCMOchz we Leuooav .n.:

memo» wouzu mo answcflz

Emma vacuom

memo; usom
xvsum augmuw>wcz
we when» mmuzu no uzom

venom
mofluompm Hmowvmz :mwfisowz

 

Asmzv :cozucuaam Emu
lace: mumscmumumcczz .N

:sz
:ofimmfievm doocom dmo
taco: new wcwumamum: .H

Aocauaamz Lo Louuoov .o.z

memo» manna mo answcfiz

Lam» ccoomm

memo» usom
xvsum
>u~mu0>fic= no acme» oeuzh

mowofiaoo Hmowcoz :mo
twuos< uo :ofiuafiuomm< one

sawmcm>wcs
come no AmumvcmamuV meOn umo>

Asumwusm we uofimzomm use
mewOflcoz we “camcommv .m.su.m.z

mnucos O>H03H

.aaco Lama vufizu :M

an euamu mew ecu .mao .e<z
.umw> nausea Ou

a: menace» 9H3 “Lama :uwww
Haas macaucou mum .am: .902
.qu> vcooom cw u“ mooszuu
1:“ Ho: “maoozom ecu no umos
um new; vufizu cw voozvouucw .H

N

.momuaoo Hmofivws
Iona cu“: mwummv m.»o~ozomm
a nu“: mumm> xfim cmcu mqu .N

.ANH mvohuv OH cumucmum
uwuuw meow» xwm mo Ezswcwz .a

momusoo amowvws
new; spa: omnmwv m.uo«o:omm
a no ANH mumuuv Hoozom nwwz

Auaz<mv afiucsou Hmucma
use amuwuoz =AUALL< zusom use

 

=m3

to:

3m:

«Hoogum Hansen: ~H<

 

cowumELOWCW
w>onm mo nowhsom

mcficumuu we ecu
um umuuwucou momuwwa

veauoa
awcmcu6ucm\>u:wvmmom

Amhmws afiv uzwsmu
ma awoaoumEumcm
sows: um wwmum

Amuse» :wv
mewcwmuu we cowumusa

Aomam
~.H wanes oomv meow»
ImuHuflHmsv oucwuucm

mcwmwcmum
mafiHHoLucou atom

 

z<o~=owz

<mm

emuH

 

oszH<xH 2H mmHHHm<AHszmHa mzom

H.H mam<e

.xuo3
uncumuonmw saw: mowmsza
wmumcmw no new» mac

.xuoz >u0umuoamw
mcwvswocw muse; xww

.mwnmuamoom mw
xuumwemco wOmeOwOwn
can >humwsoco wmo
lwmxca .mwmxwmcm m>wu
lmuwucmsc .mwmwwmcm

.xuoz
mucumLOQOH mcwvawo
law AmuwvmuoIEuOu av
muwvmquLOumewm xwm

.xuos secumucnmw
cw on umze Amuwvmuu
IELOH mv muwcmwo

mowmxnm .COwu
Isuwumcw co sawmum>wcs cm>0uq
lam umzuocw on Law» umuww ecu
cw .OBmcmm ecu an vmcwuov mm
vumvcmum :ww: mwucmwOwwwzm m
vwcwmuno o>mc on: mwuwvwvcmo
wmonu scum vouovwmcoo mw use;

 

 

w>wumuwwmsa cw sue: .m lcmummemm owns» .N ecooom eucw :Owumowwaam uomuwo .N
xuoz >u0u¢uo "spumwsmco Owcmwuo .cowumcwemxm ucwwm>waco uo cOwu
Inmw mo meson ovunu .N ccm owcmmuocw Lyon Imwsowuume ecu :w mcmcm uocww:
>u0umuonww saw: .Uwcmmuo wcwv:HOCw muwvwwu m um cmwwwcm use wo:Owom
xuumwawno uwcmwwo was was Owcmwuocw wmcwcmm lane» va muwvmuo xuumwemzo wmuwmxzm .>w0w6wm .mowumemzumz
Owcmwwocw we some new“ mac :uom .muso: ucmwm .w luwummewm uzwwm .w wwmuaou common w>mn umse mumvwvcmu .w H<z
.awOwme
vcm mocmwum wmonxnm awnmCOH
Iwua tam mowumswzums cw mama
cmuovwmcou mum a 305m umae Oumuwuwuumu 02H .N
zuzum muwmum>wca mo mummy .cowumwoommm cumom :Owumw36wuumz
«menu vOqunEoo w>wc 0:3 wmcowwOL muw an emuwv .mmwwwu m.u0wozomn m ucw0h on» so vaucmum :Owum:
ucwem>mwcom Owsmumum vcm Imuuum mw nOwcz Auwmuw> cu wcwummw ucmwm>w=cm twemxm :owumw:Owuums 0:» Beam
auwuaums wmzmsca we mucmv Iwcb no mwmwdou :wwnmcmu Lo .xcoz wmuaoo mo newuaeoxm wo eunuwwwupmu a no
Isum wwwmcowmmooc “ovum no .m.: m cw >n=um mane» omega vocmwcww vumom sewBMwsowuumz uchfi on»
new m.u0wwcomn w pounce mo Amuse: umumosmm Aoov swwswmmoouam m>mz umse avsum zuwmwm> wo aumowmwuuwu ANw wkuov Ow
w>mz umze mucmowwaq< when» omega ummOw u< mucmvsum kumooom ww< Iwc: Esswcwz vumccwum m o>mz amps mumvwvcmu .w mm:
=m3 :03 2m: ecuw mueoemuwaowm auwmuo>wcz
z<uH=Uwz cmm

 

aoo=Um A<Uwomz OFzH mkzmzmmwaomm onmeza<

N.w mqm<P

.ow eumccmum cw cmow

 

 

awe o 00
Awuwvocolscmu av wowucm lewmmca uo\cmm AwOwan co\vcu
III! III: muwcocoucwummewm wwm awOwocommm oucOwom mewm cm mmm cu vomw>
Ive zwwcocum mum mwumvwccmu .N
.mowumsmcumz cw mmma a
.ucme>w:vo 302m umss mumowwwuuou och
mOw co omcsoo wonwoo .vcmom cowBMw=Uwcumz uchH on»
accuoscOcucw wmsm: ecu Amuwvmconacmu av mo Ouwowwwuuou cOwuanxo cm
.wvsum cum» mco mo meson noumwsmm xwm muwcmcoILOUmeom m>wm cmwwwcm co mumuwwwucoo cOwumwcowuume
o o>mc umce mumvwccmu och .w whm
.wocozcmm thwowo .chwm >c~u0a
ecu cw on omwm waw uoc usp acmuom ccm
neauaeo co wmwumume weom >wo~oo~ cw mcsoc uOu
umcu mwcmmw>rm mw uw Imoeom mecca mo mmmcsoO .m .ocmcw cumvcmuw ecu
vcw wocmcvow AwOwowc co cw Now ummmw um co cocwwc ozu
wcu mo ucma on umze thwoou co wwOwpr cw stwowm co mocOwom woo
MUqucww cw omccoo < .N wmcmcww cocuwo cw xcoz iwmxcm .muwumewcume cw mmmu a
.xcoa accumconmw mcsoc heumosmw xwm .N scOuchBmw cw on umss uOOqup umcs mumowmwuuoo mwch .N
saw: mwOwoou ho awOw .Axco3 AmuwcwcuIEcOu mv muwcouu .vcmom cOwumwsuwcumz ucwow
lawn wmcocow we muwcmcu mcoumcoamw mo mcsoc tumummemm mecca cows: cmowpw< cusom 6:» ma vmsm
caucus: coaucmwo no mecca wcwuswocwv uo AmuvaCOIEcOu av Imw wumowwwucoo cOwumwcowcums
muwvwcuucmummemm m>wwrh .w muse; cOumoewm xwm .w muwvmcunwmumwemm xwm wwOwme m wcw>mc on umcs muavwvcwu .w mam
am: to: am: Beam mucoewcwsuwm cuwmco>wc=
z<UH=qu <mm

 

Aoomum A<0wnmz DHzH mkzmzmmwaomm onmmHzo<

Acoscwucouv N.w mam<fi

 

 

wwnmwwm>m yo: mama PH:
.ovmcw ccmccmum
:wz ecu co mowumswcume vmmmwc
:cOwumoccw wmowcoe o>mc umzs wumvwvcmu och .N
mumscmcwcwccs: .N .vcmom cOwumwsuwcumz uchfi
ow Canasc :cmeme cmuwcu< cuaom mg» mp cocmmw
cwowlqwow .cwuonsm .ww waswo> .cwuwwwcm cmw lc< woocom wmuwcoz cOwumEcowcw OUMOwuwuumo cOwumwaowcumE m
auwmcm>wc3 mucum wcwmz Iwcowz mo xuwmcm>wc2 och co“ wcwumamcm: .w mo moccom mcw>mc on umne ouwkucmu och .w who
.xcumweocu vcm wowmmcm
ccm muwumemcuws cw wm>mw|o um
New ummmw um saw: no .wm>0w
cecaooom go: a ceaamoum co: m cmuaooom co: m mmumcu :2 co wm>0wl< um «Om ummOw
um cow: ammo w .wuwcwm ecu >3
.wocmwom woowwowOwn co mmoaccu mwcu cow vowwcwoowu
wmowemco .mewmwcc cmcu xuwcocuam cm s; voammw cOwu
cmcuo muowmcsm cw on Imuaco no Oquwuwuceu wmcmcww
.momcsoo mucm wwmcm m>onm cmuoc Occu .mucwemcwcvmc oocwwom o no covwoc m we mmmu ecu cw .N
wmcwnww cw muwvwco we» Imcmuww vcm cOwuwmanoo wmwoom ccm cwwwwcm co .mucmwom mewmwcc
Imoeom xuwcwc cmumwceou cmwwwcm we mczoc cOu occwocw coo cows: ccm mowumeocume cw wcmcw
u>mc umss mwoocom wchwm imoewm xwm ecu wcwczwocw AmuwcoculEcmu hwy muwc oucwwom coz ucmchuw mcu co New quOw um
Iwmwoca 50cm mucmowwcc< muse: cmumwemm cmmucmwm Imco cwummewm cmwucwwm wmcmcmo co ocmcm cmcwwc ecu co mama < .w BU:
3m: 20: :m: emuw mucmEchsvom sawmum>wc2
z<uH=UHz <mm

 

goomum 4<0Homz OHzH mhzmzmmwzomm onmmwza<

Acmsccucoov ~.w mam<c

1.2 Background Information

1.2.1 The Medical Schools of Interest

 

1. University of Cape Town (UCT) - for the English—speaking
*Whites:

2. Medical University of Southern Africa (MEDUNSA; MED) -
for the *Blacks;

3. University of Natal (NAT) - for the *Non-Whites: *Asiatics,
Blacks, and *Coloreds;

4. University of the Orange Free State (OFS) - for the
Afrikaans-speaking whites;

5. University of Pretoria (PRE) - for the Afrikaans-speaking
whites;

6. University of Stellenbosch (STE) - for the Afrikaans-
speaking whites;

7. University of Witwatersrand (WIT) - for the English—
speaking whites.

 

*White: A person identified as a member of the Caucasian
race.

*Black: A person indigenous to Africa and of African descent.

*Non-white: A person who is either Asiatic, Black, or
Colored.

*Asiatic: A descendent of people who originate from India,
Malay and other East Indies islands of South
Asia.

*Colored: An official tag for a person of "mixed race."

MICHIGAN

1. Michigan State University (MSU)
2. University of Michigan (UOM)

3. Wayne State University (WSU)

1.2.2 Bodies Governingfithe Standards of Medical Training

The South African Medical and Dental Council (SAMDC)
controls the training of medical doctors in the RSA. In
Michigan, MSU and WSU train medical doctors according to
the requirements of the Association of American Medical
Colleges, while UOM follows the stipulations of the Michigan

Medical Practice Board (see Table 1.1) above.

1.2.3 Admission Requirements

The RSA and Michigan differ considerably on admission
requirements (see Tables 1.1 and 1.2 above). The Michigan
candidates must have had at least three years of University
study. In the RSA candidates enter the medical school main-
ly after a successful completion of high school study (Grade
12/Standard 10). A few enter medical school after obtaining
a bachelor's degree with premedical courses (see Tables

1.1 and 1.2 above).

1.2.4 Duration of Training

 

Six years is the minimum of training in the RSA.
Thereafter, the medical graduate spends a minimum<mfonecalen—
dar year working under supervision. This is the internship
period and has to be in an institution approved by SAMDC.
After internship, the graduate registers with SAMDC as a
medical practitioner and can be on his/her own.

In Michigan medical training lasts four years, there-
after the graduate takes two parts of the National Board
Examination, then enters a year of internship. Thereafter,
he takes the third part of the National Board Examination,
subsequent to which he has to be licensed with the Michigan
Medical Board as a practitioner. If he chooses to specialize,
he then goes into a minimum of three years of residency,

depending on the speciality chosen.

1.2.5 Stage (in years) at which Pharmacology is Taught

Most South African medical schools introduce basic
pharmacology in the third year. UCT, MED, PRE and WIT con—
tinue teaching pharmacology up to the fifth year. NAT, OFS,
and STE teach basic pharmacology in the third year only.
From fourth year onward, all medical schools teach "Applied
Pharmacology" (Therapeutics).

The Michigan medical schools teach basic pharmacology

in the second year.

10
1.2.6 Degrees at the End of Training

The M.B.Ch.B. (Bachelor of Medicine and Bachelor of
Surgery) is awarded after the six years of training in the
RSA. Michigan awards an M.D. (Doctor of Medicine) degree
after four years of training, which follows three or four
years of undergraduate education.

The M.D. degree in the RSA is a graduate degree ob—
tained at least five years after the M.B.Ch.B. degree. A
candidate for the M.D. degree must have practiced as a medi-
cal doctor for at least two years. PRE requires a masters
degree in medicine for admission into the M.D. program (See
Table 1.3 and Appendix D5). The M.D. degree can be obtained
in any discipline in medicine. The training involves an
original research and the solving of a specific problem in
medicine. The candidate must pass an examination based on
the thesis.

Even though on the basis of the foregoing background
information and the accompanying tables there are apparent
dissimilarities, it is the writer's view that the commonal-
ities between the RSA and the Michigan systems of training
are strong enough to justify this comparison. The commonal-
ities are:

1. the products of both systems are dealing with the health
of human beings, and writing of prescriptions;

2. each medical doctor, whether trained in the RSA or in
Michigan, has to contend with a fast-growing number of
medicinal products;

11

ewoc ocwowcoz Lo cucsonc

hcomcsm mo cOwococm ccm occo_coz cc cococumm u .m.cu.m.z *

 

ccocmcouozuwz ocu mo cuwmco>wc2 .oocococo cw mw oocmoa hc3
wouocom ocu cc concmoooc huwmco>wca cocuo hco mo co auwmco>wc= ocu we oocwoc .voz .: .m
.cocmwswcwwoc cowuocumwwoc umcu vcm mcooa ooccu umoow no
yew oocwoc .n.z ocu ecu cocoumwwoc whom» oco ammow am new oocwoc .2.: oz» hem cOwuocumwwom .N
.oumcom ocu cc co>ocaam huwmuo>wcc
Nw woos «wow xooccmmw cocuo hco co huwmco>wcs mwcu uo cocoomoc wcwov cco wcw>vsum cooc o>oc vwsocm ouocwccou
cumoccowwoum co> uwouwmco>wca ocu cowcoc coo» o>wm ocu mcwcsa .oocmov .m.co.m.: ocu wcw>woooc couwo mcoox o>ww umoow u< .w mhm
QQOw xoocuoow
owLOuocm co> uwouwmco>wc= A.coz xmcm .zv oOwuoocm swwsmm co A.voz .zv ocwowvo: cw oocwov muoummz mam
.couuwscsm on coo mwmocu ocu
ocouoc memo» osu ammow um cow auwwco>wc= ocu cow: vououmwwoc coon o>mc cwzocm ouovwvcou och .N
.voccowcoo on coo oocwoc .a.z ocu ocowoc .oocwoc ucowo>w=co co
quw o wooo xooccmmfi .m.>.o.: co m.cu.m.: ocu vo>woooc cmc ouocwccmo ocu couwo comaowo o>oc cwcocm memo» o>ww umooc u< .w who
.mcoo» oweovmum osu cocu mmow uOc cow coucocw coon
mo; cowmmecm cosm cows: mo ozucw> an cOwumowwwwosa ocu cwoc mm; vcm huwmco>wcz ocu cw
mcuoum .m.cu.m.z ocu o» vouquvm coon mmc cc: huwmwo>wcz voncwoooc cocuoco no oposcocw < .N
.qmow ochwcoz uo .cmemeco
howsomm wmuoz mo huwmco>wc= cow cocwzcoc mw wcwccoum mcmo» oau coca mwoc uoc mo huwmuo>wc= ocu mo oocwoc.m.co.m.:* .w h<z
.cooh oco ammow um LOW cocOwuwuoocc woOwcoe
m we wwocaoo woucoa ccm wmowcoz coowcm< cuaom ocu cuws vocoumwwou coon o>oc wwocm uco .suwm
ico>wcz ocu so vouwcwoooc cowumowwwwoav ucowo>w=co co co cmemommoc cw co .muoom oJu unmow
.xoom pooh <mzzncz mwow um ecu cuwmco>wc= ocu mo oocwoc m.co.m.z cm we cowmmommoc cw coon o>oc umss oumvwccoo och am:
.huwmco>wc: mwcu mo mwmocu
ocu uo uooncsm ocu mw cOwc3 xcox ocu voscoucoq o>oc ho: coco cocuo mowuwmco>wc= we moon
vscocw uocu vocw>0cc .omcacna ocu cOu ouocom ocu cc vouwcwoooc .cOwumowwwwocc ucowo>wcco
co mo powwoc o co huwmco>wc= cocuo hcm we ocwuwcoe cw ouocvmcm a on umss ououwccmu ocu .N
.ocwuwvoz mo auwaomm co mcwccoum
c30h oaou mo muwmuo>wc2 memo» use“ coca mmow uoc we cuwmco>wc= mwcu mo ouocvoum wmuwvoe a on umse ouovwccmu och .w ho:
cOwuoEcOch mo oocccm oocwo: ocu new mcowuowscwum huwmco>wca

 

<UHmm< =h:om 2H mmmumo AmzHUHomz mo achuoov .n.z mzh
m.w mcm<h

12

3. the aim in both types of training is to equip the medical
doctor with the principles he requires for rational use
of drugs.

1.3 Statement of the Problem

The controversy about what should be taught in basic
pharmacology at the medical schools in the RSA, by whom,
how, and for how long, has been going on for years (Sapeika,
1964; 1965; Joubert, 1976; Catzel, 1976; Straughan, 1976;
Gilliland, 1978; Charlton, 1978; Offermeier, 1978; Van den
Berg, 1978; MUller, 1978).

Based on experience as a hospital pharmacist in the
RSA and as a student in medical pharmacology at MSU, the
writer wonders whether the teaching of pharmacology at the
RSA medical schools may be insufficient.

The writer also agrees with the thinking that nobody
can replace the pharmacologist in the teaching of basics
in pharmacology at the medical school (Eales, 1964; Sapeika,
1964; Maren, 1973; Reynolds, 1976; Schnieden, 1976; Folb and
Bowey, 1978).

There are far fewer medical school basic pharmacolo-
gists in the RSA than in Michigan (Table 1.4 below). The
situation in the RSA described by Sapeika in 1964 seems to
have changed very little:

The classes at our medical schools are in

general very large, and the number of students
is increasing. The number of teachers and the

13

facilities for proper theoretical and practical

tuition are small. There are five medical

schools at none of which are the facilities

comparable with corresponding departments over-

seas. A single department at most places has

at least as many teaching personnel as all our

five medical schools put together, and their

students are fewer in number. Our staff-student

ratio is grossly inadequate and improvements

are urgently required in all our medical schools

if we are not to fail in our duty as teachers

and if we are not to be lacking in prestige

with our overseas colleagues (Sapeika, 1964,

p. 63).

One of the changes that occurred since the above statement
was made, is the increase of medical schools from five to
seven by the addition of the Orange Free State medical school
and MEDUNSA. As far as an increase in faculty is concerned,
the changes which took place in pharmacology in Michigan
since 1964 far exceed the changes which might have occurred
in the RSA. For example, the MSU Department of Pharmacology
started as a separate department in 1966, and in 1985, there
are seventeen Ph.D.'s on the staff.

According to Table 1.4 below, on the average the RSA
has three doctoral degrees in pharmacology per medical school,
while Michigan has eighteen per medical school. Even though
some of the professors in the Michigan medical schools may
not be involved in teaching, they are a resource to draw
from when necessary. They are available to provide informa-
tion the medical student might require about the area the

particular professor specializes in. On the basis of this

type of resource, the RSA has much ground to cover.

214

.ocwHQwomwc cocuo oeom cw co anewoooEumcm cw mw oocwoc woc0uuou ocu cocuoca 30cm uoc cwv mxooc coo» Eocu cocwmuco ouov <mm och Any

A.c0wuoo=asou ocu cw cocswocw cooc uoc ooc auwaoow hwz ochv

.mwowoooscocc cw woocom onwvoE cog

moocwoc wocOuooc cooucwwo mac cowwcowz owwcz .swowoooEcmcc cw woocom woOwcos con moocwoc wchuooc ooccu moc <mm ocu .owouo>o ocu :0 Amy

«mow .ocwowco:
we howsoom vcmumcouozuwz

.owcmh mwcu mcwwwasou cw
coccwuxo coon o>oc comwcowz vcm <mm ocu cuoc cw moocwo: .um.z ocu mm wcos om .moocmoa Acmwwcowzv .o.: ocu vco A<mmv .m.cu.m.: och va .m.z

owcawwm>o

 

 

ocu mo auwmco>wca uoc cowumEcoucw hwz
omOw
:coumom Nw wooo cooccoow .wwoum Axwmv o whm
tom cwocu ccm muwcomm och:
saccoumstmcc mumum mace: Aeomuowcv ma cm: smoc Home xoonumas .Dmtc coauv N mcc
cmOw .o wooo cooccomw m>o: Aozcv N who
:.cmwwc0wz
Lo huwmco>wc2 ocu um thH .cwow ocwuwvoz mo .
loomEcmcm cw cvsum ouozcmcu: Ao3uu>uco3uv mm to: muwzoom wmumz we huwmco>wcs AooccuV n h<z
Axwvcoac< oomv shew omcsvoz Aozuv N am:
Achcoaa< oomv Ecom
Amm cu: «was mecuwemz co consumc
lemva ocwowouou ouoacocw 3m: Acoouco>omv hw :mz c30h ocou mo huwmco>wc2 Aooccuv m hu:
cOwuoacOHcH mo oucaom moocwoa .n.cm ccwmco>wcb cOwuoECONcH mo oucsom moocmon .a.: no .n.cm muwmco>wca
cmmwcuwz <mm

 

mcoozum c<owamz mzh h< mhzmzhm<mma hoocou<2m<=m 2H mmmmuma c<x0huoa chm: hhcao<m

c.w mcm<h

15

The situation in the RSA is not in line with what
Maren advises:

Other aspects of pharmacology which must now

be taught include absorption, distribution,

metabolism and excretion of drugs, toxic ef-

fects, possible interactions with other drugs,

tolerance and dependence where they may occur,

and genetic variables which can effect the

response of drugs . . . It should also be em-

phasized that training in these areas can be

provided most effectively by pharmacologists

with a diversity of backgrounds, including

those dominantly physiological, chemical and

medical, and with either Ph.D. or M.D. degrees

(Maren, 1973, p. 464).
The above idea is similar to what Botha (1978) suggested
at the symposium of South African Pharmacological Society,
that the pharmacologist should teach fundamental pharmaco-
logy for a period of several months in the preclinical years
of study, and the pharmacologist should teach pharmacology
to the clinician during his/her (clinician's) graduate train-
ing and subsequently when he/she (clinician) is practicing
as a specialist.

The dearth of pharmacologists in the RSA makes what
Maren and Botha advise difficult to achieve, and the teaching
of pharmacology at the medical school remains wanting.
This is evidenced by the lack of insight, into drug effects,
with which some prescriptions are written. It is the writer's

experience as a hospital pharmacist in the RSA that some

medical practitioners appear to have:

l6

1. no idea about the format of a prescription;

2. no insight into the significance of the frequency of
medication;

3. no idea about the advantages and disadvantages of cer-
tain drug combinations;

4. no awareness that the same drug can appear in many
brand names.

It is the experience of the writer that the prescriptions

of concern can be broadly grouped into three categories:

1. those less appropriate to the diagnosis, for example,
castor oil for constipation due to pregnancy, but with

no intention of interfering with the pregnancy;

2. those more of lists than prescriptions, for example,
three or more antihistamines in the same prescription;

3. those with incompatible components.

The above types of prescriptions seem to point to a
multidimensional problem, and insufficient pharmacology in-
struction is possibly one of the dimensions. The writer
has further experienced that incomplete prescription writing
has other implications which on a long term basis can put
health services in a chaotic state. The cost effectiveness
of health services can also be adversely affected by current
prescription writing.

The need for better teaching of pharmacology at the
medical school in the RSA became more evident after pharma-
cology was made a compulsory major as of 1970 at the pharmacy

schools. The result is that the pharmacist and the medical

l7

practitioner have different insights with regard to the pre-
scription. The depth at which basic pharmacology is taught
at some medical schools in the RSA does not enable the medi-
cal practitioner to appreciate why the pharmacist:
l. insists that certain components of the prescription

must not be left out;
2. objects to certain drug combinations;
3. declines to be party to certain ways of administering

drugs to the patient.

It is a well known claim in medical circles in the
RSA that

Our medical schools and examining bodies have

provided a medical profession that is perhaps

second to none in the world (Sapeika, 1965,

p. 63).
This might be true in other aspects of medical practice,
but prescription writing technique is wanting and this relates
to pharmacology instruction at the RSA medical schools.
A giant effort is required to provide the teachers needed
for adequate training in pharmacology. Without this effort
at faculty training, the medical profession may find it
difficult if not impossible to keep pace with the fast grow—
ing population and pharmaceutical industry. The "new" (known
drug appearing under a new brand name) pharmaceutical pro—
ducts will continue to add confusion to the health services.

Over the twenty year period (1964-1984), when one

views:

18

1. the progress made by pharmacology as a discipline;
2. the expansion of the pharmaceutical industry;

3. growth of the RSA population;

and:

1. the low rate of production of pharmacologists in the
RSA;

2. the increase in the number of medical schools in the
RSA;

3. the increase in the responsibility of the RSA medical
pharmacology teachers because of the addition of
pharmacy schools to existing medical schools;

4. the increase in the numbers of the RSA medical students
and the pharmacy students to be taught;

one realizes that the teaching of pharmacology at the medical
schools has become even more inadequate.
The factors responsible for the fewer Ph.D.'s in pharma-

cology per medical school in the RSA appear to be:

1. Separate campuses for the pharmacy and the medical schools
which results in the division, of the few qualified
persons that the country has, among the different cam-
puses;

2. Inadequate financing. Van Zyl (1978) points out:

Students do not regard pharmacology as

being particularly attractive. In order

to develop the discipline in a rational

way, I think that people in authority should
inject sufficient financial means into
pharmacology departments so that they might
enjoy status similar to departments such

as physiology, biochemistry and the clini-

cal departments (Folb and Bewey, 1978,.p. 32).

(7‘

l9

Fewer professors with high qualifications. These ap-
parently have many responsiblities, and less time for
training anybody.

The growth of the number of the institutions is wrongly
footed: if the resources used for establishing addi-
tional schools (pharmacy schools on medical campuses,
and medical schools on pharmacy campuses) were used

for the training of teachers in the various areas of
pharmacology, the country would have fewer, but
effective schools. There would be teaching teams of
reasonable sizes and highest qualifications. With time
these schools would produce enough professionals to
allow an increase in the number of schools without
lowering the quality of instruction, as is the trend

at present (building of more schools not being paral-
leled by training of appropriate and sufficient number
of pharmacology teachers).

1.4 Purpose of the Study

 

To compare the teaching of basic pharmacology at the
medical schools in the RSA with the teaching of basic
pharmacology at the medical schools in Michigan.

To compare the faculty responsible for instruction in
pharmacology at the medical schools in the RSA and at
the medical schools in Michigan.

To evaluate who should be responsible for pharmacology
instruction in medical schools in the RSA.

To compare the duration of teaching of basic pharmacology
at the medical schools in the RSA with the duration of
teaching of basic pharmacology at the medical schools

in Michigan.

To make recommendations pertinent to the improvement
of the curriculum and instruction in basic pharmacology
at the medical schools in the RSA.

To serve as a basis for further studies related to the

teaching of pharmacology at the medical schools in the
RSA.

20

1.5 Rationale for the Study

Deficiencies in pharmacology instruction at the medi-
cal schools in the RSA were highlighted as early as 1964
by Sapeika:

As has recently been pointed out in connection

with the teaching of genetics in the medical

curriculum, and applicable to pharmacology,

the contrast with what is being done abroad

is striking and not a little humiliating.

By international standards South Africa has

much leeway to make up. Practically, nothing

has been done in this country to keep pace

with the remarkable developments in the field
of pharmacology (Sapeika, 1965, p. 63).

Sapeika further pointed out that the teaching of pharmacology
is not a matter of taking up one drug after another in alpha-
betical order. It is necessary to deal with groups of drugs
and to emphasize general principles.

Opinion is strong that the instruction in pharmacology
in the RSA is not sufficient. In his remarks at the symposium
of the South African Pharmacological Society (1978) Gilliland
said:

The teaching of pharmacology at the South

African medical and pharmacy schools does

not adequately prepare the medical practitioner

and the pharmacist of the future to meet

the challenge of the present day health care

needs (Gilliland, 1978, p. 5).

Gilliland further argued that the cause of many adverse

drug reactions is the doctor's lack of knowledge of the

21

pharmacology, pharmacokinetics and chemistry of the drugs
he uses, and the factors in both health and disease that
predispose to drug reactions. He advises thatmedical doc-
tors should be trained in the evaluation of claims made for
drugs.

Van den Berg also highlighted the inadequacy of the
training of the medical doctors in pharmacology as follows:

The medical practitioner is permitted to

prescribe a host of medicines the pharma-

cology of which he understand very little.

The reason for this lack of knowledge is

that undergraduate teaching has been insuf—

ficient, and inappropriate at the preclinical

level. This can be attributed to lack of

correlation between clinical and pharmacologi-

cal teaching . . . The doctor has attempted

to keep pace by means of associating diagnosis

with trade names of medicines, without knowl-

edge of their generic names, or their pharma-

cological properties (Van den berg, 1978, p. 21).

The apparent inadequacy in pharmacology instruction
at the medical schools in the RSA is also evident when we
view the hours of pharmacology relative to the total hours
of instruction the student receives throughout the medical
training. MUller points out that in the third and fourth
year clinical examinations, pharmacology represents about
10% of the total number of questions. In fifth year, pharma-
cology is represented by questions comprising up to 20% of

two of the papers. In the final analysis pharmacology re—

presents about 5% of the marks allocated on the basis of

l.m

22

continued evaluation and about 5% of the marks allocated
for the professional examination.

Using these proportions together with the fact that
the pass mark for all RSA examinations is 50%, it is the
writer's opinion that a student can pass the examination
knowing little or no pharmacology.

The controversy about pharmacologists and clinicians
as teachers of pharmacology added to the need for this study.
MUller (1978) mentioned that efforts are being made to £3—
cruit physicians, anesthetists, pediatricians, psychiatrists,
and ophthalmologists for instruction of students in pharma-
cology and therapeutics. The writer does not see how this
team, which included no pharmacologists, can adequately give
instruction in basic pharmacology. The team proposedis con-
tradictory to what Sapeika advised:

Pharmacology is not synonymous with thera-

peutics. It is a rare person indeed who can

teach both subjects adequately. No one indi-

vidual can teach drug therapy in all its wide

applications throughout the many departments

of a hospital, . . . proper systematic and

comprehensive teaching about drugs cannot be

done at the bed side (Sapeika, 1965, p. 61).

Charlton (1978) supports this view. He mentions that
therapeutics should not be regarded as part of the pharma-

cology course. He maintains that pharmacologists should

be involved in teaching therapeutics and that it should be

23

a joint responsibility of both clinicians and the pharma-
cologists.

Offermeier agrees with both Sapeika and Charlton,
and points out that pharmacologists should be involved until
the end of the medical training, and sufficient number of
clinical pharmacologists on the staff is required. Botha,
who is both a clinician and a pharmacologist, points out
that:

. . . the frequently held view of pharmacolo-

gists (only admitted in their own circle)

that in the eyes of the student in his clini-

cal years the authority of the clinician super-

sedes that of the pharmacologist, is an incon-

trovertible fact. The teacher who is a doer,

and proves himself on the battlefield, has a

clear advantage over the teacher who is merely

a sayer. Neither changes in methodology nor

curriculum can alter this reality (Folb and

Bowey, 1978, pp. 32—33).
The strategy he suggests is that pharmacologists should
teach fundamental pharmacology for a period of several months
in the preclinical years of study, and the pharmacologist
should also teach pharmacology to the clinician during his/her
(clinician's) graduate training and subsequently when he/she
(clinician) is practicing as a specialist.

Van Zyl (1978) points out that pharmacology is regarded
as less attractive, than other basic sciences, by students.

' the reason for

Apart from Botha's "incontrovertible fact,’
unattractiveness seem to be mainly the status of pharmacology
at the medical schools in the RSA. Sapeika illuminates this

fact as follows:

24

In practically all medical schools and in
research institutions,pharmacology has sepa-
rate and independent status. This is essential
if the resources are not curtailed and the
growth of the department not hampered. In
those places where pharmacology was previously
housed in another department, its separation
put it on its own feet, established many
practical advantages and developed a feeling

of departmental pride and responsibility.

Such benefits are not only important for the
teaching staff, but the prestige created estab-
lishes a better psychological and practical
atmosphere from the point of view of the stu-
dent (Sapeika, 1965, p. 61).

Van Zyl (1978) advises that in order to develop the
discipline in a rational way, people in authority should
provide sufficient money into pharmacology departments so
that they might enjoy a status similar to that enjoyed by
departments such as physiology, biochemistry and the clini-
cal departments. He further points out that one of the prob-
lems at South African universities is that most medical schools
do not offer pharmacology as a major for the B.Sc. degree.

Lubbe (19%” suggeststhat pharmacology should not be
taught at medical school:

It is formidable to see what has to be taught

in pharmacology today. I think it is infact

impossible to teach pharmacology and I would

suggest that the student should be introduced

to the concept of self-learning (Folb and

Bowey, 1978, p. 31).

The writer does not understand how the concept of self-
learning can equip the studentwith the principles involved

in pharmacology, particularly when it is "formidable" and

25

"impossible." Guidance in the study of pharmacology is as
imperative as it is in the study of physiology and biochemis-
try. Physiology and biochemistry are basic to the study
of pharmacology. If self-learning does not apply to the
basic courses, the writer does not see how it can apply to
an advanced science like pharmacology.

Landau seems to agree with Lubbe:

. . . I would say that I do not believe that

every student must necessarily be taught

pharmacology (Folb and Bowey, 1978, p. 32).
The writer assumes that by "every student" Landau meant
every medical student, the prospective drug prescriber.
The writer does not understand how this approach proposes
to prepare those prospective drug prescribers for rational
drug use without teaching them pharmacology.

From the foregoing views the need for this study can-

not be overemphasized.

1.6 Limitations and Delimitations of the Study

When interpreting and/or generalizing the findings
of this study, the following points should be taken into
consideration:

1. The writer had a limited time within which to do the

study, therefore certain aspects might not have received
the thoroughness they deserve.

10.

ll.

26

There were some communication problems with regard to

data collection. Because of the distance between Michigan
and the RSA, data collection was mainly through cor-
respondence.

Non-professional translation of the data from the Afri-
kaans speaking medical schools in the RSA. The writer
did the translation, backed by thirteen years of study-
ing Afrikaans as a school subject in the RSA.

Except for NAT, 1984 pharmacology notes were used to
explain prescription writing patterns of doctors who
studied basic pharmacology years before 1984. For NAT
1975—76 and 1981 notes were used.

The information from university year books about faculty
qualifications is not specific as to whether the doc-
toral degree is in pharmacology or some other discipline.

It is the policy of WIT not to make known the qualifi-
cations of their staff as well as the budget for the
pharmacology department (See Appendix A2).

The OFS department of pharmacology has not responded

to any request for information. The author wrote

to the registrar to find out whether it was the univer-
sity's policy not to participate in academic research.
The response is as shown in Appendix A . The researcher
outlined the information required (See Appendix A ).
The response was as in Appendix A . No data was re-
ceived from the Department of Pharmacology. The data
used in this study, was obtained from the year book
(available at MSU), and from the proceedings of the
South African Pharmacological Society according to

Folb and Bowey (1978).

STE did not respond about facilities, faculty and budget.
The information about faculty used in this study has

been obtained from the year book (the STE registrar's
office provided it on request).

PRE appears "unwilling" to disclose the budget for the
pharmacology department and that of the medical school
(see Appendix A6).

It was not possible to know exactly, from the course
outlines and/or the notes, what is being taught in the
class room. Brief outlines do not necessarily indicate
insufficient teaching.

The prescription writing pattern of the Michigan physician
is not known in this study.

27

1.7 Organization of the Study

This study has six chapters: the first chapter gives
the introduction, background information, statement of
the problem, purpose of the study, rationale for the study,
and limitations and delimitations of the study. The second
chapter is the review of selected literature; the third
chapter is on the research methodology: data collection,
treatment and analysis of data. The fourth chapter dis—
cusses the findings. The fifth chapter gives the summary,
conclusion, and recommendations. The sixth chapter are

the appendices, bibliography and general references.

CHAPTER 2

THE REVIEW OF SELECTED LITERATURE

2.1 Introduction

This chapter includes a historical background in
the teaching of pharmacology at medical school; the impor-
tance of pharmacology; the curriculum, the faculty, and

the methods used in teaching.

2.2 Historical Background

To teach the future doctor what medicine to use for
what disease, is an old practice. With time, both methodo—
logy and subject matter in the teaching of 'medicine' have
changed. As Bucheim's paper (1876) indicates, pharmacology
began to be recognized as a distinct discipline during
the nineteenth century. However, the debate continues
about what to teach, how, and by whom.

Initially, the teaching of pharmacology was part
of the folklore. From folklore it developed to 'a tradi-
tional art, an empirical craft' (Dale, 1963). At present
both the subject matter and the methodology of teaching
pharmacology are based on research findings.

Studies on the teaching of pharmacology fall into:

those on the teaching per se, and those on what pharmacology

28

29

is, its curriculum, its relationship with therapeutics,

and who should teach it.

2.2.1 On Teaching of Pharmacology

 

Csaky (1976) on whether there is an identity crisis
in medical school pharmacology, reported that Bucheim (1876)
in his basic paper on why and how to teach pharmacology
to medical students, clearly delineated the logical need
for a full-fledged course in pharmacology and described
the fundamental characteristics of an ideal teacher of
medical pharmacology: he should possess a good knowledge
of chemistry and physiology and a basic understanding of
the disease process.

Since Bucheim's paper, the literature seems silent
on the teaching of pharmacology at medical school until
1910. In both his reports (1910 and 1925), Flexner empha-
sized that pharmacology is a practical science and the
laboratory and the demonstration were valuable as teaching
tools.

During the 1930's and 1940's, research again appears
silent on the teaching of pharmacology at medical school.
This can perhaps be understood in the light of what Seevers

(1969) said:

In the darkest days (1930's) pharmacologists,
in dwindling numbers, found principal pre-
occupation with the question: What is the
matter with pharmacology? Attempts were made
to redefine the subject, give it a different

30

name, shift it from a biological to a physi-

cal science (pharmacy) and the like . . .

The development of the sulphonamides and the

antibiotics, the coming of the atomic age,

the great achievements in organic and physi-

cal chemistry and biophysics associated with

World War II, and the phenomenal advances

in the knowledge of cell and organ function

in all of the biomedical sciences furnished

the substance from which a new pharmacology

was built (Seevers, 1969, pp. 209-210).

In 1956, Goldstein in his study on a controlled com-
parison of the project method with standard laboratory teach-
ing in pharmacology concluded that the regular laboratory
in the teaching of pharmacology at medical school was un-
necessary. They found that if a project that holds students'
interest and presents no unusual technical difficulties
can be substituted for the laboratory, the regular labora—
tory course can be omitted without adverse influence upon
student knowledge of pharmacology.

The project calls upon the student to plan, execute,
and interpret experiments, in order to throw light upon
real problems. The "project group" occupied a separate
laboratory, was requested not to visit the regular labora-
tory; did not receive a laboratory manual, and was exempted
(in writing and orally) from any responsibility for knowledge
of the regular laboratory work. Each team in the project
group had to pursue a single randomly-assigned project through-

out the semester. The projects were based upon investiga—

tions recently reported in the literature. The students

31

were furnished with a brief general statement of the problem
and references to some relevant published work. Precise
definition of the problem and the methods for investigating
it were left for the student to work out under instructor
guidance. The project laboratory was designed to require
maximum student initiative, ingenuity and persistence, with
minimum instructor intervention.

In 1957, Joyce and Weatherall in a study of controlled
experiments in teaching concluded that discussion groups lead
to slightly more gain in knowledge than lectures or practical
classes, and unsupervised reading was consistently least
effective. They also found that as lectures were only slightly
inferior to discussion groups and were considerably less time
consuming, especially for faculty,their efficiency in terms
of results obtained for amount of work done ranked the highest.
In their 1959 study on effective use of teaching time, Joyce
and Weatherall concluded that demonstrations saved time (than
practical classes) for teachers, technicians, and students.
They found that discussions required less time of teachers
than seminars, and the corresponding difference for students
was very slight; students thought demonstrations were more
enjoyable and more useful than practical classes and they
valued seminars more than discussions.

Evaluation of the teaching of pharmacology in the
1960's is marked, among others, by Kahn's study (1965) on

whether the pharmacology laboratory was a teaching tool

32

or a sacrament; a study by the U.S. Department of Health,
Education and Welfare: Task Force on Prescription Drugs
(1968-69), as well as by two papers by Sapeika (1964; 1965).
The conclusion of Kahn's study is that none of the criteria
used in the study indicated that the laboratory had the
slightest effect on student learning not attainable by easier
methods. The findings of the U.S. Department of Health,
Education and Welfare, Task Force on Prescription Drugs were:
that the nature of the pharmacology instruction has been a
matter of much debate but little change: that pharmacology
is in reality a clinical as well as a basic science, but it
is taught primarily as a basic science; that after the usual
course in basic pharmacology most medical students are given
no formal training in the applied aspects of the course.

They are left to acquire what practical training they can
absorb from a variety of courses in the several fields of
clinical medicine; that the most serious criticism of the
informal exposure is that it fails to equip the student with
the essential scientific and critical attitudes toward the
use of drugs and the evaluation of drug promotion — the most
intensive promotion to which he/she will be subjected the
rest of his/her professional career; that some medical
schools have responded to the deficiency by establishing
courses in clinical pharmacology or pharmacotherapeutics;
that a course in pharmacotherapeutics and clinical pharmacol-

ogy should be a required part of the curriculum and that

33

this course should be taught neither by the pharmacologist
nor by the majority of clinicians, but by clinical pharmaco—
logists, though pharmacotherapeutically oriented clinicians
can make valuable contributions.

Sapeika (1964) made the following points: pharmaco-
logy is not synonymous with therapeutics; medical students
should be taught how to Efllflk about drugs so that they are
better prepared to withstand the flood of unsubstantiated
claims that are often made for drugs; no one person can
teach both pharmacology and therapeutics adequately. Sapeika
(1965) further pointed out that experienced teachers are
required in each institution not only to give lectures,
but to conduct experimental classes, tutorial classes, and
possibly seminars; that lectures are very important as far
as student populations are concerned; teacher—controlled
seminars have advantages, but need more time than lectures;
laboratory work is expensive in teachers' and students'
time, apparatus and supplies; demonstrations are valuable;

a museum suitably provided with visual—aid material, speci-
mens, graphs, photographs would be most useful for private
study and for teaching purposes; that the dearth of teachers
and facilities hinder the teaching of pharmacology at the
medical schools in South Africa.

The 1970's are marked by more publications on the
teaching of pharmacology than any other decade before.
Mandel et al. (1971) in their study on the value of labora-

tory teaching in pharmacology, concluded that a brief

34

laboratory program in pharmacology is of some value in in-
creasing the performance of the students in pharmacology.

They point out that closer and more informal contact between
students and staff contributed at least as much as the experi-
ments did.

James (1971) in a paper on pharmacology in the medical
curriculum, indicates that one of the problems in the teaching
of pharmacology at medical school is the phasing and timing
of the course in relation to the other subjects in the curric-
ulum.

Sinclair (1972) in his study on the evaluation of a
new medical curriculum, indicated that a monitoring system
to detect possible deterioration or improvement as a result
of curricular changes is a practical proposition. He pointed
out that it is when the new curriculum is being formed that
the methods by which it should be assessed should be con-
sidered, and the tests to be applied should be carefully
chosen and validated in advance. He further suggested that
the objectives should be limited, so as to be more likely
of achievement and the number involved in the trial should
be adequate and comparable in terms of intelligence and
motivation.

Maren (1973) in his article on the role of pharmacology
in physician education, emphasized that pharmacology is both
a basic science and an applied science; it should be taught
by pharmacologists with a diversity of backgrounds and with

either Ph.D. or M.D. degrees.

 

35

Burford and Stritter (1974) on evaluation of a teach-
ing program in medical pharmacology, concluded that teaching
objectives, an individualized instructional approach, and
concern about students' attitudes and performance are success-
ful as educational strategies which foster learning.

Engel et al. (1974) in their study on experimental
self-instructional approach in teaching basic pharmacology
to medical students, concluded that a combination of audio-
tape, text and an illustrated notebook were as effective as
the lectures; that the team approach where the subject expert
is assisted by educational technologists and a senior student
was useful.

Kahn and Bigger (1974) in their study on instruction
in pharmacokinetics which used a computer-assisted demonstra-
tion system, showed that the computer-assisted demonstration
system provided a high degree of speed and precision in the
mathematical solution to the problems at hand and presented
the solutions with greater accuracy than an instructor could
by drawing curves on a chalkboard; that the procedure simpli-
fied the demonstration of changes in a biological system;
that the system makes it simple to accommodate wide-ranging
student suggestions and question into the exercise; that
the system allowed students to select and change the variables
at will as the exercise proceeds; that the system maintained
a high level of students' interest; that the system allowed

the instructor more control over the demonstration, and the

E!

(“9'

dt

:1
(D

C"!
L I)

36

system produced (incidentally) a high degree of credibility
among students about the computer-generated curves. The
tentative conclusion was that the student had a better under-
standing of pharmacokinetic principles than in previous years,
and it was the students' view that the better understanding

is attributable to the new mode of instruction.

Bogner et al. (1975) in their study on the effective-
ness of audio-based instruction in medical pharmacology,
showed that medical students can learn complex subject matter
in an audio-based format as well or better than in a lecture
format.

Sicé (1975) in his study on objectives of pharmacologi—
cal education concluded that valid evaluations of pharmacolo-
gical education that really measure the extent to which its
objectives are fulfilled, would require determination of actual
prescribing practices. The collaboration of many institu-
tions will be necessary if such determinations are to be
made because of the dispersion which occurs after gradua-
tion.

D'Mello and Kruk (1976) in their study of effective
demonstration in pharmacology to 100 students, concluded
that demonstrations have many advantages over conventional
large practical classes especially in these times of in-
creased student numbers and restriction on appointment of
new staff. They contend that small group demonstrations are

more effective.

37

Reynolds (1976) in his paper on pharmacology educa-
tion in medical school, emphasized that the clinical and
the laboratory aspects of pharmacology need to be bridged
by clinical pharmacologists. He indicates that the teach-
ing of pharmacology neglected faculties with skills in be-
havioral sciences and communication, that would help the
medical student and physician understand the social dimen-
sions of drug prescribing.

In 1978 the South African Pharmacological Society
expressed concern about the teaching of pharmacology at
the RSA medical schools. The papers read at the annual
symposium are: Charlton, on objectives of the undergraduate
course in pharmacology for medical students, pointed out
that therapeutics should not be regarded as part of the
pharmacology course; medical students should be taught the
general principles in pharmacology to enable them to evaluate
the advantages and disadvantages of new products; medical
students must have a working knowledge of the relevant legis-
lation concerning medicines, including the formalities which
have to be followed if they wish to have controlled drugs
in the higher schedules in their possession; medical stu-
dents need to be taught how to write a prescription.

Gilliland in his opening address indicated that the
proliferation of pharmaceutical products has led to changes

in the teaching of pharmacology and changes will continue

 

38

to occur; there should be a follow up on the basic pharma—
cology course taught in preclinical period; medical stu—
dents should be trained in evaluation of claims made for
drugs; after graduation medical doctors should continue to
read in pharmacology.

MHller on an integrated common final professional
examination in medicine which includes pharmacology pointed
out that a first semester course in basic principles of
pharmacology (100 hours) is offered at the University of the
Orange Free State; that at the end of the semester 3 three
hour multiple choice examination and 20 minute oral have to
be passed and the pass mark is 50%; that in the final analy-
sis pharmacology represents about 5% of marks allocated
on the basis of continuous evaluation and about 5% of the
marks allocated for the final professional examination.

Offermeier on what he regarded as fundamental knowledge
in pharmacology for medical students, explained that the
aim of teaching pharmacology to medical students should be
to provide a rational approach to the multitude of often
confusing facts, claims and hypotheses which inundate the
medical practitioner; that medical students should be taught
fundamentals in pharmacodynamics, pharmacokinetics, and
systematic pharmacology.

Van den Berg discussing what the family practitioner
requires to know about medicines, and what the medical train-

ing should involve, pointed out that:

39

The medical practitioner is permitted to

prescribe a host of medicines, the pharma-

cology and rationale of which he under-

stands very little (Van Den Berg, 1978,

p. 21).
that the basic concepts to be taught in pharmacology
are drug actions, categories of medicines, and the human
element; that medical doctors need to continue reading in
pharmacology to keep their knowledge up to date.

Abraham et al. (1981) in their study on the comparison
of didactic lecture, self-reading (unsupervised) and self-
instruction as learning methods in medical students of
West India, concluded that learning methods which place a
student entirely on his own are neither effective (as shown
by test scores) nor acceptable (to the students), that an
objective assessment, lecture and self-instruction are equi-
effective; students showed a preference for self-instruction.

The American Association of Dental Schools (1982)
study on curricular guidelines in pharmacology, offers
guidelines which represent a consensus on what would be
a minimally acceptable pharmacology course; sources of in—
formation, terminology, absorption, biotransformation, dis-
tribution, excretion of drugs (ABDE), routes of administra-
tion, dose response relationships, drug-receptor interaction
(mechanisms of action), drug interactions, drug toxicity,

and placebo effects.

40

Jason and Westberg (1982) in their study on teachers
and teaching in the U.S. medical schools, relate to the
teaching of pharmacology indirectly. This study points
out some significant differences between basic science
teachers'and clinical science teachers. They (authors)

argue that the medical student needs teaching from both.

2.2.2 On What Pharmacology is; Why it should be taught,
and by Whom

 

In this section, the few studies done touch on a variety
of themes. These themes have a bearing on the teaching of
pharmacology.

Becker'g£_al. (1972) on differential education concern-
ing therapeutics and resultant physician prescribing patterns
established that practicing medical doctors want medical
schools to teach more about generics and side effects and
should make therapeutics a part of the students' clinical
training.

Spilman and Spilman (1975) in their study on a paired
comparison of the relevance of nine basic science courses,
found that physiology, pathology and pharmacology comprise
the stratum of maximum relevancy.

Joubert (1976) argues that pharmacology should be

taught as a clinical subject, not as a basic science.

41

Catzel (1976) points out that the basic teaching of
pharmacology in the preclinical years is essential, the
problem is that there is no follow up.

Straughan (1976) indicates that clinical pharmacology
is taught at medical school, but it needs to be preceeded
by a strong foundation in basic pharmacology.

Csaky (1976) argued that the problem of pharmacology
at medical school is acceptance, not identity; that the
pharmacologist is eminently qualified to teach pharmacology
to medical students as compared with the pharmacist and
the clinical faculty.

Schnieden (1976) pointed out that it is not benefi-
cial to replace a basic pharmacology department with a de-
partment for clinical pharmacology. He contends that where
it can be supported financially, it would be better if a
chair in pharmacology exists alongside a chair in clinical
pharmacology because on the research side the loss of depart-
ments of pharmacology within medical schools is likely to
hinder advances in clinical pharmacology; for advancement,
interaction between applied and basic aspects of pharmaco-
logy is important, and geographical and faculty separation
would be a hindrance; clinical pharmacology draws on the
'deposits' in the non-clinical bank, and if the 'deposits'
are not replaced, advancement in clinical pharmacology may
be halted; the financial advantage gained by replacing the

basic pharmacology chair with one for clinical pharmacology

42

is outweighed by the effects of the depletion of the

'deposits' made by basic pharmacology.

2.3 The Importance of Pharmacology Instruction

It is more than one hundred years since Bucheim's
(1876) basic paper on the teaching of pharmacology. Opinion
is almost unanimous that in order to be able to use drugs
rationally, the medical student has to be taught pharmaco-
logy. However, Landau (1978) argues that medical students

should not be taught pharmacology:

Knowledge of pharmacology is not going to
help the medical student unless it is applied
to the problem at the bedside. I think that
instruction of pharmacology has to be given
at the particular time when the patient re—
quires a specific drug. The student has to
view the drug against the total treatment

of the total illness in the particular
patient. After many years of experience,
both in clinical practice and in teaching,

I would say that I do not believe that every
student must necessarily be taught pharma-
cology (Folb and Bowey, 1978, p. 32— under—
lining mine).

This view does not indicate how those students not taught
pharmacology are supposed to acquire the principles which
will enable them to use drugs rationally. The view also
seems not to recognize the basic aspect of pharmacology,

on which successful teaching of the clinical aspect depends.

Lubbe (1978), seems to share Landau's view:

43

It is formidable to see what has to be taught

in pharmacology today. I think it is in fact

impossible to teach pharmacology, and I would

suggest that the student should be introduced

to the concept of self-learning.(Folb and Bowey,

1978, p. 31).

Lubbe's view seem to exemplify what Dale, as quoted by
Sapeika (1965), predicted:

. . . that he cannot help wondering how those

responsible for the teaching of pharmacology

to the students are now going to select their

material for a course which will meet the

educational and practical needs of the doctor

of today and of the immediate future from the

almost overwhelming torrent of detailed knowl—

edge which now challenge their attention (Sapeika,

1965, p. 60).

Spilman and Spilman (1975) in their study on the rele—
vance of nine basic science courses, established that the
relevance of pharmacology at medical school is unquestionable.
They utilized the judgements of medical students, interns,
and residents, basic science faculty, and clinical faculty.

Weiner and|Walker (1977) in their study of the co—
ordinated multidisciplinary competency—based program on
drugs, disease, and human behavior, used a program which,
among others, included: pharmacology to provide an under-
standing of bioavailability and physiocochemical factors
affecting dissolution, absorption, distribution, metabolism
and excretion, and their relationship to therapeutic response.
The program was used for both medical students and pharmacy

students. The researchers found that the approach was ad—

vantageous since there is a need for all practitioners not

44

only to know the capabilities of others, but also to recog-
nize their own limitations. The conclusions drawn from this
study were: that the students found the objectives of the
course relevant to them both in terms of their progression
through the curriculum and with respect to their professional
goals; that the course in its current form appealed to
students as an appropriate vehicle through which the content
can be learned; that medical teachers view the coordinated,
multidisciplinary program as an improvement in the quality
of preclinical and clinical education of health profes-
sionals; that the understanding of doctor and pharmacist
roles and the development of a co-operative attitude for solv—
ing health problems in the theoretical setting of the class-
room is likely to be nurtured in practice.

In both his papers, Sapeika (1964; 1965) emphasized
the importance of teaching students how to thigk about drugs,
and the importance of teaching basic principles in pharma—
cology. The importance of pharmacological instruction at
medical school is highlighted, among others, by Charlton,
1978; Gilliland, 1978; Muller, 1978; Offermeier, 1978; Reynolds,
1976; Schnieden, 1976; and Van den Berg, 1978. Opinion on
the importance of teaching pharmacology at medical schools
is almost unanimous. Flexner's reports (1910 and 1925) dis—
cuss pharmacology as one of the essential subjects at the

medical school.

45

2.4 Curriculum Content

It appears that the curriculum of basic pharmacology
presents problems to medical educators. The Association
of American Medical Colleges (1981) pointed out that the
rapid expansion of knowledge in the biomedical sciences
and the consequent broadening of concepts about the nature
of living organisms and life processes are exerting pressure
on medical school faculties to prepare students; that facul-
ties constrained by the time available are faced with the
necessity of reappraising Egg; is to be taught and £21 stu-
dents can be assisted to cope with the expansion of knowledge
and its application to medical practice throughout their
professional careers.

Medical pharmacology is no exception to the above
pressures. Its curriculum appears to be of continuing con—
cern to medical educators. In his 1925 report on medical
education, Flexner made the observation that four subdivi-
sions make up the pharmacology curriculum: materia medica,
prescription writing, toxicology and experimental pharma-
cology.

The U.S. Task Force on prescription drugs (1968-9),
argued that the nature of pharmacology instruction has been
a matter of much debate but little change. They point out
that though it is a clinical as well as a basic science
subject, pharmacology is taught mainly as a basic subject

with emphasis on:

46

l. the principles of drug action;
2. a review of specific drug groups;
3. examples of drug applications, and

4. the broad fundamentals of prescription writing.

That the nature of instruction in pharmacology is
a matter of much debate and little change is contradicted
by a number of studies published supporting the idea that

pharmacology curricula are not static:

In 1971, at the symposium on teaching and research
in pharmacology with special reference to West Africa, James
indicated that the Department of Pharmacology at the Univer-
sity of Ibadan reviewed its curriculum for the second time
to suit local conditions and needs. The new curriculum
deferred the teaching of pharmacology until after the pre-
clinical subjects had been examined, and merged the time
available for basic pharmacology into one continuous block
period during the early part of the clinical course. The
problems that led to the new curriculum were mainly with
regard to the phasing and timing of the course in relation
to the other subjects in the curriculum.

Sinclair (1972) reported on the evaluation of a new

medical curriculum at the University of Aberdeen. Under

the new curriculum, the teaching of pharmacology was con-
siderably altered: in the old curriculum the subject was

introduced under the aegis of the Department of Physiology,

47

and continued in the clinical years by the Department of
Materia Medica and Therapeutics. In the new curriculum

a formal course in pharmacology was instituted by a newly
formed Department of Pharmacology. Because of this change,
the last component of the experimental investigation was a
multiple choice objective examination in pharmacology and
therapeutics.

Becker et al. (1972) in their study on differential
education concerning therapeutics and resultant physician
prescribing patterns, relate the physician's prescription
writing pattern to the medical curriculum of his training.
The study focused on therapeutics, but to be meaningful the
therapeutics curriculum has to be coordinated with that of
basic pharmacology.

Sicé (1976) in his study of the objectives of pharmaco-
logical education, also relates prescription writing patterns
to the pharmacology curriculum. He pointed out that opinion
on the contents of what candidates should be taught, must
learn, or ought to know is deadlocked. Some urge the teach-
ing of the practical aspects of drug use, others maintain
that facts and theories underlying pharmacotherapy should
be taught more extensively than in the past. He further
argues that this debate which lasted a decade, has revealed
the complexity of the problem. He points out that several

approaches are being tried at various schools to develop

48

processes that would fulfill the objectives of pharmaco—
logical education for medical practice.

Burford and Stritter (1974) in their study on the
evaluation of a teaching program in medical pharmacology
emphasized that clearly stated teaching objectives, relevant
practice in the accomplishment of objectives, an individual-
ized instructional approach, and concern about students'
attitudes and performance are successful as educational

strategies which foster learning.

2.4.1 Curriculum Models

 

2.4.1.1 American Association of Dental Schools' Model

 

The American Association of Dental Schools (AADS)
released a special report on curricular guidelines in pharma—
cology (1982). The association had recognized that there
is a diversity in the content and format of the pharmacology
courses offered in the dental schools. They observed that
some of the courses offered were somewhat shorter than is
appropriate for the proper training of the dentist.

The curriculum outline suggested is as follows:

1. Sources of information
2. Terminology
3. Absorption, biotransformation, distribution, excretion

of drugs (ABDE)

49

4. Routes of administration

5. Dose response relationships

6. Drug—receptor interaction: mechanisms of drug action
7. Drug interactions

8. Drug toxicity

9. Placebo effects.

The above pattern is to be followed in dealing with
the various drugs and drug groups. The AADS maintains that
basic principles of pharmacology are essential in at least
two respects: they provide a framework in which all drugs
may be studied; second they equip the student to evaluate
rationally new therapeutic agents. AADS suggested sequencing
of pharmacology instruction to follow courses in anatomy,
physiology, biochemistry, and at least concurrent with courses
in microbiology and pathology. The AADS suggests that facul-
ties for teaching pharmacology should have professional

training in pharmacology at the Ph.D. level.

2.4.1.2 Association for Medical School Pharmacology's Model

In spring 1984, the Association for Medical School
Pharmacology AMSP Committee on essential knowledge base in
pharmacology released an outline on knowledge of objectives
in medical pharmacology(AMSP, 1984). The document identifies
the minimum essential knowledge in pharmacology which every

medical student trained as an undifferentiated physician

50

must have at the time of graduation from medical school.

Each topic has been developed by a special subcommittee with
expertise in the particular area of pharmacOlogy. The objec-
tives were not designed for any particular medical pharma-
cology course. They are meant to serve as guidelines for

the minimum knowledge of pharmacology that every medical
student should possess when he/she graduates from medical
school.

The AMSP document further defines the minimum number
of drugs which should be taught. Whenever possible, proto—
typical drugs are included with major emphasis On teaching
the principles of pharmacology. The principles and knowledge
objectives included in the document center around mechanism
of action, actions on organ systems, pharmacokinetics, thera-
peutic indications including some disease entities, adverse
effects, contraindications and drug interactions. Every
effort has been made to reduce the number of drugs taught
in medical school, and to focus on the essence of pharma-
cology emphasizing principles and knowledge objectives.

The AMSP document is intended to provide guidance for
medical school pharmacology departments as well as clinical
departments in medical schools which have the responsibility
for teaching medical students in pharmacology.

According to the document the scope of pharmacology
embraces history of pharmacology, the chemistry of drugs,

pharmacodynamics, pharmacokinetics, clinical pharmacology

51

and therapeutics, and toxicology. The areas of pharmacology

in a core curriculum, with the hours (in brackets) required

for each area are outlined as follows:

2.4.1.2.1 AMSP Areas of Pharmacology

10.
ll.
12.
13.

14.

15.

l6.

17.

General principles (11)

Drugs acting at synaptic and neuroeffector junctional
sites — autonomic and neuromuscular pharmacology (11)

Drugs acting on the central nervous system (23)
Autacoids and antiinflamatory drugs (5)
Cardiovascular pharmacology (10)

Diuretics and drugs affecting renal function and elec-
trolyte metabolism including water, salts and ions (4)

Gastrointestinal drugs (1)

Drugs affecting uterine motility (1)

Chemotherapy (13)

Drugs acting on the blood and blood forming organs (2)
Endocrine pharmacology (9)

Toxicology (5)

Vitamins (1.5)

Principles of prescription order writing and patient
compliance instruction, dosage regimens (1.5)

Laboratories (15) — student participation - 1-3 experi-
ments (3—9 hours - average 6 hours) demonstrations (aver-
age 9 hours)

Conference (Tutorial) (12)

Clinical Round tables (Topic teaching) (8)

52

Summary

Lecture hours = 98

Conference hours = 12

Clinical round table = 8

Laboratory = 15
Total 133

The detailed outline of some of the AMSP areas was pre—

ceded by some explanation as shown below:

General principles

 

A series of 10-13 contact hours is considered appro-
priate for a development of the general principles of pharma-
cology. The information content of this section should be
reinforced throughout the pharmacology course by making
reference to this material when specific drugs are discussed
in the appropriate sections of the course. Thus for virtually
every drug to be discussed, reference will be made to pharma—
cokinetic aspects, drug metabolism, and receptor interactions,
making use of the information developed in this portion of

the course.

53

Drugs Acting at Synaptic and Neuroeffector Junctional Sites —
Autonomic and Neuromuscular Pharmacology (11)

In general, medical students come to pharmacology
with a sound background in the anatomy of the autonomic
nervous system, but need an indepth review of the physio-
logy of the autonomic nervous system. The importance of
autonomic pharmacology is greater than that of its collective
therapeutic agents. It is the foundation for understanding
other areas such as cardiovascular pharmacology and pharma-
cology of the central nervous system. Autonomic nerves
and/or their effector cells are the sites of actions respon-
sible for the side effects of many drugs whose primary sites

of action are elsewhere.

Drugs Acting on the Central Nervous System (23)

Understanding of central nervous system pharmacology
depends upon prerequisite knowledge of neurochemistry, the
physiology of sleep and of pain and its modulation, psycho-
pathology (neurosis, psychosis, and affective disorders,
and neuropathology). In many medical schools the pharmaco-
logy course is scheduled before some or all of these prere-
quisites are achieved. In such instances the discussion
of many centrally acting drugs in the pharmacology course
must be prefaced with the appropriate neurochemistry, psychi-
atry, or neurology. Taking this into account, a core curri—

culum in CNS pharmacology might require from 20—25 hours.

54

Cardiovascular Pharmacology (10)

Review of cardiovascular physiology (2)

This is the review of the heart including contractility,
automaticity, excitability, refractory period, and conduc-
tion; excitation contraction coupling and electrical activity
of the heart including the action potential and electrocar-
diogram.

Diuretics and Drugs Affecting Renal Function and Electrolyte
Metabolism Including Watery Salt and Ions (4)

Review of renal physiology/Biochemistry (1)

Chemotherapy (13)

The time devoted to various topics in chemotherapy
will vary from institution to institution depending on a
number of factors including: the amount of time spent in
microbiology on basic mechanisms of bacterial cell wall
synthesis, mechanisms of action of antibacterial drugs,
etc; the coverage of this class of drugs in clinical correla-
tion conference sessions or in lectures given by clinical
departments; the expertise of the department, and teaching
time available to the department.

Information regarding toxicity antibacterial spectrum,
therapeutic uses, and specific pharmacology should be covered

as part of the discussion of individual drug classes. It

55

was thought that antimicrobial drugs should be organized
for pedagogical reasons by mechanism of action, i.e. inhibi-
tors of cell wall synthesis, protein synthesis inhibitors,

metabolic inhibitors, antifols etc.

Endocrine Pharmacology (9)

Introduction (0.5)

Describe the general mechanism of action of hormones:
peptides vs steriods or thyroxin; describe the general use
of hormones/drugs for therapeutic use of natural hormones
for replacement therapy; use of hormones for specific pharma-
cological action e.g. antiinflamatory; for diagnostic pur-
poses; to mimic action of natural hormones;to block synthesis

or action of natural hormones.

Toxicology (5)

Introduction

AMSP contends that a medical pharmacology course should
be primarily concerned with three aspects of toxicology:
adverse effects of therapeutic agents, acute intoxications
and chronic poisoning. The adverse effects of drugs should
be taught along with the pharmacology of the individual
drugs or groups of drugs. The discussion of acute intoxica-
tions should constitute a short but important part of the

course and should deal with techniques and procedures used

56

in dealing with unexpected exposure to acutely toxic materials.
Lectures dealing with chronic intoxications should emphasize
environmental toxicology and risk assessment; for this rea-
son a deletion of much of the material that has been tradi-

tionally presented, such as heavy metals, is recommended.

Major Recommendations

1. Principles of Toxicology: Because the mechanisms
by which chemicals produce toxic effects are governed by
the same principles that govern the pharmacological effects
of chemicals, the principles section of the pharmacology
course should cover both topics. This can be done with
little or no additional time. Moreover, these principles
can be reinforced and reiterated later in the toxicology
section of the course (1).

2. Toxicology of Individual Drugs and Drug Groups:
The toxicological effects of drugs should be included in
the discussion of the pharmacology of the specific drugs
and drug groups.

3. Priority Toxic Chemicals: Because acute intoxica-
tions with drug or non—drug chemicals are rare, extensive
discussions of individual toxic non-drug chemicals are not
recommended. Priority chemicals include carbon monoxide,
cyanide, lead, iron (if not discussed in the autonomic ner-
vous system section of the course). This list may be expanded

in some schools to satisfy perceived local or regional needs;

57

for example, agricultural chemicals may be given more empha—
sis in rural areas and air pollutants may be emphasized

in urban areas. But, the traditional emphasis on heavy
metals and solvents is no longer warranted. Finally, the
therapeutic use of specific antidotes could be covered along
with the relevant priority chemicals or could be discussed
in connection with the management of intoxications (2).

4. Management of Acute Intoxications: The therapeutic
approach to the management of acute intoxications with either
drug or non-drug chemicals should be taught. This lecture
approach could effectively present a "decision-tree" approach;
if the identity of the poison is known, the approach would
be different than the case where the identity of the poison
is not known.

5. Environmental Toxicology/Risk Assessment: Because
acute high-dose exposures to chemicals occur infrequently
and because long-term low-level exposures occur frequently,
medical students should be provided with information about
the evaluation of risk assessment and the hazard associated
with long—term exposure to chemicals. Moreover, long-term
use of therapeutic agents at moderately high doses compared
to chemicals in the food, air, and water, is not commonplace.

6. Lectures in this area should deal with the carcino-
genic, mutagenic, and teratogenic potential of chemicals:
carcinogenic (e.g. concept of precarcinogenic, proximate
and ultimate carcinogen); metabolic transformations of chemi—

cal carcinogens; mechanisms of carcinogenesis (initiation

58

and promotion processes, relationship with DNA binding,
concept of DNA repair); mutagenicity and relationships with
carcinogens in cigarette smoke; chemical prevention of car-
cinogenicty (e.g. antioxidants). These lectures provide

an excellent opportunity to reinforce fundamental concepts
(dose response, variability of responses in a population,
etc.) and to train students to use these concepts in evalu-
ating risks; the reliance of fundamental concepts is impor-
tant in an area where reliable data for the human population
is usually lacking (2).

7. Sources of Information: Because intoxication
associated with diverse types of chemicals may be encountered
in clinical practice, medical students should be made aware
of the information sources available to them. A presenta-
tion by the director of the local or regional poison in-
formation center may be effective. In the future, computer-
accessed data bases may become available, and students should
be made aware of this source of information.

8. Lecture Time: In the idealized curriculum, about
five lectures should be devoted to toxicology. These lec-
tures may be held in conjunction with discussions on clini-

cal conferences.

Vitamins (1.5)

 

Vitamins play a minor role in contemporary therapy,

although their consumption in OTC preparations is common.

59

The conclusion is that the discussion of the rational use
and toxicity of vitamins should be presented in the medical
curriculum; this information could be presented in a bio—

chemistry, nutrition, or pharmacology course.

2.4.1.2.2 Experimental Laboratories as Learning Tools in
a Pharmacology Curriculum (15)

There seems to be a resurgence in the use of student
laboratories to teach pharmacology. Twenty—four U.S. medical
schools of 126 are using them (19 are mandatory and 5 are
optional). There are at least 12 other schools that use
demonstrations only.

One of the problems with laboratory teaching relates
to the supply and proper maintenance of laboratory animals.
Laboratory exercises are available in which the animals were
not sacrificed (AMSP, 1984). These take a great deal of time
and effort but are said to be worth it.

The AMSP committee felt that the time is right to intro-
duce laboratories back into medical education. The committee
hoped that some will be modern experiments as those used at
present are very old (1920—1935). They pointed out that it
should be possible to achieve modern creditable pharmaco-
kinetic experiments (they do not exist today). The committee
suggested that AMSP should collect a data bank of proven
laboratory exercises. These can be made available to member

schools.

60

2.4.1.2.3 Clinical Pharmacology

The AMSP committee agreed that it was not useful to
try to distinguish between "clinical pharmacology" and other
aspects of pharmacology in establishing the goals, length,
content and format of a required sophomore (preclinical)
year course in pharmacology for medical students. At the
sophomore (preclinical) level, a distinction may be made
between teaching clinical pharmacology and attempting to teach
pharmacotherapeutics, a distinction based on the level of
students' knowledge and experience.

The AMSP committee further agreed that teaching and
learning clinical pharmacology can be approached successfully
using a variety of formats, not excluding such conventional
formats as the lecture or the use of textbooks and other read-
ing and study materials. In teaching or learning clinical
pharmacology, particular attention should be directed to-
wards providing students with knowledge and skills necessary
to adapting generalized pharmacological information to the
needs of specific, individual patients, factors influencing
the individuality of patients, the nature and severity of
prior and present illnesses, the concurrent use of other
drugs and treatment modalities, diet, the use of alcohol,
tobacco etc. Properties of specific drugs should be empha—
sized which enhance or limit their adaptability to the needs

of specific patients; such properties may include cost,

61

suitability or unsuitability for use in, for example, out-
patient settings the need and cost for drug level monitoring,
special routes of administration, etc.

The AMSP committee was unanimous that students should
be encouraged to develop skills which will permit their effec-
tive and efficient acquisition of information about drugs
from resources additional to structured medical school and
continuing education courses. They (committee) developed
learning objectives. They indicated that the order in which
the objectives are listed is not intended to show rank or
order of importance. The choice of learning objectives in
clinical pharmacology and the times and places at which they
can be addressed, will vary somewhat from curriculum to curri—
culum. The objectives are not intended, collectively, to
represent a prototype for learning of clinical pharmacology
at the sophomore (preclinical) level. The objectives exempli-
fy areas which the committee believes desirable to address,
at least to some degree, in a conventional sophomore (pre-
clinical) level course. Although the objectives are written
in rather general terms, the committee believes that learning
outcomes from each of them can be identified and measured.
Clearly, retention of the skills and knowledge acquired, and
the continued development of facility in using them, requires

their being reinforced in parts of the medical school curri-

 

culum subsequent to the sophomore (preclinical) course (e.g.

junior and senior/clinical year curriculum). The clinical

62

objectives should be developed in an integrated fashion begin—

 

ning in the sophomore (preclinical) year and extending through—

out the junior and senior (clinical) years.

2.5 The Faculty

In their study on teachers and teaching in U.S. medical

schools, Jason and Westberg (1982) quote Millis as saying

Practically all medical schools are being called
upon to train larger student bodies despite
declining financial support. If the schools

are to continue to meet society's demands for
more physicians without endangering the quality
of their training, they must improve their
instructional efficiency and make more effec-
tive use of faculty time (Jason and Westberg,
1982, p. 3 - underlining is mine).

In relating types of programs to the types of teacher they

(Jason and westberg, 1982) quote Miller who said:

It is increasingly clear that the design and
implementation of many new instructional
programs resemble nothing so much as building
a new home and then living the same life in
it. The architecture may be admirable, but
the social interactions are often deplorable.
If that aspect of education is to be altered,
then the actors, not merely the stage setting,
probably need attention as well (Jason and
Westberg, 1982, p. 5).

Accordingly this study focuses on some aspects of the teach—
ers of pharmacology. While the literature is almost unani-

mous that pharmacology is not synonymous with therapeutics,

and that pharmacology is a basic course which should be

63

taught at the end of the preclinical period but before thera—
peutics, the debate about who should teach pharmacology
and who should teach therapeutics seems to continue.

Opinion seems strong that the teaching of basic pharma-
cology is the responsibility of the pharmacologist (Sapeika,
1964; Eales, 1964; Maren, 1976; Reynolds, 1976; Charlton,
1978; Botha, 1978). The roles of the pharmacologist and
the clinician in clinical pharmacology as well as in thera-
peutics are not well defined. The studies done and observa-
tions made to date, seem not to bring about a solution as
to who should be responsible for the teaching of clinical
pharmacology and therapeutics.- The U.S. Task Force on pre-
scription drugs (1968—69) received a comment at Harvard
University that a course in pharmacotherapeutics and clini-
cal pharmacology should be a required part of the curriculum;
that such a clinically oriented course in pharmacotherapeu-
tics caa be taught neither by basic pharmacologists nor
by the majority of clinicians, and it should be coordinated
and largely taught by clinical pharmacologists, although
pharmacotherapeutically-oriented clinicians would be expected
to make valuable contributions. The same Task Force found
that at the University of Florida, applied pharmacology
was taught by clinical pharmacologists, basic pharmacologists,
and selected clinicians. At Stanford University they found
that systematic pharmacology was a bridge between basic

pharmacology and therapeutics; at the University of Chicago

64

they found that clinical pharmacologists were teaching
therapeutics.

Botha (1978) suggests that during training, and subse—
quently when practicing as a specialist, the clinician should
be taught pharmacology by the pharmacologist. The pharmacolo-
gist should also teach basic pharmacology to the medical stu—
dents for a period of several months in the preclinical period.
The clinicians should be responsible for teaching therapeu—
tics, after students have acquired sound background in basic
pharmacology.

Some medical educators are skeptical about clinical
pharmacologists becoming the teachers of pharmacology to
undergraduate medical students. Eales (1964) quotes Modell
as saying:

. . . clinical pharmacology is in danger of

becoming a mere drug-evaluating service run

by glorified technicians with the consequent

decline of basic research into drug action.

A repetitive, unimaginative drug-testing ser-

vice would be an undesirable milieu for the

training of undergraduates (Eales, 1964, p. 69).

Schnieden (1976) warned that if clinical pharmacology
were to replace basic pharmacology, the "deposits" which
basic pharmacology makes are likely to be depleted, and
this will hinder the teaching of clinical pharmacology.

This view implies that clinical pharmacology requires basic

pharmacology. but not the other way round. The mutual depen-

dency of these two aspects of pharmacology is unquestionable:

65

some drugs effects in man do necessitate further experimenta—
tion by basic pharmacology. It would seem that the medical
student is likely to benefit from both basic pharmacologist
and clinical pharmacologist.

Jason and Westberg (1982) approach the problem of who
should teach what differently. They argue that there are
differences between basic science teachers and clinical teach-
ers with regard to qualification, the professional group
they identify with, reasons for leaving a university, criteria
for evaluating students, and teaching styles. These dif—
ferences affect the approaches used by each type of teacher
in imparting information to students; the differences also
affect the attitude of the student toward the teacher.

Jason and Westberg (1982) further point out that students
can be helped considerably by observing and interacting with
people who are genuine role models, who are engaged in the
very pursuits for which the students are being prepared.
Students seem to benefit from being exposed early and regu—
larly to clinically active physicians as role models, parti—
cularly physicians who regularly pursue the kind of chal-
lenges the students are likely to face in the future.

Jason and Westberg (1982) contend that it is also im-
portant for learners that they understand the ways in
which the material they are now learning links to what

they will ultimately need to be able to do. It seems

66

that active clinicians are best equipped to help students
understand these links. A disproportionately large number
of basic scientists do not attempt to tie the learning goals
they offer to students' career goals.

These researchers argue that their findings and the
findings of other studies seem to point toward the importance
of involving clinicians in the direct learning experiences
of medical students from the opening days of their medical
education. They also found, in considering the role of
basic science teachers, a number of issues have to be con-
sidered. First, there are multiple responsibilities to be
fulfilled. Medical students comprise only one of many
groups educated in current medical schools. Basic science
teachers are not only appropritate teachers, they are the
definitive role models for the other groups.

Second, the provision of a proper education for future
physicians is a highly complex set of tasks, not a single,
homogenous process. It is naive and inappropriate to provide
all students with the same experiences or to have all teach-
ers do similar things. Many different role models and ex—
periences are needed, at different times for some students
and in different forms for different students. All students
do not have to be prepared in only one way for a profession
as multifaceted as medicine with such a large array of

different career opportunities. It seems reasonable to

67

consider basic scientists in medical schools as a valuable
resource, to be drawn upon in different ways for different
purposes. Some students can be provided with opportunities
for individualized exposures to the real world of basic re—
search in the context of electives or "track" type programs.
In some schools, basic scientists regularly do this. For
groups of interested students, basic scientists can provide
indepth supplements to the somewhat superficial treatments
their disciplines inevitably receive as part of routine
medical education.

Third, an appointment to medical school faculty does
not confer automatic qualifications for teaching undergradu-
ate medical students. For both basic scientists and clini-
cians, there is no assurance that competence in one's pri-
mary field, which is the usual basis for a faculty appoint-
ment, is accompanied by the particular characteristics needed
to be an effective teacher, particularly a teacher of begin—
ners who will pursue careers outside one's own discipline.
Like all qualifications for complex tasks, the qualifications
needed for that responsibility are not equally distributed
among people, especially people who have had virtually no
preparation for that responsibility. All faculty members,
not just basic scientists, should devote their energies to
those tasks for which they are best prepared or have the

highest inclination. It is a disservice to faculty members,

68

as well as to their students, to convey an expectation that
everyone should instruct medical students.

Jason and Westberg (1982) go on to say that some schools
have already sought to achieve the blend by having basic
science and clinical teachers participate jointly in selected
courses for medical students, particularly courses involving
the solving of real clinical problems. In such courses,
with this kind of collaboration, basic science and clinical
faculty can more fully appreciate each other's perspectives
and areas of potential contribution.

They further indicate that valuable collaborations
have also taken place in schools where basic science faculty
have taught jointly with clinical faculty in clinical set-
tings.

The idea of blending basic science teaching with clini-
cal teaching sounds similar to the "longitudinal" teaching
described by Reid (1964) at the proceedings of the conference
on medical education held at the University of Natal in
South Africa. Reid pointed out that the approach benefited
not only the students, but the teachers as well.

In the pharmacological year, whenever a

human preparation is available which is

better than an animal one, we use it: not

for any reason other than that it may be a

good one. For instance a very good human

preparation is the inflammation of the eye,

where we can show the various phenomena of

inflammation and the effects of pharmacological

interference most effectively. There are
a number of other human preparations which

69

are also useful, but they are fairly limited.

Sometimes we use them not so much because of

their practical use, but because of the emo-

tional lift that it gives to a student to be

dealing at last with this thing, the patient,

which he spent so many years working up to-

wards. . . . The ability to plan longitudi-

nally from first right through to sixth year

has been the most rewarding thing that we have

been able to do (Reid, 1964, p. 87).

On the effects of the ways medical teachers relate
to students, Jason and Westberg (1982) point out that stu-
dents who are treated in an authoritarian way, become pas—
sive learners. Passive learners can be unnecessarily expen-
sive to educate, because they tend to expect their teachers
to do for them many of those things they can, and should be
doing for themselves. Students who do not learn to criti-
que their own performance and to develop their own plans
for learning while still in formal training are at risk of
becoming rapidly and dangerously obsolete. Students who
have been treated in an authoritarian way by their teachers
tend to treat their patients also in an authoritarina
way. Their patients become dependent on the physician even
for things they can do for themselves. This substantially
increases the cost of their medical care. Collaborative
teaching leads to active, independent, skilled students,
who take responsibility for their own learning during their
formal training and during their careers as practicing physi-

cians. The researchers observed that the patients of physi-

cians who have been taught in a collaborative manner, remain

7O

actively involved in maintaining their own health, and when
necessary, in dealing with their illnesses because their
physicians treat in a collaborative manner also.

It is the writer's view that the key to effective
teaching, and the solution to who should teach what seems
to be not only proper qualification and proper attitude,
but also the ability to coordinate the teaching of pharmaco—
logy very finely with the teaching of the other disciplines.
It also appears that the finer coordination of the teaching
of pharmacology with the teaching of therapeutics is more
practicable for the six year (South African) approach than
for the four year (Michigan) approach because the students
are on the medical school campus for all the six years and
feedback by the clinical departments on to the basic pharma—

cology department can be faster.

2.6 Teaching Methods

2.6.1 Introduction

Teaching methods in pharmacology are mainly the conven-
tional ones: lecture, demonstration, laboratory exercise,
projects, and discussion. Some new techniques are being
introduced. Among these are various formats of self-
instructional approaches. As Bogner et al. (1975) pointed
out, the self-instruction formats include programmed materials

which utilize written texts, computers, and other electronic

71

devices; sophisticated multimedia packages such as televi—
sion, film, and slides accompanied with learning guides; and
simple media packages which employ audiotapes with illus-
trated workbooks. They contend that if these types of self-
instructional materials are to justify their development

in terms of instructional effectiveness and cost—benefit,
their comparison with conventional teaching modes is inevit—
able. They further indicate that research studies concerning
the relative effectiveness of programmed material and sophis—
ticated multimedia packages as compared with the traditional

modes of instruction have been reported.

2.6.2 Lectures

 

Lectures are the most preferred (by faculty and students)
teaching tool. In their 1957 study on controlled experiments
in teaching, Joyce and Weatherall found that lectures were
second only to discussion in effectiveness, but were better
than practical classes and reading. Their 1959 study on
effective use of teaching time, they established that students
rated lectures the highest compared to demonstrations, prac-
ticals, seminars, discussions and reading. The American
Association of Dental Schools Report (1982) seems to recommend
lectures as the main teaching tool in pharmacology. The
Association for Medical School Pharmacology (1984) suggest

that about 74% of the teaching time be for lectures.

72

2.6.3 Demonstrations

The 1959 study by Joyce and Weatherall showed that
students rated demonstrations second to lectures and better
than practicals, seminars, discussions and reading. Kahn
and Bigger (1974) in their study on instruction in pharmaco—
kinetics: a computer assisted demonstration system concluded
that the demonstration enhanced the understanding of the
students. D'Mello and Kruk (1976) in their study on effec-
tive pharmacological demonstration to 100 students concluded
that the method has many advantages over conventional large
practical classes, especially in these times of increasing
student numbers and restriction on appointment of new staff.
They point out that there was no decrease in standards and
the method is popular with both staff and students. The
Association for Medical School Pharmacology (1984) suggests

demonstrations as one of the teaching tools.

2.6.4 Laboratogy Exercises

This appears to be the most controversial of all the
teaching methods. In both his reports (1910 and 1925) Flexner
emphasized the laboratory as an important teaching tool.

Kahn (1965) however pointed out that the mistake Flexner
might have made was to take the teaching laboratory and
the research laboratory to be the same. Kahn (1965) con-

cluded that the criteria he used indicated no effect on

73

student learning not attainable by easier methods. He argues
that the tests used in evaluating the laboratory effect

may not be appropriate, or what the laboratory is supposed

to achieve is not well defined.

The study by Joyce and Weatherall (1957) on controlled
experiments in teaching focused on the four methods of teach-
ing: lectures, discussion groups, practical classes and
unsupervised reading. Practical classes were found to be
less effective compared to discussion and lectures as teach—
ing method. In their 1959 study, Joyce and Weatherall focused
on effective use of teaching time. They considered lectures,
demonstrations, practicals, discussions, seminars, and read-
ing as teaching methods. They found that practical classes
required more time and students found them less enjoyable.
Goldstein (1956) in his study on a controlled comparison
of the project method with standard laboratory teaching,
found that the laboratory was the lesser effective. Mandel
§£_gl. (1971) in their study on the value of the laboratory
in teaching pharmacology, concluded that a brief laboratory
program in pharmacology is of some value in increasing the
performance of the students in pharmacology. The Associa-
tion for Medical School Pharmacology (1984) suggests the
laboratory as one of the teaching tools. There seems to
be a feeling that without the laboratory, reinforcement

of concepts learnt in lectures is missing.

74

2.6.5 Discussions

Joyce and Weatherall (1957) in their study on controlled
experiments in teaching found that discussions were more
effective than lectures. Their 1959 study on effective
use of teaching time, established that discussions required
less time of teachers than seminars, and the corresponding
difference for students was very slight. The Association
for Medical School Pharmacology (1984) suggests discussions

as teaching tools.

2.6.6 Seminars

 

Joyce and Weatherall (1959) found that seminars were
more effective than practicals, reading, and discussions,

but were less effective than lectures and demonstrations.

2.6.7 Unsupervised Reading

In both studies (1957 and 1959) Joyce and Weatherall

found unsupervised reading to be the least effective.

2.6.8 Project

In his study on a controlled comparison of the project
method with standard laboratory teaching in pharmacology,
Goldstein (1956) found the project to be more effective

than the laboratory.

75

2.6.9 Self-instruction

 

Engel g£_gl. (1974) in their study on teaching basic
pharmacology to medical students; an experimental self-
instructional approach, found that self-instruction was
just as effective as the lecture.

Abraham g£_al. (1981) on the study of comparison of
didactic lecture, self—instruction (guided) and self-reading
(unsupervised) as learning methods, concluded that self—
instruction is as effective as the lecture. They further

point out that students prefer self-instruction.

2.6.10 Audio-based Self-instruction

In their study on the effectiveness of audio-based
instruction, Bogner et al. (1975) found that the audio—based

instruction was more effective than the lecture.

CHAPTER 3

METHODOLOGY OF DATA COLLECTION AND ANALYSIS PROCEDURES

3.1 Introduction

 

Most of the data for this study was collected by cor-
respondence. Interviewng, telephone calls, and reference
to university prospectuses and bulletins were also used.
The type of data was decided upon with a few research ques—
tions in mind. The collected data has been summarized in
tables for comparison purposes.

This chapter includes research questions, selection
of medical schools, type of data, data collection methods,

and data analysis procedures.

3.2 Research Questions

 

First, are there differences or similarities between
the RSA and the Michigan medical schools with regard to the

basic principles of the pharmacology course: drug absorp-

 

tion, distribution, metabolism, excretion, mechanism of

action, interactions, drug development and evaluation?
Second, are there differences or similarities between

the RSA and the Michigan medical schools with regard to the

depth of the basic pharmacology course?

76

77

Third, are there differences or similarities between
the RSA and the Michigan medical schools with regard to the
instructional strategies for the basic pharmacology course?

Fourth, are there differences or similarities between
the RSA and the Michigan medical schools with regard to the

organization of the basic pharmacology course, particularly

 

about knowledge objectives, sequence of topics, groups and
subgroups?

Fifth, are there differences or similarities between
the RSA and the Michigan medical schools with regard to
teaching on Specific drugs?

Sixth, are there differences or similarities between
the RSA and the Michigan medical schools, with regard to

prescribed texts the manner of use of the texts, and the

 

 

other sources of information for the basic pharmacology

 

course?
Seventh, are there differences or similarities between
the RSA and the Michigan medical schools with regard to

facilities (size of department space), faculty (number and

 

qualifications of the pharmacologists), the doctoral instruc-

tor:student ratio, and the budget proportion for the pharma-

 

cology departments?

3.3 Selection of Medical Schools

 

The debate on the teaching of pharmacology at medical

schools in the RSA, seems to have started in 1964, at the

78

conference held in Natal. In 1977, the symposium held at

UCT on the teaching of pharmacology at Southern African

Universities, indicated that the teaching of pharmacology

is continuing to be cause for concern among South African

medical educators.

It is the writer's experience that medical doctors,
in the RSA, who qualified from the same medical school have
certain prescribing tendencies in common, and these seemed
to differ from school to school. It would not serve the
purpose for this study to focus on a few of the medical
schools in the RSA, because this might leave out some aspects
of the problem. Instead this study focused on the seven
medical schools in the RSA.

The Michigan medical schools were chosen because it
is at MSU where the writer J perceived that there might
be differences in the teaching of basic pharmacology at
the medical schools in the RSA and the medical schools in
Michigan. UOM and WSU have been added for the following
reasons:

1. to minimize bias because it is at MSU where the re—
searcher studied medical pharmacology, and where the
perception, that there might be differences in the
teaching of basic pharmacology in the RSA medical
schools and in the medical schools in Michigan, started
and continued to develop as the researcher went

through the course. There would therefore be a bias
towards MSU.

79

2. they make the comparison of the RSA and Michigan
a more reasonable one: if UOM and WSU teach basic
pharmacology almost the same way as MSU, and all three
do not experience the problems that are experienced
by the RSA schools, then the RSA schools have some-
thing to learn from the medical schools in Michigan.

3.4 Type of Data and Collection Methods

Apart from class room observations, class notes would
come closer to revealing what the student is taught in basic
pharmacology. Class room observations were not practicable
for this study. Correspondence, travelling and interviewing,
telephone calls and reference to university brochures (calen—
dars), and bulletins, are the methods this study used for

data collection.

3.4.1 Correspondence

 

A letter asking for basic pharmacology notes from
the various medical schools was compiled. After consulta-
tion with the guidance committee, it became evident that
the quality of teaching depends on the financial support
available to each medical school. Money determines the
facilities and the type of professor the medical school
can afford. It also became important to know the hours that
each school spends teaching basic pharmacology. The class
size is also a factor in teaching. To obtain the informa-

tion on the facilities, faculty, average class size for

80

basic pharmacology and the money available, tables 1 and 2
(see Appendix A6 — A10) were made and sent to each medical
school in the RSA.

Letters were individualized, and in some cases follow-
up letters were written to clarify certain points. The
letter in Appendix A1 is a summary of all the letters
written to the universities.

The various medical schools responded as outlined in

the first chapter of this study.

3.4.2 Traveling and Interviewing

 

The writer traveled to South Africa in July, 1984 with
the intention of discussing this study with the pharmacology
department of each medical school. Visits were made to PRE
and WIT. Thereafter, traveling became hazardous because
of the unrest in the country.

The writer then sought and obtained permission from
the Lebowa Government Service's Department of Health to
interview the medical doctors working in the Lebowa hos-
pitals. In this area, some of the doctors employed have
qualified from the various medical schools in the RSA. Thus,
even though the writer has not been able to visit some of
the medical schools, some information about them could be

obtained in discussions with the medical doctors. Informal

81

interviews were preferred because the interviewee is relaxed
and participates more naturally.

The Lebowa Department of Health notified its hospitals
about the interviews, and asked them to assist the writer
the best way possible (See Appendix A5).

Both the writer and the hospital authorities agreed
that the interviews should nOt disturb the hospital routine.
The doctors were interviewed individually, or in groups
depending on the number of doctors available at the particu-

lar hospital.

3.4.3 Interview Questions:
1. Which Univeristy conferred the medical degree upon you?
Which year?

2. During which year of training were you taught basic
pharmacology and for how many months.

3. How did you find the course?
4. Do you recall being taught things like:

(1) rationale for the frequency of medication;
(2) rationale for drug combination;
(3) mechanism of action of drugs?

5. Were you made aware that a drug can have many trade
names?

6. Was prescription writing taught in this course or else—
where?

7. What approach was used in teaching basic pharmacology?
Where the drugs grouped or were you presented with a
list of drugs in an alphabetical order?

82

8. Did you take any examinations in this course? What
was the passing score?

9. Who taught this course? Was he/she a pharmacologist,
a clinician, a pharmacist, a chemist, or some other
person?

10. What did you like most about the course?

11. Do you think this course should be eliminated from
the medical curriculum?

12. As you have been practicing for some time, when you
look back at your training, do you think, as far as
basic pharmacology is concerned, that you have been
adequately prepared or not?

13. What recommendations would you make to your medical
school with regard to pharmacology?

3.4.4 Telephone Calls Consultations and References

At MSU, the writer ‘ consulted with experts in medi-
cal curriculum, and experts in clinical pharmacology. The
MSU Office of Educational Programs, and the Office of Medical
Education Research and Development (OMERAD), contributed
some valuable ideas to this study.

Data from UOM and WSU were obtained through correspon—
dence and telephone calls. Reference to bulletins and cata-
logues provided additional information about the Michigan
medical schools.

Some information about the RSA medical schools was
obtained from brochures (calendars) kept in the MSU main

library and the African Studies Center.

83

3.5 Data Analysis Procedures

 

This section describes the procedures of data analysis

about:

1.

The basic principles of drug absorption, distribution,
metabolism, excretion, mechanism of action, inter—
actions, development and evaluation;

The organization of the course as a whole;

The depth of the teaching;

The pattern of teaching about specific drugs or groups
of drugs; and

Facilities, faculty (pharmacologists) hours and
financial support.

Tables gave better comparison in this study. The data

from each medical school was tabulated according to the

above list.

 

CHAPTER 4

ANALYSIS OF DATA

4.1 Introduction

 

This chapter presents the summaries of the pharmaco-
logy course syllabi of the various medical schools, the
comparative analyses of data, and the summary of the
answers to the interview questions. The summaries of
the syllabi are necessary to put the information from

the class notes and/or prescribed texts in perspective.

4.2 Summaries of the Syllabi

 

4.2.1 Michigan

 

4.2.1.1 MSU

 

Medical pharmacology is taught as a two course
sequence, Pharmacology 520 and 521. The courses are
offered in the second year for two terms of ten weeks
each. During each week four lectures are given. The
mode of instruction is the lecture. There are three
one—hour, interval examinations each term. The pass

mark is 70%. Areas covered are indicated in Appendix B1.

84

85

4.2.1.2 UOM

 

The course title is Medical Pharmacology. It is
offered in second year for two terms of sixteen and four—
teen weeks respectively. In each week four lectures are
given. There are three one—hour, interval examinations,
and one three-hour comprehensive final examination in each
term. The final examination in the second term is on all
the work done during the two terms. The mode of instruc-
tion is the lecture. The pass mark is 70%. Areas covered
are shown in Appendix B

2.

4.2.1.3 WSU

 

The course title is Pharmacology. It is a self-
study course offered in second year. It is organized into
modules of varying lengths. At the end of each module,
there is an examination. Students are expected to pass
a module examination at 90% competence level or better.
Each student is assigned a tutor. A final comprehensive
examination is taken at the end of the course. The pass
mark is 70%. Areas covered under each module are indi-
cated in Appendix B3.

Table 4.1 below, gives the summary of the Michigan

medical pharmacology syllabi.

86

TABLE 4.1

SYMMARY OF THE MICHIGAN SYLLABI

 

Item

MSU

UOM

WSU

 

Course Title

Stage taught

Mode of in—
struction

Number of
lectures

Examination

Pass mark
Knowledge

objectives

Student feed—
back

Prescription
writing

Medical Pharma-
cology I and II

Second year

Lecture

79

6 one—hour
interval

70%

Specified for
each topic

Not shown on

class notes, but
it is policy for
students to evalu—
ate the way they
have been taught

Taught in
this course

Medical Pharma-
cology

Second year

Lecture

101

6 one-hour
interval,

2 three-hour com-
prehensive finals

70%

Specified for the
whole course; re—
view questions
provided for each
topic

Material supplied
did not show any

At end of course

Pharmacology

Second year

Self-study with
tutorials

8 modules of dif—
ferent lengths

8 "mini-examina—
tions",

1 comprehensive
final

90% in each module
70% on whole course

Specified for each
module

At the end of some
modules

Not taught in
this course.

 

87

4.2.2 RSA

 

4.2.2.1 UCT

 

Pharmacology is offered in second, third, fourth,
and fifth years. In second year the title is Introductory
Pharmacology; in third year, Principles of Pharmacology;
in fourth and fifth years the title is Applied Pharmacology
and Therapeutics. In second, third and fourth years, the
student must perform satisfactorily to get into the next
year of study. In fifth year an examination is taken.

Modes of instruction are lecture, discussion, and demonstra-
tion.

In fourth year the course is said to comprise a series
of forty weekly lecture/clinical demonstrations. The fourth
year students also participate in small groups of 8—10 in
a two—weekly block in clinical pharmacology. During the
block period, students attend for eighteen sessions (1-1%
hours each) of instruction and discussion. Over half of
the sessions are involved in bedside teaching.

In fifth year, the discussions are said to be,as far
as possible,based on a clinical example. Considerable empha—
sis is laid upon the safe and rational use of medicines.

The scientific basis of everyday therapeutics is considered.
An important element is to examine limits of knowledge and
points of controversy. Previous instruction in basic and

systematic pharmacology forms the basis for this program.

88

The course is not designed to provide a comprehensive and
didactic lecture series. The areas covered are shown in

Appendix B4.

4.2.2.2. MED

 

The course title is Pharmacology and Therapeutics.
It is offered in third, fourth and fifth years of study.
Modes of instruction are lecture, laboratory exercises and
seminars. An examination is taken in the third and fifth
years. Areas covered are indicated in Appendix B

5.

4.2.2.3 NAT

 

The course title is Pharmacology. It is offered in
third year. There are twenty-nine weeks of instruction,
and four lectures every week. The instructional modes are
lectures, and discussions. Areas covered are given in

Appendix B6'

4.2.2.4 OFS

 

The course title is Pharmacology. It is offered in
third year. It is a lecture course with one three-hour
written examination and one twenty—minute oral examination
at the end of the course. The course is taught for one

hundred hours. Areas covered are shown in Appendix B7.

89

4.2.2.5 PRE

 

The course title is Pharmacology. It is offered in
third, fourth and fifth years. Modes of instruction are
lectures and demonstrations. One hundred and eight lectures
are given from mid—January to beginning of September. An
examination is taken at the end of the course. The areas

covered are indicated in Appendix B8°

4.2.2.6 STE

 

The course title is Pharmacology. It is offered in
third year. It is a lecture course. An examination is
taken at the end of the course. Areas covered are given
in Appendix B9.

4.2.2.7 WIT

 

The course title is Pharmacology. It is offered in
the third and the fourth years of study. It is a non-
qualifying course for the third year. During the first ten
weeks a course of lectures, demonstrations and seminars are
given on:

1. the fundamental principles of pharmacology including
absorption, distribution, metabolism and excretion.

2. The receptor theory of drug action, drug interaction,
adverse reactions, biological variability, effects of
disease and pharmacogenetics.

90

The principles are illustrated by considering the pro-
files of drugs that affect neurohumoral transmission. These
are followed by systematic lectures on therapeutic, diag-
nostic and poisonous substances relevant to the practice
of medicine. Areas covered are shown in Appendix B10.
Table 4.2 below, summarizes the RSA syllabi.

4.3 Answers to the Research Questions

 

4.3.1 First Research Question:

 

Are there differences or similarities between the
RSA and the Michigan medical schools with regard
to basic principles in pharmacology: drug ab—
sorption, distribution, metabolism, excretion,
mechanism of action, interactions, drug develop—
ment and evaluation?
Tables 4.3.1 and 4.3.2 below, on basic principles in pharma-
cology shows more similarities between the RSA and the

Michigan medical schools with regard to the basic principles

in pharmacology.

4.3.2 Second Research Question:

 

Are there differences or similarities between the

RSA and the Michigan medical schools with regard

to depth about the basic pharmacology course?
Tables 4.3.1 and 4.3.2 below, on basic principles in pharma-
cology show a vast difference in depth about basic prin-

ciples in pharmacology between the RSA and the Michigan

medical schools. Few of the RSA schools give the complete

921

 

Nemh Non Nomh New News Nomh Nomh cums moon
weco ouscwe
Iwucoxu w .wocoquEOHQ
omc20o occ we omcaoo ocu we couuwua cocoa mw cOwuoc mcooh cuwww .uoom cowlccm
coo» cuc50w cw w cco ocu on w vco ocu co w unocuooccu w leoxo oeom wsoom cco vcwcu cw “wooh cuwwu cw cOwuocwonm
mwouwuoocm consac
New cmw: a wccaw on
I mcowmmcomwc woo meoom sawzuwuwau
owcowwo>o Nw « mcocwsom lwcwwu a wcocweom mo vooucm "ocwa mousuuoc
we u moccuooc uoc moon mew u mocsuooc 00w u moccuuoc omw « mowsuooc 00 I moucuuoc Iuouoc uoc cwsoo wo coce=z
Aowcoh
uoohocm vczom woOwcwav
mcocwsom chwmmom ucwow mwocweom cOwuowumcoeon
cOwuocumcoeoQ cOwuocumcosoa wowcoush mwouwuuocm cmemsomwa cOwuoccuw
owcuuoc occuooc occuooc occuooc occuuoc occuuoc ocsuooc ch we owe:
sauce can cucwo can cause can cucaow cactus»
nausea ecu ecwac stage gae:0c .ecwcc euwcc euwcw sacsoo .etwcc .ecwga .ecouom Dawson macaw
memos can a cue
mowuzoqococh ecu
thwoooauocm Awou
-wcwwoc cowwaaa .m
pooh
can hwowouosuocm
we mowcwocwum .N
mowusocouoch cooh
vco ccm hw0woooacocm
hmowouoawmcm >m0wooo2uocm >w0womacmcm thHOOoBLocm hm0woooacocm thHOOoEcocm acouuscOHucH .w omuaoo mo oemz
hwz whm man who h<z am: ho: souH

 

Hm<Achm <mm mmh mo hm<zzbm
N.e mcm<h

€92

.acwwcou cu name
0: no: ococh .eoumhm wmcowuousvo <mm ocu cw Non mw cums moon ocu hwwmcocow omsoooc Non oc ou coacmwo ow cums moon ocu mcooa Nemh .mz

 

 

AcOwuoa

vowwccsm cowwccsm cowwccsm cowwccam cowwccsm ocwwuao two>o omcsouV

wmwcouoe co wowcoume co coon wmwcoume co cmoc owco wmwcoume co coon wmwcouoe co coon omccou co coocao xuocvoou

unocco uoc moon lam uoc moon 1cm uoc moon Iwwm>o uoc mama law we: moon ice uoc moon uoc moon ucovaum

cowwccsm cowwcqsm cowwqczm cowwaccm cowwcccw omucou

wowcoums co wowcoums co cooc wmwcoume co coon _ owco wowcooma co coon wowcocms co coon coo» cuwcu ocu mo>wuuohco

coocqo uoc moon law we: moon ago we: moon Iwwo>o uoc mama lam uoc moon tam uoc moon wow vowwwuocm owvowxocu
th mhm man who h<z am: ho: souH

 

Hm<qawm «we ace co wc<zz=m
Asmaawuaoov «.4 mamas

913

mucuoou uwuocow
ac vocwEuouoc cOwuozvcw oehwcm
ounce osom uco ococcoUchcc
owwuhohwoc so vousccw m cm .uau
coocOcocc ac cousvcw Omcm .umu
owuwuocmlcoc I cOwuucvcw osancm
mam < mum
.m.o mwscc ha mossnco woaom
IOcOwe mo cOwuwcwccw o>wuwuocaou
mmscc
wcoso cOwuwcwccw o>wuwuoqeou
Emwmowouoe macv mo wocucoo.m
m m oeoucOOuho mo owom
chwuoooc anewum>
“Emwwocouoe
mccc owuocom no scumwsocUme.<

cOwuuaccw oEancm
cOwuowuo> mowoocm
Oman osoccOOuho mo owom

Emwwocouos macc wcwuoowmo mucuumm chwuuavoc
me vco chwuocwomo woeomOLOwEIcoz
chwuocwxo mucoz
mowneoxo
Omen oEOLcoouso w mocha: cOwuocvou Owuoco:
mo owoc chwuoooc o>wuocwxo mowaeoxo

msoacuoc owwocouoz a mochuucOwuocwxo Owuocoz

 

Emwwocouoe mace cow vooc och “mmscv cu mooc amwwocmuos uocz .moh Hw vco H momocm .moh amwchouox mace
cOwumwsowmo muw Av>v cOwusc
lwcumwv mo oscwo> acococc<
.za co uumccm
.macc mo
.uw occhouov cOwc3 mc0u huwwwccwom vwnww mo uuouwm
cOwumwsowmo muw "cOwuccwuumwc loom .cOwumw20wmu mow .cOwu .suww
we oacwo> wcwcwacouov mucuoom Iscwcumwv we oscwo> acocoac< .moh Iwcooeuoa ococnsoe we uuouwm .moh cowuzcwuumwo
“moqumxo
cOwucuowco we cOwuocumwcweco «0 mouse» uwuwooam cow: ma «0 uoowmm -
mouwm nwcwcco>ow mowcwucwum wcwcwEuouov occuuom .vocwwon .moh “huwwwcawom vwcww we uuowwm .moh cOwuquomc<
cm: smz co: owawucwtc

 

hoocou<zx<rm 2H mmcmHoszm UHm<m
w.m.¢ mcm<h

14
n7

 

oz

.mvwaww

cmeaucw eccw mwzcc mo cOwuwcco
.m.o woowmccc co wooweoco uuocwa
ocowm wscc we

coca uocmwc uoowuo l cOwuowucouoc
.Emwwcochm .huw>wuwcc< .mouwm
wcwvcwc cwouocc um “mouwm ucoa
Imcocu o>wuoo uo chwoe wccv twang

.hwwsu cocwowcxo
mcocuo .memcwmwv cco mocauozcum
meweoco cow: couocumzwww oscm

.owcwo
Icwun soouocc och .oococoocu mo
ucoocou ncOwuocoxo mcwuoouuo who“

cocwmwcxo mowmum mDOwcm> .moh

Emwcowmucm mewEocu .Emwcom
touco wmoweocoowc .Emwcommucm
mewwOwoooEcocq .Echommuco woo
lmewme>ca .Emwmcocam uoowuo
o>wuwccm .cOwumeszm "cOwu

.moh IoOwuwmmowo vcm >w0wocwEuoh .moh

.hwwcw vocwowcxo cocuo

oz

chwuomcoucw qumcacoumEcmcm
chwuoocoucw owuocwxoomEcmcm

chwuom

Icoucw mace we mEmwcocuoz

MOHDUUU." 03h. o m0>

.hwwau cocwmwaxo
“memcmowc vcm mocsuoacum mcocuo .memcwowc ucm moczuuccum

 

.moh woOwEocu cuwz voumcumcwww oeom .moh coOwEocu cow: couocumcwww osom
omov oucocou
Icme vcm omoc wcwswcc Acv
Aoumum
accoumv owcwocwwc smoumwa Amy
"ox cco u no cOwuoowwcc<
cOwu caocm cOwumw>oa
lmcwEwwo wscc cow moucoc cocuo m
mg a. a «c
.IW x moo. I «a mac ”Amwccc
.c> cco *u cu oucmcmowo . mo ouww mwmcv *h vcm Accoumcou
mo cwcchwuococ noocouoowu we locwswwov ox ou cOwuzcwcumwc we

.moh

loom .ouaoc canoe ocu mw hocvwx .moh ucoocou uzc mo uuowum .cocwmoo .moh oscwo> ucococcm we cwcchwuowom .moh

cOwuozco>o ccm
acosa0wo>ov mace

chwuomcoucH mace

cOwuom
wscv mo Emwcocooz

cOwuouuxm

 

am:

am:

woocou<zc<=c 2H mmcccqucc ocm<m
ceosccucouv H.m.e mmm<h

:0:

ownwocwcm

95

oWHUCer—U MO
mEhUH Cw HOG UMNQH< HO mEHOH CH

.cocwowcxo awwsw cocwowcxo mocwmoomww uowccoo .cocwowqxo hwwcw muocuo
mcocco .meocmowc cco mocauosccm com .wowuowcwuco Lew omocu "co .msmcwowc cco moccuoacum woo cOwuuo mace
wooweocu cow: cououumcwww osom .moh lcwowqxo oc uac cocOwucoE oeom .moh IwEoco cow: couocumawww oEom .moh mo amwcocuoz

.cOwuowuxo wcwcco>ow mowcwu
Icwca wococou .cOwuocoxo acowwwm
.wo>ww cco hoccwx ocu cw=0ccu

 

.cocwmwcxo co: .cocowccoe . .Am ma moocoumcam msoomomncoz .mwccw
«a "hoccwx ocu cusoccu hwcwmz .moh I w ma chcocco oomv cocOwucoz cm30ccu moocoumcam maoommo .moh cOwuocuxm mace
.mosawco
.omcm o50cc60u>o wmaomOMszncoz cOwuwchcw
«o oHOc we cOwucoE oc “cOwawcwccw osxncm ncOwuucccw oehncm A0 «A .
co cowuucvcw oehsco we cOwucoE oEOccUOuaov moehnco wosomOLsz
oc “co>wo>cw moEmNco wo cOwucoE “co>wo>cw moshncm .HH omocm cco
oz .owcemxo co mo com: chmwcomw . . H omocm cOwumEcOHmcocquc sew
luo>ww ocu cw awcwme mcnooo .cOwu Am no I w ma chcocco cooz .cOwuwcwon .cowuoELOw
noEHOHmcocqum wouc: commsumwn .moh oomv hcouoxm cOwuoEcowcw usc .moh imcocqum wccc coccs commaumwn .moh Emwwocouoz mace
.xwws m.coccoe cw “oucooowc ocu .xwwe m.cocuos cw20ccu cowoocu
moccuo "cowccmn cwocc cOOHc och lxm .oucooown ocu mmocoo .cwouc
.mEmwcocoos ucoamcocu .ouwm cowso . . ou c00wc Eocw cOwuscwcumwo
Iowoe .huwwwcswom cwcww .mcwccwc Am me I w ma chcoacm .wcwocwc cwouocc Ou one cOwuoo
ococ uwcwccwc cwoBOcm .cocwuon .moh oomv hcoBoxm cOwumEcowcw usc .moh Icoucw wccv .mcwccwc cwouowm .moh cOwuacwuumwn mace
.wcwuco
inwwcw mucuuow ccm cowuocumwcwe cmeccmoco mace .cOwuocumwccho wccc we mouaom
1cm mace mo moasom .vocwwoa uzwwvos mucuumm .Ao a chcocqov .mococceoe moccoo wemwcocoos
.moquwcwuco we mscou cw ucwcoh .moh acouocm mcoocco cOwuoEcOch uzc .moh upocmcoch .mcwuoowwo mcouoom .moh cOwunuomc< maca
chm am: mam owcwocwcm

 

hoocou<xm<=m no mmcmHUszm on<m
N.m.< mcm<h

965

oz

.czocm no: wwwmuou can o>wmcoc
Iocceoo mcoocco oeocom "mOwcou

cOwuozwo>o cco

 

cocuo ou cocmceoo cowwouoc ocoz .moh .:w:cc o we cucwc och: .moh uco8c0wo>on was:
.chwuoocoucw macc Hawscmc wo cOwu
Ico>ocm .omocc oweocthOmEcmcc .mvwzww cmecwcw
.omocc owcocwxoomscocc .omoca cu mwccc wcwcco .w.o mwsuv wo
wmowusouoEcocc ”mommcc wouwwOwoo . . confisc m we cOwuocchoo ou occ
IoEcmcm .mcwaww cmeswcw cw on .Am mg I e ma chcocco oomv omocu “OwemcchOoEumcc .OwwOwoo
cOwaocwceoo wouwmmcm .cocwwon .moh .hcouoxm mcooqco cOwuoEcowcw usc .moh IoEcmcm "chwuoououcw we moahh .moh chwuuououcH mace
mcm cm: mac mmwcwucwcc

 

wooaoo<2c<=c co mmccHUZHcc on<m
Aeoscwucouv ~.m.a mam<h

€17

.cOwumEcOch coccczw oc 30cm
mouoc ocu can :cOwuocoxm cco Emwwoc
Imuoz: mo owcvocom occuoow co muoocc<

.cowccmc wmucooocm

“cowccoc cwocc cOOHc "cOwoscwcc

Imwc oocw wcwuco>occ mcowccmm

.wcchwuwucoc cco cOwuscwcumwc

Ion “mouwm wcwccwc gem cOwuwuoc

IEOo .wcwuoowwo mucuomm .cOwuzc
Iwcumwcloc "cowuscwcuwwc wowuwcw .moh

.cOwuouumwcchm wzcv we mousom
umwm0w>uocwm .cOwwswuwc coco»
Iwwwomw "ucocmcmwu o>wuoo "wcw
Ivcwc cwouOcq “mocmccsoe moccoo
cmecwwwc o>wmmoc ucwucoswwcw
mucuoow “ococceoe woOwwOHmehcm .moh

.mcwooowwo

mucuomm .cOwuoEcmecocquc wo
oucoowwwcwwm HmmeOwoomEcmcm
.woeomOcOwEIcoc .wmeomOcowE
"axowosancm “mcowuomoc Owuocu
Ichm .chwuoooc OwuocuchmIcoz

.mcwccwc osmmwu
.wcwccwc cwoa0cm "muwnuo cw
mucosucmceou hccc N o>wumwom

.cOwuocumwccho
wscv mo mocaom .mococcsoe
moccuo mEmwcocuoE ucocmcouh

.cOwuoEcowmcocuowc wacc
wosomocoweuccz .cOwuwcwccw oehnco
.cowuozccw ochnco "mosmuco woeom
ocowz .wcwucoswwcw mucuoou ”cemcm
oEOccoouhoV thwmeacc "souwam
wcwmwwocouoe mcwv woeomowuws

uwuocoz .owuocuchm .owuocuchm

Icoc uchwuoooc cOwumEcOHOcmuu

news we moocosaomcoo "cOwuoEuow

.moh Imcocquc mace covc: commcumwa

.xwwe uwoocc cco mmccc

“uwcs wmcowIwoucoomwQIwoccouoE

ocu cw mowuocwx “oucooowc moccoo

"mzu cu ommmmmm “cOwuoocoucw

wscc we uoowwm "wcwuoowwo chu

Ioom “omen msoco>ocucw owwcwm

a co muwuonx "cowuaawcumwe

.moh mo oscwo> .mwocoe ucosuwmcecu

.muwuocwx wocwo umcww

cco.coccOIoco~ we mowcwocwcm
.cOwumcumwccho mace we mousom
.cOwuacomco mace we mowuocwx
.mcwocoswwcw occuomw ”Emwcmcooe
acocmcmuu wacc .ococchE wwou mo
mowumwcouumcmcu "mwzco we ucon

.moh Imcocu ococcsoz .mcwwwcowwo>oowm

.moh

.moh

.moh

Emwwocouot mace

cOwuscwcumwn mac:

cOwuawomc< mace

 

hH3

h<z

ho:

mowcwocwwm

 

cooaou<2c<=c 2w mmacwqucc ocmam
Aco==_scccv N.m.q macaw

98

 

oz

.aoccwx cw acoamcmcu

o>wuuo cow cowuwuocsoo ou out
omocu "cOwuocoxo co cowuocouwo ou
one omocu “cowuocsh cowcomssocooc
co “mouwm caucooow Owwcococco aw.
"mEmwcmcooE owwcococco wcwuoowwo
omocu “Amcwvcwc cwouoccv cOwuscwcu
Imwc wscc mcwuoowwo omocu umwocc
mo cowuccomco hHo wcw>wo>cw omoch

.cwoasouaowum co uncooxo m chcoc
Ico oom .mcwumcqo cooc Ou soom
chwuocowcxo oeom .cocwowcxo cwwaw
cocuo "meocwowc cco mocouooccm
wooweoco cow: couocumawww oEom

.xwwe

m.cocuoe .uoozm .mwcow "mousow
uocwz .cOwuocoxo wooow "oococoowo
wocom .ocowwow wmcoc couwmcEw

mo muoowwm .cOwuowsawcmE :c “ocwco
no use ocoucanu o>wuoo .Occw
cowuouoom .cOwuocuwww cowocoeoww
“acocwca "cowuowoxo wo mouaom

oz

.mcouwcwccw o>wuwuoceou
Icoc cco o>wuwuoceou "chu

.woh Iwcwccw oEz~co :mcoucooocz cocc:

.moh

.moh

.msocwowc ccm mocsuoccum mewEoco
cow: couocumzwww oEom "meow:
Iocooe co mwmmc woOwEocOIoowmxcm
.cOucoooc ocu wo ucoocoo “mosauco
cow: compoucw uoc cos “mos

Izwco cwcwccw co oum>wuoo mwoca

.owcwucwcq smouowc
“oucocmowo .mh .cowumcwEwwo wscu
wo mowuocwx .ou20c acoucoa

IEw umoE ocu ow hocvwc och .cowu
Iouoxo chowwwm .mccoww acoEEmE
cco .mccmww umozm .Eswwocuwco
chocoEwoc "cowuocoxo we ouwm

.ocwwuco
omcoou co caocm uoc wwwmuoa

.wo
mwmoc wowcoowos .owcouc=05c=mcw
.owcoocaoEcom .wocowuuccw "Emwc
Iowouc< .c0wuwcwccw o>wuwuoceoo
Icoc .cOwuwcwccw o>wuwuoa

Ieoo .cowuowucouoc .Emwwcochm

.moh Homocq OwEmczcouoEcmca ocu cH

.moh

.mquwau uco cowuow:E=ooo

moon .cOwuocoxo acowwwm “mwm
Izwowc woococwouocuxm .mowuocwc
cowuocwEwwm “wcwocoowwcw whey

.moh Ioow “oococoowo osmqu “wocoz

.moh

.moh

.mwwmuou 30cm uoc cwc ocwwono omcsoo

.moh

cowuoowo>o cco
acouc0wo>oa mafia

mcowuoocoucw wake

cowuo< we
Emwcocooz wcca

cowuocoxm was:

 

hwz

h<z

hU:

mowcwucwcm

 

hoocoo<2m<zm zH mmmeUszm me<m
Acoscwucoov ~.m.q mcm<h

99

discussion on: compartment models, apparent volume of dis-
tribution, the concept of clearance, T% (half-life), and

the plateau principle. STE and WIT seem to teach the least
on the above concepts (Table 4.3.2). MED and NAT give part
of the discussion (Table 4.3.2). PRE and UCT seem to give

a complete exposition.

The Michigan schools give a full explanation on all
the above concepts (Table 4.3.1 above).

Differences in depth are evident also with regard to
drug metabolism. Few of the RSA schools give a complete
explanation. Again, STE and WIT (Table 4.3.2 above) omit
most of the essential information: the enzymes involved
in metabolism, enzyme induction, enzyme inhibition, and the
role of cytochrome P450 are not discussed. MED gives part
of the discussion in a sketchy form (see Appendix D3.1 -
D3.5)' UCT, NAT and PRE give a more complete discussion
(Table 4.3.2 above). The Michigan schools give a complete
explanation, and teach at the same depth on metabolism

(Table 4.3.1). WSU adds the role of cytochrome P The

448'
Michigan schoolsappear to be in line with what AMSP recom-
mends on depth about the basic principles.

Tables 4.4.1 and 4.4.2 below, on a specific drug show
vast differences in depth, for example, on the mechanism
of action of chloramphenicol/streptomycin. The Michigan
schools, particularly UOM, discuss the mechanism of action

with high specificity (Table 4.4.1 and Appendix C1). The

RSA schools, particularly MED, PRE and WIT, lack in

100

specificity on the mechanism of chloramphenicol/streptomycin.
STE does not discuss the mechanism of action for chloram-
phenicol. This is not a contradiction to Table 4.3.2 above
on the basic principles. This shows thatsome RSA schools
do not reinforce the basic principles discussed earlier in
the course when they discuss specific drugs. AMSP recom—
mends reinforcement of the basic principles throughout the
course.

Without adequate depth of the basic pharmacology
course, it is likely that the student will not develop an
insight into drug effects and as a physician will not be
critical enough to evaluate the claims made for drugs.

Without sufficient knowledge of the concepts of compartment
models, volume of distribution, the concept of clearance,
T%’ the plateau principle and their interrelationship with
metabolism and excretion, it is likely that the physician
may have problems in deciding on dosage frequencies with

insight.

4.3.3 Third Research Question:

 

Are there differences or similarities between

the RSA and the Michigan medical schools with
regard to the instructional strategies for the
basic pharmacology course?

Tables 4.1 and 4.2 above, show that there are more

differences than similarities between the RSA and the

Michigan medical schools with regard to the instructional

1(31

omamooc mw mwca "ocaoasoo ucocoa ocu couoco
Ixo awzowm awco cco mace ocu onwwocoaoe ou
owcmca oco: coccwwcu och .woowcocaemcowco co>ww
moaocooc cw coccaooo moc A:oEocccam aocw:v
cowumwaoucw wouow coca ucmucoasw mw on .uoow
Iwo owuuww mac aocowowwwamcw wococ .o>wuoocw
mw ouwcocouos ocu omaoooc uac .wouwcocancocco
we owww acmc ocu omoococw aoE owoemc Owuoaoz
.wacv vouocoxo ocu wo xwac ocu momwcasou

cco ocwca ocu cocw couocuom awo>wuoo mw ocwc
Iocouaww och .wo>ww oco cw ocwcocooaww o>wu
”mmmm.co ou Emwwocmuos muw mw woowcocQEmHOch
we cowamcwswwo ocu cw ocuoow ucoucoaew umoe
och .mcwaww acoc oco cw couacwcumwc wwoa mw
cco oucooowa ocu mommoa .amu ocu ou voaacwcu
Imwc awwcmoc mw owuowcwoco och .mcaoc woco>om
ao owww wwoc 0 mac wacc oco uvcaoc cwuoOca mw
wo>ow coowc ocu wo Noe uaoc< .uoocu .H.o ocu
sown concomco awcwamu mw wouwcocaeocowco .N
.uuacoca o>wu

Ioocw co co wauv ocu mouwwocmuoe cOwcz oEauco
cm mo commocaxo mw oco cOwummancoo ac coucoa
Imcocu mw owHOwcwucm ocu o» oocmumwmoz .mwm
Iocucam cwouoca uoowwo acococu oco omocowmcocu
wacwuaoa mo cowwoc ocu cw <zzlu wauotocwso oco
mo cowcmucowco ocu cow: ocowcoucw cu ucwaoca
mw wouwcoccEmHOwcu .oacu uoc mw omco>oc oco

 

.cowuocaw wococ commocooc cow: cowwwcos

oc ou o>mc uoc moon omomoc cco ovwcocooacm

ocu cu cOwummancoo ac cowawxouoc awouoca

Isoo mw 2<o cowuucaw Owaoaoc woscoc we oocom
Iowa ocu cH .wwoz mo mcwo cooa NIH cw awoke»
caouo coo .omamwwoo vco owscocuoaac .mmecau
cwwwoa o>wmmocw0cc .wcwuweo> .cowucoumwc
wmcweovco ooaoOca oco ouowaeauoo wast ocu mo
mwo>ow cmwc uac .c3ocxca mw emwcmcooz .cooacoc
mw cowumcuwww cowacoeon omamooc cco ocwcoc
Iooawm oco ou z<u oummamcoo o» owcm uoc oco
aocu omaoooc mcuocaoc cw cowo>oc coo coca
cowaumoc “Home awcawucmooa < I mZOcczam a<cm
.waou uoc mw ocwc
Iocooawm och .uo>ww ocu cw ocwcocooaww ocu ou
cowumwancou ac coum>wuomcw .mmo ocu wcwcawucw
mcwaww vco mowuw>oo acoc oco oucw cowuacwuu
Imwc cooo .muaoc N cw mwo>ow xmoa cow: coocu
.H.o ocu 50cm voccomco wwoz "Nmmmmmmammmm..ww
.owcwmco>ou acwcmow

oco mwmocucam cwouOca wo cowawcwccw ocu vco
Lasagna mom was on z<o co mcascwa one .eaua
ocweo oco .ououumcam mow cow: wcwuowuommo

socw couco>ocq mw oEaNco wcwscownccoc ocwuaoa
oco mach .couooow mw ommcowmcmcu wacwuaoc ocu
ococz owuwucma mom oco om <zmu oco wo cco ocwe
Io oco wo mcwccwc ocu wcwuco>oca ac ccoc ouwu

uac wcwvcwc wOUwcocaEmcowcu uco>oca www) cwoacraoa oco wo cOwumEc0m ocu muwcwccw aw .oEomocwu

Icocuaco .awmancau .uwcacam wmeomocwc owcow
ocu ou mcwccwc ac mwmocucam cwoaoca wowcocuwe
mowcwccw woOwcocceocOwco .cwoaso»cuaco och

.mcowuoowcw owvaemwco ccm mammwmoOaz wmwmuuoxoww

cw wawoma mw omwo uw .mocwwoauocoou oco och
.owcouomc o>wumwoc Emcw oco o>wuwmoa socw we
auowco> o umcwmwm o>wuoowwo mw vco ucowo owuoum
Iowcouomc o awucocweococa mw wOuwcocancowco .w

mOa oco mo uwcacam mom oco 0» mucwc z<o .cou
Iwcwccw oc coo mwmocucam cwou0ca wmwcccocOOsz
.mwmocu

Icam cwouocq OwEmowaouau Emwwoesos ou uooamoc
cow: cOwuom o>wuuowom mw ococu mach .mom

ac me: man moeomocwu mOa ac cocoocwc mwmocu
Icam cwouOca muwcwccH «cowooo wo Emwcocooz .H
Azaov Houwcmaaeatowco

 

.owcocouau
IOcEOccu .owcocooaow .owEOco cw muwamoc you
Icoa ococ wo cowmmocaov och .wauc ocu maocv
Icuwa oco ww owcwmuo>ou oco vouowou omov
mw mwcu "cowmmoccov 3ouwml ococ waoh .w
. "locum: ocom Amy
.eoumam cowaomo>0wvcou oco ecu Joccms
ococ cow: coumwoommo moaau menus 03h mflmwmwmmw

emwwocuuo:
cOwuocomOwocIon
cow»
cOwao IowauoooIon
I N
HMMMW cowuocuom cowuoa NA///
oco . Iwcocouawu woo Alwouwcocc
we cowacah uwsw\nlo»0wco
vowcmcuca

“rowoc Eocwowc oom

.acowo wowcocquwucm co co: mw cco ouwwoc
Imaoe o>wuum cm uoc mw cowc: ocwcocouaww ocu
mw ocwca ocu :w wake ocu no Noo .ououuxo ou
aoccwx ocu cow cowmoo ocoaococu oco owcawom
coco: ocoe aw moxoe cowc: occhcOOaww ocu ou
voumwancoo mw mw ococz co>ww ocu cw vonwwoc
Iouoe mw ow .cOwuouuxo wocow ac vozowwow
Emwwocouoe ac mw cOwuoo we cowuocchoh
.vocwouco awwmmo oco

mwuwwcwcos mo ocoEuoouu LOw mwo>ow owuaon
Iococh .mmo ocu ou mouacwuumwv moot aw .hwo
ocu Eccw coccomco wwoa mw um ”mmmmummmmfl
.Eacuooom cw coouc ecu .uwuoumowcou

Iooc mw “H .mwmocucam cwououa wcwcac cOwu
IoEcow ccoc ocwuaoc muwcwccw aw .uwcacam woe
IOmocwu mom oco co muu< ”cOwuoo wo Imwcmcuo:

 

 

2m:

2m:

 

:0:
AOUHzmzmz<zocxo "03mg meaummw <
w.q.< mcm<h

102

.co>ow cwocaau

cw oOwocu uo mac: ocu mw ow .occowwm>o oco
mo>wumccouco cocz coanan oc co>oc vwaocm oco
.chwuooucw ocoaom .vocwuoc wwoz cow co>comoc mw
woowcocasocowco .mowquwxou mow uo omaooom .a
.mowuw>wuwmcomuoaac ucoaaocwcw ocawocw ucoEumocu
oowoaaom cocuo .muoowuo ccm30oca ucmucoasw omwo
oco acowcaw oco o>wumwoc Eocwv chwuuoucwmcaam
.voamcoc couwo oco cowmmocaaam accwoe ocOc mo
mEouaEam Lo oocmcooaam ocu oco .omoc co ccoaoc
cu cmoaam uoc moon mwcoQOUaocoa och .Amwoav
Iw>wucw 3ow m cw mcauoo acco .o.wv omcoamoc owu
ImecamOwcw co oc ou mcooaao vcm ococ mw omoomwv
wouow awwoama mwcu .acouocaucom .oweocm Uwumcwc
Io vooaocw wacu no omamo ocoaaocu umoE ocu mw
vco cowmmocaov soccme ococ momamo omwm wOuwcoca
IEQqucu .owsocm owcwmco>oc cco acoocoaoc omoc o
mw coOwaau umos ocu “mowuwmecoccm voocc cow
vououwcoe on acaOcm woowcocaEmLOch co>ww mucowu
0mm .muoouwo vcozouca mow mo omaoooc coawEww
awoco>om mw woowcocasocowco mo oma och .m
.awwocoucocoa cocoumwcwsvm awwmama

mw woowcocaeocowco .waco mwcu ouowahcoo ou
auwwwcm m.cwwco oco ou oumcoesouom ou cochwoca
momoc coozuoc mco>coucw ocu oco vooavoc mw omov
oco ww cMaocu .acouom coccwwco cw coOwcoca
Ieococco oma ou owcwmmoa mw uw .cucwc comma
mcucoE oEom wwuca coaoco>oc uoc oco mowuww
Iwcoamo wmcoc wwau oco Emwwocouos mace Owumaoc

.mcouocwwao co mewwcwcoE

.ockcoacccw macwwcmoeoz vcm co>ou vwocaau mo
ucoEumocu oco you acco oOwoco wowuwcw wo wacc
m mo com: oc vwaocm z<u Acv ”om: qu mocww
Iocwaw ouowcaocaam oco wcwaowwOw och .Emwcowco

 

mo oococcoc_ oco “cocacccu cc mewmcwcoz
"vovcoeeoooc mc oma ococz oucovwocw cowuoam
.maca oco

Iococuw3 .mwcoaouaoc Mo cwcm umcwu oco u<
.mucaOO ouaoooaow ac~<n oxmu umaE 30a .ucoE

mwco cow: cOwuooucw mzo wcwuoocu cow coccoe Iuoocu wcwwao .oma cocooaom vcm vomcowoca vwo>

 

Isoooc mw oco .mwcwwocw movwocouumm mm coam
.mwcouomc Uwcocoocm woco>om umcwowm o>wooowwo
mw Z<u .Avocmwwcoumo mw Emwcmwco oco mo auw>
Iwowmcom oco cocz cwcwwowaem ou wcwmcmcoV z<u

cow: coumwuwcw oc cwaocm Emwcmwwo mwcu cow:

Amwquwwwao co mwowwcwcoev cowuuowcw oco>om

mo ucoEumouu .mmmmmmflwqw.flm mo mcwmwum oeom
cw oocmumwmoc cwwchwaso mo oocowcoeo oco mo
omamoom A.umo3cuaom oco oco oowxoz cw mmocaau

.m “0 mcwmcum oeom cw coom 30c mw oocmu
Imwmoc Eco coumwaoe cocoon .m.m.zv mmmmmHM
mwwmmmmwmw mo ocosooocu com oowoco mo mama
oco awwoama mw cw .3om aco> oco oowoco umcwu
uo mace o cococwmcoo on cwaoz z<o cuwcz cow
mcowcoowcw mo cocEac ocu .co>ozoc .cowuoooc
ccmzocca wo xmwu oco ou oao .AEacoco> meow
Iacmcwocaan .mwuw>wuocancoo cowmawocw .meoco
Imcu .mwmooouuwmav omwcaeowco oco owmuuowac
.chouooc wcwcawucw .cowuom co Eacuuoam coocc
aco> m moc Z<U "mcowumowccw Owuaoqococh .>H
.cowuoooc wacv uwumcocam

 

I< .woowcocaschwco oma coco .mocwmouawwocwem
oco .mcwcoamOwocaoo .cwwwwOwcon eacuooam
coocc ou acoumwmoc mw Emwcmwco cm aw .Emwcmw
Ioo ucoumwmoc co awcowwm mo omamooc coma on
uoccoo Uwuowcwucm cowom awo>wumwoc o cowcz cw
chwuoowcw omoco cow woOwcocasococco mo oma
oco o>comoc cwaocm oco .awco co>ow cwoc
Iaau cow oOwoco mo mace ocu mw ow .voquww
uocsoeom mw woowcocaeocOwco mo oma och "om:
.coowcocaEmLOwco

ouwchmuos ou ccoczoc oco mo auwwwcocw
o>wuococ ocu Ou voumwoc mw mwch .Aocam
Imoca voowcv mm ocu wo :uao mcwmw scuuoc:
och .Eoumam cowaomm>wccou oco mo cowm
Imocaov coxcoe aco> o mw ococh .Eoumam acou
Iowaocwu ocu mo Eowcoca m mw mwch .osocccam
acom aocu I meowcoca cocaumm>owccou any
.vwou a cow cowu

Imcumwcwsco couwm oco: momma omocu we wa
umOEw< .mowmccomac coocc maowuom wo uocEac m
oco: ococu .oma o>wmmoe coam cow: ocowococh

IOwcw cm mucomouaoc awcwmmoa uocu oweoco owu.anuooam voouc mow mo omamooc awouocwEwcomwccw

Immwao co mw cw .aucosumocu mo momcaou ooo.o<
o» ooo.<~ cw wv ococ mw oaau ccouom och

coma mm: uw .uao oemo umuww aw coc3 .mwcu oo
cowumcoc cw oeoc vac o uow couwcocaemqucu

.mwwoo soccme cw mwmocucam cwouOLQ AmOav wmwcv.ooo.oquw uaocm mw meocm Owummwam mo oococwucw

Icocoouwe mo cowuwcwccw Eocw awamoc wwoz auo>
amE mwch .cowmmocaoc 3occme owau owcwmco>oc
m mw oco .mowmocomac coocc mo moaau N momaou

z<u ”Eoumam Owuowoaouoeoz oco co muoouum .HHH

 

och .cooa mw mwmocwoca oco oco maowcom aco>

mw mwch .vouowoc omov awuowcum aoc mw mwch
.auw>wuom 3owcms ococ mo cowmmocaoc ccm mmoH
ccaowooa aco> o mw mwch ”owsoc< owummwa< .N

 

3m:

:0:

3m:

 

covazmzmz<moczu ”03mm owmwummm <
Acoacwucouv w.q.¢ mcm<h

l()3

.chooowIm ac common

mommcoamcocu wauooo Ou oaa I mmmmmmmmmm..>
.mcaooo owcoaouaow

aw voacwucOUmwv oc vcaocm aamcocu oco coo: com
moEwo m »o N cocoa oc cwaocm wowucououwwc o
cow: mucaoo ouaoouaoc Amy .cocwo>o oc cwaocm
ouamoaxo uoococ ucm owmma cowcowoum Amv .mcowu
Ioowcw ccwe mo ucoEuoowu oco wow co mwxowaca
Ioca com com: oc wo>oc cwaocm an .o>wuoccouwo
~0wcoaam oco awcoowo mw z<u oco coma oc moccou
oowoco wo mwacv ocu ococz cowuoowcw wcwcoumoccu
Iowww ou vouuwuumoc oc vwaocm oma muw omwxcocuo

.wacc
ouowccoccam oco o>oeoc .oco o» o>wuwmcom
uw onuwcocceooOwcu oco o>oeou aOa coca
.cuoc ou o>wuwmcom mo: uw um .voma oco:

mmacc cuoc owwcz cooco cw cwoc oc vwao: cowu
Ioowcw ocu oocwm cuoc cu o>wuwmcom mw Emwcom
Ico ocu ww wcwuoumo>ov oco uo: m.uH .cuoc
oma cwaocm aoa om .ucoumwmoc cwwwwowaeo ouo
acme aco cowuoowcw maowcom o cuam mw mwcu
coca mw ocoanco coucaoo ocu ham .uooucoO

mw mwch .xcoz cu cwwwwOwaeo you awommoOOc
cowoocowwwoca maoum vco owuoumOwwouooc mw aw
oocwm cOwuom wocwowcouooc muwcwccw uwv cwwwwo
Iwceo oco wo cowuoo ocu wcwuwcwccw oc cwaoz
wOOwcocancowcu ocu coca .omoo oco mw mwcu
ww .mwacc cuoc ou o>wuwmcom oc awe smwcowho
oco coco mvcaouw oco co mwcu cu comwoc ohm
mcowuuonco .wouwcocanHOwco oco rocccuwz :Oa
.o>wuwmcom cwwwwowaeo mw Emwcowco ocu uocu
ououwccw mumou acouococow ww coch .wOOwcoca
Isacoacu cz< cwawwuwcem cow: awmoa eaaocm
aamcocu mwuwwcwcoa we ucoauoouu ocu cw

uocu woow owaooa acoz .mwuwmcwcoa mwcu new
oOwoco wo mace oco mw cuwcz .cwwwwowceo nah»
Iooam coocc ou ucoumwmou on on oncoawwcw .2
oco ecu aocovcou wcwmoocucw co omwo mw ouoch
.wcwmoocucw mw oucoawucw .: cu one mwuwmcwcoa

 

am; :0:

am:

 

aooczmccz<coa=u "mace occcomcm <
causewacoov H.e.q mam<c

1(14

.amcw mccau acoc .momcowcoo cowuowao

Iuwo .momoococw auwowxou .cocowo>ov awwaw uoc
aoccwx ccm co>wc .mucmwcw cw woowcocaeocOHco
mo auwuwxou comoowocw "ococccam acoc aocu .>H
.coumw

oc coo oac owcwmco>ow mw cOwc3 mwsoco uwummwco
momaoo “aamcocu cowumcac wcow cco omoc cwwc co
cmemocaoc 30ccos ococ coocaococa momaoo .HHH
.ocwccoo awcmwooa

Imo cowcuowcwcoaam ou mcooc Eacuooam cooum .HH
ococwccw hwo .H

cowuomou omco>c<

.scowwwoo A.ouo mwuwwcwcosv

mawwwcaoeox Amacaauv owmucoxowc Acwocaauv
owwocoEwmm umcwowm awwowuoamo cOwuocmaoca Eacu
Iooam vmocc o mw um .mEmwcmwco o>wuowoc Emcw
vco o>wowmocleowo umoe umcwowo o>wuu< .ww
ocwca mocwemwaoo ou cooacoc

cw Now mocowamcoo vwoo owcocouacm

cocacwccmwc awocwz .cocuomco awouowaeou

Acowuowoxo oco
emwcoamoos .cowaaawcumwe .cowucuomamv mzc< .H

.oeomocwu ou <zzz wo ucoe

 

Icuouco wcwaOwc ac conOca oco cwlmcweoocw oco

 

cowcz mcwoo ocwEm mcoowm Awmwcouoomv mwmocucam
cwouocqlmuco>oum .awwmuwuocucam ococ oc coo

 

 

umouoz ch\maac

.oweoco Owummwao
.w.o mmwmmcomac coowm .mcowuoowcwuocam
.moucoccaumwv wmcwumouconcumoo “mcowcoa
.mcowuoow
Icw wcwcocooucu owww cocuo oco cocvwwco
cw mwuwwcwcos oucoawacw mawwwcaoeoz
.co>ow cwoccau cw awco coma oc cwaocm ”mom:
OwcmumOwcouoom
.mwmocucam cwouocc wwou muwcwccw "cowuo<

awn chcocao oco .mwacv wowcochawuco we
cOwuoowwwmmowu co ~.o.< owcou oomv commaomwc
oc ou uoc msoom ow .mocwwocwam acaum ocu

co uoc uac .uxou cocwcumocc ocu cw muooca<

 

h<z

om:

ho:

 

AOUHzm:&2<mOcco "0:29 ohaaummm <
N.<.q mcm<h

.cwanOuaowom oco
<zmIE .mowowocoa woeomocwc mom oco
m0m we xowaeoo o wo umwmcoo :moEom
Iocoe cwanOoaocom: och :.moeomocos
cwoasoucocum: oco cow: oowwwococw oco
mwwoo oco cw ooowaeaooo oocu muwca men
och :.mosomocoe cwoaeoucocum: cowwoo
Iom ou ccaoc awocwwu mw cwanOuaocum
coco mcoocao ow "cowuoo wo smwcocooz
mmmwammmmwww .m

Amo chcoaao oomv

1(15

mocwmooawwocwso cow: ocaooow oeom oco.

cw commaomwc mw woowcocceocowco .N
wmo xwucocao oomv .cocOwocoE uman mw
uw ococ: moquwcwoco maoocowwoomwe
cocca uaooxo .woowcocceocowco co

coawo wcow cooaco omwo coo oac .cOwcoa
ccoscoowu ocu mcwcav uooaao coo aw
.mwmochca coon o moc oco owcwmco>occw
awomoe mw oco ococcococ omoc uoc mw ow
.Joccoe ococ owomowao cow: owcoaocaocoa
oco meooasam mow "oweoco owomowmfl,acv
.mwmococam cwouoca wowcccOcoOowE

wo cowuwcwccw oco oc Ou Eoom cowmmocc
Ioc 30ccoe ococ oco wo Emwcocooe och
.aoc\wo wo mowomov cuwz ccosooocu no
omcaoo o coc o>oc cc: mucowooa omocu
wo ON wo uao ww cw maowo>oc ow uocu
czocm moc acaum woowcwwo < .Aaoc\mN
coco cocwwc momocv momoc cwwc o>woo
Ioc cc: mocowuoc cw mzocm uoowwo mwch
.owcocooaoocEOccu co owcoQOoaow cow:
moEwuoeom .owEoco mo mcooaao cowcz
cOwoocaw soccoe ococ wo cmemocaaam
owcwmco>oc .ococcococ omoc o mw mwch
.cmemownov 30ccoe ococ owxoh on
"mao: ozu cw Eoumam oco mooocwo woo
IwcocasocOwco "soumam owoowoqosoz .N
.czocxca mw

:oeocccam aocm: oco cOw Emwcocooe och
.mwo>ow owxou cwwc wo wcwcwwac oco oo
coow ouocoxo 0o aocvwx oco mo aowwwco
Icw och .uoa mo woowcocasocOwco ooow
Iamcoo coccoo acoc oco coco mw omaoo
och .omaowwoo ocooeomo> cw ococchou
ocwws cowcz cowmcoooaac oco cOwu
Iocwamoc cowamoccw .mwmocoao o>wmmocw
Ioca oco wcwuweo> .cmecocmwc wocwsov
Ico oco meccasam mow =.oeocvcam aocw:
oco mo crocc mw mwco .ooocooc ocu cw

 

 

 

 

mwwoooc oc Iocm cowwcaam wowwoooz .w cowo>ov aoa cOwooooc owau wowucooom .w

.m oaau .oncoawwcw .: ac comaoo mwowwcwcos wo ocoauoocu oco ow
cwwwwowaeo mo owwwooqm mo mw wOowcocaaouowcu .ucowo o>wuomaoo
ocu wo cowoowomw ocu ocowoc co>oo oquwcwuco umoc ocu mw wOo
Iwcoccsocowco mawc cwwwwowaso co o cwwwwowcoc wo cOwuocchoo oco
.mwuwwcwcos wo mewow wouocooc oco we cOwuaooxo ocu cuwz any
uvcwa cw

ococ oc cwaocm mccwoa wcwzowwOw oco .oweoco owumowao wo cowcov
oco wo oowam cw .mo>wooccoowo owwwooam ococ oco ococo omaoo
Ioc mmmwmmmwmmw ooawomco oc moc woowcocceocOwco awucomocm .o
.ocwca cw cowcococa mcoocao woowccocaeouowco we New .momoo
ooo.m~ cw w uaoco cw mcaooo oco .mauv oco wo wozocvcuwz wouwo
mcucos o>ww ou mxoo: ooccu momoo umoa cw moom cowuwvcoo och
.wouow awwococom mw cowc3 AmmeHooc occcoa ococ wo ocoaaomcoo
o mo owcocooaooceoccu o awocoacoww mmow cco mmeuaoowacowmo
.owsoco cow: owcocouaocoa o awwoauoov owsoco owumowao cow)
cmemocaov soccoe ococ owwcowwo co momaoo woowcocceocOwcu In
.mowcoc Show wwaw

pew aoc\wx\we on vco mowcoc ocaooaoca wow aov\wx\ma mm mw
vowcoa wooocooc oco wcwcac omomoc owom o oco ococcocov omov mw
cowuwccoo mwch .cuooc moswuoeom oco omcowwoo cowaomo>0wvcoo
.mwmocoao .moomaa coosoum cow: aquwxou woowcocaaocowco Ou
mcoow mwch .cwoo owoccooawwlma: ocu ooowancoo uoccoo woowcoca
IEocOwco awocoaaomcoo oco Amoowwocoooe owcawom cow m.acoc oco
mooocoxo cocuoa oco cocwc ocOwoc omaooocv co>ww oco cw owouwocm
omocowmcoco wacocooaww o mw ococo maov caucocIumoc wNImw umcww
ocu com .=oeocccam aocw: ocu ou voow coo woowcocchHOwco om
.czocccuw: mw wacv ocu coc>

awooowaeoo comco>oc oc coo oco ucovcoaov omov mw ow nowsono

oo coow coo cOwowccoo mwch .caooo mwwoo Iowuoa ococ oco

wo cowuoscow owoaoo> oco mooaoowaowoow cw omoocoou < .momooho
Ioc ococ wo ocoocoo sacom oco omaoooc cacw aauom cw omoococw
co co mcoow ow .mwwoo zocuoe ococ woaaoa oco cw mmmmmmmflmlmmmm
lecq wowcccocOOuws uwcwccw coo oco ouwchouoawuco co mw aw
.owcasowco cco owmoooxowc omcwomo o>wuoo mw oco owoowcwoso
Eacuooam coocc o mw woowcocchcOwco mocwwoaoocuou ocu och .w

 

 

 

hwz

whm

mam

 

aoowzmccz<coa=o "mama owcwomcm <
aeoaccacouV ~.q.q oam<h

1(16

.ooaoc woowaou

co OwEocmam cocowo ac co>owcoo oco mwo>ow vOOwc voow omaoooc
comoco couwo mw wOowcocchcOwco chwuoowcw oao wowcooooc aoa va

.vwocaau cOw owoNoNOEwcooo

co cwwwaxoeo .cwwwwowaeo coca cocooc mw woowcocaaocOch va

.co>w0>

Icw cocwo oco mwwwwocw .m oxww mocOHooco omaoooc ucosuoocu

omoc oco cocwo mw u cwwwwowcoa oco woowcocasocOwco wo cOwu

Iocwcsoo oco coo oco cw ouocwwwco cowcx mommoomco cwocc com on
.Aosocccam aocw oco oco>oca ou cocouwcos oc cwaocm mwo>ow

voowc ococooc occ cwv cwoaeoocow vco cwwwwowaeo cu wwo> ccocmow

coc oc cowcz mwuwwcwcos wooocooc co .owcwmmoa coc oco mwo>ow ocwm
Iooawwocweo wo wcchowcoE ococ: cowo oco cw owsoowcaom .wo wwoo

.AcOwu .m mo coam wwwwooc o>woowocleocw cu oat mcowuoowcw oco>om Aev
.woowcocceocOwco mw mocowuoc o>wcwmcom
o mw ow coco ucoocoo oeomv ccaocwxooc cwwwwowcoa cow mwowwcwcos mocowOuaoocoe owcoumwc wo wooo0ooeaocn
owuococamowcw «0 oc cu Eoom omaoo och .woooooowcwcoa no ucosooocu ocu cow wacv ouauwumcam umoc och on

Ioooc owwcowwo oEom wo oaau o wo uwamow

.uw wcw>wooow mocowooa omoco wo ooo.o<"w

.owcosaocn cco .mwuwwawwoo .mwu

I ooo.qmuw wo oococwocw co cow: ococ mw Iwwoaeooumo .mwuuowwwao mo coam chwooowcw .c oaau oncoawwcw .2
cowowvcoo och .cocaoum moc ucosuooco cocoo cow oowoco wo wacc owcwmmoa o omwo mw woowcocaaoqucU Acv

 

hw3 mhm

mam

 

aooczmacz<moazo "once owcwoocm <
causewacoov N.q.q cac<h

107

strategies for the basic pharmacology course.

Mode of Instruction: At MSU and UOM, the mode of

 

instruction is the lecture. At WSU the course is self-
instructional with tutorials. UCT uses lecture, discussion
and demonstration. MED uses lecture, laboratory exercises
and seminars. NAT uses lecture and discussions (Topic
Teaching/Focal Problem sessions). OFS uses lecture. PRE
uses lecture and demonstration. STE uses lecture. WIT uses
lecture, demonstration, seminars and project. Most of the
RSA schools appear in line with what AMSP recommends:
lecture, tutorial/conference, laboratory exercises.

Examination: The RSA schools seem to have a lower

 

frequency of examinations and lower pass mark, while the
Michigan schools have a higher frequency of examinations
and a higher pass mark. MSU gives three interval examina-
tions and one comprehensive final during the first term;
three interval examinations and one comprehensive final,
on the work of both terms, at the end of the second term.
WSU gives a "mini-examination" at the end of each module,
and one comprehensive final at the end of the course. For
the Michigan schools the pass mark is 70%. In the RSA the
pass mark for most of the schools is 50%, same as in other
countries, for example, Canada. The examination pattern
for the RSA schools appears to be: UCT, examination in
fifth year; in second, third and fourth year, the course

is promotional. MED gives an examination before beginning

108

drug groups and systemic pharmacology (see Appendix D 3.6)'
The answers to the interview questions showed that MED gives
an examination in fifth year. NAT and PRE are said to give
an examination at the end of the course (interview answers).
OFS gives a three-hour written examination and a twenty-
minute oral. No data is available for STE. WIT gives a
test in fourth year (see Appendix B12:3).

The approach used by the Michigan schools seems to
ensure thorough knowledge of the basic course while the
approach of most of the RSA schools seems to encourage
students to postpone thoroughness during the promotional
years thinking they will catch up in the fifth year when
an examination is taken. This approach seems to compromise
a thorough knowledge of the basic principles, and is likely
to lead to confusion when the knowledge of basics and the
knowledge of the application of basics are acquired at the
same time. This approach seems similar to learning the

alphabet and essay or poetry writing at the same time.

4.3.4 Fourth Research Question:

 

Are there differences or similarities between the
RSA and the Michigan medical schools with regard
to the organization of the basic pharmacology
course, particularly about knowledge objectives,
sequence of topics, groups and subgroups?

The summaries of the syllabi (Tables 4.1 and 4.2

above), the outlines of the syllabi (Appendices B1 - B10)

109

and the classification of antibiotics (Tables 4.5.1 and
4.5.2 below and Appendix D1.1 - D1.2) show fewer similari-
ties, but more differences between the RSA and the Michigan
medical schools with regard to the organization of the basic

pharmacology course, particularly about knowledge objec-

tives, sequence of topics, groups and subgroups.

Similarities:

 

Main trend: Most of the RSA schools and the three
Michigan schools start by teaching the basic principles of
absorption, distribution, metabolism and excretion, then
autonomic pharmacology, then the various drug groups. The
STE data on organization of the courseicsrun:available. Most
of the schools seem to be in line with the AMSP main trend.

Prescription writing: UCT teaches it during the
fourth and the fifth years; PRE and WIT teach it at the end
of the basic pharmacology course, but before the clinical
period. UOM teaches it at the end, MSU teaches it at the
beginning of the course. WSU does not teach it in this

course (Table 4.1 above).

Differences:
Sequencing: Most of the RSA and Michigan medical
schools start pharmacology with the basic principles (see

Appendices B B10). Most of the medical schools, in dis-

1

cussing the autonomic pharmacology, bring in the drug effects

before completing the physiological interrelationship

llflO

.owouoccocoe .ooooeoc ancw>caa .ouoosoa woccocaa
.ouoccwo ocwwocoawa .ocwsomOwOwc .cwaUOccacchwc

.owouocwcocuos .oowcoe< cucoz cw awcoesoo caooo
coco mcowooowcw owuwmocoa oooco oo coma mwaca .m

.cwoo

owcowaoocca .ouoowocw0c .owonoawcuowo .owon
Iocoowa .cw>wawoomowcw .ocmeUaoaww .mocoawoa
oco "mcowuoowcw wowcaw uooco oo coma mmaca .a
.wouaceocoo .cwowcsowam .cwnowcomw
"mwmowaococah ooocu ou coma mwaca coho: .o

.ocwsococoos .cwoucocachcwc .cwoo owcwwoxo .cwoo

mucowo wowcawwcc< .m
mocowo wocw>wuc< .<
.c cwowcooocaeo cco m cwxaanom

owchwwoc .w.o mowuaomwuc< cooch acocww: .m
.mcwxasawoa

ococceos wwoo oco co coo coco mowoowcwuc< .c
.owouoxoccoeowwamIEwuaocuoe

Iwch cowcocwceoo oco cco swcaocuoEwch ww ococ
mococwam was one Am<cv

cwooowwaowwom ocwEoIocoa .mocweocowwam w ococ
mouwwocoooEwuco och .m

I ococcsoe wochcowE oco cw mcowoocouw< .m.mocwwoaoocuou .cwoaeocwcoocm .m.o owcacam wosom

.oeom

Iocwc wowcooooc wo uwcacam mom oo ccwc cwan
Ioccwwo cco cwoaeoccoawo .wOowcocancowco on
Acoocmcocca awucoa awco aowawooowom

wo mwmocv mom cu ccwc mocwwoaooccou Acv
chwcoocmws momaoo cco mwmococam cwooOca
mcwocswv cwoaeooaocum I mocwmooawwocwso on
oeomocwc

Iocww men oco cow: uoocoocw coca mwaca ww coon

cwoaeoccwwo cco cwoaeoocww

.cwanOcccaco .woowcocancOwco .w.o uwca
Icam mow ocu cow: ooowoucw coco mwaco w ococ
moquwcwuc< owooomowwouoom coho: .N
.cwanOcoa cco cwanOccocom

.cwanooz .cwoaeocox .cwooxweo .cwanoccoo
.cwoasoccow .mo mocwmooawwocweo oco “mwmocu

wowcouooc wo owcacam men oo wcwccwc ac mwm Icam cwouoca wo mucuwcwccw wocwowcoooom ww ucom

Iocucam cwoooca wowcouooc mcwowcwccw omoch .N

.ocwcomOwoao cco

.cwoasoccwwo "cwoocu cwanOoco> .cwoowowooc .mcwcoamowocaoo .mcwwwwo
Iwooc cco cwoaeoocoa .mcwwwwowcoa ”mwmococam Iwcoa "mwmococam wwoa wwoo we chcwcwccw w ococ

wwoz wwoo wowcouooc cow: wcwcowcoucw omoch .w
cowuoo wo Emwcocooe cu wcwccOoo<

owuoumowcocooc I Ewcaocuoswcu Acv
owuocmowcooooc I mocwEocowwam on
Emwwocouos acowcoEcoucw wcwuoowwo mucom< .n
cwoasoccwwo

.cwanoocww .cwoaeocccaco .woowcoccsocOwco
"cwcacam wosomocwc men :0 wcwuoo mucowo Acv
mcwanOoaowom .mocwwoao

Iocuou .uwcacam mom :0 mcwuoo mucowo on
AowuoomOwuou

Ioocv mwmococam cwowoca wcuwcwccw omoch .c
wowuoumowcoooomv cwaeowwc "mwmococam <2: Acv

Aowuoumowcawv cw>wawoomowww "mwmocucam <2: on

"mwmocu

Icam cwoo owowoac cow: wcwcowcoocw omoch .m
.m cwowcouocaso..cwumwwwoo .cwxaaawoa Awoc
Iwowcoooocv ococceoa wwoo wcwuoowwo omoch .N
.ocwuomOwoao .cwoaloo

Ico> .cwoowowooc .mcwcoamOwoccoo .mcwwwwowcoa

mowuowcwuc< wocwowcouoom coho: och .wAwocwowcouoocv wwoz wwoo oco wcwuoowwo omoch .w

cowooo wo Emwcocoos oo mcwccooo<

cowooo wo smwcocooa oo wcwccouo<

 

:m3

:0:

3m:

 

mocmn c<wm0m0w2whz< mo szh<owmwmm<cu
w.m.q mcm<h

11.1

.cwowaeowwc .mocowwam ”amOccoc Aw>v

wouaceocoo .ocweocOwcoo .ocwEochocaa .cwnowcomw

.ccoocoa cowwEwm 30cm moooz wwow

"mwacc wocwowcoooom .ww

.co>o ococ coo smwcocooe

ocaEEwOoao occ coca om wcwawawowae socw mwwoo
wowcooooc maoum .o>wooowco oc oo Emwcocooe
omcowoc m.acoc zowwo cowca msmwcowcoocowe wo
cu3ocm o>wuoo cco>oca "mwacc owooomowcouoom .w
.owuocucamwsom oco osom .ocaooc cw ccaow cco
auw>wuoo wowcoooocwoco cow: waca ”owcowcwcc<
.xmmo owcwoocm wwo

Icam 0c cocwwmoc cooc moc owaoowoe macn .owc
Iocucam oco coco chwcocoaoca ”mwowcocowswuc<
”mommowo ozu oocw awcoocc cocw>wc

oc coo mucomo owuaooaococuoeoco wowcoooocwoc<

mouoz ch\maow

.cwowaeowwc .cwoaeooaocom "mwmowaococah w>v

woowcocaeocowco .mocwwoaoocuou "owmuooxowz a>wv

Acwoaeocaoo ov cwuwxowoo

.cwoaeoccwwo .owooocwcocooe "mocOcooc< Awwwv
owoNoxOEwquo .wOowcocanc

Iowco .mocwwoaoocuoc “Saccooam coocm Awwv
Acwoocho .cwanoucowv mocwm
“chwcoowcw o>woomoc Eocu va
"msmwcomco o>wuwmcomcw cow Acv
cwoaeoccwwo

\cwoaeoocww .mocwsocowwam .mcwcocmowocaoo
.mcwoaeoccoaco "mucowuoa o>wowmcom com on
mo>wuoccoowo cwwwwowcom .m

. . owuwmocoa

Iwcco .wocw>wcco .wowcawwuco .wowcouoocwuco
.w.o aowowao o>wooowom "oma oweoomam .N
.mcowOwwoc .mcwomIowwwouoE .mwococa .woc
Icowo .w.o mowcaomwuc< "awco oma woowaoh .w

Iooawwocweo

.ocawwow cco omoomwc owuoaoc

.cowoocwswwo wocou .muoowwo ocwm .momoeouoow
ococ "mowcowcwoco woowaoh "mowuowcwuc< .m
.cwoococachcwc .cwoo owch

Iwwoc nocawwow wococ cw ocosooocu “chwuoow
Icw cooowoommoIcococuoo .chwooowcw couooa
Ioc .chwooowcw cocoowwaEOoca wo aaohocu
wowcocowEwuc< ”mcowooowcw coowh acocwca .c
.aococ

Iwoca cw mwxowacQOca .mccomo wowwoonwoco we
muoowwo omwo>co .owcowos woccocoo ”owcowoz .m
.ocmeuauaww

In .m cwowcooOcas< umcowooowcw wowcah .N
.aococmoca .aowowx

IOcOuoaoc .ocawwow wocow .mowwwowa auwowKOu
.ocawwow ocosuoocu .oowoco wo mmacn uchwuoow
Icw wowcouoocooal cocuo cco mwmowaococah .w
wn chcoaao oom

 

h<z

am:

ho:

 

mocmn c<wm0mow2whz< no szh<mewmm<cU
N.m.o mcm<h

11.2

mwacc owcwmocoawcc< .o
mwacc wocw>wuc< .m
mwacc womcawwuc< .N
mmew

Icocah c0w coma mwawn va
mtmzoo Amv

acw>wooo wowcaw
Iwoco cow: mowoowcwcco oco awv
mowoowcwoco ocwuaoaawoa oco on
mocwwoaoocuou oco Acv
mocwwocoos oco on
mocwmooawwocwso oco Acv

mucowo cooowoc cco mcwcoamow
Iocaoo oco .mcwwwwowcoa oco aov
"mowcowc
Iwoco wo maaocw cocoa och .w

.momoo wowooam “coow coco Ecoc ococ "mwxowacaocaoeocu .oN
.mocweomoocww .cwanOccuawo .woowcoccsocowco
.mocwwoaoocooh "owoocmowcouoom acoEwwm .swcaocuoEwcoIowwam .mcwxaanoa

 

 

.mocwmoowawocweo .mcwcoamOwocaoo .mcwwwwowcom "wocwowcocoomlwwoswcm
.aaowocu cowuocchoo wowcocowswcco co mxcoeow wowcm .Ow

.Emwwcocam .cowuowocouoa .cOwooEEam .omwcowo

”mcowuocchOo wacc wo muoowwo ocwcomoc ou coma mEcou wo cowuwcwwon .mw
mwacc wowcocowewcco we cowuocwceoo och .aw

aaococu wo cOwuocaa .Ow

.cowuocucoo

Icoo wocwoOwcooooc caEwcwE oco cco cowuocucoocoo acoowcwccw saEwcwE och..mw
cowuoowcwcoaam .ow

saEwcwE o co oococmwmoc wcwaoox cow mowawocwcm .mw

oocoumwmoc mmowo .Nw

mwacc wowcocowswcco cco mcouoow owuocoo .ww

Aoocoomwmomv moquwcwuco wo ocawwom .Ow

moquwcwoco wocwowcooooc oma cu coc3 .o

.mooowwo wocwowcoooom cco owuoumOwcoooom .m

.wwwwooc o>wuowoc coco cco o>wuwmoaIEoco .a

.mowawocwca

ococcanw omoe oco wo acosEamv aaococooeoco wowcocowEwcco wo cowooowwaao ocu

cw mowawocwca wococom "mowcowcwcco mo cOwcwcwwoc "mcowuoowcw wo aaococooEocU .c

mcowcoocoucw wacc cocwmocc: .m
.Eoomam owuowoaoeoc oco "auwowx
Icooaoc “eoomam wocowumoocwocomow oco "soumam wococ oco “soumam ma0>coc oco

"mEoomam cowco owwwooam co mwacc wowcocowswcco co mooowuo owau cco 3o: och .o

.mwwoo cmoc cosac oco co mowuowcwoco wo mooowwo omco>c< .m

.ocwEocOccOca cco .ocweocowcuo .ocwEochocaa

.wooacsocuo .cwooasowwc .cwnowcomw "mmewaococah wo ocoEuoocu cOw mwaca .N
.Amowaeoxo oEOm cow a.o owcoh oomv mwacc wowcawwuco cco .mocwa

Iocowwam .mocwwoaoocoou .cwoaeoccoaco .woowcocaeocOwco .mocwmooawwocwso .mcwc
loamOwocaoo .mcwwwwowcoc "mOwoOwcwoco wcwzowwOw oco wo macou cw commaomwc oco
cOwoocoxo cco Emwwococoe .cowuacwcumwc .cOwuacomco wo mowawocwca owmoc och .w

"mzowwow mo mw coooca
Iao och .cowwcaam wowcouoe co mcooaao cowuoowwwmmowo wo ccooooa owwwooam oz

.mo>wo
Ioawcoc owooocwsw och .mw
mucomo wowcawwuc< .Nw
mucomo wocwawuc< .ww
mowuaomwoco acocwcc .Ow
mocweocOwwam och .9
amOcaow cco
mwmowaococah cow mwacn .m
woowcocaeowcu
cco woowcocaaocOwco .h
moccwcwoco ocwuaoaawoa och .0
mocwmooawwocwao och .m
mocwwoaoocoou och .o
caucus..oz cco
cwanOoco> on

cwoasoccwwo
cco cwanOocwc Acv

cwoaeouccaco
.w.o mocwchool oco on
mcww
Iwwowcoa ou mo>wooccouw< .m
mcwcoamowoccoo och .N
.mEcow
wcwumwmou omocwwwwowcoa
Isacooocm coocc .mcoowwwcoom
cwoo .mEcow uoaoc .u cww
Iwwowcoav mcwwwwocoa och .w

 

th

mhm

mmm

 

mwcmn c<wmoz0w2whz< mo zowh<owmwmm<cu
Acoacwccoov N.m.o mcm<h

113

between the cholinergic and adrenergic systems, and the
physiological interrelationship between the autonomic and
central control reflexes. UOM, WSU, UCT, MED, NAT, PRE,

STE and WIT (Appendices B B10) discuss one of the auto-

1
nomic systems according to neurotransmission, synthesis of

neurotransmitter, drugs affecting, then the other system.

MSU has its autonomic lectures organized as follows:

1. autonomic nervous system and reflexes,
2. chemical neurotransmission — acetylcholine,
3. chemical neurotransmission — norepinephrine.

These are followed by lectures on adrenergic drugs, cholin-
ergic drugs, etc. AMSP points out that even though medical
students come to pharmacology with a sound background in
the anatomy of the autonomic nervous system, they need an
indepth review of the physiology of the autonomic nervous
system. AMSP further points out that the importance of
autonomic pharmacology is greater than that of its collec-
tive therapeutic agents. It is the foundation for under-
standing many areas of cardiovascular and central nervous
system pharmacology. Autonomic nerves and/or their effector
cells are sites of action responsible for the side effects
of many drugs whose primary site of action is elsewhere.

In specifying the knowledge objectives for autonomic
pharmacology, AMSP suggested that the understanding of the

physiological interrelationship between the cholinergic and

114

the adrenergic systems; and the physiological interrelation-
ship between the autonomic and the central control reflexes
should preceed the discussion of drug effects on the auto-
nomic nervous system. This is the pattern followed by MSU.
The pattern followed by most of the schools is such that

the discussions of the effects of the drugs on the system
started with will bring in the role of the other system,

and the role of the central control reflexes,which the
student will not have studied yet. These discussions are
likely to make less sense to the student.

Grouping: while the curriculae outlines may not show
it, in most cases the classification of antibiotics (Tables
4.5.1 and 4.5.2 above) show vast differences in the prin—
ciples followed in the grouping of drugs in the RSA schools
and the principles followed in the grouping of drugs in the
Michigan schools. Thus, even though the syllabi (Appendices
B1 - B10) appear to contain most of the main topics taught
in medical pharmacology, most of the RSA schools seem to
have problems with regard to what falls under each topic.
The STE treatment of antibiotics seems to illustrate this
(Table 4.5.2 above). The Michigan schools group antibiotics
according to their mechanism of action. This is in line
with what AMSP recommends:

. . . antimicrobial drugs should be organized

for pedagogical reasons by mechanism of action,

i.e., inhibitors of cell wall synthesis, protein

synthesis inhibitors, metabolic inhibitors,
antifols, etc. (AMSP, 1984, p. 51).

115

The RSA schools have a variety of approaches: PRE and WIT
(Table 4.5.2 above) group the antibiotics according to both
their chemical structure and their use. UCT, MED and NAT
(Table 4.5.2 above) group the antibiotics mainly according
to their use. STE seems to have no specific classification
pattern (Tables 4.5.2 above and 4.6 below). Most of the
concepts about antibiotics are discussed by STE but the
logic in the sequencing and grouping of sub—topics is diffi-
cult to understand.

Both the Michigan and the AMSP approaches reduce the
number of the subgroups discussed under antibiotics; this
approach also seems to make the concepts easier to under—
stand, and easier to remember. The approach of most of the
RSA schools makes the list of the groups of antibiotics
longer; the RSA approach also seems to lend the material
to memorization rather than to understanding, for example,
PRE has the subgroup "Alternatives to penicillins." This

includes:

1. the macrolides, for example, erythromycin,
2. lincomycin and clindamycin,

3. vancomycin,

4. novobiocin.

The student is likely to wonder shy the above drugs
are alternatives to the penicillins. The above drugs have

neither chemical structure nor mechanism of action in common.

116

acaaaemaom

 

cwoaeocccacm
cwanooco>
Acwoaeoccwwov

mocweomoocww och
mocwwoaoocoou och owmhmumww”mw
.aach cwowceowwm
mwcu socw omOOco oo moc oco omoo cwuowcomw
cw oowoco wo mwacc oco oco cwoae ocwwoaoaxon
cwo< owcwcwoaa Iocoa cco cwoaeoucou .co>owcoo owowocwcowuoz
.m.<.m oc coo mwo>ow owcocomooc coco Ewcaocooawch
cwomawoo woow mucoaxo oeom ”mocwmooawwocweo mocweococnwam
m cwwaawom mcwcocmowocaou Amaaocw wwov mcwwwwowcoa och wOowcocaao»0ch
ocowo coma oc ooccoo .cOwuoB

.co>owcoo
co>oc oco mwo>ow owuaoaococh

Iococu och

mwacc omoco macu .acouoowmwoom
ooc moswooeom oco mwo>ow owoaoa
.mowomoc ccoccoum cow:
co>owcoo oc ocwwE cwaww wocwamOcc

Iocoo oco cw mwo>ow owoaoaococh

.cowcoesowwcw wo oocomoca ocu
cw awcowaowucoa momomoc cowaomae
Iococw co maoco>ococw cwwc cow)
co>owcoo oco cwaww wocwamOcc
Iocoo ocu cw mwo>ow owuaoaococh

Isowwcw mo oocomco oco cw co>o I
cowoocumwcwcco wo mouaoc ccoccoum
cco momomoc cuoccoum cow:
co>owcoo oco cwaww wocwcmOcc
Iocoo oco cw mwo>ow owuaoaococh

 

mmwzm<m zw<mm noocm mzh mm>o mowhowmwhz< ho UZwmszu Hmhm
c.o mcm<h

117

With no principle to go on the student will resort to memori—
zation. The apparent lack of these principles is possibly
one of the causes of the feeling of inundation expressed

in the RSA about pharmacology:

As far as the student is concerned, we have

a dragon of a subject. It is vast, with
enormous ramifications, and in his clinical
immaturity the student is unable fully to

grasp it. He solves his problem simply by
learning by rote (Folb and Bowey, 1978, p. 30).

It is formidable to see what has to be taught
in pharmacology today. I think it is in fact
impossible to teach pharmacology, and I would
suggest that the student should be introduced
to the concept of self-learning. Folb and
Bowey, 1978, p. 32).

4.3.5 Fifth Research Question:

 

Are there differences or similarities between
the RSA and the Michigan medical schools with
regard to teaching on specific drugs?
Tables 4.4.1 and 4.4.2 above, on chloramphenicol, show dif-

ferences and similarities on teaching about a specific drug

in the RSA schools and in the Michigan schools.

Similarities:

 

Detail: The Michigan schools give considerable detail
on chloramphenicol (Table 4.4.1) and so do PRE, STE and NAT.

Mechanism of action: The Michigan schools indicate
how chloramphenicol interfereswith protein synthesis (Table

4.4.1), so does PRE and NAT (Table 4.4.2).

118

Absorption, distribution, metabolism and excretion:
The Michigan schools discuss these topics with regard to
chloramphenicol (Table 4.4.1), so does PRE and NAT (Table
4.4.2). STE (Table 4.4.2) seems to be excluding a discus-
sion of these concepts probably because it discussed the
basic principles of absorption, distribution, metabolism
and excretion in terms of antibiotics, and chloramphenicol
featured here and there. This omission is contrary to what

AMSP advises on general principles:

A series of 10—12 contact hours is considered
appropriate for a development of the general
principles of pharmacology. The information
content of this section should be reinforced
throughout the pharmacology course by making
reference to this material when specific drugs
are discussed in the appropriate sections of
the course. Thus, for virtually every drug to
be discussed reference will be made to
pharmacokinetic aspects, drug metabolism

and receptor interactions, making use of the
information developed in this portion of the
course (AMSP, 1984, p. 12 — underlining mine).

 

 

MED mentions what chloramphenicol does, without explaining
how it does it (Table 4.4.2 above). The UCT and the WIT
data did not show details on chloramphenicol. The discus-
sion of the mechanism of action of streptomycin by WIT gives
no clear picture as to how streptomycin brings about its
effects (Table 4.4.2 above).

Toxic effects: The Michigan schools discuss the toxic
effects of chloramphenicol (Table 4.4.1 above), so does PRE

and STE (Table 4.4.2 above). MED enumerates instead of

119

explaining the toxic effects. NAT discusses the toxic
effect briefly (Table 4.4.2 above).

Therapeutic indications: The Michigan schools discuss
this in detail (Table 4.4.1 above), so does PRE (Table 4.4.2
above).' The other schools in the RSA seem not to discuss

this aspect.

Differences:

 

The Michigan schools discuss every detail known up to
the present about chloramphenicol. The RSA schools discuss
different aspects to different extents.

The aproaches of the RSA schools make one wonder
whether the information discussed is sufficient to enable
the future physician to prescribe with insight. It seems
the MED approach lends itself to memorization (Table 4.4.2

above) rather than understanding.

4.3.6 Sixth Research Question:

 

Are there differences or similarities between

the RSA and the Michigan medical schools with

regard to prescribed texts, the manner of use

of the texts, and other sources of information

for the basic pharmacology course?
Table 4.7 below, shows more differences than similarities
between the RSA and the Michigan medical schools with regard
to prescribed texts, the manner of use of the texts, and

other sources of information for the basic pharmacology

course. MED, like MSU, UOM and WSU uses Goodman and

1220

oococowom cmon m.cowowmacm och

xoccw coco: och

A.m.zv acowaEcoa wocowcoz och

A.m.m.:v oowoaoooEcocm mououm couwc: och

.o
.n
.N
.w

moocaom cocoa

mzow>om woowwowoooEcocm .m
mowcaoaococh cco amowoooEcocm woowcwwu .N
mowoaoaococh woocoEwcocxm cco amowoooacocm wo woccaoc och .w
mwoccaoc
.man .cOcmom ..ou cco caowm .owuuww
.cOwuwcm ccOoom .mcowooooz cco mcowuo< waca .amowoooEcocm .m .m .cw>oc .m
.cowoocoacou cowcocoz .amOwoooEcocm wo cooccco: .U .3 .mcwuuao .h
.owccOwaou .mouw< moc .mcowuoowwcam woowcoz omcoc
.awowoooscocm woowcoz wo 3ow>om .< .cowwcwoo cco .m .Nuosoc ..= .m .mcoaoz .o
.mmow .cowowem comwc .cowomawa>m mstc <z< .m
.mew
.mwaoc ccwom ..oo acmoz .> .0 ..co cucoh .awOwoooEcocm woowcoz .< .cuou .c
.oaow ..co ccm .xcoa 3oz .3om w coacoz
.cOwco< mac: «0 mowawocwcm .2 .m .coEwox cco ..c .3oc0c< ..< .cwocmcwou .m
.Nmow .coomom .acoaeou
cco czocm .owcuwc .awowOooEcocm ccocox .m .m .woncwcm cco .m .0 .wwoco .N
.Auxou
woacoeowacam ocowwooxmv omOw ccowwcm .ccowxo .mcowuoowwcam owwwucowom wwoa
Icoowm ..co ccooom .amowoooEcocm we coccuxoh .c .: .ccoz cco ..U .3 .cosaom .w
.couoow woowcoz och .c
.wwow ..am eon .cowuaawm>o mace <z< .m
.man ..ou cco czocm
.owuuwc ..co ccm .cw>oc .m coax ac chwoooom cco mcowuo< mace “awOwoooEcocm .o
.mcow ..oo same: .> .o ..eo coo .cooo an cwowooastocc waoweoz .m
.man .cowwwzooz ..co ch .wwoccoz cco coswoz ac amowoooscocm woowcwwu .N
.oaow
aowwz ..co ch .coswox cco zococ< .cwoomcwou ac cowuoo wacc mo mowawocwwm .w

mcwcoom
cocoocwc

wcwcoom
couoocwn

.omow .cowwwzooz uco
coo .coEwwo cco coEcooo ac mowuaoa

Iococh wo mwmom woomewoooEcocm och :0:

.omow cowwwzooz uco
cue .coswwu cco coEcooo ac mowuaoa

Iococh mo mwmom woomewoooEcocm och 3m:

 

cowuoEcowcw we moocaom cocoo

om: wo cocco:

moxoh :Owuaowumcw

 

zowh<2mom2w no mmom:om zmzho .mm: no zmzz<z .mhxmh ammwmummmm

h.o mcm<h

1121

.coccoc .coucmaOum cco coccoz
.wmow .wwowouoercc Hmowcwwo
wo coocoxoh < .z .c .oocaoch

 

.aco 30cm coc mooc cowwaaam wowcoooz cocoowccw uoz ..o .x .cOuooam ..o .= .muowom h<z
.acoa.zoz .=Awwwzua:
.cowuwcm coo .mowcaoaococh
wo mwmom woomewoooEcocm och
.< .caecwo cco .m .a .caEeooo .N
mo>wooccomocaox woowcoz .o .owcuowwwou .mouw<
ocoomo . m .mcowuoowwca woowcoz
ma chcoaa< oom owmoasam .mommocwcow .M owcowomNmaw .amOwoooMcocm woo
otaamcoowa .w cosmowecw ooz Iwcwwo a gamma .o .o .mcsuuac .w co:
.m chcoaao oom "cooa ccwch
.AOAowV .xcoa :mz .cmwwwzomz .cowuwem can
.mowoaocococh wo mwmom woowwOwoooEcocm och .< .coewwo cco .m .c .coEcooo .m
.wmwnwowmm .mocweowocoocoo .AManv cwoowwam woowcoz cmwowcm .a
.aoimmnomm .coowcoe< Owwwocowom .mwwou o>coz co cOwoowococowwwa
wooweoco och .Awaowv .c .m .coacmcaa cco .a .a .coooom ..: .a .comcoooom .c
.coccoc .mmocm
cowwaoox .mEoomam owmcocwwocu co mcowoo< mace .Aoanv .3 .m .oceooowcswcm .m
.xcoa 3oz .oocowom .wcacwocwo:
Icoucwlaoww3 .awowoooEcocm cowaoowoz wo mwowucommm .thva .< .mo>oxwocoa .q .coccow .wowco>lcowcwcam
.oomIommummw_.oocowum .muuoam< amoweocooam .qmow mowuoacc Hmowcwwo
ucowoo< ocwwocowacoo< Aocowv .o .m .wocowcm cco ..h .c .ccowcoo ..c .wwocan .m cw auouom macs .w .m .cwoa .N
.ocaoooc wocoz .cowuoo o>coc wo cowmmemcoco wooweoco och Acmocv .o .wzooc .N .coccoc .coocwaoom cco coccoz
.owauooc wocoz .momwacsw o>coc wo mooowwo oco wwOw .awowoooacocm woowcwwo
wo cowmmwsmcoco woowEoco oco wo chwmcooxo ocooou oEom Acmowv .: .z .owoo .w . wo coocuxoh < .z .c .oocaOch
"cooa ccooom cocoowccw ooz .m .c .wouoocm .u .c .mcowoz .w ho:
.couuoc woowcoz och .m
.00 cco cJOcm owuowc ..co ch :.aw0w0ooscocm: .cw>oc .N .omow .cowwaooz ..co
.mcom cco wcwcoom coo .coEwwe cco coEcoou ac mowuaom
aoww3 ccoc ..co ch .:c0wco< waca wo mowawocwwm: coswoa .zococ< .cwoomcwoo .w cocoouwa Iococh wo mwmom woowwOwoooEcocm och 3w:
cowooEcowcw wo moocaom cocoo om: wo coccoz moxoh cOwoauwcmcw

 

zccw<zm0c2c co mmocaom emcee .mma co mozzaz .mwxmw cccccomccc
causewacoov w.a mam<w

1122

 

.aco 30cm ooc mooc cowwaaam wowcoooz couoowccw uoz ococ oz hw3
.aco 30cm uoc mooc cowwaaam wowcocoz cocoowccw uoz mooc oz whm
Acowuwcm ch
.amowoooewocm .z.oo .mcoEEowv
ozomuwz ocoo>h
.aco 30cm uoc moOc cowwaaam wowcouoz cocoowccw ooz owwowoxoscom .a.on .mcoesow mum
ococ oz ococ oz ococ oz who
cowuoEwowcw wo moocaom cocoo om: wo coccoz moxoh cOwuaowumcw

 

zocwazcoczc cc mmoccom cmzco .mma co cmzz<z .mwxmc cmmwcommcc
Aeoscwocooo w.o mam<w

123

Gilman's: Theypharmacological Basis of Therapeutics. MED
does not indicate how it uses the book. Most of the RSA
schools do not indicate how their prescribed texts are being
used. The Michigan medical schools direct the reading of
their students.

Undirected reading in books like that of Goodman and
Gilman's The Pharmacological Basis of Therapeutics is likely
to make the student feel overwhelmed, particularly those
students who only have a high school education. This

applies to other texts as well.

4.3.7 Seventh Research Question:

 

Are there differences of similarities between

the RSA and the Michigan medical schools with

regard to facilities (size of department space),

faculty (number and qualifications of the

pharmacologists), the doctoral instructor:

student ratio, and the budget proportion for

the pharmacology departments?
Table 4.8 shows more differences than similarities between
the RSA and the Michigan pharmacology departments with re—
gard to facilities, faculty, the doctoral instructorzstudent
ratio, and the budget proportion for the pharmacology
departments. Most of the RSA pharmacology departments are
smaller than the pharmacology departments in Michigan.
There are more instructors with doctoral qualifications at

the Michigan medical pharmacology departments than at the

RSA medical pharmacology departments. There are less than

 

.ccowowwwamcw mo: cowooscowcw "ocaoooo oucw cocoa cooc ooc o>oc
mcommowoca wcwuwmw> .owuoc ccocaomncocoacumcw wocOcooc oco wcwccaoaeoo cw .co>oaoc .cocuoE commowoca wcwcmw> ocu wo ocozo mw acaum mwch .m.z

 

owco
owcowwo>o coc ococ owcowwo>o ooc ococ owcowwo>o uoc ococ Iwwo>o uoc moon hw3
owco
owcowwo>o ooc ococ o owcowwo>o coc ococ Iwwo>o uoc ococ whm
caocx ooc com
Icac woocom woowco: cco
oowuw OON N oowcac awowoooswocm OwN.w mam
owco
owcowwo>o uoc ococ N owcowwo>o ooc ococ Iwwo>o ooc oco: who
/4
N no A H 02 N 8 . mom :2
omuw 00 N «O. an.w am:
.cOwuacwum
czocc coc woocom woo Icw ocu wo mucoa
IwcoE cOw ccaoso "awow acoE cw ocwaou
emuw omw m IoooEcocm hem oooww mw amowoooEcocm ho:
wwnw ocN mw mo. ooN.w cm:
ouw 00w NN mo. Nwo.m to:
cnw 00w hw mo. oom.N cm:
owuoz ccocaom\w0coacomcw wocOooon oowm mmowo omoco>< a<mmv .a.: co .n.cm auwaoom cowuooca oowcam z cw Aoooamv auwmuo>wc2

oomecw ocoEowoaon

 

mhszhz<mmn huocoo<2m<=m mzh

m.o mcm<h

125

twenty Students for each doctoral instructor at the Michigan
schools, and for the RSA schools, the range is from thirty

to a hundred students for each doctoral instructor. The

 

Michigan schools have a uniform budget ratio for the pharma—
cology departments. The RSA schools have a variety of ratios.
In his 1910 report on medical education, Flexner

mentions a critical ratio with regard to both funding and
the doctoral instructor:student ratio, below which a medical
school cannot operate efficiently. With the picture that
Table 4.8, below, is showing about the RSA schools, the
fact that each medical school has or is about to start
degree training in Pharmacy (UCT, MED, STE and WIT); and
some of the Pharmacy schools are to start with medical
training (University of the Western Cape for Coloreds, Uni-
versity of the North for Blacks, University of Durban West-
ville for Indians and Asiatics), one wonders what the
efficiency of teaching pharmacology at these schools is
going to be. These developments are not paralleled by the

training of a sufficient number of the appropriate teachers

 

that pharmacology requires. Folb and Bowey (1978) indicate
that PRE had sixteen students in masters programs in pharma-
cology and Potchefstroom had thirty-six pharmacology gradu—
ate students, twenty—four of whom were honours (senior)
students. The rest were in masters of Ph.D. programs.

It also seems that the lack of learning objectives

(Table 4.2 above), problems with the organization, grouping

126

of drugs, the approach used in teaching on specific drugs,
and the undirected reading from the prescribed texts are
compounding factors in the developing attitude that South

African students have about pharmacology.

4.4 Summary of the Interview Answers

 

The thirty-seven interviewees represented five of the
seven medical schools in the RSA: UCT, MED, NAT, PRE and
WIT. The years of graduation from medical school ranged
from 1949 to 1982. Most of the interviewees studied basic
pharmacology in the third year. For some, the course was
boring, and for most, there was nothing they liked about
the course. However, none wanted the course removed from
the medical curriculum. Most of the interviewees were not
certain whether the instructor was a clinician or a pharma-
cologist. Some of the courses were said to be too abstract
and somewhat disorganized.

At NAT and PRE some of the topics are taught by a
pharmacist. At most of the schools, the drugs were grouped
and rationale for the frequency of medication, for drug com-
bination, mechanism of action, were taught. Most of the
interviewees did not remember being taught drug nomenclature.

Most of the interviewees were not certain whether or
not prescription writing was taught during the pharmacology
course. Some of the medical schools gave examinations on

the basic pharmacology course, others did not, but examined

127

the students in fifth year on all the work done from third
year. The pass mark for all examinations was 50%. The
majority of the interviewees seemed to feel that they have
been inadequately prepared for their responsibilities in
the community. The 1975—76 NAT pharmacology course; and
the UCT's course under Sapeika seem to have prepared stu—
dents adequately. Most of the interviewees recommended
better teaching in pharmacology at the medical schools.
These answers to the interview questions seem to have
some correlation with what this study has revealed:
1. The PRE course was said to be good, but not well
organized.
2. MED, NAT and PRE gave examinations in fifth year.

3. The pass score is 50% for those schools that give
examinations.

4. Based on the interviews, the teaching of pharmacology
was judged adequate at NAT and UCT.

CHAPTER 5

SUMMARY, CONCLUSIONS, AND RECOMMENDATIONS

5.1 Introduction

 

This chapter summarizes the main features of the re-
search study, and includes conclusions and recommendations
based on the findings. It is divided into five main sections:
brief review of the study, summary of major findings, some

miscellaneous observations, and recommendations.

5.2 Brief Review of the Study

The prescriptions which the researcher handled in
some hospitals in the RSA, inspired the undertaking of this
study. Most of the prescriptions referred to above, seemed
to be written with little insight into drug effects. Study-
ing medical pharmacology at MSU indicated that something
might be missing in the teaching of pharmacology at the
medical schools in the RSA.

This study was designed to find out whether there
is anything missing in the teaching of pharmacology at the
medical schools in the RSA as compared to the teaching of
pharmacology at the medical schools in Michigan. It is

intended that the findings may serve as a basis for more

128

129

effective teaching in pharmacology at the medical schools in

 

the RSA to enable the physician to use the ever-increasing
numbers of pharmaceutical products effectively without feel-
ing inundated by them. It is further hoped that on the long
term basis, this study will ensure better and more cost
effective drug therapy for the patient and higher health
standards for the RSA communities.

The study sought to answer the following questions:

First, are there differences or similarities between
the RSA and the Michigan medical schools with regard to the

basic principles of the pharmacology course: drug absorp-

 

tion, distribution, metabolism, excretion, mechanism of
action, interactions, drug development and evaluation?
Second, are there differences or similarities between
the RSA and the Michigan medical schools with regard to the
depth of the basic pharmacology course?
Third, are there differences or similarities between
the RSA and the Michigan medical schools with regard to the

instructional strategies for the basic pharmacology course?

 

Fourth, are there differences or similarities between
the RSA and the Michigan medical schools with regard to the

organization of the basic pharmacology course, particularly

 

about knowledge objectives, sequence of tOpics, groups and

subgroups?

130

Fifth, are there differences or similarities between
the RSA and the Michigan medical schools with regard to

teaching on specific drugs?

 

Sixth, are there differences or similarities between
the RSA and the Michigan medical schools, with regard to

prescribed texts, the manner of use of the texts, and other

 

 

sources of information for the basic pharmacology course?
Seventh, are there differences or similarities between
the RSA and the Michigan medical schools with regard to

facilities (size of department space), faculty (number and

 

qualifications of the pharmacologists), the doctoral in-

 

structor:student ratio and the budget proportion for the

 

 

pharmacology departments?

5.3 Summary of the Major Finding - RSA

 

The major finding of this study is that the teaching
of basic pharmacology at some of the RSA medical schools

appears inadequate:

 

1. The dgpph of the courses may be wanting: discus—
sion of the basic principles (Tables 4.3.1 and 4.3.2), the
classification of the antibiotics (Table 4.5.2), the discus-
sionof a specific drug (Table 4.4.2 and Appendix C3). The
depth at which some of the RSA schools teach, is likely not
to develop, in the student, the insight into drug effects,

which the physician requires to critically evaluate the

131

claims made for drugs. The depth at which the Michigan
schools teach (Tables 4.3, 4.5.1, 4.4.1 and Appendices

C1.1 - C2.6) is likely to make the physician critical enOUgh
in evaluating claims made for drugs.

2. Instructional strategies: The RSA lower frequency

 

of examinations and the lower pass mark (50%) may predispose
the student to mediocrity, whereas the Michigan higher fre-
quency of examination and higher pass mark (70%) may pre—
dispose the student to more thoroughness (Tables 4.1 and 4.2).
3. The Organization of the Course: The Michigan
medical schools organize the course in a manner that facili—
tates learning. Some RSA schools seem to give less atten-
tion to this type of organization, but more consideration
to completeness of the subject matter under each topic and
completeness of syllabi irrespective of whether the sequenc—
ing of the topics facilitates learning (see Appendices
B1 - B10 and Tables 4.5.1, 4.5.2, 4.4.1, and 4.4.2). The
organization of some of the RSA courses is more likely to

confuse rather than assist learning.

4. Approach on Specific Drugs: The RSA schools have

 

a variety of approaches (Table 4.4.2). The information that
MED gives (Table 4.4.2) appears very insufficient. PRE
(Table 4.4.2) seems to dwell less on the mechanism of action
at molecular level, but more on the physiological and patho—
physiological effects. STE (Table 4.4.2) seems not to re-

inforce principles taught earlier. It starts the discussion

132

of chloramphenicol with the toxic effects, probably because
it discussed the basic principles in terms of the anti-
biotics. The 1975—76 and the 1981 NAT courses, though the
discussions on chloramphenicol are brief, the approach is
in line with what AMSP recommends: basic principles taught
at the beginning of the course are reinforced in discussing
each drug. The UCT and WIT material showed no details on
chloramphenicol. The WIT discussion of the mechanism of
action of streptomycin (Table 4.4.2 and Appendix C3) lacks
in specificity and the information seems to require up-
dating. There was no data from OFS.

5. Prescribed Texts: Most of the RSA texts seem

 

slanted toward the applied rather than the basic aspect of
pharmacology (Table 4.7) and the reading of the student is
not directed. The specific pages relating to the pppi£_in
question are not indicated. This is likely to make the
student feel overwhelmed, particularly with books like

Goodman and Gilman's, The Pharmacological Basis of Thera—

 

peutics.

6. The Pharmacology Departments: The RSA pharmaco-
logy departments are smaller than the Michigan ones, but
teach a larger number of students than is the case in
Michigan (Table 4.8). The Michigan schools are research
institutions; thus, the faculty is expected to spend 50%
of their time doing research. The RSA schools are also re—

search oriented. The dearth of highly qualified teachers

133

and the high student populations makes it inconceivable how
these teachers can devote 50% of the time to research as

the Michigan teachers do. The proportion of the money allo—
cated to the pharmacology departments in the RSA is uneven.
The Michigan allocations are even (Table 4.8). In the RSA
the doctoral instructor:student ratio ranges from 1:30—1:100;
in Michigan it is below 1:18. There are fewer instructors
with high qualifications in the RSA than in the Michigan

schools.

5.3.1 Findings Based on the Interviews Conducted in the RSA

 

Findings from the interviews with the practicing
physicians are similar to those revealed by the answers to
the research questions that:

1. Some of the RSA pharmacology courses appear not well
organized: interviewees found courses to be good but

"a bit mixed up."

2. Some of the RSA medical schools give examinations for
the basic pharmacology course, others do not.

3. Most of the interviewees felt confused and would have
preferred more guidance in basic pharmacology.

4. Few of the interviewees (NAT and UCT) felt adequately
prepared in pharmacology.

5.4 Summary of Incidental Findings - Michigan

This study was not designed to study the Michigan
medical schools per se, however, the following practices

at some of the Michigan medical schools became evident:

134

1. Topic Sequence: UOM and WSU (see Appendices B2
and B3) in discussing autonomic pharmacology, start with
the physiology of one system (either cholinergic or adren-
ergic), then introduce the drugs affecting that system
before completing the physiological interrelationship be—
tween the systems and between the systems and the central
control reflexes. AMSP suggests that the complete physio—
logical interrelationships be discussed before drugs are
introduced.

2. Instructional Strategies: MSU, UOM and WSU do

not use laboratory exercises as a teaching tool (Table 4.1).

AMSP suggests the use of teaching laboratory, demonstration,

 

round table and conference as instructional strategies.

5.5 Some Interesting Miscellaneous Observations

 

This section includes some practices in the teaching
of basic pharmacology which became noticeable throughout
this study, though some of them did not fall directly within

the focus of the research questions. These observations are:

1. Some of the RSA schools give a deeper teaching
in pharmacology to the pharmacy students than to the medical
students; the least to the nurse (see Appendices B4 and B11,
35' B15.1 ' 315.2' B7.1 ‘ 37.2' and B10’ B12 ' BIA)° This
approach parallels teaching the whole alphabet to the phar-
macy students; only the consonants to the medical students,

and only the vowels to the nurses and expect the three

135

professionals to be able to write essays, poetry, novels,
etc. The pharmacology which the RSA doctor, pharmacist and
nurse learns does not enable these professionals to communi-
cate in pharmacology.

2. In the RSA the majority of the pharmacology in—

structors are clinicians (Appendices A A7 4 and

7.1
Table 4.7). The approach used is such that applied aspects
overshadow basic aspects. Most of the prescribed texts
(Table 4.7) emphasize the application rather than basic
aspects. As this study has shown, pharmacology defies the
RSA approach, but not the Michigan one. In Michigan the
teachers of pharmacology are basic pharmacologists who have
as basic qualifications either medicine, pharmacy or some
expertise in one of the biomedical sciences.

3. The UOM explanations of the mechanism of action
of chloramphenicol (Table 4.4.1), penicillins, bacitracin

and vancomycin (Appendices C - C1 2), seem to show that

1.1
some sound background in biochemistry and microbiology are
required if the student is to understand fully the mechanism
of action of these drugs.

4. STE teaches on the basic principles: absorption,
distribution, metabolism and excretion in terms of the anti-
biotics (Tables 4.3.2 and 4.4.2). This approach may lead
the student to think that these basic principles apply only
to the antibiotics. STE seems not to reinforce the basic

principles when teaching on specific drugs (Table 4.4.2).

The STE approach on basic principles is likely to confuse

136

rather than facilitate the understanding of the basic prin-
ciples. This approach is analogous to teaching the alphabet
in terms of essay writing. Acquisition of basics and
acquisition of the use of the basics at the same time are
less beneficial to the learner.

5. The South African Medical and Dental Council
(SAMDC) is said to control the training of medical doctors
to ensure high standards and uniformity, but has no written
guidelines for the basic pharmacology course (Appendix A4).
The diversity of syllabi (according to organization) which
this study has revealed implies lack of a common point of
reference. Guidelines similar to those of AMSP may be
helpful.

6. Sometimes a diagram facilitates the understanding

of some of the most abstract concepts, for example:

WSU:
(l) The cell wall synthesis in some bacteria
(Appendix C2.2)
(2) The cell walls of the gram positive, gram
negative bacteria (Appendix C2 5)
(3) The representation of GABA-benzodiazepine-
chloride ionophore receptor complex
(Appendix E1)
MSU:

(l) Mechanismcfl action of local anesthetics
(Appendix E2)

Some diagrams, particularly when accompanied by insufficient

information, might confuse instead of facilitate the learning

137

of a concept, for example, the discussion of streptomycin
mechanism of action by WIT (Appendix C3). WIT may be giving
more information in the lecture than is shown in the

material supplied.

5.6 Conclusions

 

This section presents conclusions based on the re—
search answers, summary of the interview answers, and the
observations which this study has made.

This study has revealed that the cause of most of the
RSA pharmacology problems is the low number of highly quali-
fied pharmacology instructors. The situation seems aggra-
vated by the fact that these few instructors have to teach
medical students as well as pharmacy students.

The growth in demand for pharmacology teachers seems
unparalleled by growth in the training of sufficient numbers
of appropriate pharmacology teachers. As the Working Party
of the South African Pharmacological Society reports (1982),
only PRE and the University of Potchefstroom (School of
Pharmacy) are training clinical pharmacologists. Very £31
of these trainees are in Ph.D. programs, and there is no
guarantee that after graduating they will be interested in

teaching. These two universities educate primarily the

 

Afrikaner student. Therefore, as far as local effort is
concerned, there will be a steady supply of clinical pharma-

cologists for teaching in the Afrikaans medical schools.

138

The English, the Blacks, the Coloreds and the Asiatics,
having no training programs for pharmacologists at their
universities, will have a continuing shortage of well-
qualified teachers in pharmacology.

A coordinated RSA effort to train basic pharmacology
Ph.D's is currently nonexistent. The debate on the teaching
of pharmacology started in 1964 at the conference held in
Natal (Sapeika, 1964). The pharmaceutical industry, the
population and the discipline of pharmacology have not
remained static over the same twenty-year period. A massive
training program for pharmacologists, particularly basic
pharmacologists, is required to meet the needs of the grow-
ing population, the increase in the number of medical
schools and pharmacy schools.

At the Michigan schools, the teaching of basic pharma-
cology may be even more effective if some of the AMSP
recommendations were implemented; for example, reorganiza—
tion of the autonomic pharmacology discussion, introduction

of the teaching laboratory, demonstrations and discussions.

5.7 Recommendations

 

Quality instruction is necessary if a society is
striving for excellence in health services. The teaching of
pharmacology in the RSA is no exception if the RSA communi—
ties are to be assured of cost effective and high standard

treatment of their patients. Quality instruction goes

139

together with quality teachers. In order to have quality
teachers there has to be quality pre—teaching training.

On the basis of the results of this study, it is clear
that the local effort in the RSA is insufficient to solve
the problems of teaching medical pharmacology. Since the
1964 conference held in Natal, the teaching of pharmacology
at the RSA medical schools seems to have changed very little.
Table 4.8 shows that the RSA doctoral instructor:student
ratio is too high. Sapeika (1965) pointed out that the RSA
pharmacology instructor:student ratio was too high. Sapeika
(1965) also indicated that a single department of some
universities overseas have the same number of highly quali-
fied teachers as all the highly qualified teachers in all
the RSA medical schools combined. Table 4.8 shows that
the faculty at the MSU Department of Pharmacology is almost
equal to all the pharmacologists with high qualifications
at all the RSA medical schools combined. The MSU Department
of Pharmacology started in 1966, almost at the same time
when the RSA debate on the teaching of pharmacology started
(1964).

Based on the above factors, this study has these

recommendations to make:

1. The RSA medical schools should work as a team in
teaching pharmacology. Blending of some of the aspects of
the various syllabi is likely to lead to some improvement.

For example, combining the UCT second and third years course

140

organization with the subject matter of PRE, and the overall
approach of the 1975—76 NAT course is likely to minimize

the lack of depth, the disorganization, in some cases, and
the lack of reinforcement of the basic principles in teach-
ing on groups and subgroups of drugs. NAT seems to have

a smooth introduction of the concept of receptors

 

(Appendix D4).

2. The RSA schools should form a pharmacology subject
committee which will from time to time review the subject
matter of the course with regard to organization, freshness,
consistency of facts, examination formats, frequency of
examinations and pass marks.

3. The RSA schools should set some general learning
objectives for the pharmacology course and should evaluate
the curriculum from time to time to see whether the objec-
tives are achieved. A longitudinal study would be ideal.
This evaluation should include feedback from medical
students, medical practitioners already in the field, as
well as the clinical departments. The clinical departments
are in a better position to assess whether the students come
to them with a good command of the basics in pharmacology.

4. The RSA medical schools should teach pharmacology
in greater depth, as the Michigan medical schools are doing.
This way the RSA schools are likely to produce medical prac—
titioners who possess what AMSP considers the minimum
essential knowledge in pharmacology which every medical

student (trained as an undifferentiated physician) must have

141

at the time of graduation from medical school.

5. The RSA medical schools should consider intro—
ducing more examinations and a higher pass mark, or find
some other way of making students acquire higher competency
in pharmacology.

6. The RSA Medical schools should organize their
syllabi such that the grouping and the subgrouping of drugs,
and the sequencing of the topics facilitate learning,
particularly for students who have only high school educa—
tion as background.

7. The RSA medical schools should reinforce the basic
principles throughout the course. This means that for each
drug group, or subgroup, and for each prototype drug, the
basic principles should be discussed, particularly those
aspects that make the group, subgroup or the prototype
special.

8. The RSA medical schools should define the concepts
they teach, and clearly state the learning objectives for
their students for every section of the course, and should
direct the reading of their students through the prescribed
texts. Learning objectives, definition of concepts, and
directed reading, may reduce the feeling of inundation by
pharmacology which the RSA student is said to experience.

9. The pharmacology syllabi for medical students,
pharmacy students, and nursing students in the RSA should
be designed such that these professionals are able to com—

municate in pharmacology through the prescription. For

142

example, with respect to the frequency of medication, the
nurse should administer the medication at the particular
frequency not only because it is doctor's orders, but also
because she understands the pharmacological importance of
it. The pharmacist should dispense the required quantity
(frequency of medication determines the quantity to be
dispensed), fully understanding the pharmacological impor—
tance of the frequency of medication. This understanding
is also important when the pharmacist tells the patient how
the medication is to be used. If the pharmacology syllabi
are not designed to facilitate communication through the
prescription, the probability for errors in medication may
be high.

10. The RSA medical schools should allocate a con-
sistent budget proportion for the pharmacology departments.
Flexner's 1910 report emphasizes that there is a critical
fraction of funding below which teaching cannot be effective.
For the Michigan schools that fraction is .03 of the total
medical school budget. The RSA schools should collectively
find their critical fraction and this should be the minimum
for all pharmacology departments at the medical schools.

If they prefer the .04, that minimum should apply to 3333
RSA medical pharmacology department.

11. The RSA needs to take a giant step in training a
sufficient number of pgglp pharmacologists. The RSA
pharmacy schools seem to have produced enough students to

draw from to train pharmacology teachers. The Michigan

143

experience shows that basic pharmacologists develop from
various backgrounds: pharmacy, medicine, or expertise in
any of the biomedical sciences.

Since 1970 pharmacology became a compulsory major at
the pharmacy school in the RSA. The observations of this
study lead one to conclude that the RSA pharmacy students
get a more thorough training in basic pharmacology than the
medical student does. Van Zyl (1978) points out that:

Most medical schools in the Republic do not

offer pharmacology as a major for the B.Sc.

degree. (Folb and Bowey, 1978, p. 87)

As Appendix D5 shows, developing basic pharmacologists from
medical doctors may take longer. Material to draw from:
the report of the South African Pharmacy Board (1 March to

31 August 1984) shows the total number of pharmacists in

the RSA to be as follows:

Male 4423
Female 2343
Total 6766

Total Number of Male and Female per Race

Male Female
White 4100 2238
Indian 199 53
Black 53 24
Colored 46 15
Chinese 25 13
Total 4423 2343

144

(The above numbers are not necessarily indicative of the
abilities among the various races; they are indicative of
the availability of the opportunity to study pharmacy).

To alleviate the shortage of teachers well qualified
in diverse areas of pharmacology, the following plan is a

possible solution.

Plan for Diversified Training of Pharmacologists

1. Teams of pharmacists who majored in pharmacology
are to be constituted according to the needs of the medical
schools which may participate in this basic pharmacologist
training program.

2. These teams are sent abroad to undergo training
at graduate level in the various areas of pharmacology.
(ASMP has specified the areas). Each team goes to a uni—
versity competent in some specific area in pharmacology.
For example, if Holland has excellent competence in neuro—
pharmacology, the neuropharmacology team is sent there; if
Britain has excellent competence in cardiac pharmacology,
the cardiac pharmacology team is sent there, etc.

3. When the teams come back, they rearrange according
to the medical schools assigned their communities. This
means that there will be a training center for pharmacolo-
gists for each community, and in this way there will be an
internal steady supply of pharmacologists in each community

for service in academic, industrial research and other areas

145

where expertise in pharmacology is required.

According to the RSA Pharmacy Board statistics, all
the RSA communities can participate in the plan, and all
stand a chance of succeeding: the white pharmacists have
had better facilities and better teachers; the other racial
groups have qualified despite the unfavourable conditions
at their pharmacy schools. In able hands and with better
facilities the other races are likely to do better than what

their undergraduate records may be reflecting.

Implementation of the Plan

 

1. Negotiations are entered into with specific
universities abroad, on behalf of the teams constituted
as suggested above.

2. The RSA government pays for the training of each
team.

3. The various communities select the pharmacists

to represent them in each team.

The above plan can be implemented over a period of
ten years, at the rate of a team or two teams a year. Each
team might need about four years for training, depending
on the program they will be following.

How do we make sure that they teach when they come
back? One of the conditions for participating in the plan
might be academic service for some time after qualifying.

How are the pharmacists likely to respond? An

146

opportunity to study abroad, to acquire some expertise in
pharmacology, and a higher qualification; the feeling that
one is representing one's community —- all these are likely
to be appealing.

How is the international cummunity likely to respond?

Positively: the teams will be representing all the races

 

in the RSA. By training these teams the international com-
munity will be contributing to all the communities of the
RSA.

What will this plan mean to the people of the RSA?
Nobody will feel left out of a significant development.

It is hoped that for Medunsa this development will
be accelerated because the need in the Black community is

great.

CHAPTER 6

APPENDICES, BIBLIOGRAPHY AND GENERAL REFERENCES

Appendix Al

1449C Spartan Village

Michigan State University

East Lansing, Michigan 48823
U.S.A.

January 2, 1984

Head of the Department of Pharmacology
University of

Dear Sir:
INFORMATION ON THE PHARMACOLOGY COURSE FOR MEDICAL STUDENTS

I am studying for a masters degree in pharmacology at the
above mentioned University. For my thesis I am doing a
comparative study of the curriculum and the teaching of
pharmacology at the medical schools in the Republic of South
Africa and the medical schools in the state of Michigan
(U.S.A.).

I am registered with the South African Pharmacy Board as
a pharmacist.

Would you please supply me with the following information:

1. The pharmacology class notes used for the medical students;

2. The prescribed text book;

3. Information on the size of the pharmacology department
(space), the faculty (pharmacologists), their qualifica-
tions and areas of specialization; the amount of money
allocated to pharmacology, and the amount for the whole
medical school, the average class size (Tables 1 and

2).

4. The lecture schedule indicating the sequence of the topics,and
the hours spent on teaching pharmacology.

Thank you very much for your co—operation.
Yours sincerely,

We.

H. E. Mateme (Mrs.) 147

MIIIIICaI SIJIUIII

Yoth Hood. Puthlowu
JulIaIIIu-sluuq
:NWSSmMHAku

Appendix A2

 

 

'I'II'I'OIHII?) 'WIlmII-Ml

lt'h'a 4 L'?'“)(’ NA
UNIVERSITY OF THE WITWATERSRAND. JOHANNESBURG 5 (on; 047- I I II
Medical School DEPARTMENT OF EXPERIMENTAL AND CLINICAL PHARMACOLOGY

hM1MHmIW|H 647-2042

l8 July 1984

Mrs H E Mateme,

1449C Spartan Village.
Michigan State University,
East Lansing,

Michigan 48823,

UNITED STATES OF AMERICA.

Dear Mrs Mateme.

Thank you for your letter dated July 4, 1984 addressed to Professor
Charlton. I would like to advise that Professor Charlton has left
this Department.

I refer to your last letter dated March l9 in which you requested that
class notes and other information be sent to you c/o Sister E Molapo,

P 0 Box le, Jane Furse Hospital. A large bundle was sent Off on April 2,
1984 to this address but was returned to our Department marked “UNCLAIMED”.

In your last letter you enclosed two Tables to be completed. I would
like to advise that any information with regard to Budget and Qualifications.
and Names of Lecturers at this University is considered as strictly

confidential and I therefore regret that the forms cannot be completed.

Yours sincerely,

3’ {it} c ( iii/(1x)

F Price
Secretary, Department of Pharmacology.

148

NEDUNSA
“II

Appendix A3

 

FACULTY OF MEDICINE

Department: Pharmacology

 

Mrs H E Mateme

P O Medunsa 0204
. I Soo '
144 9C Spartan Village $333.0... $131325“
. . TIII M Medunsa
Michigan State University ImmamwsA

East Lansing
Michigan 48823
U S A ' Oulwl

Dear Mrs Mateme
YOUR LETTER DATED 27 DECEMBER 1984

We are glad to furnish the following information, as you
requested: °

1. The total hours allocated to the teaching of basic
pharmacology: Lectures = 60 hours, Seminars and Clinical
Discussions = 147 hours, Practicals = 81 hours (These are
for undergraduate medical students only).

2. The order in which the topics are presented to the class:
enclosed please find copies of our teaching programmes for
1985, from which you will get this information.

Yours sincerely
., ,>, _/

(. Pf/Kbflmt—f .
/?\'_'__/-T
DR A D STAHMER

13 February 1985
/cv

1&9

MEDICAL UNIVERSITY OF SOUTHERN AFRICA

 

Appendix A4
THE SOUTH AFRICAN

 

MEDICAL & DENTAL COUNCIL

-_—— --—-——- —-

 

 

 

. mu . “-- m-.—— to.---o-r.-

nut VLFIMLULLN SIHLL I
[\IIILAIVIIA
MIL [CHIA

f9? INATION/fl (O I?) I‘d-mm”
INIL HNAIIUNAL 1 ;",' I.’ 9,; 9“,“)
'5 ML UI-‘HAR

Mrs M E Mateme

449C Sparton Village
Michigan State University
East Lansing

MICHIGAN

48823

U S A

My HUI

Yuul IIUI

Dear Madam

In reply to your letter of 19 September

1-] 20f)
I’HLTOHIA
UIJUI

M 2/84
Mrs Schoeman

8 October 1984

1984 concerning

stipulationSfor the Teaching of Pharmacology at the
Medical School; I suggest that you direct your inquiries
to the various Medical Schools in the Republic in South

Africa. They would be in a position to
their Curricula.

Yours faithfully

Siam

’N M PRINSLOO
REGISTRAR
DS/hd

 

156

An COHRLSO‘ONOI‘NCI [0 I.“ ADORCb‘oED 10 "If. REGSII‘AR

furnish you with

“/03

 

 

 

 

“.50 IA LEIOIA/LSS.“=A L- SERVICE

Mm.yaTUNpouo £££_
Vom- Nn/ROI- No. SP Mateme , II. [-2 .

DINV AK 15150
NAVRAE IENOUIRIES: Machupe Mphahiele(DR)
No. yl T oIoIomo
Td-Nn W 01529 - 2336/7/8 Department of Health & Social Welfare
13.LNL,Nm Lebowa Government Service

Private Bag X04

CHUENESPOORT

0745

GISI VA/KAN'KKII VM DIE/WHO! G M

1984.07.24

CIRCUALR No 32 OF 1984
HEADS 0F HOSPITALS UNDER THE CONTROL OF THE DEPARTMENT OF HEALTH AND SOCIAL WELFARE.

Mrs H.E. Mateme the Pharmacist stationed at Jane Furse Memorial Hospital is currently
carrying on research for her Thesis on a topic related to Health Care, Pharmacy and

Therapeutics.

She would like to approach our Medical Officers trained in the Republic of South

Africa in her research.

Please give her every facility and opportunity to meet your Medical Officers.

MAW/t4”

MACHUPE MPHAHLELE
SECRETARY FOR HEALTH AND SOCIAL WELFARE.

151

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Appendix A6
T A B L E 2
larrversity Space devoted t2 Pharmacology l984 Budget for Pharmacology
- in m w_ -. -c.munn,
, ”' ' '°—Cl5§§r56m§_lLaboratories Offices Total for nedical Ahmunt allocated to
’L T) school , ., .________.._. _-..~.':'.):11:I3es_9lwy .
J :I as ‘4’ $000
‘ -_-- ’ _..-..___. T A B L E 2
n‘versity Space devoted to Pharmacology 1984 Budget for Pharmacology
ingm? ._.”___h-__
Classrooms Laboratories Offices Total for nggiggl Amount allocated LJ
school Pharmacolouy
PM ‘2' "a, , "7 ,3-7>)o .,;,.,
LblL/VS‘H. 60' 6" 3‘0 l Alb I A“ ' A1 >0 (”’0'
l A B L E 2
a;ivornity Space devoted to Pharmacology l984 Budget for Pharmacology
_ . -_._-.- in m" .. M._-§fi.<€€£:‘.fé-_ ,_
Classrooms Laboratories Offices Total for Medical Amount allocated L
school Pharmacology
1* RT s L ~------ ' --_-
54 105 39 253 740 (>730
”-Jl“ ii. ”TIA B L E 2
hiversity Space devoted to Pharmacology l984 Budget for Pharmacology” w“
........... WW..- Ln In” W W..-_ .. .. I.
Classrooms Laboratories Offices Total for uedical FAmount allocated to
L_ih school Pharmacology
.iversity 4 lecture 3 laboratoi 10 .
PruLuru rooms 2 1 x 40 m2 i.36 ml each Unknown Unknown
9
2 x -20 m2 1 x 50 mg.
l x 40 m l x 220 mm
1 x so mzf

 

 

 

13:!

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

. . . 3. ngw
. . . I.
is . .Ez W v.%&2_n< iii.
..._ . W . .3 S . . . .
ch.— W .427. £33. W +3 9.1% , .— f? 4k.
3. W E 2 Mafia...“ 5 £3.26: . 191.“...
m 2.
. . 1 a5¢7§3fl .
W .2 data/a: A". 35.3.. .Tsaatiw
. . «a 9d
a . :2 43.9.. azwiafi 3.....H..,,
- _ . é a ...
7. 7:: a; W. E ..
.m .3 £1 ‘1). if... m (35.33.: B
f. e 521. 33:. 1
M. or . (\Z . {TALMmLa .9... W335: §~3Tc . .
. \ L395. 2:2.c is; a.
a. .2 ,3... e .. .3... . .
xfisté 3.15 3%.... $3... an
. -. . .99.. 39..
cm. {7. 4.: .rzmuav 3.2.3.” .3. er a _
. 2 Cu:
538.325 5:25: 558.525 555.22...” .3 8: 33:52.55
3332.. $33.82.... 2C
33 mmmalfi l
mmupu 3953 5:: 9:55.. mw fiawmumfimmum 57.52;
.7 a m . -

Hm4m<h

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

.... .l .m...
..I ..m. at at man». .2. .. 6...qu A...» €At!kv.3§§
: a ......G. a. u. é¥
. a, s. .. Was .9. Kc .
m II! . .W.\~ “~Q “t qu—QMQ “Q §§KK§ fihh§£.4ml.\\
= .. ...!tmh 4.9.
t a . uMuQW§ K. U KQQK
.w II II. 63m... .3. .w... 8t .2.. giuaé .fiu§u.\ .qw§§
“I . . .336 r18 .Qfixm
.232 mmm .32 m an .. .. .
1 N3 Hubs). .Wmm V3.28: .36 W .. «Fm; EW
Ill Ill 2 z a a
2 .... .... w
7. : : . =
A ,
x I rII : s. s.
m I II... t 2 .. W.“
m . . 1
W On» ll. l § § § 0. 599A inh§
A l
.. VF»... .vbwocgi‘aufi.
.uo .t ...uh ..m, ...wQun.ut%att&©~3uwQ .§t~.M.N.<
. . iéfi an: \wQ if}. ..Q 993%. «E says... .
wuok x3»... $31.6. as... u§-uo§m r ggtsg.
.. ......éxfiwé a4 ..Unmmmé...‘ 3i 1
. . . ......at .8 .8 t ...». svttum... nzkownwwifin arm
.IQU “$335K \KNQ MHQKWQ W .Mts “V ?
.qtésxy. uh. .t x U.S.—...... «33:... 333
..u uuk .ynwt . ismiiit $1.... on. U 8 3 42m «eunwgou $5.33. gmsdowufi
_ ..t A. 50385:... 2. yngoZHnu
.0 W ..uuwk .VQQ ggqiét «Vigknhévahcx "230 .... n58. «tanfith §S§Kux§k . mex, Adm .thiwqfl...
copuuuttgo c3358.. 553C325 5333233 $0 3.2 $33.53 .thimkaRfi
pouvaunga pmuwuwgowgh
3: game: i
“may... 8222 53. 9563... v4 sac—38:2.— .3333.
. :35. «a macaw L

 

 

H u4m<h

....»mlxtofixoir‘ 3.4km t .390. g m

 

 

 

 

 

 

 

 

 

 

 

 

is:
_ a. N..)X.x¢\5\ .
Wu. . ...vi _ 8.353%
. h . b. .Mwovduse
A; kmwuuvaudLdexS ” xugér V5 KwA
~93 {X ..M\ $ . umfl m 93.10.} V40...“ 2(>.¥.E_
Eéc§x m .
5.3%. oiuwvéx 3% 33!?
g > 8130.50 g.
m9\\u. 2.1m4. ACWVOOK .7543
36.... 019.99.“ .63.? 363. 339$ .aiitdfi
3 3 rN). g .50
7. )\~\ . . \ (ORCubx
A . ) .
u. 3.0- $3.0 \ «v 3 u
.m . . w $843985...“ .5.
m. V\d.u. .. \ . 4.132%? 1
A *9qu g . . menuswnfi .. 2 a . .
m .33 . . ..xw gt»... $533.38“. $3.85
25.. $3 .. . .
. . K.
3.3.x 3‘ {fiwo‘uo r\\ . .quV 3.5A‘N
3.... . .... ...... 5......
Navajo.» ASWV ...uku 39.x. EM » [Dd £2 .1.th
3360‘ . E 9‘OKO uga 3% E0 (E
53% 9x .Sa w: .8: Sin. . \23. .30. um. ...: .3: s» 6.... mo
533E326 _ cmpuvcfifl coBuut—Zgo 533.3393 we 8.2 538.52 vaUZZD .
23385 323585.
3: 2w...“ i:
3.29 $202 85% §A Vs 3» .25 9.539 .... 328.52.. 3.22::
. gut... an 333

 

 

“mam”...

 

 

.I'. I 1‘! Ill“ .. -.t.‘ .11 1‘. II in! [1.1 1:11

Appendix A7.4

 

 

 

mmwuwmv
mumummz
.uowq .mmm mafiumfifionu Hmcwuaumfi muwusu
meoamwo x H uomq .ucm H : Havauwuomna Iooav mm”
0mm x n .aznoua v .o.: ".woum.¢oum5hmnm Hmowcaau Hommomoum
covum~mparuunm we auu< Louuauumcn

 

 

:ovuuuwvaaao cawuwcguuh cowuouwvamac

 

 

quwuuagm Faumuogowzh

 

156

mum sum new

39.3

fig .28 «Co».

xummsm

 

u~wm
awn—u umoLm><

 

=<mh azazu<uh

my amp—cumsuuga

 

 

Urgz an mumuum

 

H u._m < h

l'.

‘ Gag
v.5:

Appendix A8

1M UKIVfRSHY 0F THL ORAhGL FRU SlAlL
IM'ULTY or MI'DICINE

OffICl 0! TH! DEPUTY REGISIRAR

TELEPHHJE 7071.1 >. 314px). EC». 339. BLOLMF‘O’.‘TL!.\’
Mr B D H van den Berg 9300
Fmi: FACULTY OF MEDICINE A5

7 February 1985

Mrs H E Mateme

14490 Spartan Village
Michigan State University
East Lansing

Michigan 48823

USA

Dear Mrs Mateme

REQUEST FOR INFORMATION

Receipt of your letter dated December 27th, 1984 is acknow-
ledged.

According to the mentioned letter you have requested certain
information. This request was never received by my office.

This university does actively take part in all kinds of
research and will supply you with information on receipt of
the necessary details you require.

Yours faithfully

 

f/DEPUTY-REGISTRAR: ACU'LTY OF MEDICINE
hp

157

 

Appendix A9

THE UNIVERSITY OF THE ORANGE FREE STATE
FACULTY or MEDICINE

OFFICE OF THE DEPUTY REGISTRAR

TELEPHONE 70741 xifi4 Fno. BOX 339 BLOEMFONTEIN
Mr B D H van den Berg 9300

Ref: FACULTY OF MEDICINE J4
13 March 1985

Mrs H E Mateme

1449C Spartan Village
Michigan State University
East Lansing

Michigan 48823

USA

Dear Mrs
TEACHING OF MEDICAL PHARMACOLOGY

Receipt of your letter dated 25 February 1985 is acknow-
ledged.

The letter was forwarded to the head of the department of

Pharmacology, prof F O Mfiller, who will contact you in due
course.

In case of any further enquiries it will be appreciated if

you can contact him directly at the above-mentioned address.

Yours faithfully

  

dV’DEPUTY-RBGISTRAR ULTY or MEDICINE

lcp

158

 

Appendix Bl

Michigan State University

Medical Pharmacology I

1. Introduction: Definitions and scope; the use of drugs

in the treatment of disease; general principles; source

of drugs; process of new drug development; drug nomenclature;
2. Drug receptor interactions; 3. Passage of drugs across
biological membranes; 4. Drug absorption; 5. Drug distri-
bution; 6. Drug elimination; 7. Drug metabolism; 8. Bio-
logical variation; 9. Pharmacogenetics; 10. Pharmaco-
kinetics; ll. Dosage regimens; 12. Factors affecting

drug response I, II; 13. Review: Application of principles
to drug use; 14. The autonomic nervous system and reflexes;
15. Chemical neurotransmission-Acetylcholine; 16. Norepine-
phrine; l7. Adrenergic drugs; 18. Adrenergic drugs -

CNS. 19. Adrenergic Blockade I and II; 20. Cholinesterase
and anticholinesterase drugs; 21. Cholinergic blockade;

22. Ganglionic blockade; 23. Neuromuscular junction;

24. Muscle relaxants; 25. Drug allergy; 26. Review

of electrophysiological properties of cardiac tissue I and
II; 27. Cardiac glycosides and congestive heart failure;
28. Antiarrythmic agents I and II; 29. Ischemic heart
disease and anti-anginal drugs; 30. Vasodilators; 31.
Antihypertensive drugs; 32. Diuretics I, II and III; 33.

Antiasthmatic drugs; 34. GIT drugs.

159

160

Medical Pharmacology II

1. Introduction to CNS drugs; 2. Local anesthetics;

3. Pain/analgesia; 4. Narcotic analgesics I and II;

5. Alcohols; 6. Sedative Hypnotics; 7. Principles of
general anesthetics; 8. General anesthetics I and II;

9. Aspirin and related analgesics; 10. Non-steroid anti-
inflammatory drugs. 11. Anti-inflammatory steroids; 12.
CNS stimulants; l3. Anticonvulsants; 14. Psychoactive
drugs; 15. Neuroleptics; l6. Antidepressants; 17. Anti-
anxiety drugs; 18. Drug abuse I and II; 19. Insulin;

20. Thyroid; 21. Oral contraception; 22. Autacoids;

23. Histamines, antihistamines; 24. Introduction of Anti-
microbials; 25. Antimicrobials I, II, III and IV; 26.
Cancer Chemotherapy I, II and III; 27. Anti-viral Chemo-

therapy; 28. Toxicology I, II, III and IV.

Appendix B2

University of Michigan

Fall Term

1. Introduction; 2. Dose/response Relationships; 3. Drug
disposition I and II; 4. Drug metabolism I and II; 5.
Pharmacokinetics I, II and III; 6. Cholinesterase Inhibi—
tors; 7. Neuromuscular blocking drugs; 8. Histamine

and antihistaminics; 9. Serotonin; 10. Adrenergic drugs
I, II and III; 11. Adrenergic blocking drugs I and II;

12. Muscarinic drugs; 13. Muscarinic blocking drugs;

14. Human pharmacology of Nicotine; 15. Autonomic drugs
and the eye; 16. Antibiotics I, II, III, IV, V, VI and
VII. 17. G.A.I.; 18. Chemotherapy of parasitic disease;
19. G.A.II; 20. Barbiturates (NBS); 21. Isotopes;

22. Cancer chemotherapy I, II, III and IV; 23. Benzodia—
zephines (NBS); 24. Cancer Chemotherapy; 25. Local anes-
thetics; 26. AntiParkinson drugs; 27. Anticonvulsants;

28. Psychomotor stimulants.

Winter Term

1. Narcotic analgesics I and II; 2. Clinical cancer chemo-
therapy; 3. Digitalis I and II; 4. Antiarrythmics I
and II; 5. Anterior Pituitary control; 9. Antipsychotic

drugs I and II; 10. Adrenal cortical steroids I and II;

161

162

ll. Insulin; 12. Oral hypoglycemics; l3. Adrenal cortical
steroidsIII; l4. Affective disorders I and II. 15. Thyroid
drugs; 16. Antithyroid drugs; 17. Antianginal drugs

I and II. 18. Prostaglandins; l9. Antiplatelet drugs;

20. Anticoagulants; 21. Oxytocics; 22. Sudden Cardiac
death; 23. Diuretics I and II; 24. Antihypertensive

drugs I and II; 25. Non-narcotic analygesics I and II;

26. Gout and hyperuricemia; 27. Drugs in chronic obstruc—
tive pulmonary disease I and II; 28. Peptic ulceration

I and II; 29. GIT drug; 30. Antihyperlipidemic drugs;

31. Radioisotopes; 32. Vitamins; 33. Pharmacogenetics

I and II; 34. Drug Interactions I and II; 35. Blood

and blood organs I and II; 36. Oxygen therapy; 37. Estro-
gens; 38. Progestins; 39. Androgens; 40. Toxicology -
Gases and solvents; 41. Toxicology - heavy metals; 42.
Chemical carcinogenesis; 43. OTC drugs; 44. Prescription

writing.

Appendix B3

Wayne State University

General Pharmacology (Module 1)

 

I. Introduction: Definitions of pharmacology, pharmaco-
dynamics, pharmacokinetics. II. Pharmacodynamics: Mecha-
nisms of drug action at cellular level A. Receptors and
cell membranes; B. Dose-response curves (graded); C.
Structure activity relationships. III. Pharmacokinetics:

A qualitative treatment of the factors determining the con-
centration of drug at the active site. A. Transport (per-
meation) through membranes, ion tapping. B. Absorption
routes of administration. C. Distribution. D. Excretion.
IV. Drug Metabolism: A. Biochemistry of drug metabolism.
B. Control of drug metabolism. V. Pharmacokinetics:

A quantitative approach. VI. Factors modifying drug action
and response. A. size, age, sex, disease, genetic factors
etc. B. Drug interactions. Additivity, supradditivity,
potentiation, synergism, plasma protein binding effects.
VII. Population (quantal) dose-response curves EDSO’ LDSO'
Certain Safety Factor, Therapeutic Index. VIII. Drug serum
levels and the therapeutic effect. Reference materials

for future use. IX. Appendix on Pharmacokinetics - problems.

X. Core concepts on II, III, VI, VII and VIII.

163

164

Cholinergic Pharmacology (Module 2)

I. Cholinergic transmission. A. Synthesis of Ach. B.
Release of Ach. C. Cholinergic Receptors. l. muscarinic,
2. nicotinic. D. Metabolism of Ach. II. Mechanisms of
action of cholinergic agents. III. Effects of cholinergic
agents on muscarinic receptors. A. Organ sites and effects;
B. Direct acting cholinergic agonists; C. Cholinerterase
inhibition; 1. mechanism of action and general effects,

2. Anticholine - sterase agents: reversible, irreversible;
D. Muscarinic antagonists. IV. Nicotinic blocking agents
on the neuromuscular juntion; A. Mechanism of action; B.
Competitive antagonism; C. Agonist depolarizing blockade.
V. Miscellaneous sketal muscle relaxant. VI. Ganglionic

transmission and blockade.

Adrenergic Pharmacology (Module 3)

 

1. Synthesis of catecholamines. 2. Storage of catechola-
mines. 3. Release of catecholamines. A. Normal exocytosis;
B. Indirect acting adrenergic drugs; 4. Fate of catechola-
mines; A. re-uptake, uptake; B. metabolism; 5. Drugs
which influence NE synthesis, storage, release and metabolism;
A. Synthesis; B. Storage; C. Release; D. Metabolism;

6. Adrenergic receptors; A. receptor classification;

B. Agonists and their pharmacologic properties; C. Antago—
nists and their pharmacologic properties; D. Mechanisms

of receptor—effector coupling.

 

I65

Behavioral Pharmacology (Module 4)

A. Introduction: objectives, directions for study, key
drugs, definitions of some psychiatric terms. 1. Biologi-
cal basis of behavior; 2. Perception of the real world;

3. Arousal states; 4. Subsystems which modulate states

of arousal; 5. Neurophysiological substrates of mood;

6. A neurochemical basis for mind; 7. The pharmacology

of behavior; 8. Neurohumoral theories of behavioral diseases;
9. Key concepts; 10. A note of caution. B. Antidepres-
sant and antimania drugs; 1. Tricyclic antidepressants;

2. Monoamine oxidase inhibitors; 3. Lithium carbonate.

C. Neuroleptics (major tranquilizers, antipsychotic drugs);
1. substituted phenothiazines; 2. Butyrophenomes; 3.
Ranwolfia alkaloids; 4. Pharmacology of extrapyramidal
symptoms. D. Ansciolytic drugs; 1. "Sedative" Phenothiazine
tranquilizers; 2. Substituted propanediols; 3. Benzodia-

zepines; 4. Methylmethanol.

Analgesia-Antiinflammatory (Module 5)

I. General anesthesia; A. General characteristics and
mechanism of action; B. Inhalation anesthetics; 1. Dis-
position of inhalation anesthetics; 2. Additional proper-
ties of inhalation anesthetics: skeletal muscle relaxation,
analgesia, respiration, Cardiovascular, Hepatotoxicity,
Nephrotoxicity, Flammability and explosiveness. 3. Proper-

ties of individual agents: nitrous oxide, ethes, halogenated

166

hydrocarbons: halothane, methoxythurane, enflurane. C.
Barbiturates. 1. Structure activity relationships and
mechanism of action; 2. Characteristics of barbiturate
anesthesia; 3. Characteristics of barbiturates as sedative
hyperotics; 4. In vivo disposition: absorption, distribu-
tion, metabolism and excretion; 5. Side effects and contrain-
dications. D. Ketamine and phencyclidine. E. Preanesthetic
medication. F. Other sedative — hypnotics: chloral hydrate
and paraledhyde, glutethimide (Doriden) methoqualone (Quaalude).
G. Physical dependence and tolerance. H. Alcohol. II.
Local anesthetics: A. Mechanism of action. B. Structural
characteristics and related properties concerning mechanism.
C. Achieving selectivity; 1. Differential sensitivity of
nerve fibres; 2. Selectivity by local application; D. Meta-
bolism; E. Effects on organ system: CNS, cardiovascular,

respiration, muscle, allergies.

The Pharmacology of Pain (Module 6)

I. Pain: sensation and reaction; anatomical and physiologi-
cal correlates of the dual phenomenon. A. The nociceptor
(pain receptor) a specific sensory apparatus for algesic
(painful)stimuli; B. Chemical mediators of inflammation

and pain; C. Conduction of pain information in the CNS;

D. Central modulationof pain input; gate control hypothesis.

II. Opiate analgesics: A. Morphine — the prototype of

 

167

this class, Chemical structure; requirements for binding

to an opiate receptor; Bioavailability: absorption, distri—
bution, inactivation and excretion; Analgesia, CNS effects
(mood, attention etc); Respiratory depression, emesis; stimula—
tion of the CTZ, antitussive action, miosis, cardiovascular
effects, spasmogenesis of visceral smooth muscle, water reten-
sion. Suppression of adrenocorticoids and sex steroids;

B. Opiate receptors and endorphins; C. Opiates for special
use; D. Interactions of opiates with other drugs; E.

Acute opiate intoxication (overdose); F. Phenomena of toler-
ance and dependence; 1. Tolerance to opiates; 2. Physical
dependence; 3. Psychological dependence; 4. Cross tolerance
and cross dependence; G. Narcotic antagonists; a hetero-
geneous class; 1. Partial agonist (pentazocine); 2. Mixed
antagonist (narlophine); 3. Pure antagonist (naloxone,
naltrexone); H. Use, Misuse and Abuse of narcotics. I.
Antipyretic, antiinflammatory analgesics; l. Salicylates
(aspirin - acetylsalicylate) Bioavailability: absorpition,
distribution, inactivation, excretion; Analgesia; Antipyresis;
Antiinflammatory effect; Metabolic actions; Respiratory stimula-
tion and depression; Acid-base imbalance; Prolongation of

blood coagulation; Gastric irritation; Hypersensitivity reac-
tions; Acute and chronic intoxication; 2. Acetaminophen

and phenacetin; 3. Phenylbutazone; 4. Indomethacin;

5. Iboprufen and other new NSAID; 6. Corticosteroids.

168

Antibacterial Chemotherapy (Module 7)

Penicillins, Cephalosporins, tetracyclines, aminoglycosides,

others, anti—folates, Antiviral agents, Antifungal agents.

Cancer Chemotherapy (Module 8)

Appendix B4
University of Cape Town

Second Year: Introductory Pharmacology; The autonomic ner-
vous system in the "consensus partium"; Functional and Struc-
tural arrangements of the autonomic nervous system: dual
innervation of organs, parasympathetic characteristics, sym-
pathetic characteristics, central nervous connections, organi-
zational features of the peripheral component of the auto-
nomic nervous system; General Principles of Neurohumoral
Transmission; Cholinergic Neurotransmission: synthesis and
structure of acetylcholine, conceptualization of the choliner-
gic receptor (muscarinic), the termination of acetylcholine
action (acetylcholine sterase), the mechanism of action of
acetylcholine at the cholinergic receptor (muscarinic), nico-
tinic and muscarinic receptor differences, and location;
Physiological effects of cholinergic stimulation and over-
stimulation; Acetylcholine Congeners: structural require-
ments for cholinergic receptor agonist, common characteris-
tics of pharmacologically active acetylcholine cangeners,
methacholine chloride, bethanechol chloride, carbanyl chloride,
pilocarpine, muscarine poisoning (Inocybe); Anticholinergic
Agents: atropine, scopolamine, others; pharmacological uses
of atropine and its congeners, atropine toxicity. Anticho-
linesterase Agents: steps involved in the hydrolysis of

acetylcholine, mechanisms of inhibition of acetylcholinesterase,

169

170

anticholinesterases (reversible, irreversible), therapeutic

use of anticholinesterase drugs, organiophosphorus poisoning
(acute effects, chronic effects, principles of management)
Sympathetic Neurotransmission: the synthesis and release

of adrenergic neurotransmitters, catecholamine biosynthesis,
ontogeny of the adrenergic nerve, electron microscopic studies,
factors influencing the release of noradrenaline from adrener-
gic nerve terminals; The fate of the Released Adrenergic
Neurotransmitter: uptake I and II, catechol o-methyl trans-
ferase, monoamine oxidase; Adrenergic Receptors: structure
activity relationships of the catecholamines, historical
evolution of the adrenergic receptor concept, alpha-receptor
agonist and their pharmacological effects, beta-receptor
agonists and their effects, a profile of adrenergic receptors
(d5 Bflfg. ) Pharmacological Effects of Sympathomimetic agents:
direct-acting sympathomimetic agents, indirect-acting sympatho-
mimetic agents, therapeutic uses of sympathomimetic agents,
profiles of adrenaline, noradrenaline, dopamine, dobutamine,
ephedrine, isoprenaline, salbutamol, terbutaline, amphetamine.
Adrenergic-Receptor Blocking Agents: alpha-blocking agents,
beta—blocking agents (consequences of beta-receptor blockade,
the development of the beta-blockers; structural characteris-
tics of beta-blockers, pharmacological properties of beta-
blockers, pharmacokinetics of propranolol, clinical indications
for the use of beta—blockers, side-effects of beta-blockers,
and special precautions. Future Avenues for Research in

the Study of the Autonomic Nervous System.

171

Third Year: Principles of Pharmacology (lecture course);

1. Introduction: definitions (Pharmacology, Therapeutics
etc.), historical overview, pharmacology as an interdisciplinary
subject in the medical school, pharmacology and modern medical
education, stages in the development and testing of medicines
today, scientific, social and economic aspects of pharmaco—
logy, the objectives of this course. 2. Absorption of Drugs:
bioavailability, membrane transport of drugs (microanatomical
characteristics of the cell membrane, drug transport mechanisms,
factors influencing drug passage across membranes), kinetics
of drug absorption, routes of drug administration, principles
of zero-order and first order kinetics. 3. The Distribution
of Drugs After Administration: compartment modeals (single
compartment model, two compartment model, three compartment
model, and other compartment models), volume of distribution,
the kinetics of a single intravenous dose of a drug, factors
influencing the distribution of a drug (physicochemical pro-
perties of the drug itself, physiological factors), the effect
of disease on drug distribution, drug—protein binding, and

the effects of drug-drug interaction on protein binding of
drugs, drug distribution to special tissues (the passage

of drugs into the central nervous system, the passage of

drugs across the placenta, Drug kinetics in the maternal-
placental-fetal unit, drugs and breast milk). 4. Biotrans-
formation of drugs: consequences of biotransformation of

drugs (biological significance), biotransformation reactions

172

(non—synthetic reactions, synthetic reactions), the hepatic
microsomal drug—metabolizing system (physiology: particular
erference to cytochrome P450, factors influencing drug meta-
bolism by microsomal enzymes-species differences, hormonal,
age, nutritional, genetic, disease processes), introduction

of microsomal enzymes (clinical significance of enzyme induc-
tion, inhibition of enzyme induction), non—microsomal drug
biotransformation. 5. Drug Elimination: renal excretion,
plasma clearance of drugs (factors influencing plasma clearances),
elimination kinetics, extracorporeal dialysis and drug removal
from the body, biliary excretion of drugs, drug accumulation
and toxicity. 6. Drug Receptor Interactions and molecular
pharmacology: the Ferguson principle, characteristics of
"structurally-specific" drugs, structurally "non-specific"
drugs, the nature of drug receptors, theories of drug action
(the occupancy theory, rate theory, induce fit theory, macro-
molecular perturbation theory), the dose-response curve,

space receptors, the Clark-Ariens—Stephenson model, conse-
quences of drug-receptor binding, stereochemical aspects

of drug-receptor interactions. 7. The Relationship Between
Therapeutic Effect and Toxic Effect of Drugs: therapeutic
margin, safety margin, time-effect relations and drug toxi—
city, principles of counteracting toxic effects of drugs.

8. Interactions Between Drugs in the Pharmacodynamic Phase:
synergism, potentiation, competitive inhibition, non-competitive

inhibition, antagonism (functional antagonism, "surmountable"

173

antagonism, "insurmountable antagonism, the molecular basis
of antagonism). 9. Tisue Sensitivity to Drugs in Disease

states. 10. Tolerance to Drugs, and Physical Dependence:

definitions, interrelationships between tolerance, physical
dependence and compulsive drug abuse, delirium tremens —

"withdrawal syndrome," morphine tolerance and

an example of
addiction, tachyphylaxis, theories as to mechanisms of drug

tolerance.

Fourth year: Applied Pharmacology and Therapeutics: Local

 

and General anesthetics, Muscle Relaxants, Narcotic Analge-
sics, Non-Steroidal Antiinflammatories, Diuretics, Antihyper-
tensives, Antiarrythmic Agents, Antianginal Agents, Drugs

used in Gastrointestinal Disorders, Drug Treatment of Asthma,
Drugs used in the Treatment of Gout, Endocrine Drugs, Anti-
convulsants, Anti—Parkinsonian Treatments, Tranquilizers,
Hyponotics, Stimulants, Neuroleptics, Antidepressants, Drug
Compliance, Principles of Clinical Pharmacokinetics. Fourth
Year Block: 1. Principles of Drug Selection for Certain
Common Diseases such as Cardiac failure, Hypertension, Dia-
betes Mellitus, Meningitis and Pneumonia. 2. Important

Causes of Primary and Secondary Treatment Failure. 3. The
Principle of Diagnosis and Management of Acute Poisoning.

4. The Principles of Clinical Trial Design and Ethical Medico-
legal, Community and Administrative Issues of Drug Therapy.

5. Doctor-Patient Communication in Prescribing. 6. Introduc-
tion to research Models in Pharmacology. &. Visit to Hospital

Pharmacy.

174

Fifth Year: Applied Pharmacology and Therapeutics: 1.

The Principles underlying the Treatment of Common Illnesses.

2. Drugs in Common Use — With Special Reference to Safety
Issues, Risk—Benefit Assessment and Cost-Benefit Assessment

in Practice. 3. Consideration of Patients at Special Risk

of drug Injury. 4. Drug Injuries in Practice, and Their
Diagnosis, Prevention, and Management. 5. Clinical Trials

and Claims Made for Therapy: design of studies, common causes
of bias, ethical issues, statistical methods commonly used;
relevance for the medical practitioner, and evaluation of
claims. 6. The Registration and Control of Medicines in

South Africa, economic issues, and the cost of various medi—
cines in the private and public sectors, ethical responsibi-
lities in drug prescribing and therapy. 7. Toxicology:

acute and chronic drug poisoning and its management, venomo—
logy, environmental and radiation hazards. 8. Non-traditional
(complementary) forms of treatment of disease e.g. acupuncture,

faith-healing, homeopathy, African tribal medical practices.

Appendix B5

MEDUNSA

Third Year: Introductory lectures on general aspects of
pharmacology, principles of pharmacokinetics and pharmacodyna—
mics, Drug development and legislation, Autonomic pharmaco-

logy and principles of oxicology. Lectures in the co-ordinated
system of teaching deal with pharmacological aspects of growth
and development, Nutrition, Fluid and base balance, the respira-
tory system, the cardiovascular system, immunopharmacology,
infections and infestations, the nervous system. Practical
exercises are on the principles of analytical pharmacology,
animal tests, clinical trials. Seminars in small groups

are held on selected topics.

Fourth Year: Lectures within the co—ordinated system on
pharmacological aspects of reproduction, genetics, the gastro—
intestinal system, the hepatobiliary system, the genitourinary
system, psychiatric and psychosomatic conditions, the muscu-
loskeletal system, environmental problems, Endocrine condi-
tions, metabolic conditions, the skin and mucus membranes,

blood and lymph.

Fifth Year: Lectures within the co-ordinated system on the
pharmacological aspects of ophthalmology, ear-nose and throat

conditions, anesthesiology, trauma, multisystem diseases

175

176

e.g. neoplasia, collagen disease, poisoning. Lectures on
practical aspects such as risk-benefit assessments, keeping
up to date, assessing the literature, emergency treatment.
Ward rounds on patients with therapeutic problems. Seminars

on selected topics.

Appendix B6
University of Natal

Topics covered are Introduction, General Principles: Pharmaco-
kinetics and Pharmacodynamics, Autonomic Pharmacology, Hypno—
tics, Sedatives and Tranquilizers, Anticonvulsants, Antide-
pressants, Steroids — Corticosteroids, Contraceptives, Dia—
betes, Thyroid, Pituitary, Hormones, neuromuscular Blockers,
Antibiotics, Tuberculosis, Malaria, Parasites, Antifungal

and Antiviral agents, Antiseptics, Cytotoxic Agents, Asthma,
Cardiac Glycosides, Diuretics, Gout, Antihypertensives, Antiar-
rythmias, Angina, P.V.D., Parkinsonism, Antihistamines, Anti-
emetics, Cough therapy, Diarrhoea, Ulcer therapy, Constipa—
tion, Ergot alkaloids, Vitamins, Hematinics, Appetite supres-
sants, Non-narcotic analgesics, Narcotic analgesics, Calcium
and Parathyroid, Hyperlipidemias, Anticoagulants, Drug Inter—
actions, Teratology, Adverse Drug Reactions, Clinical Trials,
Pharmacogenetics, Drugs Acting on Enzymes, Drug Regulations,

Toxicology, Anesthetics.

177

 

Appendix B7.l

University of the Orange Free State
Syllabus for M.B.Ch.B.

Topics covered are General principles and Definitions, Mole-
cular Pharmacology and Pharmacokinetics, Drugs which affect
the Nervous System: central, autonomic, peripheral; Anti-
inflamatory and Antiallergic Drugs, Cardiovascular Pharmaco-
logy, Pulmonary Pharmacology, Renal Pharmacology, Hormonal
Pharmacology, Vitamins, Drugs and the Alimentary Canal, Anti-
microbes, Antiprotozoan, Antiparasitic Drugs, Cytostatics,

Principles of Human Poisoning and Treatment thereof.

Appendix B7.2
Syllabus for Diploma in Nursing

General pharmacology principles, Drugs affecting the Nervous
system: central nervous system and autonomic nervous system.
Cardiovascular pharmacology, Pulmonary pharmacology, Renal
pharmacology; Drugs and the GIT, Antimicrobial drugs, Hormonal

pharmacology, Toxicology.

178

 

Appendix B8

University of Pretoria

Topics covered are The Birth of a Drug; Quartenary and Terti-
ary Ammonium Compounds; Receptors; Antagonisms; those involv-
ing same receptors (antihistamines at histamine receptors),
those acting on different receptors, biochemical; Structure
Activity Relationships of sympathomimetics and Sympatholytics;
Cardiotonic Drugs; "Glolinerge" Drugs; Anticholinergic Drugs;
Histaminergic Receptors; Serotoninergic Receptors; Drugs

for Anaphylaxis; Drugs for Bronchial Asthma; Drugs for Hyper-
tension; Dopaminergic Receptors; Smooth Muscles: Spasmolytics
(papaverine, camilofen) Drugs for angina pectoris (nitrate,
adenosine deamination suppressants and perhexylin) Tone raisers
(ergot preparations for migraine and labor), Neurohypophysis
Hormones (oxytocin and vassopressin for labor and diabetes
insipidus), Prostaglandins etc. Analgesics: narcotics,
non-narcotics; Drugs for gout; Drugs for the GIT; Antimicrobic
Drugs; Local Anesthetics; General Anesthetics; Psychotropic
Drugs; Hormones; Diuretics and the Kidney; Anticoagulants,
thrombolytic drugs and hemostatics; Drugs for arrythmias;
Vitamins and Hematinics Cytostatics; Legal Aspects of Control
and Divisions into schedules; Prescriptions, their Require—
ments; General Pharmacology: Nature of biological membranes,
absorption of drugs, distribution of drugs, biotransformation,

excretion, drug interaction; Treatment of acute poisoning.

179

180

At the Department of Internal Medicine, the topics covered

are the Chemotherapy of metazoan and protozoan infections;

The Chemotherapy of meningitis and pneumonia; A pharmacological
approach to the treatment of hypertension; Digitalis and

the treatment of heart failure; Antiarrythmic Drugs; The
Kinetics of Anticonvulsant Drugs; Analgesics, Antiinflammatory
and uricosuric drugs; Prescriptions and examples of incorrect

USE.

Appendix B9
University of Stellenbosch

Areas covered are: l. The broad spectrum of pain killing;

2. The beta-adrenergic blocking agents; 3. Cardiovascular
pharmacology; 4. Pharmacology of angina; 5. Local anesthe-
tics; 6. Local Hormones (antacoids); 7. Drugs and the

GIT; 8. Narcotic analgesics: the opiates; 9. Lipid lower-
ing drugs; 10. Central control of muscle activity: Drugs
for Parkinson's and epilepsy; 11. The principles of Toxicity;
Antidotes; 12. The Pharmacology of the Antiarrythmic drugs;
13. Pharmacokinetic profiles; 14. The Non-steroid Anti-
inflammatory Analygesics, the antiphyretic analgesics; 15.
The Urinary Antiseptics; 16. Drugs for hypertension; 17.
General Principles of Antimicrobial Chemotherapy Influence

on the drug (Pharmacokinetics); 18 Antimicrobials for Tuber-
culosis; 19. The possible adverse effects which antibiotics
can cause on the host of the microorganism; 20. Chemotherapy
of infections: General Principles; 21. Pharmacology of

the central nervous system; 22. Insulin Preparations and
oral antidiabetics; 23. Iodine Metabolism and Antithyroid
Drugs; 24. Diuretics; 25. Drugs influencing Fe-metabolism
and coagulation; 26. Drug interactions; 27. Pharmacology
of the Peripheral Nervous System; 28. The Pharmacological
Aspects of Sex Hormones; 29. Thyroid Preparations and Anti-
thyroid substances; 30. Pharmacology of Natural and Synthetic

Steroids.

181

Appendix B10

University of the Witwatersrand

Third Year

1. Introduction; 2. Absorption and distribution; 3.
Metabolism and excretion; 4. Receptor theory and dose response
relationships; 5. Cholinergic pharmacology I, II and III;

6. Adrenergic pharmacology I and II; 7. Selective toxicity
and sulphonamides I; 8. Sulphonamides II and Trimethoprim;

9. Penicillins; lO. Cephalosporins; ll. Chloramphenicol/
Aminoglycosides; 12. Nacrolides, tetracyclines and miscel-
laneous antibiotics; 13. Anticonvulsants; 14. Analgesics

I, II, III and IV; 15. General anesthetics.

Fourth Year

1. Antifungal agents; 2. Antiviral agents; 3. Antimalarial
agents; 4. Antiamoebic and antibilharzials; 5. Anthelmin-
tics; 6. Diuretics I, II; 7. Drugs for hypertension I,

II; 8. Cardiac glycosides; 9. Antidysrhythmic agents;

10. Drugs for asthma; 11. Therapy for upper GIT disorders
I; 12. Treatment for Tuberculosis; 13. Laxatives and
anti-diarrhoels; 14. Major tranquilizers and antidepres-
sants; 15. Local anesthetics; l6. Hepatotoxic effects

of drugs; 17. Treatment of poisoning; 18. Drug dosage

in children; 19. Therapy of upper GIT disorders II; 20.

Pharmacology of pregnancy and the neonate; 21. Oxytocics;

182

 

183

22. Anti-diabetic drugs; 23. Anti-thyroid drugs; 24.
Prostaglandins; 25. Adrenal Steroids; 26. Oral contra—
ceptives and fertility drugs; 27. Heavy metals and chelating
agents; 28. Cytostatics I, II; 29. Immunosuppression;

30. Antiemetics; 31. Renal excretion of drugs; 32. Pharma-
cology of K+; 33. Treatment of urinary tract infections;

34. Drug treatment in chronic renal failures; 35. Drug

dependence; 36. Drug legislation and prescription writing.

 

Appendix B11
8. PHARH - PHARMACOLOGY COURSE (University of Cape Town)

 

The Pharmacology course runs over 3 years (2nd, 3rd and 4th years).

2nd Year

Pharmacy students join the 2nd year Medical students for an introductory
course in Pharmacology. (20 lectures). This covers principles of
pharmacology including pharmacokinetics and pharmacodynamics, and also an
introduction to the pharmacology of the autonomic nervous system.

 

3rd Year

Lectures: 1100 lectures.

10 lectures covering further principles.

Systematic pharmacology (:90 lectures): This covers pharmacology of the
autonomic and central nervous system and neuromuscular junction, drugs
acting on the gastrointestinal, respiratory, cardiovascular, and urinary
systems, and drug treatment of pain, inflammation and fever. '

Practicals

Twenty 3 hour practicals involving experiments on absorption, distribution,
metabolism, excretion and toxic effects of drugs: competitive and non-
competitive antagonism and competitive dualism; the effect of pH on local
anaesthetic activity; the effects of drugs on cardiac, skeletal and smooth
muscle: and miniprojects studying drugs affecting the cardiovascular,
respiratory, endocrine, renal and central nervous system.

4th Year

(Course still under review. The first 4th year group commence in 1984).

This will involve further systematic pharmacology and applied pharmacology.

It is envisaged that practicals will be in the farm of clinical demonstrations
and hospital visits.

184

 

Appendix B12.l

UNIVERSITY OF THE WITWATERSRAND

DEPARTMENT OF EXPERIMENTAL AND CLINICAL PHARMACOLOGY

I
THIRD YEAR MBBCh and THIRD YEAR BDS - PHARMACOLOGY LECTURES - 1984

 

VENUE - LECTURE THEATRE 2, LEVEL US, MEDICAL SCHOOL

DATE

February

Tues 7
Tues 14
Tues 21
Tues 28

March

Tues 6
Tues 13
Tues 20
Tues 27

April
Tues 24

Tues

Tues 8
Tues 15
Tues 22
Tues 29

June

 

Tues 5

Tues 12

Tues 19

TIME

OQhOO
OQhOO
OQhOO
OQhOO

OQhOO
OQhOO
OQhOO
OQhOO

OQhOO

OQhOO
OQhOO
OQhOO
OQhOO
OQhOO

OQhOO
09hOO

OQhOO

OShOO
OQhOO

OQhOO
OQhOO
OQhOO

LECTURE LECTURER
Introduction Prof. K.I. Furman
Absorption and distribution Dr G. Galasko
Metabolism and Excretion Dr G. Galasko
Receptor theory and dose response
relationships Dr G. Galasko
Cholinergic pharmacology I Dr G. Galasko
Cholinergic pharmacology II Dr G. Galasko
Cholinergic pharmacology III Dr G. Galasko
Adrenergic pharmacology I Dr G. Galasko
Adrenergic pharmacology 11 Dr G. Galasko
Selective toxicity and Sulphonamides I Prof. J. Kriel
Sulphonamides II and Trimethoprim Prof. J. Kriel
Penicillins -Prof. J. Kriel
Cephalosporins Prat. J. Kriel
*rChloramphenicol Dr G. Galasko
Aminoglycosides
Macrolides. Tetracyclines and
Miscellaneous antibotics Dr G. Gslasko
Sedatives, hypnotics and minor
tranquillizers Dr E. Sachs
Anti-convulsants Dr E. Sachs
Analgesics I Prof. K.I. Furman
Analgesics 11 Prof. K.I. Furman
Analgesics III Prof. K.I. Furman
Analgesics IV Prof. K.I. Furman
General Anaesthetics Dr G. Galasko

10:

Appendix B

DEPARTMENT OF EXPERIMENTAL AND CLINICAL PHARMACOLOGY

MBBCh IV LECTURES IN PHARMACOLOGY - 1984

Lecture Theatre THREE, Level U5, Medical School

 

 

Venue

Date Time Lecture

Januar

Tues 10 thOO Antifungal agents

Tues 17 12h00 Antiviral agents

Tues 24 12h00 Anti-malarials

Tues 31 12h00 Anti-amoebic and anti-bilharzials

'February

Tues 7 12h00 Anthelmintics

Tues 21 thOO Diuretics

Tues 28 12h00 Diuretics

are:

Fri 2 14h00 Drugs used in the treatment of
hypertension

Tues 6 thOO Hypertension II

Tues 13 thOO Cardiac glycosides

Tues 20 12h00 Anti-dysrhythmic agents

Tues 27 12h00 Drugs for Asthma

59:2

Tues 3 thOO Therapy of upper GIT disorders I.

Mon 9 12h00 Treatment of TB

Mon 16 thOO Laxatives & anti—diarrhoeals

Tues 17 12h00 ' Major tranquillizers & anti-depressants

May

Tues 8 thOO Local anaesthetics

Mon l4 lGhOO Hepatotoxic effects of drugs

Tues 15 12hOO Treatment of poisoning

Tues 22 thOO Drug dosage in children

2186

Lecturer

Prof
Prof
Prof

Prof

Prof
Prof

Prof

Prof
Prof
Prof
Prof

Dr E

Dr 3
Prof
Dr E

Prof

Dr G
Dr E
Dr P

Dr P

/2.....

Sachs

Sachs
K I Furman
Sachs

K I Furman

Galasko
Sachs
Catzel

Catzel.

 

MBBCh IV

2253
’19.!
Mon‘ 28
Tues 29
gggéii
Tues“ 5
Wed 6
Mon 11
Tues 19
Tues 26
Thurs 28

Fri 29

Tues 24
Tues 31
asses

Tues 14
Tues 21

Tues 28

September

Tues 4
Tues 11
Tues 18

Wed 26

October
Tues 2

Tues 9

Time

12hOO

.12hOO

12hOO

thOO

thOO

12hOO

12hOO

14hOO

lShOO

thOO

12hOO

thOO

21hOO

thOO

12hOO
thOO
14hOO

thOO

12hOO

IZhOO

Appgndix B12.3

Lecture

Therapy of upper GIT disorders II

Pharmacology of pregnancy and neonate

Oxytocics
Anti-diabetic drugs
Anti-thyroid drugs
Prostaglandins
T E S T

Adrenal steroids

Oral contraceptives and fertility
drugs

Heavy metals and chelating agents

Cytostatics I

Cytostatics II
Immunosuppression

Anti-emetics

Renal excretion of drugs
Pharmacology of K+
Treatment of urinary tract infections

\

Drug treatment in chronic renal
failure

Drug dependence

Drug legislation and prescription
writing ” " '

187

Lecturer

Dr E Sachs

Dr P Catzel

Dr G Galasko
Dr G Galasko
Dr G Galasko
Dr G Galasko
Dr G Galasko
Dr G Galasko

Prof K I Furman

Prof K I Furman

Prof K I Furman
Prof K I Furman

Dr E Sachs

Dr G Galaako
Prof K I Furman

Prof K I Furman

Prof K I Furman

Prof K I Furman

Prof K I Furman

 

Appendix B13.1

UNIVERSITY OF THE UITWATERSRAND

DEPARTMENT OF EXPERIMENTAL AND CLINICAL PHARMACOLOGY

 

B.PHARM III - LECTURES IN PHARMACOLOGY 1984

Venue

Date

February

Mon

Thurs

Mon

Thurs

March

Thurs

Mon

Thurs

Mon

Thurs

Mon

Thurs

Mon

Thurs

13

15

20

23

12

15

19

22

26

29

Seminar Room 3 -

Time

OBhOO
09h30

OShOO

09hOO

08hOO)
)
OQhOO)

OBhOO)
09h001

08hOO
09h00

osnoo)
osnooi
osnoo)
osnooi
osnoo
09h00
oanoo
09hOO
OBhOO
osnoo
osnoo
osnoo)
08hOO
OQhOOi
oshoo)
oshooi

Lecture

8AO4 Department of Pharmacology, Medical School.

Lecturer

Introduction Dr G Galasko

Physiological membranes and drug

management. Mrs I Roper
Degree of ionisation and Henderson-

Hasselbalch equation Dr G Galasko
Routes of administration and

absorption Mrs I Roper

Distribution - blood-brain & placental
barrier sequestration; entero-hepatic Mrs I Roper
shunt; apparent Vd

Biotransformation and enzyme induction Dr G Galasko

Excretion Mrs I Roper
Half-life, die-away curves and
compartment models Mrs I Roper
Tutorial

‘\
T E S T
Definitions Mrs I Roper
Receptor theories Mrs I Roper
Discuss test Mrs I Roper
Phelix
Dose response curves Mrs I Roper

and principles

Tutorial

T E S T

Introduction to autonomic nervous system Mrs I Roper

1188

Date
am;
Mon 2
Thurs 5
Thurs 26
Mon 30
531
Thurs 3
Mon 7
Thurs 10
Mon 14
Tmmsl7
Mon 21
Thurs 24
Mon 28
June

Mon 4
Thurs 7
igly

Mon 23
Thurs 26

Time

osnoo
09h00
osnoo;
OQhOO)
osnoo;
OQhOO)
osnoo
osnoo

OBhOO
OShOOE
OBhOO)
OShOO
OBhOO}
OQhOO)
OBhOO
09hOO
OBhOO
09hOO
OBhOO
OQhOO
OBhOO
O9hOO
OBhOO;
OQhOO)

OBhOO)
OQhOOi
OShOO)
O9hOO

08hOO
09h00
OBhOO
OQhOO

Appendix B
- 2 -

13.2

Lecture

Discuss test
Cholinergics

Cholinergics

Adrenergic

Adrenergic

Peripheral dopaminergic

Tutorial ANS

T E S T

Introduction to CNS

Discuss test

Alcohol and disulfiram
General anaesthetics ,
Local anaesthetics
Benzodiazepines
Barbiturates
Anticonvulsants

Central muscle relaxants

Allergy and antihistamines

Tutorial

T E S T

Discuss test

Central dOpamine

Schizophrenia and major tranquillizers

Treatment of Parkinson's disease

Free I

2189

Lecturer

Dr G Galasko
Dr G Galasko

Mrs I Roper

Mrs I Roper
Mrs I Roper

Mrs I Roper

Dr E Sachs
Mrs I Roper
Mrs I Roper
Dr E Sachs
Dr E Sachs
Dr E Sachs
Mrs I Roper

‘

Mrs I Reper

Mrs I Roper
Mrs I Roper
Mrs I Roper
Mrs I Roper

August
Thurs 2

Mon 6

Thurs 9

Mon 13

Thurs l6

~Mon 20

Thurs 23

Mon 27

Thurs 30

September

Mon 3

Thurs 6

Mon 17

Time

OBhOO
09hOO

OBhOO;
OQhOO)

oanco
osnoo
osnoo
09h00)

OBhOO
OQhOO)
OBhOO
OQhOO

OBhOO
OQhOO
OBhOO}
09hOO)

08h00;

OQhOO)
OShOO
OQhOO

OBhOO;

OShOO)
OBhOO)
09h001

OBhOO)
OQhOO)

Appendix B13.3

- 3 -

assess

Vomiting and anti-emetics

Endorphins and enkephalins

Opioids

Prac II
Xanthines and anorexiants

Tutorial

Prac III

T E S T

Allergy and antihistamines
Ulcers and their treatment
Prac IV

Antidiarrhoeals and laxatives
Discuss test

Inflammation and non-steroidal anti-
inflammatories

Prac V

Non-narcotic analgesics

Drug toxicity
Pharmacogenetics

Prac VI

Anticoagulants and fibrinolytics

Tutorial
Prac VII

T E S T

19()

Lecturer

Dr E Sachs
Mrs I Roper

Mrs I Roper

Mrs I Roper
Mrs I Roper

Mrs I Roper
Dr E Sachs

Dr E Sachs

Mrs I Roper

Mrs I Roper

Date

 

September
Thurs 20

Mon 24

October

Mon 1

Time

OBhOO
09hOO
OBhOO)
OQhOO)

OBhOO)
09hOO

Appendix B13"4
- 4 -
Lecture

Discuss test

Revision/Phelix

Revision/Phelix

Revision/Phelix

(D

191.

Lecturer

Mrs I Roper
Mrs I Roper

Mrs I Roper

 

Appendix B14.1

DEPARTMENT OF EXPERIMENTAL AND CLINICAL PHARMACOLOGY

B. PHARM IV - LECTURES IN PHARMACOLOGY 1984

 

 

Venue Seminar Room 3 - 8AO4 Department of Pharmacology, Medical School.

2253 Time Lecture Eggpppgp

February

Wed 15 08h15 Autonomic Nervous System Revision I Dr G Galasko
09h30 V " " " II Dr G Galasko

Fri 17 08h15 " " " " 111 Mrs S M Doran
09h30 " " " " IV Mrs S M Doran

Wed 22 08h15 Cardiac Glycosides Mrs S M Doran
09h30 Inotropic Agents Mrs S M Doran

Fri 24 08h15 Anti dysrhythmic drugs I Mrs S M Doran
09h30 " " " II Mrs S M Doran

Wed 29 08h15 Anti-hypertensives I Dr E Sachs'
09h30 " " II Dr E Sachs

12222

Fri 2 08h15 Anti-anginal agents Mrs S M Doran
09h30 Calcium antagonists Mrs S M Doran

Wed 7 S P 0 R T S D A Y

Fri 08h15 Pharmacology of calcium, potassium

and other metals Mrs S M Doran

09h30 Immunosuppressive drugs Mrs S M Doran

Wed 14 08h15 Serum lipid lowering agents Mrs S M Doran
09h30 Antiseptics Mrs S M Doran

Fri 16 08h15 Tutorial
09h30 Tutorial

Wed 21 08h15 TEST Mrs S M Doran

Fri 23 08h15 Test Review Mrs S M Doran
09h30 " " Mrs S M Doran

Wed 28 08h15 Kinetics I Mrs S M Doran
09h30 Kinetics II (problems) Mrs S M Doran

Fri 30 08h15 Cytostatics I Mrs S M Doran
09h30 Cytostatics II Mrs S M Doran

53.1.1.

Wed 4 08h15 Drugs used in asthma and anti-tussives Dr E Sachs
09h30 Phelix

Wed 25 08h15 Treatment of Gout Dr E Sachs
09h30 " " " Dr E Sachs

Fri 27 08h15 Analgesic revision I Mrs S M Doran
09h30 " " II Mrs S M Doran

192

 

Date

August (cont)

Fri 10
Wed 15
Fri 17
Wed 22
Fri 24
Wed 29
Fri 31
September
Wed

Fri

Wed 19
Fri 21
Wed 26
October
Wed 3
Fri 5
Wed 10
ONWARDS

Time

08h15
09h30
08h15
09h30
08h15
09h30
08h15
09h30
08h15
09h30
08h15
09h30
08h15
09h30

08h15
08h15
09h30
08h15
09h30
08h15
09h30
08h15
09h30

08h15
09h30
08h15
08h15

Appendix B14 2

Lecture

Insulin
Oral anti-diabetic agents
Adrenocorticosteriods
Sex hormones
Antithyroid agents
Oxytocics
Phelix

n
Antifungal agents
Antiviral agents
Antituberculous agents
Antileprotic agents
Tutorial

T E S T

Test review

Test review
Antimalarials
Antibilharzial agents
Anthelmintics
Anti-amoebic agents

3rd year revision tutorial

Drug interactions

3rd year work REVISION TEST
Phelix and tutorials by arrangement

1193

Lecturer

Dr G Galasko
Dr G Galasko
Dr G Galasko
G Galasko
G Galasko
G Galasko

Dr
Dr
Dr

Mrs S M Doran
Mrs S M Doran
Dr E Sachs

Mrs S M Doran

irssssas
:2:::::““

Mrs

33

Doran
Doran
Doran
Doran
Doran
Doran
Doran
Doran

Doran

Doran

Doran

 

Date

2L3!
Wed 2
Fri 4
Wed 9
Fri 11
Wed 16
Fri 18
Wed 23
Fri 25
Wed 30
June

Wed 6
Fri 8
July

Wed 25
Fri 27
Augpst
Wed 1
Fri 3
Wed 8

Time

08h15
09h30
08h15
09h30
08h15
08h15
09h30
08h15
09h30
08h15
09h30
08h15
09h30
08h15
09h30
08h15
09h30

08h15
09h30
08h15
09h30

08h15
09h30
08h15
09h30

08h15
09h30
08h15
09h30
08h15
09h30

Appendix B14.3

Lecture

Pharmacogenetics I

" II
Tutorial

u
Student conference
TEST
n

Heavy metals
Poisons and antidotes
Anticoagulants

u
Haematinics
Vitamins
Antibiotic resistance
Specific toxicity
Sulphonamides Trimethaprim
Penicillins

Cephalosporins

Chloramphenicol & other antibiotics
Aminoglycosides

Tetracyclines & macrolides

TEST (Date to be arranged)

Drugs in neonate and pregnancy
Drugs in the aged
Prostaglandins

Revision anti-inflammatory drugs

Diuretics I
Diuretics II
Drugs in renal failure I
Drugs in renal failure II

Urinary excretion and pKa (revision)

194,

Lecturer

Mrs S M Doran
Mrs S M Doran

Mrs S M Doran
Mrs S M Doran
Mrs S M Doran
Mrs S M Doran
Mrs S M Doran
Mrs S M Doran
Mrs S M Doran
Mrs S M Doran
Mrs S M Doran
Mrs S M Doran
Prof J Kriel

Prof J Kriel

Prof J Kriel

Mrs S M Doran
Mrs S M Doran
Mrs S M Doran

Mrs S M Doran
Mrs S M Doran
Mrs S M Doran
Mrs S M Doran

Dr E Sachs

Dr E Sachs

Prof K I Furman
Prof K I Furman
Dr G Galasko

Dr G Galasko

 

V‘H

 

 

 

 

 

Appendix BISII FFPLXEB

,«

-(«hifixUlPS

L:rI~1110N

. ~’-— ---

The effect of the body on drugs (absorption, distribution, metabolism
and excretion).

PROCESSES INVOngp

2.1 ABSORPTION - Determined by nature of the drug (formulation,
fat-solubility, size of molecule) absorptive surface, nature of

membranes, blgod supply.

2.1.1 §ystemic administration

2.1.1.1 Enteral (Orallyl- Drugs absorped from the
‘ G. I. T. —. portal circulation —-+ liver—y systemic
circulation
2.1.1.2 Parenteral (directly into the systemic circula=
tion) eg. subcutaneous, intramuscular or
intravenous
2.1.2 L99 1 administration

 

Eg suppositories, nosedrOps, ointments, intra-thecal

administration
2.2 DISTRIBUTION - To have an effect d1ugs must reach the site of
action (biophase). This determined by: nature of the drug,

protein- binding (only the unbound fraction is pharmacologically
active), permeability of membranes, blood supply.

2.3 ETABOLISM - Mostly active-eir: ctive (increased water-
:olubility, better excretion). Occurs primarily in the liver.

2.4 EXCRETION - Occurs primarily in the urine. Excretion of
acids enhanced by an alkaline’ urine and alkalis by an acid urine.

 

£1335L1F£ (t4)

The time taken for the amount of drug in the body to decrease by 50%
(determined by metabolism and excretion).

It +‘1cs S x t) for a drug given at a constant dose and at a constant

L;

r e interval to achieve a constant concentration (steady state) in

Vh'

trxe body.

195

 

|llIIIIE::————————————————————————————————————————*"’ . ....nrur.§g(:u.
" Appepdix B15 2 '

 

. gag-.55; ficooyxam cs
1. IrmINITION The effect of drugs on the body (wanted and unwanted)
2. 3011.111 $115 or ACT] on

 

2.1 Receptors é Drugs produce their effects by binding to
specific receptors.

2.2 Affinity - The ability of a drug to bind to a receptor
Intrinsic activity, - The ability of a drug to produce an effect.

2.4 Agonist - A drug with affinity and intrinsic activity.
Antagonist -, A drug with affinity but no intrinsic activity.

2.6 .Competition - Drugs with affinity for the same receptor compete
with each other for binding.

 

 

 

3 . DRUG EFFECTS

3.1 Wanted effects - The dose-response curve is important in
determining drug dosage. Drug effects are preventive, curative
or symptomatic. F "' ‘—

3.2 Unwanted effects

3.2.1 Side—effects - .Predictable, dose-dependent. Occurs
with therapEutic doses.

3.2.2 Toxicity - Predictable, dose-dependent. Occurs with
overdose - avoidable.

 

 

 

 

3.2.3 Idiosyncracy(Pharmacogenetic effects) - Some peOple
are congenitally sensitive or resistant to certain drugs.

 

3.3 Drugpinteractions'
Possibilities when two drugs are combined
/ a
3.3.1 No effect on each othgg

3.3.2 Antagonism. - may affect wanted or unwanted effects
Teg. chemIcal, pharmacokinetic or pharmacodynamic).

3.3.3 Potentiation - may affect wanted or unwanted effects
Teg. pharmacokinetic or pharmacodynamic)

 

 

3.4 Therapeutic index - The relationship between the therapeutic
and toxic dose (small = dangerous, large = relatively safe).

 

196

 

 

Appendix C1.1

/' THE ANTIMICROBIAL DRUGS PRATT

INTRODUCTION

In each class of drugs you should concentrate on learning 1) the mechanism of
action and basis for selective toxicity. 2) the mechanism(s) of resistance, 3)
the major undesirable effects. 4) the pharmacology (i.e. aspects of
absorption, distribution, metabolism and excretion that are emphasized in the
handout and lecture), and 5) whether the drug effect is Meriostatic or
‘pactericidal: Antibiotics are used to aid the host defense in 2 ways - CIDAL
effect or STATIC effect. Important to use bactericidal drug if the patient's
ability to respond to infection is compromised due to immunosuppression, other
diseases (diabetes, Hodgkin's, etc.) or overwhelming. infection. In
suppurative regions phagocytosis, cell killing .and antibiotic effects are

compromised. When treating abscesses,.one cannot rely on antibiotic alone -
surgical drainage is necessary.

 

THE MAJOR BACTERICIDAL ANTIBIOTIQ§

 

PART I INHIBITORS OF CELL WALL SYNTHESIS - Penicillins, Cephalosporins, Bacitracin,
Vancomycin and Cycloserine. ° .

1. Structures: Know basic structural features of B-lactam antibiotics.

6 Amino penicilianic acid
r

n—E—NH-fi—H (2:: Raj—NH-j—H H,R

’ H—COOH —-N. fol-:2.-

O

D-Lm ting Thiuolidino ring ‘
Miciilio!

II. Mechanisms by which Wall Synthesis is Inhibited:

Cephalosporins

A. Stage I - Precursor Synthesis:
Synthesis of basic repeating unit
inside cell. D-cycloserine is a
structural analog of D-al'anine.

 

 

It is a competitive inhibitor of ”mm-WWW“- swam-rm “3.“?— m. MAW“...
D-alanine-D alanine synthetase ' m
and an irreversible (”suicide a“.
substrate") inhibitor of alanine t“: it
racemase. Cycloserine is a very g“.
neurotoxic drug used only in the *QP
treatment of mycobacterial = W ...»... W ...
infections resistant to the 3 '*“”‘“"“'“"‘"” \
preferred drugs. ' - ’“g “““‘“ I
I Pp nu on: sun-- ouvu-g-p-nhIr-aau
,_._/ 51:54”),
T k? H w.“ . Ht:
. o /
0M /

OM
WW hull) ' , ' "9" . /?9“
' '17: swarm-firm :fié (mm-nag?“
' M“ W'- Cunt-u
a' ' '

mm- "on tutu
" on we“

ll‘PIF— ;

Appendix C1.2

B. Stage II - Membrane-bound reactions:

During stage II, the precursor unit (the UDP-acetylmuramylpentapeptide)

becomes attached to the cell membrane via a long chain lipid and it is

modified. The modification differs from( one bacterium to another. The
modified precursor unit is transferred from the inside to the outside of the
cytoplasmic membrane, detached from the lipid, and covalently linked to
pre-existing cell wall (peptidoglycan). The membrane lipid pyrophosphate must
then be dephosphorylated before it can repeat the process.

Important points regarding Stage II: ' '

a) VANCOMYCIN inhibits the reaction where the completed lipid-bound
unit is released from the membrane and attached to the pre-existing
cell wall. The drug binds with very high affinity to the pentapeptide
precursor while it is still attached to cell membrane. There is an
absolute requirement for the acyl-D-alaéD-ala end group of the
pentapeptide and these three terminal amino acids probably constitute the
major determinant of the drug receptor.' Apparently the presence of the
drug (M.W. 1448) bound to the end of the peptide produces enough steric
hinderance to prevent. the {precursor unit from. being utilized as a
substrate by the peptidoglycan synthetase enzyme.

b) BACITRACIN inhibits the last reaction - the dephosphorylation of the
lipid pyrophosphate to lipid phosphate'. Bacitracin binds very tightly
to the lipid carrier which accumulates in the inactive form, bringing
synthesis to a halt.---Bacitracin is present in many topical creams and
ointments, often mixed with other antibiotics such as polymyxin and
neomycin (e.g. trade names ; corticosporin, neosporin, polysporin).
Active against gram-pos. organisms that commonly infect the skin. No
longer used systemically because of severe toxicity (nephrotoxic).

C. Stage III - Cross-linking and modification of the cell wall:

The glycopeptide polymers become cross-linked. This involves a transpeptida-
tion reaction in which the D-alanine-D-alanine peptide bond is broken and (in
the case of ‘g. ‘yureus) the 'terminal glycine' in the side chain of one
glycopeptide strand is covalently linked with the remaining D-alanine in a
repeating unit lccated in another chain. All of the side chains are not
cross-linked because other wall modifying enzymes called carboxypeptidases

cleave off some of the terminal D-alanines creating units that cannot be
cross-linked by transpeptidases.

Important points regarding Stage III:
The PENICILLINS and CEPHALOSPORINS
inhibit transpeptidases and thus pre-
vent crosslinking of the cell wall. An
intact B-lactam ring is required for drug
action. These drugs are structural
analogs of the D-ala-D-ala terminus of
the repeating unit of the cell wall. The
penicillins and cephalosporins occupy the
substrate site of transpeptidases where
the strained, four membered B-lactam ring
is opened and the drugs become covalently
linked to a serine moiety in the active
site of the enzyme.

Penicillin D-o ianyi-D-e 1min.

 

n—CON
- “MudmwmdmmmuMMol
NWumDLMMMuNCO-Nmmmm
0 l—CONH S HUMOUINCGNMnerumu-ummdm:

m Inns. lfm “W on“!

Panama \ t N
hummus Pmmoyl cum
I Em

"M W a Ion-ovum» hut-m n m
WmmquWmmdum¢umm
mummnmumummwumm.
mmmwmnumwmmn-mmvm , o-'-
Imminent-nun b1 {6

Appendix C2~1

 

 

2. Introduction - OPTIONAL

This section is intended to provide a background for the remainder of the
module. The material presented here will 22£_appear on either the unit or
comprehensive examination unless it is also repeated in one of the following
ten sections.

a. Bacterial cell wall synthesis. An important mode of antibacterial
action is the inhibition of bacterial cell wall, or more particularly
peptidoglycan synthesis. The peptidoglycan is a mucopolysacchnride polymer
which surrounds the bacterial cell. This component of the wall is
extensively crosslinked and forms the mechanical support that protects the
cell from odmotic damage in media that are hypotonic with respect to the
cell's interior. ' -

The synthesis of the peptidoglycan begins inside the bacterium with the'
sugar phosphate N-acetylglucosamine-P. Through a series of reactions,
involving phosphoenol p ruvate, NADPH and UTP, the sugar is modified to R-
acetylmuramic acid (NAM . A.pentapeptide chain is then added to the sugar
by ATP dependent ensymatic,(not ribosomal) formation of peptide bonds. This

sugar-peptide (often called ”Park peptide” or ”Park nucleotide” after its
discoverer) consists of the following sequence:

UDP-NAM (ala)-(d-glu)-(lys)-(d-ala)-(d-ala)

The synthesis of the Park peptide occurs in the cytosol of the cell;
however, in the next step, the UDP is displaced by‘a bacterial lipid,
bactoprenol (BP)' Bactoprenol 1' ‘ cSgopolyiso renoid alcohol phosphate,
and as you can imagine is very firmly und to he bacterial ce 1 membrane
so that the next few reactions occur in or very close to the
membrane. First, the lipid bound sugar-peptide is coverted to a disaccharide
by the additon of N-acetyl glucosamine (NAG) and then another series of
amino acids are added to the peptide chain. In this instance a pentapeptide.
consisting entirely of glycine and carried by a t-RNA is attached to the
epsilon-amino group of lysine. This reaction is enzymatic (the t-RNA does
.not participate in ribosomal protein synthesis) and results in the
production of the following branched chain peptide:

BP-NAH-(ala)-(d-glu)-(lys)"(d-ala)2

NAG . (sly)5
199

 

Appendix C2 .2

 

 

 

 

4WW°§SW new)”
a“ mtg.mt§l--CW ogy UN FNMA—
“'3‘“ oh
i
a a \u
hit @0'5 \‘3\@
(A: Q“ N%\ #1.
A’ \ O: 0. Q
« Q Q \' [..&- o\a D _
C855 URI-W:
‘EEACMR \n .
CELL “ALL. I M ARV ———
swam: on: ”T’—
d’:%\\\ &:°)\H
\ i. a \
d-OM ° °‘
\
d- Q\q

 

 

 

200

 

(“C

 

Appendix C2.3

The sugar-peptide is transfered through the bacterial cell membrane and
the bond with bactoprenol is broken. The lipid carrier remains in the
‘ membrane and is recycled while the sugar-peptide is added to the growing

peptidoglycan on the exterior of the cell (i.e. the addition is catalyzed by
extracellular enzymes).

At this stage the sugar residues are incorporated into a linear
polysaccharide; however, the next reaction results in the crosslinking of
all of these polymers to form a murein sacculus which envelopes the whole
cell in one huge polymer. The reaction is catalyzed by an extracellular
transpeptidase and is depicted on the following page. There is an
interesting feature of this reaction; that is, a peptide bond has been
formed extracellularly and apparently without ATP being utilized. Actually
what happens is that the transpeptidase breaks the bond between the two (d-
ala) residues and forms an enzyme bound intermediate that conserves the
energy of the peptide bond. This intermediate is involved in the formation
of the (gly)-(d-ala) bond and so the reaction is thermodynamically sound
without additional ATP.

If the extensive crosslinking in the peptidoglycan is responsible for
the stability of bacteria in their environment then it stands to reason that
less crosslinking will make them more vulnerable. The usual explanation for
the bactericial effects of penicillins and cephalosporins is that they
interfere with the synthesis of the crosslinks and thereby labilize dividing
cells to osmotic injury. Both of these types of antibiotics are said to
have steric features in common with the (d-ala)2 portion of the sugar-
peptide and it is thought that the drugs act as false substrates for the
enzyme, transpeptidase. The result is that the beta-lactam portion of the
drugs is involved in a reaction that causes the irreversible inactivation .
(by alkylation) of the enzyme. Cell death is preceeded by a bulging of the
cell membrane at the midline of the cell wall and the ”rounding” of the cell
as more breaks occur in the sacculus. The final event is rupture of the
cell either by osmotic forces or autolysins.

Although this scheme adequately describes the action of most commonly
used penicillins and cephalosporins, recent evidence suggests that the
situation is considerably more complicated. It has been known for some time
that penicillins alkylate a number of bacterial proteins in a given species.
In E coli there are seven that range in molecular weight from 90,000 to
40,000. All seem to be involved in specific processes related to cell shape
and cell wall integrity. For example, PEP-1A and PBP~lB appear to be
involved in cell elongation while PEP-3 seems to be involved in the
formation of a septum during cell division. PEP-3 seems to be involved in
the formation of a septum during cell division. PBP~2 appears to have some
function in maintaining the rod-like shape of the cell. The remaining PBP's
(PEP-4,5 and 6) all have carboxypeptidase activity, but their specific
function in the cell is unclear. PBP-l, 2, and 3 seem to be essential for .
survival wheareas mutants that do not have PBP~4, 5 or 6 are viable. These
PBP's are enormously important in the pharmacology of antibiotics since
structural modifications on the penicillin and cephalosporin molecules
affect the affinity of the antibiotic for a given protein, and hence the
antibacterial spectrum, as will be discussed later. Other antibiotics can
also interfere with cell wall synthesis. Bacitracin interferes with the

201

Appendix C2.4

recycling of bactoprenol. As it turns out, bactoprenol is in the form of a
pyrophosphate at the end of its cycle, and must be dephosphorylated before

it can be reused. Bacitracin binds the pyrophosphate form of the lipid and
prevents the conversion to the lipid phosphate. Vancomycin acts by binding

to the (d-ala) region of the Park pe tide and prevents further maturation
to the peptide-disaccharide and pep igoglycan. '

 

Drugs that prevent the synthesis of the murein sacculus are generally
more effective against gram positive bacteria. This is not because gram
negatives do not have peptidoglycan because as can be seen from the .
schematics on the next page they do (albeit less than gram positives). The
reason for the selectivity is not clear but it maybe in part because gram

positives have a higher internal osmotic pressure (about 5 times higher) and

in part because the outer membrane of gram negative bacteria may exclude

some of these antibiotics. In support of the latter argument ampicillin has

activity against some gram negatives that penicillin C does not affect, but
both antibiotics are equally good inhibitors of tranSpeptidase activity in
preparations where the outer membrane is no longer a barrier.

b. Inhibition 2i Bacterial Protein Synthesis. Another common
mechanism for antibiotic action is the inhibition of bacterial synthesis of
proteins. The aminoglycosides (the prototype being streptomycin) inhibit

bacterial protein synthesis as_a consequence of their ability to bind to the

'small or 306 subunit of the bacterial ribosome. The binding site is quite
well characterized and it has been shown that a single amino acid
substitution in one of the ribosomal proteins is sufficient to preventing
binding. Once bound, streptomycin has the curious effect of causing the
ribosome to misread the messenger RNA (e.g. UUU (phe) may provoke the
incorporation of isoleucine which normally has the codon AUU). In this
manner, the antibiotic may cause the synthesis of bogus enzymes. -
Streptomycin has another effect, however, that is better correlated with
cell death and this is, that it causes the ribosome to remain frozen as a
708 initiation complex (step 2 on the next page).' Whether this is because
the drug prevents the initiation factors from dissociating or because it
prevents the newly initiated message from being translated is not known;

however, cell death is closely related to the breakdown of polysomes and the

accumulation of "703 streptomycin ribosomes".

It also should be pointed out that streptomycin and the other
aminoglycosides are the only inhibitors of bacterial protein synthesis that
are bactericidal. This may be because the inhibition is long lasting
(streptomycin binds to the 308 subunit with vefy high affinity), or because
the drug has two effects on protein synthesis (i.e. impairs protein
synthesis and causes misreadings). There is still another explanation that
stems from the fact that the aminoglycosides are basic drugs and do not
passively enter bacteria. It seems that the during one phase of entry
(there are two energy dependent energy dependent entry processes) the cell
membrane is damaged and this injury may contribute to the lethal effect.
Note that since protein synthesis occurs inside the cell any inhibitor of
protein synthesis must penetrate the bacterial cell. Changes in pH,
anaerobic conditions or the presence of divalent cations all adversely
affect the uptake of aminoglycosides.

202

U

U

. . . A. . I ...\.| u .\l"
sai.)av-nl (.aal ll.».lau.- ul an. alu:.n..(,lt ' i a... i “' \‘V‘I.

..bllll‘ . .. - -. _-u- ' .I ---..-

a’ {I A ll

 

2.5

Appendix C

..\.\

 

   

O."
332....ch Ioc!
sealer: Isis-ms. sssss
....I V228... turn vs ' i so;

4.
..\
a,

a

(evades-......

  

act's—an x
resist! wee vary on

«3:89.: .a
c920. “.3033. we

cegvuneu as. c.

gin-91330.0,

livitali
its:

a . wales! seas has
L... 2.9! Esta..- (a

. (0‘ :-
CQSVL-‘I

 

’1‘

 

Appendix C2 6

"steam was

 

 

Mi
.3 7:003 SWIM) * mm“ , . . -
swam “MM
3; qua): Us)“
Set M"?
. 3)»
. - )6
—\ {fig Mn 630‘.
. ‘ l ' .— ( A \\ Q\
a?“ ‘ ‘ 2 Q3? “km“
‘1 ' 150$ ' - _.

 

 

 

 

Appendix C3

  

It appears that STREPTOMYCIN is tightly bound to so-called "STREPTOMYCIN-
MONOSOMES". The 70 S unitsthat accumulate in the cells are identified
with the "streptomycin monosomes". The "streptomycin monosomes"

consist of a complex of 30 S and 50 S ribosomal particles, m-RNA and
streptomycin.

70 S oRIBOSOME

W

(M135
‘Q . 9101‘ ‘55
i 3&6!“me
a .'
% ......
d: "'.'c
a . . .

PHARMACOKINETICS

' Streptomycin is usually administered intramuscularly
' Peek Levels are attained within X - 1% hours

' PlasmaHalf-life (t3) 3 27; hours

' There is poor penetration of the Blood—Brain Barrier

' Streptomycin diffuses into tuberculous and peritoneal cavities

' Similar concentrations are found in the pleural fluid as determined
in plasma

' It is eliminated by glomerular filtration
and

' Between 30-90% appear in the urine in 24 hours
/3 .....

ran:-

Appendix D1.1

TABLE I - PRINCIPLES UNDERLYING TREATMENT OF

COMMON ILLNESSES

 

HeartFailurc
Excessive diuresis, diuretic escape; hypolcalaemia;
digitalis toxicity; myocardial ischaemia; adverse
drug-drug interaCtions; lack of response to therapy
Hypertension..........................
Stepped approach to drug treatment; captopril;
methyIdOpa; heta-adrenoreceptor blocking agents;
frusemide; prazosin; minoxidil; drug treatment in
the elderly

Cough ........... . ......................................................... .
Codeine; mucolytic agents; antihistamines
Bronchial Asthma ........................ . ......................
Methylxaiithmes, combination anti-anhmatic
preparations

l‘")

 

Drugs of choice; treatment failure; toxicity profiles;
renal failure. hepamtoxicit}; pregnancy

n A

\ oooooooooooooooooooooooooo o ooooooooooooooooooooo 00.0

Amphmeticm B; 5- fluorocytosine

4.1le ...................................................................
Cerebral malaria; adxerse effects of antimalarial
agents; prephxlaxis in pregnancy "'
urinar y [mg lgfggng n ...................................
Antimicrobial therapy of uncomplicated infeCtions;
repeated infeCiions, catheter- associated infections;
treatment in renal failure; nalidixit acid;
nitrofiirantoin

Cancer Chcmmherap ... .. ... .. ... ... ...
PesiStance to cytotoxic agents; general guidelines

Iron-Deficiency Anaemia
Contraindications to iron; failed response; choice of
an oral iron preparation; adverse effects of oral
therapy; hazards of parenteral therapy; iron
supplements

Diabetes Mellitus ............................ . ........
Insulin allergy; insulin lipoatmph} and
lipohypertmphy; insulin resisrance; insulin
hypoglycaemic reaCtions: the Somogyi effect; beta-
adrenoreceptor blocking drugs and blood sugar
control; sulphonylureas; laCtic acidosis;
chlorpropamide-alcohol flush

Colchicine; indomethacm uricosuric agents;
aHopunnol

MyaSthenia Grayis
Anticholinesrerases; atropine; corticosterOids;
Other drugs affecting the myoneuronal iuncnon

206

--—'—-—_—o.------—-. -..«_l - ._

Appendix D1.2

'TABLE 2 - DRUGS IN COMMON USE

 

Opica antibiOtics; beta~lactamases; side-effects;
renal elimination; hepatic disease and failure
AntihiStamines
Use in the common cold and upper respiratory tract
infecrions; special problems; interaCtion with Other
drugs; adverse effecrs on the nervous sysrem; topical
use; acute pOisoning

HiStaminez-Receptor Blocking Agents ... .... ..
Cinieridine; ranitidine

Antacids............. .......... .....
Aluminium toxicity, chronic aluminium toxicity;
bismurh encephalopathy and neuropathy

Laxatives . ......................... .. ....... .. ............
Safety profiles; cathartic syndrome; chronic
hypoltalaernia; mineral Oil deposits; phenolphthalein

Antidiarrhoeal Agents .... ... ... .....
l’anlin; pecrin; bismuth ahticholinergics; opiates;
r‘vphenoxylate and atropine; iodochlorhydroxyquin;
antidiarrhoeal.‘antibi0ticcombinations

Aspirin and the Acidic Non-steroidal
Anti-inflammatory Agents ................................
Gastrointestinal injury; sensitiiity teacrions;
analgesic neph. oparhi; redistributional drug
interaCtions; general considerations for use in
chronic rheumatic conditions

Pinitalis ........................ ..................... . ...... .........
Clinical signs of digitalis toxicity; early recognition
0’ cardiomxicity; contraindications to digitalis
therapy; massive digitalis intoxication; di"0‘ in and
atiinidine

Sympathomimetic Drugs - -- -
Adrenaline; ephedrine; phenylpropanolamine;
noradrenaline; isoprenaline; betaz-selecrive agents;
dopamine and dobutamine; clonidine
Alpha-Adrenoreceptor Blocking Agents ..................
Phenoxybenzamine; ptazosin; indoramin

Beta-Adrenoreceptor Blocking Agents ..
Potassium Supplements

N'tratcs ......IOCII...O....0‘D.........-..........C-O.......O..............

Adverse Effects; Tolerance

Calcium Antagonists
Verapamil; nifedipine; perhexilene; prenylamine;
diltiazem

Benzodiazepines. ... .. - - --
Guidelines for use; dependence

Tricyclic Antidepressants - -- - - _
Cardioroxiciry; postural hyporension; anticholinergic
effects; epilepsy; acute withdrawal effeCts

iczh)'lphcnldatc - IOCOOOOOOQOOOOOOOOI;.;‘osO.OIOOOOOOOOOOOOOO0.0.0....

Anorectic Agents ..
Sympathomimetic amines; safety; fenflutamine;
phenylpro'p'anolamine; comparative
pharmacological effeas

Ad .iirion of Drugs to Intravenous Fluids ................

Pare ntetal Nutrition
Microniirrienr deficiencies; metabolic bone disease;
hepatic dysfunction; fat overload syndrome

Topical Corticosteroids - -.. -
Porency; activity; local toxicity; systemic toxicity;
minimismg risks of adverse effecrs; use in '
Ophthalmology

Methylene Blue

Use in methaemoglobinaemia; toxicity

 

Vitamins .......... . ..... . .....
Vitamin A (retinol): requirements;
hypervitaminosis A

Vitamin Bi: and folic acid

Vitamin C: antiscorbutic activity; toxicity

\‘itamin D: Normal requirements; individual
susceptibility; hypervitaminosis D

Vitamin K. adverse effecrs; treatment Of
hypoprorhrombinaemia

207

Appendix D} . t .. 1 \

£3180! il-IElm'ED READING

VARIIJtILITY IN HUMAN DRUG RESPONSE . A :
SMITH, 8.£. and RAWLIHS, M..D. . Butteruorthe (1973) r . .- .0

o
. - ‘o...-—- -—....—— ...

Til}; l‘li.'.r.?t.'.(;OLOC ICAL BASIS OF THERAPEUTICS ' .
moment. 1.. s. and mus/1N, A. hat-Julian (I975) . .
Chapter I. General Principles ' :.

FIOI‘NOHIILMBILITY OF DRUGS ' '
KOCH- ih ”SIR J. (1974) new England Journal of Medicine, 291: 233.

FLUID liOSItIC NOBEL 0? It CELL MEMBRANE
SINGER, S. J. and NICHOLSON, 6.1. (1972) science, 175: 720

EFFECT O? DISEASE STATES ON PLASMA PROTEIN BINDING OF DRUGS
REIECFERC, NM. (1974) Med. Clinics 6 North America, 29.: 1103.

 

«C unit-rim, H.
’ 'riii: nou: OF THE Liven IN nnuc HETABOLISH
American Journal of Medicine (1970) £23 617.
THE wo-coumnnmrtr OPEN MODEL :-
CRED:I~LATI‘, 9.1. end KOCH-WESER, J.
flew England Journal of Medicine (1915) 293: 702
amt/atom READING ' ‘
i
sssrit TIuLS or lmDICINAI. CHEMISTRY
KOROL" WAS A. and BURCJWATER, LB. (1976). Chapter 3. '
. John Riley A Sons, New York. . '
PRINCIPLES OF DRUG ACTION (Chapters 1-5: tin-peer 9)
commtit, ‘A., AROix‘O'rJ, 1... Karma, 8.». (1971.)
John Viloy A Sons, Row York. . a
... :sszirrtns or iiOstuiii mums/mower

KOROLKOVAS, A. (1970) Chapters 1, 2,. 3, 6, 7. 9.
John Wiley A Sons, flew York.

' — n-g.......-o-. tr-

PUliDAi-ifitfrliLS OF BIOCHEMICAL PHARMACOLOGY
Pcrgamon Press, Oxford. '

PERINATAL PRARN»KCOLOCY ARD‘THERAPEUTICS
HIRKIN, 3.1.. (1976) Chapter 1. . ,
Academic Press. New York. '

 

 

 

- . ," s p s ’ ‘ - ' .. . . " ' ' .
‘ ‘ J' o ' _ .t_ L" .’ "L .- 0 "g‘ _ _ . I... 3“,.» ‘9‘. .
39% «NS- mama‘s km: «rt 5. «than: in: -2- ..t...._..4~.-_-_-.__.- ' - \ .. _~,.. ,,- ---- _._.. 1 - . .w-r .

.. ‘
-.r- “Y.

MnChh Ill' PJ
. Pharmacology 5 Therapnutics
4‘ Append” D3.1 MEDUNSA i983 -

\

PHARMACOLOQI : rrs SCOPE AND PLACE IN Ct.I.i~_igc}§i. 3391ng

 

Pharmacolo embraces the knowledge and skills required for the effective
and safe use of drugs in the prevention, diagnosis and treatment of disease.

In this sense it is an apolied rather than a basic science

Aetiological,

 

 

   

 

contributing-
and precipitating *
factors Progression ‘ F
i
‘g.£¢C°V9r ‘*_.___
HEALTHY INDIVIDUAL DISEASED SIGNS*
INDIVIDUAL SYMPTOMS*
Possible sites
* .
of drug action
Approach to drug‘therapya /
a. Kgiwledge of disease: Aetiology, pathOphysiology,-course ',
b. Knowledge of patient: Age, sex, organ function, pregnancy, etc.

c. Knowledge of drugs: _“:
i) Structure / group
ii) Pharmacokinetics: Effect of body on drug
iii) Pharmacodynamics: Effect of drug on body, mechanism of action,

wanted and unwanted effects

d. Interrelationships:
i) Patient / drug / pathophysiolog Should a drug be used? Which drug(s)?
ii) Risks and benefits f}. How much? How long?

e. Use of pharmacological laboratories - serum levels, pharmacogenetics

f. Keeping up-to—date

Literature
Congresses, symposia
Research

.9( Medical representatives

1209

GASTRO-JNTHSTINAL TRACT

 

MBCfiB Tn" .--“ ”“ pJ -‘-‘=*
PharmaCOIOgy a Therapeutics

fizaexmcoximrr-Ics a. PHARMACODYNAMICS I . MFDUNSA 1983
Introduction; 2

Appendix D3.2

Oral administration

(D)
l

 

 

 

 

 

 

 

 

 

 

 

 

PORTAL LIVER BLOOD BIOPHASE
BLOOD
(D)———9 (D) ———-> (D) PROTEIN
fl 3
II
'I
\QN '9
(DM) \ (D) ‘ (D) -’ R EFFECT
(ON) v— (DM) <—
I \\ :-
4, , e v , -:
BILE \_1_J' (D) :_ :

 

(DM) < —/ (DM) KIDNEY

 

 

 

 

j
y \- ‘ ”F".

D—
DM
R

drug
drug metabolite
receptor

.e—...
49———.
|
j.
213 ’~

    
  
 

 

FABCES URINE -

S
zxkfi
‘fiéef

J

.2nigggngINLTICS the effect of the body on drug(s)
ie. absorbtion, distribution, metabolism and excretion

f;

   

1.1 DRUG PASSAGE ACROSS MEMBRANES (Absorption, distribution, excretion)

1.1.1 Processes igyolygg Passive - diffusion (through membranes),
filtration (through cannels) ,
Active - energy required

 

...
o
...
o
M

Important factors in passive diffusion
Concentration gradient, ionization

In general:

 

 

 

 

Equilibrium
.Unionized Fraction ‘ Ionized Fraction
\
(Non—polar, fat soluble (Polar, water—soluble,
passes readily across passes poorly through
membranes) membranes)

Note: pKa = pH at which drug is 50% ionized

In summary:

 

 

 

 

 

Acid drug
ionized < 3 unionized
pH of the [34 7 1 I k»
n‘¢dium 7 0.0.0.0.... oco-coon... 7 ,‘
Basic drug é
unionized (%—~ 4; ionized

\ I ‘.§
. .
'-&‘,a‘ ..

*1

1.2 FACTORS MODIFYING DRUG ABSORPTION

Formulation (solubility, dissolution. concentration)
Blood supply
Absorpzive surface
Size of molecule .
Effect of gastric acid and digveti\u “”2?“”5
Trar. .1 t time-
21()

 

 

He

ii

 

COr

13.
t

n-
1
x

I

m

1.3

1.4

1.5

-f "nutnu ill
Pharmacology & Therapeutics

. ‘. ,. MEDUNSA 1983
-;pgenalx U3.3 Introduction 3

P”Q§fl§99§lNFTL§S AND PHARMACODYNAHI§§HEE_

'W-n--c--~V“--V-‘h-——H-vfl. -

DRUG METABOLISg (usually increases water solubility)

a) Sites: mainly liver (also plasma, placenta, etc)

 

b) Mechanisms:

Conjugation (eg. glucuronide)
Oxidation (liver microsomes)
Hydrolysis

c) "First pass" metabolism

 

-—...-—— . “.—

DRUG DISTRIBUTION

Protein binding (albumin)

Lipid solubility
Blood supply
Size of molecule

Transport mechanisms

(fat in tissues)

 

TIME-COURSE PHARMACOKINETICS (Plasma profiles)
\

i) Single dose

 

concentration
in blood

 

 

 

 

 

b
a = absorption
a b = distribution
/ c = elimination
Time

Eliminw‘icn can be:

Half-life (ti):

ii) Multiple dose:

 

COHC . I

 

first order (constant % per unit time)
zero order (constant amount per unit time)

time taken for concentration to decrease by 50%
(note: distribution t} or elimination ti)

(same dose, constant dosage interval)

 

TIME

It takes roughly 5 x ti to achieve steady state. One can bypass 5 x t} by

a loading dose to achieve steady-state rapidly - this is followed by

 

maintenance dose.

 

\
(.'\\ iuv.

211

Pharmacology & Therapeutics

' MEDUNSA 1983
Appendix D3.4 . .
Introduction. 4

—e—-—-.——_¢-—-——-—.—

 

EflfififACODYNAMICS Effect of drug on the body

 

2.1 PREREQUISITES FOR DRUG ACTION

 

i) Adequate conc. in biophase (has to be there)
ii) Reaction with a specific receptor (has to produce effect)

Note: affinity: ability to react with a receptor
intrinsic activity: ability to produce an effect

 

3.? DOSE-EFFECT CURVES
a a} Two different
b a b b drugs
- A = differing intrinsic
Effect activity
A B B = differing affinity

 

 

 

 

log dose log dose

2.3 ANTAGONISM

 

 

 

 

 

 

/
2.3.1 At the receptor
2
a I
a = agonist
b = antagonist
a a+b a+b
Competitive Non—competitive
2.3.2 Different receptors: Physiological antagonism

 

2.3.3 Chemical antagonism: Chemical interaction

 

2.3.4 Therapeutic index (T.I.)

 

 

 

 

 

a = therapeutic effect
a
a b b = toxic effect
Wide T.I. Narrow T.I.
LD 50
T01. - ED 50

212

MBChB III 08
. Pharmacology & Therapeutics
Appendix D3 5 MEDUNSA 1983
° Introduction 5

PHAREAEOEINETlCSHAED_P§A§i§CODX§AflICS Iv

..--—

 

 

2 . 4 £926.19 MIND. IXEELAJJJAFLETI ON

2.4.1 EFFElHPEEESER (Normal)

No. of People
responding "Unimodal"

 

 

dose

2.4.2 Occasign3}_ggtte{n (Inherited)

...—...—

 

 

 

 

"Bimodal"
2.5 UNTOWARD EFFECTS OF DRUGS
./
2.5.1 Dose dependant (Predictable) Wanted
Side effects — unavoidable U y t d I
Overdose toxicity - avoidable nwan e .
2.5.2 Dose_lpdeoendant (Unpredictable) Allergic response and Pharmacogenetics

 

- Type I - IV responses
- Cross reactions

2 - 5- 3 95-93. ”$9.33. r9319”:
- Pot’ntiation
E . . '} Enhancement Of effect
- Summation (SynerOism)
wanted

— Antagonism. Diminished effect
nwanted

2.5.4 ‘Erug_dependen£e_
’ a) Physical dependence: - Tolerance & cross tolerance
- Withdrawal symptoms
b) Psychological dependence: - Compulsive abuse

~¥g2.6 QBUG INTERACTIONS

 

2.6.1 Pharmacokinetic interactions:

 

- Incompatibility — Parenteral fluids

- In the digestive tract

Plasma protein binding

- Changes in rate Of elimination - Biotransformation, Renal excretion

 

2.6.2 Pharmacodynamic interactions '

- f toxicity
- ieffectivity

2153

‘1llllllllllplllll--L_i

I

' I.“

 

Appendix D4

THE MECHANISM OF DRUG MZ'J'ION

It is difficult to offer any general comment as to how drugs act

as all too little is known about this subject and there must be

many complex interactions that will be difficult to analyse. It

is. however. currently assumed that drugs may interact with an
organism in three major ways. The first possibility is that drugs
activate or. more likely. inhibit an enzyme. or a series of enzymes.
and thus produce their effects (cf; 1.h.P). These drugs show a

high degree of structural specificity and are active in low concen-
trations.

in addition and/or alternatively drngs'may not interact with
enzymes to produce their effect. but they may still be active in
very small concentrations and show a high degree of structural

‘specificity. To explain this type of drug action a drug RECEPTOR

theory has been postulated (cf. 1.h.1) where the drug combines
with a specific site.

Nonspecific drugs. on the other hand. exert their effects on a
mucly.physicochemical basis and because they have no biological
system to simplify the effects these drugs are used in high
concentrations compared to the two types of specific drugs above.
Nonspecific drug effects include pH changes that accompany the
administration of large amounts of acidic pr basic "drugs"; the
increased osmotic pressures that follow the.use of colloidal
macromolecular polysaccharide (Dextran) "plasma expanders" or the
narcosis that is associated with the inhalation of a large group
of volatile liposoluble compounds such as‘cthyl other. Xenon.
cyclopropane or nitrous oxide.-- . -- ~ "- - '-

1.h.1 Drug receptors

Host drugs have high structural specificity (whereas morphine
is a potent narcotic, N-allylmorphine has no effect. also
steric changes may grossly alter a drug's properties. L (+)
muscarine is three hundred times more pg££2£_than its D (-)
enantiomorph) and are active in very small concentrations
(isoprenaline may alter the action of the heart at con-
centrations as low as 10 g/ml. prostaglandins. digitalis

' and the polypeptide kinins are active in namogram to
picogram concentrations per ml). and it is assumed that
macromolecules on or in the organisms have certain struc-
turally specific arena (REQEEIQ§§7_73'which the drug (micro-
molecule) becomes affixed. This drug-receptor cSEEInation
is rgggrsiblg_and causes excitation 01 the macromolecule

pith a resultant confiEiEéEZi§3;1:gngnge. This. on.its own
£ELthrgggh eliciting a ch in reaction of those slight
changes may cause an "effect" - this may be muscle contraction.
increased secretioniwchange.in membrane permeability.
inhibition of enzymes. change in metabolism. etc. For a
.drug to occupy the receptor it must be present in a suf-
ficiently large concentration in the BIQEEASE - the immediate
vicinity of the receptor.-v;~ :. - ' ;

 

 

 

 

214

 

 

Appendix D5 ‘

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

DOCTDR'S
M D THESIS DEGREE
(THESIS)
3
M MED A ;§
4 M MIL MED M PRAx NED h
DR M PHARmrED MASTER'S H
5 YEARS 2 YEARS DEGREE "
PART_TIME (EDUCATION
FULL-TIME . + 3 YEARS AND
TRAINING 1 YEAR PART-TIME TRAINING)
a
8 DR MDRE
7
:MB ChB
VI l
v
. DEGREE 0F
‘ IV BACHELOR
OF MEDICINE
AND
III . SURGERY
II
I
L

 

DEGREES IN THE FACULTY OF MEDICINE
UNIVERSITY OF PRETORIA.

 

 

215 '

 

 

 

Appendix El

Figure 6 summarizes current theoretical ideas about the coupling of the
benzodiazepine receptor. the GABA receptor and the chloride ionophore. hany
psychopharmacologic agents. including anxiolytics and hypnosedatives other than
Imenzodiazepines, as well as some convulsants and anticonvulsants may exert many of
theflr pharmacologic (and side) effects by affecting components in this system.

 

RECEPTOR

 

 

—-— Inside

ezo (benzodiazepine)

   

 

Bicucuuine P '
. M oscimol umes lnoune. cafleinel
Barbiturates THIP '
. on." GAGA Endogenoos lactate)
Endogenous lactors - “‘9"
Cl’ 0‘19 * H’ \\\HlI// Aflimtv
C N’
I \

 

 

 

W
W
M

i

Fig , 6 Diagranuuatic representation of GABA-henzodiazepine-chlorule
ionophore receptor complex.. Occupation of GADA receptor induces
allosteric change in conformation of benzodiazepine recognition site
resulting in increased affinity of receptor for benzodiazepines. A variety
of anxiolyric drugs are believed to modulate receptor through associated
regulatory site: (see Paul and Skoluiclt. l98l).

216

.._.. “ .M‘w
__ _ -_ .

Appendix E2

MECHANISM or ACTION or
Loan. Mac'nlnrcs

  

 

 

fig...“ p____h L30

LOCAL ANESTHETIC
MOLECULE

STABILIIED At bod |l!‘('®'N°<§'€ #B-Q-g-‘Eg

( M207. ( ~ 807»)
- me - meeded as
parietal; active «Form

217 PKa'S = 8- 9

BIBLIOGRAPHY

Abraham, G. J. S., Dhume, V. G. and Diniz, R. S. "Compari—
son Didactic Lecture, Self—Reading and Self-Instruc-
tion as Learning Methods in Medical Students of
Western India," in Medical Education 1981, Volume

15, pp. 222-225.

Association for Medical School Pharmacology. Knowledge
Objectives in Medical Pharmacology, Spring, 1984.

 

Association of American Dental Schools. "Curricular Guide-
lines in Pharmacology" in Journal of Dental Education,
1982, Volume 46, No. 3, pp. 176-183.

Association of American Medical Colleges. Institutions,
Characteristics, and Programs - a background paper,
in Medical Education, Washington, D. C., 1981.

Becker, M. H., Stolley, P. D., Lasagna, L., McEvilla, J. D.,
Sloane, L.M. "Differential Education Concerning
Therapeutics and Resultant Physician Prescribing
Patterns" in Journal of Medical Education, February

1972, Volume 47, pp. 118—127.

Bogner, P., Sajid, A. W., Ford, D. L. "Effectiveness of
Audio—Based Instruction in Medical Pharmacology" in
Journal of Medical Education, July 1975, Volume 50(7),
pp. 677-682.

Buchheim, R. "Ueber die Aufgaben und die Stellung der
Pharmakologie an den deutschen Hochschulen" in Archiv
fur Egperiment Pathologie u. Pharmakologie, 1976,
Volume 5, pp. 261-278.

Burford, H. J. and Stritter, F. T. "Evaluation of a Teach-

ing Program in Medical Pharmacology" in Journal of
Medical Education, March 1974, Volume 49, pp. 236-244.

 

 

Cape Town, University of, Faculty of Medicine, 1984.

 

Catzel, P. "Pharmacology as a Basic Science in the Medical
Curriculum" in South African Medical Journal, 22 May
1976, p. 832.

218

219

Charlton, R. W. "Objectives of the Undergraduate Course in
Pharmacology for Medical Students" in The Teaching
of Pharmacology at Southern African Universities,
eds.: Folb, P. I. and Bowey, F. S. B., Department
of Pharmacology, University of Cape Town, 1978.

 

CSaky, T. Z. "Is There an Identity Crisis in Medical School
Pharmacology?" in Journal of Medical Education,
November 1976, Volume 51, pp. 935—937.

Dale, H. H. "Pharmacology During the Past Sixty Years" in
Annual Review of Pharmacology, 1963, Volume 3, pp.
1-8.

D'Mello, A. and Kruk, Z. L. "Effective Pharmacological
Demonstrations to 100 Students" in Proceedings of the
B.P.S., 15th-16th July, 1976, p. 314P.

 

Eales, L. "The Teaching of Therapeutics" in Medical Educa—
tion in South Africa, eds.: Reid, J. V. 0. and
Wilmot, A. J. Natal University Press Pietermaritzburg
1965.

 

Engel, C. B., Lowe, G. D. 0., Marshall, P. B., Wakeford,
R. E. "Teaching Basic Pharmacology to Medical Stu-
dents. An Experimental Self-Instructional Approach"
in Medical and Biological Illustration, 1974, Volume
24, pp. 130-134.

Fisher, J. W., Gouley, D., Greenbaum, L. "Knowledge Objec-
tives in Medical Pharmacology," A Working Paper of
the Association for Medical School Pharmacology Com-
mittee on Essential Knowledge Base in Pharmacology,
Spring 1984.

 

Flexner, A. Medical Education in the United States and
Canada, A Report to the Carnergie Foundation for the
Advancement of Teaching, with an Introduction by Henry
S. Prichett, New York City, 1910 (Reproduced in 1960).

 

Folb, P. I. and Bowey, F. S. B. The Teaching of Pharmaco-
logy at Southern African Universities, Department of
Pharmacology. University of Cape Town, 1978.

Gilliland, J. "Opening Address" in The Teaching of Pharma—
cology at Southern African Universities, eds.: Folb,
P. I. and Bowey, F. S. B. Department of Pharmacology,
University of Cape Town, 1978.

Goldstein, A. "A Controlled Comparison of the Project
Method with Standard Laboratory Teaching in Pharma—
cology" in Journal of Medical Education, 1956, Volume
31, pp. 365-375.

220

James, D. M. "Pharmacology in the Medical Curriculum at
Ibadan" in Proceedings of the West African Society
for Pharmacology, Inaugural Meeting, 20 March, 1971.

 

Jason, H. and Westberg, J. Teachers and Teachin in U.S.
Medical Schools, Appleton-Century-Crofts, East Norwalk
1982.

 

Joubert, P. "Pharmacology as a Basic Science in the Medical
Curriculum: An Illogical Anachronism" in South
African Medical Journal, 3 April 1976, Volume 50, pp.
567-568.

 

Joyce, C. R. B. and Weatherall, M. "Controlled Experiments
in Teaching" in The Lancet, August 31, 1957, pp. 402-
406.

 

Joyce, C. R. B. and Weatherall, M. "Effective Use of Teach-
ing Time" in The Lancet, March 1959, pp. 568-571.

Kahn, J. B. Jr. "The Pharmacology Laboratory: Teaching
Tool or Sacrament?" in Journal of Medical Education,
Volume 40, July-December 1965, pp. 870-877.

Kahn, N. and Bigger, J. T. "Instruction in Pharmacokinetics:
A Computer-Assisted Demonstration System" in Journal
of Medical Education, Vol. 49, March 1974, pp. 292-295.

 

Mandel, H. G., Cohn, V. H., Straw, J. A. "The Value of
Laboratory Teaching in Pharmacology" in Journal of
Medical Education, January 1971, Volume 46, pp. 69-77.

 

 

Malherbe, E. G. "Foreword" in Medical Education in South
Africa, eds.: Reid, J. V. 0. and Wilmot, A. J., Natal
University Press, Pietermaritzburg, 1965.

Maren, T. H. "Role of Pharmacology in Physician Education"
in Journal of Medical Education, May 1973, Volume
48(5), PP- 464-465.

 

Medical University of Southern Africa. MEDUNSA - Calendar
1985, Prmedia, Pretoria.

Michigan State University, College of Human Medicine, Office
of Student Affairs and Admissions, Preparing for
Medical School Admission, 1984.

 

Michigan State University, College of Human Medicine, Under-
ggaduate Medical Education, 1984.

Michigan, University of. Bulletin, Volume 11, Number 16,
February 17, 1982. The University of Michigan,
Ann Arbor.

 

221

MUller, F. 0. "An Integrated Common Final Professional Exami-
nation in Medicine which Includes Pharmacology - The
University of the Orange Free State Experience," in
The Teaching of Pharmacolggy at Southern African Uni-
versities, eds.: Folb, P. I. and Bowey, F. S. B.,
Department of Pharmacology, University of Cape Town,
1978.

Natal, University of, Faculty of Medicine, 1984.

Offermeier, J. "What I Regard as Fundamental Knowledge in
Pharmacology for Medical Students" in The Teaching
of Pharmacology at Southern African Universities, eds.:
Folb, P. I. and Bowey, F. S. B., Department of Pharma-
cology, University of Cape Town, 1978.

Oranje-Vrystaat, Universiteit van, Fakulteit Geneeskunde,
Jaarboek, 1984, Deel 9.

Pretoria, Universiteit van, Jaarboek 1984, Fakulteit Geneeskunde,
Deel X.

Reid, J. V. 0. "Discussion III" in Medical Education in
South Africa, eds.: Reid, J. V. 0. and Wilmot, A.
J., Natal University Press, Pietermaritzburg, 1965.

 

Reynolds, R. C. "Pharmacology Education in Medical Schools"
in Journal of Medical Education, November 1976, Volume
51, pp. 947-948.

 

Sapeika, N. "Pharmacology Today" in South African Medical
Journal, 11 January 1964, pp. 34-35.

Sapeika, N. "The Teaching of Pharmacology Today" in Medical
Education in South Africa, eds.: Reid, J. V. 0. and
Wilmot, A. J., Natal University Press, Pietermaritzburg,
1965.

Schnieden, H. "Has Pharmacology a Place in Today's Medical
Schools?" in the British Journal of Clinical Pharmaco-
logy, 1976, Volume BCU, p. 193.

Seevers, M. H. "A Projection to the Future" in the First
Sixty Years 1908-1969 - The American Society For Pharma-
cology and Experimental Therapeutics, ed.: Chen, K. K.

Sicé, J. "Objectives of Pharmacological Education" in Journal
of Medical Education, August 1975, Volume 50, pp. 773-
778.

 

Sinclair, D. "Evaluation of a New Medical Curriculum" in
British Journal of Medical Education, 1972, Volume
6, pp. 176-1830

222

Spilman, E. L. and Spilman, H. W. "A Pair Comparison Study
of the Relevance of Nine Basic Science Courses" in
Journal of Medical education, July 1975, Volume 50,
pp. 667-671.

Stellenbosch, Universiteit van, Fakulteit Geneeskunde, Jaar-
boek 1984, Deel 12.

Straughan, J. L. "Undergraduate Pharmacology" in South African
Medical Journal, 24 July 1976, p. 1232.

United States Department of Health, Education, and Welfare.
The Teaching of Pharmacology. In Task Force on Pre-
scription Drugs, The Drug Prescribers. Washington,
D. C.: U.S. Government Printing Office, 1968, pp.
6-8.

Van den Bergh, A. D. P. "What the Family Practitioner Requires
to Know about Medicines, and How he should be Trained
for it" in the Teaching of Pharmacology at Southern
African Universities, eds.: Folb, P. I. and Bowey,
F. S. B., Department of Pharmacology, University of
Cape Town, 1978.

Wayne State University, 1982-1984 Bulletin.

Weiner, M. and Walker, J. R. "Utilization of Basic and Clini—
cal Health Science Personnel in a Team Approach for
the Achievement of Competency in Therapeutics" in
Medical Education, 1977, Volume 11, pp. 114-118.

Witwatersrand, University of, Faculty of Medicine, The Natal
Witness (Pty) Ltd., Pietermaritzburg, 1984.

GENERAL REFERENCES

Cox, B., Fozard, J. R., Small, R. C. "Slide-Tape Programmes
in the Teaching of Pharmacology" in Proceedings of
the B.P.S., 15th-16th July, 1976, p. 315P.

 

Cséky, T. Z. Introduction to General Pharmacology, Appleton—
Century—Crofts Educational Division, Meredith Corpora-
tion, New York, 1969.

Dunlop, D. "Medicines, Governments and Doctors" in Drug,

Folb, P. I. Drug Safety in Clinical Practice, Springer-
Verlag, New York, 1984.

Marcum, J. A. Education, Race, and Social Change in South
Africa, Berkeley, California: University of California
Press, 1982.

Rogers, H. J., Spector, R. C., Trounce, J. R. A Textbook
of Clinical Pharmacology, Hodder and Stoughton, London,
1981.

 

Troup, F. Forbidden Pastures: Education Under Apartheid,
International Defense and Aid Fund, London, 1976.

223