First Edition

Undergraduate
Practical Manual
[Document
subtitle]

Name of student:
Roll No:
Session:

Prepared by:
Department of Pharmacology
Tripura Medical College & Dr. B.R.A.M. Teaching Hospital
Hapania, Agartala, Tripura(W), Pin- 799014.
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Web: www.tmc.nic.in Email: [email protected]
 INSTRUCTIONS:
This Undergraduate Practical Manual has been prepared by all the

teachers of the department of Pharmacology, TMC &Dr. BRAM Teaching

Hospital, to implement competency based medical education (CBME) as

per guidelines of Nationa Medical Council (NMC).The purpose of this

manual is to provide guidelines to the students as well as to the teachers

to achieve defined outcomes in the subject of Pharmacology in 2nd

professional MBBS course through learning and assessment. All the

competencies mentioned in the index of this manual for the training of

2nd professional MBBS students are to be documented in the manual. The

manual is designed for filing of all documentation created in relation to

the different competencies. The manual remains in the possession of the

student and is his/her everyday companion during daily activities. The

manual must be kept carefully and has to be submitted to the department

when asked for. The relevant forms for assessment are included in the

manual and will be assessed by the assessor periodically. The assessor will

sign the assessment form with appropriate feedback to the students. The

students also must put his/her signature on the form of assessment after

understanding the different aspects mentioned in the feedback provided

by the assessor. The APPRAISAL FORM, included at the end of the

“PRACTICAL SKILL” section of the manual, ensures achievement of all

2
mandatory practical skills in the course and will be signed at the end of

the course by the assessor(s) and Head of the Department. In the

APPRAISAL FORM, a student must achieve the level of “competent” along

with other criteria stipulated by NMC, to be eligible for appearing 2nd

professional MBBS university examination in the subject of Pharmacology.

Second Professional teaching hours- Pharmacology:

TEACHING LEARNING METHOD HOURS

Lectures: 80
Practical Class: 100
Tutorials/ Seminars/Integrated learning: 38
Self- Directed Learning: 12
Total: 230

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 CONTENTS
Sl. Competencies Page No
A. BASIC PROFORMA OF THE STUDENT 05
B. ATTENDANCE RECORDS: THEORY & PRACTICAL 06
C. SCORE SHEET FOR MAINTENANCE OF LOG BOOK 07
D. PRACTICAL SKILLS 08-69
1 Demonstrate understanding of the use of different dosage 08-18
forms.
2 Calculate drug dose in patients in different clinical 19-22
situations.
3 Administer drugs for different clinical situations through 23-27
various routes using mannequins.
4 To prepare and explain a list of P- drugs for a given 28-33
case/condition.
5 Write a rational, correct and legible generic prescription for 34-39
a given condition.
6 Communicate with the patient regarding optimal use of 40-47
drug therapy and devices.
7 Perform and interpret a critical appraisal (audit) of a given 48-53
prescription.
8 Perform a critical evaluation of the drug promotional 54-57
literature.
9 To recognize and report an adverse drug reaction. 58-66

10 Demonstrate the effect of drugs on blood pressure using 67-69

computer aided learning.
E. SELF DIRECTED LEARNING (SDL)
F. SEMINAR BY STUDENTS
G. ASSIGNMENT SUBMISSION
H. PROJECT SUBMISSION
I. GROUP DISCUSSION
J. TUOTORIAL

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 BASIC PROFORMA OF THE STUDENT

Name of the student:

Photograph
of the
student.
Class roll number:

University roll number:

Date of Birth:

Father’s name: MobileNo:

Mother’s name : MobileNo:

Address:

Mobile No of Student :

Email id of Student :

Email id of Mother/Father:

Signature of Student: ...................................

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 Summary of the performance of the student.
Sl. Competencies
ATTENDANCE RECORDS: THEORY & PRACTICAL
SCORE SHEET FOR MAINTENANCE OF LOG BOOK
PRACTICAL SKILLS
SELF DIRECTED LEARNING (SDL)
SEMINAR BY STUDENTS
ASSIGNMENT SUBMISSION
PROJECT SUBMISSION
GROUP DISCUSSION
TUOTORIAL

6
 Attendance of students.
Name of the student: Roll number of the student:

A] 1ST INTERNAL ASSESSMENT (DATE: DD/MM/YYYY )

Theory attrendance Practical attrendance Remarks

Theory % Marks Practical % Marks

Signature of Student Signature of Teacher

B] 2ND INTERNAL ASSESSMENT (DATE: DD/MM/YYYY )

Theory attrendance Practical attrendance Remarks

Theory % Marks Practical % Marks

Signature of Student Signature of Teacher

C] 3RD INTERNAL ASSESSMENT (DATE: DD/MM/YYYY )

Theory attrendance Practical attrendance Remarks

Theory % Marks Practical % Marks

Signature of Student Signature of Teacher

D] Scoring system in attendance

Percentage of attendance Score

100 % 5

>95- 99 % 4

>85- 95 % 3

>75- 85 % 2

<75 % 1

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 SCORE SHEET FOR LOG BOOK MAINTENANCE.
Name of the student:
Roll number of the student:

Guideline for scoring: [Total 20 marks in each internal assessment].

1. Content of logbook: 5marks.
2. Arrangement of logbook as per instruction: 5marks.
3. Punctuality of submission: 5 marks.
4. Maintenance of logbook: 5 marks.

Date Internal assessment Score Comment & signature

First

Second

Third

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 PRACTICAL SKILLS:
1. DEMONSTRATE UNDERSTANDING OF THE USE OF
DIFFERENT DOSAGE FORMS.
Background: Dosage forms of drugs are different pharmaceutical
forms/preparations/formulations of drugs suitable for administration by
various routes. They may be solid, semisolid, liquid and gaseous.
Competencies addressed:

The student should be able to Level

List the common dosage forms pertaining to the various K
routes of administration.
Demonstrate the correct method of using the common SH
dosage forms.

Teaching learning methods:

List the common dosage forms pertaining to the various routes of
administration.
Hours: 8 (2hours each for solid, semisolid, liquid and inhalational dosage form)
The students are divided into small groups. The dosage forms of the drug are
displayed at the various stations. The students are asked to write down the
dosage forms. The teacher discusses with small group of students regarding
various dosage forms.

SOLID DOSAGE FORMS:

Tablet may be defined as solid dosage form containing drugs with or without
suitable diluents and prepared by compression or moulding methods.

Sugar coated tablets contain sugar coating-which help to cover up any

disagreeable taste or odors of drug. It may be 50% larger and heavier than the
original uncoated tablet.

Film coated tablets are covered with a thin layer of polymeric substance that
protects the drug from atmospheric conditions and mask the objectionable
taste and the odor of drug.
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Enteric-coated tablets are coated with cellulose acetate phthalate that is
insoluble between pH 1-3 but dissolves between pH 5-7. They are used to
protect the drug from destruction by acidic gastric juice and to prevent gastric
irritation by the drug.

Sustained release tablets contain special additives or prepared by special

procedures that modify the rate of release of the drug into gastrointestinal
tract at a predetermined rate.

Effervescent tablets contain sodium bicarbonate and an organic acid such as

tartaric or citric acid besides the drug. In the presence of water, these additives
react, liberating carbon dioxide, which acts as a disintegrator and produce
effervescence.

Chewable tablets have a smooth, rapid disintegration when chewed or allowed

to dissolve in the mouth, have a flavored cream base.

Capsule is a cylindrical envelop of gelatin in which a drug is enclosed for oral

administration.

Hard shell gelatin capsules contain the solid drug in powder form and also
diluents, disintegrants and lubricants.

Soft shell gelatin capsules contain the liquid drugs with poor bioavailability.
Enclosure of liquid drugs in soft shell capsule improves bioavailability.
Spansules or sustained release capsules contain the drug in the form of
granules having different coatings that dissolve at different time intervals and
provide uniform release of drug over a prolonged period.
Suppository is a cone shaped solid dosage form of various weights, usually
medicated, for insertion into the rectum. Following insertion, the suppository
melts at body temperature.

Pessary is an oval shaped solid medicinal preparation intended for local use in
the vagina.

Bougies are solid pencil shaped body meant for urethral administration.

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Powders are intimate mixture of one or more solid substances reduced to a
fine state.
Simple powder- contains a single active ingredient.
Compound powder- contains two or more active ingredients.

SEMI SOLID DOSAGE FORMS

Ointments are semisolid greasy preparation containing one or more active
ingredients dispersed in a suitable base of animal, vegetable, mineral or
synthetic origin, meant for application on skin & mucous membrane for local &
systemic effects. They contain less than 10%-powdered ingredients,

Cream is a semisolid preparation consisting of an opaque emulsion that is

miscible with the skin secretions. Cream is less greasy than ointment. They can
be oil-in –water (aqueous cream) or water-in-oil (oily cream) types.

Paste is a semisolid preparation intended for external application, containing

more than 10% of the powdered ingredients.

LIQUID DOSAGE FORMS

Mixture is a liquid medicinal preparation containing one or more medicinal
ingredients usually dispersed in several doses, meant for oral administration
for local, systemic and reflex actions; e.g., carminative mixture.
Solution is a homogenous mixture (when all the ingredients are soluble in the
solvent used) is called a solution.
Suspension is a heterogeneous mixture (when or more ingredients are
insoluble in the solvent used and a turbidity is formed) is called a suspension.
e.g., milk of magnesia.
Emulsion is an emulsion is a special type of mixture of two immiscible liquids,
one of which is uniformly dispersed as globules throughout the other with the
help of an emulsifying agent e.g., castor oil emulsion.
Syrup is a 66%solution of sucrose (sugar) in water. It is a sweetening
agent.Used as a vehicle for active ingredients of cough mixture
Linctus is a concentrated viscid syrup preparation and is taken by licking. Used
alone as a peripheral antitussive or as a vehicle for central antitussivese.g.,
linctus codeine phosphate.

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Lotion is a liquid suspension intended for external application. e.g calamine
lotion

Liniment is a liquid preparation intended for external application, applied on

unbroken skin withfriction. e.g. turpentine liniment

Enema is a liquid preparation containing medicinal ingredient meant for rectal

administration. Evacuant enema is used for evacuation of bowels before any
operation, radiological investigation, labour etc. e.g., soap-water enema.
Diagnostic enema is used for radiological investigation of rectum & colon e.g.,
Barium sulphate. Retention enemae.g., prednisolone enema in ulcerative
colitis.

INHALATIONAL DOSAGE FORMS

They contain drug particle or solutions administered by respiratory route for

local or systemic effects.
Metered dose inhaler (MDI): it is pressurized dosage form containing one or
more drugs which upon actuation emit a fine dispersion of liquid in gaseous
medium. A metered valve is used to regulate the amount of drug discharged
e.g., salbutamol inhaler.

Dry powder inhaler: It delivers a measured dose of the drug in a powdered

form for inhalation. It is suitable dose for patients having difficulty with MDI.
e.g., salbutamol rotahaler

Nebuliser: It is a device for the inhalation of drug solutions as droplets suitable

for use in children and in emergencies. e. g., salbutamol solution

Demonstrate the correct method of using the common dosage forms.

Hours: 10 (2hours each for pessary, suppository, metered dose inhaler, dry
powder inhaler and insulin pen etc).
The teacher will demonstrate the correct method of using following dosage
forms. The students will observe the demonstration. The teacher assists the
students to demonstrate in a simulated environment. Then the student
demonstrates independently.
How to take oral medicines:

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 1. Wash hands with soap and water.
2. Sit straight while taking the drug.
3. Check the drug label for date of expiry. Ensure that the drug name,
strength and dosage form match with that on prescription.
4. Open any pre-packaged medications and place the tablet/capsule in the
hand.
5. Take one glass of potable water (200 ml) to the other hand.
6. Take a mouthful of water from the glass and then put the tablet or
capsule in the mouth. Swallow the tablet or capsule along with adequate
water so that the capsule /tablet don’t get stuck in upper GIT.
7. Liquid oral medication will require gentle shaking of the medication for a
few seconds to ensure the equal distribution of the medication within
the liquid.
8. Follow proper Information regarding association of food, diurnal
variation and drug interactions, if any.
How to take Sublingual Medicine:
1. Wash hands with soap and water.
2. Sit straight while taking the drug.
3. Check the drug label for date of expiry. Ensure that the drug name,
strength and dosage form match with that on prescription.
4. Open any pre-packaged medications and place the tablet/capsule in the
hand.
5. Put the drug under the tongue and leave it there until dissolved.
6. The drug should not be crushed, chewed or swallowed.
7. The drug has to be spitted when the desired effect is obtained.
How to apply Topical medications:
1. Wash the affected area of skin well and rinse away all traces of soap or
cleanser.
2. Measure a fingertip unit (FTU) of cream or ointment on your index finger
before application. [One fingertip unit is amount of ointment or cream
squeezed out of a tube from the tip of an adult index finger to the first
crease in the finger.
 One FTU = 0.25 – 0.31 gm for males.
 One FTU = 0.23- 0.29 gm for females.]
3. Apply the cream or ointment thinly and evenly to the affected area.

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 4. Gently message the cream/ointment into the skin until it has all
disappeared.
5. If you have other creams/ointments/ lotions to use on the same area of
skin you should try and leave about half an hour between applying each
one so that they do not mix on the skin.
How to insert Pessary:
Without the applicator
1. Wash the hands.
2. Remove the wrapper from the tablet.
3. Dip the tablet in lukewarm water just to moisten it.
4. Tell the patient to lie on her back, draw her knees up a little and spread
them apart.
5. Gently insert the tablet into the vagina as far as possible, tell the patient
not to use force.
6. Wash the hands.
7. Pessaries are adversely affected by heat and high humidity and so it
must be stored in cool and dry place.
With applicator
1. Wash the hands.
2. Remove the wrapper from the tablet.
3. Place the tablet into the open end of the applicator.
4. Tell the patient to lie on her back, draw her knees up a little and spread
them apart.
5. Gently insert the applicator with the tablet in front into the vagina as far
as possible, do not use force.
6. Depress the plunger so that the tablet is released.
7. Withdraw the applicator.
8. Discard the applicator (if disposable).
9. Clean both parts of the applicator thoroughly with soap and boiled
water (if not disposable).
10.Wash the hands.
How to insert Suppository by caretaker of the patient:
1. Wash the hands and wear gloves.
2. Remove the covering (unless too soft) of the suppository.

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 3. If the suppository is too soft, let it harden fast by cooling it (fridge or
hold under cold running water, still packed,) then remove covering.
4. Remove possible sharp rims by warming in the hand.
5. Moisten the suppository with cold water.
6. Tell the patient to lay on his/her side with lower leg straightened out
and upper leg bent forward towards the stomach.
7. Hold one buttock gently to one side so that you can see the anus.
8. Hold the suppository by the non-pointed end and insert the tip into the
anal opening.
9. Now just gradually push, keep pushing (it may be further than can be
imagined) and at some point the suppository will be pulled into the
rectum by the anal sphincter.
10.Ask the patient to remain lying down for five minutes.
11.Wash the hands.
12.Try not to have bowel movement during the first hour.
13.Suppositories are adversely affected by heat and high humidity and so it
must be stored in cool and dry place.
How to instill ophthalmic medication (eye drop) by caretaker of the patient:
1. Wash the hands.
2. Do not touch the dropper opening.
3. Make the patient lie down on his/her back or tilt the head back on
sitting position.
4. Ask the patient to look upward.
5. Pull the lower eyelid down to make a “gutter” or pouch to expose the
conjunctival sac.
6. Bring the dropper as close to the gutter as possible without touching the
eye.
7. Be careful about that the eyedropper should be 1-2 cm above the
conjunctival sac.
8. Instill the prescribed number of drops (usually 1or 2) in the “gutter.”
9. Release the eyelid & ask the patient to rotate the eyeball for distribution
of the medication.
10. Ask the patient to close the eye for about two minutes. The eye should
not be closed too tightly.
11.If more than one kind of eye drop has to be instilled then wait at least
five minutes before next instillation

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How to instill ophthalmic medication (eye ointment) by caretaker of the
patient:
1. Wash the hands with soap & water.
2. Do not touch the tip of the tube.
3. Tilt the head of the patient backward a little in sitting position.
4. Take the tube in one hand and pull down the lower eyelid of the patient
with the other hand, to make a “gutter.”
5. Bring the tip of the tube as close to the “gutter” as possible.
6. Apply the amount (usually 1 cm length) of ointment.
7. Close the eye for two minutes.
8. Remove excess ointment with a tissue a paper.
9. Clean the tip of the tube with another tissue.
How to instill otic medication (eardrop) by caretaker of the patient:
1. Wash the hands with soap & water.
2. Allow the patient to lie on his/ her side with the ear upward.
3. Do not touch the dropper opening.
4. Hold the medicine filled dropper/container approximately 1-2 cm above
the ear canal.
5. Straighten the ear canal to help the medication reach the eardrum. For
adult, gently pull the auricle up and back. For young child & infant gently
pull the auricle down and back.
6. Instill the prescribed amount of drops.
7. Wait for five minutes before turning to the other ear.
How to instill nasal medication (nasal drop) by caretaker of the patient:
1. Wash the hands with soap & water.
2. Ask the patient to blow the nose gently to clear the nasal passage.
3. Avoid touching the dropper tip against the nose.
4. Ask the patient to tilt the head as far as possible on sitting position or
ask the patient to lie down on his/her back on a flat surface keeping the
head straight.
5. Insert the dropper 1cm into the nostril.
6. Instill the number of drops prescribed (usually 3-4 drops).
7. Ask the patient to sit up after few seconds (10-15secs), the drops will
then drip into the pharynx.
8. Repeat the procedure for the other nostril, if necessary.

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How to instill nasal medication (nasal spray) :
1. Wash the hands with soap & water.
2. Gently blow the nose to clear the nasal passage.
3. Sit with the head slightly tilted forward.
4. Shake the spray. Insert the tip in one nostril.
5. Close the other nostril and mouth.
6. Spray by squeezing the vial (container) and sniff slowly.
7. Sit up after a few seconds (10-15secs), the spray will drip down the
pharynx.
8. Repeat the procedure for the other nostril, if necessary.
How to use Metered dose inhaler:
Without the spacer
1. Remove the cap of the inhaler.
2. The inhaler should be shaken well.
3. Patient will breath out through the mouth.
4. The inhaler is then placed between lips and during inspiration, the
top end of the inhaler has to be pressed.
5. Breathing must be steady and deep.
6. After withdrawing the canister, the patient should be instructed to
hold the breath for 10 seconds.
7. Rinse the mouth.
8. Wait for at least one minute before puffing the next dose.
With the spacer
1. Push the two halves of the spacer together firmly.
2. Remove the mouthpiece cap of the inhaler and shake the inhaler
vigorously.
3. Fix the inhaler into the narrow end of the spacer device.
4. Place the mouthpiece cap over the other end of the spacer.
5. Holding the inhaler, press down on the canister to release a dose into
the spacer.
6. Remove the mouth piece cap. Close lips firmly around the mouth
piece to create a good seal.
7. Inhale deeply through mouth from the spacer. Remove the spacer
from the mouth and hold the breath for as long comfortable.
8. Breath out slowly.

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 9. Rinse the mouth.

How to use Dry powder inhaler:

1. Load the rota capsule into the device.
2. Break/ Pierce the rota capsule by proper technique.
3. Hold the device in position in front of mouth.
4. Breathe out slowly and gently until the lungs are comfortably empty.
5. Tilt the head back and close the lips tightly around the mouth piece.
6. Take a deep fast breath in through the device
7. Remove the device from the mouth while holding the breath as long
as possible
8. Rinse of mouth after the procedure.

How to use Insulin pen:

1. Wash hands with soap and water.
2. Check expiry date.
3. Bring insulin to room temperature.
4. Ensure there is sufficient insulin for dose.
5. Re-suspend insulin if required by gently rolling for 20 cycles until the
crystals go back into suspension.
6. Attach new needle.
7. Prime the device observing drop of insulin at needle tip.
8. Dial desired dose.
9. Choose the appropriate site.
10.Push the needle through the skin at 900 keeping thumb away from
dosage button.
11.Push thumb button down completely and count to 10.
12.Remove needle from subcutaneous tissue.
13.Remove needle from pen.
14.Dispose of needle safely.

Assessment: By using checklist (Format given below).

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 Check list of skill assessment for dosage forms of drugs.
Date:
Topic:
Roll no of the student:
Name of the assessor:
Criteria scale:
Sl Items Marks Score
1. Proper instructions given to the 4
patients on the correct method of
using the dosage form.

2. Proper caution regarding 2

methods/side effects given to the
patients.

3. Attitude (tone of voice, gesture, 3

audibility) while giving instructions

09
Total

Overall score: Not satisfactory : 1-3.

Satisfactory : 4-6.
More than satisfactory : 7-9.
Feedback:

Signature of student:
Signature of assessor:

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 2. CALCULATE DRUG DOSE IN PATIENTS IN DIFFERENT
CLINICAL SITUATIONS.
Background: Dose is the appropriate amount of a drug needed to produce a
certain degree of response in a given patient. The calculation of dosage for a
patient becomes essential and has to be done quickly during emergency
situation for individualization of therapy. Hence, a basic knowledge regarding
the dosage calculation, conversion factors and molar strength is vital for
individualization of therapy especially in extremes of ages (pediatrics and
geriatrics), pregnancy and in patients having hepatic and renal dysfunction.

Competency addressed
The student should be able to: Level
1 Calculate drug dose in patients in different clinical Performs
situations.

Teaching learning methods: Calculate drug dose in patients in different clinical

situations.
Hours: 10 (5 sessions will be conducted each session with 2hours duration).

A teacher will introduce the various concepts in relation to dose calculation for
30 mins covering rules of conversion, percentage solutions, molar
solutions,etc.

A. Expression of drug concentration:The drug concentration can be expressed

as weight (mg or gm) for solid medicaments. For liquid formulations like syrups
and injections, the concentration may be expressed as:
Weight in volume (W/V)- mg or gm or U in ml, e.g., insulin 40 U/ml, dopamine
200mg/5ml, 5% dextrose solution (5gm in 100ml)
Volume in volume (V/V)- e.g., 70% ethyl alcohol (70ml absolute alcohol in 100
ml of aqueous solution).
In case of semisolid medications like ointments, gel and creams, the drug
concentration is expressed as:
Weight/ volume- 1 gm of solute in 100 ml of solvent (1% W/V)
Volume/ volume- 1 ml of solute in 100 ml of solvent (1% V/V)

20
 Weight/ weight- 1 gm of solute in 100 g of solvent (1% W/W)

Mole & Molar solution:

Mole: A mole of a particular substance is molecular weight expressed in grams.
For example, molecular weight of sodium bicarbonate is 84. So, 1 mole of
sodium bicarbonate contains 84 g.
Molar solution: one molar solution can be defined as one mole of a substance
dissolved in 1 litre of solution (1 mole/ L). For example, 1 molar sodium
bicarbonate represents 84 g of sodium bicarbonate dissolved in 1 litre of
distilled water.

B. Adult dose calculation based on body weight and body surface area:
Based on weight (expressed as mg/kg body weight):
Individual dose = Body weight (kg)/ 70 X average adult dose.
Based on body surface area:
Individual dose = Body surface area (m2)/ 1.7 X average adult dose.
Pediatric dose calculation based on age:
Child dose = Age in years X adult dose/ Age + 12
Dose calculation in patients with renal failure:
Dose calculation is based on creatinine clearance. Cockroft Gault’s formula is
used to calculate creatinine clearance.
Creatinine clearance (ml/min) = [140- age (in years)] X Weight (in kg)/ 72 X
Serum creatinine (mg/dl)
For females, multiply by 0.85
Creatinine clearance (ml/ Dose rate to be
min) reduced to
50- 70 70 %
30- 50 50 %
10- 30 30 %
5- 10 20 %

21
The batch will be divided into groups of 5-6 students each. About twenty
minutes will be allocated for the group tasks. The drug samples that will be
required for the calculation will be provided. Each student will work out the
different problems on individual basis. Few of such examples are:
1. Dose of Atropine and Pralidoxime in a patient of organophosphorus
poisoning
2. Dose of Dopamine in a patient with cardiogenic shock with renal
insufficiency
3. Rate of infusion of Ringer’s Lactate in a Paediatric patient with diarrhea
& severe dehydration.
4. Dose of different drugs in an unconscious patient with diabetic
ketoacidosis.
5. Dose of Gentamycin in upper UTI in a renal compromised patient.
At the end, a plenary session will be held for onehour where different groups
will present their problem.

Assessment:
Skill assessment by using checklist (Format given below).

22
 Checklist for skill assessment of dose calculation.
Date:
Topic:
Roll no of the student:
Name of the assessor:
Criteria scale:
Sequence of steps are maintained:
Unsatisfactory Satisfactory Superior
1 2 3 4 5 6 7 8 9

Appropriate units are used:

Unsatisfactory Satisfactory Superior
1 2 3 4 5 6 7 8 9

Correct result:
Unsatisfactory Satisfactory Superior
1 2 3 4 5 6 7 8 9

Calculations are shown at appropriate place:

Unsatisfactory Satisfactory Superior
1 2 3 4 5 6 7 8 9

Fairness:
Unsatisfactory Satisfactory Superior
1 2 3 4 5 6 7 8 9

Response to related questions:

Unsatisfactory Satisfactory Superior
1 2 3 4 5 6 7 8 9

Overall assessment
Unsatisfactory Satisfactory Superior
1 2 3 4 5 6 7 8 9

Feedback:

Signature of student:

Signature of assessor:

23
 3. ADMINISTRATION OF DRUGS THROUGH PARENTERAL
ROUTES IN A SIMULATED ENVIRONMENT USING
MANNEQUINS.

Background: Parenteral route is of great significance when the drug cannot be

given by locally or orally. Parenteral dosage forms are expensive and require
expertise to administer. Extreme care is necessary for administration of drugs
by parenteral routes. Exact site selection, aseptic measures and selection of
suitable formulations is mandatory.

Competency addressed:
The student should be able to: Level
Administer drug through parenteral (intravenous bolus, Shows
intravenous infusion, intramuscular and subcutaneous) routes in how
a simulated environment using mannequins

Teaching learning methods:

Hour: 8 (2 hours each for intravenous bolus, intravenous infusion,
intramuscular and subcutaneous).

In this DOAP session a student will observe the demonstrations for

administration of drug through parenteral routes by a performer (teacher),
assist the performer and then perform individually in a simulated
environmentusing mannequins, different parenteral dosage forms and devices
&other accessories (syringes of different volumes/ IV drip set & infusion
bottle/ Insulin syringe/Sprit swab/ Insulin pen).

Intravenous bolus: The following steps have to be followed during

administration of drug by intravenous bolus:
Expiry date & correct drug: Check the expiry date of the drug and ensure that
the vial or ampule contains the right drug in the right strength.
Sterility: During the preparation procedure, materials should be kept sterile.
Wash your hands prior to preparing the injection and also after the procedure.
Disinfect the injection site with appropriate antiseptic. Take care not to prick
yourself or somebody else during the procedure.
24
Technique:
Dissolving dry medicine: Disinfect the rubber cap (top) of the vial containing
dry medicine. Select appropriate syringe with the required volume of solvent.
Insert the needle into the vial holding it upright. Suck up as much as much air
as the amount of solvent already in the syringe. Inject only the fluid into the
vial, not the air and shake it well.
Aspiration of drug into syringe: Use a syringe with a volume of twice the
required amount of drug solution and add the needle. Suck up as much air as
the amount of solution needed to aspirate. Insert needle into the vial and turn
upside down. Pump air into vial (creating pressure). Aspirate the required
volume of drug solution from the vial. Make sure the tip of needle is below the
fluid surface and no air enters into the syringe. Remove any air from the
syringe. In case of ampoule first remove the liquid from the neck of it by
flicking it. Now file around the neck of the ampoule. Carefully break off the top
of the ampoule. For a plastic ampoule, twist the top. Then aspirate the
required volume of drug from the ampoule and remove any air in the syringe.
Administration of drug: Reassure the patient and explain the procedure.
Uncover the arm completely. Apply tourniquet and look for a suitable vein and
wait for the vein to swell. Disinfect the skin and stabilize the vein by pulling the
skin taut in the longitudinal direction of the vein with your another hand.
Insert the needle at an angle of around 450 with keeping the beveling of the
needle up. Aspirate and if blood appears, loosen the tourniquet and inject the
drug slowly. Withdraw the needle swiftly and press the sterile cotton onto the
opening and secure with adhesive tape.
Waste: Make sure that the contaminated wastes including the needle and
syringe are disposed safely.

Intravenous infusion.
The following steps have to be followed during administration of drug by
intravenous infusion:
Expiry date & correct drug: Check the expiry date of the intravenous fluid and
ensure that the container contains the right drug in the right strength.
Sterility: same as intravenous bolus.

25
Technique:Reassure the patient and explain the procedure. Make the whole
system air free & ensure free flow of fluid. Uncover the arm completely. Apply
tourniquet and look for a suitable vein and wait for the vein to swell. Disinfect
the skin and stabilize the vein by pulling the skin taut in the longitudinal
direction of the vein with your another hand. Insert the needle at an angle of
around 450 with keeping the beveling of the needle up. Place the needle at
appropriate place inside the vein. Compress and release the rubber part of
intravenous set. If blood appears in the transparent area of intravenous set,
loosen the tourniquet and start the drip slowly. Adjust the drip with the help of
the regulator as per requirement.
Waste: Make sure that the contaminated wastes including the needle, drip set
and containers are disposed safely.

Intramuscular.
The following steps have to be followed during administration of drug by
intramuscular route:
Expiry date & correct drug: same as intravenous bolus.
Sterility:same as intravenous bolus.
Technique:
Dissolving dry medicine:same as intravenous bolus.
Aspiration of drug into syringe: same as intravenous bolus.
Administration of drug: Reassure the patient and explain the procedure.
Uncover the area to be injected (lateral upper quadrant of major gluteal
muscle or deltoid muscle). Disinfect the skin and tell the patient to relax the
muscle. Insert the needle swiftly at an angle of 900 (watch depth). Aspirate
briefly, if blood appears, withdraw the needle and replace it with new one. If
blood does not appear inject the drug slowly. Withdraw the needle swiftly and
press the sterile cotton onto the opening and secure with adhesive tape.
Waste: same as intravenous bolus.

Subcutaneous.

26
The following steps have to be followed during administration of drug by
subcutaneous route:
Expiry date & correct drug: same as intravenous bolus.
Sterility: same as intravenous bolus.
Technique:
Dissolving dry medicine: same as intravenous bolus.
Aspiration of drug into syringe: same as intravenous bolus.
Administration of drug: Reassure the patient and explain the procedure.
Uncover the area to be injected (upper arm, upper leg, abdomen). Disinfect
the skin and pinch fold of the skin. Insert the needle in the base of the skin fold
at an angle of 300. Release the skin. Aspirate briefly, if blood appears, withdraw
the needle and replace it with new one. If blood does not appear inject the
drug slowly. Withdraw the needle swiftly and press the sterile cotton onto the
opening and secure with adhesive tape.
Waste: same as intravenous bolus.

Assessment: By using check-list as given below.

27
Check-list for Skill assessment of administration of drugs
through parenteral routes.
Date:
Topic:
Roll no of the student:
Name of the assessor:
Criteria scale:
Sl Items Marks Score
1 Checking for expiry date & 1
correct drug

2 Reassurance and explanation 1

to the patient regarding the
procedure
3 Maintenance of sterility 2

4 Technique 4

5 Proper disposal of wastes 1

Total : 09
Overall score: Not satisfactory:1-3.
Satisfactory: 4-6.
More than satisfactory: 7-9.
Feed back:

Signature of student:
Signature of assessor:

28
 4. TO PREPARE AND EXPLAIN A “P- DRUG” FOR A GIVEN CASE
/CONDITION.
Background:P-drugs are the drugs you have chosen to prescribe regularly, and
with which you have become familiar. They are your priority choice for given
indications.
Competencies addressed:
The student should be able to: Level
Understand the concept of 'p' drug K
To prepare and explain a P-drug for a disease Performs

Teaching learning methods:

Understand the concept of 'p' drug
Hours: 2.
A teacher will explain the concept of p drug and the following steps
involved in preparing p- drug.
Step1: Define the diagnosis: When selecting a P-drug, it is important to
remember that you are choosing a drug of first choice for a common
condition. To be able to select the best drug for a given condition, you
should study the pathophysiology of the disease. The more you know
about this, the easier it is to choose a P-drug. Sometimes the physiology
of the disease is unknown, while treatment is possible and necessary.
Step 2: Specify the therapeutic objective: It is very useful to define
exactly what you want to achieve with a drug, for example, to decrease
the diastolic blood pressure to a certain level, to cure an infectious
disease, or to suppress feelings of anxiety. Always remember that the
(patho)physiology determines the possible site of action of your drug
and the maximum therapeutic effect that you can achieve. The better
you define your therapeutic objective, the easier it is to select your P-
drug.
Step 3: Make an inventory of effective groups of drugs: In this step you
link the therapeutic objective to various drugs. Drugs that are not
effective are not worth examining any further, so efficacy is the first
criterion for selection. Initially, you should look at groups of drugs rather
than individual drugs. There are two ways to identify effective groups of
drugs. The first is to look at formularies or guidelines that exist in your

29
hospital or health system, or at international guidelines, such as the
WHO treatment guidelines for certain common disease groups, or the
WHO Model List of Essential Drugs. Another way is to check the index of
a good pharmacology reference book and determine which groups are
listed for your diagnosis or therapeutic objective. In most cases you will
find only 2-4 groups of drugs which are effective.
Step 4: Choose an effective group according to criteria: To compare
groups of effective drugs, you need information on efficacy, safety,
suitability and cost.
Efficacy:In order to be effective, the drug has to reach a minimum
plasma concentration and the kinetic profile of the drug must allow for
this with an easy dosage schedule. Kinetic data on the drug group as a
whole may not be available as they are related to dosage form and
product formulation, but in most cases general features can be listed.
Kinetics should be compared on the grounds of Absorption, Distribution,
Metabolism and Excretion.
Safety:It is necessary to summarize possible side effects and toxic
effects. If possible, the incidence of frequent side effects and the safety
margins should be listed. Almost all side effects are directly linked to the
working mechanism of the drug, with the exception of allergic reactions.
Suitability:Although the final check will only be made with the individual
patient, some general aspects of suitability can be considered when
selecting your P-drugs. Contraindications are related to patient
conditions, such as other illnesses which make it impossible to use a P-
drug that is otherwise effective and safe. A change in the physiology of
your patient may influence the dynamics or kinetics of your P-drug: the
required plasma levels may not be reached, or toxic side effects may
occur at normal plasma concentrations. In pregnancy or lactation, the
well-being of the child has to be considered. Interactions with food or
other drugs can also strengthen or diminish the effect of a drug. A
convenient dosage form or dosage schedule can have a strong impact on
patient adherence to the treatment. All these aspects should be taken
into account when choosing a P-drug. For example, in the elderly and
children drugs should be in convenient dosage forms, such as tablets or
liquid formulations that are easy to handle. For urinary tract infections,
some of your patients will be pregnant women in whom sulphonamides-
a possible P-drug – are contraindicated in the third trimester. Anticipate

30
this by choosing a second P-drug for urinary tract infections in this group
of patients.
Cost of treatment: The cost of the treatment is always an important
criterion, in both developed and developing countries, and whether it is
covered by the state, an insurance company or directly by the patient.
Cost is sometimes difficult to determine for a group of drugs, but you
should always keep it in mind. Certain groups are definitely more
expensive than others. Always look at the total cost of treatment rather
than the cost per unit. The cost arguments really start counting when
you choose between individual drugs. The final choice between drug
groups is your own. It needs practice, but making this choice on the basis
of efficacy, safety, suitability and cost of treatment makes it easier.
Sometimes you will not be able to select only one group, and will have
to take two or three groups on to the next step.
Step 5: Choose a P-drug: There are several steps to the process of
choosing a P-drug. Sometimes short-cuts are possible. Don't hesitate to
look for them, but do not forget to collect and consider all essential
information, including existing treatment guidelines.
Choose an active substance and a dosage form:
Choosing an active substance is like choosing a drug group, and the
information can be listed in a similar way. In practice it is almost
impossible to choose an active substance without considering the
dosage form as well; so consider them together. First, the active
substance and its dosage form have to be effective. This is mostly a
matter of kinetics. Although active substances within one drug group
share the same working mechanism, differences may exist in safety and
suitability because of differences in kinetics. Large differences may exist
in convenience to the patient and these will have a strong influence on
adherence to treatment. Different dosage forms will usually lead to
different dosage schedules, and this should be taken into account when
choosing your P-drug. Last, but not least, cost of treatment should
always be considered. Price lists may be available from the hospital
pharmacy or from a national formulary. Keep in mind that drugs sold
under generic (nonproprietary) name are usually cheaper than patented
brand-name products. If two drugs from the same group appear equal
you could consider which drug has been longest on the market
(indicating wide experience and probably safety), or which drug is

31
manufactured in your country. When two drugs from two different
groups appear equal you can choose both. This will give you an
alternative if one is not suitable for a particular patient.
Choose a standard dosage schedule
A recommended dosage schedule is based on clinical investigations in a
group of patients. However, this statistical average is not necessarily the
optimal schedule for your individual patient. If age, metabolism,
absorption and excretion in your patient are all average, and if no other
diseases or other drugs are involved, the average dosage is probably
adequate. The more your patient varies from this average, the more
likely the need for an individualized dosage schedule. Recommended
dosage schedules for all P-drugs can be found in formularies,
desk references or pharmacology textbooks. In most of these references
you will find rather vague statements such as ‘2-4 times 30-90 mg per
day’. What will you choose in practice?
The best solution is to copy the different dosage schedules into your
own formulary. This will indicate the minimum and maximum limits of
the dosage. When dealing with an individual patient you can make your
definitive choice. Some drugs need an initial loading dose to quickly
reach steady state plasma concentration. Others require a slowly rising
dosage schedule, usually to let the patient adapt to the side effects.
Choose a standard duration of treatment
When you prescribe your P-drug to a patient you need to decide the
duration of the treatment. By knowing the pathophysiology and the
prognosis of the disease you will usually have a good idea of how long
the treatment should be continued.

To prepare and explain a p-drug for a disease:

Total hour: 10 hours (5 sessions will be conducted each session with
2hours duration).

Group tasks will be distributed. About twenty minutes will be allocated

for the group tasks. Each group will prepare and explain p-drug for the
given clinical condition with the help of:
Drug information literature/ Standard Text book.
CIMS / MIMS.
Format for preparing and explaining P-drug:
32
Format for preparing and explaining P-drug:
1. Specify the therapeutic objective:

2. Make an inventory of effective groups:

3. Choose a group according to criteria (Number of groups may

increase or decrease according to requirement):
Efficacy Safety Suitability Cost
Group 1
Group 2
Group 3
Group 4
Selected Group is:
Give reasons for selection of the group.

4. Choose a P-drug according to criteria (Number of drugs may

increase or decrease according to requirement):
Efficacy Safety Suitability Cost
Drug 1
Drug 2
Drug 3
Drug 4
Selected P-drug is:
Give reasons for selection of the P-drug.
5. Details of the selected P-drug:
a) Active substance, Dosage form:
b) Standard dosage schedule:
c) Standard duration:

At the end, a plenary session will be held for one and a half hours where
different groups will present their prescription.

Assessment: Checklist & Maintenance of log book.

33
Checklist of Skill assessment for selection of P-drug.
Date:
Topic:
Roll no of the student:
Name of the assessor:
Criteria scale:
Sl Items Marks Score
1. Specify the therapeutic objective: 1

2. Enlisting effective group of drugs 1

3. Group selection with justification 3

4. P-drug selection with justification 3

5. Details about P-drug 1

Total 09

Feedback:

Signature of student:

Signature of assessor

34
 5. WRITE A RATIONAL, CORRECT AND LEGIBLE GENERIC
PRESCRIPTION FOR THE GIVEN CONDITIONS.

Background:A prescription is the prescribers order to pharmacist to prepare or

dispense a specific treatment for a specific patient given in a written form.
According to WHO (1985), “Rational use of drugs requires that patients receive
medications appropriate to their clinical needs, in doses that meet their own
individual requirements for an adequate period of time, and at the lowest cost
to them and their community”. These requirements will be fulfilled if the
process of prescribing is appropriately followed.
Competencies to be addressed:
The student should be able to: Level

Identify the parts of a prescription and realize the KH

importance of each.

Write a rational, correct and legible generic Performs

prescription for different clinical conditions.

Teaching learning methods:

Identify the parts of a prescription and realize the importance of each:

Hours: 2.

A faculty member introduces the parts of a prescription and discusses

the importance of each.A prescription order contains a series of
components that allow it to be interpreted and executed correctly. All
prescriptions should be written in ink or typed. A prescription should
include:

a) PRESCRIBER’S INFORMATION: - The name, professional degree, address

and telephone number (both the chamber and residence) and

35
 registration number should be included to identify the prescriber and
facilitate communication with other health care professionals. The
date of the prescription also should be mentioned.

b) PATIENT’S INFORMTAITON: - The patient’s name, age, sex and address

are needed on the order to assure that the correct medication goes to
the correct patient and also for identification and record keeping
purposes. For medications whose dosage involves a calculation, a
patient’s pertinent factors such as weight, age or body surface area
also should be listed on the prescription.

a) THE SUPERSCRIPTION: - ℞-Its appearance is purely symbolic. It is

generally believed to have originated as either an abbreviation of recipe
(Latin, “take thou”) or the symbol for Jupiter 21, the Roman God whose
blessing was requested in the healing arts.

b) THE INSCRIPTION: - The main body of the prescription consists of the

name and strength of the medications, the dose, the route, frequency
and duration of administration of each drug. In order to avoid any
confusion and mistake in dispensing, it is advisable to write quantities
less than one gram(g) as milligrams (mg). Thus, instead of writing 0.5g,
500mg is mentioned. Similarly, instead of writing 0.5mg it is advisable to
write 500 micrograms (no abbreviation). The strength of a solution is
expressed as the quantity of solute in sufficient solvent to make 100ml
(microliters). Thus a 10% solution of potassium chloride represents 10
grams of the salt per deciliter (g/dl).

e) THE SUBSCRIPTION: - Written instruction to the dispenser concerning

preparation and dispensing of the prescription. This part should be
clear and understandable to the pharmacist. With the advent of
proprietary preparation this part is rarely used now-a-days.

f) SIGNATURA: - Instructions to the patient regarding intake of the

prescribed drugs. It clearly indicates the mode and frequency of
administration. The direction for use of the medications should be
36
 clear and simple, and explained to the patient by the physician and the
pharmacist. If the drug is to be taken at a specific time (at bed time or
after meals), this has to be clearly mentioned. Latin abbreviations, very
popular at one time, are infrequently used now-a-days. Some
common abbreviation still in use are given below. Instructions may be
written in local language if needed.
Note: It is always safer to write out the direction without
abbreviating.

g) PHYSICIAN’S SIGNATURE WITH DATE: Physician’s signature with date

should be given at the bottom and right side of the prescription.

Commonly used abbreviations in prescriptions:

Sl Abbreviations Explanation
No.
ac before meals
bid twice a day
cap capsule
g gram
hs at bedtime
IA intra-arterial
IM intramuscular
IV intravenous
kg kilogram
mEq, meq milliequivalent
mg milligram
mcg,g microgram (always write “microgram”)
OD once a day
pc after meals
PO by mouth
PR per rectum
qid four times a day
SC subcutaneous
sos if needed
stat at once
sup, supp suppository

37
 susp suspension
tab tablet
tbsp tablespoon (always write “15 mL”)
tid three times a day
tsp teaspoon (always write “5 mL”)
U units (always write “units”)
vag vaginal

1. Write a rational, correct and legible generic prescription for different

clinical conditions:

38
Hour: 10 (5 sessions for different clinical conditions will be conducted
each session with 2hours duration).
Group tasks will be distributed. About twenty minutes will be allocated
for the group tasks. Each group will prepare a prescription for the given
clinical condition following the guidelines for writing good prescription
like:
Making a specific diagnosis
Consideration of the pathophysiology of the diagnosis selected
Selecting a specific therapeutic objective
Selecting appropriate drug
Determining the appropriate dosing regimen
Providing appropriate information to the patient
Devising a plan for monitoring the drug’s action.

The following materials will be provided to each group for preparing the
prescription:
Current guidelines for treatment of different conditions for choosing
appropriate therapy.
National List of Essential Medicines 2015 for choosing drugs from the
list.
CIMS/MIMS for assessing cost.
Guidelines on format of prescription.

At the end a plenary session will be held for one and a half hours where
different groups will present their prescription.

Assessment: Skill assessment for writing prescription by using check-list

(Format given below).

39
 Checklist for Skill assessment of writing prescription.
Date:
Topic:
Roll no of the student:
Name of the assessor:
Criteria scale:
a) Legible handwriting:
Unsatisfactory Satisfactory Superior
1 2 3 4 5 6 7 8 9

b) Different components of prescription:

Unsatisfactory Satisfactory Superior
1 2 3 4 5 6 7 8 9

c) Selection of drug, drug name in capital, dosage form, dose, duration:

Unsatisfactory Satisfactory Superior
1 2 3 4 5 6 7 8 9

d) Non-pharmacological advice:
Unsatisfactory Satisfactory Superior
1 2 3 4 5 6 7 8 9

e) Overall assessment
Unsatisfactory Satisfactory Superior
1 2 3 4 5 6 7 8 9

Feedback:

Signature of student:

Signature of assessor:

40
 6. COMMUNICATE WITH THE PATIENT REGARDING OPTIMAL
USE OF DRUG THERAPY.
Background: NMC has implemented Attitude, Ethics and Communication
module (AETCOM) as a longitudinal program in MBBS curriculum that will help
students acquire necessary skills in the attitudinal, ethical and
communicational domains. However, effective interpersonal communication
between doctor and patient in relation to optimal use of drug has a pivotal role
for any effective and successful therapy. Considering this fact, communication
skill in relation to optimal use of drug therapy is kept in this section.
Competency to be addressed
The student should be able to: Level
Communicate with the patient regarding optimal use Performs
of drug therapy for a clinical condition.

Teaching learning methods:

A short introduction on communication and its importance for 1 hour will be
given in large group session. The following points will be emphasized in
sequence:
1. Elements of 5-R Framework in communication:
A. Reason:
o Explain disease.
o Explain why the drug is prescribed.
o When the drug effect is expected to occur.
o Importance of completing the course.

B. Regimen
o Drug name, Dose, Frequency, Durafion
o How to prepare
o Advice regarding relation to load
o Advice about missed dose
o Storage
o Adjutant therapy.

C. Risks
o Common ADRs: What should be done? Tolerate/ Treat/ Visit if
persistent or severe.
41
 o Serious ADRs: What should be done? Stop the drug and contact
immediately.
o Concomitant drugs to be avoided/ Diseases to be informed.

D. Revisit instructions:
o When to come?
o Whether to get tab report?
o When to come early? If complaints persists.
o Whether husband Io be treated?

E. Revision Statements
o Ask the patient whether everything is clear.
o Patient has any questions.
o Ask the patient to repeat the most relevant points
o Repeat what the patient has forgottenReassurance
o For short-term therapy: flat to worry, you will be alright soon.
o For tong term or lifelong therapy: If you take the medicines regularly as
prescribed and follow the given advice, then you can enjoy a good quality
healthy life despite medication.

2. Communication skills Involve listenlng, speeking, observing and

empathising.
a. Do’s for effective communication:
o Listen actively: This is the first step of effective communicalJon. Look
interested in while the patient has to say (e.g. by nodding).
o Keep your devices on silent mode or turn off: Display your
involvement and active listening. In addition, it indicates that you
value another person’s time as much as your own.
o Limit communication: Be brief, yet specific. Tell what is essential with
clarity.
o Keep it positive: Begin all communication on a positive note. Speak with
conviction. Offer the best possible solutions to ADRs that may likely
to occur.
o Speak in assertive manner: Being well informed, having clarity of
thought and precision in your communication will demonstrate your
confidence. This will help in trust development in patients.

42
 o Use of ‘professional language’: Use simple language that patient can
understand. Avoid jargon. Avoid any lose talk.
o Show that you Care: Remember. Non-verbal cues speak volumes! Be human-
centered in your approach that helps you in building therapeutic
relationship with your patients.
o Treat your patient with respect: Do not talk down to your patient. Keep eye
contact.
o Use of questions: Allow questions if patient wishes clarification and clarify. Ask
questions to check that the information provided is clearly understood.
o Be calm and consistent: Maintain consistent body language and keep an
even tone of voice.
b. Don’ts for effective communication:
o Avoiding eye contact.
o Inappropriate facial expressions that can annoy patient.
o Using hands constantly and purposelessly (e.g. jingling coins, c l i cking
pen, playing with keys etc.).
o Standing or silting too close to the patient.
o Exhibiting negative feelings like anger, boredom, and confusion through
body language.

After that, some video of role play in relation to communication skill can
be shown to the students. Some case scenario can be discussed with the
students by role-play. One example of such case Scenario is given below:
Casa Scenario:
A 30-year- old married lady, Mis Arpita Joshi, comes to the gynaeœlogy OPD with
complaints of vaginal discharge and pruritus since last 3 days. You enquire about
her menstrual history. She informs her periods are regular and her LMP was 10
days back. She informs you that she has been married since last 1 year and it is
the first time she has experïenced such symptoms. You as the treating
gynaecologist perform per speculum examination which reveals a creamy, foul
smelling discharge with vascular congestion of the vagina and cervix. No other
abnormallty is detected on per vaginal examination. Wet smear of the vaglnal
discharge demonstrates the presence of trichomonas vaginalis. You confirm the
diagnosis as Trichomonas vaginalis. You inquire whether Mrs. Joshi in the past has
any liver disease or seizures. She informs that she has not suffered from any such
illness in the past. You also enquire whether she drinks alcohol, regularly or at
social occasions. She replies that she teetotaler.

43
 You wrlte the followlng prescnption for Mrs. Arpita Joshi.

Tab. METRONIDAZOLE (500 mg) 4 tablets orally stat as a single dose

after dinner To avoid sexual Intercourse for 15 days or use a condom
To request husband of Mrs. Joshi to visit the clinic tomorrow.

Information regarding the prescription for patient having

Trichomonas vaginalis to be communicated:
Mrs. Joshi you are having vaginal infection due to a parasite catled Trichomonas
vaginalis. This Infection is acquired through sexual intercourse. However, do not
worry; there is an effective treatment for this infection. I am prescribing you
Metronidazole, which will kill the infective organisms.
Please make 4 tablets one after another with a full glass of water or milk to
prevent stomach upset, preferably after dinner. This is a single dose one-time
therapy. You will get relief within 2-3 days. Inform me if your condition persists
or worsens.
Please remember that this dose of metronldazoie Is llkely to cause nausea, loss
of appetite, constpation, stomach pain, and dry mouth. It also produses metallic
taste in mouth. One may develop dizziness, headache or diarrhoea. You should not
preferably drive, use machinery, or do any activity that requires alertness until you
are sure you can perform such activities safety. Though these side effects occur,
they are usually mild and do not require treatment. They usually subside in a day or
two. However, if you get any of these effects and they persist for a longer time or if
you feel they are severe, inform me promptly. You may pass dark coloured urine but
do not panic. It is harmless.
Rarely, some serious side effects occur like unsteadiness, seizures, mood changes
(such as confusion), numbness, tingling of hands/feet, painful urination, severe
persistent headache, sudden vision changes, stiff/painful neck, sore throat,
persistent fever, unusual bleeding/bruising and persistent vomiting and serious
allergic reactions may occur. If you experience any of these please contact me
immediately.

There is no problem as you do not drink alcohol but you must avoid any beverages
that contain alcohol like Irish coffee or any mocktails or liquor chocolates while
taking this medication and for at least next 3 days. Alcohol should not be taken in
any form, including drugs/ products e.g. cough and cold syrups that contain alcohol,
with this drug. This is because unpleasant symptoms like severe stomach upset,

44
cramps in abdomen, nausea, vomiting, headache and flushing are experienced,
if alcohol is taken during this therapy.

As this infection gets sexually transmitted, your husband also must be treated to avoid
re-infection in you. Please request Mr. Joshi to come tomorrow to the clinic for
treatment. For next 15 days, you should refrain from sexual intercourse or use a condom.
This medication has been prescribed for your current condition only. Remember there are
different types of infections that may gel sexually transmitted. In case your symptoms
recur, consult me.

I hope you have understood what I told you. Do you have any questions?
WiIl you repeat the important information I told you. (Patient needs to
report- when and how to take the drug, when relief expected, treatment of
husband, advice on alcohol)

Good. Remember-— (tell missing points If the lady forgets to report). I hope you
will be alright soon. Do not hesitate to contact me if you need any help.

Next also discuss the noncommunication/inadequate

communication and its harm as follows:

Non-communication/ Harm
inadequate communication
No instructions regarding what medicines Drug-drug interactions
are to be avoided with the prescribed leading to treatment failure or
medicine enhanced effects causing ADRs
Inadequate communication about how to Systemic absorption causing
administermedicines e.g. eye drops adverse effects
Improper administration of drugs: OR5 given Diarrhoea aggravation
with fruit juice
No instructions given for appropriate storage Degradation resulting in loss of
of efficacy
medicines( e.g. nitroglycerine / insulin)
No instructions given regarding how much Increases anxiety of parents-
time change of doctors/ unnecessary
the prescribed medicine will take to show useof antibiotics
itseHect, what is to be observed ( e.g. ORS Inadequate treatment: resistant
in diarrhoea) or how long to continue ( organisms , hypertensive crisis
e.g. antibiotics, antihypertensives etc.)
Lack of warnings: e.g avoidance of alcohol or Noxious manifestations ( due to
alcohol containing food items while on acetaldehyde) that result in abrupt
metronidazole discontinuation of therapy

45
Clinical scenarios for communication skill.
Chronic therapy: Epilepsy.
Mr. Sushanta Banik, 30 years, is brought to the OPD by his father with
history of generalized tonic clonic seizure, with two episodes of seizure
attack in the last one month. EEG confirmed the diagnosis and CT scan of
brain showed no abnormalities. You have prescribed Tab. Sodium
Valproate extended release 500 mg twice daily. Counsel Mr. Banik and
his father for the given prescription.

Short term antimicrobial therapy- Lower UTI.

Mrs. Anima Pal, 25 years, having one child has attended OPD with
features of Lower UTI. She is prescribed Tab. Nitrofurantoin 100mg
twice daily for 5 days. Counsel the patient regarding the drug therapy.

Emphasis on application of drugs: Scabies.

Master Amal, 10 years, is brought to the OPD by his mother with clinical
features suggestive of scabies. He is prescribed 5% Permethrin solution
for topical application. Counsel the mother regarding the drug therapy.

Chronic therapy: Essential hypertension

Mr. Prakash Das, 60 years, is diagnosed to have essential hypertension
and is prescribed Tab. Amlodipine 5mg once daily. Counsel the patient
regarding the drug therapy.

Short term antimicrobial therapy- Enteric fever.

Master Amal, 8 years (weight 20 kg) is diagnosed to be suffering from
enteric fever. He is prescribed Tab. Cefixime 200mg twice daily for 14
days and Tab. Paracetamol 250mg as and when necessary. Counsel the
mother regarding the drug therapy.

Emphasis on application of drugs: Glaucoma.

Mrs. Kavita Roy, 45 years, is diagnosed to be suffering from chronic
glaucoma. She is prescribed Latanoprost 0.005% eye drop, one drop in
each each eye once daily in the evening. Counsel the caregiver of the
patient regarding the therapy.

46
Chronic therapy: Chronic gout.
Mr. Rajesh Paul, 45 years, has attended the OPD with increased serum
uric acid. He is diagnosed to be suffering from chronic gout and Tab.
Allopurinol 100mg once daily is prescribed. Counsel the patient
regarding the drug therapy.

Hypopthyroidism:
Mrs. Kabita Koloi, 40 years, has attended OPD with features of
hypothyroidism like lethargy, fatigue, feeling cold, hair loss, weight gain
& irregularity in menstrual cycle. Her thyroid profile is as follows:
T3- 112 (100- 200 ng/dl)
T4- 06 (5- 11 µgm/ dl)
TSH- 10 (0.4- 4.5 mIU/ml)
She was prescribed Tab. Levothyroxine 25 µgm once daily. Counsel the
patient regarding the drug therapy.

Short course antimicrobial therapy in URTI: A patient has come with

complaints of cough with purulent sputum, running nose and spiking
fever for 4 days. He has taken paracetamol and fever has not come
down. You have made a diagnosis of upper respiratory tract bacterial
infection and prescribed Capsule Amoxicillin 500mg thrice daily for 5
days and Paracetamol SOS. How would you counsel the patient?

Long course antimicrobial therapy in pulmonary tuberculosis: A 45

year old male patient has been diagnosed with pulmonary tuberculosis.
He has been informed that he will be on RNTCP regimen. INH,
rifampicin, pyrazinamide and ethambutol for 2 months, followed by INH,
rifampicin and ethambutol for 4 months. Pyridoxine 20mg once a day at
night. The patient is worried about taking the drugs for 6 months. He
feels these will have side effects. He also tells you that he is the bread
earner of his family and cannot afford these drugs. How would you
counsel this patient?

Assessment: By using checklist as given below.

47
 Checklist for assessment of communication skill.
Date:
Topic:
Name of the assessor:
Criteria scale:
a) Reason for prescribing the drug (s):
Unsatisfactory Satisfactory Superior
1 2 3 4 5 6 7 8 9

b) Regimen of the prescribed drug (s) along with non- pharmacological advices:
Unsatisfactory Satisfactory Superior
1 2 3 4 5 6 7 8 9

c) Risk (s) involved in the prescribed drug therapy:

Unsatisfactory Satisfactory Superior
1 2 3 4 5 6 7 8 9

d) Revisit instructions:
Unsatisfactory Satisfactory Superior
1 2 3 4 5 6 7 8 9

e) Revision & re- check:

Unsatisfactory Satisfactory Superior
1 2 3 4 5 6 7 8 9

f) Promoting adherence to therapy:

Unsatisfactory Satisfactory Superior
1 2 3 4 5 6 7 8 9

g) Non- verbal cues:

Unsatisfactory Satisfactory Superior
1 2 3 4 5 6 7 8 9

h) Overall assessment:
Unsatisfactory Satisfactory Superior
1 2 3 4 5 6 7 8 9

Feedback:

Signature of student:

Signature of assessor:

48
 7. PERFORM AND INTERPRET A CRITICAL APPRAISAL (AUDIT) OF
A GIVEN PRESCRIPTION.
Background: The inappropriate use of drugs is a global health problem,
especially in a developing country like India. Irrational prescriptions have an ill
effect on health as well as health-care expenditure. Prescription auditing is an
important tool to improve the quality of prescriptions, which in turn improves
the quality of health care provided.
Competency addressed:
The student should be able to: Level
1. Understand the concept of prescription audit K

2 Perform and interpret a critical appraisal (audit) Performs

of a given prescription.

Teaching learning methods:

Understand the concept of prescription audit
Hours: 2
A teacher will explain the concept of prescription audit and the various
parameters to critically appraise a prescription.
The following aspects to be looked for during critical appraisal of a
prescription:
Format of the prescription: Look for the completeness of the different
parts of prescription like prescriber’s information, patient’s information,
superscription, inscription, subscription, signatura, signature of the
prescriber with date and non-pharmacological advices. Check whether
diagnosis is recorded or not in the prescription. The generic name of the
drug should be used as far as practicable.

Common Errors in the format of Prescription:

Dosage form: The dosage form of drug like tablets, capsule and injection
must be mentioned as prefix of the drug. If the dosage form is not
mentioned in the prescription, pharmacist/patient decides on their own
about the dosage form. Suppose a patient is prescribed an injection for a
serious infection, but he takes only tablets.

49
Strength of the dosage form: Missing strength of the prescribed drug in a
preparation can cause havoc with lives of patients. Error in strength of
the dosage form when prescribing to children can lead to serious
adverse effects. Sometimes you may find a prescription for an amount
that does not exist.

Use of decimal points: Decimal points has to be used with caution to

avoid ambiguity. For example:
5 mL to be used instead of 5.0 ml to avoid misinterpretation of 5.0 = 50.
0.5 ml to be used instead of .5 ml to avoid misinterpretation with .5= 5.
0.5 ml to be used instead of .50 ml to avoid misinterpretation with .50 =
50.
Decimals altogether should be avoided by changing the units: 0.5g =
500mg.

Length of therapy: This is a common error with most of the

prescriptions. The result is that most of patients decide on their own
when to stop or when to restart. This leads to irrational use especially
with antimicrobials. With antimicrobials you need to be very specific
about duration.

Date: Very important to track back when medication was started, how
much time has passed and when to refill prescription.

Signature & Registration number: May sometimes be missing on

prescriptions. These mistakes are now a days considered very serious
because of consumer protection act (CPA).

Directions: A busy physician will not explain or explain in such a hurry

that the patient does not understand or understand in incorrect way,
e.g. a lady took methotrexate daily which was to be taken weekly. She
died because of severe bone marrow suppression. Most commonly, drug
error results from a patient's confusion about how to take drugs. Drugs
may be administered incorrectly. A drug may be given to the wrong
patient, at the wrong time or by the wrong route. Certain drugs must be

50
given slowly when given IV, and some drugs cannot be given
simultaneously.

Hand writing: Bad hand writing often leads to confusion. The

prescription has to be written legibly. If the physician has poor writing,
preprinted or typed prescriptions may help. It is a good practice to write
the drugs in generic names and in capitals letter. Special caution to be
taken for "look-alikes" and “sound-alikes" drugs. Some examples of such
drugs are:
Acetazolamide & acetohexamide.
Cotrimoxazole & clotrimazole
Chlorpromazine & chlorpheniramine.
Cycloserine & cyclosporine
Eltroxin (levothyroxin) & althrocin (erythromycin)

Avoid uncommon abbreviations. Latin abbreviations such as q.i.d. may

be interpreted as q.d. or o.d. and are no longer recommended. Avoid
non-standardized units such as "teaspoons" or "tablespoons." Write out
numbers as words and numerals, for example dispense 30 (thirty)
tablets.

a. Choice of drug(s) for the given condition: For appropriate selection

of a drug, both the drug and patient factors have to be considered.
The DRUG FACTORS will include risk-benefit ratio, its proven efficacy,
safety, suitability, the formulation, route of administration, dosage
regimen, duration of treatment and cost consideration from different
alternatives. The PATIENT FACTORS will include, presence of
concomitant disease, extremes of age, hepatic and renal impairment,
pregnancy, lactation and genetic factors. In multiple drug therapy the
possibility of drug interactions has to be considered.
b. Prescription of drugs from National List of Essential Medicine
(NLEM): Essential drugs are selected with due regard to public health
relevance, evidence on efficacy and safety, and comparative cost
effectiveness. India produced its National Essential Drugs List in 1996,
and has revised it in 2011, and now in 2015 with the title "National
List of Essential Medicines." The latest list includes 376 medicines, of

51
 which 20 are FDCs. These medicines have been marked into 3
categories for being available at primary, secondary and tertiary
levels ofhealth care facility. It is advisable to prescribe drugs from
"National List of Essential Medicines" as far as possible.
c. Over prescription: Overprescription occurs when doctors prescribe
drugs to patients who do not need them. Antibiotics and analgesics
are common examples. Aggressive marketing by drug companies is
sometimes cited as a reason for overprescription.
Under prescription: Under prescription is the lack of an indicated drug,
while no reason could be found for not prescribing it. Under prescription
can be considered to be an important part of inappropriate prescribing.
Undertreatment in middle-aged and elderly patients is reported in a high
percentage for cardiovascular diseases, hyperlipidemia, osteoporosis,
COPD, depression and cancer.

Perform and interpret a critical appraisal (audit) of a given prescription.

Total hour: 10 hours (5 sessions will be conducted each session with

2hours duration).

Group tasks will be distributed. About twenty minutes will be allocated

for the group tasks. Each group will perform critical appraisal of
prescription using the following materials:
Drug information literature.
MIMS/ CIMS.
National list of essential medicine (NLEM).
Prescriptions for critical appraisal.
Format for critical appraisal of the given prescription:

Format for critical appraisal of the given prescription:

Sl Parameters for performing critical Interpretation

appraisal of the given prescription.

1 Format of the prescription. Complete/ Incomplete

(If incomplete, specify)

52
2 Proper recording of diagnosis. Yes / No

3 Use of drug nomenclature. Generic name / Brand name.

4 Legible hand writing Yes/No

5 Use of uncommon abbreviations. Yes/No

6 Choice of drug(s) for the given Correct / Incorrect

condition (Give reasons).

7 Drugs are prescribed from NLEM Yes / No

8 Over prescription Yes / No

(Give reasons).

9 Under prescription Yes/ No

(Give reasons).

10 Summary of interpretations:
a.
b.
c.
d.

Assessment: Skill assessment by using check-list (Format given below).

53
Checklist for assessment of critical appraisal of a given
prescription.
Date:
Topic:
Roll no of the student:
Name of the assessor:
Criteria scale:
Sl Critical analysis of the Items Marks Score
1 Format of the prescription 2
2 Diagnosis is recorded in the 1
prescription, Drug Nomenclature
used, legible hand writing, use of
uncommon abbreviations.

3 Choice of drug(s) for the given 2

condition
4 Drugs are prescribed from NLEM 1

5 Over prescription 1

6 Under prescription 1

7 Conclusion 1

Total 09

Overall score: Not satisfactory : 1-3.

Satisfactory : 4-6.
More than satisfactory : 7-9.

Feed back:

Signature of student:

Signature of assessor:

54
 8. PERFORM A CRITICAL EVALUATION OF THE DRUG
PROMOTIONAL LITERATURE.
Background: All informational and persuasive activities by manufacturers and
distributors, the effect of which is to induce the prescription, supply, purchase
and /or use of medicinal drugs is termed as drug promotion. About 15-20% of
budget of a pharmaceutical industry is for promotion of products. One of the
most important sources of drug information to the clinicians is the promotional
literature provided by the pharmaceutical companies. Drug promotion
influences physicians, especially those in training. Hence the information
provided in this promotional literature should be factual, evidence-based,
unambiguous and balanced. Unfortunately, most of the times, these literatures
are neither factual nor evidence based. Every physician should be equipped
with necessary skills, patience and knowledge to critically evaluate the
information provided in the drug promotional literature.
Competency addressed:
The student should be able to Level
Critically analyse drug promotional literature Performs

Teaching learning methods:

Hours: 10 (2hours each for 5 different drug promotional literatures)
A brief introduction (15-20 mins.) on drug promotion will be given by a faculty
member highlighting its advantages anddisadvantages, ethical and unethical
aspects. The ethical criteria for medicinal drug promotion andits key messages
will be discussed. The batch will be divided into groups of 5-6 students each
andeach group will be given one or two printed drug promotional material and
asked to critically evaluate the promotional literature (30minutes) followed by
a plenary discussion (one and a half hours).

Drug promotional literature is critically analysed for:

1. Validity of scientific claims:

 Check the claims made in the promotional literature. Claims are
made about the efficacy, safety, cost, convenience,
pharmacokinetic properties. Some examples of extravagant
emotional claims are: 1st of its kind, flavored, packaging

55
 characteristics, etc. The promotional claims should be current,
accurate, balanced and not misleading, either directly or by
implication or omission.
 Relevance of references cited: Check whether there are sufficient
references to substantiate the claims made by the new products.
Design and methodology of the study should also be checked.
Clinicians should be equipped to identify studies of poor
methodological quality. Retrievability and validity of references
should be checked as well.

2. Content of scientific information:

 Drug name size: Letters of the generic names should be at least half as
large (actual size, not the font size) of the proprietary names. The
generic names should have the same prominence as that of proprietary
names (in terms of typography, layout, contrast and other printing
features).
 Clinical information:
 Indications
 Dosage form or regimen
 Contraindications
 Precautions and warnings (reference to pregnancy, lactation etc.)
 Adverse effects
 Drug interactions (included only if clinically relevant; drugs used for self-
medication should be included).
 Over dosage- brief clinical description of symptoms, non-drug treatment
and supportive therapy, specific antidotes.

3. Appropriateness of illustrations:
 Pictures: The type and relevance of the pictures should be assessed.
 Scientific table and graphs: Tables and graphs should be proper with
appropriate legends, data presentation, axes and appropriate
references. Many a times, pseudographs (graphical presentation
without proper axes, labeling legend) are presented in drug
promotional literature.
Assessment: By using the checklist as given below.

56
Format for critical evaluation of the drug promotional literature:
1. Validity of scientific claim (s):
Scientific claims Mention the scientific Appropriate/Inappropriate.
claims. Justify:
2.Content of scientific information:
a. Approved therapeutic Enlist the therapeutic Complete/Incomplete.
uses. uses given in DPL. Justify:
b. Dosage regimen. Mention the dosage Complete/Incomplete.
regimen (if given in Justify:
the DPL).
c. Adverse drug reactions. Mention the adverse Complete/Incomplete.
drug reactions (if Justify:
given in the DPL).
d. Contraindications. Mention the Complete/Incomplete.
contraindications (if Justify:
given in the DPL).
3. Appropriateness of illustrations:
a. Drug name. i. Write the generic name:

ii. Write the brand name:

b. Size of brand name as Mention the ratio of Meets the criteria/ Does
compared to generic the generic name to not meet the criteria.
name. brand name given in Justify:
the DPL.
c. Picture (if any). Mention scientific Give your comment:
relevance of picture in
relation to medicine,
disease or therapy.
d. Scientific tables & Analyze the scientific Give your comment:
graphs (if any). tables and graph on
the following
parameters:
Proper axes /Labeling/
Legend/Appropriate
scientific content.
4. Conclusion:

57
Checklist for assessment of critical evaluationof drug
promotional literature.
Date:
Topic:
Roll no of the student:
Name of the assessor:
Criteria scale:

Sl Critical analysis of the Items Marks Score

1 Validity of scientific claims 3

2 Content of scientific information: 3

3 Appropriateness of illustrations 3

Total 09

Overall score: Not satisfactory :1-3.

Satisfactory : 4-6.
More than satisfactory : 7-9.

Feed back:

Signature of student:

Signature of assessor:

58
 9. TO RECOGNISE & REPORT AN ADVERSE DRUG REACTION.
Background: Any substance that is capable of producing a therapeutic effect
can also produce unwanted or adverse effects. Lack of knowledge of
pharmacovigilance and adverse eventreporting culture among the healthcare
providers have been identified as major factorsfor under reporting of adverse
events in developing countries.
Competencies to be addressed:
The student should be able to: Level
Recognize an adverse drug reaction (ADR)& know K
NationalPharmacovigilance Programme of India.
Report an adverse drug reaction (ADR). Shows how
Teaching learning methods:
To recognize an adverse drug reaction (ADR).
Hour: 2.
A faculty member will define the different terminologies in relation to ADR and
explain the different types of ADRs with example and management. He / She
will also discuss the NationalPharmacovigilance Programme of India. They will
be taken to ADR monitoring center.
To report an adverse drug reaction (ADR), The student will be made
acquainted with the different aspects of “SUSPECTED ADVERSE DRUG
REACTION REPORTING FORM” of Indian Pharmacopoeia Commission. The
students will then be provided a clinical scenario of ADR for filling up the
different parts of the form. The student will also assess causality of adverse
events with the help ofWHO
SCALE OF CAUSALITY ASSESSMENT.
CATEGORY TIME DISEASE OR OTHER DECHALLANGE RECHALLANGE
SEQUENCE DRUGS PROVIDE
PLAUSIBLE EXPLANATION
CERTAIN YES NO YES YES
PROBABLE YES NO YES NO
POSSIBLE YES YES NO NO
UNLIKELY NO YES NO NO

Assessment: Skill assessment by check-list as given below.

59
Case scenarios for reporting adverse drug reactions:

1. AD, 60-year-old hypertensive and diabetic was on tablet enalapril

10mg twice daily since 02/03/2020. He developed drycough after 2
months of taking the drug. It was replaced with tablet losartan 50mg
once daily on10/05/2020. Thecough subsided.

2. RG, 40-year-old unmarried female patient was diagnosed as

schizophrenia and started on tablet haloperidol 5mg once daily from
10/04/2020. After 2 weeks of therapy, she developed tremors and
musculardystonia. Then tablet haloperidol was replaced with tablet
olanzapine 5 mg once daily since 26/04/2020 and the symptoms
were subsided.

3. BG, 25 year-old- female was diagnosed as generalized tonic-clonic

seizure and started on tablet valproate 200 mg thrice daily with effect
from 20/01/2020. Meanwhile she became pregnant. In first trimester
USG abdomen on 22/04/2020 showed neural tube defect. Tablet
valproate was replaced with tablet phenobarbitone.

4. CB, 9 years old male child was diagnosed as a case of acute

lymphoblastic leukemia andchemotherapy was given on 02/02/2020
which includes vincristine, l-asparaginase, cytarabine
andprednisolone. After a week some of his laboratory data were as
given below,
Serum amylase = 260 U/L (n-20 to 96 U/L)
Serum lipase = 150 U/L (n-3 to 43 U/L)
Haemoglobin = 11.6 gm/dl
Total leucocyte count = 6900 cells /cu mm
Platelet count = 1.3 lacs/cu mm
Chemotherapy was not stopped.

5. DG, 45 years old female was diagnosed as a case of rheumatoid

arthritis 1 year back and wastaking NSAIDS but her condition was not
improving. She was started on tablet methotrexate 7.5mg once
weekly on 18/03/2020.She was on regular blood monitoring. After 2
weeks her Hb – 8gm/dl and peripheral bloodsmear shown

60
 anisocytosis, poikilocytosis, macrocytes. The drug was stopped and
within amonth the blood report was normal.

6. AD, 73-year-old woman with a history of deep venous thrombosis of

the lower limbs wasstarted with sunitinib 37.5 mg daily from
03/03/2020 for renal cancer with hepatic and pulmonary
secondaries. While on thistreatment, she noticed painful ulcers of the
right lower limb on 15/03/2020, despite having neverpreviously
presented leg ulceration. On discontinuation of sunitinib on
17/03/2020, the lesions improved.The drug was reintroduced at a
lower dosage of 25mg daily on 27/03/2020, resulted in relapse of her
ulcers.

7. RD, (01 year / Male), weighing 9.5 kg, was under the therapy of
monocef-O Syrup 50mg twice daily since 02/03/2020 for the
treatment of a bacterial infection. But since 03/03/2020 he
developed loss of appetite. Monocef-O syrup was stopped by
06/03/2020 and the patient was recovered by 08/03/2020. The
patient was also under the therapy of Paracetamol syrup 120mg
orally once in 6 hrs since 02/03/2020 for fever. The patient had a
history of urine infection before.

8. LD, (30 years/Female), was under the therapy of Tablet

carbamazepine 400mg twice daily for convulsion since 20/02/2020.
But since 22/02/2020 she started developing Toxic Epidermal
Necrolysis. For that she was being hospitalized for some days. The
medication was withdrawn on 24/02/2020 and the patient was
recovered by 04/03/2020.There was no information about the
concomitant medications & medication history available.

9. MB, a 56 years old housewife of unknown weight, visited her doctor

with a complaint of general weakness. She is hypertensive and
receiving NATRILIX SR 1.5mg and STAMLO 5mg tablets once daily
each on a long term basis. Her doctor ordered various blood tests
which reveals Hemoglobin to be 10.2gm/dl (Normal: 13gm/dl) and
serum sodium to be 127mmol/L (Normal: 135mmol/L). The doctor
withdraws NATRILIX SR 1.5mg and after 10 days of withdrawal, serum

61
 sodium level comes to 137mmol/L with some improvement in
weakness & her Blood pressure however climbs to 160/100 mmHg.

10.Mr. Nitin Biswas (65 yrs/M, Wt=68 kg) was admitted in the Medicine
ward of TMC & Dr. BRAM Hospital on 09-06-2018 at 2.20 pm with a
history of syncope 10 mins back. His blood pressure was 60/40
mmHg, pulse rate was irregular, rapid and feeble. ECG monitoring
showed the tracing as below:

A diagnosis of ventricular flutter was made. Blood examination revealed,

Na+= 138 mEq/L, K+= 1.5 mEq/L, RBS= 90 mg/dl, Urea= 14 mg/dl ,
Creatinine= 0.8 mg/dl. Drug history revealed that for the last 5 yrs he
was taking Tab. Enalapril-5mg, 1 tab OD, Tab. Digoxin 0.25mg, 1 tab OD
and Tab. Carvedilol 3.125 1 tab BD for the treatment of Congestive heart
failure. For his severe pedal oedema he was also given Tab. Furosemide
40mg, 1tab OD everyday morning for the last 10 days. After admission all
the drugs were stopped and the patient was treated with inj. Lidocaine
100mg IV bolus, potassium supplementation & other supportive
measures.

11.SD, a 28-year-old unmarried female was admitted in the female

Psychiatry ward for treatment of bipolar affective disorder on
20.01.2020. From the day of admission, she received tab divalproex
sodium 1000mg /day and tab lorazepam 2 mg at bed time. With the
treatment, the psychiatric problems improved & her discharge was
planned on 10.02.2020 with due advice. However, due to appearance of
red spots on the skin that looked burnt, the discharge was withheld. The
next day, blisters were seen on the skin, in the mouth & nose, & she was
referred to medicine ward & case was diagnosed as SJS. Divalproex
sodium was stopped on the same day. She was admitted in the medicine
ward & given supportive treatments. Skin care was provided with
regular dressings, topical steroids & antibiotics in consultation with
dermatologists. She was discharged after improvement on 15.03.20 with
the advice to attend psychiatry OPD.
62
12.Mr AG, a 30 years old male patient with 68kg weight was diagnosed as a
case of bacterial meningitis. He was started empirically with injection
ceftriaxone 1gm IV twice daily& injection vancomycin 500mg IV four
times daily on 12/01/2020. First dose of injection ceftriaxone was given
at 8.00 am and injection vancomycin at 9.00am on 12/01/2020. After 10
min of second drug administration, he started developing chills, rigors,
fever, urticaria& intense flushing. He was treated with injection
pheniramine 25mg IM, following which the reaction subsided & injection
ceftriaxone was continued. However, next dose of injection vancomycin
scheduled on day 1 was not given. On day 2, injection vancomycin was
re-introduced at 9.00 am but similar symptoms appeared again & quickly
resolved after injecting injection pheniramine 25mg IM.

13.Kamla Devi, a 70-year-old female patient admitted to hospital on

20.01.2020 with chief complaints of pain in upper abdomen and nausea
since last 5 days. On physical examination, she had yellowish
discoloration of palm, conjunctiva, and nail bed. Her weight was 62 kg.
She had few episodes of psychotic attacks, for which she was on
Chlorpromazine therapy since last 4 weeks. On enquiry, she told that she
was taking Tab. Megatil (Chlorpromazine) 200 mg, 2 tablets at bed time.
She was also taking Tab. Drotin (Drotaverin) 80 mg twice-a-day (self-
medication) for abdominal pain for 3 days before admitting to hospital.
She was investigated on the day of admission for laboratory parameters,
which are as follows: Alkaline Phosphatase = 200 U/L (Normal range: 25
– 100 U / L), ALT = 250 U/L (Normal range: 10 – 40 Units / L), Total
Bilirubin = 7.0 mg/dL (Normal range: 0.8 – 1.2 mg / dL). On admission,
Chlorpromazine and Drotaverin therapy was stopped. After 7 days of
stopping the medications, the intensity of pain decreased. Also, she was
re-investigated for above parameters which are as follows: Alkaline
Phosphatase = 100 IU/L ALT = 80 Units/L Total Bilirubin = 1.5 mg/dL.

14.36 years old female patient was suffering from acne all over her face.
She visited dermatologist on 7/12/18 and was prescribed with Trimovate
(clobetasol+nystatin+oxytetracycline) cream to apply over the affected
area twice daily. Her problem was resolved within few days & she

63
 stopped applying the cream. But within 3 days of stopping the drug,
rashes developed all over her face & she again started to apply the
cream & got cured. After stoppage of the cream, rashes reappeared
excessively. Ultimately the drug was withdrawn by the doctor.

15.LRH, 35 years, female, weighing 46 kg, was under the therapy of

Phenytoin tablet 100mg once daily for the treatment of epilepsy since
20/ 04/ 2018. But on 05/ 05/ 2018, the patient developed erosions in
the oral cavity and genital mucosa and papules in the legs. It was
diagnosed as Steven Johnson Syndrome (SJS). The patient was
hospitalized and the doctor withdrawn the medication on 07/ 05/ 2018.
The patient was recovered on 28/ 05/ 2018. Some lab data wre:
Hb: 10.9 g/dl
Blood urea: 38 mg/dl
Serum creatinine: 1.2 mg/dl
There was no medical history & concomitant medications available.
16. AR is a 65-year-old man, weighing 70 kg, who has been receiving Tab.
Losacar- H (Losartan 50 mg + Hydrochlorothiazide 12.5 mg) for essential
hypertension for at least past one year and has his blood pressure under
control. One afternoon he suffers an episode of unexplained confusion
and weakness, lasting for about 1 hour, which recovers spontaneously.
He undergoes, on his own, several blood tests the following morning and
only abnormality detected is serum sodium 129 mEq/ L (Normal: 135-
145 mEq/ L). his physician withholds Tab. Losacar- H and replaces it with
Tab. Losacar- A (Losartan 50 mg + Amlodipine 5mg). there are no further
episodes and 7 days later a repeat blood test shows serum sodium 137
mEq/ L. the blood pressure is now recorded to be 140/ 90 mmHg at rest.

17. Miss DG, a 4-year-old girl had vomited twice and had loose motion five
times in the morning on 20/01/2022. She was given injection
metoclopramide IM single dose, metronidazoe oral suspension 200mg
thrice daily and oral rehydration solution. After about 2 hours, she
developed rigid neck, tilted head to one side, clinched teeth and
intermittent purposeless movements of the upper limbs.

64
65
 No: 9.1

66
Checklist of Skill assessment for filling up ADR form.
Date:
Topic:
Roll no of the student:
Name of the assessor:
Criteria scale:
a) Description of event/reaction:
Unsatisfactory Satisfactory Superior
1 2 3 4 5 6 7 8 9

b) Filling up of suspected medication:

Unsatisfactory Satisfactory Superior
1 2 3 4 5 6 7 8 9

c) Causality assessment:
Unsatisfactory Satisfactory Superior
1 2 3 4 5 6 7 8 9

d) Assessment of seriousness of reaction:

Unsatisfactory Satisfactory Superior
1 2 3 4 5 6 7 8 9

e) Filling up of other information:

Unsatisfactory Satisfactory Superior
1 2 3 4 5 6 7 8 9

f) Overall assessment
Unsatisfactory Satisfactory Superior
1 2 3 4 5 6 7 8 9

Feedback:

Signature of student:

Signature of assessor:

67
 10. DEMONSTRATE THE EFFECT OF DRUGS ON BLOOD
PRESSURE USING COMPUTER AIDED LEARNING.
Background: Animal experiments have become difficult due to problems of
availability, procurement, cost, maintenance, use of animals and ethics
regulations. Guidelines by Committee for the Purpose of Control and
Supervision of Experiments on Animals (CPCSEA) and Medical Council of India
(MCI), suggest ‘3 R’ i.e. Reduction, Refinement and Replacement in animal
experiments, with the 4th ‘R’(Rehabilitation) added as an added measure for
animal care. A change in MCI recommendation insists that computerized
learning should be an alternative to live animal experiments.
Competency addressed
The student should be able to: Level
1. Understand the concept of computer aided K
learning
2 Demonstrate the effect of drugs on blood Performs
pressure using computer aided learning.
Teaching learning methods: Understand the concept of computer aided
learning.
Hours: 2
A teacher will explain the concept of computer aided learning and the soft-
wares used for this purpose.
Replacement of animal experiments by computer aided learning has made
pharmacology learning highly interactive and motivating. Computer aided
learning improves students’ critical thinking and clinical reasoning.Various
computer animal experiment simulated soft-wares are now being used for
undergraduatepractical teaching in various medical institutes of India.

Ex‑pharm: The package contains programs such as effects of drugs on the

rabbit eye, effects of drugs on the frog heart, bioassay of histamine on the
guinea pig ileum, effects of drugs on the frog oesophagus, and effects of drugs
on dog blood pressure and heart rate. These programs can simulate drug
actions in various animal tissues. The user can conduct experiments and collect
as well as analyse data. Each program can be run in two modes – a tutorial
mode and an examination mode.
X‑cology: This software displays complete video demonstrations of different
procedures such as isolation and mounting of animal tissues followed by

68
on‑screen interactive interface to study the effects of various drugs on the
isolated tissues.The details on the experiments involving animal use are
divided into different topics to facilitate their presentation and ease the
navigation through the details. The content is classified into the following
topics:
The experimental animals: This section includes biological names of the
common experimental animals and their use in experimental pharmacology
The equipment: This section includes the common instruments used for the
demonstration of animal experiments.
Experimental techniques: This section includes the information on manual
skills and routine procedures involved in the experimental pharmacology such
as collection of blood samples, preparation of drug solutions, and routes of
drug administration. The experimental section contains exhaustive details such
as video demonstrations on isolation and mounting of different tissues from
experimental animals, an interactive interface to study effects of different
drugs on isolated tissues, procedures to carry out bioassays and experiments
on whole animals related to screening and evaluation.
Demonstrate the effect of drugs on BP using computer aided learning.
Hours: 10 (5 sessions will be conducted each session with 2hours duration).
The students will be taken to the computer lab where the computers are
preloaded with ExPharm software. The batch will be divided into groups of 5-6
students each. The teacher will then outline how to operate the software and
the students are allowed to work on their own. About twenty minutes will be
allocated for the group tasks.
Each student will demonstrate the following effects of drugs on blood pressure
of anaesthetized dog using computer aided learning.
 Effect of adrenaline, noradrenaline, isoprenaline, ephedrine,
acetylcholine and histamine on BP of anaesthetized dog.
 Muscarinic and nicotinic effects of acetylcholine.
 Vasomotor reversal of Dale
 Vasomotor re-reversal of Dale.
 Tachyphylaxis.
Assessment: Skill assessment by using check-list (Format given below).

69
 Checklist for assessment of CAL.
Date:
Topic:
Roll no of the student:

Name of the assessor:

Criteria scale
a) Demonstration of the exercise:
Unsatisfactory Satisfactory Superior
1 2 3 4 5 6 7 8 9

b) Interpretation on the effects of drugs:

Unsatisfactory Satisfactory Superior
1 2 3 4 5 6 7 8 9

c) Ability to clarify the queries:

Unsatisfactory Satisfactory Superior
1 2 3 4 5 6 7 8 9

d) Overall assessment:
Unsatisfactory Satisfactory Superior
1 2 3 4 5 6 7 8 9

Feedback:

Signature of student:

Signature of assessor:

70
 2ndProfessional MBBS Student’s APPRAISAL FORM
Department of Pharmacology
TMC &Dr. BRAM Teaching Hospital

Certificate of completion of competencies for

skill in Pharmacology.
Name of the Student:
Class Roll number:
Photograph
University Roll number: of the
student.
Session:

Sl Particulars Competent Not competent

No
1 Demonstrate understanding of the use of
different dosage forms
2 Calculate drug dose in patients in different
clinical situations.
3 Administer drugs for different clinical situations
through various routes using mannequins.
4 To prepare and explain a list of P- drugs for a
given case/condition.
5 Write a rational, correct and legible generic
prescription for a given condition.
6 Communicate with the patient regarding optimal
use of drug therapy.
7 Perform and interpret a critical appraisal (audit)
of a given prescription.
8 Perform a critical evaluation of the drug
promotional literature.
9 To recognize and report an adverse drug
reaction.
10 Demonstrate the effect of drugs on blood
pressure using computer aided learning.

This is to certify that this is the bonafide record of work done by the above named
student during the practical pharmacology sessions in the laboratories of the Department of
Pharmacology, TMC &Dr. BRAM Teaching Hospital and he /she is now competent in all the
above mentioned competencies.

Signature of accessor. Signature of HOD

71
 SELF DIRECTED LEARNING (SDL)
SELF DIRECTRD LEARING (SDL): WHAT DOES IT MEAN?

In its simplest form SDL means the learner taking responsibility for his/her own learning. However, it
does not mean leaving the learner alone; rather the earner has the constant support of the teachers
and peers.

STEPS OF SDL:

ADVANTAGES OF SDL:

1) Provides autonomy to the learners.

2) Encourages development of life-long learning skills.
3) Promotes active, peer-assisted and co-operated learning.
4) Essential in the development and maintenance of professional competence. It is integral to
self regulation.

CONDUCT OF THE SDL SESSION:

One SDL session will be divided into three parts: SESSION – 1, INTERSESSION PERIOD & SESSION – 2.

Session – 1: (time 2 hours)

a) Students will be divided into two groups and different facilitators will take charge of
each group (Time: 15 minutes).
b) Discussing the "challenge" (case) with the students and encouraging them to identify
their learning needs and learning resources (Time: 45 minutes).
c) Brainstorming by students to formulate the learning objectives so as to bridge the
knowledge gap identified by them (guided by the facilitators) (Time: 90 minutes).
d) Sharing of the resource material by the facilitators (Time: 30 minutes).

Intersession period: (time 1 week)

72
 a) Students will be divided into five groups under one facilitator for guidance.
b) This period extends over one week and students find and explore resources, read and
approach facilitator as needed. Students learn to manage their own time as well as
resources.
c) Facilitator’s role is to facilitate learning, guide for resources, and make sure to engage
them in learning. Facilitators share additional resources and motivate students utilizing
the Whatsapp group for doing self-directed learning.

Session-2: (time: 2 hours)

a) It will be conducted during the 2-hour small group-teaching slot.

b) Students will be divided into 05 groups under the guidance of one facilitator as
intersession period (Time: 10 minutes).
c) Presentation by students on different objectives followed by discussion. There are many
opportunities for learning to be assimilated. Facilitator needs to guide on those learning
points keeping in view the learning objectives. (Time: 60 minutes)
d) This session also involves assessment of learning. (Time: 50 minutes).

73
 Seminar by students.
The schedule for seminar presentation by students will be declared at least one month prior
to the presentation. A format of schedule is given below. Three students will present on different
subtopics of a selected main topic per session. The students will be divided into five groups with one
teacher as mentor for each group. The students have to follow the rules as stipulated below while
presenting the seminar.

Rules for seminar for the students:

1. The students will present the seminar in their respective group. The concerned teacher of
that group will act as moderator as well as assessor.
2. The concerned teacher will send the link 10 minutes prior of the session in their concerned
group.
3. Time for seminar for a student- 10 minutes.
4. Mode of presentation- power point presentation.
5. Number of slides for power point presentation-maximum 10.
6. Number of students as presenter will be 3 (three) in a session.
7. The students other than the presenters will ask questions to the presenters for clarification
of their doubts or addition of other points at the end of the session.
8. Each student will be assessed for their presentation, and assessed score will enter into
internal assessment of practical. The assessment criteria will be as follows:
a) Content quality.
b) Presentation skill.
c) Quality of slide preparation.
d) Utilization of different resources.
e) Ability to respond to queries.
9. The students must follow the schedule of the seminar. The session will not be changed
without any valid and justified reason. If a student misses his/her session, the internal
assessment will be lost for that session. The timing will be from 2-3pm.
Format of schedule for seminar:

DATE & TOPIC SUB TOPIC *GROUPS AND ROLL NUMBER

A B C D E

DD/MM/YYYY SUB TOPIC-1A 1 7 13 19 25

(DAY):
SUB TOPIC-1B 2 8 14 20 26
TOPIC-1
SUB TOPIC-1C 3 9 15 21 27

DD/MM/YYYY SUB TOPIC-2A 4 10 16 22 28

(DAY):
SUB TOPIC-2B 5 11 17 23 29
TOPIC-2
SUB TOPIC-2C 6 12 18 24 30

74
DD/MM/YYYY SUB TOPIC-3A 31 37 43 49 55
(DAY):
SUB TOPIC-3B 32 38 44 50 56
TOPIC-3
SUB TOPIC-3C 33 39 45 51 57

DD/MM/YYYY SUB TOPIC-4A 34 40 46 52 58

(DAY):
SUB TOPIC-4B 35 41 47 53 59
TOPIC-4
SUB TOPIC-4C 36 42 48 54 60

DD/MM/YYYY SUB TOPIC-5A 61 67 73 79 85

(DAY):
SUB TOPIC-5B 62 68 74 80 86
TOPIC-5
SUB TOPIC-5C 63 69 75 81 87

DD/MM/YYYY SUB TOPIC-6A 64 70 76 82 88

(DAY):
SUB TOPIC-6B 65 71 77 83 89
TOPIC-6
SUB TOPIC-6C 66 72 78 84 90

*Groups

A- Teacher-1
B- Teacher-2
C- Teacher-3
D- Teacher-4
E- Teacher-5

75
 Assessment sheet- Seminar presentation.
Date:
Topic:
Roll no of the student:
Name of the assessor:
Criteria scale:
a) Content quality:
Unsatisfactory Satisfactory Superior
1 2 3 4 5 6 7 8 9

b) Presentation skill:
Unsatisfactory Satisfactory Superior
1 2 3 4 5 6 7 8 9

c) Quality of utilization of media (PPT/Black board/white boaed etc):

Unsatisfactory Satisfactory Superior
1 2 3 4 5 6 7 8 9

d) Utilization of different resources:

Unsatisfactory Satisfactory Superior
1 2 3 4 5 6 7 8 9

e) Ability to respond to questions:

Unsatisfactory Satisfactory Superior
1 2 3 4 5 6 7 8 9

f) Overall assessment:
Unsatisfactory Satisfactory Superior
1 2 3 4 5 6 7 8 9

Feedback:

Signature of student:

Signature of assessor:

76
 Assignment submission
The students will be assigned different tasks for submission to the concerned teacher. The
students have to submit their assignments on regular basis. The criteria for scoring for
assignment submission are given below. The marks secured will be considered while calculating
internal assessment.

Distribution of students:

Roll no
Teacher Batch A Batch B Batch C
1

Guidelines for scoring of Assignment:

Sl no Parameters Score

1 Submits on time with excellent quality & content 5

2 Submits late (after scheduled time but within 2 days) with good quality & 3
content

3 Submits on time with poor quality & content 2

4 Submits late (after scheduled time but within 2 days) with poor quality & 1
content

77
 Assignment scoring sheet
Name of student: Roll no:
Sl Date of Topic Score Signature of student Signature of teacher Remarks
no notification with date
of
assignment

Total score =

Average score =

78
 AETCOM
Module 2.1: The foundations of communication – 2
Background

Communication is a fundamental prerequisite of the medical profession and beside skills is crucial
in ensuring professional success for doctors. This module continues to provide an emphasis on
effective communication skills. During professional year II, the emphasis is on active listening and
data gathering.

Competency addressed:

The student should be able to:

Demonstrate ability to communicate to patients in a patient, respectful, non-threatening, non-
judgmental and empathetic manner.

Specific objectives:

At the end of session, the student should be able to:

1. Describe principles of communication with focus on opening the discussion, listening and
gathering data.

2. Discuss common mistakes in opening the discussion, listening and data gathering with role play
and videos.

3. Demonstrate the understanding of effective communication skills on standardised or regular

patients.

The essential elements:

Seven essential sets of communication tasks have been identified:

1. Build a Relationship: The Fundamental Communication Task- A strong, therapeutic, and

effective relationship is the sine qua non of physician– patient communication. The group
endorses a patient-centered, or relationship-centered, approach to care, which emphasizes both
the patient’s disease and his or her illness experience. This requires eliciting the patient’s story of
illness while guiding the interview through a process of diagnostic reasoning. It also requires an
awareness that the ideas, feelings, and values of both the patient and the physician influence the
relationship. Further, this approach regards the physician–patient relationship as a partnership,
and respects patients’ active participation in decision making. The task of building a relationship is
also relevant for work with patients’ families and support networks. In essence, building a
relationship is an ongoing task within and across encounters.

2. Open the Discussion- Allow the patient to complete his or her opening statement. Elicit the
patient’s full set of concerns. Establish/maintain a personal connection.

3. Gather Information- Use open-ended and closed-ended questions appropriately. Structure,

clarify, and summarize information. Actively listen using nonverbal (e.g., eye contact) and verbal
(e.g., words of encouragement) techniques.

79
4. Understand the Patient’s Perspective- Explore contextual factors (e.g., family, culture, gender,
age, socioeconomic status, spirituality). Explore beliefs, concerns, and expectations about health
and illness. Acknowledge and respond to the patient’s ideas, feelings, and values.

5. Share Information- Use language the patient can understand. Check for understanding.
Encourage questions.

6. Reach Agreement on Problems and Plans- Encourage the patient to participate in decisions to
the extent he or she desires. Check the patient’s willingness and ability to follow the plan. Identify
and enlist resources and supports.

7. Provide Closure- Ask whether the patient has other issues or concerns. Summarize and affirm
agreement with the plan of action. Discuss follow-up (e.g., next visit, plan for unexpected
outcomes).

Schedule

Sl no Objective Activity TL method Requirements Duration

1. At the end of session, Introductory y Lecture Classroom 01 hour
student should be small group setting with AV
able to describe session system etc
principles of
communication with
focus on opening the
discussion, listening
and gathering data.
2. At the end of session, Focused small Small group Classroom 02 hours
student should be group session discussion setting with AV
able to discuss with role play system.
common mistakes in and videos White board,
opening the paper, marker
discussion, listening pen – for notes
and data gathering and
observations
3. At the end of session, Skills lab DOAP session Standardised 01 hour
student should be session or regular
able to demonstrate patients
the understanding of
effective
communication skills
on standardized or
regular patients.
4. Reflections based on Group Group Study 1 hour
1, 2 and 3 discussion discussion materials e.g.,
articles,
movies etc
A4 white
paper – for
notes and
observations

80
 Format for reflection

Session no: : Date:

Time: Duration

Name of the faculty:

Learning objectives:

1.

2.

Teaching method used:

Reflection:

1. Please describe what happened during the session………

2. What did you learn from the session? …………

3. How do you think it will be helpful for you to become a good doctor?...................

Signature of the Teacher……………………………..

DEPARTMENT: Pharmacology

Assessment

1. Formative: The student may be assessed based on their active participation in the sessions.

2. Summative

81
Module 2.8: What does it mean to be family member
of a sick patient?
Background

Doctors deal with human suffering throughout their professional careers. A balanced approach to
the patient care experience requires an understanding of support systems of patients, priorities
coping and emotions of families, the role of the doctor, an exploration of empathy vs equanimity
and the difference between healing and curing and support. Competency addressed.

The student should be able to: Level

Demonstrate empathy in patient encounters KH

Specific objectives:

1. To describe the support systems of patients

2. priorities coping and emotions of families
3. an exploration of empathy vs equanimity
4. difference between healing and curing and support

Learning Experience
Year of study: Professional year 2
Hours: 6 (includes 2 hours of SDL)

i. Hospital visit & interviews - 2 hours

ii. Large Group Discussions with patients’ relatives - 1 hour
iii. Self-directed Learning - 2 hours
iv. Discussion and closure - 1 hour

1. Students are assigned to patients in the hospital, interview their family about their illnesses,
experience, reactions, emotions, outlook and expectations (or can be done in a controlled
environment with standardized patients.

2. Family members of patients with different illnesses may be brought to a large group discussion
with permission and an interactive discussion (based on the items outlined in option A. Can use
standardised patients)

3. Self-directed learning where students write a report from reflection based on sessions 1& 2 and
on other readings, TV series, movies etc.

4. A closure session with students to share their reflections based on 1, 2 and 3 so that it includes
how they intend to incorporate the lessons learnt in patient care.

82
Sl no Objective Activity TL method Requirements Time
1. To assess the Hospital visit interview Bed 2 hours
illnesses, experience, side(patients)
reactions, emotions, A4 white
outlook and paper-for note
expectations of the and
patients observations
2. To assess the - interview Patients’ 1 hour
reactions, emotions, relatives
outlook and
expectations of the A4 white
patients relatives paper-for note
and
observations
3. Report from Self directed Self study Study 2hours
reflection based learning materials
4. Reflections based on Group Group Chair, A-V 1 hour
1, 2 and 3 discussion discussion system Etc …

DEPARTMENT: Pharmacology.

Assessment

1. Formative: The student may be assessed based on their active participation in the sessions and
submission of the written narrative.

2. Summative: Short questions on the role of doctors in the community and expectations of society
form doctors.

e.g. 1. What is empathy? What is the role of empathy in the care of patients?

83
 Project submission:

Sl Topic Score Remarks with signature

1

84