PRESCRIBING FOR REAL PATIENTS
In 2012, we founded the first European Student Run Clinic (SRC) focused on medical education with insured patients in Amsterdam University Medical Centers, location VUmc. This new learner-centred SRC (LC-SRC; “Studentenpoli” in Dutch) was set up with a view to providing medical students with clinical learning opportunities, such as patient consultations, patient management, and pharmacotherapy. Participation in this LC-SRC is available for medical students, pharmacy students, physician assistant students, or advanced nursing practice students following their training in VU University Amsterdam and Hogeschool Inholland Amsterdam. Recently we are also welcoming medical, physician assistant and pharmacy students from other universities and colleges in the Netherlands such as: University of Utrecht, University of Groningen, University of Leiden, Hogeschool Utrecht and University of Bologna (Italy) and started multiple inter-professional and an international LC-SRC.
As the results of a pilot and feasibility study of the LC-SRC were encouraging, the project was scaled-up and now includes programs focused on three main topics “medication safety and pharmacovigilance”, “Inter-professional and international programs focused on medication safety and diversity” and “programs focuses on primary care”. These topics includes SRC focused on adverse drug reactions (ADR) reporting, cardiovascular risk management, polypharmacy, and medication reviews in geriatric, ophthalmology and general practice offices. There are now also programs in which pharmacotherapy is less central, such as an program for aftercare focused on quality of life for ex-cancer patients. Since the start the LC-SRC has been nominated for multiple awards and prices and has published numerous studies in international peer-reviewed journals (see below).
In these studies, we have analysed the educational value for students and described how participation contributes to learning and how learning is influenced. Additionally, we have also examined the added value of our interventions for modern day healthcare practices and patients. Our most recent controlled clinical trial has also shown that the addition of a inter-professional student-run medication review program to standard care is an effective intervention for optimizing pharmacotherapy, medication safety and reduces the number of ADRs in patients at a geriatric outpatient clinic.
Medication safety and pharmacovigilance programs
In the Student-run pharmacovigilance program medical and pharmacy students assess real ADR-reports submitted to the pharmacovigilance centre Lareb. The program offers students an insight into ADR reports, it creates awareness in future doctors, and has the potential to increase pharmacovigilance skills and knowledge. When medical students participate in the Junior-Adverse Drug Event Managers program they are tasked to detect and manage patients who are suspected of hospitalization because of an ADR. After analysing and assessing the case, the students report the ADR to the pharmacovigilance centre Lareb. In some patient cases they also provide valuable medication advices to prevent further ADRs or advice in additional patient treatment.
Interprofessional and international programs focused on medication safety and diversity
When participating in our interprofessional student-run medication review program, medical and pharmacy students form an inter-professional team (ISP-team) with physician assistant and or advanced nursing practice students. This ISP-team performs a medication interview and review for patients visiting the geriatric memory outpatient clinic at the AmsterdamUMC whereafter students pitch their findings in the geriatric multidisciplinary meeting. While learning this team shows additional value on top of the standard (high quality, tertiary) care for optimizing pharmacotherapy and medication safety. The ISP-team has also shown to reduce the number of ADRs in patients visiting this outpatient clinic. In our International student-run medication review program medical students from the VU-University Amsterdam and medical and pharmacy students from Universities in Europe (e.g University of Bologna in Italy) analyse real-patient cases in monthly digital sessions. In these sessions students analyse real-patient cases to provide an answer for the practitioner and learn about differences within clinical pharmacology between European countries. In the medication review program at a local clinic a team of interprofessional students perform a medication interview and review in hospitalized geriatric patients. By adding this standard medication review to patients hospitalized in this small and local clinic the students can optimize pharmacotherapy and increase medication safety. In our latest medication review program in ophthalmology, students perform a medication interview and review in patients of the ophthalmology department who were referred within the hospital. The students focus extra on ophthalmic side effects and systemic side effects of ophthalmic medications.
Programs focuses on primary care
Are final two programs are located at the University General Practice office of the AmsterdamUMC, location VUmc. The student-run cardiovascular risk management program is set up to offer primary prevention to patients with known risk factors in a general practitioner's practice. In this clinic two medical students asses a patients' actual cardiovascular risk and formulated a cardiovascular risk management plan, which they discuss with the patient after approval by a GP. In our Student-run clinic polypharmacy medical students assess patients with five or more chronic medications. After a patient interview, students perform a medication review and present their findings in a multidisciplinary meeting with the general practitioner, pharmacists and clinical pharmacologists. After the plan has been approved in the multidisciplinary meeting the students themselves perform a second consultation to explain the medication changes and follow-up.
Currently, we are expanding our programs and implementing them into the curricula of master medical students studying at the VU University Amsterdam and physician assistant and advanced nursing practice students at the Hogeschool Inholland Amsterdam and Hogeschool Utrecht.
General scientific output
• Schutte T, Tichelaar J, Dekker RS, van Agtmael MA, de Vries TP, Richir MC. Learning in student-run clinics: a systematic review. Med Educ. 2015 Mar;49(3):249-63.
• Schutte T, Tichelaar J, Dekker RS, Thijs A, de Vries TP, Kusurkar RA, Richir MC, van Agtmael MA. Motivation and competence of participants in a learner-centered student-run clinic: an exploratory pilot study. BMC Med Educ. 2017 Jan 25;17(1):23.
• Schutte T, Tichelaar J, Donker E, Richir MC, Westerman M, van Agtmael MA. Clarifying learning experiences in student-run clinics: a qualitative study. BMC Med Educ. 2018 Oct 26;18(1):244.
• Dekker RS, Schutte T, Tichelaar J, Thijs A, van Agtmael MA, de Vries TP, Richir MC. A novel approach to teaching pharmacotherapeutics--feasibility of the learner-centered student-run clinic. Eur J Clin Pharmacol. 2015 Nov;71(11):1381-7.
• Schutte T, Tichelaar J, van Agtmael M. Learning to prescribe in a student-run clinic. Med Teach. 2016 Apr;38(4):425.
Medication safety programme
• Schutte T, Tichelaar J, Reumerman MO, van Eekeren R, Rolfes L, van Puijenbroek EP, Richir MC, van Agtmael MA. Feasibility and Educational Value of a Student-Run Pharmacovigilance Programme: A Prospective Cohort Study. Drug Saf. 2017 May;40(5):409-418.
• Reumerman MO, Tichelaar J, Richir MC, van Agtmael MA. Medical Students as Junior Adverse Drug Event Managers facilitating reporting of ADRs. Br J Clin Pharmacol. 2021 May 5. doi: 10.1111/bcp.14885. Epub ahead of print. PMID: 33955031.
• Reumerman M, Tichelaar J, Richir MC, van Agtmael MA. Medical students as adverse drug event managers, learning about side effects while improving their reporting in clinical practice. Naunyn Schmiedebergs Arch Pharmacol. 2021 Mar 5. doi: 10.1007/s00210-021-02060-y. Epub ahead of print. PMID: 33666715.
Interprofessional and international programme
• Reumerman MO, Richir MC, Domela Nieuwenhuis PM, Sultan R, Daelmans HEM, Springer H, Muller M, van Agtmael MA, Tichelaar J. The clinical and educational outcomes of an inter-professional student-led medication review team, a pilot study. Eur J Clin Pharmacol; 2021 Aug 8. doi: 10.1007/s00228-020-02972-3.
• Sultan R, & van den Beukel TO, Reumerman MO, Daelmans HEM, Springer H, Grijmans E, Muller M, Richir MC. van Agtmael MA, & Tichelaar J. The Interprofessional Student-Run Medication Program: The clinical STOPP/START-based outcomes of a controlled clinical trial in a geriatric outpatient clinic. Clin Pharmacol Ther 2021; 2021 Nov 2. doi: 10.1002/cpt.247 doi: 10.1002/cpt.247
• Reumerman MO, Richir MC, Sultan R, Daelmans HEM, Springer H, Grijmans E, Muller M, van Agtmael MA, & Tichelaar J. Reducing adverse drug reactions in a memory outpatient clinic. Expert Opin Drug Saf; 2022 Apr 28. doi: 10.1080/14740338.2022.2069748.
Primary care programme
• Schutte T, Prince K, Richir M, Donker E, van Gastel L, Bastiaans F, de Vries H, Tichelaar J, van Agtmael M. Opportunities for Students to Prescribe: An Evaluation of 185 Consultations in the Student-run Cardiovascular Risk Management Programme. Basic Clin Pharmacol Toxicol. 2018 Feb;122(2):299-302.