Welcome to our next literature roundup. We apologize that things have been a bit slow around here, but they will be picking them up again starting…now.
Here is a simple and very important question: do pharmacy and medical students have an awareness of deprescribing and polypharmacy management?
We seem to remember having our hands full worrying about which medications to initiate. On the other hand, we didn’t hear much about how routinely we would be seeing frail 90-year-olds with sub-7% HbA1cs, dubious use of gabapentinoids, and people on 15 medications (let alone learning what to do about it). So maybe some deprescribing tips would have went a long way!
But enough about us…let’s take a look at this study:
Poots AJ, et al. Education around medication review and deprescribing: a survey of medical and pharmacy students’ perspectives. Ther Adv Drug Saf 2020; https://doi.org/10.1177/2042098620909610
What did the authors do?
The authors surveyed medical (n=117) and pharmacy (n=54) students at King’s College London in the UK, to explore their awareness of deprescribing, polypharmacy, and medication reviews. We will focus mostly on the deprescribing angle to this study.
Let us first point out this is an area that is underexplored in the deprescribing literature, and so it is refreshing and exciting to see it being examined more closely.
What did the authors find?
Around 15% of students were familiar with the term “deprescribing”. That may not seem so encouraging, but the authors found that most (94%) had in fact learnt about stopping medications and polypharmacy (92%).
The authors report that out of 4 learning topics, both student groups ranked the topic of starting medications as the most important subject taught to them, while ranking stopping medications the least.
Most of the students endorsed wanting support from senior colleagues when it came to decisions around stopping medications but felt comfortable bringing the topic of deprescribing up with their senior colleagues.
When conducting medication reviews, medical students tended to emphasize checking for an indication, adverse effects, and interactions, while pharmacy students emphasized those elements but also endorsed looking into the patient experience with medications and adherence.
Around 80% of medical students were aware of medication review tools, only 50% of pharmacy students were.
What does this mean?
The authors conclude that most healthcare students are familiar with polypharmacy and stopping medications, though less familiar with the specific term “deprescribing”.
In general, it is encouraging that there is a wide awareness of polypharmacy and stopping medications. The authors do make a great point that teaching on these topics is not necessarily about knowing which medications to stop, but also about how to make and implement these decisions in practice (monitoring, follow-up, safe dose reduction), and how to acknowledge and overcome barriers to deprescribing. We certainly agree.
One challenge is that it’s hard to know exactly what to make of the lack of awareness of the term “deprescribing”. Most students did have awareness and teaching on stopping medications, so was it simply a lack of awareness of the term “deprescribing” itself?
A good area for future studies might be to dive deeper on this point and more closely examine the depth of students’ awareness and knowledge around specific steps/topics under the deprescribing (or stopping medicine) umbrella. That is, going beyond awareness and looking more closely at what the students know about these topics.
The authors also suggest that it is encouraging that students felt comfortable bringing deprescribing up. They note that increasing awareness of polypharmacy and deprescribing from students may create learning opportunities from senior colleagues and thus enhance knowledge, experience, and confidence around deprescribing. This signals how important it is for more senior healthcare providers to teach and support more junior colleagues when it comes to managing polypharmacy. One thing to consider is that this is contingent on more senior colleagues themselves having self-efficacy related to deprescribing.
Keep in mind…
We realize that healthcare curricula are going to vary widely between and even within countries, so we definitely need to remember that these findings apply to directly to one school in the UK. As the authors also point out, the response rate was only 34% and participants self-selected to participate. Therefore, it is unclear how representative the sample is of the general student population.
As touched on above, it would have also been helpful to get a little bit more insight related to awareness of deprescribing and stopping medications. For example, what specific topics the students had learnt about stopping medications, and how deep was their awareness/knowledge of these topics?
This study provides valuable insight into student awareness of deprescribing-related topics. Hopefully, it will prompt more in-depth investigations of teaching and education related to deprescribing, including studies in other countries with large, representative samples. And maybe this will inspire educators to think about how deprescribing and polypharmacy management are being taught in their schools?
With a greater understanding of the educational needs of students, we can hopefully move toward improved integration of deprescribing-related topics in healthcare curricula. Ultimately, we would hope that would lead to improved confidence and knowledge from new graduates and greater uptake of deprescribing in practice.
The deprescribing blog is hosted by pharmacists and PhD students, Carina Lundby and Wade Thompson. We hope to be your new best deprescribing friends and supply you with deprescribing content and analysis on a biweekly basis. Please reach out to us if you have any questions or comments, or would like to contribute.