An integrated scenario-based adverse drug reaction education programme

Adverse drug reaction (ADR) assessment, reporting and communication by healthcare professionals (HCPs) remains suboptimal, potentially leading to poor patient outcomes.1 Variability of ADR management in hospital settings is partly due to limited teaching of basic scientific principles concerning ADRs in pre-vocational university courses, as well as the lack of opportunities to apply integrated ADR concepts to solve complex problems commonly encountered in clinical practice.1 Crucial concepts behind severe immunologically mediated ADRs, such as anaphylaxis and severe cutaneous reactions, and translation of these into clinical practice, are not familiar to many HCPs. A vocational non-mandatory adverse drug reaction education programme (ADREP) was developed at our institution, to upskill HCPs involved in ADR management. ADREP design and development started in mid-2021, guided by the needs analysis of 25 clinical pharmacists and junior medical staff (JMS). The first version was pilot tested in November 2022 by 10 clinical pharmacists and in January 2023 by five JMS and one physician. ADREP is an interactive, scenario-based, active-learning style workshop delivered via six sequential modules in 3 one-hour face-to-face sessions. Specialist clinicians from allergy and immunology, dermatology, internal medicine, infectious diseases, clinical pharmacology, medical/pharmacy education, and medication safety contributed to the content and design of the modules. The modules were designed to allow the learner to achieve progressive mastery from basic to complex ADR concepts, that lead to integration of knowledge and skills in clinical application. The concepts discussed, in order of increasing complexity, included ADR classification, immunological mechanisms, recognition of ADR syndromes, medication causality assessment, ADR reporting and practical aspects of risk communication to patients, including medication cross-reactivity. Throughout the modules, interactive case scenarios and multiple-choice questions illustrated the concepts and helped consolidate learnings. A subject matter expert moderated the programme to maintain the required level of interaction and engagement, and to provide instantaneous feedback to the questions from the learners regarding more difficult concepts. Learners applied the theoretical concepts discussed at the beginning of each module to the management of real-life scenario-based cases in each session. Each case built in complexity, interleaving knowledge obtained from the preceding modules. This ensured the learner could recognise the ADR syndrome, derive differential diagnoses, suggest appropriate investigations, construct medication timelines, conduct causality assessment to determine culprit medications, and provide safe and actionable information to the patient. The participating HCPs found the programme highly relevant to their clinical practice. The content was pitched at the right level and improved their knowledge and confidence in ADR management. An expert moderator was required for effective delivery. Participants also suggested converting the modules into a hybrid ‘flipped classroom’ style, whereby learners completed online modules in ADR classification and immunological mechanisms before the interactive sessions. This may provide more time in face-to-face sessions for facilitated discussion and assist better in integration and application of knowledge to scenario-based cases. For next steps, the authors are working to determine how to objectively measure improvement in clinical practice following successful completion of the ADREP.