The module titled 'The Skeptic Doctor' was held on Mondays during early clinical exposure from April to early August 2011. The 100 students of the 2009 batch were divided into two batches of 50 students each; two parallel sessions were held on alternate Mondays from 8 05-9 10 am. The batches were further divided into small groups of 10 students each; each batch being further subdivided into five small groups of 10 students. Facilitator presentations, case scenarios, brain storming sessions, group activities and role plays were the teaching/learning methods/strategies used. The module was developed based on the book 'Understanding and responding to pharmaceutical promotion.' Two of the authors, PRS and RMP acted as facilitators for the small group sessions. Students facilitated some of the sessions under the guidance and supervision of the faculty. The topics addressed during the facilitator presentations included 'Tension between health and commercial aims', ' Analyzing advertisements in medical journals concentrating on text, pictures, tables and graphs', 'Medical representatives', 'Medical students and the pharmaceutical industry', 'Independent sources of medicine information' and 'Evaluating the quality of health information on the internet'. The case scenarios and group activities dealt with criteria for assessing the quality of health information on the internet, reasons why doctors should carefully consider whether or not to accept free drug samples, students being offered sponsorship and gifts by the pharmaceutical industry, analyzing pharmaceutical advertisements in medical journals, analyzing advertisements directed at consumers in television, analyzing company sponsored internet blogs. The role plays dealt with a medical representative (MR) promoting a medicine to a doctor and the onlookers critically analyzing the presentation using a checklist and issues linked with industry-doctor relationship. In a parallel session, the other batch engaged with assignments and group exercises based on the manual under the supervision and guidance of the author KKS.
The sessions conducted were 'Promotion of medicines and public health', 'Techniques that influence the use of medicines', 'Analyzing pharmaceutical advertisements in medical journals', 'Pharmaceutical sales representatives', 'Promotion to consumers', 'Students and the pharmaceutical industry', and 'Using unbiased prescribing information'. Students critically analyzed offers by the pharmaceutical industry to promote different student events and supply free textbooks and other study equipment. They also developed criteria to assess the quality of health websites on the internet. Facilitator inputs were followed by discussion in each session. The criteria developed by the French drug bulletin 'La revue Prescrire' to analyze information provided by MRs was used to critically analyze role plays. Ethical issues concerning the relationship between pharmaceutical companies and doctors were explored using role plays.
Participant perception about the influence of the module on knowledge, attitude and skills was measured using a retrospective pre questionnaire developed by the authors. The study was approved by the Institutional Review Board of KIST Medical College. The statements to be included in the questionnaire were developed based on points covered during the module and highlighted in the manual after discussion among the authors. The questionnaire was pilot tested for comprehensibility among three third year students. The retrospective pre questionnaire used is shown as an additional file 1. Gender and method of financing of medical education were noted. Differences in scores according to gender have been noted by the authors in previous studies. The college admits two categories of students - (i) scholarship students selected on the basis of ranks obtained in an entrance examination conducted by Ministry of Education and (ii) self-financing students who have to pass (obtaining 50% marks) in an examination conducted by the University. Scholarship students are on the whole stronger academically than self-financing ones. Scores were allotted to various categories. The three categories for 'Knowledge' were 'No idea', 'Have a vague idea' and 'Clear idea'. The score for 'No idea' was 1, 2 for 'Have a vague idea', and 3 for 'Clear idea'. Six areas were explored under the heading 'Knowledge', giving a total score of 18.
For 'Attitudes' respondents' agreement with a set of five statements was explored using a Likert-type scale. The scores were: 5 = strongly agree, 4 = agree, 3 = no opinion, 2 = disagree and 1 = strongly disagree with the statement. The scores were reversed for negative statements. The scores for five statements were added to obtain the total 'Attitude' score. The maximum possible score was 25.
Five sets of 'Skills' were studied. For each skill the respondent was given the following choices: 'he/she was not confident', 'somewhat confident', 'very confident' in performing the skill and 'will be able to do independently in future'. These were given the scores 1, 2, 3 and 4 respectively. The total skills score was calculated adding the scores of the five skills. The maximum score was 20.
The total scores before and after the module was obtained by adding the 'Knowledge', 'Attitude' and 'Skills' scores. The maximum total score was 63. The median total 'Knowledge', 'Attitude', 'Skills', overall scores, and interquartile range were calculated. The data was analyzed using SPSS version 17 for Windows. One sample Kolmogorov-Smirnov test was used to determine the normality of the variables. Most variables were found not to follow a normal distribution and hence non-parametric tests were used. Median scores were compared according to gender and method of financing of medical education before and after the module, using the Mann-Whitney test. Median scores before and after the module were compared using the Wilcoxon signed ranks test. A p value less than 0.05 was taken as statistically significant.