Learning Pharmacology in Mexico: A Survey of the Use and Views of Pharmacology Textbooks by Undergraduate Medical Students

doi:10.4236/ce.2014.51009

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Creative Education

2014. Vol.5, No.1, 46-52

Published Online January 2014 in SciRes (http://www.scirp.org/journal/ce) http://dx.doi.org/10.4236/ce.2014.51009

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Learning Pharmacology in Mexico: A Survey of the

Use and Views of Pharmacology Textbooks by

Undergraduate Medical Students

Rosa Ventura-Martinez, Rebeca Aguirre-Hernandez,

Jacinto Santiago-Mejia , Claudia Gomez, Rodolfo Rodriguez*

Department of Pharmacology, School of Medicine, National University of Mexico

Email: [email protected], [email protected],

[email protected], [email protected], *[email protected]

Received December 6th, 2013; revised January 6 th, 2014; accepted January 13th, 2014

Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium,

provided the original work is properly cited. In accordance of the Creative Commons Attribution License all

Background: To date, little is known about the view of medical students towards pharmacology text-

books. This study aimed to investigate the preferences of second-year medical students towards pharma-

cology textbooks, and to identify the factors involved in book selection. Methods: Second-year medical

students of the Medical School at the National University of Mexico (classes of 2010, 2011, and 2012)

were asked to select their preferred textbook for studying pharmacology and preparing for exams from a

list of nine textbooks. They also completed a 19-item questionnaire to identify and evaluate the reasons

for their preferences. Results: A total of 1323 students completed the questionnaire, representing 45.59%

of all medical students enrolled in 2010-2012. The two textbooks most preferred by students were Good-

man & Gilman (25.3%) and Rodriguez et al. (27.3%); preferences for the other books were Harvey &

Champe (13.9%), Rang et al. (13.5%), or Katzung et al. (12.3%), and others (7.6%). The usefulness and

the adequacy of content were deemed equally important by students when choosing a textbook. Conclu-

sions: Goodman & Gilman, a well-known pharmacology textbook, and Rodriguez et al., a small-volume

textbook, were preferred by these second-year medical students; their choices were based on relevant

pharmacological information and adequacy of content.

Keywords: Pharmacology; Learning; Teaching; Textbooks; Medical Schools

Introduction

Academic success during the first 2 years of medical school

generally depends on the ability of students to cope with a sig-

nificantly more voluminous and demanding course load than

previously experienced (Sawyer et al., 1996). This is true for all

biomedical sciences, particularly pharmacology, a discipline with

ever-increasing information. Basic pharmacology is a funda-

mental course that is usually taught in the second year in most

medical schools, using traditional discipline-based or problem-

based learning curricula. Most medical schools mandate that a

solid foundation i n basic pharmac ology is essent ial to unde rstand

and practice therapy , because dru gs cannot be safe ly or rati onally

administered without a clear unde rstanding of their sit e a nd mode

of action, pharmacokinetics, side effects, interactions, and toxic-

ity. However, learning and retention deficits of pharmacological

information are major pro blems in undergraduate medical educa-

tion, and these deficiencies are recognized worldwide (Ingenito et

al., 1989; Dean et al., 2002; Rodriguez et al., 2002; Ling et al.,

2008). Many studies have shown that many final-year medical

students and new doctors are unde rpre pared for effective and safe

prescribing of drugs (Walley et al., 1994; Garbutt et al., 2005;

Han et al., 2006; Maxwell et al., 2007; Harding et al., 2010), a

view shared by many medical students (Heaton et al., 2008). It

has been suggested that inadequate skill or knowledge of phar-

macology contribute to prescribing faults (i.e., failure to decide

which drug to use and how) and compromising patient safety

(Dean et al., 2002; Harding et al., 2010; Otoom et al., 2006;

Aronson, 2009; Gwee, 2009). Information overload, the prolif-

eration of new drugs, recent curricular reforms, and inadequate

teaching of medical pharmacology are the four main factors that

contribute to the inadequate pharmacological education of medi-

cal students (Ingeni to et al., 1989; Han et a l., 2006; Heaton et al .,

2008; Otoom et al., 2006; Achike et al., 2000).

To overcome these issues, a curriculum with a more selective

content, coupled with a restricted list of drugs (“student formu-

lary”), has been proposed and implemented in many medical

schools (Orme et al., 2002; Maxwell et al., 2003; Rodriguez et

al., 2009; Baker et al., 2011). We consider that the recent pro-

posal of Ross and Maxwell is the most complete and useful ap-

proach for teaching and learning pharmacology in medical

schools (Ross et al., 2012). However, the lack of appropriate

textbook material is a major challenge for students who must

*Corresponding a uthor.

R. VENTURA-MARTINEZ ET AL.

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cope with the tradi tional, ove rsized, pharmacology t extbooks tha t

grow larger with each new edi tion (Achike et al., 2000). In addi-

tion, most textbooks treat phar macology as a basic science rather

than a discipline that forms part of a medical curriculum; conse-

quently, the clinical perspective may be lost in the vast quantity

of basic pharmacological information. Most medical students

dislike such textbooks. Faced with the ever-increasing breadth

of pharmacology knowledge that they need to address, students

(and medical educators) are confronted with the problem of

how to extract the key information that is most relevant to their

future clinical education.

To date, little is known about the view of medical students to-

wards pharmacology textbooks. Therefore, the present research

aimed to report on the development, reliability and validity of a

questionnaire to investigate the preferences of second-year

undergraduate medical students towards pharmacology text-

books. In addition to the planned validation studies, we deter-

mined the feasibility of using the same questionnaire to identify

the factors that may influence their decisions when choosing a

pharmacology textbook. The textbooks used to investigate stu-

dents’ view and prefe rences were chosen bec ause all of them are

recommended in our academic program, our medical library

contains many copies of them, and because they vary c onsidera-

bly in terms of the amount of information being presented and the

means of presenting this information. A total of 1323 second-year

medical students of the Medical School at the National Univer-

sity of Mexico (classes of 2010, 2011, and 2012) participated in

this study.

Methods

Participants

We enrolled 1360 medical students in the second year (448

in the class of 2010, 496 in the class of 2011, and 416 in the

class of 2012) at the National University of Mexico Medical

School, representing 45.59% of the total number of students

(2983). Our school uses a traditi onal discipline-based curriculu m

in which pharmacology is a required course that is taught every

year to approximately 950 undergraduate medical students di-

vided into 32 groups of about 25 - 30 students each. The phar-

macology course is taught in the second year alongside other

discipline-based science courses, but before pathology and

extensive clinical teaching. The course consists of two sessions

lasting 2 h each per week on different weekdays. Although an

active methodology is promoted, most sessions consist of 2 h

lectures that are given by the same group of professors. The

course also includes 30 laboratory sessions (mainly computer

simulations) that last 4 h each. All groups begin and end the

course on the same date.

Textbooks Evaluated

Nine pharmacology textbooks were chosen: “Pharmacology”

(Harvey & Champe, 4th/5th editions, 2008-2011, USA), “Princi-

ples of Pharmacology: The Pathophysiologic Basis of Drug

Therapy” (Golan et al., 2nd/3rd editions, 2007-2011, USA),

“Goodman & Gilman’s The Pharmacological Basis of Thera-

peutics” (Brunton et al., 11th/12th editions, 2006-2011, USA),

“Basic and Clinical Pharmacology” (Katzung et al., 11th/12th

editions, 2009-2011, USA), “Pharmacology” (Rang et al.,

6th/7th editions, 2007-2011, UK), “Levine’s Pharmacology,

Actions and Reactions” (Walsh et al., 7th edition, 2005, UK),

“Velazquez Basic and Clinical Pharmacology” (Lorenzo-Fer-

nandez, 17th/18th editions, 2004-2009, Spain), “Medical Phar-

macology” (Mendoza, 1st edition, 2008, Mexico), and “Phar-

macology and Therapeutics Guide” (Rodriguez et al., 2nd edi-

tion, 2009, Mexico). These textbooks were chosen because they

are listed in our academic program and our medical library

contains many copies of these textbooks (Spanish version).

Development of the Questionnaire

We determined that the questionnaire should focus on the

students’ perceptions of pharmacology textbooks. Therefore,

we developed a questionnaire that included items derived from

informal conversations with and complaints from medical stu-

dents about the pharmacology textbooks they had used through-

out the year.

The initial questionnaire included 20 items that were de-

signed to investigate the students’ textbook preferences and to

gain some insight into the reasons for their preferences, as well

as items designed to evaluate the usefulness and adequacy of

the preferred textbook. In May 2009, we conducted a pilot

study of 416 medical students to evaluate the comprehensibility

and relevance of the questions, and several changes were made

based on their feedback. We also tried to improve the compre-

hensibility and clarity of each item. The questionnaire took <

10 min to complete.

The final version of the questionnaire was two pages long,

and consisted of 20 questions (Table 1). The questionnaire first

asked students to select the pharmacology textbook that they

used during the year to study and prepare for examinations, as

well as how often they used it. Next, the students completed 19

items that explored the reasons for their preference. The stu-

dents were asked to indicate how much they agreed with each

statement using a 5-point Likert scale (1 = never; 2 = some-

times; 3 = frequently; 4 = almost always; 5 = always). To help

the students identify the textbook, we provided them with a

colour page containing ima ges of the pharmacology te xtbooks in

alphabetical orde r. Participation was voluntary and anonymous,

answers were manually reviewed, and data were entered into a

database for statistical analysis.

At the end of the questionnaire, students were asked to state

their overall textbook preferences (encyclopaedic vs. concise)

for studying basic medical sciences. The surveys were con-

ducted in May 2010, 2011, and 2012, coinciding with the end

of each academ ic year.

Ethical statement

All of the participants were informed about the aim of the

study and the content of the questionnaire. The questionnaire

was anonymous and did not request any information that could

reveal the identity of the respondents. The students voluntarily

participated in the survey. They were free to leave any ques-

tions or the whole questionnaire unanswered if they wished to

do so. Studies in which only questionnaires are applied or in-

terviews are made are classified, by the General Health Law for

Health Research of Mexico, as research studies in which the

population is not put at any risk (General Health Law Regula-

tions with regard to Research on the Health Sciences, Mexico).

It also states that in this type of studies, the Ethical Committee

can exempt the researchers from requesting the informed con-

sent.

Data Analysis

We calculated percentages to summarize the information of

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Table 1.

Questionnaire given to second-year medical students regarding pharmacology textbooks.

INSTRUCTIONS: First, select from the attached page the phar macology textbook that you preferred during the year when preparing for your coursework or

examinat i ons; then, a nswer the following questio ns .

1) How ofte n did you use it ?

2) Does it describe the fundamentals of pharmacology?

3) Does it explain the phar macodynamics and pharmacokinetics of major drugs in a comprehensi ve manner?

4) Does it identify drugs that are more frequently used (prototy pes) in general medicine?

5) Does it describe the physiopathology of major diseases and explain its importance in drug selection?

6) Does it provide detailed descriptions of the pharmacology of drugs as a basis for their clinical use?

7) Does it refer to pharmacological topics that are only useful for second-year medical students?

8) Does it stimulate your interest in the topic and mot i vate you to learn on your own?

9) Does it encourage the integration of pharmacology with other disciplines in the curriculum?

10) Does it stimulate your interest i n more comm on di s eases?

11) Is the material well organized?

12) Does the sequence of themes facilitate comprehension of the entire discipline?

13) Is the information p resented sm oothly and does it help to integrate your k nowledge?

14) Are the contents clear and concise?

15) Was the writing easily understood and did chapter length favour learning?

16) Was it necessary to consult another textbook to achieve your learning objectives?

17) Does it prompt you to consult useful literature i n this field?

18) Does it offer an opportunity for self-evaluation?

19) Would you recomme nd t hi s t extbook to other student s?

20) Does the t extbook cover all of the scheduled topics in the cur ri culum?

nominal and ordinal variables. Exploratory factor analysis (Ta-

bachnick et al., 2007) was applied to each student population

and to the whole sample in order to determine if the correlation

between the questions could be explained by a few latent va-

riables. Additive scales were calculated based on the results of

the factor model. A multinomial logistic regression model

(Hosmer et al., 2000) was fitted to predict the book preferred by

the students using as independent variables the additive scales

and the school class. Statistical analyses were done with R Core

Team 2012 version 2.15.1 (R Core Team) and SPSS for Win-

dows Statistic Package (version 20). A P value of <0.05 was

considered significant.

Results

Summary Statistics

The questionnaire was fully answered by 1323 medical stu-

dents (97.3%); thirty-seven incomplete questionnaires were

excluded from the analysis. In the whole population, the mean

age was 19.3 (range 17 - 41) years; 63.1% were female and

36.9% were male.

About 50% of the 1323 surveyed students preferred the

books by either Goodman & Gilman or Rodriguez et al. (Table

2). Nearly 40% of the students preferred the textbooks by Har-

vey and Champe, Rang et al. or Katzung et al., and less than

10% of the students used another textbook. The percentage of

students that used the book by Katzung et al. increased 7.5%

between the first and the last academic years reported in Table

2. Also, in this time period, the percentage of students that fa-

vored the book by Rodriguez et al. increased 5% while 8.4%

less students chose the book by Goodman & Gilman.

Questionnaire’s Latent Variables

More than 90% of the answers to the 19 items comprising the

second part of the questionnaire were concentrated in just three

categories: “frequently”, “almost always” and “always”. Ques-

tion 16 regarding the need to look up another pharmacology

textbook in order to achieve the study objectives had a different

response pattern and was ignored in subsequent analysis. The

polychoric correlation coefficient (Mislewy, 1986) was used to

measure the association between items and to do an exploratory

factor analysis. The correlation matrices of the three studied

populations were similar to each other. Thus we decided to

work with a single data set that contained information of 1323

students from the three academic years instead of doing a sepa-

rate analysis for each of them.

Based on several criterions (Tabachnick et al., 2007) and

preliminary analyses we decided to extract 4 factors. We ex-

amined the rotated and unrotated solutions, the percentage of

variance explained and the communality values. The model was

re-fitted using weighted least squares and omitting questions 17

and 18 because their communality values were around 0.35.

The factor loadings shown in Table 3 were obtained after ap-

plying a quartimin rotation. This model explained 66% of the

total variance of the sixteen questions. The correlation between

the four extracted factors ranged between 0.56 and 0.74. The

elements of the residual matrix ranged between −0.03 and 0.49.

Cronbach’s alpha was 0.838 for Factor 1, 0.859 for Factor 2,

0.788 for Factor 3 and 0.776 for Factor 4. Factor loadings

greater than 0.31 were considered as significantly different

from zero. We interpreted the factors as follows: Factor 1, per-

tinent pharmacological information; Factor 2, appropriate in-

formation presentation; Factor 3, meaningful medical context;

and Factor 4, adequacy of content.

Characteristics of the Chosen Book

Additive scales were calculated by adding the codes (never =

1, sometimes = 2, frequently = 3, almost always = 4, always =

5) assigned to the categories of the variables that loaded heavily

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Table 2.

Number of undergraduate medical students that studied pharmacology in their second year and the percentages of students that preferred each text-

book.

Academic year N

Harvey &

Champe

Goodman & Gil-

man

Katzung et al . Rang et al. Rodriguez et al. Others Total

2009-2010 448 14.5 27.9 8.0 16.3 24.8 8.5 100

2010-2011 476 12.2 27.7 13.7 13.4 27.5 5.5 100

2011-2012 399 15.3 19.5 15.5 10.5 29.8 9.3 100

Overall 1323 13.9 25.3 12.3 13.5 27.3 7.6 100

Table 3.

Factor loading and communalities for the four factors.

Item Factor Communality

F1 F2 F3 F4

Factor 1: Pertinent phar macologic al informati on

3) Does it explain the phar macodynamics and pharmacokinetics

of major dru gs in a comprehensive manner? 0.80 –0.11 –0.04 0.13 0.63

2) Does it describe the fundamentals of pha rm a c ology ? 0.73 0.03 –0.03 0.09 0.61

4) Does it identify drugs that are more frequently used (prototy pes) in general medicine? 0.70 0.04 0.05 –0.01 0.58

6) Does it provide detailed descriptions of the pharmacology

of drugs as a ba s is for their clinical use ?

0.68 0.06 0.15 –0.03 0.67

5) Does it describe the physiopathology of major diseases

and explain its importance in drug selection?

0.53 0.28 0.20 –0.14 0.62

Factor 2: Appropriate in f ormation presentation

14) Are the contents clear and concise? 0.04 0.86 0.01 0.00 0.79

13) Is the information p resented sm oothly and does it help to integrate your k nowledge? –0.06 0.84 –0.03 0.09 0.73

15) Was the writing easily understood and did chapter length favour learning? 0.05 0.68 0.06 0.09 0.67

19) Would you recomme nd t hi s t extbook to other student s? 0.26 0.32 0.13 0.23 0.65

7) Does it refer to pharmacological topics that are only useful for

second-year medical students? 0.30 0.32 0.18 0.12 0.63

Factor 3: Meaningful medical context

9) Does it encourage the integration of pharmacology with other disciplines in the cur-

riculum? 0.01 –0.10 0.85 0.08 0.73

10) Does it stimulate your interest i n more comm on di s eases? 0.00 0.06 0.76 –0.01 0.62

8) Does it stimulate your interest in the topic and motivate you to learn on your own? 0.14 0.19 0.53 0.00 0.60

Factor 4: Adequacy of content

12) Does the sequence of themes facilitate comprehension of the entire discipline? –0.04 0.13 0.13 0.72 0.76

11) Is the material well organized? 0.14 0.03 –0.01 0.72 0.69

20) Does it cover all of the scheduled topics in the curriculum? 0.15 0.13 0.12 0.42 0.51

The model was fitted usin g the we ighted least squar es m ethod and quartim in rotation. Loading val ues >0.31 w ere c onsidered significant.

on each factor. A multinomial logistic regression model was

fitted to determine if the additive scales and the school class

predicted the book preferred by the students. In this analysis,

the books were classified into four categories: 1, Goodman and

Gilman; 2, Rodriguez et al.; 3, Harvey and Champe, and Rang

et al.; and 4, Katzung et al, and “Others”. Only additive scales

1, 2, and 4 were significantly associated with the student’s book

preferences (Table 4). An increment in the value of the second

additive scale (appropriate information presentation) increased

the odds of preferring any book instead of Goodman and Gil-

man. However, an increment in the first and fourth additive

scales (pertinent pharmacological information and adequacy of

content respectively) reduced the odds of preferring any book

as compared to that written by Goodman and Gilman

Among 2010 students, the odds of preferring the book of

Rodriguez et al. was significantly smaller than the odds of

Goodman and Gilman (P = 0.028). No significant differences

were found between the textbook preferred by cohorts 2011 and

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Table 4.

Multinomial logistic regression model fitted to predict the book preferred by the students1.

Book Variable Coefficient Stand.

Error P OR 95% confidence interval

Lower limit Upper limit

Rodriguez et al. Constant 0.51 0.64 0.426

class 2010 –0.46 0.21 0.028 0.63 0.42 0.95

class 2011 –0.29 0.21 0.165 0.75 0.50 1.12

additive scale 1 –0.39 0.04 0.000 0.68 0.63 0.73

additive scale 2 0.46 0.04 0.000 1.59 1.46 1.72

additive scale 4 –0.12 0.06 0.045 0.88 0.78 1.00

Harvey and Champe; Rang et al. Constant 0.46 0.63 0.459

class 2010 –0.09 0.21 0.669 0.92 0.61 1.37

class 2011 –0.21 0.21 0.320 0.81 0.54 1.22

additive scale 1 –0.32 0.04 0.000 0.72 0.67 0.78

additive scale 2 0.44 0.04 0.000 1.55 1.43 1.68

additive scale 4 –0.20 0.06 0.001 0.82 0.73 0.92

Katzung et al.;

“Others”

Constant 1.98 0.62 0.001

class 2010 –0.72 0.22 0.001 0.48 0.32 0.74

class 2011 –0.52 0.21 0.014 0.59 0.39 0.90

additive scale 1 –0.27 0.04 0.000 0.76 0.71 0.83

additive scale 2 0.28 0.04 0.000 1.32 1.22 1.43

additive scale 4 –0.13 0.06 0.028 0.88 0.78 0.99

1The reference category for the dependent variable was the book by Goodman and Gilman; therefore, its odds ratios were 1. The reference category for the school class w as

2012. The additive scales are interpreted as follows: 1) pertinent pharmacological information, 2) appropriate information presentation, 4) adequacy of content. OR means

odds ratio.

2012 (P = 0.165), Table 4. The odds of choosing either Harvey

and Champe or Rang et al instead of Goodman and Gilman did

not depend on the class to which the students belonged (P =

0.669 for class 2010 against 2012 and P = 0.320 for class 2011

compared to 2012). Significant differences were found between

class 2012 and the other two with regard to the odds of choos-

ing between Katzung et al or the “Others” and Goodman and

Gilman (P = 0.001 for class 2010 versus 2012; P = 0.014 for

class 2011 compared to 2012).

Finally, almost three-quarters (72%) of the students ex-

pressed their overall preferences for small-size, concise books

over lengthy, more complete textbooks.

Discussion

Despite the importanc e of Internet source s to provide infor ma-

tion on health scie nce s, pri nted textbooks have long been central

to medical curricula and continue to play a valuable role in

medical education. Pharmacology is not an exception, and te-

xtbooks are the main resource for medical students in search of

knowledge, as opposed to information, on drugs. However, the

most widely recommended pharmacology textbooks are volumi-

nous, containing copious information (Achike et al., 2000) that

far exceeds the core knowle dge recommended for undergra duate

medical students (Orme et al., 2002; Rodriguez et al., 2009;

Dornhorst, 1981; Klatt et al., 2011). Many medical students dis-

like this type of textbook, and frequently complain about their

length and complexity.

In the present study, the textbooks by Goodman & Gilman

and Rodriguez et al. were the two most preferred pharmacology

textbooks among second-year medical students for studying

and preparing for their exams. Our finding that Goodman &

Gilman was one of the two most preferred textbooks is not

surprising. Since its first publication in 1941, this textbook has

become accepted as the most important textbook in its class,

and as one of the most complete guides for teaching and learn-

ing pharmacology. However, as the extent of pharmacology

knowledge grows, the content of the textbook increases with

each new edition, continuing to include details pertinent to the

discipline but that may be of limited relevance to undergraduate

medical students.

The high preference among these medical students for Rod-

riguez et al. is also notable. There are many differences be-

tween Goodman & Gilman and Rodriguez et al. For example,

Goodman & Gilman is an accredited pharmacology reference

source that is useful for all types of students and health profes-

sionals interested in pharmacology, whereas Rodriguez et al. is

R. VENTURA-MARTINEZ ET AL.

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a small-volume text that is designed to confront the changes

that are taking place in the medical curriculum (Chiu-Yin, 2002;

Faingold et al., 2002), and to limit information overload. Rather

than including a range of issues of basic pharmacology, it focuses

on core pharmacology knowledge, referring only to the general

concepts and principles of the discipline that are important for

medical students. It also includes a careful summary of essential

drug information that all medical students should master before

graduation, which is complemented by a core list of commonly

prescribed drugs consistent with British Pharmacology Society

recommendations (Maxwell et al., 2003).

It can be inferred that Goodman & Gilman was preferred be-

cause of its encyclopaedic c ontent, while the preference for Rod-

riguez et al. probably reflects the pragmatism of some students

who prefer more concrete, medically relevant information. The

marked differences in content between these two textbooks are

particularly c lear in terms of ho w the y dea l with indivi dual to pics

and the entire discipline. For example, Goodman & Gilman as-

signs 115 pages to pharmacokinetics, whereas Rodriguez et al.

assign 30 pages to t he same the me. The 12th edition of Goodman

& Gilman is >1800 pages long, indexes over 1250 generic

drugs (some of them without real clinical use), and weighs over

3.8 kg. In contrast, the 2nd edition of Rodriguez et al. is <400

pages long, indexes <440 chemical entities, and weighs <800 g.

Rodriguez et al. focuses on wha t medic a l stude nt s nee d t o study

and at what depth. This textbook gives priority to 160 repre-

sentative, clinically important classes of drugs (therapeutic

prototypes) that medical students are expected to know in detail,

including the name and drug class, mechanism of action, evi-

dence-based clinical indications, important contraindications,

most frequent and severe adverse reactions, clinically signifi-

cant interactions, and possible substitutes. This textbook fo-

cuses on drugs that are commonly prescribed in primary and

secondary care. Interestingly, 47 of the 100 drugs that are most

commonly used in primary and secondary care settings in the

UK (Baker et al., 2011) are mentioned in Rodriguez et al. Of

the remaining 53, 28 are considered to be complementary drugs

and 25 are not listed in Rodriguez et al. Differences in the

numbers of drugs and the importance given to each drug be-

tween the core list in the UK and the list included in Rodriguez

et al. can be explained by differences in healthcare between

Mexico and Europe (Rodriguez et al., 2009).

We found that between 2010 and 2012, the percentage of

students that preferred Rodriguez et al. increased by 5% while

the percentage of students that preferred Goodman & Gilman

decreased by 8.4%. We also found that other well-known text-

books (Harvey & Champe, Rang et al, and Katzung et al.) were

preferred by fewer students than expected, but the preference

for Katzung et al. increased by 7.5% from 2010 to 2012.

The pharmacology textbooks evaluated in the present study

vary considerably in terms of the amount of information being

presented and th e means of presenting this info rmation. The stu-

dents rated each factor listed in the questionnaire for their pre-

ferred textbook. The wide variations in responses suggest that

students are discerning consumers of textbooks. The usefulness

and the adequacy of content were deemed equally important by

students when choosing a textbook. Factor analysis grouped the

reasons that influenced the preference of students for a given

textbook into 4 clusters: 1) pertinence of pharmacological in-

formation (e.g., the textbook explains the pharmacodynamic

and pharmacokinetic properties of the major drugs in a com-

prehensive manner, and identifies drugs that are commonly

used in general medicine); 2) appropriate information presenta-

tion (e.g., the textbook content is clear and concise, and the

information is smoothly presented and helps to integrate

knowledge); 3) meaningful medical context (e.g., the textbook

encourages integration of pharmacology knowledge with that of

other medical disciplines, and focuses on the more common

diseases); and 4) adequacy of content (e.g., the sequence of

themes facilitates comprehension of the entire discipline, and

the material is well-organized). Cronbach’s α coefficients indi-

cated good internal consistency among the items included in

each of the four factors (0.838, 0.859, 0.788, and 0.776, respec-

tively). Overall, these findings indicate that we developed a

valid and reliable questionnaire.

Intriguingly, the preference for Goodman & Gilman in our

student population decreased between 2010 and 2012, whereas

Rodriguez et al. and Katzung et al. gained popularity during

this time. From a student’s perspective, Goodman & Gilman

has adequate content and pertinent pharmacological informa-

tion but fails to present the information appropriately. Regard-

ing the other textbooks included in our survey, the preference

for Rang et al. decreased slightly, while the preference for

Harvey & Champe or the other textbooks was largely un-

changed over the 3 years.

Finally, most of the student s (72%) reported their overall pref-

erence for concise medical textbooks. This confirms the view of

some authors who think that, in medical education, bulky text-

books are suitable as reference textbooks but not for regular

reading (Achike et al., 2000).

In medicine, students and faculty members rely on textbooks

for guidance and learning. We believe that this educational re-

source should be evaluated first, when trying to improve phar-

macology educat ion in medica l school s. We als o propo se that the

pharmacology textbooks reco mmended to un dergr aduate medical

students are medically oriented and of a manageable and appro-

priate length with respect to the topics covered in the textbook.

To our knowledge, this is the first study to provide compre-

hensive data on the reading preferences of medical students in

relation to pharmacology, and the reasons for preferring a spe-

cific pharmacology textbook. We believe that our results will

assist authors to facilitate pharmacology learning by producing

textbooks that suit different styles of learning (Gurpinar et al.,

2011; Shukr et al., 2013).

Three important limitations of our study must be considered

when interpreting our results. First, our study was conducted at

one medical school in one country. Therefore, the results cannot

be extrapolated to medical students at other medical schools.

Second, the scope of our study was limited in that we only in-

cluded nine of more than two dozen pharmacology wide ly avail-

able textbooks. Three, we sur veyed young medical students with

relatively limited medical knowledge and skills. Thus, our find-

ings need to be confirmed in other studies.

Conclusions

Pharmacology t extbooks vary in terms of the a mount of infor-

mation being presented as well as the means of presenting the

information. Goodman & Gilman, a well-known treatise of

pharmacology, and Rodriguez et al., a small, concise textbook

of pharmacology, were the preferred pharmacology textbooks

among these second-year undergraduate medical students. Other

well-known textbooks were used less frequently than expected.

Medical students have different educational abilities and may

R. VENTURA-MARTINEZ ET AL.

OPEN ACCESS

benefit from the availability of different types of textbooks be-

cause it enables them to choose a textbook that fulfils their in-

formation needs and reading skills. As long as students are the

centre of medical education, these results suggest that textbook

authors should carefully consider the views and preferences of

students. The next step is to test whether the use of these text-

books influences the learning and retention of pharmacological

knowledge among medical students.

Competing Interests

The authors declare that they have no competing interests.

Acknowledgements

The authors thank the students from the Faculty of Medicine

of the National University of Mexico who participated in the

study. In addition, we appreciate the editorial assistance from

Stallard Scientific Editing.

REFERENCES

Achike, F. I., & Ogle, C. W. (2000). Information overload in the teach-

ing of pharmacology. Journal of Clinical Pharmacology, 40, 177-183.

http://dx.doi.org/10.1177/00912700022008838

Aronson, J. K. (2009). Medication errors: Emerging solutions. British

Journal of Clinical Pharmacology , 67, 589-591.

http://dx.doi.org/10.1111/j.1365-2125.2009.03420.x

Baker, E., Roberts, A. P., Wilde, K., Walton, H., Suri, S., Rull, G., &

Webb, A. (2011). Development of a core drug list towards improving

prescribing education an d reducing errors in th e UK. British Journal

of Clinical Pharmacology, 71, 190-198.

http://dx.doi.org/10.1111/j.1365-2125.2010.03823.x

Chiu-Yin, K. (2002). Problem-based learning and teaching of medical

pharmacology. Naunyn Schmiedebergs Archives of Pharmacology,

366, 10-17. http://dx.doi.org/10.1007/s00210-002-0561-y

Dean, B., Schacht er, M., Vincent, C., & B arber, N. (2002). Prescribing

errors in hospital inpatients: Their incid ence and clinical significance.

Quality & Safety Health, 11, 340-344.

http://dx.doi.org/10.1136/qhc.11.4.340

Dornhorst, A. C. (1981). Information overload: Why medical education

needs a shake-up. Lancet, 2, 513-514.

http://dx.doi.org/10.1016/S0140-6736(81)90894-1

Faingold, C. L., & Dunaway, G. A. (2002). Teaching pharmacology wi-

thin a multidisciplinary organ s ystem-based medical curriculu m. Na-

unyn Schmiedebergs Archives of Pharmacology, 366, 18-25.

http://dx.doi.org/10.1007/s00210-002-0565-7

Garbutt, J. M., Highstein, G., Jeffe, D. B., Dunagan, W. C., & Frasier,

V. J. (2005). Safe medication p rescri bin g : Training and experience of

medical students and house staff at a large teaching hospital. Aca-

demic Medicine, 80, 594-599.

http://dx.doi.org/10.1097/00001888-200506000-00015

Gurpinar, E., Bati, H., & Tetik, C. (2011). Learning styles of medical

students change in relation to time. Advances in Physiology Edu-

cation, 35, 307-311. http://dx.doi.org/10.1152/advan.00047.2011

Gwee, M. C. E. (2009). Teaching medical pharmacology: The need to

nurture the early development of desired attitudes for safe and ra-

tional drug prescribing. Medical Teacher, 31, 847-854.

http://dx.doi.org/10.1080/01421590903168119

Han, W. H., & Maxwell, S. R. J. (2006). Are medical students ade-

quately trained to prescribe at the po int of graduation? Views of first

year foundation doctors. Scottish Medical Journal, 51, 27-32.

http://dx.doi.org/10.1258/rsmsmj.51.4.27

Harding, S., Britten, N., & Bristow, D. (2010). The performance of

junior doctors in applying clinical pharmacology knowledge and

prescribing skills to standardized clinical cases. British Journal of

Clinical Pharmacology, 69, 598-606.

http://dx.doi.org/10.1111/j.1365-2125.2010.03645.x

Heaton, A., Webb, D. J., & Maxwell, S. R. J. (2008). Undergraduate

preparation for prescribing : The views of 2412 UK medical students

and recent graduates. British Journal of Clinical Pharmacology, 66,

128-134. http://dx.doi.org/10.1111/j.1365-2125.2008.03197.x

Hosmer, D. W., & Lemeshow, S. (2000). Applied logistic regression.

New York: Wiley-Interscience.

http://dx.doi.org/10.1002/0471722146

Ingenito, A. J., Lathers, C. M., & Burford, H. J. (1989). Instruction in

clinical pharmacology: Changes in the wind. Journal of Clinical

Pharmacology, 29, 7-17.

http://dx.doi.org/10.1002/j.1552-4604.1989.tb03231.x

Klatt, E. C., & Klatt, C. A. (2011). How much is too much reading for

medical students? Ass igned reading and readin g rates at one medical

school. Academic Medicine, 86, 1079-1083.

http://dx.doi.org/10.1002/j.1552-4604.1989.tb03231.x

Ling, Y., Swanson, D. B., Holtzman, K., & Bucak, S. D. (2008). Re-

tention of basic science inf ormation by senior medical students. Aca-

demic Medicine, 83, S82-S85.

http://dx.doi.org/10.1097/ACM.0b013e318183e2fc

Maxwell, S. R. J., & Walley, T. (2003). Teaching safe and effective

prescribing in UK medical schools: A core curriculum for tomor-

row’s doctors. British Journal of Clinical Pharmacology, 55, 496-

503. http://dx.doi.org/10.1046/j.1365-2125.2003.01878.x

Maxwell, S. R. J., Cascorbi, I., Orme, M., & Webb, D. (2007). Edu-

cating European (junior) doctors for safe prescribing. Basic & Cli-

nical Pharmacology & Toxicology, 101, 395-400.

http://dx.doi.org/10.1111/j.1742-7843.2007.00141.x

Mislevy, R. J. (1986). Recent developments in the factor analysis of

categorical data. Journal of Educational Statistics, 11, 3-31.

http://dx.doi.org/10.2307/1164846

Orme, M., Frolich, J., & Vrhovac, B. (2002). Towards a core curricu-

lum in clinical pharmacology for undergraduate medical students.

European Journal of Clinical Phar macology, 58, 635-640.

http://dx.doi.org/10.1007/s00228-002-0531-9

Otoom, A. S., & Sequeira, R. P. (2006). Health care prov iders’ percep-

tions of the problems and causes of irrational use of drugs in two

Middle East countries. International Journal of Clinical Practice, 60,

565-570. http://dx.doi.org/10.1111/j.1742-1241.2005.00808.x

R Core Team. A language an d environment for statistical computing. R

Foundation for Statistical Computing. http://www.R-project.org

General Health Law Reg ulations with reg ard to Resear ch on the Health

Sciences, Mexico.

http://www.salud.gob.mx/unidades/cdi/nom/compi/rlgsmis.html

Rodriguez, R., Campos-Sepulveda, E., Vidrio, H., Contreras, E., &

Valenzuela, F. (2002). Evaluating knowledge retention of third-year

medical students taught with an innovative pharmacology program.

Academic Medicine, 77, 574-577.

http://dx.doi.org/10.1097/00001888-200206000-00018

Rodriguez, R., Vidrio, H., & Campos, E. (2009). Medicalization of

pharmacology teaching: An urgent need in the medical curriculum.

Proccedings of the Western Pharmacology Society, New York, NY:

Curran Associates, 120-128.

Ross, S., & Maxwell, S. (2012). Prescribing and the curriculum for

tomorrow’s doctors: BPS curriculum in clinical pharmacology and

prescribing for medical stu dents . British Jo urn al of Clinical Pha rma-

cology, 74, 644-661.

http://dx.doi.org/10.1097/00001888-200206000-00018

Sawyer, S. J., Sylvestre, P. B., Girard, R. A., & Snow, M. H. (1996).

Effects of supplemental instruction on mean test scores and failure

rates in medical school courses. Academic Medicine, 71, 1357-1359.

http://dx.doi.org/10.1097/00001888-199612000-00021

Shukr, I., Zainab, R., & Rana, M. H. (2013). Learning styles of post-

graduate and undergraduate medical students. Journal of College of

Physicians and Surgeons Pakistan, 23, 25-30.

Tabachnick, B. G., & Fidell, L. S. (2007). Using multivariate statistics.

Upper Saddle River NJ: Pearson Education Inc.

Walley, T., Bligh, J., Orme, M., & Breckendrige, A. (1994). Clinical

pharmacology and therapeutics in undergraduate medical education

in the UK: Current status. British Journ al of Clinical Pharmacolo gy,

37, 129-135. http://dx.doi.org/10.1111/j.1365-2125.1994.tb04252.x