Inclusion of Symposium-Based Learning of Rational Drug Use for Medical Undergraduates: Evaluation of its Effectiveness and Feedback

A pre-post interventional study was conducted among 150 second-year MBBS students to evaluate the impact of a RDU symposium on knowledge, attitude, practice, and awareness related to rational drug prescribing. The sample size represented a census of all eligible second-year MBBS students during the study period, reflecting pragmatic feasibility rather than an a priori statistical estimation. The study objectives and procedures were clearly explained to the students prior to data collection, and participation was entirely voluntary. Students who provided informed consent were included, with no exclusions based on academic performance or demographic characteristics, thereby enhancing the representativeness of the sample. Confidentiality and anonymity of the responses were strictly maintained using coded questionnaires and secure data handling practices. No identifying information was collected at any stage of the survey. The data collection process was supervised by trained faculty to ensure uniform administration of the questionnaires. This methodological rigor strengthened the internal validity of the findings and supported the reliability of the students’ self-reported responses. A structured, pre-validated questionnaire was administered to all participants immediately before (pre-assessment) and after (post-assessment) the symposium. The questionnaire was designed to cover five domains: Knowledge, Attitude, Practice, Feedback and Awareness. For the Knowledge, Attitude, Feedback and Practice (KAFP) sections, responses were collected individually from all 150 students to obtain a comprehensive measure of baseline understanding and post-intervention improvement across the entire cohort. For the Awareness domain, students were stratified into five equal cohorts (n=30 each) according to their clinical posting allocation—participants were stratified into five cohorts based on their exposure to clinical rotations: General Medicine (n=30), General Surgery (n=30), Pediatrics (n=30), Obstetrics and Gynecology (n=30), and Community Medicine (n=30). This stratification enabled domain-specific assessment of awareness related to rational drug use before and after symposium exposure. Such grouping ensured comparability across clinical disciplines and enhanced the interpretive rigor of pre- and post-intervention analyse. This stratification was deliberately employed to acknowledge and control for the inherent variability in clinical learning environments, including diversity in patient presentations, pharmacotherapeutic practices, prescribing behaviors, and experiential engagement with drug-related decision-making across specialties. Such structured grouping enabled a more targeted evaluation of awareness levels and facilitated a nuanced interpretation of how learners from distinct clinical contexts assimilate and operationalize the core principles of RDU. Moreover, this approach minimized potential bias from knowledge disparities and enhanced the interpretability of interdepartmental differences in awareness levels. All collected data were anonymized, coded, and subjected to statistical analysis using paired comparisons to evaluate pre- and post-symposium changes within each domain, with particular attention to differential gains across grouped subpopulations in the Awareness section.

A pre-validated and structured questionnaire was employed to assess the Knowledge, Attitude, Practice, Feedback and Awareness (KAPFA) domains before and after the symposium. The instrument comprised 37 core items distributed across multiple sections. Section 1 (Knowledge) included ten multiple-choice questions that evaluated students’ conceptual understanding of RDU, with each correct answer scored as 1 and incorrect responses scored as 0. Section 2 (Attitude) consisted of five statements rated on a five-point “Likert scale”, capturing participants’ perceptions and disposition toward rational prescribing. Section 3 (Practice) presented five clinical vignettes designed to assess real-world decisionmaking and application of RDU principles. Section 4 (Feedback) included seven items eliciting participants’ evaluation of the symposium’s relevance, clarity, and perceived impact. Section 5 (Awareness) comprised ten Likert-based statements measuring students’ baseline and post-symposium awareness of RDU concepts and drug-selection criteria. The questionnaire underwent a multi-step validation process. It was developed using the WHO Guide to Good Prescribing, National Essential Medicines List (NLEM), and established RDU instruments. Content validity was ensured by expert review (pharmacologist, clinician, and clinical pharmacist). A pilot study in 30 second-year MBBS students assessed clarity and feasibility. Internal consistency showed good reliability with a Cronbach’s alpha of 0.82 across domains. Test–retest reliability over two weeks demonstrated good stability (ICC >0.75). Thus, the tool showed strong content validity, face validity, internal consistency, and reproducibility for assessing RDU-related KAPFA outcomes.

Section 5 (Awareness) consisted of ten statements assessing students’ awareness of Rational Drug Use (RDU) concepts, including correct drug selection, therapeutic objectives, appropriate information sources, and awareness of pharmaceutical influence. This Awareness section consisted of 10 statements, each comprising four sub-options (A–D). Each sub-option was rated independently by the students using a six-category response Likert scale: 0 = No idea, 1 = Strongly disagree, 2 = Disagree, 3 = Neutral, 4 = Agree, 5 = Strongly agree. Thus, each statement had a maximum possible score of 20 (4 options × 5 points), and the overall maximum Awareness score was 200 (10 statements × 20 points). Scores from all sub-options were summed to generate the composite Awareness score used for statistical analysis. This approach was adopted to capture the depth and consistency of students’ awareness across multiple facets of each RDU concept. Rating all options individually allowed finer discrimination of partial knowledge, misconceptions, and overall conceptual clarity beyond single-choice responses. All ten items contributed to the cumulative Awareness score. For group-wise analysis, students were stratified according to their clinical postings, and mean Awareness scores were calculated separately for each group to allow comparison across clinical disciplines. To facilitate clearer interpretation of key RDU concepts, selected Awareness items were additionally dichotomized for descriptive reporting. Responses of Agree and Strongly agree were categorized as “Yes”, indicating adequate awareness, while Neutral, Disagree, strongly disagree, and No idea where categorized as “No”. This dichotomization was applied only to selected core items and was used to present proportions of students demonstrating correct awareness, without replacing the primary Likert-based composite score analysis. Thus, the Awareness results are presented using both continuous composite scores (for statistical comparison and group-wise analysis) and Yes/No frequencies (for key concept clarity), ensuring methodological rigor while improving reader interpretability.

A single multidisciplinary symposium functioned as the educational intervention convened for four hours and led by specialists in pharmacology, clinical pharmacy, medicine, and nursing. The programme integrated focused didactic presentations with case-based discussions to strengthen conceptual and practical understanding of RDU. Content systematically addressed core RDU principles: therapeutic efficacy, safety, cost-effectiveness, and evidence-based prescribing, while explicitly mapping the complementary responsibilities of clinicians, pharmacists, nurses, and pharmacologists in medication stewardship, reconciliation, monitoring, and pharmacovigilance. Faculty identified common antecedents of irrational drug use (diagnostic uncertainty, polypharmacy, commercial influences, and system constraints) and described measurable consequences such as adverse drug reactions, antimicrobial resistance, and increased healthcare costs. Practical implementation strategies for resource-limited clinical environments were emphasized, including standardized treatment protocols, point-of-care decision aids, interprofessional communication pathways, and audit-andfeedback mechanisms. Subsequently, 150 students were allocated into five groups; each group generated questions and perceptions that were explored during a two-hour, faculty-moderated interactive panel to consolidate learning and identify curricular gaps.

The structured and pre-validated questionnaire was administered to all participants immediately before and after the symposium to assess changes in knowledge, attitudes, and perceptions related to rational drug use. On both occasions, students were allotted 20 minutes to complete the questionnaire under supervised conditions to minimize external influences. They were explicitly instructed not to consult textbooks, electronic resources, class notes, or peers to ensure that responses reflected individual understanding rather than collaborative input. Completed questionnaires were collected promptly and reviewed for completeness before being coded with anonymized identifiers to maintain confidentiality and enable paired pre- and post-intervention analysis. All data were subsequently entered into a secure database, crosschecked for entry accuracy, and prepared for statistical evaluation. This standardized administration protocol ensured methodological consistency, reduced response bias, and allowed reliable comparison of learning outcomes attributable to the symposium.

Data were entered into Microsoft Excel and analysed using SPSS version 29. Descriptive statistics, such as mean and standard deviation, were used to summarise KAP scores. Pre- and post-symposium knowledge and practice scores were compared using the paired Student’s t-test. Assumptions for the paired t-test, including normal distribution of difference scores, were verified prior to analysis. A p-value < 0.05 was considered statistically significant.

The participating students’ demography highlights several critical factors that may influence learning and attitudes toward RDU. For analytical purposes, pharmacology practical attendance was classified as High (>85%), Moderate (75–85%), and Low (<75%). “Type of schooling” denoted the higher secondary education board (State Board, CBSE, ICSE, or Others). All participants were from the same institution and received an identical educational intervention. The “Others” category included alternative programs. Consistent post-intervention improvements suggest that schooling background did not materially influence study outcomes.. Most of the students lacked prior exposure to RDU education (93.4%), indicating that the symposium addressed a major educational gap. A high proportion reported exposure to self-medication practices at home (60.7%), suggesting that personal and family-level behaviors may shape their understanding of drug use. Interest in pharmacology was mostly moderate to low (72.4%), reflecting the need for engaging teaching strategies to strengthen motivation in this subject. Although all participants had access to smartphones and the internet (100%), awareness of prescription regulations remained low (19.5%), stressing the importance of structured educational interventions to improve regulatory literacy among medical students.

The symposium led to a substantial and statistically significant improvement in participants’ knowledge, demonstrating the effectiveness of the educational intervention. Post-session responses reflected greater accuracy, clearer understanding, and more consistent performance on RDU-related concepts. The mean knowledge score significantly increased from 5.45 ± 1.03 before the symposium to 7.02 ± 0.86 after the symposium, indicating a substantial improvement in participants’ understanding of Rational Drug Use (RDU) concepts. The mean difference of 1.57 points reflects a meaningful gain in knowledge attributable to the educational intervention. The 95% confidence interval (1.43–1.71) does not cross zero, confirming that the improvement is statistically reliable. The paired t-test yielded a t-value of 12.34 (df = 149) with a p-value < 0.001, demonstrating a highly significant increase in knowledge scores following the symposium. This suggests that the educational session had a strong positive impact on participants’ conceptual understanding and ability to answer RDU-related MCQs correctly. Overall, the symposium was effective in enhancing knowledge, with post-intervention scores showing higher accuracy, improved comprehension, and reduced variability, as reflected by the lower SD in post-test scores.

Students already had positive attitudes toward rational drug use, which were further strengthened by the symposium, with appreciable increase in strong agreement across all domains, reflecting enhanced understanding, commitment, and appreciation of evidence-based prescribing principle (Table 2).

Across all five statements, students’ attitude showed very high agreement even before the symposium, but the postsymposium responses demonstrated a clear shift from “Agree” to “Strongly Agree,” indicating strengthened attitudes rather than newly formed opinions. Interest in learning evidence-based prescribing (1A) remained consistently high, while perceptions of the symposium’s value in improving understanding of RDU and its practical challenges (1B) increased to almost unanimous agreement. Awareness of costeffectiveness in prescribing (1C) and the role of RDU in preventing antibiotic resistance (1D) also improved markedly, with substantial rises in “Strongly Agree” responses. Recognition of the influence of pharmaceutical promotions (1E) showed one of the largest positive shifts. Overall, the symposium enhanced students’ depth of understanding and reinforced their commitment to rational drug use principles.

Students showed a large, consistent improvement in practice-based case-scenario performance after the symposium, with statistical tests indicating the gain is highly significant and unlikely due to chance. In short, the symposium meaningfully improved students’ practical competence in applying RDU principles.

The practice-based (case-scenario) scores showed a substantial improvement following the symposium, with the mean increasing from 2.34 ± 0.61 pre-symposium to 4.06 ± 0.57 post-symposium. The paired difference analysis demonstrated a highly significant gain, with the mean difference falling within a narrow and positive 95% confidence interval (1.24–1.43), indicating a consistent improvement across participants. The very high t-value (26.85) and the p-value < 0.001 confirm that the increase in scores is statistically significant and unlikely due to chance. Overall, the symposium effectively enhanced students’ ability to apply rational drug use principles in case-based scenarios, reflecting meaningful gains in practical, application-level competence.

The feedback scores indicate that the symposium was highly well-received, with students finding it relevant, engaging, and valuable for improving their understanding of RDU, and showing strong interest in attending similar sessions in the future.

The overall feedback from participants was overwhelmingly positive, with the majority responding “Yes” across all evaluation statements. Most students found the topics highly relevant (94%) and felt that the programme met their expectations (96%). A similarly high proportion (94%) expressed that they would recommend the symposium to peers, and 94% reported that the sessions were interesting. Furthermore, 96% believed that the symposium improved their awareness and understanding of rational drug use. Importantly, 95% of participants indicated that they look forward to attending similar sessions in the future. These results collectively demonstrate strong acceptance, high perceived value, and clear educational impact of the symposium among the students.

The symposium led to a substantial improvement across all assessed domains, significantly enhancing students’ knowledge, awareness, and application skills related to RDU. Students demonstrated marked gains in understanding pharmaceutical influence, correct information, drug use, and decision-making.

The outcome measures demonstrated remarkable improvement across all domains following the symposium, with each parameter showing more than a 250% increase from pre- to post-assessment. The largest gain was seen in awareness of pharmaceutical influence (+395%), indicating a substantial shift in students’ critical understanding of industry impact on prescribing. Correct information (+345%) and correct drug use (+324%) also showed strong improvements, reflecting enhanced conceptual clarity and application skills. RDU awareness (+304%) and correct drug selection (+277%) improved significantly, demonstrating strengthened foundational knowledge and decision-making ability. Overall, the total awareness score increased by 325%, confirming that the symposium had a profound and comprehensive educational impact across all components of rational drug use.

All Clinical Posting groups demonstrated substantial improvement following the symposium, with post-symposia scores nearly quadrupling compared to baseline. The Obstetrics and Gynecology and Community Medicine groups showed the highest proportional gains (+362% and +330%, respectively), indicating exceptional enhancement in RDU understanding among these students. General Surgery also showed a strong improvement (+343%), while General Medicine and Pediatrics exhibited slightly lower, but still highly significant with increases of +292% and +278%. Overall, the combined improvement across all groups was +319%, reflecting a uniformly positive educational impact of the symposium irrespective of departmental background.

Across all domains, there was a striking shift from moderate baseline understanding to near-universal correctness after the symposium. Pre-symposia responses showed that only about half of the students recognized key criteria for rational drug selection, such as safety, tolerability, efficacy, and cost as essential, with “All of the above” acknowledged by just 50.6%. Post-symposia, however, over 94–99% of students answered correctly across all items, indicating an exceptional rise in conceptual clarity. Similarly, understanding the need for a detailed history and the importance of defining therapeutic objectives increased from around 52–55% pre-symposia to 98–99% post-symposia. Recognition of therapeutic goals such as treating symptoms, eradicating disease, and preventing complications also improved dramatically from 50–53% to nearly 97–99%. Overall, the symposium produced a transformative improvement in students’ foundational knowledge of rational drug use, elevating all domains to near-perfect understanding.

Despite the encouraging outcomes observed in this study, certain methodological limitations should be acknowledged. First, the study employed a single-group pre–post quasi-interventional design without a parallel control group. Although this design is commonly used for educational interventions implemented as part of routine academic programs, it limits causal inference and does not entirely exclude the influence of external factors such as maturation or concurrent learning experiences. To minimize this risk, the pre- and post-assessments were conducted immediately before and after the symposium, thereby reducing the likelihood of confounding educational exposures. Second, the study was conducted at a single institution, which may limit the generalizability of the findings to other medical colleges with differing curricula, teaching environments, or student demographics. However, inclusion of the entire eligible second-year MBBS cohort enhanced internal validity and reduced selection bias. Third, outcomes were primarily measured using self-reported questionnaire responses, which are susceptible to response and social desirability bias. This potential bias was mitigated by ensuring anonymity, using coded questionnaires, prohibiting peer discussion during data collection, and employing a rigorously validated instrument with good internal consistency (Cronbach’s alpha = 0.82). Fourth, the assessment focused on short-term learning gains immediately following the symposium. Long-term retention of knowledge and sustained changes in prescribing behaviour could not be evaluated within the scope of the present study. Future longitudinal and multi-institutional studies are warranted to assess the durability and clinical translation of these educational gains. Finally, although students were stratified by clinical posting for awareness assessment to control for variability in clinical exposure, unmeasured differences in individual learning styles and prior informal exposure to prescribing practices may have influenced baseline scores. Nonetheless, uniform improvement across all groups suggests that the symposium had a consistent educational impact.