Implementation of the WHO-6-step method in the medical curriculum to improve pharmacology knowledge and pharmacotherapy skills

Carolina J P W Keijsers, Wieke S Segers, Dick J de Wildt, Jacobus R B J Brouwers, L. Keijsers, Paul A F Jansen

Research output: Contribution to journalArticleScientificpeer-review

15 Citations (Scopus)



The only validated tool for pharmacotherapy education for medical students is the 6-step method of the World Health Organization. It has proven effective in experimental studies with short term interventions. The generalizability of this effect after implementation in a contextual-rich medical curriculum was investigated.


The pharmacology knowledge and pharmacotherapy skills of cohorts of students, from years before, during and after implementation of a WHO-6-step-based integrated learning programme were tested using a standardized assessment containing 50 items covering knowledge of basic (n = 25) and clinical (n = 24) pharmacology, and pharmacotherapy skills (n = 1 open question). All scores are expressed as a percentage of the maximum score possible per (sub)domain.


In total, 1652 students were included between September 2010 and July 2014 (participation rate 89%). The WHO-6-step-based learning programme improved students' knowledge of basic pharmacology (mean score ± SD, 60.6 ± 10.5% vs. 63.4 ± 10.9%, P < 0.01) and clinical or applied pharmacology (63.7 ± 10.4% vs. 67.4 ± 10.3%, P < 0.01), and improved their pharmacotherapy skills (68.8 ± 26.1% vs. 74.6% ± 22.9%, P 0.02). Moreover, satisfaction with education increased (5.7 ± 1.3 vs. 6.3 ± 1.0 on a 10-point scale, P < 0.01) and as did students' confidence in daily practice (from -0.81 ± 0.72 to -0.50 ± 0.79 on a -2 to +2 scale, P < 0.01).


The WHO-6-step method was successfully implemented in a medical curriculum. In this observational study, the integrated learning programme had positive effects on students' knowledge of basic and applied pharmacology, improved their pharmacotherapy skills, and increased satisfaction with education and self-confidence in prescribing. Whether this training method leads to better patient care remains to be established.

Original languageEnglish
Pages (from-to)896-906
JournalBritish Journal of Clinical Pharmacology
Issue number6
Publication statusPublished - Jun 2015


  • Adult
  • Attitude of Health Personnel
  • Clinical Competence
  • Curriculum
  • Education, Medical
  • Educational Measurement
  • Educational Status
  • Female
  • Health Knowledge, Attitudes, Practice
  • Humans
  • Learning
  • Male
  • Motivation
  • Netherlands
  • Pharmacology, Clinical
  • Program Evaluation
  • Students, Medical
  • Surveys and Questionnaires
  • Test Taking Skills
  • World Health Organization
  • Young Adult


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