Medication-related examination questions in clinical courses within undergraduate medical education

Abstract

Pharmacotherapy is a core competence for physicians and students’ learning is guided by examinations. This study aimed to examine medication-related examination questions across clinical courses spanning four semesters within a Swedish medical programme. In total, 375 questions used in four examinations (spring 2025; University of Gothenburg) were categorised independently, followed by consensus discussions, into mutually exclusive groups. In the first step, it was determined whether a question was medication-related; if so, the second step involved categorising its content according to the WHO 6-Step Model, which structures the physician ‘s pharmacotherapeutic workflow from defining the patient’s problem (differential diagnosis) and the therapeutic goal, to selecting and prescribing appropriate medications, counselling, and planning for monitoring and follow-up. Ninety-four (25%) questions were related to medications, and an additional 44 (12%) included medications but they were not the primary focus. Half of the medication-related examination questions concerned general medication knowledge, including items where a condition was to be matched with the standard treatment (n = 47). The remaining questions (n = 47) addressed the first (n = 8), second (n = 5), third (n = 33), and fifth (n = 1) steps of the WHO 6-Step Model. No questions were related to the fourth and sixth steps. Pharmacotherapeutic aspects appeared as an integral component of written examinations in undergraduate clinical courses, but the questions often concerned drug selection and factual recall; other steps in the WHO Model deserve attention in other assessment procedures, including pharmacotherapy-related differential diagnosis, goal setting, technical aspects of prescribing, patient counselling, and follow-up monitoring.