Open Access Research article

Identifying outcome-based indicators and developing a curriculum for a continuing medical education programme on rational prescribing using a modified Delphi process

Hamideh M Esmaily123*, Carl Savage4, Rezagoli Vahidi35, Abolghasem Amini26, Mohammad Hossein Zarrintan7 and Rolf Wahlstrom18

Author Affiliations

1 Division of International Health (IHCAR), Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden

2 Educational Development Center (EDC), Tabriz University of Medical Sciences, Tabriz, Iran

3 National Public Health Management Center (NPMC), Tabriz, Iran

4 PhD student, Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden

5 Health and Nutrition Department, Tabriz University of Medical Sciences, Tabriz, Iran

6 Medicine Department, Tabriz University of Medical Sciences, Tabriz, Iran

7 Pharmacy Department, Tabriz University of Medical Sciences, Tabriz, Iran

8 Department of Public Health and Caring Sciences, Family Medicine and Epidemiology, Uppsala University, Uppsala, Sweden

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BMC Medical Education 2008, 8:33  doi:10.1186/1472-6920-8-33

Published: 30 May 2008



Continuing medical education (CME) is compulsory for physicians in Iran. Recent studies in Iran show that modifications of CME elements are necessary to improve the effectiveness of the educational programmes. Other studies point to an inappropriate, even irrational drug prescribing. Based on a needs assessment study regarding CME for general physicians in the East Azerbaijan province in Iran, rational prescribing practice was recognized as a high priority issue. Considering different educational methods, outcome-based education has been proposed as a suitable approach for CME. The purpose of the study was to obtain experts' consensus about appropriate educational outcomes of rational prescribing for general physicians in CME and developing curricular contents for this education.


The study consisted of two phases: The first phase was conducted using a two-round Delphi consensus process to identify the outcome-based educational indicators regarding rational prescribing for general physicians in primary care (GPs). In the second phase the agreed indicators were submitted to panels of experts for assessment and determination of content for a CME program in the field.


Twenty one learning outcomes were identified through a modified Delphi process. The indicators were used by the panels of experts and six educational topics were determined for the CME programme and the curricular content of each was defined. The topics were 1) Principles of prescription writing, 2) Adverse drug reactions, 3) Drug interactions, 4) Injections, 5) Antibiotic therapy, and 6) Anti-inflammatory agents therapy. One of the topics was not directly related to any outcome, raising a question about the need for a discussion on constructive alignment.


Consensus on learning outcomes was achieved and an educational guideline was designed. Before suggesting widespread use in the country the educational package should be tested in the CME context.