3rd Place WINNER: Product of the Year at the 2009 Reynolds Grantees Meeting in Las Vegas, NV

“Lions and tigers and bears! Oh, my!” exclaimed a young Dorothy in the 1939 film “The Wizard of Oz”. A much older Dorothy would have exclaimed “Pills, pills and more pills!” if she had the average number of chronic illnesses that older adults have along with the illnesses' concomitant treatment with pharmaceutical agents. This problem of polypharmacy is the issue addressed in “Pills, Pills and More Pills: A Pill Box Exercise to Reduce Polypharmacy” by an interactive, “hands-on” experience paired with group reflection by Diane Brown, Kathryn Denson and Jessica Kuester from The Medical College of Wisconsin. This POGOe product was voted 3rd Place WINNER as Product of the Year at the 2009 Reynolds Grantees Meeting in Las Vegas, NV.

Targeting learners at various levels – medical students, residents and fellows - the goal of this exercise is to improve the learner’s awareness of the barriers to medication adherence and to increase medication discontinuance/dosing changes. Learners are each given a pillbox and a medication list. They must fill the box with the dosages from a list of “prescriptions” that are given to them as a fictitious patient, “Mr. K”. The prescriptions consist of candies of varying colors and shapes, which are used to represent real medications. Learners must take the “medications” for one week and take note of any problems that they might encounter (e.g. forgetting to take a dose). This is then followed by a faculty-facilitated discussion about barriers and solutions (both physician and patient/family initiated) that could be used to aid adherence.

This product provides detailed instructions on how to implement the program, including a sample list of 15 medications for “Mr. K” and a 5-item pre/post survey to assess the effectiveness of this educational intervention. The educator who may want to implement this exercise must prepare the educational materials in advance. The materials include a seven-day pillbox with AM-Noon-PM-Bedtime per day compartments for each student. The assignment also requires 15 labeled prescription bottles handed out in a large bag for every 2-3 students. All of these items can be reused, making this a one-time purchase. The educator will also need to purchase different types of candies in bulk for all of the students to fill their fake prescriptions. With the variety of candy shapes and colors available, this is an effective way to simulate taking various medications.

By putting the students in a patient’s shoes, this exercise shows them first hand how complicated medication adherence can be. Learners will experience the challenges of medication adherence to a long list of prescriptions. Hopefully, the learners, especially those in the postgraduate levels, will be more aware of their patients’ medication lists and the issue of polypharmacy and aid in reducing medication non-adherence among their patients.

Try this interactive exercise now! It is available for FREE right here at POGOe.org. Besides, eating candy for a homework assignment is not a bad deal and would certainly make this a memorable and fun experience for all!