Treatment guidelines differ significantly, not only between Europe and North America but also among European countries [1,2,3,4]. Reasons for these differences include antimicrobial resistance patterns, accessibility to and reimbursement policies for medicines, and culturally and historically determined prescribing attitudes. The European Association of Clinical Pharmacology and Therapeutics’ Education Working Group has launched several initiatives to improve and harmonize European pharmacotherapy education, but international differences have proven to be a major barrier to these efforts [5,6,7]. While we have taken steps to chart these differences [6, 8], it will probably not be possible to fully resolve them. Rather than viewing these differences as a barrier, we should perhaps see them as an opportunity for intercultural learning by providing students and teachers a valuable lesson in the context-dependent nature of prescribing medication and the different interpretations of evidence-based medicine. Here, we extend our experience with interprofessional student-run clinics [9, 10], to report on our first experiences with the “International and Interprofessional Student-run Clinic.”

We organized three successful video meetings with medical and pharmacy students of the Amsterdam UMC, location VU University (the Netherlands), and the University of Bologna (Italy). During these meetings, one of the students presented a real-life case of a patient on polypharmacy. Then, in a 45-min session, the students split into smaller groups (break-out rooms) to review the patient’s medication, using the prescribing optimization method and STOPP/START criteria [11, 12]. The teachers rotated between the different rooms and assisted the students when necessary. Teachers and students reconvened for 60 min for debriefing, with students presenting their findings and suggestions to revise the medication list and teachers stimulating discussion and indicating how they would alter the medication list. Participation was voluntary, and the meetings were held in the evenings to accommodate students in clinical rotations.

Third-to-final-year medical and pharmacy students participated in the three meetings (n = 17, n = 20, n = 12, respectively). They reported learning a lot from each other, gaining an international and interprofessional perspective. Moreover, they learned to always consider the patient’s perspective, that evidence-based medicine is context-dependent, and that guidelines should be adapted to the patient’s situation.

There were marked differences in prescribing guidelines and the use and accessibility of medicines (Table 1). In both countries, national societies develop guidelines based on international standards, but in the Netherlands, most hospitals have their own local guidelines as well, resulting in different prescribing preferences (e.g., use of different low-molecular-weight heparins). Differences in prescribing preferences exist in Italy, but are based on regional, not local, formularies. For instance, the Emilia-Romagna region has a periodically revised formulary, whereas the Lombardy region does not. Moreover, while in the Netherlands, physicians are allowed to prescribe almost all marketed drugs, even if their costs are not always reimbursed; in Italy, certain drugs may only be prescribed by a specialist (e.g., new glucose-lowering drugs, until January 2022) [13].

Table 1 Examples of differences between clinical practice guidelines and the use of medicines in the Netherlands and Italy
Full size table

These first experiences with international and interprofessional case discussions during the COVID pandemic have taught us that geographical distance no longer needs to be an obstacle to organizing educational events. This, together with the earlier finding that an interprofessional student-run medication review program could optimize pharmacotherapy and reduce adverse drug events, is a promising development [14, 15]. We intend to expand the scope of these case discussions by including different universities and larger (intra-curricular) assignments. Five other European universities monitored the last two meetings and want to participate in future meetings. The European Open Platform of Prescribing Education (EurOP2E) provides a meeting place for international teachers wishing to organize such meetings and helps to facilitate them. Interested teachers can apply via www.prescribingeducation.eu.