main topic Wien Med Wochenschr DOI 10.1007/s10354-013-0261-x
Preventive medicine: self-assessment of knowledge, skills and attitudes of medical students at the Medical University of Vienna Livia Borsoi · Anita Rieder · Katharina Viktoria Stein · Angelika Hofhansl · Thomas Ernst Dorner
Received: 14 August 2013 / Accepted: 25 December 2013 © Springer-Verlag Wien 2014
Summary Prevention and health promotion are gaining importance in modern medical curricula. Aim of this study was to evaluate the self-assessment of knowledge, skills and attitudes of medical students towards health promotion and prevention. In 2012, at the Medical University of Vienna, 27 % of the 633 fourth-year medical students (50.3 % male and 49.7 % female; mean age: 24 years) completed a questionnaire. Results show a high assessment of prevention in most respondents. Knowledge gaps were detected on occupational health and mother–child pass examinations. However, almost all students reported sufficient knowledge on screening and risk assessment of developing cardiovascular diseases. Almost all respondents estimated to be able to identify risky behaviours. Overall, estimation towards prevention of tomorrow’s physicians is very positive. However, only 40 % believed to have been adequately trained on preventive medicine so far. Relevant preventive aspects were added to the medical curriculum in 2012–2013 with the new block ‘Public Health’. Keywords Prevention · Health-care promotion · Undergraduate medical curriculum
Dr. med. L. Borsoi, MPH () · Dr. med. Univ. Prof. A. Rieder · Dr. K. V. Stein · Ass.-Prof. Priv.-Doz. Dr. T. E. Dorner, MPH Institute of Social Medicine, Centre for Public Health, Medical University of Vienna, Kinderspitalgasse 15, 1090 Vienna, Austria e-mail: [email protected] Dr. med. Univ. Prof. A. Rieder · Mag. Dr. A. Hofhansl, MME Department for Medical Education, Medical University of Vienna, Vienna, Austria
13
Präventivmedizin: Selbsteinschätzung von Wissen, Fähigkeiten und Haltungen von Medizinstudierenden an der Medizinischen Universität Wien Zusammenfassung Prävention und Gesundheitsförderung gewinnen in modernen Medizincurricula zunehmend an Bedeutung. Ziel dieser Studie war die Selbsteinschätzung von Wissen, Fähigkeiten und Haltungen von Medizinstudierenden gegenüber Gesundheitsförderung und Prävention zu erheben. 2012 füllten 27 % der 633 Studierenden im 4. Studienjahr an der Medizinischen Universität Wien (50,3 % männlich und 49,7 % weiblich; Durchschnittsalter = 24 Jahre) einen Fragebogen aus. Die Ergebnisse zeigen einen hohen Stellenwert von Prävention beim Großteil der Befragten. Wissenslücken gab es bezüglich arbeitsmedizinischen bzw. MutterKind-Pass-Untersuchungen. Hingegen gaben beinahe alle Studierende ausreichende Kenntnisse hinsichtlich Vorsorgeuntersuchungen sowie Risikoeinschätzung zur Entwicklung von Herzkreislauferkrankungen an. Fast alle Befragten glaubten Risikoverhalten identifizieren zu können. Insgesamt ist die kommende Generation von ÄrztInnen sehr positiv gegenüber Prävention eingestellt. Allerdings fühlten sich lediglich 40 % bisher durch das Studium ausreichend zum Thema Präventivmedizin ausgebildet. Das Medizincurriculum wurde nun mit der Etablierung des neuen Blocks „Public Health“ ab 2012–2013 u. a. um relevante präventive Aspekte erweitert. Schlüsselwörter Prävention · Gesundheitsförderung · Medizin-Curriculum
Introduction Prevention as a teaching subject in its own right in the medical undergraduate curriculum was first introduced
Preventive medicine: self-assessment of knowledge, skills and attitudes of medical students
1
main topic
in Austria in 1973 under the name ‘Social Medicine’ at the University of Vienna [1]. Social Medicine was added as an examination subject in the third Rigorosum (an examination, laid down by the ‘Medizinische Rigorosenordnung’, 1903, covering the last part of medical studies before receiving the doctor’s degree [2]). After establishing a new medical curriculum (N202) in 2002, the teaching of prevention at the Medical University of Vienna was realised within Block 6, ‘Environment, Family and Society’, in the first year of medical studies (second semester) and again in the fourth year (seventh semester). However, awareness and attitudes of the students about prevention were never assessed in Austria. The question of how to improve the awareness and knowledge on prevention in the current and future curriculum hence was an important issue. Against this background, the survey intent was to assess knowledge and attitudes of medical students about prevention and health promotion as part of a curriculum evaluation project.
education [3] and adapted to specific topics of teaching at the Medical University of Vienna. Along with sociodemographic information (sex, age), the questionnaire included 31 questions that addressed knowledge on prevention, skills on health care and prevention counselling, as well as attitudes and beliefs towards prevention. Each question used five-point Likert scales. For all Likert scales, a score of 1 indicated the strongest degree of agreement, importance or estimation (very good), while 5 expressed the strongest degree of disagreement, insignificance or disestimation (insufficient). Sex-related differences were tested by chi-square test. To address topics that were not mentioned in the closed questions, students were asked to answer two open questions at the end of the questionnaire: ‘Which aspects of preventive medicine have not been taught yet?’ and ‘Is there anything more that you would like to say on preventive medicine?’ The mean score of the nine questions pertaining to knowledge on prevention (listed in Fig. 1) and the mean of the seven questions on skills (listed in Fig. 2) and of the four questions on importance of prevention (listed in Fig. 3) were computed. By unweighted summation of scores of the nine questions in Fig. 1 as well as of the seven questions in Fig. 2 and of the four queries in Fig. 3, three new variables were created called, respectively, ‘knowledge’, ‘skills’ and ‘importance’. On these variables, a Mann–Whitney U test was performed searching differences between sexes. Statistical analysis was done with SPSS 21.0.
Methods During the summer semester of 2012, a questionnaire was handed out to fourth-year medical students of the Medical University of Vienna attending mandatory lessons. Although 633 students were registered at the fourth year, only a small part of them could be reached by the survey due to the limited duration of the survey (2 weeks). Moreover, the quote of responders between those attending lessons was not calculated. Students voluntary filled out the anonymous questionnaire. A declaration of consent was filled out. The study was approved by the ethics committee of the Medical University Vienna (EC # 1260/2012). Queries were chosen based on recent literature on predictors of student preferences in undergraduate medical Fig. 1 Self-estimation of previous knowledge on preventive medicine topics (five-point Likert scale). X-axis: percentage of answers. In columns, absolute numbers are shown
Results Of 633 students, 169 filled the questionnaire (27 %). Responders were equally distributed between sexes (49.7 % women and 50.3 % men), with mean age of 24 (range: 20–33) years.
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main topic Fig. 2 Self-estimation of the skills on preventive medicine measures (five-point Likert scale). X-axis: percentage of answers. In columns, absolute numbers are shown
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Almost all interviewed students believed to be able to assess the risk of developing a cardiovascular disease at least sufficiently. Only 4 % of the participants estimated not to have a sufficient knowledge on screening, although, when asked on risk–benefit evaluations in screening programmes, the percentage of those without know-how doubled. Moreover, almost 40 % defined their knowledge about patient information and counselling on screening programmes as less than satisfactory. On mother–child pass examinations, one-fifth of the participants believed not to have acquired enough information, while almost one-third of the surveyed students declared not to have sufficient knowledge on prevention at the workplace (Fig. 1). Regarding self-evaluation of skills (Fig. 2), almost all study participants believed to be able to identify a risk behaviour and dangerous lifestyle at least sufficiently, where significantly more women than men estimated their knowledge on this point as good or very good (89
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Fig. 3 Self-estimation of the importance of prevention topics (five-point Likert scale). Xaxis: percentage of answers. In columns, absolute numbers are shown
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vs. 70 %, p = 0.033). A total of 8 % of the participants were not confident regarding their nutrition counselling skills, where significantly more women believed to have good or very good skills on diet counselling compared with their male colleagues (77 % women vs. 50 % men, p = 0.008). Skills on smoking cessation counselling were valued by almost all of the study participants as at least sufficient. One-fifth of the participants expressed low confidence in the ability to provide counselling on tertiary prevention. Approximately one-tenth of the students believed not to be competent on vaccination and screening counselling. Concerning the importance of prevention (Fig. 3), more than 90 % of medical students declared prevention to be important or very important for personal health behaviour (smoking, unhealthy diet, lack of physical activity), for their future medical activity and for the field of family medicine. Only one-sixth of the subjects believed that prevention should play a moderate or minor role in medical curricula. About this point,
Preventive medicine: self-assessment of knowledge, skills and attitudes of medical students
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Fig. 4 Assessment of positions on prevention-related statements. X-axis: percentage of answers. In columns, absolute numbers are shown
women estimated learning preventive medicine during undergraduate medical studies as more important than men (90 % women vs. 78 % men marked important or very important, p = 0.028). Similarly, 95 % women vs. 88 % men reported prevention to be important or very important for the personal health behaviour (p = 0.002). Concerning the evaluation of opinions and attitudes by means of judging relevant statements (Fig. 4), shared decision making on health behaviour was sustained by most students: 86 % of the participants believed in the necessity of an agreement between physician and patient on therapy goals in lifestyle medicine. Moreover, threequarter of the participants rejected the statement asserting that health-related decisions should be taken only by the physician and shared the opinion that each individual is responsible for his health behaviour. Finally, 42 % of responders agreed with the statement that people should be held accountable for consequences of harmful health behaviours. Prevention was considered as an important task of family medicine by almost the totality of the responders; 85 % considered prevention also an important skill of practicing specialists. In contrast, only 62 % believed in the function of prevention in hospitals, including outpatient departments. Approximately 90 % of the students believed that prevention has an important or very important role in the society and that health-care providers (social insurance, rental system) benefit from implementing preventive measures.
Four-fifth of the responders considered psycho-social elements to be at least as important as biological and physiological components in prevention. Regarding the last point, the quote of women who gave a strong agreement was significantly higher (54 % women vs. 31 % men, p = 0.04) than that of men. Only 40 % of the responders agreed with the statement regarding their training in prevention to be sufficient so far. Mean score of the nine questions on knowledge of prevention listed in Fig. 1 was 2.8; mean of the skills listed in Fig. 2 was 2.5 (both corresponding to a value between good and satisfactory). Conversely, between very high and high (1.5) was the estimation of the importance towards prevention according to the mean of the four questions shown in Fig. 3. Mann–Whitney U test performed on the medians of the variables ‘knowledge’, ‘skills’ and ‘importance’ by sex was significant only concerning the importance of prevention (median 5 in women vs. 6 in men, p
Preventive medicine: self-assessment of knowledge, skills and attitudes of medical students at the Medical University of Vienna Livia Borsoi · Anita Rieder · Katharina Viktoria Stein · Angelika Hofhansl · Thomas Ernst Dorner
Received: 14 August 2013 / Accepted: 25 December 2013 © Springer-Verlag Wien 2014
Summary Prevention and health promotion are gaining importance in modern medical curricula. Aim of this study was to evaluate the self-assessment of knowledge, skills and attitudes of medical students towards health promotion and prevention. In 2012, at the Medical University of Vienna, 27 % of the 633 fourth-year medical students (50.3 % male and 49.7 % female; mean age: 24 years) completed a questionnaire. Results show a high assessment of prevention in most respondents. Knowledge gaps were detected on occupational health and mother–child pass examinations. However, almost all students reported sufficient knowledge on screening and risk assessment of developing cardiovascular diseases. Almost all respondents estimated to be able to identify risky behaviours. Overall, estimation towards prevention of tomorrow’s physicians is very positive. However, only 40 % believed to have been adequately trained on preventive medicine so far. Relevant preventive aspects were added to the medical curriculum in 2012–2013 with the new block ‘Public Health’. Keywords Prevention · Health-care promotion · Undergraduate medical curriculum
Dr. med. L. Borsoi, MPH () · Dr. med. Univ. Prof. A. Rieder · Dr. K. V. Stein · Ass.-Prof. Priv.-Doz. Dr. T. E. Dorner, MPH Institute of Social Medicine, Centre for Public Health, Medical University of Vienna, Kinderspitalgasse 15, 1090 Vienna, Austria e-mail: [email protected] Dr. med. Univ. Prof. A. Rieder · Mag. Dr. A. Hofhansl, MME Department for Medical Education, Medical University of Vienna, Vienna, Austria
13
Präventivmedizin: Selbsteinschätzung von Wissen, Fähigkeiten und Haltungen von Medizinstudierenden an der Medizinischen Universität Wien Zusammenfassung Prävention und Gesundheitsförderung gewinnen in modernen Medizincurricula zunehmend an Bedeutung. Ziel dieser Studie war die Selbsteinschätzung von Wissen, Fähigkeiten und Haltungen von Medizinstudierenden gegenüber Gesundheitsförderung und Prävention zu erheben. 2012 füllten 27 % der 633 Studierenden im 4. Studienjahr an der Medizinischen Universität Wien (50,3 % männlich und 49,7 % weiblich; Durchschnittsalter = 24 Jahre) einen Fragebogen aus. Die Ergebnisse zeigen einen hohen Stellenwert von Prävention beim Großteil der Befragten. Wissenslücken gab es bezüglich arbeitsmedizinischen bzw. MutterKind-Pass-Untersuchungen. Hingegen gaben beinahe alle Studierende ausreichende Kenntnisse hinsichtlich Vorsorgeuntersuchungen sowie Risikoeinschätzung zur Entwicklung von Herzkreislauferkrankungen an. Fast alle Befragten glaubten Risikoverhalten identifizieren zu können. Insgesamt ist die kommende Generation von ÄrztInnen sehr positiv gegenüber Prävention eingestellt. Allerdings fühlten sich lediglich 40 % bisher durch das Studium ausreichend zum Thema Präventivmedizin ausgebildet. Das Medizincurriculum wurde nun mit der Etablierung des neuen Blocks „Public Health“ ab 2012–2013 u. a. um relevante präventive Aspekte erweitert. Schlüsselwörter Prävention · Gesundheitsförderung · Medizin-Curriculum
Introduction Prevention as a teaching subject in its own right in the medical undergraduate curriculum was first introduced
Preventive medicine: self-assessment of knowledge, skills and attitudes of medical students
1
main topic
in Austria in 1973 under the name ‘Social Medicine’ at the University of Vienna [1]. Social Medicine was added as an examination subject in the third Rigorosum (an examination, laid down by the ‘Medizinische Rigorosenordnung’, 1903, covering the last part of medical studies before receiving the doctor’s degree [2]). After establishing a new medical curriculum (N202) in 2002, the teaching of prevention at the Medical University of Vienna was realised within Block 6, ‘Environment, Family and Society’, in the first year of medical studies (second semester) and again in the fourth year (seventh semester). However, awareness and attitudes of the students about prevention were never assessed in Austria. The question of how to improve the awareness and knowledge on prevention in the current and future curriculum hence was an important issue. Against this background, the survey intent was to assess knowledge and attitudes of medical students about prevention and health promotion as part of a curriculum evaluation project.
education [3] and adapted to specific topics of teaching at the Medical University of Vienna. Along with sociodemographic information (sex, age), the questionnaire included 31 questions that addressed knowledge on prevention, skills on health care and prevention counselling, as well as attitudes and beliefs towards prevention. Each question used five-point Likert scales. For all Likert scales, a score of 1 indicated the strongest degree of agreement, importance or estimation (very good), while 5 expressed the strongest degree of disagreement, insignificance or disestimation (insufficient). Sex-related differences were tested by chi-square test. To address topics that were not mentioned in the closed questions, students were asked to answer two open questions at the end of the questionnaire: ‘Which aspects of preventive medicine have not been taught yet?’ and ‘Is there anything more that you would like to say on preventive medicine?’ The mean score of the nine questions pertaining to knowledge on prevention (listed in Fig. 1) and the mean of the seven questions on skills (listed in Fig. 2) and of the four questions on importance of prevention (listed in Fig. 3) were computed. By unweighted summation of scores of the nine questions in Fig. 1 as well as of the seven questions in Fig. 2 and of the four queries in Fig. 3, three new variables were created called, respectively, ‘knowledge’, ‘skills’ and ‘importance’. On these variables, a Mann–Whitney U test was performed searching differences between sexes. Statistical analysis was done with SPSS 21.0.
Methods During the summer semester of 2012, a questionnaire was handed out to fourth-year medical students of the Medical University of Vienna attending mandatory lessons. Although 633 students were registered at the fourth year, only a small part of them could be reached by the survey due to the limited duration of the survey (2 weeks). Moreover, the quote of responders between those attending lessons was not calculated. Students voluntary filled out the anonymous questionnaire. A declaration of consent was filled out. The study was approved by the ethics committee of the Medical University Vienna (EC # 1260/2012). Queries were chosen based on recent literature on predictors of student preferences in undergraduate medical Fig. 1 Self-estimation of previous knowledge on preventive medicine topics (five-point Likert scale). X-axis: percentage of answers. In columns, absolute numbers are shown
Results Of 633 students, 169 filled the questionnaire (27 %). Responders were equally distributed between sexes (49.7 % women and 50.3 % men), with mean age of 24 (range: 20–33) years.
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main topic Fig. 2 Self-estimation of the skills on preventive medicine measures (five-point Likert scale). X-axis: percentage of answers. In columns, absolute numbers are shown
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Almost all interviewed students believed to be able to assess the risk of developing a cardiovascular disease at least sufficiently. Only 4 % of the participants estimated not to have a sufficient knowledge on screening, although, when asked on risk–benefit evaluations in screening programmes, the percentage of those without know-how doubled. Moreover, almost 40 % defined their knowledge about patient information and counselling on screening programmes as less than satisfactory. On mother–child pass examinations, one-fifth of the participants believed not to have acquired enough information, while almost one-third of the surveyed students declared not to have sufficient knowledge on prevention at the workplace (Fig. 1). Regarding self-evaluation of skills (Fig. 2), almost all study participants believed to be able to identify a risk behaviour and dangerous lifestyle at least sufficiently, where significantly more women than men estimated their knowledge on this point as good or very good (89
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Fig. 3 Self-estimation of the importance of prevention topics (five-point Likert scale). Xaxis: percentage of answers. In columns, absolute numbers are shown
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vs. 70 %, p = 0.033). A total of 8 % of the participants were not confident regarding their nutrition counselling skills, where significantly more women believed to have good or very good skills on diet counselling compared with their male colleagues (77 % women vs. 50 % men, p = 0.008). Skills on smoking cessation counselling were valued by almost all of the study participants as at least sufficient. One-fifth of the participants expressed low confidence in the ability to provide counselling on tertiary prevention. Approximately one-tenth of the students believed not to be competent on vaccination and screening counselling. Concerning the importance of prevention (Fig. 3), more than 90 % of medical students declared prevention to be important or very important for personal health behaviour (smoking, unhealthy diet, lack of physical activity), for their future medical activity and for the field of family medicine. Only one-sixth of the subjects believed that prevention should play a moderate or minor role in medical curricula. About this point,
Preventive medicine: self-assessment of knowledge, skills and attitudes of medical students
3
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Fig. 4 Assessment of positions on prevention-related statements. X-axis: percentage of answers. In columns, absolute numbers are shown
women estimated learning preventive medicine during undergraduate medical studies as more important than men (90 % women vs. 78 % men marked important or very important, p = 0.028). Similarly, 95 % women vs. 88 % men reported prevention to be important or very important for the personal health behaviour (p = 0.002). Concerning the evaluation of opinions and attitudes by means of judging relevant statements (Fig. 4), shared decision making on health behaviour was sustained by most students: 86 % of the participants believed in the necessity of an agreement between physician and patient on therapy goals in lifestyle medicine. Moreover, threequarter of the participants rejected the statement asserting that health-related decisions should be taken only by the physician and shared the opinion that each individual is responsible for his health behaviour. Finally, 42 % of responders agreed with the statement that people should be held accountable for consequences of harmful health behaviours. Prevention was considered as an important task of family medicine by almost the totality of the responders; 85 % considered prevention also an important skill of practicing specialists. In contrast, only 62 % believed in the function of prevention in hospitals, including outpatient departments. Approximately 90 % of the students believed that prevention has an important or very important role in the society and that health-care providers (social insurance, rental system) benefit from implementing preventive measures.
Four-fifth of the responders considered psycho-social elements to be at least as important as biological and physiological components in prevention. Regarding the last point, the quote of women who gave a strong agreement was significantly higher (54 % women vs. 31 % men, p = 0.04) than that of men. Only 40 % of the responders agreed with the statement regarding their training in prevention to be sufficient so far. Mean score of the nine questions on knowledge of prevention listed in Fig. 1 was 2.8; mean of the skills listed in Fig. 2 was 2.5 (both corresponding to a value between good and satisfactory). Conversely, between very high and high (1.5) was the estimation of the importance towards prevention according to the mean of the four questions shown in Fig. 3. Mann–Whitney U test performed on the medians of the variables ‘knowledge’, ‘skills’ and ‘importance’ by sex was significant only concerning the importance of prevention (median 5 in women vs. 6 in men, p
