Eduacational Intervention For Medical Students To Promote Rational Use Of Antimicrobials

ObjectiveSurvey the clinical medical students'current knowledge and understanding of rational use of antimicrobial and promote rational use of antimicrobials,which are achieved through mastering knowledge and information, increasing awareness and enhancing the attitudes, hastening the behaviors of clinical medicine students. Conduct a stable model for educational intervention to promote rational use of antimicrobials.Subjects and MethodsExperiment DesignTwo parallel educational interventions at Xian-ning medical college and Tongji Medical College of Huazhong University of Science and Technology, pre-post self-comparison which always are regarded as quasi-experiments were performed.InterventionStudents majoring in clinical medicine at grade 4 in two colleges were selected as the observed subjects. Three kinds of different educational interventions were conducted in a month, and the main educational content were the hazards of irrational use of antimicrobials, the principles of rational use of antimicrobials(RUA), good prescribing antibacterial medicines for infectious diseases and somethings on. The educational interventions were performed in 3 different ways which included taking the courses of lectures about RUA, discussion in groups in the way of problems-based-learning and both above.Data collection and analysis The intervention effects was evaluated by a sieries of questionnaire surveys. Subjects were chosen by stratified random sampling in two college in which every 70-100 students were put into each three groups in both. Datas were sampled three times, the first one as the baseline was adopted before the intervention and the second one right after the intervention and the third later after 3 months respectively. The questionnaire covered three main fields:knowledge, awareness and attitudes, and behaviors of RUA. Data were collected and analyzed in the following way:At first, data were scaled by scores according to a standard and desriptively analyzed, the higher it scored, the more RUA existed. For each knowledge item, differences of genders, family total incomes or the burden ways for the healthcare charge in correct rates was tested byχ2 test, and differences among scores concerning awareness and attitudes, were analyzed by t-test and variance analysis,and also behaviors did in same way. The effect of educational intervention on overall scores of knowledge was done by covariance analysis with factors above as covariates, the performance of each item of awareness and attitude, behavior were dilcoxon singned-rank test and rank sum test. Also Kruskal-Wallis H test was done to compare the effects of three typies interventions.Results1. A new model suit for certain type of educational intervention was structed in this study based on some theories or models include of KAP (Knowledge-Attitude-belive-Practice)model and TRA and some else. Influnted by the longlasting and effective variable parameter of the society and mental factors and accumulated knowledge and clues, an awareness of the susceptivity and severity arises; Under certain knowledge background, social circumstance and else demographic characters, a belief including ubjective criterion and abojective judgement standards generates, the belief would determine the attitude. Affected by the former two aspects combined, intention was formed, and with graduatedly being streghened by all kinds of infactors, the real action was persued.2. At baseline, clinical medicine students showed very poor knowledge of RUA, with total average scores 4.69 for Tongji group and 4.52 for Xianning group; There were no statistical discrepancy between both genders and both two colleges. There was no regression relationship between the knowledge and the attitude or behavior, also between the attitude and behavior.3. After the execution of the three typies of educational interventions, the average scores of knowledge, of clinical medicine students did improve in all six groups, but the change of the scores of awareness and attitude did not made difference statistically. The scores of knowledge and behavior made difference statistically significal while the attitude did not. Three different interventions made signifcal difference in changing the levels of knowledge and behavior, but did not affect the score of the attitude. There were no statistical difference between the two surveys with 3 interval months in all three parts of the questionnaire survey.4. All three typies interventions could affect the total average scores of the knowledge. There were significant differece between the intventions of courses of lectures and grouped-discussion in PBL way or both two combined. With Wilcoxon singned rank test and rank sum test, there were statistically significal difference in judging the change levels of the behavior but not with the attitude parts.5. A stable model for educational intervention to promote rational use of antimicrobials was estabished which could explain the results of the research.Conclusion1. Clinical Medicine students have limited knowledge of the rational use of antimicrobials, also have some wrong attitute and awareness around RUA, which lead to misuse of the antimicrobials.2. In the study, the three typies of educational interventions executed in the medical college did have some positive effects on enriching medical students'knowledge and promoting their behaviors on rational use of antimicrobials.3. There were no regression relationships between the knowledge and the awareness or the behavior on rational use of antimicrobials of the medical students.4. More attention should be paid to medical students'education on rational use of antimicrobials. Meanwhile, courses based on RUA must be merged into the curriculum for medical students in the way of PBL.InnovationThe educational intervention method based on the PBL were seldom adapted to study the effect of promoting rational use of antimicrobials among clinical medicince students in China; and a new model suitable for certain type of the educational intervention was established on the basic of KAP, TRA(Theroy of Reasoned Action) and HBM(Health Belife Model), and other models. The model got a comparative stability and excellently interpreted the result of this study.