Knowledge Levels And Training Needs Of Disaster Medicine In Shanghai-a Cross-sectional Study And The Exploration Of Training Programs

Objective: Over the past decade, the intensity and frequency of natural and man-madedisasters have been noticeably increasing in our country, which have caused hugeeconomic losses, serious environmental disruption and lasting psychological impairment tothe survivors. However, disaster medicine has not been included either in theundergraduate curriculum of medical schools or in the continuing medical education inChina. Health professionals and community residents are main players in disasterresponses but their knowledge levels of disaster medicine are not readily available. Thisstudy aimed to evaluate knowledge levels and training needs of disaster medicine amongpotential disaster responders via a large-scale epidemiological survey and explore thereasonable training programs suitable for different populations.Methods: A self-reporting questionnaire survey on knowledge level and training needsof disaster medicine was conducted in Shanghai, China.600health professionals includingmedical practitioners, medical teachers and health administrators,500medical students,and1,600local residents were randomly selected to survey. Chi-square test, analysis ofvariance, Student-Newman-Keuls (SNK) test, and linear regression were used forstatistical analysis.Results: The total response rate was93.7%. A total of2,529participants including547health professionals,456medical students, and1,526community residents providedcomplete information. Only33(1.3%) had ever received systematic training of disastermedicine. For all2,529participants, most of them (87.1%) had low or moderateself-estimated knowledge concerning disaster medicine, and media (newspaper, magazine,internet, and TV/radio) was the most common channel to acquire knowledge on disastermedicine.1. For health professionals, less accurate responses to ‘diagnosis of post-traumatic stressdisorder (PTSD)’,‘difference between remote and urban rescue’, and ‘populationvulnerability assessment’ indicate the low levels of knowledge on disaster psychology anddisaster administration. In health professionals, the score was10.97(95%CI=10.73-11.21),11.89(95%CI=11.33-12.45), and10.57(95%CI=10.10-11.04) for medical practitioners,medical teachers, and health administrators, respectively (p=0.002). Medical teachers didbetter than medical practitioners and health administrators. The significant differences among different professions were mainly presented in the answers to the9questionscovering4aspects: self-help and first-aid skills, triage and evacuation, psychological relief,and population vulnerability assessment. Health administrators did not show theirproficiency in disaster administration and disaster rescue organization, for they poorlyanswered the related questions. Moreover, there were significant differences in knowledgelevels among4specialties (clinicians, public health physicians, nurses, and medicaltechnicians) of medical practitioners. Clinicians showed higher knowledge level than otherspecialties, even on the aspect of epidemic prevention and control (p<0.001). Thedifferences in the knowledge level indicate that the medical education in China had beenlargely clinically oriented; and little attention has been paid to public health preparedness,especially disaster preparedness. Multivariate linear regression analysis indicated thateducational level (β=0.204, p<0.001) and professional title (β=0.142, p=0.008) weresignificantly associated with an increased knowledge score, whereas age was inverselyrelated to the score (β=-0.193, p<0.001), in health professionals.2. Medical students also had low levels of knowledge on disaster psychology anddisaster administration. In medical students, the score in public health students (11.54,95%CI=11.28-11.80) was higher than that in clinical medicine students (10.79,95%CI=10.51-11.07)(p<0.001). The rates of correctly answering8questions about basic concepts,triage and evacuation and epidemic prevention and control were significantly differentbetween the students of2majors (p<0.05). Public health major was the factor significantlyassociated with an increased score in medical students (β=0.661, p=0.002). Although thescore of health professionals and medical students was not significantly different (p=0.661), there were significant differences in correctly answering5questions.3. For community residents, less accurate responses to ‘cardiopulmonary resuscitationprocedure’ and ‘difference between remote and urban rescue’ indicate the low levels ofknowledge on first-aid skills and disaster administration. After stratified by educationallevel, the score of well-educated (bachelor or higher) group (7.42,95%CI=7.20-7.65) wassignificantly higher than that of poor-educated (junior college or lower) group (6.91,95%CI=6.80-7.03)(p<0.001). Educational level was the unique factor significantlyassociated with an increased score in community residents (β=0.214, p=0.001). Wecompared the rates of correctly answering the8common questions in both questionnairesbetween health professionals and community residents. The rates were generally lower in community residents than in health professionals except one question.4. The overall opinions on teaching method, course arrangement, and teaching materialwere consistent among health professionals and medical students. More than half of healthprofessionals and medical students selected ‘lecture’,‘practical training’, and ‘disastermovies or videos’ as preferred teaching methods, chose ‘required course for public healthprofessional’ as the major training course, and preferred using ‘national unified textbook’as standard teaching material. The majority of community residents selected ‘need to learndisaster medicine’ and ‘need of disaster medicine course for children’. About half ofcommunity residents selected ‘lecture’ and ‘practical training’ as preferred teachingmethods. More than70%of community residents selected ‘willing to participate indisaster simulation drill regularly’ and believed that ‘community volunteer team fordisaster relief should be set up and willing to participate volunteer team’.5. More than50%of health professionals and medical students selected the contents of‘first aid skills’,‘epidemic prevention and control’,‘psychological problems inpost-disaster relief’, and ‘principles of disaster disposal’ as important contents; while themost community residents chose ‘first aid skills’ and ‘basic concepts of disaster medicine’as important contents. Significant differences existed among subgroups within each groupof participants. Health professionals selected ‘basic principles of disaster rescue’(74.0%),‘treatment principles and first-aid skills’(69.8%), and ‘psychological relief’(64.4%) as themost interested contents, while community residents selected ‘basic principles of disasterrescue’(47.9%) and specific disaster events such as ‘earthquakes’(40.9%) and ‘firedisaster’(40.8%).Conclusions: In general, our results reflected a high vulnerability of our populationswhen facing disaster. Although the majority of the health professionals received formalmedical education, few of them have ever received systematic training of disaster medicine.Traditional clinical-oriented medical education might lead to a huge gap between theknowledge level on disaster medicine and the current needs of disaster preparedness. Theseresults indicate that the training needs of disaster medicine is very high in Chinese societyand disaster medicine trainings should be executed as indispensable courses for healthprofessionals, medical students, and community residents. Meanwhile, the three groups ofparticipants selected some different key and interested contents for disaster medicinetraining. This reflects that distinct perception of disaster determines the different needs of disaster medicine training in different populations. Based on these data, we suggest adiagram flow of disaster medicine training as Shanghai model. From a health educationperspective, disaster training programs are immediately needed, with specific emphasis oncertain contents, such as psychological relief and administrative skills. Continuing medicaleducation and public education plans on disaster medicine via media should bepractice-oriented, and selectively applied to different populations and take the knowledgelevels and training needs into consideration.