Education Intervention For Medical Students To Promote Rational Use Of Antimicrobials

BackgroundAntimicrobial resistance is rapidly developing and has caused enormous hazards all over the world. The major causes for the widespread resistance of antimicrobes are attributed to their irrational use. In some countries, kinds of strategies and methods are implemented to intervene on irrational use of antimicrobial, and varities of researches are also excuted; however, there is seldom one about eductation intervention on medical students.ObjectiveFind out the medical students'current understanding of rational use of antimicrobial (RUA) and promote RUA from the source of health care, which are achievable through mastering information, increasing awareness, and enhancing the attitudes and behaviors of medical students.Subjects and MethodsDesignAn educational intervention at Tongji Medical College of Huazhong University of Science and Technology, pre-post self-comparison (quasi-experiment) were performed.InterventionIn this study, sophomores majoring in clinical medicine, pharmacology and preventive medicine, who are closely related to RUA, were selected as the study subjects. The 1.5 months educational interventions were conducted, and the main promotional contents were the irrational use of antimicrobials and their hazards in China, the principles of RUA, prescribing antibacterial medicines for common infectious diseases, bacterial resistance to antimicrobials and so on. The educational materials used included video and pamphlets of RUA. Video was broadcasted during the class intervals, once every two weeks, and pamphlets were distributed to every student.Data collection and analysisA questionnaire survey was adopted to evaluate the intervention effects. Subjects were chosen by stratified random sampling, where 30 students in each major were sampled one week before the intervention and two weeks after the intervention, respectively. The questionnaire contained four main parts: knowledge, awareness, attitudes and behaviors. Data were collected and analyzed as the following: First, data were scaled by scores according to a standard i.e., the higher the score the more RUA existed, and were desriptively analyzed. For each knowledge item, differences of genders and majors in correct rates was tested byχ2 test, and differences among scores concerning awareness, attitudes and behaviors were analyzed by t-test and variance analysis; the impact of educational intervention on overall scores of knowledge, awareness, attitude and behavior were done by covariance analysis, with professional and gender as covariates.Results1. Based on some models or theories, such as Knowledge- Attitude- belive- Practice model, a model was structed in this study:a. Influnted by the accumulated knowledge and clues, an awareness of the severity and susceptivity arises;b. Under certain demographic characters, social circumstance and knowledge background, a belief generates, which determines the attitude, decision criterion and self-efficiency;c. Affected by the former two aspects combined, intention forms, and graduatedly leads to the real action.2. At baseline, medical students showed very limited knowledge on RUA, with a total average score (AS) was 4.21; the items "how long should post-surgery antibacterial drug use must lasts" and "whether yellow-green dense nose flow requires antimicrobials or not" got the lowest correct rates, 24.4% and 32.2%, respectively. For the awareness aspect, the total AS was 16.21; the item "some bacteria becoming difficult to treat with antibiotic therapy" got an AS of 4.21, followed by "it is very important to prevent bacterial resistance by restricting antimicrobials use ", with an AS of 4.09. On the attitude aspect, total AS was 19.82, medical students did not agree with patient's behaviors requiring health professional staff to describe antibacterial medicines (AS was 3.61), and they were in favor of using broad-spectrum antibacterial drug to treat bacterial infection disease (AS was 3.13). On the behavior aspect (total AS was 20.39), medical students reported that"when found some one around with irrational use of antimicrobials, immediate correction of behavior were put into action", however the AS was only 3.13, and"when felt the health condition turned to better, or symptoms disappeared, cessation of antibacterial use took place", scored an average of 2.75. The overall score of knowledge had a regression relationship with the overall score of awareness (β=0.430,P=0.005), and was not with overall score of attitude; there were no regression relationship between consciousness and behavior, however attitude had such relationship with behavior (β= 0.201, P = 0.023).3. After the execution of the educational intervention, the scores of knowledge, awareness and attitude of medical students did improve, with a corrected AS of knowledge increasing from 4.22 to 5.07 (P = 0.001); however, a corrected AS of behavior decreased from 20.34 to 20.03 (P = 0.515). Medical students have had improved their basic knowledge about antibacterial drugs and their indications (P values were both 0.000) and received a higher recognition on that there has been a larger magnitude of irrational use of antimicrobials where AS increased from 4.04 to 4.29 (P = 0.017). Medical students gradually started to oppose the use of antimicrobial for treating flu-like symptoms lasting for three days (P = 0.021); the action of"when felt the health condition turned to better, or symptoms disappeared, cessation of antibacterial use took place"changed better, however, the scores for the two evaluated items which reflected medical students'influence on their prescription of antibacterial for people did not improve, but decreased by about 0.2 points (both were no statistically significal).ConclusionMedical students have poor knowledge on RUA as well as having medication. In this study, the executed educational intervention at the medical college did have some effects towards enhancing medical students'knowledge and raising their awareness on RUA. There were regression relationships with knowledge on RUA among medical students and their awareness, while for attitudes were regression to their behaviors, which was consistent with that in the model established in this study. More attention should be paid to medical students'education on RUA; at the same time, courses on RUA must be merged into the curriculum for medical students, especially for the postgraduates, in order to achieve a long-lasting effect.InnovationThe intervention method were seldom adapted to research on the education effect of promoting RUA among medical students in China; and a Knowledge-awareness-attitude-behavior model was established on the basic of KAP, Health Belife Model, Theroy of Reasoned Action and other models, which got a comparative stability and excellently interpreted the result of this study.