Italian medical students and disaster medicine: awareness and formative needs

Should We Focus More on Teaching and Training Disaster Management in Health-care Colleges? An Insight into the Students' Knowledge, Attitude, and Readiness to Practice

Background

The critical aspects of risk management for students are providing knowledge, building positive attitudes, and readiness to practice. Our study aimed to assess Chinese health-care university students' knowledge (K), attitude (A), and readiness to practice (rP) regarding disaster medicine and preparedness.

Materials and Methods

A survey was carried out using a self-administered disaster medicine and preparedness questionnaire. Three main outcome measures were K (22 items), A (16 items), and rP (11 items). Responses were scored and classified as high, moderate, and low. Descriptive and inferential statistics were performed for data analysis.

Results

A total of 769 valid questionnaires were collected. The associations between K, A, and rP scores was significant, i.e., K-A scores (r = 0.449, P = 0.000), K-rP scores (r = 0.312, P = 0.000), and A-rP scores (r = 0.656, P = 0.000). Multiple linear regression analysis indicated direct low-to-moderate effects of gender, age, attitude, and knowledge on readiness to practice (R ² = 0.198; P < 0.001).

Conclusions

The study discovered that most of the students had a moderate level of knowledge, moderate level of attitude, high level of readiness to practice, and a moderate level of total KArP. K, A, and rP were significantly correlated, and K and A were predictors for rP among the health-care students. The findings indicate the importance of health-care colleges for building students' knowledge, attitudes, and readiness to practice disaster medicine and preparedness before joining the profession.

Presentation and evaluation of a modern course in disaster medicine and humanitarian assistance for medical students

BACKGROUND

Disaster medicine is a component of the German medical education since 2003. Nevertheless, studies have shown some inconsistencies within the implementation of the national curriculum, and limits in the number of students trained over the years. Recently, the SARS-CoV-2 pandemic and other disasters have called attention to the importance of training medical students in disaster medicine on a coordinated basis. The aim of this study is to present and evaluate the disaster medicine and humanitarian assistance course, which was developed in the University of Tübingen, Germany.

METHODS

The University Clinic for Anesthesiology and Intensive Care Medicine in Tübingen expanded the existing curriculum of undergraduate disaster medicine training with fundamentals of humanitarian medicine, integrating distance learning, interactive teaching and simulation sessions in a 40 h course for third-, fourth- and fifth- year medical students. This prospective and cross-sectional study evaluates the Disaster Medicine and Humanitarian Assistance course carried out over five semesters during the period between 2018 and 2020. Three survey tools were used to assess participants' previous experiences and interest in the field of disaster medicine, to compare the subjective and objective level of knowledge before and after training, and to evaluate the course quality.

RESULTS

The total number of medical students attending the five courses was n = 102 of which n = 60 females (59%) and n = 42 males (41%). One hundred two students entered the mandatory knowledge assessment, with the rate of correct answers passing from 73.27% in the pre-test to 95.23% in the post-test (t [101] = 18.939, p < .001, d = 1.88). To determine the subjective perception of knowledge data were collected from 107 observations. Twenty-five did not complete the both questionnaires. Out of a remaining sample of 82 observations, the subjective perception of knowledge increased after the course (t [81] = 24.426, p < .001, d = 2.69), alongside with the interest in engaging in the field of disaster medicine (t [81] = 7.031, p < .001, d = .78). The 93.46% of the medical students (n = 100) graded the training received with an excellent overall score (1.01 out of 6).

CONCLUSION

The study indicates a significant increase in students' understanding of disaster medicine using both subjective and objective measurements, as well as an increase interest in the field of disaster medicine and humanitarian assistance. Whereas former studies showed insufficient objective knowledge regarding disaster medical practices as well as subjective insecurities about their skills and knowledge to deal with disaster scenarios, the presented course seems to overcome these deficiencies preparing future physicians with the fundamentals of analysis and response to disasters. The development and successful implementation of this course is a first step towards fulfilling disaster medicine education requirements, appearing to address the deficiencies documented in previous studies. A possible adaptation with virtual reality approaches could expand access to a larger audience. Further effort must be made to develop also international training programs, which should be a mandatory component of medical schools' curricula.

Implementation of disaster medicine education in German medical schools - a nationwide survey

Objectives: Floods, earthquakes and terror attacks in recent years emphasize the importance of disaster preparedness for the medical community. To best prepare doctors for providing optimal care in disaster situations, specific education and training should start at the medical school level. This study containes an online survey among German medical schools to evaluate the status quo of teaching disaster medicine and to reveal potential obstacles. Methods: The dean's offices of 36 German medical schools were contacted from April 2016 to May 2017. Via an e-mail link, recipients could anonymously and voluntarily access an online questionnaire (74 items, 42 with a four-point "Likert-like" scale, 12 yes/no questions and 20 with listed items to choose from). The answers were analyzed by descriptive statistics. Results: A total of 25 medical schools participated in the survey. Twenty respondents were in favor of expanding disaster medicine teaching at their institutions. Incorporating single topics ranging from triage (n=21) to accidents involving radioactive materials (n=4) into the curriculum varied widely. Only two schools had established a teaching coordinator for disaster medicine and only one e-learning course had been established. Twenty-one respondents regarded funding issues and 18 regarded organizational matters to be major hurdles in the future. Conclusion: Though most faculty representatives indicated that they favor expanding and implementing disaster medicine education, German medical schools still have a lot of room for enhancement in this field. The incorporation of e-learning tools could facilitate the expansion of disaster medicine teaching while simultaneously addressing the expressed concerns of the survey's participants and guarantee nationwide standardization.

A comparative study of online learning in response to the coronavirus disease 2019 pandemic versus conventional learning

OBJECTIVES

To explore the attitude and perception of undergraduate medical students and their staff towards the educational methods (conventional versus online) and to assess their performance accordingly.

METHODS

It was a comparative cross sectional study, conducted at the Faculty of Medicine, Al- Imam University, Riyadh, Saudi Arabia on May 30, 2020. A structured questionnaire was designed to collect the data from students and staff about conventional teaching, online teaching, conventional examination and online examination. It was in the form of 5-point Likert-type scale ranging from 5-strongly agree, to 1-strongly disagree, in addition to age and gender. The results of conventional and online examination were recorded.

RESULTS

The total sample reached 230 students and 20 staff. Mean scores for conventional teaching and examination were significantly higher than online. The mean values for grades of online final examination was significantly higher than those of midterm conventional examination. Most of the statements related to conventional teaching and examination attained a good response where students and their staff conveyed a negative perception pertinent to online examination. Students and staff showed a higher percentage of agreement in favor of online examination allowing immediate feedback.

CONCLUSION

Conventional teaching was perceived as more effective, accessible, less technical difficulties and less fraud and cheating. Online learning, should be allowed in undergraduate medical education, by combining it with conventional learning, and students should be prepared to it.

Medical students and COVID-19: the need for pandemic preparedness

The COVID-19 pandemic has prompted unprecedented global disruption. For medical schools, this has manifested as examination and curricular restructuring as well as significant changes to clinical attachments. With the available evidence suggesting that medical students' mental health status is already poorer than that of the general population, with academic stress being a chief predictor, such changes are likely to have a significant effect on these students. In addition, there is an assumption that these students are an available resource in terms of volunteerism during a crisis. This conjecture should be questioned; however, as those engaging in such work without sufficient preparation are susceptible to moral trauma and adverse health outcomes. This, in conjunction with the likelihood of future pandemics, highlights the need for 'pandemic preparedness' to be embedded in the medical curriculum.

Pilot study of a longitudinal integrated disaster and military medicine education program for undergraduate medical students

Disaster medicine education in medical curricula is scarce and frequently nonexistent. It is reasonable to initiate educational approaches for physicians in this field at the medical school level. An understanding of disaster medicine and the health care system during massive casualty incidents has been recommended as an integral part of the medical curriculum in the United States and Germany.The goal of the reformed curriculum was to develop a longitudinal integrated disaster and military medicine education program extending from the first year to the sixth year based on previously separated clinical and military medicine topics. Emergency medicine physicians, military emergency medical technicians, and Tactical Combat Casualty Care instructors formed an interprofessional faculty group and designed a learning curriculum.A total of 230 medical students participated in the revised disaster preparedness curriculum. Satisfaction survey response rates were high (201/230, 87.4%). Most of the free-text comments on the program were highly appreciative. The students considered the number of teaching hours for the whole program to be adequate. The students showed significant improvements in knowledge and judgment regarding disaster medicine after the program.We found that medical students were highly interested, were appreciative of, and actively participated in this longitudinal integrated disaster and military medicine education program, but gaps existed between the students' scores and the educators' expectations. The educators believed that the students needed more disaster preparedness knowledge and skills.

[Terror awareness of 5th year medical students in the Mannheim reformed curriculum medicine plus]

BACKGROUND

The treatment of gunshot wounds and wounds caused by explosive devices as used in terrorist attacks is not currently an issue for education in most medical faculties; however, because of the increasing number of terrorist attacks in Germany and Europe this is becoming more important. The aim of this study was to evaluate the knowledge of dealing with and treatment of patients as victims of terrorist attacks of 5th year medical students at the Mannheim Medical Faculty of Heidelberg University prior to and after a specific seminar.

METHODS

All students offered to participate voluntarily. Before the seminar a questionnaire with six questions about previous knowledge on terror awareness was distributed. After the seminar another almost identical questionnaire with six questions was distributed and completed by the students.

RESULTS

A total of 97 medical students agreed to take part in the study of whom 53 were female. The mean age was 25.4 years (SD 2.75 years). After the seminar the students wanted to statistically significantly intensify the topic and believed that hospitals should be prepared for the treatment of victims of terrorism.

CONCLUSION

With the seminar "Military Medicine", which was held as part of the Mannheim reformed curriculum of medicine (MaReCuM plus) in the 5th year, the interest of medical students could be significantly increased. This study could show for the first time that terrorist attacks and the resulting injuries have significant relevance for medical students. Consideration of this topic in all medical school curricula would be justified.

Research on Disaster Literacy and Affecting Factors of College Students in Central China

OBJECTIVES

Disaster literacy, which is a concept involved in moral quality, knowledge, and ability, impacts the disaster response. This study aimed to evaluate disaster education needs and to determine the affecting factors of disaster literacy among college students.

METHODS

A cross-sectional study was conducted through questionnaires. A total of 7200 college students from 10 colleges and universities in 5 provinces and cities in China were investigated.

RESULTS

Disaster education needs were urgently. For the participants, 79.43% stated that their families were not prepared for disaster prevention items, 96.36% suggested a campus emergency rescue team, and 88.64% obtained disaster knowledge through TV or Internet, and only 12.89% had offered relevant courses in their disciplines. The total scores of college students' disaster literacy were 87.85 ± 19.86, which was at a low level. Multiple linear regression analysis showed that age, major, grade, place of residence, parental education, mother's occupation, disaster experience, disaster training experience, and family disaster preparedness significantly affected college students' disaster literacy, especially grade, family disaster preparedness, and place of residence.

CONCLUSIONS

College students' disaster literacy education is urgently needed. Families, communities, colleges and the government should attach importance to disaster literacy education for college students.

Evaluation of Disaster Medicine Preparedness among Healthcare Profession Students: A Cross-Sectional Study in Pakistan

Background: Disasters are devastating incidents, especially when occurring suddenly and causing damage, great loss of life, or suffering. Disasters can affect health and the social and economic development of a nation. The article analyzes the knowledge (K), attitude (A), and readiness to practice (rP) of healthcare professional students in universities in Pakistan. Methods: We carried out a cross-sectional study using a pretested and validated self-administered disaster medicine and preparedness questionnaire. The study recruited 310 students. Responses were scored and categorized as high (75th quartile), moderate (75-25th quartiles), and low (25th quartile). Independent t-test, one-way ANOVA, Pearson correlation, and regression analyses were performed at an alpha level of 0.05. Results: The study found that most of the students had moderate knowledge, attitude, readiness to practice, and total KArP scores. All K, A, and rP scores were significantly correlated with overall KArP scores. Knowledge and attitude factors were significant predictors of readiness to practice. Conclusions: We strongly believe that educators and health policymakers should build a strong curriculum in disaster medicine management and preparedness to prepare competent future healthcare professionals for the nation.

Assessment of Knowledge, Attitudes, and Readiness to Practice Regarding Disaster Medicine and Preparedness Among University Health Students

OBJECTIVES

The aim of this study is to assess the knowledge (K), attitude (A), and readiness to practice (rP) levels regarding disaster medicine and preparedness among health profession students at Qatar University.

METHODS

A survey-based study was carried out to assess medical, pharmacy, and health sciences students' KArP levels using pretested and validated questionnaire. Student's t-test, analysis of variance, correlation, and linear regression were used with an alpha level of 0.05.

RESULTS

The difference in the mean KArP level between genders was not significant (P > 0.05). Students from the College of Health Sciences had significantly higher KArP levels than those from the College of Pharmacy (101.5 vs 90.0; P = 0.033). Overall, Qatari students had better knowledge, attitude, and readiness to practice scores and total KArP scores than non-Qatari students. Moreover, students who were born in Qatar also had better knowledge, attitude, and readiness to practice scores and total KArP scores than students who were born outside Qatar. Significant direct moderate correlations were found among the 3 KArP parameters (P < 0.001). Knowledge and attitudes were indicated to be significant predictors of readiness to practice (P < 0.001).

CONCLUSIONS

Students from the health colleges at Qatar University have moderate disaster medicine preparedness.

Development and evaluation of an elective course of pharmacist's roles in disaster management in France

PURPOSE

To describe Faculty of Pharmacy experience in the development of an elective course of pharmacist's roles in disaster management for third-year pharmacy students and to evaluate the effectiveness of this innovative teaching module in students' knowledge and their perception of the introduction of this specific course into their curriculum.

METHODS

An expert team of physicians, surgeons and pharmacists of the Service de Santé des Armées, pharmacists teaching at the Faculty and pharmacists of Bataillon des Marins Pompiers de Marseille defined the program of a 30-hour module in disaster response in line with previously published recommendations, literature analysis and international guidelines on disaster response training. Students' knowledge of key competencies was assessed after each teaching session through a multiple-choice questionnaire. Assessment of self-perceived students' knowledge, teaching quality and students' degree of satisfaction was carried out using a volunteer survey just after the last teaching, the November 15th.

RESULTS

The creation of the final curriculum resulted in a course of 6 modules. Concerning the students' knowledge of key competencies, a mean score of 19/25 for the multiple-choice questionnaire was obtained. 98.3% of students reported that this teaching allowed them to improve their knowledge in the field of pharmacist's roles in disaster management. 79.3% of them will recommend this optional course.

CONCLUSION

This teaching represents a potential to increase the number of pharmacists prepared to respond to disasters. It also expands students' understanding of pharmacist's roles and stimulates their interest in emergency preparedness. Further formation, including emergency simulation in mass triage will be conducted next year.

Self-Perception of Medical Students' Knowledge and Interest in Disaster Medicine: Nine Years After the Approval of the Curriculum in German Universities

BACKGROUND

Following the recommendations of the World Association for Disaster and Emergency Medicine (WADEM; Madison, Wisconsin USA) to develop standards for training the undergraduates in disaster-relevant fields (2004), a German curriculum was approved in 2006. This paper aims to describe the level of training and interest of medical students nine years later. Problem The aim of this study was to assess the self-perception of medical students' knowledge and interest in disaster medicine nine years after the implementation of a standardized disaster medicine curriculum in German medical schools.

METHODS

This prospective, cross-sectional, observational study was conducted with medical students in Germany using a web-based, purpose-designed questionnaire consisting of 27 mandatory and 11 optional questions.

RESULTS

Nine hundred ninety-two students from 36 of 37 medical schools in Germany participated. More than one-half of medical students were aware of the field of disaster medicine. One hundred twenty-one students undertook training internally within their university and 307 undertook training externally at other institutions. Only a small content of the curriculum was taught. A difference in self-perception of knowledge between trained and untrained participants was found, despite the level of training being low in both groups. Participants were generally highly motivated to learn disaster medicine in a variety of institutions.

CONCLUSION

German students are still largely not well educated regarding disaster medicine, despite their high motivation. The curriculum of 2006 was not implemented as originally planned and the number of trained students still remains low as the self-perception of knowledge. Currently, there is no clear and standardized training concept in place. A renewal in the agreement of implementation of the curriculum at medical schools should be targeted in order to follow the recommendation of WADEM. Wunderlich R Ragazzoni L Ingrassia PL Della Corte F Grundgeiger J Bickelmayer JW Domres B . Self-perception of medical students' knowledge and interest in disaster medicine: nine years after the approval of the curriculum in German universities. Prehosp Disaster Med. 2017;32(4):374-381.

Are Belgian military students in medical sciences better educated in disaster medicine than their civilian colleagues?

Introduction

Historically, medical students have been deployed to care for disaster victims but may not have been properly educated to do so. A previous evaluation of senior civilian medical students in Belgium revealed that they are woefully unprepared. Based on the nature of their military training, we hypothesised that military medical students were better educated and prepared than their civilian counterparts for disasters. We evaluated the impact of military training on disaster education in medical science students.

Methods

Students completed an online survey on disaster medicine, training, and knowledge, tested using a mixed set of 10 theoretical and practical questions. The results were compared with those of a similar evaluation of senior civilian medical students.

Results

The response rate was 77.5%, mean age 23 years and 59% were males. Overall, 95% of military medical students received some chemical, biological, radiological and nuclear training and 22% took part in other disaster management training; 44% perceived it is absolutely necessary that disaster management should be incorporated into the regular curriculum. Self-estimated knowledge ranged from 3.75 on biological incidents to 4.55 on influenza pandemics, based on a 10-point scale. Intention to respond in case of an incident ranged from 7 in biological incidents to 7.25 in chemical incidents. The mean test score was 5.52; scores improved with educational level attained. A comparison of survey data from civilian senior medical master students revealed that, except for influenza pandemic, military students scored higher on knowledge and capability, even though only 27% of them were senior master students. Data on willingness to work are comparable between the two groups. Results of the question/case set were significantly better for the military students.

Conclusions

The military background and training of these students makes them better prepared for disaster situations than their civilian counterparts.

Dutch senior medical students and disaster medicine: a national survey

Background

Medical students have been deployed in victim care of several disasters throughout history. They are corner stones in first-line care in recent pandemic planning. Furthermore, every physician and senior medical student is expected to assist in case of disaster situations, but are they educated to do so? Being one of Europe’s densest populated countries with multiple nuclear installations, a large petrochemical industry and also at risk for terrorist attacks, The Netherlands bear some risks for incidents. We evaluated the knowledge on Disaster Medicine in the Dutch medical curriculum. Our hypothesis is that Dutch senior medical students are not prepared at all.

Methods

Senior Dutch medical students were invited through their faculty to complete an online survey on Disaster Medicine, training and knowledge. This reported knowledge was tested by a mixed set of 10 theoretical and practical questions.

Results

With a mean age of 25.5 years and 60 % females, 999 participants completed the survey. Of the participants, 51 % considered that Disaster Medicine should absolutely be taught in the regular medical curriculum and only 2 % felt it as useless; 13 % stated to have some knowledge on disaster medicine. Self-estimated capability to deal with various disaster situations varied from 1.47/10 in nuclear incidents to 3.92/10 in influenza pandemics. Self-estimated knowledge on these incidents is in the same line (1.71/10 for nuclear incidents and 4.27/10 in pandemics). Despite this limited knowledge and confidence, there is a high willingness to respond (ranging from 4.31/10 in Ebola outbreak over 5.21/10 in nuclear incidents to 7.54/10 in pandemics). The case/theoretical mix gave a mean score of 3.71/10 and raised some food for thought. Although a positive attitude, 48 % will place contaminated walking wounded in a waiting room and 53 % would use iodine tablets as first step in nuclear decontamination. Of the participants, 52 % even believes that these tablets protect against external radiation, 41 % thinks that these tablets limit radiation effects more than shielding and 57 % believes that decontamination of chemical victims consists of a specific antidote spray in military cabins.

Conclusions

Despite a high willingness to respond, our students are not educated for disaster situations.

Electronic supplementary material

The online version of this article (doi:10.1186/s12245-015-0077-0) contains supplementary material, which is available to authorized users.

Securing the second front: achieving first receiver safety and security through competency-based tools

INTRODUCTION

Limited research has focused on the safety and security of First Responders and Receivers, including clinicians, hospital workers, public safety officials, community volunteers, and other lay personnel, during public health emergencies. These providers are, in some cases, at greater peril during large-scale disasters due to their lack of training and inadequate resources to handle major influxes of patients. Exemplified in the 1995 Tokyo sarin gas attacks and the 2008 Wenchuan earthquakes, lack of training results in poor outcomes for both patients and First Receivers.

OBJECTIVE

The improvement of knowledge and comfort level of First Receivers preparing for a medical disaster via an affordable, repeatable emergency preparedness training (EPT) curriculum.

METHODS

A 5-hour EPT curriculum was developed including nine learning objectives, 18 competencies, and 34 performance objectives. Following brief didactic and small group sessions, interprofessional teams of four to six trainees were observed in a large patient simulator designed to recreate environmentally challenging (ie, flood evacuation), multi-patient scenarios using a novel technique developed to utilize trainees as actors. Trained observers assessed successful completion of 16 individual and 18 team performance objectives. Prior to training, team members completed a 24-question knowledge assessment, a demographic survey, and a comfort level self-assessment. Following training, trainees repeated the 24 questions, self-assessment, and course assessment.

RESULTS

One hundred ninety-five participants completed the course between November 2012 and August 2013. One hundred ninety-one (98.5%), 150 (76.9%), and 66 (33.8%) participants completed the pretest, post-test, and course assessment, respectively. The mean (SD) percentage of correct answers between the pretest and post-test increased from 46.3 (13.4) to 75.3 (12.2), P < .0001. Thirty-eight participants (19.5%) reported more than three hours of disaster EPT each year while 157 participants (80.5%) reported three hours or less of yearly EPT. Sixty-six (100%) reported the course relevant to care providers and 61 (92.4%) highly recommended the course. Comfort level increased from 37.0/100 (n = 192) before training to 76.3/100 (n = 145) after training.

CONCLUSION

The Center for Health Professional Training and Emergency Response's (CHPTER's) 5-hour EPT curriculum for patient care providers recreates simultaneous multi-actor disasters, measures EPT performance, and improves trainee knowledge and comfort level to save patient and provider lives during a disaster, via an affordable, repeatable EPT curriculum. A larger-scale study, or preferably a multi-center trial, is needed to further study the impact of this curriculum and its potential to enhance the safety and security of the "Second Front.

Nationwide Program of Education for Undergraduates in the Field of Disaster Medicine: Development of a Core Curriculum Centered on Blended Learning and Simulation Tools

In recent years, effective models of disaster medicine curricula for medical schools have been established. However, only a small percentage of medical schools worldwide have considered at least basic disaster medicine teaching in their study program. In Italy, disaster medicine has not yet been included in the medical school curriculum. Perceiving the lack of a specific course on disaster medicine, the Segretariato Italiano Studenti in Medicina (SISM) contacted the Centro di Ricerca Interdipartimentale in Medicina di Emergenza e dei Disastri ed Informatica applicata alla didattica e alla pratica Medica (CRIMEDIM) with a proposal for a nationwide program in this field. Seven modules (introduction to disaster medicine, prehospital disaster management, definition of triage, characteristics of hospital disaster plans, treatment of the health consequences of different disasters, psychosocial care, and presentation of past disasters) were developed using an e-learning platform and a 12-hour classroom session which involved problem-based learning (PBL) activities, table-top exercises, and a computerized simulation (Table 1). The modules were designed as a framework for a disaster medicine curriculum for undergraduates and covered the three main disciplines (clinical and psychosocial, public health, and emergency and risk management) of the core of “Disaster Health” according to the World Association for Disaster and Emergency Medicine (WADEM) international guidelines for disaster medicine education. From January 2011 through May 2013, 21 editions of the course were delivered to 21 different medical schools, and 524 students attended the course. The blended approach and the use of simulation tools were appreciated by all participants and successfully increased participants’ knowledge of disaster medicine and basic competencies in performing mass-casualty triage. This manuscript reports on the designing process and the initial outcomes with respect to learners' achievements and satisfaction of a 1-month educational course on the fundamentals of disaster medicine. This experience might represent a valid and innovative solution for a disaster medicine curriculum for medical students that is easily delivered by medical schools.Table 1

IngrassiaPL, RagazzoniL, TengattiniM, CarenzoL, Della CorteF. Nationwide program of education for undergraduates in the field of disaster medicine: development of a core curriculum centered on blended learning and simulation tools. Prehosp Disaster Med. 2014;29(5):1-8.