Between 11th December 2020 until 31st March 2021 241 responses were collected and all students consented for their data to be used in this study.
Medical demographics
237 respondents completed questions relating to their medical school demographics. Responses were received from 8 medical schools (Table 1).
Table 1 Breakdown of number of students at each medical school by course length (n=240)
Course Length
|
Medical School n=
|
|
4 years (n=42)
|
B
|
1
|
C
|
1
|
F
|
2
|
G
|
6
|
H
|
32
|
5 years (n=146)
|
A
|
21
|
C
|
4
|
E
|
89
|
F
|
32
|
6 years (n=52)
|
C
|
2
|
D
|
1
|
E
|
8
|
F
|
2
|
G
|
39
|
One student selected other specifying course length may vary from 5-6 years depending on if they chose to intercalate. For each medical school total number of students is as follows: A n=21, B n=1, C n=8, D n=1, E n=97. F n=36, G n=45 and H n=32.
Figure 1 demonstrates numbers of participants included at each step of analysis. 17.8% of students were on a 4-year graduate medical programme. No students that completed the survey had recently graduated to help with the ongoing coronavirus pandemic. Course length varied from 4 years to 6 years with most students being on a 5-year programme (n=146). Median year of study at time of completion of the study was 2 and majority of students were 20% of the way through their medical degree (n=81).
KNOWLEDGE OF THE H1N1 1918 INFLUENZA PANDEMIC AND INFECTION CONTROL
Previous teaching
34% of respondents reported previous teaching on the history of pandemics (71/210). Of the remaining 139 students that answered no, 78% (108/139) displayed a positive stance to inclusion of the history of pandemics within the curriculum. Distribution of the themes generated from free-text responses are shown in figure 2.
Where reasons for a positive response were given, these centred on the recent pandemic including “in light of recent events” and “given the current COVID-19 pandemic”. Additionally, 5 students reported it being beneficial in terms of infection control and prevention. 10 students reported a neutral response with terms including “maybe”, “not sure” and “perhaps”. 21/122 students’ (9%) displayed a negative stance to inclusion of the history of pandemics with 2 students explanations surrounding content of medical school exams for example, “…already have too much to remember. This would be extra examinable content”.
33/210 (15%) of students reported specific teaching on the 1918 H1N1 Influenza Pandemic at Medical school and this data is shown in Figure 3.
Of the remaining 177 students responding no, 62% (110/177) displayed a positive desire to have this included within the curriculum with 9 students commenting that it would be useful from a public health perspective and 6 students mentioning COVID-19 in their answers. 15/167 (9%) of student’s answers centred on themes of uncertainty on content “I don’t know what it would entail so I don’t know if I would benefit…” and “Depends on how they teach it and what its learning objectives are”. Finally, 29/167 (17%) students showed a negative stance with 3 students being grouped into the theme - curriculum overload.
Knowledge on pandemics and infection control
Overall, knowledge was poor, with only 12/210 (5.7%) students answering all 4 questions correctly and median number of correctly answered questions was 2.
97% (204/210) of students correctly identified the difference between a pandemic and an epidemic. Students were more likely to correctly answer if they had had previous teaching on the history of pandemics (100% vs. 96% P=0.001) (Table 2).
Table 2 Further analysis of question ‘What is the difference between an epidemic and a pandemic?” (n=210)
Variable
|
|
Correct Answer (n=)
|
Incorrect Answer (n=)
|
Value
|
P-Value
|
4-year programme
|
Yes
|
35
|
1
|
22.850*
|
0.001
|
No
|
169
|
5
|
% of the way through the Medicine Course
|
100
|
18
|
0
|
31.544*
|
0.009
|
80
|
22
|
6
|
75
|
4
|
1
|
70
|
1
|
0
|
60
|
20
|
0
|
50
|
18
|
0
|
40
|
41
|
1
|
25
|
11
|
0
|
20
|
69
|
4
|
Previous teaching on history of pandemics
|
Yes
|
71
|
0
|
215.185
|
0.001
|
No
|
133
|
6
|
Previous teaching on the 1918 H1N1 Influenza pandemic
|
Yes
|
33
|
0
|
213.163
|
0.001
|
No
|
171
|
6
|
Significant P-values are indicated in bold. Values marked by * indicate Fisher Exact test was performed.
76/210 (36%) of students correctly identified all 3 methods of transmission of influenza spread (close contact with infected person, coughs and sneezes and contact with infected animals). 30/210 (14%) of students incorrectly identified that influenza can be spread via blood transfusions and 36/210 (17%) of students incorrectly identified that influenza can be spread via sexual contact. No significant difference with previous teaching was seen. However, students were more likely to correctly answer how influenza can spread if they were closer to the start of their degree (43% vs 56% P=0.009) (Table 3).
Table 3 Further analysis of question ‘Select all correct answers for how influenza can be spread (n=210)
Variable
|
|
Correct Answer n=
|
Incorrect Answer n=
|
Value
|
P-Value
|
4-year programme
|
Yes
|
13
|
23
|
43.184*
|
0.072
|
No
|
63
|
111
|
% of the way through the Medicine Course
|
100
|
7
|
11
|
148.403*
|
0.048
|
80
|
10
|
22
|
75
|
2
|
2
|
70
|
0
|
1
|
60
|
9
|
11
|
50
|
4
|
14
|
40
|
17
|
25
|
25
|
4
|
7
|
20
|
23
|
50
|
Previous teaching on history of pandemics
|
Yes
|
24
|
47
|
50.520*
|
0.005
|
No
|
52
|
87
|
Previous teaching on the 1918 H1N1 Influenza pandemic
|
Yes
|
11
|
22
|
45.925
|
0.035
|
No
|
65
|
112
|
Correct Answer is referring to all 3 methods of transmission being correctly identified (close contact with infected person, coughs and sneezes and contact with infected animals). Incorrect answer refers to all other combinations of answers. Significant P-values are indicated in bold. Values marked by * indicate Fisher Exact test was performed.
Limited knowledge on reduction of transmission in viral pandemics was seen with only 53/210 (25%) of students correctly identifying all 7 methods (social distancing, covering nose and mouth when coughing/ sneezing, hand washing, staying home, wearing protective clothing when in public places, antiviral drugs and vaccinations). No significant difference was seen by year of medical school (P=0.195) (Table 4). Students were more likely to answer correctly if they had not had previous teaching on the history of pandemics (21% vs. 27%, p=0.013).
Table 4 Further analysis of question ‘Select all correct answers for how influenza/ viral pandemic can be prevented
Variable
|
|
Correct Answer n=
|
Incorrect Answer n=
|
Value
|
P-Value
|
4-year programme
|
Yes
|
10
|
26
|
99.107*
|
0.107
|
No
|
43
|
131
|
% of the way through the Medicine Course
|
100
|
2
|
16
|
379.882*
|
0.195
|
80
|
4
|
69
|
75
|
3
|
8
|
70
|
0
|
42
|
60
|
6
|
12
|
50
|
2
|
18
|
40
|
7
|
35
|
25
|
4
|
7
|
20
|
25
|
48
|
Previous teaching on history of pandemics
|
Yes
|
15
|
56
|
103.846*
|
0.013
|
No
|
38
|
101
|
Previous teaching on the 1918 H1N1 Influenza pandemic
|
Yes
|
8
|
25
|
97.207*
|
0.090
|
No
|
45
|
132
|
Correct Answer is referring to all 7 methods of being correctly identified (social distancing, covering nose and mouth when coughing/ sneezing, hand washing, staying home, wearing protective clothing when in public places, antiviral drugs and vaccinations). Incorrect answer refers to all other combinations of answers. Significant P-values are indicated in bold. Values marked by * indicate Fisher Exact test was performed.
82/210 (39%) of students correctly identified treatment options for influenza. Students were more likely to answer correctly if they were towards the start of their medical degree (P=0.030) (Table 5). 44% of students with previous teaching on the history of pandemics answered correctly compared to 37% without (P=0.051) (Table 5).
Table 5 Further analysis of question ‘Select all correct answers for how influenza/ viral pandemic can be treated?”
Variable
|
|
Correct Answer n=
|
Incorrect Answer n=
|
Value
|
P-Value
|
4-year programme
|
Yes
|
12
|
24
|
71.174*
|
0.027
|
No
|
70
|
104
|
% of the way through the Medicine Course
|
100
|
6
|
12
|
259.811*
|
0.030
|
80
|
8
|
15
|
75
|
1
|
3
|
70
|
0
|
1
|
60
|
12
|
8
|
50
|
7
|
11
|
40
|
13
|
29
|
25
|
5
|
6
|
20
|
30
|
43
|
Previous teaching on history of pandemics
|
Yes
|
31
|
40
|
67.681*
|
0.051
|
No
|
51
|
88
|
Previous teaching on the 1918 H1N1 Influenza pandemic
|
Yes
|
15
|
18
|
67.602*
|
0.078
|
No
|
67
|
110
|
Correct Answer is referring to both methods of being correctly identified (bedrest and antivirals). Incorrect answer refers to all other combinations of answers. Significant P-values are indicated in bold. Values marked by * indicate Fisher Exact test was performed.
History of Medicine
Only 33% (63/190) of students reported that the history of Medicine is taught at their medical school (Figure 4).
Of those reporting teaching over half (56% - 35/63) reported this being via lectures with the remainder reporting being taught by essays, problem-based learning, or student selected components. 29% of comments were grouped around the emergent theme of brief engagement with the topic including “very limited amounts”, “very briefly” and “brief relevant points at the start of a lecture”. Most content was coded around the theme of generalised, “general epidemiology”, “pretty much everything”, “a wide range of topics”. 12 students reported having choice over the area that they study, and 6 students reported learning the history of Medicine in relation to Anatomy. 4 students reported pandemics being taught with one commenting “a bit on famous pandemics like HIV, H1N1, Swine Flu”. Additionally, only one student commented on the impact of learning about the history of Medicine with regards to current care: “what we can learn from our history to provide more ethical care now”.
72% (137/190) of students were positive about the importance of learning history of medicine as demonstrated in figure 5.
Only 15% (28/190) of students answered disagree. Those with a positive response (87%) included themes such as helping to guide future practice: “To better prepare students for potentially needing to work in pandemic conditions in the future” and “History repeats itself so we must learn from it”. 24% of students’ responses themed around mistake avoidance. Additionally, one student commented “I only know as much as I do due to my essay title, but I think it would have been important for everyone… By learning history of Medicine, we can learn from previous mistakes…”.
Overall, students were positive (79% 150/190) about the benefit of learning around the H1N1 pandemic given the Covid-19 pandemic. Only 7% of students answered strongly disagree or somewhat disagree and the remainder (14%) answering neither agree nor disagree.
52% (92/177) of students felt there was more they wanted to be included within their course whilst 33% (65/177) felt there wasn’t and 11% (20/117) were unsure. 94 students commented on what they felt should be taught, the emergent themes for this can be seen in figure 6.
The majority (29% 27/94) of student’s responses centred on history and in particular infectious disease history and development of medical and surgical techniques (24/94). Ethics and culture was also a common theme with a desire to learn the “…specific basis for key ethno-cultural attitudes towards treatments…”, “…socioeconomic inequalities…” and “traditional medical practises…”. A further theme that emerged centred on an understanding of previous medical injustice with a desire to learn “... Guatemalan STD trials as an example of malpractice” , “…Racial bias…” and “Medicine around the world – we are not all equally developed”.
Finally, students were asked on if they had any other comments they wanted to add. A handful of students answered with responses including “Being integrated and a natural part of the course is important…because the history of medicine provides context to modern medical practices…”.