Effectiveness of preventive medicine education and its determinants among medical students in Malaysia

Abstract

Preventive medicine has been incorporated in the medical school curriculum, but its effectiveness and the factors that affect it are yet to be widely looked into in the context of Malaysia. We aimed to measure the familiarity with, perception about the importance to learn, and the ability to practice preventive medicine as well as its determinants among the medical students in Malaysia. Thus, a cross sectional study was conducted through an anonymous online survey among 387 randomly selected final year medical students of four large public medical schools in Malaysia from March to September 2014. Of the total sample, only 340 (response rate 87.8%) gave a written informed consent and took part in the survey. The familiarity of the sample with preventive medicine was measured in 19 preventive medicine areas, and their perception about the importance of preventive medicine and their ability to practice it were gauged on a Likert scale (low score indicates disagreement and high indicates agreement). Descriptive statistical analysis was performed, followed by logistic regression. The mean age of the respondents was 23.7 (SD 0.77) years, and 61.2% (n = 208) of them were females. Results showed that 22.9% of the sample (n = 78) had a low familiarity with preventive medicine, whereas 76.8% (n = 261) had a high familiarity. The study sample specified that among all the preventive medicine subjects, screening and control as well as smoking cessation and immunization are “extremely important to learn.” In univariable analysis, being a female, medical school, family size, and perception about the importance to learn preventive medicine were associated with the ability to practice it. In multivariable analysis, the perception towards the importance to learn preventive medicine was the only significant determinant: aOR (adjusted odds ratio) for those who “agreed” 17.28 (95% CI aOR 4.44 – 67.26, P<0.001) and for “strongly agreed” 35.87 (95% CI aOR 8.04 – 159.87, P<0.001). Considering these findings, the familiarity of medical students with preventive medicine should be increased. The perception about the importance to learn preventive medicine is a strong determinant for the ability to practice it.

Keywords

preventive medicine / medical school / medical students

References

[1] Kuller LH. Prevention research strategies. Nutr Rev 2006; 64(2 Pt 2): S2–S8

[2] Hauer KE, Carney PA, Chang A, Satterfield J. Behavior change counseling curricula for medical trainees: a systematic review. Acad Med 2012; 87(7): 956–968

[3] Hill LL, Maltz A, Park KM. Preventive medicine physicians: unique skill sets that can enhance the health center mission. Bethesda, MD 2010. Available fromhttp://www.nachc.com/client/documents/Preventive%20Medicine%20Physicians.pdf. <Date>Accessed on January 27</Date>,2015

[4] Hull SK. A larger role for preventive medicine. Virtual Mentor 2008; 10(11): 724–729

[5] Murray CJ, Vos T, Lozano R, Naghavi M, Flaxman AD, Michaud C, Ezzati M, Shibuya K, Salomon JA, Abdalla S, Aboyans V, Abraham J, Ackerman I, Aggarwal R, Ahn SY, Ali MK, Alvarado M, Anderson HR, Anderson LM, Andrews KG, Atkinson C, Baddour LM, Bahalim AN, Barker-Collo S, Barrero LH, Bartels DH, Basáñez MG, Baxter A, Bell ML, Benjamin EJ, Bennett D, Bernabé E, Bhalla K, Bhandari B, Bikbov B, Bin Abdulhak A, Birbeck G, Black JA, Blencowe H, Blore JD, Blyth F, Bolliger I, Bonaventure A, Boufous S, Bourne R, Boussinesq M, Braithwaite T, Brayne C, Bridgett L, Brooker S, Brooks P, Brugha TS, Bryan-Hancock C, Bucello C, Buchbinder R, Buckle G, Budke CM, Burch M, Burney P, Burstein R, Calabria B, Campbell B, Canter CE, Carabin H, Carapetis J, Carmona L, Cella C, Charlson F, Chen H, Cheng AT, Chou D, Chugh SS, Coffeng LE, Colan SD, Colquhoun S, Colson KE, Condon J, Connor MD, Cooper LT, Corriere M, Cortinovis M, de Vaccaro KC, Couser W, Cowie BC, Criqui MH, Cross M, Dabhadkar KC, Dahiya M, Dahodwala N, Damsere-Derry J, Danaei G, Davis A, De Leo D, Degenhardt L, Dellavalle R, Delossantos A, Denenberg J, Derrett S, Des Jarlais DC, Dharmaratne SD, Dherani M, Diaz-Torne C, Dolk H, Dorsey ER, Driscoll T, Duber H, Ebel B, Edmond K, Elbaz A, Ali SE, Erskine H, Erwin PJ, Espindola P, Ewoigbokhan SE, Farzadfar F, Feigin V, Felson DT, Ferrari A, Ferri CP, Fèvre EM, Finucane MM, Flaxman S, Flood L, Foreman K, Forouzanfar MH, Fowkes FG, Fransen M, Freeman MK, Gabbe BJ, Gabriel SE, Gakidou E, Ganatra HA, Garcia B, Gaspari F, Gillum RF, Gmel G, Gonzalez-Medina D, Gosselin R, Grainger R, Grant B, Groeger J, Guillemin F, Gunnell D, Gupta R, Haagsma J, Hagan H, Halasa YA, Hall W, Haring D, Haro JM, Harrison JE, Havmoeller R, Hay RJ, Higashi H, Hill C, Hoen B, Hoffman H, Hotez PJ, Hoy D, Huang JJ, Ibeanusi SE, Jacobsen KH, James SL, Jarvis D, Jasrasaria R, Jayaraman S, Johns N, Jonas JB, Karthikeyan G, Kassebaum N, Kawakami N, Keren A, Khoo JP, King CH, Knowlton LM, Kobusingye O, Koranteng A, Krishnamurthi R, Laden F, Lalloo R, Laslett LL, Lathlean T, Leasher JL, Lee YY, Leigh J, Levinson D, Lim SS, Limb E, Lin JK, Lipnick M, Lipshultz SE, Liu W, Loane M, Ohno SL, Lyons R, Mabweijano J, MacIntyre MF, Malekzadeh R, Mallinger L, Manivannan S, Marcenes W, March L, Margolis DJ, Marks GB, Marks R, Matsumori A, Matzopoulos R, Mayosi BM, McAnulty JH, McDermott MM, McGill N, McGrath J, Medina-Mora ME, Meltzer M, Mensah GA, Merriman TR, Meyer AC, Miglioli V, Miller M, Miller TR, Mitchell PB, Mock C, Mocumbi AO, Moffitt TE, Mokdad AA, Monasta L, Montico M, Moradi-Lakeh M, Moran A, Morawska L, Mori R, Murdoch ME, Mwaniki MK, Naidoo K, Nair MN, Naldi L, Narayan KM, Nelson PK, Nelson RG, Nevitt MC, Newton CR, Nolte S, Norman P, Norman R, O’Donnell M, O’Hanlon S, Olives C, Omer SB, Ortblad K, Osborne R, Ozgediz D, Page A, Pahari B, Pandian JD, Rivero AP, Patten SB, Pearce N, Padilla RP, Perez-Ruiz F, Perico N, Pesudovs K, Phillips D, Phillips MR, Pierce K, Pion S, Polanczyk GV, Polinder S, Pope CA 3rd, Popova S, Porrini E, Pourmalek F, Prince M, Pullan RL, Ramaiah KD, Ranganathan D, Razavi H, Regan M, Rehm JT, Rein DB, Remuzzi G, Richardson K, Rivara FP, Roberts T, Robinson C, De Leòn FR, Ronfani L, Room R, Rosenfeld LC, Rushton L, Sacco RL, Saha S, Sampson U, Sanchez-Riera L, Sanman E, Schwebel DC, Scott JG, Segui-Gomez M, Shahraz S, Shepard DS, Shin H, Shivakoti R, Singh D, Singh GM, Singh JA, Singleton J, Sleet DA, Sliwa K, Smith E, Smith JL, Stapelberg NJ, Steer A, Steiner T, Stolk WA, Stovner LJ, Sudfeld C, Syed S, Tamburlini G, Tavakkoli M, Taylor HR, Taylor JA, Taylor WJ, Thomas B, Thomson WM, Thurston GD, Tleyjeh IM, Tonelli M, Towbin JA, Truelsen T, Tsilimbaris MK, Ubeda C, Undurraga EA, van der Werf MJ, van Os J, Vavilala MS, Venketasubramanian N, Wang M, Wang W, Watt K, Weatherall DJ, Weinstock MA, Weintraub R, Weisskopf MG, Weissman MM, White RA, Whiteford H, Wiebe N, Wiersma ST, Wilkinson JD, Williams HC, Williams SR, Witt E, Wolfe F, Woolf AD, Wulf S, Yeh PH, Zaidi AK, Zheng ZJ, Zonies D, Lopez AD, AlMazroa MA, Memish ZA. Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012; 380(9859): 2197–2223

[6] Lim SS, Vos T, Flaxman AD, Danaei G, Shibuya K, Adair-Rohani H, Amann M, Anderson HR, Andrews KG, Aryee M, Atkinson C, Bacchus LJ, Bahalim AN, Balakrishnan K, Balmes J, Barker-Collo S, Baxter A, Bell ML, Blore JD, Blyth F, Bonner C, Borges G, Bourne R, Boussinesq M, Brauer M, Brooks P, Bruce NG, Brunekreef B, Bryan-Hancock C, Bucello C, Buchbinder R, Bull F, Burnett RT, Byers TE, Calabria B, Carapetis J, Carnahan E, Chafe Z, Charlson F, Chen H, Chen JS, Cheng AT, Child JC, Cohen A, Colson KE, Cowie BC, Darby S, Darling S, Davis A, Degenhardt L, Dentener F, Des Jarlais DC, Devries K, Dherani M, Ding EL, Dorsey ER, Driscoll T, Edmond K, Ali SE, Engell RE, Erwin PJ, Fahimi S, Falder G, Farzadfar F, Ferrari A, Finucane MM, Flaxman S, Fowkes FG, Freedman G, Freeman MK, Gakidou E, Ghosh S, Giovannucci E, Gmel G, Graham K, Grainger R, Grant B, Gunnell D, Gutierrez HR, Hall W, Hoek HW, Hogan A, Hosgood HD 3rd, Hoy D, Hu H, Hubbell BJ, Hutchings SJ, Ibeanusi SE, Jacklyn GL, Jasrasaria R, Jonas JB, Kan H, Kanis JA, Kassebaum N, Kawakami N, Khang YH, Khatibzadeh S, Khoo JP, Kok C, Laden F, Lalloo R, Lan Q, Lathlean T, Leasher JL, Leigh J, Li Y, Lin JK, Lipshultz SE, London S, Lozano R, Lu Y, Mak J, Malekzadeh R, Mallinger L, Marcenes W, March L, Marks R, Martin R, McGale P, McGrath J, Mehta S, Mensah GA, Merriman TR, Micha R, Michaud C, Mishra V, Mohd Hanafiah K, Mokdad AA, Morawska L, Mozaffarian D, Murphy T, Naghavi M, Neal B, Nelson PK, Nolla JM, Norman R, Olives C, Omer SB, Orchard J, Osborne R, Ostro B, Page A, Pandey KD, Parry CD, Passmore E, Patra J, Pearce N, Pelizzari PM, Petzold M, Phillips MR, Pope D, Pope CA 3rd, Powles J, Rao M, Razavi H, Rehfuess EA, Rehm JT, Ritz B, Rivara FP, Roberts T, Robinson C, Rodriguez-Portales JA, Romieu I, Room R, Rosenfeld LC, Roy A, Rushton L, Salomon JA, Sampson U, Sanchez-Riera L, Sanman E, Sapkota A, Seedat S, Shi P, Shield K, Shivakoti R, Singh GM, Sleet DA, Smith E, Smith KR, Stapelberg NJ, Steenland K, Stöckl H, Stovner LJ, Straif K, Straney L, Thurston GD, Tran JH, Van Dingenen R, van Donkelaar A, Veerman JL, Vijayakumar L, Weintraub R, Weissman MM, White RA, Whiteford H, Wiersma ST, Wilkinson JD, Williams HC, Williams W, Wilson N, Woolf AD, Yip P, Zielinski JM, Lopez AD, Murray CJ, Ezzati M, AlMazroa MA, Memish ZA. A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012; 380(9859): 2224–2260

[7] Lee IM, Shiroma EJ, Lobelo F, Puska P, Blair SN, Katzmarzyk PT, for the Lancet Physical Activity Series Working Group.Effect of physical inactivity on major non-communicable diseases worldwide: an analysis of burden of disease and life expectancy. Lancet 2012; 380(9838): 219–229PMID:22818936

[8] Parekh AK, Goodman RA, Gordon C, Koh HK, for HHS Interagency Workgroup on Multiple Chronic Conditions. Managing multiple chronic conditions: a strategic framework for improving health outcomes and quality of life. Public Health Rep 2011; 126(4): 460–471

[9] Demaio AR, Kragelund Nielsen K, Pinkowski TersbØl B, Kallestrup P, Meyrowitsch DW. Primary Health Care: a strategic framework for the prevention and control of chronic non-communicable disease. Glob Health Action 2014;7: 10.3402/gha.v7.24504

[10] Global Burden of Disease Study 2010. Malaysia Global Burden of Disease Study 2010 (GBD 2010) Results 1990–2010. Seattle, United States: Institute for Health Metrics and Evaluation (IHME), 2013

[11] Cheah YK. Determinants of the demand for using preventive medical care among adults in Penang, Malaysia. Malays J Med Sci 2013; 20(1): 46–55

[12] Lim VK. Medical education in Malaysia. Med Teach 2008; 30(2): 119–123

[13] Spencer EH, Frank E, Elon LK, Hertzberg VS, Serdula MK, Galuska DA. Predictors of nutrition counseling behaviors and attitudes in US medical students. Am J Clin Nutr 2006; 84(3): 655–662

[14] Schlair S, Hanley K, Gillespie C, Disney L, Kalet A, Darby PC, Frank E, Spencer E, Harris J, Jay M. How medical students’ behaviors and attitudes affect the impact of a brief curriculum on nutrition counseling. J Nutr Educ Behav 2012; 44(6): 653–657

[15] Stine C, Kohrs FP, Little DN, Kaprielian V, Gatipon BB, Haq C. Integrating prevention education into the medical school curriculum: the role of departments of family medicine. Acad Med 2000; 75(7 Suppl): S55–S59

[16] Al-Naggar RA, Bobryshev YV, Mohd Noor NA. Lifestyle practice among Malaysian university students. Asian Pac J Cancer Prev 2013; 14(3): 1895–1903

[17] Al-Naggar RA, Al-Naggar DH, Bobryshev YV, Chen R, Assabri A. Practice and barriers toward breast self-examination among young Malaysian women. Asian Pac J Cancer Prev 2011; 12(5): 1173–1178

[18] Al-Naggar RA. Practice of skin cancer prevention among road traffic police officers in Malaysia. Asian Pac J Cancer Prev 2013; 14(8): 4577–4581

[19] Al-Naggar RA, Bobryshev YV. Knowledge of colorectal cancer screening among young Malaysians. Asian Pac J Cancer Prev 2013; 14(3): 1969–1974

[20] Al-Naggar RA, Kadir SY. Lung cancer knowledge among secondary school male teachers in Kudat, Sabah, Malaysia. Asian Pac J Cancer Prev 2013; 14(1): 103–109

[21] Al-Naggar RA, Low WY, Isa ZM. Knowledge and barriers towards cervical cancer screening among young women in Malaysia. Asian Pac J Cancer Prev 2010; 11(4): 867–873

[22] Tan YY, Hesham R, Qodriyah HMS. Knowledge and attitude of university students in health sciences on the prevention of cervical cancer. Med J Malaysia 2010; 65(1): 53–57

[23] Hassali MA, Shafie AA, Awaisu A, Mohamed Ibrahim MI, Ahmed SI. A public health pharmacy course at a Malaysian pharmacy school. Am J Pharm Educ 2009; 73(7): 136

[24] Bell K, Cole BA. Improving medical students’ success in promoting health behavior change: a curriculum evaluation. J Gen Intern Med 2008; 23(9): 1503–1506

[25] Scott CS, Neighbor WE. Preventive care attitudes of medical students. Soc Sci Med 1985; 21(3): 299–305

[26] Zawahir S, Omar M, Awang R, Yong HH, Borland R, Sirirassamee B, Fong GT, Hammond D. Effectiveness of antismoking media messages and education among adolescents in Malaysia and Thailand: findings from the international tobacco control southeast Asia project. Nicotine Tob Res 2013; 15(2): 482–491

[27] Curry RH, Bene VED, Enarson C, Irby DM, Kirkland RT, Koeppen BM, Lee MY, Ludmerer KM, Rooks L, Shomaker TS, Smith CK, Watson RT, Whitcomb ME, Wile MZ. The education of medical students: ten stories of curriculum change.New York, United States: Milbank Memorial Fund, 2000. ISBN 1-887748-40-7

[28] Shifrin A. Prevention finds a new place in medicine. Virtual Mentor 2008; 10(11): 691–693

[29] Levy BS, Wegman DH. Commentary: public health and preventive medicine: proposing a transformed context for medical education and medical care. Acad Med 2012; 87(7): 837–839

[30] Gowin E, Pawlikowska T, Horst-Sikorska W, Michalak M. British and Polish general practitioners’ opinions on the importance of preventive medicine. Health Promot Int 2011; 26(2): 171–176

[31] Amodio DM. Coordinated roles of motivation and perception in the regulation of intergroup responses: frontal cortical asymmetry effects on the P2 event-related potential and behavior. J Cogn Neurosci 2010; 22(11): 2609–2617

[32] Misch DA. Andragogy and medical education: are medical students internally motivated to learn? Adv Health Sci Educ Theory Pract 2002; 7(2): 153–160

[33] Dornan T, Boshuizen H, King N, Scherpbier A. Experience-based learning: a model linking the processes and outcomes of medical students’ workplace learning. Med Educ 2007; 41(1): 84–91

[34] Sobral DT. What kind of motivation drives medical students’ learning quests? Med Educ 2004; 38(9): 950–957

Acknowledgements

The authors would like to thank the School of Pharmacy, Management and Science University, Shah Alam, Selangor, Malaysia.

Compliance with ethics guidelines

Shirin Anil, Mohamed Shukry Zawahir, and Redhwan Ahmed Al-Naggar declare that they have no conflict of interests. The study was conducted in accordance with the Declaration of Helsinki after ethical approval was obtained from the ethics committee of the Faculty of Health and Life Sciences, Management and Science University (MSU), Shah Alam, Malaysia. A written informed consent was obtained from all participants who were ensured of the confidentiality of the data they provided.

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