How Many Hours Do Doctors Spend In Medical School Learning About Vaccines

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Published: 26 November 2010

THE VAXED PROJECT: An Cess of Immunization Education in Canadian Health Professional Programs

Donna One thousand Pierrynowski MacDougallⁱⁱ,
Beth A Halperin¹,
Robert A Strang^three,
Susan 1000 Bowles^four,
Darlene M Baxendale^ane &
Shelly A McNeil⁵

BMC Medical Education volume 10, Commodity number:86 (2010) Cite this article

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Abstract

Background

Knowledge & attitudes of healthcare providers (HCP) accept significant impact on frequency with which vaccines are offered & accepted just many HCP are ill equipped to make informed recommendations about vaccine merits & risks. We performed an assessment of the educational needs of trainees regarding immunization and used the information thus ascertained to develop multi-faceted, evaluable, educational tools which can exist integrated into formal education curricula.

Methods

(i) A questionnaire was sent to all Canadian nursing, medical & chemist's schools to assess immunization-related curriculum content (ii) A 77-item web-based, validated questionnaire was emailed to terminal-year students in medicine, nursing, & chemist's at two universities in Nova Scotia, Canada to assess knowledge, attitudes, & behaviors reflecting current immunization curriculum.

Results

The curriculum review yielded responses from 18%, 48%, & 56% of medical, nursing, & pharmacy schools, respectively. Fourth dimension spent on immunization content varied essentially betwixt & within disciplines from <1 to >50 hrs. Most schools reported some content regarding vaccine preventable diseases, immunization practice & clinical skills but in that location was considerable variability and fewer schools had learning objectives or formal evaluation in these areas. 74% of respondents didn't feel comfortable discussing vaccine side effects with parents/patients & only 21% felt they received adequate teaching regarding immunization during grooming.

Conclusions

Important gaps were identified in the noesis of graduating nursing, medical, & pharmacy trainees regarding vaccine indications/contraindications, adverse events & rubber. The national curriculum review revealed broad variability in immunization curriculum content & evaluation. In that location is clearly a need for educators to appraise current curricula and accommodate existing educational resource such as the Immunization Competencies for Health Professionals in Canada.

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Background

Vaccines are undeniably ane of the most important health advances of the past century. Despite proven impact on human health and longevity, many vaccines are under-utilized. The literature has clearly documented depression levels of compliance with established immunization guidelines in a diverseness of settings [1–three]. Reasons for sub-optimal compliance and "missed-opportunities" are multi-factorial. Public and provider confidence in vaccine efficacy, concern about potential side-effects, and lack of knowledge about vaccine contraindications are common reasons for non-compliance and have been shown to contribute to lower immunization coverage in both adult and pediatric populations [4–8]. Low rates of influenza vaccination have also been reported in wellness care workers. In 2007-2008 only 54% of direct care providers and 37% of support staff in acute care facilities in Nova Scotia received flu vaccination; this rate is similar to published rates for providers in the Us and Canada [9–11].

The public views health care providers every bit credible and trusted sources of vaccine recommendations. Many individuals cite the recommendation of their physician or nurse equally the most important factor governing their determination to either become vaccinated themselves, or accept their child vaccinated, and positive attitudes of health professionals accept been shown to correlate with higher vaccination coverage rates [seven, 12]. Despite the importance of provider endorsement and advice regarding vaccines, many healthcare providers report discomfort discussing misconceptions about adverse events post-obit immunization with their patients and admit to being unsure most the relationship between vaccines and sure chronic diseases [13, xiv].

To our noesis no studies accept examined the provision of immunization-related education during health care professional grooming in Canada nor the cognition, attitudes, beliefs and behaviors of trainees graduating from Canadian health professional programs. In this written report nosotros undertook a comprehensive assessment of the needs of healthcare professional person trainees regarding formal immunization instruction. This needs assessment will grade the platform upon which to develop multi-faceted, evaluable, interprofessional educational interventions, which can exist integrated into formal education curricula.

Methods

This study was approved by the Ethics Review committees of the IWK Health Centre, Capital Health, Dalhousie University, and St. Francis Xavier University.

National Curriculum Review of Immunization-Related Content

A questionnaire was distributed to all Canadian medical, chemist's, and four-year nursing baccalaureate programs regarding immunization-related content in their curriculum (Boosted File 1). The questionnaire addressed three chief content areas: (i) bones principles and practices of immunization; (two) immunization clinical skills; and (iii) vaccine-preventable diseases. Programs were also asked to provide information on the full time allocated to immunization-related content, the scheduling of immunization content within the curriculum, and teaching methods used for content commitment. For each school, fundamental contacts with responsibility for immunization content in the curriculum were identified through public directories, and were contacted directly. They were then sent an information letter and questionnaire and asked to participate in a 15 minute phone interview.

Assessment of Knowledge and Attitudes Regarding Immunization

A 77-item spider web-based cocky-administered questionnaire (VaxEd survey), developed using Remark™ Web Survey Software and validated at the Canadian Eye for Vaccinology (Halifax, NS, Canada), was distributed to students in their last year of undergraduate training in medicine, nursing and pharmacy at two universities in Nova Scotia, Canada (the nursing schools have been identified every bit Nursing 1 and Nursing 2 to represent the different universities). Development and implementation of the survey followed the principles of Dillman [15]. Noesis questions addressed general immunization information (schedules, routine guidelines), specific vaccines and vaccine preventable diseases, contraindications, and immunization recommendations in specific populations. Attitudinal statements, structured with a Likert-response scale from "strongly disagree" to "strongly concur" were used to evaluate opinions regarding various immunization themes (i.eastward. importance of immunization, multiple injections, vaccine myths and contraindications). Behaviour questions asked about the respondent's personal uptake of vaccines (i.eastward. influenza and tetanus). The purpose of surveying these populations was to plant baseline noesis, attitudes and behaviors regarding immunization, reflecting the current curriculum content in the education programs.

Statistical Analysis

Data were converted from Remark™ Survey Software files to Excel files. These were then imported to Stata vii.0, which was used for all statistical analysis. The national curriculum review was analyzed using descriptive statistics. For the web-based survey, descriptive statistics were used to estimate the proportion of respondents correctly answering the knowledge-based questions and those who had specific attitudes and behaviours regarding immunization and immunization teaching. Discrete variables were summarized using frequency counts, percentages, and 95% confidence intervals (CIs), and comparisons were fabricated using Fisher's verbal test and odds ratios (ORs). Continuous variables were summarized using means and 95% confidence intervals and comparisons were made using two-sided t-examination and one-way ANOVA. Statistical significance was divers as a p-value ≤ 0.05.

Results

National Curriculum Review of Immunization-Related Content

Completed questionnaires regarding immunization-related content in health professional person schoolhouse curricula were received from 36% (32/89) of Canadian nursing schools. Additionally, 11 non-responding schools had identical shared curricula to i or more of the responding schools; therefore the data represented 48% (43/89) of nursing schools. But 18% of medical schools returned completed questionnaires despite follow-up. 56% of pharmacy schools returned completed questionnaires.

A wide variation in the fourth dimension allocated to immunization-related content was reported both between and within disciplines (Figure 1). Nursing programs reported the nearly variation with a minimum of less than one 60 minutes and a maximum of 52 hours. Nursing programs during which trainees participated as immunizers in public or occupational immunization campaigns had significantly more time allocated in the curriculum for immunization-related content (mean 17 h vs three h). There was also a wide-degree of variation in methods of teaching both between and inside disciplines with no particular blueprint.

Most programs reported the inclusion of some content regarding vaccine preventable diseases, immunization principles and practices, and clinical skills simply there was considerable variability in the reported content both between and within disciplines (Figure 2A, B, C). All schools were also asked whether they teach, accept specific learning objectives, and formally evaluate immunization-related clinical skills. Overall, programs reported less curriculum content related to clinical skills than to immunization principles and practices (Figure 2D, E, F).

Additionally, all schools were asked whether they teach, have specific learning objectives for, and formally evaluate content related to eleven dissimilar vaccine-preventable diseases. Nursing and pharmacy programs reported a lower proportion of curriculum content associated with specific learning objectives and formal evaluation. Medical programs reported specific learning objectives and formal evaluation associated with all of the curriculum content related to vaccine preventable diseases.

Cess of Knowledge and Attitudes Regarding Immunization

The 77-particular VaxEd survey was sent to 353 health professional students in their final twelvemonth of nursing, medicine, and chemist's shop in Nova Scotia, Canada. The overall response charge per unit was 147/353 (42%). Among programs surveyed, the response rate varied from 24% to seventy.0%: 57/92 (seventy%) Nursing 1; 24/xc (26.7%) Nursing two; 21/88 (23.9%) Medicine; and 45/83 (54.2%) Pharmacy. The majority of respondents were twenty-thirty years old (89%) and female (86%).

At that place was pregnant variation between programs in immunization knowledge (Figure 3) with hateful noesis scores ranging from 11.1/21 to sixteen.4/21 (p < 0.001). Medicine and pharmacy respondents had significantly higher mean knowledge scores than nursing respondents (Table 1).

Tabular array i Responses to selected knowledge questions including comparing of response by program.

Full size table

Pregnant correlation was observed between increased noesis and positive attitudes (Table two). Overall, only 21% of respondents felt that they had received adequate instruction about vaccines during their grooming; these respondents had higher mean knowledge scores than those who did not feel that they had received adequate training (16/21 vs 12.3/21; p < 0.001); as well, noesis scores were higher among the 16% of respondents who reported feeling comfortable responding to parent/patient concerns about vaccine side effects than among those who were not (15.8/21 vs 12.3/21; p < 0.001).

Tabular array two Attitudes regarding immunization that were significantly correlated with mean knowledge scores

Total size tabular array

85% of the students surveyed indicated that they received annual flu immunization. Individuals who did not receive annual influenza immunization were less likely to agree that un-immunized health intendance workers can spread influenza to their patients (p < 0.001); more likely to agree that a salubrious person does not need influenza immunization (p = 0.003); less likely to concord that if a health care worker does non receive influenza immunization, it is a failure of duty (p < 0.001); and much less likely to agree that receiving flu immunization is important to them (p < 0.001). As well, this grouping had significantly lower mean noesis scores than respondents who received annual flu immunization (11.viii/21 vs xiii.two/21; p = .015).

Discussion

A Canadian survey regarding preventative vaccines carried out in 2002 indicates that although support of vaccines among Canadians is broad, it is not very robust [12]. Concerns nigh vaccine safety in general (56%) and especially safety of new vaccines (43%) were quite broadly distributed. Another study indicated that attitudes, beliefs, and behaviours regarding vaccine safe concerns contribute substantially to nether-immunization in the US [three]. It was shown that concerns were increasing amongst both parents of nether-immunized and fully immunized children, too as providers, suggesting the potential for further decreased coverage and an increase in disease outbreaks.

It is important therefore that providers are aware of immunization guidelines and vaccine condom issues, both real and perceived, and are able to communicate this information to patients and parents. Although knowledge and attitudes of health intendance providers accept a meaning impact on the frequency with which vaccines are offered and accustomed, many health intendance providers are ill-equipped to make educated recommendations to their patients most the merits and risks of vaccines [seven]. Possible reasons for this, every bit identified in the present survey, could be the lack of consistency in immunization education across Canada and significant gaps in knowledge coupled with worrisome attitudes regarding immunization amid health professional trainees.

The national curriculum review demonstrated a wide caste of variation between health professional schools not simply in the immunization-related content provided simply also the amount of time allocated to immunization-related content, teaching methods used to evangelize the content, and the caste to which students' knowledge of immunization content was evaluated. This variation existed between disciplines, as expected, but there was also considerable variation betwixt programs of the aforementioned discipline. This lack of standardization results in variability in the quality of immunization education being received by wellness professional person trainees. This is not a problem unique to Canada equally like results were reported in US-based studies [xvi, 17].

Limitations of this study were identified. First, immunization-related content in most schools is scattered throughout the curriculum with little apparent communication or coordination, making the review challenging. Second, hardcopies of specific learning objectives and test questions were non obtained, potentially leading to an overestimation of what was taught. Finally, the depression response rate, particularly from medical schools makes it probable that the choice bias limits the generalizeability of our conclusions and it is probable that our results may actually overestimate immunization curriculum content in wellness professional schools due to self- selection bias past schools with more extensive immunization-related curricula.

The VaxEd survey reflected the current curriculum delivered to graduating wellness professional trainees in nursing, medicine, and chemist's. This revealed important insight into deficits in cognition and worrisome attitudes and behaviours regarding immunization. These gaps in knowledge are apropos as they are not without precedent. In previous studies, physicians reported discomfort discussing misconceptions about adverse events post-obit immunization with patients and many admitted to non being sure nearly the relationship between vaccines and chronic diseases [13, 14]. This suggests that discomfort with immunization is an result that is relevant at both a trainee and practicing level. Interestingly, 58% of students reported feeling that they had non received adequate preparation regarding immunization. This indicates that respondents had at to the lowest degree a caste of insight into the gaps in their own noesis regarding immunization.

Conclusion

In summary, despite the tremendous importance of physicians, nurses, and pharmacists in ensuring optimal commitment of immunization to Canadians, review of the curricula of undergraduate training programs revealed wide variability in immunization curriculum content and evaluation. This was reflected in the important cognition gaps identified among trainees regarding vaccine indications/contraindications, agin events, and safety and in the lack of satisfaction with immunization-related grooming reported by the majority of graduates.

Evolution and evaluation of a competency-based interprofessional immunization pedagogy program which could be adapted and integrated into formal educational curricula would contribute significantly to health professional training programs in Canada. The Immunization Competencies for Healthcare Professionals recently developed by the Professional person Education Working Group of the Canadian Immunization Committee could provide a framework for use by educators to develop and evaluate immunization educational programs adjusted to the needs of health professional trainees [18].

References

Centers for Disease Command and Prevention: Influenza vaccination coverage among children with asthma - United States, 2004-2005 flu season. MMWR. 2007, 56: 193-196.

Google Scholar
Skull SA, Andrews RM, Byrnes GB, Kelly HA, Nolan TM, Brown GA, Campbell DA: Missed opportunities to vaccinate a cohort of hospitalized elderly with pneumococcal and flu vaccines. Vaccine. 2007, 25: 5146-5154. 10.1016/j.vaccine.2007.04.082.

Article Google Scholar
Gust DA, Strine TW, Maurice E, Smith P, Yusef H, Wilkinson Thou, Battaglia M, Wright R, Schwartz : Under-immunization amongst children: effects on vaccine safety concerns on immunization status. Pediatrics. 2004, 114: e16-e22. x.1542/peds.114.1.e16.

Commodity Google Scholar
Heininger U: An internet-based survey on parental attitudes towards immunization. Vaccine. 2006, 24: 6351-6355. 10.1016/j.vaccine.2006.05.029.

Article Google Scholar
Tickner S, Leman PJ, Woodcock A: Factors underlying suboptimal childhood immunization. Vaccine. 2006, 24: 7030-7036. 10.1016/j.vaccine.2006.06.060.

Article Google Scholar
Cohen NJ, Lauderdale DS, Shete PB, Seal JB, Daum RS: Physician knowledge of catch-up regimes and contraindications to immunization. Pediatrics. 2003, 111: 925-32. 10.1542/peds.111.5.925.

Article Google Scholar
Smailbegovic MS, Laing GJ, Bedford H: Why do parents make up one's mind confronting immunization? The effect of healthcare professionals. Kid Care Wellness Dev. 2003, 29: 303-11. 10.1046/j.1365-2214.2003.00347.x.

Article Google Scholar
Wood D, Pereyra M, Halfon N: Increasing immunizations in the public sector: missed opportunities and other contributing factors. Am J Public Health. 1995, 85: 850-853. 10.2105/AJPH.85.6.850.

Article Google Scholar
Government of Nova Scotia (Wellness Promotion and Protection) [homepage on the internet]: Nova Scotia: Province of Nova Scotia. [updated 2009 Mar 12; cited 2009 Mar 30], [http://www.gov.ns.ca/hpp/cdpc/flu.asp]
National Advisory Committee on Immunization: Statement of flu vaccination for the 2007-2008 seasons. Can Commun Dis Rep. 2007, 33 (ACS-7): 1-38.

Google Scholar
Walker F, Singleton J, Lu P, Strikas R: Influenza vaccination of healthcare workers in the U.s., 1989-1997. Infect Control Hosp Epidemiol. 2000, 21: 113.

Google Scholar
Ritvo P, Irvine J, Klar N, Wilson Grand, Dark-brown L, Brenner KE, Rinfret A, Remis A, Krahn MD: A Canadian national survey of attitudes and knowledge regarding vaccines. J Immun Based Ther Vaccines. 2003, 1: 3-5. x.1186/1476-8518-1-3.

Article Google Scholar
Jelleyman T, Ure A: Attitudes to immunization: a survey of health professionals in the Roturua Commune. N Z Med J. 2004, 117: U769.

Google Scholar
Pettousis-Harris H, Goodyear-Smith F, Turner Northward, Soe B: Family medico perspectives on barriers to childhood immunization. Vaccine. 2004, 22: 2340-44. 10.1016/j.vaccine.2003.10.037.

Commodity Google Scholar
Dillman DA: Mail and internet surveys: the tailored design method. 2000, New York: John Wiley & Sons, 464-2

Google Scholar
Stammer KH, Strikas RA, Barker WH, Brugliera PD, Bandemer CJ, Doggett KB, Williams WW: Immunization in Medical Didactics - curriculum content on vaccine-preventable diseases in U.S. medical schools. American Journal of Preventive Medicine. 1994, S10: iv-10.

Google Scholar
Strikas RA, Faltar KH, Barker WH, Brugliera PD, Bandemer CJ, Doggett KB, Williams WW: Immunization in Medical Educational activity - curriculum content on vaccine-preventable diseases in primary care and preventative medicine residency programs in the Us. American Periodical of Preventive Medicine. 1994, S10: 11-17.

Google Scholar
Public Wellness Agency of Canada: Immunization competencies for wellness professionals. 2008, Ottawa: Authority of the Minister of Health

Google Scholar

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Authors and Affiliations

Canadian Centre for Vaccinology, IWK Wellness Centre, Dalhousie University, Dr. Richard B. Goldbloom RCC Pavilion, 4th Floor, 5850/5980 Academy Avenue, PO BOX 9700, Halifax, NS, B3K 6R8, Canada

Lorine P Pelly, Beth A Halperin & Darlene M Baxendale
Canadian Centre for Vaccinology, IWK Wellness Centre, St. Francis Xavier University, Dalhousie University, Dr. Richard B. Goldbloom RCC Pavilion, 4th Floor, 5850/5980 University Avenue, PO BOX 9700, Halifax, NS, B3K 6R8, Canada

Donna M Pierrynowski MacDougall
Nova Scotia Department of Wellness Promotion, and Protection; Maritime Heart, 1505 Barrington St., PO BOXC 2734, B3J 3P7, Canada

Robert A Strang
Department of Medicine, QEII Health Sciences Heart, School of Pharmacy, Dalhousie University, Halifax, Nova Scotia, B3 H 3J5, Canada

Susan G Bowles
Department of Medicine, QEII Health Sciences Centre, Canadian Center for Vaccinology, IWK Health Centre, Dalhousie University, Dr. Richard B. Goldbloom RCC Pavilion, 4th Floor, 5850/5980 Academy Avenue, PO BOX 9700, Halifax, NS, B3K 6R8, Canada

Shelly A McNeil

Corresponding author

Correspondence to Shelly A McNeil.

Additional information

Competing interests

This project is supported past an unrestricted educational grant from Sanofi Pasteur Canada Ltd. L Pelly'southward salary is supported by the Gladys Osman BSc. Medicine Studentship. South McNeil is supported past a Dalhousie University Faculty of Medicine Clinical Scholar's Honour.

Authors' contributions

All authors have contributed to the conception and pattern of the study, assay of the data, manuscript development and terminal approval of the paper submitted.

Lorine P Pelly, Donna M Pierrynowski MacDougall, Beth A Halperin, Robert A Strang, Susan Chiliad Bowles, Darlene M Baxendale and Shelly A McNeil contributed equally to this work.

Electronic supplementary material

12909_2009_435_MOESM1_ESM.PDF

Additional File 1: Review of Vaccine-related content in Canadian Medical, Nursing, and Pharmacy Schools. This file contains the survey tool used to appraise the immunization-related content in Canadian Medical, Nursing, and Pharmacy schools. (PDF 128 KB)

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Pelly, 50.P., Pierrynowski MacDougall, D.M., Halperin, B.A. et al. THE VAXED Project: An Cess of Immunization Education in Canadian Health Professional Programs. BMC Med Educ x, 86 (2010). https://doi.org/10.1186/1472-6920-x-86

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Received: 05 November 2009
Accustomed: 26 November 2010
Published: 26 November 2010
DOI : https://doi.org/10.1186/1472-6920-10-86

Keywords

Nova Scotia
Cognition Score
Curriculum Content
Influenza Immunization
Health Professional person Trainee