{"title":"医科学生对 ST 段抬高型心肌梗死处方的信心和能力：一项混合方法研究。","authors":"Teeranan Angkananard, Panida Issarasenarak, Pawita Teerawattananon, Maneekarn Kosulawath, Varunrut Samrejphol, Kamolnetr Okanurak","doi":"10.5116/ijme.62c2.c33c","DOIUrl":null,"url":null,"abstract":"<p><strong>Objectives: </strong>To explore factors associated with prescribing confidence and competence of final-year medical students for prescribing antiplatelet and fibrinolytic agents in ST-segment elevation myocardial infarction (STEMI).</p><p><strong>Methods: </strong>The study was conducted among final-year medical students with a triangular convergent mixed-methods approach. First, an online survey was conducted using a voluntary sampling method with concurrent in-depth interviews performed. The survey data was analysed using descriptive statistics and paired t-tests, while survey factors were compared using the chi-squared or Fisher's exact test. The interview data were coded and analysed thematically. The relations between the qualitative and quantitative findings were finally described.</p><p><strong>Results: </strong>Totally 92 validly replied to the questionnaire, and 20 participated in the interviews. The quantitative analysis indicated that they had high competence in the diagnosis of STEMI and prescribing antiplatelet and fibrinolytic agents. The mean confidence score of prescribing for both was medium and was significantly lower in fibrinolytic agents. (M=3.3, SD=1.1 vs. M=2.8, SD=1.0, t<sub>(91)</sub>=5.39, p<0.01). Their experience, knowledge, and mentoring were accounted for, considering the prescribing confidence factors in both approaches. Besides, providing guidelines and standing orders were derived from the interview data.</p><p><strong>Conclusions: </strong>This study has demonstrated that final-year medical students have a high ability to diagnose and prescribe essential medications in STEMI but tend to have low confidence in prescribing fibrinolytic agents. Experiential learning, mentorship and providing guidelines can help them, especially in emergency settings to prescribe confidently and safely. Further multicenter studies on undergraduate and graduate medical students' confidence and perspective of prescribing are required, especially for high-alert medications.</p>","PeriodicalId":14029,"journal":{"name":"International Journal of Medical Education","volume":"13 ","pages":"187-197"},"PeriodicalIF":1.6000,"publicationDate":"2022-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9911138/pdf/","citationCount":"0","resultStr":"{\"title\":\"Medical students' confidence and competence with prescribing in ST-elevation myocardial infarction: a mixed-methods study.\",\"authors\":\"Teeranan Angkananard, Panida Issarasenarak, Pawita Teerawattananon, Maneekarn Kosulawath, Varunrut Samrejphol, Kamolnetr Okanurak\",\"doi\":\"10.5116/ijme.62c2.c33c\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objectives: </strong>To explore factors associated with prescribing confidence and competence of final-year medical students for prescribing antiplatelet and fibrinolytic agents in ST-segment elevation myocardial infarction (STEMI).</p><p><strong>Methods: </strong>The study was conducted among final-year medical students with a triangular convergent mixed-methods approach. First, an online survey was conducted using a voluntary sampling method with concurrent in-depth interviews performed. The survey data was analysed using descriptive statistics and paired t-tests, while survey factors were compared using the chi-squared or Fisher's exact test. The interview data were coded and analysed thematically. The relations between the qualitative and quantitative findings were finally described.</p><p><strong>Results: </strong>Totally 92 validly replied to the questionnaire, and 20 participated in the interviews. The quantitative analysis indicated that they had high competence in the diagnosis of STEMI and prescribing antiplatelet and fibrinolytic agents. The mean confidence score of prescribing for both was medium and was significantly lower in fibrinolytic agents. (M=3.3, SD=1.1 vs. M=2.8, SD=1.0, t<sub>(91)</sub>=5.39, p<0.01). Their experience, knowledge, and mentoring were accounted for, considering the prescribing confidence factors in both approaches. Besides, providing guidelines and standing orders were derived from the interview data.</p><p><strong>Conclusions: </strong>This study has demonstrated that final-year medical students have a high ability to diagnose and prescribe essential medications in STEMI but tend to have low confidence in prescribing fibrinolytic agents. Experiential learning, mentorship and providing guidelines can help them, especially in emergency settings to prescribe confidently and safely. Further multicenter studies on undergraduate and graduate medical students' confidence and perspective of prescribing are required, especially for high-alert medications.</p>\",\"PeriodicalId\":14029,\"journal\":{\"name\":\"International Journal of Medical Education\",\"volume\":\"13 \",\"pages\":\"187-197\"},\"PeriodicalIF\":1.6000,\"publicationDate\":\"2022-07-29\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9911138/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"International Journal of Medical Education\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.5116/ijme.62c2.c33c\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"EDUCATION, SCIENTIFIC DISCIPLINES\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"International Journal of Medical Education","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.5116/ijme.62c2.c33c","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"EDUCATION, SCIENTIFIC DISCIPLINES","Score":null,"Total":0}
引用次数: 0
摘要
目的探讨与应届医学生在 ST 段抬高型心肌梗死（STEMI）中开具抗血小板和纤溶药物处方的信心和能力相关的因素：本研究采用三角聚合混合方法在医学专业毕业班学生中开展。首先，采用自愿抽样法进行在线调查，同时进行深度访谈。调查数据采用描述性统计和配对 t 检验进行分析，调查因素则采用卡方检验或费雪精确检验进行比较。对访谈数据进行了编码和专题分析。最后描述了定性和定量结果之间的关系：共有 92 人有效回答了问卷，20 人参加了访谈。定量分析显示，他们在诊断 STEMI 和开具抗血小板及纤维蛋白溶解药物处方方面具有很高的能力。开具抗血小板药物和纤维蛋白溶解药物处方的平均信心分数为中等，而开具纤维蛋白溶解药物处方的平均信心分数明显较低。(M=3.3, SD=1.1 vs. M=2.8, SD=1.0, t(91)=5.39, p结论：本研究表明，应届医学生诊断和处方 STEMI 必要药物的能力较高，但对处方纤溶药物的信心不足。经验学习、导师指导和提供指南可以帮助他们，尤其是在急诊环境中自信、安全地开药。需要进一步开展多中心研究，了解医科本科生和研究生对处方的信心和看法，尤其是对高警戒药物的处方。
Medical students' confidence and competence with prescribing in ST-elevation myocardial infarction: a mixed-methods study.
Objectives: To explore factors associated with prescribing confidence and competence of final-year medical students for prescribing antiplatelet and fibrinolytic agents in ST-segment elevation myocardial infarction (STEMI).
Methods: The study was conducted among final-year medical students with a triangular convergent mixed-methods approach. First, an online survey was conducted using a voluntary sampling method with concurrent in-depth interviews performed. The survey data was analysed using descriptive statistics and paired t-tests, while survey factors were compared using the chi-squared or Fisher's exact test. The interview data were coded and analysed thematically. The relations between the qualitative and quantitative findings were finally described.
Results: Totally 92 validly replied to the questionnaire, and 20 participated in the interviews. The quantitative analysis indicated that they had high competence in the diagnosis of STEMI and prescribing antiplatelet and fibrinolytic agents. The mean confidence score of prescribing for both was medium and was significantly lower in fibrinolytic agents. (M=3.3, SD=1.1 vs. M=2.8, SD=1.0, t(91)=5.39, p<0.01). Their experience, knowledge, and mentoring were accounted for, considering the prescribing confidence factors in both approaches. Besides, providing guidelines and standing orders were derived from the interview data.
Conclusions: This study has demonstrated that final-year medical students have a high ability to diagnose and prescribe essential medications in STEMI but tend to have low confidence in prescribing fibrinolytic agents. Experiential learning, mentorship and providing guidelines can help them, especially in emergency settings to prescribe confidently and safely. Further multicenter studies on undergraduate and graduate medical students' confidence and perspective of prescribing are required, especially for high-alert medications.
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