|Year : 2020 | Volume
| Issue : 7 | Page : 3707-3711
Extent of and influences on knowledge of Alzheimer's disease among undergraduate medical students
Abdulaziz M Shadid1, Abdulrahman Yousef Aldayel2, Asem Shadid2, Ali M Alqaraishi2, Maha M Gholah2, Fay A Almughiseeb2, Yara Abdullah Alessa2, Haima F Alani3, Salah Ud Din Khan4, Saleh Algarni5
1 College of Medicine, King Saud University, Kingdom of Saudi Arabia
2 College of Medicine, Al Imam Mohammad ibn Saud Islamic University, Kingdom of Saudi Arabia
3 College of Medicine, Near East University, Kingdom of Saudi Arabia
4 Department of Biochemistry, College of Medicine, Al Imam Mohammad Ibn Saud Islamic University, Kingdom of Saudi Arabia
5 Department of Clinical Neurosciences, College of Medicine, Al Imam Mohammad Ibn Saud Islamic University, Kingdom of Saudi Arabia
|Date of Submission||18-Jan-2020|
|Date of Decision||12-Mar-2020|
|Date of Acceptance||02-Apr-2020|
|Date of Web Publication||30-Jul-2020|
Dr. Asem Shadid
College of Medicine, Al Imam Mohammad Ibn Saud Islamic University, Othman Bin Affan Rd. Al-Nada.7544, Riyadh - 13317.4233
Kingdom of Saudi Arabia
Source of Support: None, Conflict of Interest: None
Background: Alzheimer's disease (AD) is a major health problem, which is of increasing concern because of rising yearly incidence and estimated cost. Early diagnosis and treatment is essential to manage AD effectively and improve the outcomes. Inadequate knowledge can delay the diagnosis. General practitioners should play a more effective role in the identification and diagnosis of AD, and medical education is key to solving this issue. Objectives: This study aimed to assess the knowledge of undergraduate medical students and to identify the factors that influenced their knowledge. Methods: This study used a quantitative cross-sectional evaluation of 327 Saudi Arabian medical students from the first and final years in Riyadh, Saudi Arabia, who participated in an online survey via email between March and May 2018. Knowledge of AD was assessed using the 12-item AD Knowledge Test for Health Professionals from the University of Alabama at Birmingham (UAB ADKT). General linear models were used to identify the most significant influence on AD knowledge scores. Results: Only 10.73% of first-year and 33.33% of final-year students scored ≥ 50% on the UAB ADKT. Students pursuing specialties related to AD (adult neurology, geriatrics, or psychiatry) and students aged ≥ 27 years had higher scores (P < 0.05). Conclusion: Undergraduate medical students lacked proper knowledge of AD, suggesting that improvements in education programs can help. Future studies are needed to assess the quality and effectiveness of AD education in the curriculum of Saudi medical schools.
Keywords: Alzheimer's disease, educational evaluation, medical education, medical students, physician training
|How to cite this article:|
Shadid AM, Aldayel AY, Shadid A, Alqaraishi AM, Gholah MM, Almughiseeb FA, Alessa YA, Alani HF, Khan S, Algarni S. Extent of and influences on knowledge of Alzheimer's disease among undergraduate medical students. J Family Med Prim Care 2020;9:3707-11
|How to cite this URL:|
Shadid AM, Aldayel AY, Shadid A, Alqaraishi AM, Gholah MM, Almughiseeb FA, Alessa YA, Alani HF, Khan S, Algarni S. Extent of and influences on knowledge of Alzheimer's disease among undergraduate medical students. J Family Med Prim Care [serial online] 2020 [cited 2020 Aug 9];9:3707-11. Available from: http://www.jfmpc.com/text.asp?2020/9/7/3707/290745
| Introduction|| |
Alzheimer's disease (AD) is a rising health problem, with an estimated 5.7 million affected in the United States (US) in 2018. By 2050, that number is projected to reach to 16 million. The global estimates of expenses associated with AD reached $957.56 billion in 2015. Early diagnosis and effective treatment is required to enable patients and their caregivers to achieve optimal management of AD and thereby decrease health-care costs. General practitioners (GPs) can play an essential role in identifying and diagnosing AD by employing a number of tests of cognitive function., Physicians of all specialties ostensibly have the knowledge and skills to diagnose, communicate, and care for patients throughout all stages of the disease. However, the extant literature finds a lack of adherence to the management and diagnosis guidelines for AD.,,
One of the main causes for suboptimal AD care is the inadequacy of knowledge about AD diagnosis and management.,,,, Therefore, two-thirds of all dementia and more than 90% of early dementia is missed by the primary-care physicians. The AD Knowledge Test from the University of Alabama at Birmingham (UAB ADKT) is designed to assess knowledge about AD clinical diagnosis, treatment, and management among health professionals. It has been used to illustrate a significant difference between GPs and AD specialists., The absence of knowledge can postpone the diagnosis, thus deferring treatment and management and ultimately lessening the time available for the patient and relatives to address legitimate issues.
Healthy People 2020 introduced a new objective: To increase the appropriate diagnosis of AD cases. Improving knowledge is considered as one solution for achieving this objective. To our knowledge, there is limited contemporary information about the adequacy of, and factors that affect, knowledge of AD diagnosis, treatment, and management among undergraduate medical students in the Middle Eastern region that includes Saudi Arabia. This study aimed to assess the knowledge gap, and factors that affect it, among future physicians during their undergraduate medical education.
| Materials and Methods|| |
Study design and subjects
This was a quantitative cross-sectional survey-based study conducted from March to May 2018 in Riyadh, the capital and largest city in Saudi Arabia. It utilized the UAB ADKT validated scale with permission from Barrett et al. to assess knowledge related to AD among first-year and final-year medical students. Medical schools selected for enrolment in this study were composed of Saudi Arabian governmental medical schools in Riyadh city, which taught both males and females and had students in their first and final years during the 2017–2018 academic year. A total of three schools met the inclusion criteria, and all three agreed to participate in this study.
From each medical school, a batch leader provided a list of contact information for first-year and final-year students. The online questionnaire, along with the purpose and significance of the study, was sent to a total of 450 medical students. A reminder e-mail was sent to the students 1 week after the first e-mail. Every response was associated with a reciprocal IP address to prevent multiple responses from the same participant.
This study protocol was approved by the Institutional Review Board of Al-Imam Muhammad Ibn Saud Islamic University, and informed consent was obtained through a formal online web page from each participant before they completed the questionnaire. Students’ scores were collected anonymously. The participants were allowed to answer voluntarily at their convenient time and not required to participate during class time.
After the informed consent, participants took the online survey, which started with general questions about demographics (age and gender), level of study ( first or final year), name of university, intended specialty, previous experience (personal, volunteering, and/or work experience), number of neurology courses taken, and the year of these courses. The survey concluded with the UAB ADKT.
[Table 1] shows the contents of the UAB ADKT, which contains 12 multiple choice questions that cover five domains: terminology, assessment, patient management, clinical course, and legal subjects. Mean scores have been established within various medical populations: 4.76 ± 1.86 for undergraduate nursing students, 8.49 ± 2.20 for GPs and 10.75 ± 1.34 for physicians of specialities.
|Table 1: University of Alabama at Birmingham Alzheimer's Disease Knowledge Test for Health Professionals (UABADKT). The 12 multiple-choice items were adapted with permission from Barrett et al. (1997)|
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Descriptive statistics were employed to measure the significance of UAB ADKT score differences among different demographics. The Fisher exact test was used to compare the scores of first-year versus final-year students. A multivariate general linear regression model was used to study factors affecting the scores of final-year students. The model analyzed how the score was affected by combinations of advanced age (≥27 years), gender, intended specialty (dichotomized as adult neurology, geriatrics, or psychiatry vs. any other), number of neurology courses taken, and type of previous experience with AD. P values ≤ 0.05 were considered significant. Data were collected and tabulated using Microsoft Excel 2016 and analyzed with the SPSS software (Version 25, IBM Corp., Armonk, NY, USA).
| Results|| |
Of the 450 questionnaires sent, a total of 327 medical students completed it (response rate = 72.7%). [Table 2] contains the demographics of the participants. First-year students accounted for 54.1% (n = 177) of the total sample while final-year students comprised the remaining 45.9% (n = 150). A percentage of 36.9 (n = 65) of first-year students and 46.6% (n = 70) of final-year students had some sort of previous experience with AD.
|Table 2: Demographics of 327 medical student participants, from three medical schools in Riyadh, Saudi Arabia, who agreed to participate in the email survey version of the University of Alabama at Birmingham Alzheimer's Disease Knowledge Test for Health Professionals|
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The mean knowledge score was 4.33 (SD = 1.697) for first-year students and 5.62 (SD = 1.938) for final-year students. Only 10.73% (n = 19) of first-year students and 33.33% (n = 50) of final-year students answered six or more questions correctly. The proportion of correct responses for each item is summarized graphically in [Figure 1]. Final-year students scored significantly better than first-year students on questions 1, 2, 3, 4, and 7 but scored significantly worse on question 11. On questions 5, 6, 8, 9, 10, and 12, there was no significant difference between students in the first and final years.
|Figure 1: Comparison of the proportion of students who answered each test item correctly in the first year versus the final year. The UAB ADKT was taken via email survey by 327 medical students|
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In the general linear model, only advanced age (≥27 years) and dichotomized intended specialty (adult neurology, geriatrics, or psychiatry vs. any other) influenced the AD knowledge score (predicting a covariate-adjusted 0.33 and 0.16 points higher, respectively; F (3, 159) =11.514, P < 0.05).
| Discussion|| |
The aim of this study was to assess the knowledge of AD among first- and final-year medical students and to identify factors that influenced this knowledge. It was found that first-year students scored poorly on the UAB ADKT, with only 10.73% answering ≥50% of the questions correctly. Final-year students scored better, with one-third (33.33%) scoring ≥50%. Beyond year in school, scores were influenced significantly by age and intended specialty; students aged ≥27 years and students who intended to pursue adult neurology, geriatrics, or psychiatry scored better on the UAB ADKT. Nagle et al. used the UAB ADKT to assess AD knowledge among 343 undergraduate US medical students in the first and final years, and those students scored better than in the present study, as 68% of final-year US students scored 10 or more of the questions correctly.
The findings of our study suggest a need for improvement in the didactics and training of undergraduate medical students in Saudi Arabia, particularly as AD is becoming a major burden and rising health problem. Desai et al. found a dramatic improvement in AD knowledge, from 57% to 71%, after implementing a sensitization program with regular patient interactions for medical students in their final year. In addition, the implementation of geriatric and AD-specific courses and clerkships can increase medical students’ confidence in assessing and diagnosing patients with AD., Furthermore, in this study, those who were interested in AD-related specialities were significantly more likely to have accurate knowledge. This aligns with a prior finding that an interest in a topic is predictive of more pertinent reading in young people, so there is a chance that AD knowledge will be improved by increasing the required reading on the topic. These and other efforts for improving the training of future primary-care physicians may aid in this lacuna.
It is crucial that future physicians who will work as GPs or in various specialities are educated and trained thoroughly in AD, particularly in light of the rising incidence of AD around the world. The addition and increase in quantity of teaching hours on this topic must be encouraged and must cover all aspects of AD, including terminology, assessment, clinical course, patient management, and legal issues.
The limitations of this study include the self-reported nature of the data, which holds the potential for misclassification. Moreover, this study was conducted only in Riyadh city, the capital and largest city in Saudi Arabia, but it may have poor generalizability to schools in different regions that use a distinct curriculum for undergraduate medical education. Lastly, the 12-question knowledge test cannot fully capture the knowledge and skills required to diagnose, assess, and manage AD appropriately. A more comprehensive examination might disclose additional relevant deficiencies among medical students and providers.
| Conclusions|| |
This study filled a gap in the literature by evaluating the knowledge of AD among medical students in their undergraduate education years in Riyadh, Saudi Arabia, and found a problematic lack of accurate knowledge. Additionally, interest in an AD-related speciality significantly predicted better knowledge, so further reading on AD may help all students obtain the necessary understanding. Further studies are needed to assess the quality and effectiveness of AD education in the curriculum of medical schools in Saudi Arabia.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Brookmeyer R, Evans DA, Hebert L, Langa KM, Heeringa SG, Plassman BL, et al
. National estimates of the prevalence of Alzheimer's disease in the United States. Alzheimers Dement 2011;7:61-73.
Jia J, Wei C, Chen S, Li F, Tang Y, Qin W, et al
. The cost of Alzheimer's disease in China and re-estimation of costs worldwide. Alzheimers Dement 2018;14:483-91.
Barnett J, Lewis L, Blackwell A, Taylor M. Early intervention in Alzheimer's disease: A health economic study of the effects of diagnostic timing. BMC Neurol 2014;14:101.
Pucci E, Angeleri F, Borsetti G, Brizioli E, Cartechini E, Giuliani G, et al
. General practitioners facing dementia: Are they fully prepared? Neurol Sci 2004;24:384-9.
Wilkinson D, Stave C, Keohane D, Vincenzino O. The role of general practitioners in the diagnosis and treatment of Alzheimer's disease: A multinational survey. J Int Med Res 2004;32:149-59.
Chodosh J, Mittman BS, Connor KI, Vassar SD, Lee ML, DeMonte RW, et al
. Caring for patients with Dementia: How good is the quality of care? Results from three health systems. J Am Geriatr Soc 2007;55:1260-8.
Boise L, Neal M, Kaye J. Dementia assessment in primary care: Results from a study in three managed care systems. J Gerontol A Biol Sci Med Sci 2004;59:M621-6.
Gifford DR, Holloway RG, Frankel MR, Albright CL, Meyerson R, Griggs RC, et al
. Improving adherence to dementia guidelines through education and opinion leaders. Ann Intern Med 1999;131:237-46.
van Hout H, Vernooij-Dassen M, Bakker K, Blom M, Grol R. General practitioners on dementia: Tasks, practices and obstacles. Patient Educ Couns 2000;39:219-25.
Pimlott NJ, Persaud M, Drummond N, Cohen CA, Silvius JL, Seigel K, et al
. Family physicians and dementia in Canada: Part 2. Understanding the challenges of dementia care. Can Fam Physician 2009;55:508-9.
Bradford A, Kunik ME, Schulz P, Williams SP, Singh H. Missed and delayed diagnosis of dementia in primary care: Prevalence and contributing factors. Alzheimer Dis Assoc Disord 2009;23:306-14.
Iliffe S, Wilcock J. The identification of barriers to the recognition of, and response to, dementia in primary care using a modified focus group approach. 2005;4:73-85. doi: 10.1177/1471301205049191.
Turner S, Iliffe S, Downs M, Wilcock J, Bryans M, Levin E, et al
. General practitioners’ knowledge, confidence and attitudes in the diagnosis and management of dementia. Age Ageing 2014;33:461-7.
Valcour V, Masaki K, Curb J, Blanchette PL. The detection of dementia in the primary care setting. Arch Intern Med 2000;160:2964-8.
Barrett JJ, Haley WE, Harrell LE, Powers RE. Knowledge about Alzheimer disease among primary. Care physicians, psychologists, nurses, and social workers. Alzheimer Dis Assoc Disord 1997;11:99-106.
Nagle BJ, Usita PM, Steven DE. United States medical students’ knowledge of Alzheimer disease. J Educ Eval Health Prof 2013;10:4.
Desai S, Jindal S, Gandhi F, Gadhvi R, Shah S, Dani P, et al
. Knowledge and attitude of medical students towards Alzheimer's disease: Can a student driven sensitization program help? J Neurol Sci 2017;381:751.
Struck BD, Bernard MA, Teasdale TA; Oklahoma University Geriatric Education Group. Effect of a mandatory geriatric medicine clerkship on third-year students. J Am Geriatr Soc 2005;53:2007-11.
Goldstein M, MaLossi R, Kim K, Young B. A Course in dementia for third year medical students. Acad Psychiatry 1999;23:142 50.
Gambrell LB. Creating classroom cultures that foster reading motivation. The Reading Teacher 1996;50:14-25.
[Table 1], [Table 2]