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Training medical students to improve the management of people with epilepsy

Capacitação de estudantes de medicina para o atendimento de pacientes com epilepsia

Abstracts

PURPOSE: To evaluate the knowledge, attitude and perception of medical students prior to and after a training course about epilepsy. METHODS: We used a KAP questionnaire with sixty-one questions which assesses knowledge, attitude and practice of epilepsy. Questionnaires were completed by 185 medical students, before and after epilepsy training. We compared the answers to see whether the lecture had changed the knowledge, attitude and practice in epilepsy. RESULTS: One hundred and six students completed the questionnaire before an eight hour course on epilepsy and 79 students completed the questionnaire one year after the course. Comparison of the knowledge scores prior to (mean=53.9, standard deviation=11.4) and after the course (mean=63.8, standard deviation=11.9) showed that students had improved knowledge after the course (t-test=5.6, p<0.001). DISCUSSION: Training course on epilepsy for medical students can promote improvement in the knowledge, attitudes and perception regarding epilepsy, which is maintained one year later. These results highlight the importance of continuous educational programs within the Medical Curriculum.

epilepsy; educational courses; training; education


OBJETIVO: Avaliar conhecimentos, atitudes e percepção sobre epilepsia em estudantes de medicina antes e depois de curso de capacitação. MÉTODO: Foi utilizado o questionário KAP da Campanha Global "Epilepsia fora das sombras", liderada pela OMS, ILAE e IBE. Este questionário avalia conhecimento, atitude e percepção sobre epilepsia em 61 questões. Foi aplicado este questionário em 185 estudantes de medicina, antes e depois de cursos de capacitação sobre epilepsia. As questões foram comparadas para analisar as mudanças obtidas com o treinamento. RESULTADOS: Cento e seis estudantes de medicina responderam ao questionário antes do curso de capacitação e 79 estudantes responderam após um ano do curso. A comparação feita a respeito do conhecimento com estes estudantes mostrou que os mesmos melhoram seu conhecimento com os cursos (pré-teste: nota média=53,9; DP=11,4 vs. pós-teste: nota média=63,8; DP=11,9; t-test=5,6; p<0,001). DISCUSSÃO: O curso de capacitação promove melhoras no conhecimento, atitude e percepção sobre epilepsia, mesmo após um ano. Estes resultados salientam a importância de programas de educação continuada dentro do currículo médico.

epilepsia; cursos de capacitação; treinamento; educação


Training medical students to improve the management of people with epilepsy

Capacitação de estudantes de medicina para o atendimento de pacientes com epilepsia

Ana L.A. Noronha, MD, PhDI, II; Paula T. Fernandes, MSc, PhDI, II; Maria da Graça G. Andrade, MD, PhDIII; Silvia M. Santiago, MD, PhDIII; Josemir W. Sander, MD, PhD, FRCPIV, V; Li M. Li, MD, PhDI, II

IDepartament of Neurology - State University of Campinas (UNICAMP)

IIAssistência à Saúde de Pacientes com Epilepsia (ASPE), Campinas, Brazil

IIIDepartament of Preventive Medicine - State University of Campinas (UNICAMP)

IVEpilepsy Institute of the Netherlands, SEIN, Heemstede, Achterweg 5, 2103 SW Heemstede, the Netherlands

VDepartment of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London UK

ABSTRACT

PURPOSE: To evaluate the knowledge, attitude and perception of medical students prior to and after a training course about epilepsy.

METHODS: We used a KAP questionnaire with sixty-one questions which assesses knowledge, attitude and practice of epilepsy. Questionnaires were completed by 185 medical students, before and after epilepsy training. We compared the answers to see whether the lecture had changed the knowledge, attitude and practice in epilepsy.

RESULTS: One hundred and six students completed the questionnaire before an eight hour course on epilepsy and 79 students completed the questionnaire one year after the course. Comparison of the knowledge scores prior to (mean=53.9, standard deviation=11.4) and after the course (mean=63.8, standard deviation=11.9) showed that students had improved knowledge after the course (t-test=5.6, p<0.001).

DISCUSSION: Training course on epilepsy for medical students can promote improvement in the knowledge, attitudes and perception regarding epilepsy, which is maintained one year later. These results highlight the importance of continuous educational programs within the Medical Curriculum.

Key words: epilepsy, educational courses, training, education.

RESUMO

OBJETIVO: Avaliar conhecimentos, atitudes e percepção sobre epilepsia em estudantes de medicina antes e depois de curso de capacitação.

MÉTODO: Foi utilizado o questionário KAP da Campanha Global "Epilepsia fora das sombras", liderada pela OMS, ILAE e IBE. Este questionário avalia conhecimento, atitude e percepção sobre epilepsia em 61 questões. Foi aplicado este questionário em 185 estudantes de medicina, antes e depois de cursos de capacitação sobre epilepsia. As questões foram comparadas para analisar as mudanças obtidas com o treinamento.

RESULTADOS: Cento e seis estudantes de medicina responderam ao questionário antes do curso de capacitação e 79 estudantes responderam após um ano do curso. A comparação feita a respeito do conhecimento com estes estudantes mostrou que os mesmos melhoram seu conhecimento com os cursos (pré-teste: nota média=53,9; DP=11,4 vs. pós-teste: nota média=63,8; DP=11,9; t-test=5,6; p<0,001).

DISCUSSÃO: O curso de capacitação promove melhoras no conhecimento, atitude e percepção sobre epilepsia, mesmo após um ano. Estes resultados salientam a importância de programas de educação continuada dentro do currículo médico.

Palavras-chave: epilepsia, cursos de capacitação, treinamento, educação.

Epilepsy is the most common and serious neurological condition all over the world1-4. Based on our epidemiological survey5 it is estimated that about one million people in Brazil have active epilepsy, of whom approximately 40% do not receive adequate treatment5. Consequently, epilepsy is considered a public health problem, especially in resource-poor countries.

Studies1-3 have shown that some health professions lack sufficient knowledge to deal with epilepsy, which may result in a high treatment gap. To improve this situation, we suggest that better education of health professionals can be instituted, especially at the undergraduate level of medicine.

This study, part of phase II of the National Demonstration Project on Epilepsy in Brazil, part of the WHO/ILAE/IBE Global Campaign Against Epilepsy, executed by ASPE, Assistência à Saúde de Pacientes com Epilepsia6, aims to evaluate the knowledge, attitude and perceptions of medical students prior to and after an epilepsy training course.

METHOD

Subjects – Students of the 5th and 6th years of the Medicine Course of UNICAMP, Campinas, Brazil.

Instrument – The KAP Questionnaire (Knowledge, Attitude and Perception) of the Global Campaign "Epilepsy out of the Shadows", from WHO, ILAE and IBE6. This questionnaire evaluates knowledge, attitude and perceptions with 61 closed questions.

Procedure – A pre-test of KAP of epilepsy was set for students in the 5th year. After this first evaluation, we delivered a course, of eight hours duration, highlighting information on the management of people of epilepsy; this included the nature of epilepsy, epilepsy diagnosis and treatment, epilepsy in special situations (women, older people, children), myths and beliefs and psycho-social aspects.

We delivered twelve courses during 2003, as a part of the discipline of Community and Preventive Medicine ("Social Medicine"), with approximately nine students in each course. The post-test was set at the end of the 6th undergraduate year to evaluate any changes since the intervention (one year later).

Each student received a booklet entitled "Epilepsy: a treatable condition", a guideline for AED prescription and a folder containing information on epilepsy treatment and diagnosis. Each question in the knowledge section of the questionnaire was given a score for the correct answer, and the final grade was based on the total score achieved, as a percentage between zero and 100 (see appendix appendix ), so that we could compare the performance prior to and after the training. We did not identified the respondents, thus a non-paired t-test was used to assess significance of the score achieved prior and after the training.

RESULTS

Prior to training, 106 medical students completed the questionnaire (58% women; mean age=23 years old). Seventy-nine students also completed the post-test questionnaire (35% women; mean age=24 years old) one year later.

The results are presented according the three items of the KAP questionnaire: knowledge, attitudes and perception. The comments and observations of the students are presented at the end of the results.

Comparison of knowledge scores prior to (mean= 53.9, standard deviation=11.4) and after the education (mean=63.8, standard deviation=11.9) showed that students had improved knowledge after the training (t-test=5.6, p<0.001) (Fig 1).


Comments made by the students – Thirty-five (33%) students expressed their opinion about the course, stating that it had significantly improved their knowledge about epilepsy. They therefore felt more confident about dealing with epilepsy, especially in the primary care system. The students expressed a desire for more details and more clinical cases and suggested that the course could be repeated in the 6th undergraduate year.

DISCUSSION

This study describes the course on epilepsy for undergraduate students in a public university in Brazil. We observed that this course can promote better knowledge of epilepsy, as showed by the difference of the score in pre-test and post-test.

In this study, we showed how the reformulation of the undergraduate medical course can contribute to improving the management of epilepsy and to decreasing the related stigma. The students felt more comfortable dealing with epilepsy after completing the course. It may be relevant that the course was taught in the discipline of Community and Preventive Medicine rather than in Neurology. This may have led students to incorporate the concept that the management of epilepsy is not the exclusive domain of the specialist.

In conclusion, this study evaluated the knowledge, attitudes and perception regarding epilepsy, and allowed a comparison of these aspects before and after a specific course on epilepsy. In the pre-test, the results showed that some students already had good information about epilepsy, perhaps because of the regular neurology course, taught in the 4th year. However, we observed a lack of knowledge, especially regarding clinical treatment, epilepsy in women and perceptions. After the course, an improvement was observed in knowledge of epilepsy which was maintained after a year. These results highlight the importance of continuous educational programs to improve the knowledge, attitudes and perception regarding epilepsy within the medical curriculum.

Acknowledgments – We wish thank to Carlos Tucassa, coordinator assistant of undergraduate course of Faculty of Medical Sciences - Unicamp for helping applying and collecting the questionnaires. This study was supported by FAEP (Fundação de Apoio ao Ensino e à Pesquisa)/UNICAMP.

Dr. Li Li Min - Department of Neurology / UNICAMP - Cx. Postal 6111 - 13083-970 Campinas SP - Brazil. E-mail: limin@fcm.unicamp.br or li@aspebrasil.org; Site: http://www.aspebrasil.org

  • 1. Reynolds EH. The ILAE/IBE/WHO Global Campaign against epilepsy: bringing epilepsy "Out of the shadows:. Epilepsy Behav 2000;1:S3-S8.
  • 2. Sander JW. The epidemiology of epilepsy revisited. Curr Opin Neurol 2003;16:165-170.
  • 3. Saraceno B. The WHO World Health Report 2001 on mental health. Epidemiol Psichiatr Soc 2002;11:83-87.
  • 4. Shorvon SD, Farmer PJ. Epilepsy in developing countries: a review of epidemiological, sociocultural, and treatment aspects. Epilepsia 1988; 29(Suppl 1):S36-S54.
  • 5. Noronha ALA, Borges A, Marques LH, et al. Prevalence and pattern of epilepsy treatment in different social-economic classes in Brazil. Epilepsia, **(*):16, 2007, doi:10.1111/j.1528-1167.2006.00974.
  • 6. Li LM, Sander JW. National demonstration project on epilepsy in Brazil. Arq Neuropsiquiatr 2003;61:153-156.

appendix

Publication Dates

  • Publication in this collection
    29 Nov 2007
  • Date of issue
    June 2007
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