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摘要:目的 调查临床医学(八年制)专业医学生甲状腺癌相关知识及甲状腺自查方法的掌握情况,为临床前医学教育和临床教学提供借鉴和指导。方法 2020年3月,采用便利抽样法选取北京协和医学院临床医学(八年制)专业三至六年级医学生为调查对象。将三、四年级医学生定义为临床前阶段医学生(preclinical medical students,PMS),将五、六年级医学生定义为临床阶段医学生(clinical medical students,CMS),采用自行设计的问卷对此两类医学生开展网络调查。结果 共发放问卷337份,回收有效问卷274份(PMS 129份,CMS 145份)。CMS在甲状腺癌预后(97.2% 比64.5%,P<0.001)、诊断方式(95.6% 比33.1%,P<0.001)及手术治疗指征(82.1% 比58.1%,P=0.001)方面的认知水平高于PMS;在甲状腺癌危险因素方面,二者的认知水平接近。相较于PMS,更高比率的CMS认为甲状腺结节出现恶变的概率在5%及以下(45.5% 比6.5%,P<0.001),且更高比率的CMS支持无症状及结节时也应进行甲状腺癌筛查(62.1% 比41.9%,P<0.001)。CMS进行甲状腺自查的比率高于PMS(55.9%比12.1%,P<0.001),但进行规律自查的比率较低(19.8%,16/81)。结论 临床教学可显著提高医学生的甲状腺癌认知水平,但CMS对甲状腺结节持更加乐观态度,轻视自查,且对甲状腺超声筛查缺乏正确的成本-效益认识。建议今后应重视医学生的临床前通识教育,丰富临床阶段的实践内容,充分发挥其社会科普宣传效应。Abstract:Objective To investigate how well medical students master knowledge about thyroid carcinoma (TC) and thyroid self-examination, and to provide guidance for pre-clinical education and clinical teaching.Methods The survey was based on the eight-year program of clinical medicine in Peking Union Medical College Medical College. Students of the third and fourth grade were defined as preclinical medical students (PMS), and students of the fifth and sixth grade were clinical medical students (CMS). The survey was conducted in March 2020 through online questionnaires.Results A total of 337 questionnaires were distributed and 274 valid responses were collected with 129 from PMS and 145 from CMS. Generally, CMS had better comprehension of TC, including prognosis (97.2% vs. 64.5%, P < 0.001), diagnosis (95.6% vs. 33.1%, P < 0.001) and surgery indications (82.1% vs. 58.1%, P=0.001). There was no significant difference between PMS and CMS on the acquaintance of the risk factors. However, more CMS stated that ≤5% of thyroid nodules might turn malignant (45.5% vs. 6.5%, P < 0.001), and more CMS suggested that people without nodules should receive TC screening tests (62.1% vs. 41.9%, P=0.001). The percentage of thyroid self-examination in CMS was higher than that of PMS (55.8% vs. 11.6%, P < 0.001), but the rate of regular self-examination was lower (19.8%, 16/81).Conclusions Medical education on TC is effective, but CMS tend to be over optimistic about TC, ignore the importance of self-examination, and lack proper awareness of cost-effectiveness in thyroid screening. It is suggested that medical schools should focus more on education of preclinical general health and clinical practices in the future to engage medical students in popularization of health science.
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Key words:
- thyroid carcinoma /
- medical students /
- cognition /
- investigation
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表 1 临床医学(八年制)专业医学生甲状腺癌相关知识认知情况[n(%)]
问题及选项 PMS CMS P值 1 你是否了解甲状腺癌这种疾病?(n=274) 0.022a 是 124(96.1) 145(100) 0.022a 否 5(3.9) 0(0) <0.001a 不清楚 0(0) 0(0) 2 据你所知,甲状腺癌的整体预后/严重程度如何?(n=269) <0.001a 相比其他癌症较好 80(64.5) 141(97.2) <0.001b 与其他癌症相近 2(1.6) 2(1.4) >0.999a 相比其他癌症较差 6(4.8) 0(0) <0.001a 不清楚 36(21.0) 2(1.4) <0.001a 3 自己或亲戚、朋友是否有人患甲状腺疾病?(n=269) 0.526b 有 48(38.7) 50(34.5) 无 76(61.3) 95(65.5) 4 你从何处获取与甲状腺癌相关的大部分信息? (n=269)(多选) 自己或周围人曾患过甲状腺相关疾病 42(33.9) 24(16.6) 0.001b 媒体(公众号、电视、广告) 53(42.7) 23(15.9) <0.001b 医学院课程 54(43.5) 139(95.9) <0.001b 医生线下科普 30(24.2) 28(19.3) 0.373b 自己感兴趣 12(9.7) 3(2.1) 0.008a 不清楚 13(10.5) 1(0.7) <0.001a 5 你认为以下哪些是甲状腺癌发生的危险因素?(多选)(n=269) 饮酒 52(41.9) 39(26.9) 0.010b 吸烟 53(42.7) 71(49.0) 0.328b 身高# 3(2.4) 6(4.1) 0.513a 肥胖# 53(42.7) 50(34.5) 0.169b 压力# 84(67.7) 88(60.7) 0.253b 气候寒冷# 21(16.9) 106(73.1) <0.001b 辐射# 80(64.5) 120(82.8) 0.157b 一级亲属(父母)有甲状腺癌病史# 83(66.9) 133(91.7) <0.001b 较高的促甲状腺激素水平# 98(79.0) 118(81.4) 0.647b 不清楚 11(8.9) 4(2.8) 0.035a 6 触摸到甲状腺结节,有多大概率为甲状腺癌?(n=269) <0.001a >25%~35% 1(0.8) 3(2.1) 0.627a >15%~25% 10(8.1) 7(4.8) 0.321a >5%~15%# 14(11.3) 27(18.6) 0.125b 5及%以下 8(6.5) 66(45.5) <0.001b 不清楚 91(73.4) 42(29.0) <0.001b 7 触摸到甲状腺结节后,应首选哪项检查确定是否为甲状腺癌?(n=269) <0.001a 细针穿刺活检 21(16.9) 23(15.9) 0.869b 甲状腺B超# 41(33.1) 110(95.6) <0.001b 头颈部CT 6(4.8) 8(5.5) >0.999a 颈部MRI 2(1.6) 1(0.7) 0.596a 不清楚 54(43.5) 3(2.1) <0.001a 8 无症状和结节时,是否也应规律行上述检查以筛查甲状腺结节?(n=269) <0.001b 是 52(41.9) 90(62.1) 0.001b 否# 24(19.4) 42(29.0) 0.088b 不清楚 48(38.7) 13(9.0) <0.001b 9 确诊甲状腺癌后,是否应立刻行手术切除?(n=269) <0.001a 是 9(43) 22(15.2) 0.021a 否# 72(58.1) 119(82.1) 0.001b 不清楚 43(34.7) 4(2.8) <0.001a 10 是否知道微小甲状腺癌可以定期监测而不需要手术治疗?*(n=191) 0.094b 知道# 53(73.6) 100(84.0) 不知道 19(26.4) 19(16.0) 11 如合并甲状腺炎,其严重程度是否与甲状腺癌的发生和治疗相关?(n=269) <0.001a 是# 53(42.7) 83(57.2) <0.001b 否 1(0.8) 22(15.2) <0.001a 不清楚 70(56.4) 40(27.6) <0.001b 12 除手术外, 甲状腺癌的治疗方式还有哪些?(多选)(n=269) 放射性核素治疗# 64(51.6) 56(38.6) 0.037b 促甲状腺激素抑制治疗# 66(53.2) 95(65.5) 0.046b 放射外照射治疗# 48(38.7) 79(54.5) 0.010b 化疗# 56(45.2) 57(39.3) 0.386b 免疫治疗 45(36.3) 37(25.5) 0.063b 不清楚 43(34.7) 5(3.4) <0.001a PMS:临床前阶段医学生;CMS:临床阶段医学生;*答题条件为:第9题回答“否”;#知识性题目的正确答案;aFisher精确概率法;b卡方检验 表 2 临床(八年制)专业医学生甲状腺自查认知情况[n(%)]
问题及选项 PMS CMS P值 1 你是否规律自查?(n=269) <0.001a 是 4(3.2) 16(11.0) 0.019a 检查过,不经常 11(8.9) 65(44.8) <0.001b 否 109(87.9) 64(44.1) <0.001b 2 你为何未规律自查?*(n=249) <0.001a 从未想过 58(48.3) 40(31.0) 0.006b 没有必要 25(20.8) 73(56.6) <0.001b 害怕发现异常情况 0(0) 2(1.6) 0.499a 不知道如何检查 32(26.7) 7(5.4) <0.001a 其他 5(4.2) 7(5.4) 0.771a 3 你从何处学习到甲状腺检查方法?#(n=96) <0.001a 自己或周围人曾患过甲状腺 相关疾病 6(40.0) 0(0) <0.001a 媒体(公众号、电视、广告等) 1(6.7) 0(0) 0.155a 医学院课程 2(13.3) 79(97.5) <0.001a 医生线下科普 3(20.0) 1(1.2) 0.011a 自己感兴趣 0(0) 0(0) 不清楚 3(20.0) 1(1.2) 0.011a *答题条件为:第1题回答“否”或“检查过,不经常”;#答题条件为:第1题回答“是”或“检查过,不经常”;PMS、CMS:同表 1;aFisher精确概率法;b卡方检验 -
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