For the countries of southeast Europe, joining the European Union would mean a fundamental reassessment of beliefs, attitudes, values, and structures developed during 50 years of communist regimes.1 This would include their healthcare systems and the training of their healthcare professionals. Medical schools in southeast Europe will need to restructure medical curriculums within the unified Europe.2 Medical students will have to learn modern evidence based medicine,3 for which they have not been prepared, mainly because of weak research output of their countries and inadequate education in research methods.4 To assess medical students' knowledge about research methods and communication and their attitudes towards research in medicine we used a specially constructed and validated questionnaire5 in medical schools in five post-communist countries.
Participants, methods, and results
In total 4307 students (66% response rate) answered a voluntary and anonymous questionnaire. The questionnaire contained a 45 item Likert-type scale developed to measure attitudes towards science, grouped in three subscales, and an eight item knowledge test of principles of scientific research.5 The study was performed simultaneously at all schools, and students in all six years of their studies who were present at lectures could take part in the study.
Students generally had poor knowledge of research methods (mean of three correct answers out of a maximum of eight), with Albanian students scoring significantly lower than all other students (table). Students from Chisinau in Moldova and Mostar in Bosnia and Herzegovina performed significantly better than other students but showed opposite trends according to year of study. In Chisinau the knowledge score increased from 36% (95% confidence interval 34% to 38%) of correct answers for first year students to 45% (43% to 47%) for sixth year students, whereas students at Mostar had the best knowledge scores in the first year (73%, 70% to 76%, correct answers) but only 22% (14% to 32%) at the end of medical studies.
Table 1.
Students' attitudes towards science and knowledge about research methods in medical schools from five post-communist European countries. Figures are percentages of maximum score* with 95% confidence intervals
|
Value of science
|
|||||
|---|---|---|---|---|---|
| School† | Total scale (range 45-225) | For medicine (range 17-85) | Methods (range 12-60) | For society (range 16-80) | Knowledge test (range 0-8) |
| Tirana, Albania (n=849) | 60.6 (60.2 to 60.9) | 64.7 (64.2 to 65.2) | 60.4 (59.9 to 60.9) | 54.7 (54.2 to 55.2) | 18.7 (17.9 to 19.6) |
| Mostar, Bosnia and Herzegovina (n=138) | 62.2 (61.1 to 63.3) | 64.7 (63.5 to 66.0) | 62.5 (61.2 to 63.7) | 59.4 (57.9 to 60.9) | 41.2 (36.8 to 45.7) |
| Osijek, Croatia (n=257) | 61.7 (61.0 to 62.3) | 64.7 (63.9 to 65.5) | 62.5 (61.6 to 63.4) | 57.8 (56.9 to 58.7) | 35.0 (32.8 to 37.1) |
| Chisinau, Moldova (n=2057) | 60.6 (60.3 to 60.8) | 63.2 (62.5 to 64.0) | 62.5 (62.2 to 62.8) | 57.8 (57.5 to 58.1) | 38.7 (37.9 to 39.6) |
| Kragujevac, Serbia and Montenegro (n=542) | 63.3 (62.8 to 63.9) | 64.71 (64.1 to 65.3) | 64.6 (63.8 to 65.3) | 60.9 (60.3 to 61.6) | 26.2 (24.9 to 27.6) |
To allow for comparisons among schools. Possible score ranges are shown for individual scales. Scores on total attitude scale and its subscales and scores on knowledge test significantly differed among the countries (analysis of variance, all P values <0.01).
Numbers in brackets indicate greatest number of valid responses (questionnaires with no missing answers); response rate among individual subscales was 85-99%.
Despite poor knowledge scores, students had generally positive attitudes towards science, the highest scores were at Kragujevac (table). The greatest differences among the schools were for the subscale measuring the value of science for society, with the students from Albania having significantly lower scores than all others (table). Multiple regression analysis showed that female sex (β = 2.15, 0.91 to 3.61, P = 0.002), higher average grade (β = 0.68, 0.01 to 1.33, P = 0.04), and higher year of training (β = 0.53, 0.12 to 0.95, P = 0.01) all positively predicted total score on the attitude scale.
Comment
Although limited by the survey methods and differences in the size and curriculums of medical schools, our results show that medical students from five post-communist countries have positive attitudes towards science despite rather poor knowledge of research methods and scientific communication. This should be considered during the integration of these countries into scientific and medical programmes of the European Union. Increases in knowledge of scientific methods and critical thinking may reinforce attitudes towards science and help these countries to embrace evidence based medicine. The knowledge of research methods differed significantly between the schools and according to the year of study, indicating that each country and school may need an individual approach.
We believe that targeting medical students may be a good way to start building up the critical mass of academic physicians with skills for understanding, performing, and communicating biomedical research and for critical thinking and appraisal of medical evidence. Most importantly, teaching principles of scientific research and evidence based medicine and fostering a positive attitude towards them among medical students can contribute to strengthening integrity in the academic environment and society as a whole. In societies with high levels of corruption, not only in the economy but in all other aspects of life, including academic medicine,1 this is perhaps the most important goal for the European Union.
What is already known on this topic
During almost 50 years of communist regimes, specific sets of values, beliefs, attitudes, and behaviour have developed in southeast European countries, which are also reflected in medical education and practice
Medical students in these countries need programmes for increasing their research capacities, knowledge of evidence based medicine, and scientific communication to join the global medical community
What this study adds
Medical students from post-communist countries have positive attitudes towards science and scientific research, despite their rather poor knowledge of research methods and scientific communication
Supplementary Material
Characteristics of the medical schools and countries in the survey can be found on bmj.com
We thank students who participated in the study and Darko Hren, for his valuable statistical advice.
Contributors: AM and MM conceived and designed the study. GB, MČ, ER, VI, SJ, TMK, ON, VS, and VŠ conducted the survey in their schools and collected the data. GB analysed the data and interpreted them with AM and MM. AM wrote the draft of the paper and all other authors critically revised the paper for important intellectual content and approved the final version. MM is the guarantor of the study.
Funding: MM received a research grant from the Croatian Ministry of Science, Education and Sports (No 108182).
Competing interests: None declared.
Ethical approval: This research was approved by the ethics committee of the Zagreb University School of Medicine.
References
- 1.Hrabak M, Vujaklija A, Vodopivec I, Hren D, Marušić M, Marušić A. Academic misconduct among medical students in a transition country. Med Educ 2004;38: 276-85. [DOI] [PubMed] [Google Scholar]
- 2.European Ministers of Education. Bologna Declaration. Joint declaration of the European Ministers of Education adopted on 19 June 1999. www.eua.be/eua/jsp/en/upload/OFFDOC_BP_bologna_declaration.1068714825768.pdf (accessed 26 Jan 2005).
- 3.Garner P, Meremikwu M, Volmink J, Xu Q, Smith H. Putting evidence into practice: how middle and low income countries “get together.” BMJ 2004;329: 1036-9. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4.Marušić A, Marušić M. Teaching students how to read and write science: mandatory course on scientific research and communication in medicine. Acad Med 2003;78: 1235-9. [DOI] [PubMed] [Google Scholar]
- 5.Hren D, Lukić IK, Marušić A, Vodopivec I, Vujaklija A, Hrabak M, et al. Medical students' attitude towards and knowledge about science and scientific research. Med Educ 2004;38: 81-6. [DOI] [PubMed] [Google Scholar]
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