Medical Student Self-Assessment of Knowledge About Vaccinations and the Quality of Vaccination Training

Gaps in vaccination coverage have repeatedly led to outbreaks of vaccine preventable infectious diseases in Germany. Patients’ decisions regarding vaccinations are shaped by the medical consultation, which is why medical students should be well prepared for these. German universities currently do not provide a consistent education (1). Studies of medical students’ knowledge about and attitudes towards vaccinations are limited (2, 3, 4). The present study investigated attitudes towards vaccination and self assessment of knowledge about vaccinations and the quality of vaccination training among medical students in Bavaria.

Methods

In the summer and winter semester 2018, a voluntary anonymized, paper based survey was conducted among medical students in their 5^th year of study in the setting of compulsory courses at the formerly five medical faculties in Bavaria (Erlangen-Nürnberg, Würzburg, LMU München, TU München, and Regensburg). The questionnaire (adapted from [2]) included 45 questions about demographic characteristics, specialty aimed for, receipt of the flu vaccine, attitudes to vaccination, practical experience with vaccination, vaccination training and was devised using the software package EvaSys V8.0 (2200). The scale of self assessment comprised the following values: 1 = insufficiently/2 = moderately/3 = adequately/4 = very well prepared. The dichotomized categorization into “feels poorly/well prepared” was achieved by the mean value from the 26 questions about self assessment of knowledge about vaccination (≤2.5: “feels poorly prepared”; >2.5: “feels well prepared”). Potential factors of influence were calculated by using univariable and multivariable regression models. The statistical analysis was descriptive—we used SPSS (version 23, 2015). We compared groups by using Pearson’s chi square test.

Results

Of 1561 medical students invited to participate in the survey, 1147 participated (73.5%). Participants (mean age 25.4 [SD±3.2] years; 60% were female) aimed for the following specialties: internal medicine (16.0%), general medicine (12.0%), surgery (10.1%), pediatrics (8.3%), anesthetics and emergency medicine (8.1%), gynecology (7.5%), neurology (5.7%), other specialty (18.0%), as yet undecided (14.3%). The students mostly had a very positive (76.1%) or positive (21.4%) attitude towards vaccination. Most of them (97.9%) considered being well informed about vaccination as important for their jobs later on. 74.8% had vaccinated patients already and 75.7% had provided information about risks and benefits of vaccination. 45.9% had had been vaccinated against flu in the current/previous influenza season, with notable differences between the five universities (26.2–63.0%).

Vaccinations in the medical degree course were the subject of lectures (86.7%), seminars (66.2%), electives, the final year of training between the second and third examinations, or internships (41.2%), active work in small groups (24.0%), and online programs (29.5%). 38.5% of medical students expressed a desire for more events. They rated as effective vaccination training in seminars (80.6%), active work in small groups (43.6%), and electives, the final year, or internships (46.5%). 27.3% rated lectures as effective and 13.7% rated online programs as effective. Students who knew such online programs (n = 220) were more likely to rate these as an effective learning tool than students without access to such services (n = 898) (41.4% versus 6.7%, p<0.001).

Of 1136 medical students, 4.9 assessed their knowledge about vaccination as very good, 64.4% as adequate, 30.3% as moderate, and 0.4% as insufficient/unsatisfactory. Especially regarding the topics of vaccine costs (75.7%), risks (72.1%) and benefits (56.7%) of adjuvants, vaccination coverage (60.3%), travel vaccinations (57.9%), and dealing with people opposed to vaccination (54.5%) they felt moderately or insufficiently prepared (Table 1).

Table 1

Selection of questions regarding medical students’ self assessment of general knowledge about vaccination

In multivariable logistic regression analyses the probability of assessing one’s own knowledge about vaccination as satisfactory was higher in male students, students who had had a flu vaccination, and those with practical experience of vaccination (Table 2).

Table 2

Univariable and multivariable logistic regression regarding factors of influence on medical students’ self assessment regarding knowledge about vaccination

Discussion

One third of medical students rated their knowledge of vaccination as moderate or insufficient. In particular—and this is similar to the results of a French study—they did not feel sufficiently prepared for patient communication regarding vaccination risks and their professional dealings with vaccine opponents (2). Fundamental communications-related and practical skills in vaccine prevention should be acquired during the medical degree course, since during the final year and specialty training (which is mostly undertaken in the hospital-inpatient setting) there is only limited scope for doing so.

In spite of overall positive attitudes towards vaccination, only about half of the medical students were vaccinated against flu. Improved vaccination training combined with vaccination programs—especially for students—could contribute to increasing vaccination rates in medical students (5).

The strengths of our study are the high numbers and rates of participants and comprehensive implementation throughout Bavaria. A limitation is the lack of objective testing of students’ knowledge about vaccination. It is possible that students with greater knowledge were more likely to participate in the study. On the other hand, we can assume that knowledge about vaccination has generally improved as a result of the COVID-19 pandemic.

The COVID-19 pandemic and current refugee movements increase the need for a standardized learning curriculum for a separate topic “vaccine prevention” in order to improve vaccination training in the medical degree course.

Acknowledgments

We thank the medical faculties of the participating universities as well as Prof. Solen Kernéis and Prof. Matthias Frosch. We also thank the students for participating.

Conflict of interest statement
The authors declare that no conflict of interest exists.

Manuscript received on 7 March 2022, revised version accepted on 3 June 2022.

Translated from the original German by Birte Twisselmann, PhD.

Cite this as:
Roberts K, Streng A, Göttler D, Hartmann K, Peter-Kern M, Roggendorf H, Bogdan C, Jilg W, Plentz A, Hübner J, Schober T, Liese J: Medical student self-assessment of knowledge about vaccinations and the quality of vaccination training. Dtsch Arztebl Int 2022; 119: 562–3. DOI: 10.3238/arztebl.m2022.0249

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