Abstract
Objective: to evaluate undergraduate medical students’ clinical decision-making process after a brief intervention lecture on quaternary prevention (P4). Methods: quantitative self-controlled intervention study carried out with fifth-year medical students of Pham Ngoc Thach University, Hochiminhcity, Vietnam. The medical students were asked to list their eventual interventions based on three different simulated clinical scenarios. The survey was conducted before and after the intervention. Student’s propositions were classified into one of the four groups of prevention, according to Jamoulle’s model. Results: 115 students participated, resulting in 211 answered sheets. The interventions proposed by the students were mostly centered on prevention groups 1, 2 and 3; the three clinical scenarios partially explained student’s intentions of counseling, screening and palliative care. Comparing the data of second phase survey, the intervention was associated with changes in students’ aptitude on clinical decision-making, which was especially more important for prevention group 1 (OR = 7.5) and prevention group 4 (OR = 30.05). There was no statistically significant difference in changing students’ decision for prevention group 2 (OR = 0.95 p = 0.466) and prevention group 3 (OR = 2.29 p = 0.932). Conclusion: introducing quaternary prevention to the undergraduate medical course can help to steer clinical decisions toward primary prevention and to avoid inappropriate medical interventions.
Highlights
In the last decades medical practice underwent an explosion of scientific facts that brought medicine to a new era of experiential science, known as evidence-based medicine (EBM).[1]
Doctor-patient relationship has changed from the patient’s dependent status, to a mutual decision sharing model or holistic model where patients take a privileged role
This lecture consisted of two slides addressing the P4 concept; followed by a talk about the differences between patient’s and doctor’s health perspectives; and some explanation on P4 concept applied as a tool in everyday clinical practice and its relation to other principles of family medicine
Summary
In the last decades medical practice underwent an explosion of scientific facts that brought medicine to a new era of experiential science, known as evidence-based medicine (EBM).[1]. Doctor-patient relationship has changed from the patient’s dependent status (i.e. in traditional medicine where health professionals were more in control over clinical decision-making and clinical intervention), to a mutual decision sharing model or holistic model where patients take a privileged role. That requires health professionals to involve actively and effectively the patient’s participation in clinical decision-making process whenever possible.[3] Payton et al.,[4] have pointed out that patients participation is based on the “recognition of the values of self-determination and the worth of individuals”. Physicians need to develop their own approaches to doctor-patient relationship by involving their patients in decision-making processes, as well as by understanding their patients’ rights and responsibilities
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