促进医学生抗菌药物合理使用的教育干预及模型研究

目的:构建稳定、有效的有关抗菌药物合理使用的教育干预理论模型,为促进医学生抗菌药物合理使用提出建议。方法:选择2所医学高校本科5年制临床医学专业4年级医学生作为干预对象,采用不同干预方法(专家专题讲座、基于问题式的小组讨论及同时采用以上2种方式),开展基线、干预结束及干预结束后较长时期的3阶段问卷调查(2所高校有效问卷分别为291、201份),了解干预对象在各阶段对抗菌药物合理使用的认知情况,评估干预效果,并探讨构建教育干预模型。结果:临床医学生普遍对抗菌药物合理使用的知识掌握差,理论与临床实践脱节,存在错误的用药行为;开展适当的教育干预可提高医学生对抗菌药物合理使用的知识认知并改善其合理用药行为(采用3种干预方案均可使其总体得分干预前、后产生显著性差异);对于医学生抗菌药物合理使用的意识和态度教育干预的效果并不理想(采用3种干预方案其总体得分干预前、后均无显著性差异),经过较长时间干预效果更趋淡化。本研究在"知识-信念-行为"模型的基础上进行修正和扩展,综合构建出新的理论模型。结论:所构建的教育干预理论模型可有效解释本次研究。研究结果表明,临床医学的专业教育要重视医学生临床药物治疗学和抗菌药物合理使用教育,而要从根本上使医学生建立合理用药的意识,真正促进抗菌药物的合理使用,必须将相关教育制度化、长期化。

Educational Intervention for Promoting Rational Use of Antimicrobials in Medical Students and Model Research

OBJECTIVE： To establish a stable and effective model for educational intervention to promote rational use of anti-microbials, and to provide suggestions for rational use of antimicrobials among medical students. METHODS ： Students majoring in clinical medicine at grade 4 in two colleges were selected as the observed subjects. Different educational interventions were per-formed （expert lecture, group discussion on the basis of questions or 2 kinds of methods combination）. The questionnaire surveys were conducted at baseline, right after intervention and 3 months after intervention （valid questionnaires of two colleges were 291 and 201）. The reorganization of subjects to rational use of antimicrobials was explored and the intervention effect was evaluated. The construction of educational intervention model was investigated. RESULTS： Clinical medical students have limited knowledge of the rational use of antimicrobials. They also have the theory of rational drug use which is out of practice and false drug use behavior. The development of educational interventions can enrich the knowledge of medical students about rational use of antimicrobials and improve their behaviors on rational use of drugs. 3 kinds of intervention methods could caused that there were significant difference in the knowledge of rational use of antimicrobials, total scores of behavior before and after intervention （There were significant differences in the total score of behavior before and after intervention）. The intervention to the awareness and attitude of medical students about rational use of antimicrobials didn＇t obtain good achievement （There were significant differences in the total score before and after intervention）, the effect of educational intervention became weak after a long time. The study verified and expanded ＂knowledge-belief-behavior＂ model to establish new theoretic model. CONCLUSIONS ： The theoretical model of educational intervention could explain the research above. Professional education of clinical medicine should emphasize clinical drug therapeutics and rational drug use education, medical sutdents should formulate awareness of rational drug use basically, systematize and establish related education system in a long-term to improve rational use of drugs.