Division of Cardiovascular Medicine, Department of Medicine, Faculty of Medicine, HRH Princess Maha Chakri Sirind-horn Medical Center, Srinakharinwirot University, Nakhon Nayok, Thailand.
Medical student of Faculty of Medicine, HRH Princess Maha Chakri Sirindhorn Medical Center, Srinakharinwirot Uni-versity, Nakhon Nayok, Thailand.
Int J Med Educ. 2022 Jul 29;13:187-197. doi: 10.5116/ijme.62c2.c33c.
To explore factors associated with prescribing confidence and competence of final-year medical students for prescribing antiplatelet and fibrinolytic agents in ST-segment elevation myocardial infarction (STEMI).
The study was conducted among final-year medical students with a triangular convergent mixed-methods approach. First, an online survey was conducted using a voluntary sampling method with concurrent in-depth interviews performed. The survey data was analysed using descriptive statistics and paired t-tests, while survey factors were compared using the chi-squared or Fisher's exact test. The interview data were coded and analysed thematically. The relations between the qualitative and quantitative findings were finally described.
Totally 92 validly replied to the questionnaire, and 20 participated in the interviews. The quantitative analysis indicated that they had high competence in the diagnosis of STEMI and prescribing antiplatelet and fibrinolytic agents. The mean confidence score of prescribing for both was medium and was significantly lower in fibrinolytic agents. (M=3.3, SD=1.1 vs. M=2.8, SD=1.0, t=5.39, p<0.01). Their experience, knowledge, and mentoring were accounted for, considering the prescribing confidence factors in both approaches. Besides, providing guidelines and standing orders were derived from the interview data.
This study has demonstrated that final-year medical students have a high ability to diagnose and prescribe essential medications in STEMI but tend to have low confidence in prescribing fibrinolytic agents. Experiential learning, mentorship and providing guidelines can help them, especially in emergency settings to prescribe confidently and safely. Further multicenter studies on undergraduate and graduate medical students' confidence and perspective of prescribing are required, especially for high-alert medications.
探讨与最后一年医学生开具抗血小板和纤维蛋白溶解药物治疗 ST 段抬高型心肌梗死（STEMI）的信心和能力相关的因素。
采用三角收敛混合方法，对最后一年的医学生进行了这项研究。首先，使用自愿抽样法进行在线调查，并同时进行深入访谈。使用描述性统计和配对 t 检验分析调查数据，使用卡方或 Fisher 确切检验比较调查因素。对访谈数据进行编码和主题分析。最后描述定性和定量发现之间的关系。
共有 92 名医学生有效回复了问卷，20 名参加了访谈。定量分析表明，他们在 STEMI 的诊断和开具抗血小板和纤维蛋白溶解药物方面具有较高的能力。这两种药物的平均开具信心评分均为中等，纤维蛋白溶解药物的评分明显较低（M=3.3，SD=1.1 与 M=2.8，SD=1.0，t=5.39，p<0.01）。在这两种方法中，考虑到开具信心因素，他们的经验、知识和指导都得到了考虑。此外，访谈数据还得出了提供指南和标准医嘱的结论。
这项研究表明，最后一年的医学生具有诊断和开具 STEMI 基本药物的高能力，但在开具纤维蛋白溶解药物方面倾向于缺乏信心。体验式学习、指导和提供指南可以帮助他们，尤其是在紧急情况下，以安全和自信的方式开具处方。需要进一步开展关于本科和研究生医学生开具处方的信心和观点的多中心研究，特别是针对高警示药物。
