Knowledge, attitudes and educational exposure regarding neglected tropical diseases among medical students and residents in Italy: a nationwide multicenter survey from the Italian Society for Tropical Medicine and Global Health (SIMET ETS).
Neglected tropical diseases (NTDs) represent a major cause of preventable morbidity and are increasingly relevant in high-income settings because of migration, international travel, climate-sensitive vector expansion and persistent health inequities. However, NTDs-related knowledge and educational exposure among future and early-career physicians in Europe remain poorly documented. This study assessed NTDs-related knowledge, attitudes and practice-related experiences among medical students and residents in Italy.
We conducted a national multicenter cross-sectional survey through a structured and previously validated REDCap questionnaire distributed across 40 Italian universities covering all 20 Italian regions. The survey included demographic and academic variables, exposure to NTDs-related teaching, six clinical vignettes, ten theoretical knowledge questions, Likert-scale attitude items and practice-related experience questions. The questionnaire had undergone a multi-step validation process, including a two-round Delphi assessment with a multidisciplinary expert panel, external expert evaluation and psychometric testing. A basic knowledge threshold of ≥ 50% correct responses was defined a priori by consensus within the SIMET working group as an operational criterion for basic knowledge. A more stringent high-knowledge threshold was defined as ≥ 12 correct answers out of 16.
A total of 2,088 questionnaires were received; 267 (12.8%) were excluded because of incomplete or insufficient data, leaving 1,821 analyzable responses (87.2%), including 1,366 medical students (75.0%) and 455 residents (25.0%). Median age was 25 years (IQR 22-29) and 60.1% were female. Regarding formal curricular teaching, 40.7% of participants reported no hours of NTDs-related teaching, whereas only 8.5% reported more than 10 h. Only 38.6% reached the basic knowledge threshold and 32.7% correctly answered at least four out of six clinical vignettes. A much smaller proportion (8.7%) reached the high-knowledge threshold of ≥ 12/16 correct answers, with markedly higher attainment among residents than medical students (32.3% vs. 0.8%; p < 0.001). Nevertheless, attitudes were highly favorable: 92.4% supported mandatory inclusion of NTDs in educational curricula, 90.8% were willing to attend dedicated courses and 93.8% considered workshops useful. In multivariable analysis, increasing hours of formal NTDs-related teaching were associated with progressively higher odds of achieving the basic knowledge threshold (< 5 h: aOR 1.25, 95% CI 1.00-1.56; 5-10 h: aOR 1.63, 95% CI 1.24-2.13; >10 h: aOR 2.42, 95% CI 1.74-3.37), with a significant linear trend across categories (p for trend = 0.002). Participation in dedicated educational activities (aOR 1.84, 95% CI 1.49-2.27) and previous suspicion or diagnosis of an NTD case (aOR 1.52, 95% CI 1.18-1.96) were also independently associated with the outcome.
NTDs-related knowledge among medical students and residents in Italy remains suboptimal despite strong interest in additional training. Fewer than four in ten participants reached a basic knowledge threshold, and fewer than one in ten reached a high-knowledge threshold. These findings highlight the need to strengthen structured NTDs-related teaching in undergraduate and postgraduate medical curricula, with emphasis on clinical decision-making competencies.
We conducted a national multicenter cross-sectional survey through a structured and previously validated REDCap questionnaire distributed across 40 Italian universities covering all 20 Italian regions. The survey included demographic and academic variables, exposure to NTDs-related teaching, six clinical vignettes, ten theoretical knowledge questions, Likert-scale attitude items and practice-related experience questions. The questionnaire had undergone a multi-step validation process, including a two-round Delphi assessment with a multidisciplinary expert panel, external expert evaluation and psychometric testing. A basic knowledge threshold of ≥ 50% correct responses was defined a priori by consensus within the SIMET working group as an operational criterion for basic knowledge. A more stringent high-knowledge threshold was defined as ≥ 12 correct answers out of 16.
A total of 2,088 questionnaires were received; 267 (12.8%) were excluded because of incomplete or insufficient data, leaving 1,821 analyzable responses (87.2%), including 1,366 medical students (75.0%) and 455 residents (25.0%). Median age was 25 years (IQR 22-29) and 60.1% were female. Regarding formal curricular teaching, 40.7% of participants reported no hours of NTDs-related teaching, whereas only 8.5% reported more than 10 h. Only 38.6% reached the basic knowledge threshold and 32.7% correctly answered at least four out of six clinical vignettes. A much smaller proportion (8.7%) reached the high-knowledge threshold of ≥ 12/16 correct answers, with markedly higher attainment among residents than medical students (32.3% vs. 0.8%; p < 0.001). Nevertheless, attitudes were highly favorable: 92.4% supported mandatory inclusion of NTDs in educational curricula, 90.8% were willing to attend dedicated courses and 93.8% considered workshops useful. In multivariable analysis, increasing hours of formal NTDs-related teaching were associated with progressively higher odds of achieving the basic knowledge threshold (< 5 h: aOR 1.25, 95% CI 1.00-1.56; 5-10 h: aOR 1.63, 95% CI 1.24-2.13; >10 h: aOR 2.42, 95% CI 1.74-3.37), with a significant linear trend across categories (p for trend = 0.002). Participation in dedicated educational activities (aOR 1.84, 95% CI 1.49-2.27) and previous suspicion or diagnosis of an NTD case (aOR 1.52, 95% CI 1.18-1.96) were also independently associated with the outcome.
NTDs-related knowledge among medical students and residents in Italy remains suboptimal despite strong interest in additional training. Fewer than four in ten participants reached a basic knowledge threshold, and fewer than one in ten reached a high-knowledge threshold. These findings highlight the need to strengthen structured NTDs-related teaching in undergraduate and postgraduate medical curricula, with emphasis on clinical decision-making competencies.
Authors
Guido Guido, Buonamassa Buonamassa, Rossi Rossi, Barbiero Barbiero, Mangiapelo Mangiapelo, Perego Perego, Perugini Perugini, Ritacco Ritacco, De Vito De Vito, Madeddu Madeddu, Serapide Serapide, Russo Russo, De Iaco De Iaco, Pisaturo Pisaturo, Coppola Coppola, Nicastri Nicastri, Gobbi Gobbi, Scarso Scarso, Marrone Marrone, Poli Poli, Rollo Rollo, Zella Zella, D'Abramo D'Abramo, Saracino Saracino, Iatta Iatta, Calleri Calleri, Corpolongo Corpolongo, Di Gennaro Di Gennaro
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