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A comparison of knowledge of medical students and practicing primary care physicians about cardiovascular risk
S S Allen1, I B Harris, P M Kofron
1Department of Family Practice and Community Health, University of Minnesota Medical School, Minneapolis.
Insights
Physician knowledge gaps in cardiovascular risk assessment persist, impacting cost-effective care. Enhanced training for medical students and faculty is crucial for adhering to national preventive medicine standards.
Area of Science:
- Cardiology
- Medical Education
- Public Health
Background:
- Cardiovascular diseases remain leading causes of death and disability in U.S. adults.
- Modifiable risk factors like hypertension, smoking, and hypercholesterolemia are key targets for prevention.
- Physician proficiency in cardiovascular risk assessment and management is essential for patient outcomes.
Purpose of the Study:
- To compare the cardiovascular risk assessment knowledge of second-year medical students with that of practicing primary care physicians.
- To evaluate the effectiveness of the tailored response test (TRT) in assessing this knowledge.
Main Methods:
- Second-year medical students underwent a structured cardiovascular risk intervention with a patient.
- Both students and a selected group of primary care physicians (clinical faculty) were tested using the TRT, which involved 43 discrete judgments on a clinical case.
- Knowledge test scores were compared between the two groups.
Main Results:
- Both students and faculty demonstrated general knowledge of major risk factors, screening tools, and interventions.
- Significant knowledge gaps were identified regarding national recommendations for specific risk assessment and interventions.
- For example, awareness of "fasting" serum cholesterol not being required for screening was low (38% faculty, 27% students).
- A notable percentage of faculty (30%) and students (32%) would incorrectly order a screening chest X-ray.
Conclusions:
- The TRT revealed that critical cardiovascular risk assessment and intervention knowledge has not been fully adopted by some clinical faculty, despite its importance for cost-effective healthcare.
- This gap is concerning given the emphasis on cost-effectiveness in current healthcare delivery.
- There is a need for enhanced undergraduate curricula and continuing medical education (CME) focused on cardiovascular preventive practices to align with national standards.
Background:
Heart attack and stroke are still prevalent causes of death and disability in the U.S. adult population (1, 2). Studies (3-9) have shown that modification of hypertension, smoking, and hypercholesterolemia can reduce risks for atherosclerosis and subsequent cardiovascular events. Therefore, it is important that physicians be skilled in assessing and modifying patients' overall cardiovascular risk. This study compares acquired knowledge of second-year medical students about cardiovascular risk assessment with knowledge in a selected group of practicing primary care physicians, who are members of the medical school's clinical faculty, using a new experimental testing technique called the tailored response test (TRT).
Methods:
Students performed a structured cardiovascular risk intervention on a patient in primary care clinics. Their acquired knowledge was then tested using the TRT, which contained 43 discrete judgments about a clinical case. Test scores of students and faculty were compared.
Results:
Both students and faculty demonstrated knowledge about the most important risk factors, appropriate screening tools, and interventions. However, the selected physicians did not demonstrate knowledge of certain important risk assessment and intervention recommendations, based on national standards. Only 38% of faculty and 27% of students were aware that a "fasting" serum cholesterol is not needed for screening, 30% of faculty believed that if cholesterol was over 300 they would "probably prescribe medicine" before other intervention strategies were tried, and 32% of faculty and 30% of students would order a screening chest X-ray, which is incorrect in the case history.
Conclusions:
The TRT, in contrast to self-report surveys, demonstrates that important cardiovascular risk assessment and intervention knowledge, with implications for cost effectiveness in health care delivery, has not penetrated to a selected group of physicians who are members of the medical school's clinical faculty and therefore serve as role models for medical students. This is disturbing, in light of current emphases on cost effectiveness in health care. Greater undergraduate curricula and CME emphasis on cardiovascular preventive practice is needed, such that almost 100% of students and faculty demonstrate knowledge, and practice, of preventive medicine according to national standards. In turn, groups developing national standards are enjoined to design and implement effective approaches for disseminating these recommendations.