临床医学(八年制)专业医学生甲状腺癌认知情况调查

聂永都; 刘芃昊; 林劲楷; 曹增涵; 徐协群

doi:10.12290/xhyxzz.2021-0359

临床医学(八年制)专业医学生甲状腺癌认知情况调查

doi: 10.12290/xhyxzz.2021-0359

1.
中国医学科学院北京协和医学院临床医学院，北京 100730
2.
中国医学科学院北京协和医学院北京协和医院基本外科，北京 100730

基金项目:

国家自然科学基金 32071436

北京协和医学院校级本科教育教学改革项目 2019zlgc0111

详细信息

通讯作者:
徐协群电话: 010-69152620, E-mail: xxq75@163.com

中图分类号: R736.1
计量
- 文章访问数: 993
- HTML全文浏览量: 118
- PDF下载量: 64
- 被引次数: 0
出版历程
- 收稿日期: 2021-04-26
- 录用日期: 2021-05-21
- 刊出日期: 2021-09-30

Investigation on Cognition of Thyroid Carcinoma Among Medical Students

1.
College of Clinical Medicine, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
2.
Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China

Funds:

National Natural Science Foundation of China 32071436

Medical Education Reform Project of Peking Union Medical College 2019zlgc0111

More Information

Corresponding author: XU Xiequn Tel: 86-10-69152620, E-mail: xxq75@163.com

摘要

摘要: 目的调查临床医学(八年制)专业医学生甲状腺癌相关知识及甲状腺自查方法的掌握情况，为临床前医学教育和临床教学提供借鉴和指导。方法 2020年3月，采用便利抽样法选取北京协和医学院临床医学(八年制)专业三至六年级医学生为调查对象。将三、四年级医学生定义为临床前阶段医学生(preclinical medical students，PMS)，将五、六年级医学生定义为临床阶段医学生(clinical medical students，CMS)，采用自行设计的问卷对此两类医学生开展网络调查。结果共发放问卷337份，回收有效问卷274份(PMS 129份，CMS 145份)。CMS在甲状腺癌预后(97.2% 比64.5%，P＜0.001)、诊断方式(95.6% 比33.1%，P＜0.001)及手术治疗指征(82.1% 比58.1%，P=0.001)方面的认知水平高于PMS；在甲状腺癌危险因素方面，二者的认知水平接近。相较于PMS，更高比率的CMS认为甲状腺结节出现恶变的概率在5%及以下(45.5% 比6.5%，P＜0.001)，且更高比率的CMS支持无症状及结节时也应进行甲状腺癌筛查(62.1% 比41.9%，P＜0.001)。CMS进行甲状腺自查的比率高于PMS(55.9%比12.1%，P＜0.001)，但进行规律自查的比率较低(19.8%，16/81)。结论临床教学可显著提高医学生的甲状腺癌认知水平，但CMS对甲状腺结节持更加乐观态度，轻视自查，且对甲状腺超声筛查缺乏正确的成本-效益认识。建议今后应重视医学生的临床前通识教育，丰富临床阶段的实践内容，充分发挥其社会科普宣传效应。
- 甲状腺癌 /
- 医学生 /
- 认知 /
- 调查
Abstract: Objective To investigate how well medical students master knowledge about thyroid carcinoma (TC) and thyroid self-examination, and to provide guidance for pre-clinical education and clinical teaching. Methods The survey was based on the eight-year program of clinical medicine in Peking Union Medical College Medical College. Students of the third and fourth grade were defined as preclinical medical students (PMS), and students of the fifth and sixth grade were clinical medical students (CMS). The survey was conducted in March 2020 through online questionnaires. Results A total of 337 questionnaires were distributed and 274 valid responses were collected with 129 from PMS and 145 from CMS. Generally, CMS had better comprehension of TC, including prognosis (97.2% vs. 64.5%, P < 0.001), diagnosis (95.6% vs. 33.1%, P < 0.001) and surgery indications (82.1% vs. 58.1%, P=0.001). There was no significant difference between PMS and CMS on the acquaintance of the risk factors. However, more CMS stated that ≤5% of thyroid nodules might turn malignant (45.5% vs. 6.5%, P < 0.001), and more CMS suggested that people without nodules should receive TC screening tests (62.1% vs. 41.9%, P=0.001). The percentage of thyroid self-examination in CMS was higher than that of PMS (55.8% vs. 11.6%, P < 0.001), but the rate of regular self-examination was lower (19.8%, 16/81). Conclusions Medical education on TC is effective, but CMS tend to be over optimistic about TC, ignore the importance of self-examination, and lack proper awareness of cost-effectiveness in thyroid screening. It is suggested that medical schools should focus more on education of preclinical general health and clinical practices in the future to engage medical students in popularization of health science.
- thyroid carcinoma /
- medical students /
- cognition /
- investigation
注释:

作者贡献：聂永都、刘芃昊、徐协群负责研究设计及论文撰写；聂永都、林劲楷、曹增涵负责问卷发放及数据分析；聂永都、徐协群负责论文修订。

利益冲突：无

HTML全文

表 1 临床医学(八年制)专业医学生甲状腺癌相关知识认知情况[n(%)]

	问题及选项	PMS	CMS	P值
1	你是否了解甲状腺癌这种疾病？(n=274)			0.022^a
	是	124(96.1)	145(100)	0.022^a
	否	5(3.9)	0(0)	＜0.001^a
	不清楚	0(0)	0(0)
2	据你所知，甲状腺癌的整体预后/严重程度如何？(n=269)			＜0.001^a
	相比其他癌症较好	80(64.5)	141(97.2)	＜0.001^b
	与其他癌症相近	2(1.6)	2(1.4)	＞0.999^a
	相比其他癌症较差	6(4.8)	0(0)	＜0.001^a
	不清楚	36(21.0)	2(1.4)	＜0.001^a
3	自己或亲戚、朋友是否有人患甲状腺疾病？(n=269)			0.526^b
	有	48(38.7)	50(34.5)
	无	76(61.3)	95(65.5)
4	你从何处获取与甲状腺癌相关的大部分信息? (n=269)(多选)
	自己或周围人曾患过甲状腺相关疾病	42(33.9)	24(16.6)	0.001^b
	媒体(公众号、电视、广告)	53(42.7)	23(15.9)	＜0.001^b
	医学院课程	54(43.5)	139(95.9)	＜0.001^b
	医生线下科普	30(24.2)	28(19.3)	0.373^b
	自己感兴趣	12(9.7)	3(2.1)	0.008^a
	不清楚	13(10.5)	1(0.7)	＜0.001^a
5	你认为以下哪些是甲状腺癌发生的危险因素？(多选)(n=269)
	饮酒	52(41.9)	39(26.9)	0.010^b
	吸烟	53(42.7)	71(49.0)	0.328^b
	身高^#	3(2.4)	6(4.1)	0.513^a
	肥胖^#	53(42.7)	50(34.5)	0.169^b
	压力^#	84(67.7)	88(60.7)	0.253^b
	气候寒冷^#	21(16.9)	106(73.1)	＜0.001^b
	辐射^#	80(64.5)	120(82.8)	0.157^b
	一级亲属(父母)有甲状腺癌病史^#	83(66.9)	133(91.7)	＜0.001^b
	较高的促甲状腺激素水平^#	98(79.0)	118(81.4)	0.647^b
	不清楚	11(8.9)	4(2.8)	0.035^a
6	触摸到甲状腺结节，有多大概率为甲状腺癌？(n=269)			＜0.001^a
	＞25%~35%	1(0.8)	3(2.1)	0.627^a
	＞15%~25%	10(8.1)	7(4.8)	0.321^a
	＞5%~15%^#	14(11.3)	27(18.6)	0.125^b
	5及%以下	8(6.5)	66(45.5)	＜0.001^b
	不清楚	91(73.4)	42(29.0)	＜0.001^b
7	触摸到甲状腺结节后，应首选哪项检查确定是否为甲状腺癌？(n=269)			＜0.001^a
	细针穿刺活检	21(16.9)	23(15.9)	0.869^b
	甲状腺B超^#	41(33.1)	110(95.6)	＜0.001^b
	头颈部CT	6(4.8)	8(5.5)	＞0.999^a
	颈部MRI	2(1.6)	1(0.7)	0.596^a
	不清楚	54(43.5)	3(2.1)	＜0.001^a
8	无症状和结节时，是否也应规律行上述检查以筛查甲状腺结节？(n=269)			＜0.001^b
	是	52(41.9)	90(62.1)	0.001^b
	否^#	24(19.4)	42(29.0)	0.088^b
	不清楚	48(38.7)	13(9.0)	＜0.001^b
9	确诊甲状腺癌后，是否应立刻行手术切除？(n=269)			＜0.001^a
	是	9(43)	22(15.2)	0.021^a
	否^#	72(58.1)	119(82.1)	0.001^b
	不清楚	43(34.7)	4(2.8)	＜0.001^a
10	是否知道微小甲状腺癌可以定期监测而不需要手术治疗？^*(n=191)			0.094^b
	知道^#	53(73.6)	100(84.0)
	不知道	19(26.4)	19(16.0)
11	如合并甲状腺炎，其严重程度是否与甲状腺癌的发生和治疗相关？(n=269)			＜0.001^a
	是^#	53(42.7)	83(57.2)	＜0.001^b
	否	1(0.8)	22(15.2)	＜0.001^a
	不清楚	70(56.4)	40(27.6)	＜0.001^b
12	除手术外, 甲状腺癌的治疗方式还有哪些？(多选)(n=269)
	放射性核素治疗^#	64(51.6)	56(38.6)	0.037^b
	促甲状腺激素抑制治疗^#	66(53.2)	95(65.5)	0.046^b
	放射外照射治疗^#	48(38.7)	79(54.5)	0.010^b
	化疗^#	56(45.2)	57(39.3)	0.386^b
	免疫治疗	45(36.3)	37(25.5)	0.063^b
	不清楚	43(34.7)	5(3.4)	＜0.001^a
PMS：临床前阶段医学生；CMS：临床阶段医学生；^*答题条件为：第9题回答“否”；^#知识性题目的正确答案；^aFisher精确概率法；^b卡方检验

下载: 导出CSV

表 2 临床(八年制)专业医学生甲状腺自查认知情况[n(%)]

	问题及选项	PMS	CMS	P值
1	你是否规律自查？(n=269)			＜0.001^a
	是	4(3.2)	16(11.0)	0.019^a
	检查过，不经常	11(8.9)	65(44.8)	＜0.001^b
	否	109(87.9)	64(44.1)	＜0.001^b
2	你为何未规律自查？^*(n=249)			＜0.001^a
	从未想过	58(48.3)	40(31.0)	0.006^b
	没有必要	25(20.8)	73(56.6)	＜0.001^b
	害怕发现异常情况	0(0)	2(1.6)	0.499^a
	不知道如何检查	32(26.7)	7(5.4)	＜0.001^a
	其他	5(4.2)	7(5.4)	0.771^a
3	你从何处学习到甲状腺检查方法？^#(n=96)			＜0.001^a
	自己或周围人曾患过甲状腺
	相关疾病	6(40.0)	0(0)	＜0.001^a
	媒体(公众号、电视、广告等)	1(6.7)	0(0)	0.155^a
	医学院课程	2(13.3)	79(97.5)	＜0.001^a
	医生线下科普	3(20.0)	1(1.2)	0.011^a
	自己感兴趣	0(0)	0(0)
	不清楚	3(20.0)	1(1.2)	0.011^a
^*答题条件为：第1题回答“否”或“检查过，不经常”；^#答题条件为：第1题回答“是”或“检查过，不经常”；PMS、CMS：同表 1；^aFisher精确概率法；^b卡方检验

下载: 导出CSV

参考文献(13)

[1]	Du L, Li R, Ge M, et al. Incidence and mortality of thyroid cancer in China, 2008-2012[J]. Chin J Cancer Res, 2019, 31: 144-151. doi: 10.21147/j.issn.1000-9604.2019.01.09
[2]	陈万青, 孙可欣, 郑荣寿, 等. 2014年中国分地区恶性肿瘤发病和死亡分析[J]. 中国肿瘤, 2018, 27: 1-14. https://www.cnki.com.cn/Article/CJFDTOTAL-ZHLU201801001.htm Chen WQ, Sun KX, Zheng RS, et al. Report of Cancer Incidence and Mortality in Different Areas of China, 2014[J]. Zhongguo Zhongliu, 2018, 27: 1-14. https://www.cnki.com.cn/Article/CJFDTOTAL-ZHLU201801001.htm
[3]	Guay B, Johnson-Obaseki S, McDonald JT, et al. Incid-ence of differentiated thyroid cancer by socioeconomic status and urban residence: Canada 1991-2006[J]. Thyroid, 2014, 24: 552-555. doi: 10.1089/thy.2013.0308
[4]	Keser G, Yilmaz G, Pekiner FN. Assessment of Knowledge Level and Awareness About Human Papillomavirus Among Dental Students[J]. J Cancer Educ, 2021, 35: 664-669. doi: 10.1007/s13187-019-01683-3
[5]	Kalil LL, Prado EHM, Resende RVU, et al. Melanoma Awareness Among Medical Students[J]. J Cancer Educ, 2021, 36: 677-681. doi: 10.1007/s13187-019-01685-1
[6]	Frates MC, Benson CB, Doubilet PM, et al. Prevalence and distribution of carcinoma in patients with solitary and multiple thyroid nodules on sonography[J]. J Clin Endocrinol Metab, 2006, 91: 3411-3417. doi: 10.1210/jc.2006-0690
[7]	Takano T. Natural history of thyroid cancer[J]. Endocr J, 2017, 64: 237-244. doi: 10.1507/endocrj.EJ17-0026
[8]	Guignard R, Truong T, Rougier Y, et al. Alcohol drink-ing, tobacco smoking, and anthropometric characteristics as risk factors for thyroid cancer: a countrywide case-control study in New Caledonia[J]. Am J Epidemiol, 2007, 166: 1140-1149. doi: 10.1093/aje/kwm204
[9]	Mizokami T, Wu Li A, El-Kaissi S, et al. Stress and thyroid autoimmunity[J]. Thyroid, 2004, 14: 1047-1055. doi: 10.1089/thy.2004.14.1047
[10]	Brito JP, Gionfriddo MR, Al Nofal A, et al. The accuracy of thyroid nodule ultrasound to predict thyroid cancer: systematic review and meta-analysis[J]. J Clin Endocrinol Metab, 2014, 99: 1253-1263. doi: 10.1210/jc.2013-2928
[11]	Ahn HS, Kim HJ, Welch HG. Korea's thyroid-cancer "epidemic" --screening and overdiagnosis[J]. N Engl J Med, 2014, 371: 1765-1767. doi: 10.1056/NEJMp1409841
[12]	Miyauchi A. Clinical Trials of Active Surveillance of Papillary Microcarcinoma of the Thyroid [J]. World J Surg, 2016, 40: 516-522. doi: 10.1007/s00268-015-3392-y
[13]	Roman BR, Morris LG, Davies L. The thyroid cancer epidemic, 2017 perspective[J]. Curr Opin Endocrinol Diabetes Obes, 2017, 24: 332-336. doi: 10.1097/MED.0000000000000359

施引文献

资源附件(0)

访问统计

点击查看大图

表(2)

计量

文章访问数: 993
HTML全文浏览量: 118
PDF下载量: 64
被引次数: 0

姓名
邮箱
手机号码
标题
留言内容
验证码

地址：	北京市东城区帅府园1号北京协和医院老楼7号楼 3层302室《协和医学杂志》编辑部
电话：	010-69154261/4262
E - mail：	medj@pumch.cn mjpumch@126.com
期刊网站版权所有：	《协和医学杂志》编辑部京ICP备 11002662

留言板

临床医学(八年制)专业医学生甲状腺癌认知情况调查

doi: 10.12290/xhyxzz.2021-0359

通讯作者:
徐协群电话: 010-69152620, E-mail: xxq75@163.com

计量

Investigation on Cognition of Thyroid Carcinoma Among Medical Students

Corresponding author: XU Xiequn Tel: 86-10-69152620, E-mail: xxq75@163.com

计量

目录

留言板

临床医学(八年制)专业医学生甲状腺癌认知情况调查

doi: 10.12290/xhyxzz.2021-0359

通讯作者: 徐协群 电话: 010-69152620, E-mail: xxq75@163.com

计量

出版历程

Investigation on Cognition of Thyroid Carcinoma Among Medical Students

Corresponding author: XU Xiequn Tel: 86-10-69152620, E-mail: xxq75@163.com

计量

出版历程

目录

通讯作者:
徐协群电话: 010-69152620, E-mail: xxq75@163.com