I don’t like to be a curmudgeon and I’m pretty tolerant when students write research papers that don’t quite make professional grade. Writing papers may look easy — you just have to report your results, right? — but it isn’t. Nor is designing a study or collecting the data. It takes time and practice to learn this and you make a lot of mistakes. I know from personal experience. It’s the job of mentors, advisors and journal editors to educate students, bring them along, show them how to do it.
Apparently none of these guardians of the literature were awake when the paper, “Medical students and pandemic influenza,” was submitted to CDC’s journal Emerging Infectious Diseases. Here’s the abstract:.
To assess knowledge of pandemic influenza, we administered a questionnaire to all medical students at the University of Alberta; 354 (69%) of 510 students responded. Data from questionnaires such as this could help determine the role of medical students during a public health emergency. (Herman et al., Emerging Infectious Diseases)
It’s an interesting question and there is essentially no data on it. The authors offered a Web-based questionnaire to Canadian medical students in one medical school in September – October 2006, inquiring about demographic information and “risk perception of pandemic influenza (likelihood of developing and dying from the illness), general knowledge about pandemic influenza, willingness to volunteer, and suggested consequences of not volunteering during a pandemic.” So what do we learn?
All 510 medical students at the University of Alberta were invited by email to complete the questionnaire; 354 (69%) responded. Most (62%) respondents were women . . . .
Presumably not all 510 medical students are in the same class but there is no indication how the 354 respondents were distributed by level of medical education. A response rate of 69% isn’t out of this world but it isn’t at all bad for a questionnaire of this type so it’s a shame more complete information wasn’t presented. If 62% of the respondents were women (most?) is this more or less or not at all representative of the sex make-up of the 510 students? This is the kind of mistake a student is likely to make but which should have been caught by faculty advisors or sponsors. How about the Editors? Peer reviewers? If demographic information was collected, why don’t we see some of it?
The text says that over 40% of respondents thought it likely they would be infected but only 4.5% (16 students) thought they were likely to die from such an infection. Interesting. But I consulted the tabulation of results in Table 1 and I find this:
Nothing can treat pandemic influenza 16 (4.5)
Antibiotics 28 (7.9)
Antibacterial drugs 208 (58.8)
Vaccination 43 (12.1)
Bed rest 275 (77.7)
Fluids 280 (79.1)
Complementary medicine 19 (5.4)
Chicken soup 66 (18.6)
The “likely to die” response is entered here as “Nothing can treat pandemic influenza.” Since these aren’t synonymous we are left wondering what the original question was. Antibiotics and antibacterial drugs? Was this supposed to be antivirals? Is “vaccination” presented as a treatment?
Slightly over 20% think sexual contact is a major route of transmission. Since 80% (correctly) saw close contact with an infected person as a major route of transmission, we may be seeing the world through the hormones of this age cohort for whom close contact has a specific meaning.
Then there’s this:
Given the time lag between identification of the pandemic strain and the time needed to produce a vaccine, any known treatment strategy would not be effective unless it could be applied to the strain that is causing the pandemic.
The conflation of a preventive vaccine and treatment modalities reappears here and suggests a lack of clarity on the part of the designers of the questionnaire. I’m not surprised. The general public thinks doctors and medical students know a lot about disease but in fact doctors are carry around with them the same conventional wisdom as the general public.
You can’t learn everything in medical school. As the authors point out, though, in an emergency it is likely medical students and their graduated counterparts in the profession who know as little about influenza (or less) than they do will be called upon to fill the gaps in a stressed health care system. One solution is to prepare in advance one page fact sheets on the salient points to give to students and other volunteers at the appropriate time. That’s when they’ll need it and when they’ll use it. And if done ahead of time we can make it more likely it isn’t full of out of date material or outright misinformation.
So I commend the students who showed initiative and took this on. I’m not so forgiving of the faculty, mentors, reviewers and editors who missed a chance to educate those students and provide a more useful paper for readers