Knowledge of and attitudes to occupational and sports medicine among medical students in Zagreb, Croatia

Normality of continuous data distribution was assessed with the Kolmogorov-Smirnov test and, depending on the test results, appropriate non-parametric tests were used in subsequent analyses. Continuous data (GPA, attitudes, and self-assessed knowledge) were represented as medians with corresponding interquartile ranges. Categorical data (correct answers to multiple-choice questions) were represented as absolute and relative frequencies. Correlation was assessed between GPA and each item referring to students’ attitudes. P values below 0.05 were considered significant. All analyses were run on the IBM SPSS Statistics version 25.0 (IBM, Armonk, NY, USA).

Our findings confirmed the first part of our hypothesis that the students would show sufficient knowledge of OSM after the course, more specifically workplace hazards, health effects, and relevant legislation. They built this knowledge on TBL cases that included occupational diseases with verified hazard exposure duration. At the beginning of the course, students were instructed to read the new textbook (14) and selected research articles to prepare for each case. Discussions on biological hazards were based on the cases of cutaneous leishmaniasis in a military commander or lung tuberculosis and viral keratoconjunctivitis in nurses. Physical hazards were discussed on the cases of noise-induced hearing loss in a carpenter and hand-arm vibration syndrome in a lumberjack. Chronic health effects of exposure to chemicals were addressed by discussing the case of bladder cancer in a car painter and learning about the International Agency for Research on Cancer (IARC) classification. As expected, they showed satisfactory knowledge in this respect.

Their knowledge about causes of occupational injuries was also sufficient. While discussing the case of chronic viral hepatitis B in a nurse, the students learned about needle stick injuries and possible complications such as chronic hepatitis. Discussing the noise-induced hearing loss in a carpenter, they learned about how to assess work ability and disability retirement within the Pension Insurance Act framework (24). Nearly all participants (98.1 %) were familiar with the PUR/SWC acronym (23), which defines workplace conditions and/or professions at risk. Students were asked to analyse specific sections of this policy and use the acronym in oral presentations in the classroom.

Three of the 12 multiple-choice questions relate to the role of occupational and general physicians in reporting occupational diseases, to the legal framework defining the role of occupational safety committees, and to vocational rehabilitation.

The participants also showed sufficient knowledge of sport codes, use of electrocardiogram, and maximum oxygen uptake measurement in athletic ability assessment. Such result was expected since they learned the basics about the types of muscle contractions and load in the second and the fifth year of medical studies.

We have noticed that knowledge was poorer about issues that were not discussed at workgroups in connection to the presented real-life cases, such as rehabilitation, ECG (QT interval), and most prominently legal coverage of partial loss of work ability (Table 3).

Part of the problem is that the current curriculum does not include visits to workplaces or occupational medicine offices, where the students would be able to put their knowledge to practice.

Interestingly, the participants were quite reserved in their own assessment of knowledge gained.

Speaking of attitudes toward OSM as a study subject and prospective career, our findings showed an interesting contradiction. The students expressed a relatively high interest in the study subject per se, most likely thanks to the problem-oriented TBL classes, but were far more reserved about pursuing OSM as future career. More precisely, they preferred sports medicine over occupational medicine. This came as no surprise, as our participants did not have a chance to visit occupational medicine services and workplaces, to speak with workers, or observe OM specialists at work and participate in counselling on the use of personal protective equipment and reporting occupational diseases or injuries at work. Even though the same is true of their lack of practice in sports medicine services, the latter seems to have a stronger general appeal. In Croatia, occupational medicine and sports medicine have been integrated in a single specialty since 2004 (14), but specialists may later focus more on either aspect.

As our 20-item questionnaire was used for the first time in this study, we could not compare our findings about knowledge and attitudes toward OSM with earlier courses relying on traditional didactic methods to assess the benefits of TBL, but this does not undermine its importance, as it has been evidenced by reports on experiences from other countries (6, 11, 12, 13).

Another limitation may be related to possible bias, as the respondents were recruited by the course teachers (who happen to be the authors of this paper) and who may have been more intrinsically interested in OSM than non-respondents. This, however, does not diminish the value of their feedback, as it points to certain realities about general attitude of medical students toward OSM, the lack of practical training first and foremost.