Relationship Between Intent to Vaccinate and the Education and Knowledge of Human Papillomavirus Among Medical School Faculty and Students in Texas

"Little attention has been given to the state of human papillomavirus (HPV) education in medical schools and how this impacts future vaccination practices."

Texas, United States (US), continues to be ranked as one of the 10 states with the lowest HPV vaccination rates. Providers play a significant role in increasing vaccination rates, but most studies on this role have focused on practicing clinicians instead of on future providers or those who train them. The objective of this study was to determine Texan medical students' and faculty members' knowledge of HPV-related topics and the HPV vaccine and to examine how willingness to recommend HPV vaccination to future patients changed over the course of medical school.

An online survey consisting of 40 questions was sent to all students and teaching faculty at eight, 4-year medical schools across Texas. In total, 895 medical students and 168 faculty members completed the survey. Among the findings:

• Faculty were found to have a lower level of HPV-related knowledge than upper-year medical students. (The researchers did not query faculty members about their area of specialisation, so the low faculty scores on HPV knowledge may reflect faculty members whose specialties do not involve HPV vaccination or HPV-related disease. This may suggest that students receive HPV-related education from a small subset of the faculty rather than a multidisciplinary educational team that reinforces this knowledge across disciplines.)
• Approximately half of students and faculty agreed with the idea that the education on most HPV-related topics was adequate. Only two-thirds of final-year students agreed that they were well taught in most HPV-related topics, with the exception of higher rates for virology, clinical presentation, and which patients should be offered HPV vaccines.
• Of those students between the ages of 20 and 30 years, 71.2% of women but only 21.7% of men had received the full HPV vaccine series.
• For each unit increase in general knowledge score, the odds of a student recommending HPV vaccination increased 10% (odds ratio (OR)=1.10, 95% confidence interval (CI): 1.02-1.17; P=.0096). However, no association was found between vaccine knowledge and the odds of a student recommending vaccination. As year in school increased, so did a student's odds of recommending the vaccine (P=.0002).
• The odds of a clinical faculty member's recommending vaccination increased 15% as general knowledge score increased by 1 point (OR 1.15, 95% CI:1.02-1.29; P = .0264), but no association was seen between vaccine knowledge and odds of recommending vaccine.

In short, the results of this study demonstrate that the faculty responsible for training the future providers are themselves often undereducated about HPV and that medical students are graduating with an inadequate level of HPV vaccine knowledge. In addition, HPV-related knowledge is related to a future provider's willingness to vaccinate.

The researchers believe a preformed, up-to-date module released by a governing body could help create consistent, efficacious HPV education across various schools. For instance, the lack of training in HPV-related topics could be reduced if a centralised location, such as the National HPV Roundtable or the Association of American Medical Colleges MedEdPortal, were to release provider education modules for each year of medical school to allow for consistent education of future providers.

Furthermore, faculty in this study were found to have a lower level of HPV-related knowledge than upper-year medical students, despite holding the responsibility for training young doctors and often caring for patients themselves. Stronger faculty development for HPV-related topics might be an additional way to address inadequate gains in medical students' knowledge.