COPD: Students' Knowledge of Making the Right Diagnosis


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Abstract

In modern medicine, chronic obstructive pulmonary disease (COPD) occupies a high position in the structure of morbidity and mortality, which determines high demands on the professionalism of medical personnel, starting from the stage of university training. Despite the fact that current clinical guidelines establish a clear diagnostic standard - spirometric confirmation of obstruction (FEV₁/FVC ratio after bronchodilation less than 0.70), in practice, difficulties with the correct interpretation of the obtained data are often encountered. In this regard, the aim of this study was to assess and compare the level of awareness of students about diagnostic markers of COPD and methods of disease verification. The materials and methods were answers to questions about the key instrumental and laboratory sign of COPD (correct answer: decrease in FEV₁/FVC <0.70) and the mandatory diagnostic method (correct answer: spirometry). The results revealed statistically significant positive dynamics: correct understanding of the diagnostic marker increased from 67.1% to 73.8% (p=0.035), and understanding of the role of spirometry increased from 82.5% to 90.0% (p=0.002). The overall average success rate increased from 74.8% to 81.9%. The obtained data confirm the effectiveness of educational processes but also indicate the need to strengthen training in strict adherence to clinical guidelines to minimize diagnostic errors.

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Background. Chronic obstructive pulmonary disease (COPD) is one of the most significant challenges in modern medicine due to its high prevalence, economic impact, disability, and mortality [1, 2]. In the Russian Federation, according to epidemiological studies, the prevalence of COPD among individuals with respiratory symptoms reaches 21.8% [3]. According to clinical guidelines, the diagnosis of COPD requires mandatory spirometric confirmation: a post-bronchodilator FEV1/FVC ratio of less than 0.70 [4, 5]. Despite the existence of standardized algorithms, difficulties in interpreting diagnostic criteria remain in clinical practice. Surveys to determine the knowledge and preferences of specialists in real-life clinical practice can be used to evaluate the results of advanced training courses [6]. The high prevalence of COPD requires high-quality training for specialists, starting from the student stage. Objective. To analyze and compare students' knowledge of the selection of instrumental and laboratory markers for COPD and mandatory diagnosis confirmation in accordance with current clinical guidelines. Materials and Methods. As part of the ASCO study, a survey was conducted: at stage 3 of ASCO-III (2019-2023) among 478 general practitioners from 11 centers and 401 students from 7 centers, and at stage 4 of ASCO-IV (2023-2025) among 480 students from 5 centers. The results of the ASCO study have been published in specialized journals [7-10]. This study analyzed students' responses to two questions on the COPD diagnostic questionnaire. The first question asked about the correct instrumental and laboratory marker for COPD (the correct answer was "a decrease in the FEV1/FVC ratio <0.70"). The second question aimed to determine the diagnostic method for confirming COPD (the correct answer was "spirometry"). The study utilized descriptive statistics, including the Pearson Chi-Square (χ2) test; significance was defined as a two-tailed p-value <0.05. Study Results: Analysis of responses to the first question revealed positive dynamics: the percentage of correct answers ("decrease in FEV₁/FVC <0.70") increased from 67.1% in the third stage to 73.8% in the fourth. At both stages, the most common incorrect answers were "decrease in FEV₁, increase in ESR, specific changes on chest X-ray" (17.3% and 13.3%, respectively). Comparison of the question about disease markers revealed significant differences in respondents' knowledge levels between stages (χ2=4.491; p=0.035). The second question also showed an improvement in results: the proportion of students who indicated spirometry increased from 82.5% to 90.0% (χ2=9.639; p=0.002). At the third stage, the main incorrect answer was "bronchoscopy" (8.5%); at the fourth stage, "bronchoscopy" was chosen by 3.3%, and the highest percentage (3.5%) received an incorrect answer regarding chest x-ray. The average level of correct answers to diagnostic questions among students at the third stage (74.8%) was lower than in the fourth (81.9%). Conclusion. The analysis of the dynamics of medical students' knowledge in stages 3 and 4 of the ASCO study demonstrates a clear positive trend in understanding the key diagnostic criteria for COPD. In the new stage, the proportion of respondents correctly identifying the main instrumental and laboratory marker of COPD (a decrease in the FEV₁/FVC ratio to <0.70) statistically significantly increased by 6.7%. An even more significant positive trend was recorded in knowledge of the "gold standard" for diagnosis verification: the proportion of students indicating spirometry as a mandatory method for confirming COPD increased by 7.5%. Despite the improvement in correct answers, some respondents made erroneous answers, specifically choosing radiography or bronchoscopy as the primary diagnostic method, as well as relying on nonspecific laboratory parameters (ESR). This underscores the need for further improvement of educational programs.

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About the authors

Maria Denisovna Nikiforova

Mari State University

Email: NikiforovaMasha2004@yandex.com
ORCID iD: 0009-0009-1678-7016
Russian Federation, 1, Lenin Square, 424000, Yoshkar-Ola, Russian Federation

Irina Olegovna Ivanova

Mari State University

Email: irinaivanova12004@yandex.ru
ORCID iD: 0009-0003-3769-9986
Russian Federation, 1, Lenin Square, 424000, Yoshkar-Ola, Russian Federation

Roman Aleksandrovich Bontsevich

Mari State University

Author for correspondence.
Email: dr.bontsevich@gmail.com
ORCID iD: 0000-0002-9328-3905
Russian Federation, 1, Lenin Square, 424000, Yoshkar-Ola, Russian Federation

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