Knowledge, attitudes and educational exposure regarding neglected tropical diseases among medical students and residents in Italy: a nationwide multicenter survey from the Italian Society for Tropical Medicine and Global Health (SIMET ETS).

BACKGROUND

Neglected tropical diseases (NTDs) represent a major cause of preventable morbidity and are increasingly relevant in high-income settings because of migration, international travel, climate-sensitive vector expansion and persistent health inequities. However, NTDs-related knowledge and educational exposure among future and early-career physicians in Europe remain poorly documented. This study assessed NTDs-related knowledge, attitudes and practice-related experiences among medical students and residents in Italy.

METHODS

We conducted a national multicenter cross-sectional survey through a structured and previously validated REDCap questionnaire distributed across 40 Italian universities covering all 20 Italian regions. The survey included demographic and academic variables, exposure to NTDs-related teaching, six clinical vignettes, ten theoretical knowledge questions, Likert-scale attitude items and practice-related experience questions. The questionnaire had undergone a multi-step validation process, including a two-round Delphi assessment with a multidisciplinary expert panel, external expert evaluation and psychometric testing. A basic knowledge threshold of ≥ 50% correct responses was defined a priori by consensus within the SIMET working group as an operational criterion for basic knowledge. A more stringent high-knowledge threshold was defined as ≥ 12 correct answers out of 16.

RESULTS

A total of 2,088 questionnaires were received; 267 (12.8%) were excluded because of incomplete or insufficient data, leaving 1,821 analyzable responses (87.2%), including 1,366 medical students (75.0%) and 455 residents (25.0%). Median age was 25 years (IQR 22-29) and 60.1% were female. Regarding formal curricular teaching, 40.7% of participants reported no hours of NTDs-related teaching, whereas only 8.5% reported more than 10 h. Only 38.6% reached the basic knowledge threshold and 32.7% correctly answered at least four out of six clinical vignettes. A much smaller proportion (8.7%) reached the high-knowledge threshold of ≥ 12/16 correct answers, with markedly higher attainment among residents than medical students (32.3% vs. 0.8%; p < 0.001). Nevertheless, attitudes were highly favorable: 92.4% supported mandatory inclusion of NTDs in educational curricula, 90.8% were willing to attend dedicated courses and 93.8% considered workshops useful. In multivariable analysis, increasing hours of formal NTDs-related teaching were associated with progressively higher odds of achieving the basic knowledge threshold (< 5 h: aOR 1.25, 95% CI 1.00-1.56; 5-10 h: aOR 1.63, 95% CI 1.24-2.13; >10 h: aOR 2.42, 95% CI 1.74-3.37), with a significant linear trend across categories (p for trend = 0.002). Participation in dedicated educational activities (aOR 1.84, 95% CI 1.49-2.27) and previous suspicion or diagnosis of an NTD case (aOR 1.52, 95% CI 1.18-1.96) were also independently associated with the outcome.

CONCLUSIONS

NTDs-related knowledge among medical students and residents in Italy remains suboptimal despite strong interest in additional training. Fewer than four in ten participants reached a basic knowledge threshold, and fewer than one in ten reached a high-knowledge threshold. These findings highlight the need to strengthen structured NTDs-related teaching in undergraduate and postgraduate medical curricula, with emphasis on clinical decision-making competencies.