Medical students' knowledge and attitude toward brain death and the influence of medical education: a cross-sectional study

Background: The medical students' knowledge and attitude toward brain death has not been investigated in China. The aims of this study were to assess the knowledge and attitude toward brain death among medical students in China and assess the influence of medical education on the knowledge and attitude. Methods: An online questionnaire consisting of 17 questions was developed and completed by undergraduates majoring in clinical medicine in China Medical University. The students' demographic data, knowledge and attitude toward brain death were collected and analyzed. Results: A total of 1075 medical students participated in the survey, and 1051 of them completed the valid questionnaire. The exploratory factor analysis grouped the 17 items into four dimensions, which explained 63.5% of the total variance. These dimensions were named as knowledge (5 items), attitude (5 items), concern (3 items) and education needs (4 items) respectively. The global Cronbach alpha of the questionnaire was 0.845 and the Cronbach alpha of the four dimensions ranged from 0.756 to 0.866. The mean dimension scores of knowledge, attitude, concern and education needs was 3.67 +/- 0.89, 3.67 +/- 0.87, 3.10 +/- 1.03 and 4.12 +/- 0.72 respectively. The clinical students had a better knowledge than the preclinical students (P < 0.001). The clinical students had a more favorable attitude in stopping the treatment for a brain-dead family member and using the organs and/or tissues of brain-dead patients for transplantation (P < 0.001). The clinical students showed more concerns than the preclinical students (P < 0.001). There was no significant difference in the education needs between the clinical and pre-clinical students. Conclusions: Most medical students in China had insufficient knowledge about brain death. Although their knowledge of brain death increased with their university degree, their attitude toward organ donation after brain death did not evolve accordingly. Their concerns about brain death increased with seniority. Most students had great education needs about brain death.